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1.
Int Emerg Nurs ; 70: 101341, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37708790

RESUMO

BACKGROUND: Deciding on triage in emergency departments is difficult and requires comprehensive knowledge and experience. PURPOSE: This study was conducted to evaluate the effect of a "computer-based emergency department triage decision support system (DSS)," which was designed and integrated into the hospital information management system, on triage decision accuracy and triage duration by using real patient data. METHODS: Single-group, pretest-posttest non-randomised clinical trial. The study was conducted with the real data of patients who had been triaged in the adult emergency department of a university hospital. The pretest was applied between July 16 and September 16, 2019, and the post-test on September 1 and October 31, 2020. In the pre-test and post-test phases of the study, triage decision accuracy rates, and triage duration were evaluated. In the post-test phase, Emergency Triage Decision Support System (ETDSS) was prepared with a rule-based decision trees method using the Emergency Severity Index Version 4 and The Australasian Triage Scale and was integrated into the hospital information management system. The effect of the developed ETDSS was evaluated. The mean, standard deviation, frequency and percentage values were calculated for the descriptive characteristics. Independent samples t-test, analysis of variance, Sidak paired comparison, and Bonferroni tests were applied. RESULTS: The effect of the computer-based emergency triage DSS on triage management was tested based on the data of 16,409 patients in the pretest phase and 7,765 patients in the posttest phase. While the accuracy rate of nurses' triage decisions was 57.8% in the pretest, it was found to increase to 64.9% in the posttest. The mean duration of triage was 1.47 ± 0.72 in the pretest and 1.79 ± 0.85 min in the posttest. CONCLUSIONS: The DSS increased triage decision accuracy independently of professional and triage experience and brought the triage duration closer to the time recommended in the literature. Clinically, this is associated with patient safety, quality improvement processes, and professional accountability.

2.
Turk J Emerg Med ; 22(4): 200-205, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36353382

RESUMO

OBJECTIVES: The increasing number of patients admitted to emergency departments (EDs) and overcrowding of EDs lead to a global problem. Advanced nursing triage is an important solution in facilitating patient and time management, also increasing the efficiency of the ED. This study was conducted to predict the possible effects of applying advanced nursing triage modeling with predetermined protocols during the current nursing triage in the ED. METHODS: This was a descriptive and cross-sectional study. An advanced "triage assessment protocol," which was developed previously, was hypothetically applied for 5 days by triage nurses in the adult ED of a university hospital. The hypothetical application was tested by triage nurses in all shifts. The nurses recorded the examination or treatment options which they thought to apply for the patient on the study form. The data recorded on the advanced triage evaluation protocol form by the triage nurses were compared with the patient outcomes and physician examination/treatment requests in the Hospital Information Management System by the researchers. RESULTS: In the study, it was determined that the rate of examination/treatment that could be requested according to the advanced nursing triage protocol was 46%. There were a good level of agreement on X-ray and a moderate level of agreement on urinary test and urinary beta- Human chorionic gonadotropin (hCG) test between physicians and triage nurses regarding examination/treatment requests. In addition, it was found that there was a 61.2% of agreement on decisions made for patients aged between 18 and 35. The rate of agreement between doctors and nurses regarding a gluco-stick request for patients admitted outside the prime time (92.2%) was found to be significantly higher (87.9%) than for patients admitted during prime time (P = 0.046). CONCLUSION: "Advanced triage" practices recommended for busy EDs were tested "hypothetically" at the national level due to the lack of legal regulations and were found to be compatible with the actual results of physicians' practices at an acceptable level, especially for selected medical conditions. The method used in this study can be useful in planning the transition to "advanced triage" practices. These results can show the readiness of nurses for the transition to this practice.

4.
Int Emerg Nurs ; 64: 101213, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36088674

RESUMO

BACKGROUND: The performance of the Quick Sequential Organ Failure Assessment (qSOFA) score needs to be explored further in the emergency triage room. This study aims to explore the performance of triage (tqSOFA) versus the dichotomized triage score (DTS) in patients admitted to the emergency room triage with fever. METHODS: This research was designed as a prospective, observational study within a six-month period, including patients who presented to the emergency room triage with infrared fever ≥ 37.5 °C. RESULTS: 771 patients were analyzed.The highest sensitivity for predicting overall hospitalization and intensive care admission was seen for DTS (95.4 %, 100 %; p < 0.0001, p < 0.0001, respectively) (AUC:0.697, 95 % CI 0.663 to 0.730; AUC:0.684, 95 % CI 0.650 to 0.717, respectively). The highest sensitivity for predicting 1st week and 1st month mortality was found for DTS (100 %, 96.3 %; p < 0.0001, p < 0.0001, respectively). However, the highest specificity for predicting 1st week and 1st month mortality was observed in tqSOFA (94.1 %, 95.16; p = 0.0845, p < 0.0001, respectively) (AUC:0.658, 95 % CI 0.623 to 0.691; AUC:0.698, 95 % CI 0.664 to 0.730, respectively). CONCLUSION: We found DTS to be as effective as tqSOFA and SIRS in determining all hospitalization times and mortality.


Assuntos
Sepse , Triagem , Serviço Hospitalar de Emergência , Febre/diagnóstico , Mortalidade Hospitalar , Humanos , Prognóstico , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos , Sepse/diagnóstico
5.
Turk J Med Sci ; 52(1): 206-215, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-36161601

RESUMO

BACKGROUND: For identifying hemorrhagic shock in trauma patients, some objective data are needed. The use of base excess (BE) and lactate values have been originated. In this study, it was aimed to determine the usability of end tidal carbon dioxide (ETCO2) in patients with multiple trauma for recognizing hemorrhagic shock. METHODS: Patients who were admitted to the emergency department between June 2019 and February 2020 with highenergy multiple trauma were included in the study. ETCO2 and BE values were measured. Correlation coefficients were calculated to determine correlations between ETCO2 and BE levels. RESULTS: One hundred and twenty-two patients were included in the study. Eighty-nine (73%) were men and 33 (27%) were women, and the mean age of the study population was 38.70 ± 19.18. The mortality rate was 14.8% in the study population. The correlation between ETCO2 and BE values was significant (r: 0.27) and in the same range in the Bland-Altmann analysis. ETCO2 levels above 35 were specific for stage 1 hemorrhagic shock. ETCO2 levels below 30 were sensitive for stage 2 and 3 hemorrhagic shocks and when the levels were measured below 22 it was found specific for stage 4 shock. The specificity increased to 99% at levels below 18. The sensitivity for ETCO2 values below 22 for predicting mortality was 33.33%, the specificity was 89.42%, the positive predictive value was 35.29% and the negative predictive value was 88.57%. The sensitivity for BE values below -10 for predicting mortality was 50%, the specificity was 93.27%, the positive predictive value was 56.25% and the negative predictive value was 91.51%.


Assuntos
Traumatismo Múltiplo , Choque Hemorrágico , Dióxido de Carbono/análise , Feminino , Humanos , Lactatos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico , Valor Preditivo dos Testes , Choque Hemorrágico/diagnóstico
6.
Technol Health Care ; 30(3): 541-549, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34397435

RESUMO

BACKGROUND: Venous oxygen saturation reflects venous oxygenation status and can be used to assess treatment and prognosis in critically ill patients. A novel method that can measure central venous oxygen saturation (ScvO2) non-invasively may be beneficial and has the potential to change the management routine of critically ill patients. OBJECTIVE: The study aims to evaluate the potential of sublingual venous oxygen saturation (SsvO2) to be used in the estimation of ScvO2. METHODS: We have developed two different approaches to calculate SsvO2. In the first one, near-infrared spectroscopy (NIRS) measurements were performed directly on the sublingual veins. In the second approach, NIRS spectra were acquired from the sublingual tissue apart from the sublingual veins, and arterial oxygen saturation was measured using a pulse oximeter on the fingertip. RESULTS: Twenty-six healthy subjects were included in the study. In the first and second approaches, average SsvO2 values were 75.0% ± 1.8 and 75.8% ± 2.1, respectively. The results of the two different approaches were close to each other and similar to ScvO2 of healthy persons (> 70%). CONCLUSION: Oxygen saturation of sublingual veins has the potential to be used in intensive care units, non-invasively and in real-time, to estimate ScvO2.


Assuntos
Estado Terminal , Saturação de Oxigênio , Humanos , Oximetria/métodos , Oxigênio , Espectroscopia de Luz Próxima ao Infravermelho/métodos
7.
Int Emerg Nurs ; 59: 101069, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34592604

RESUMO

BACKGROUND: Assessment of nurse triage decision accuracy and triage times is currently carried out through paper-based methods. This quality improvement study aims to develop a method that can assess the accuracy and duration of nurse triage decisions based on a computerized system and to share an example of the application of this method. METHODS: This is a descriptive quality improvement study. The study was carried out in two stages between March and May 2019. The functionality of the developed method was examined using 3835 patients' triage data, which were obtained between June 1 and 14, 2019. RESULTS: With this study, the determination of the accuracy and duration of nurse triage decisions was accomplished with a computerized process based on real patient outputs, and the accuracy and duration of these decisions were continuously measured, monitored, and assessed, which is different from paper-based methods. The functionality of the method was evaluated with data from 3835 real patients. The triage decision accuracy rate was 64.4%, and the average duration of triage was 81.3s. Positive feedback on the method was received from all triage nurses. CONCLUSION: The study result outputs can be integrated into quality processes and can be used internationally as performance assessment criteria and quality indicators for triage nursing.


Assuntos
Enfermagem em Emergência , Triagem , Serviço Hospitalar de Emergência , Hospitais , Humanos , Gestão da Informação , Melhoria de Qualidade
8.
Turk J Emerg Med ; 20(4): 163-167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33089023

RESUMO

OBJECTIVES: The accuracy and duration of triage is vital in emergency departments. However, patient density, diversity of cases, and time pressure make triage difficult. Triage performed properly and at the right time prevents patients from experiencing any untoward incidents that may occur because of waiting. Therefore, the study aimed to share the data obtained from the Hospital Information Management System (HIMS) regarding the accuracy and duration of nurse triage in an adult emergency department. METHODS: This descriptive and cross-sectional study evaluated the accuracy and duration of triage decisions made by nurses for patients admitted to an adult emergency department between June 15 and July 15, 2019. Statistical analysis was performed using Statistical analysis was performed using SPSS software version 23.00. RESULTS: The study included the data of 7705 adult patients. The accuracy rate of nurse triage was 59.3% (n = 4566), and the average duration of triage was 1.52 ± 2.10 min. It was observed that the average duration of accurate triage decisions was longer in patients with triage category 3. A statistically significant relationship was determined between the accuracy of nurse triage and the duration of triage, years of seniority of the nurse, and shifts (P < 0.05). CONCLUSIONS: The accuracy and duration of nurse triage in the hospital where the study was conducted can be evaluated via the HIMS. In order to increase the accuracy of nurse triage in the emergency department, it is necessary to employ experienced and trained nurses, develop computer-based support systems, and increase the number of nurses working in shifts providing care to a large number of patients.

9.
Am J Emerg Med ; 33(8): 1042-4, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25957144

RESUMO

OBJECTIVE: Critically ill patients have high mortality and admission rates requiring early recognition and a rapid management. In the present study, we evaluated the prognostic parameters in these patients and the value of perfusion index measurement as a novel tool for accomplishing emergency department (ED) triage. METHODS: Seven hundred seventy patients admitted to the critical care area of the ED in a month composed the study population. Perfusion index and vital signs (blood pressure, pulse rate, body temperature, pulse oximeter, and respiration rate) of the study patients were recorded to the study form. The communication data, admitting time, comorbidities, capillary refilling time, and blood gas analysis findings if obtained were recorded. Outcome of patients at the end of the ED period such as discharge, admission to the hospital, and death were also recorded. Outcome of patients at 15th and 30th days was identified by telephone call follow-up or from hospital records. RESULTS: Two hundred seventy-eight patients (36.1%) were admitted to the hospital, 454 patients (59%) were discharged, 3 patients (0.4%) died in the ED, 25 patients (3.2%) were transferred to another hospital, and 10 patients (1.3%) refused treatment and left the ED. Sixty patients (7.8%), 39 (5.1%) of whom had died in 15 days' period, were dead at the end of 30-day follow-up period. Respiratory rate and pulse oximetry were significant parameters in hospital admission. Systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, pulse oximetry, lactate levels in blood gas analysis, and ED length of stay were significant variables in 30-day mortality rate. Patients who were admitted to the hospital had higher rates of fever and diabetes. Patients who had died in the 30-day follow-up period had higher rates of diabetes and malignancy. In logistic regression analysis, the predictors of hospital admission were hypotension, fever, and pulse oximetry, whereas the predictors of 30-day mortality were systolic blood pressure, respiratory rate, pulse oximetry, and presence of malignancy. CONCLUSIONS: Perfusion index as a novel triage instrument was found to be an insignificant tool in predicting hospital admission and mortality of critically ill patients in the ED. However, diabetes and malignancy were found to be independent factors in determining the prognosis of these patients in addition to vital signs and should be considered by ED physicians either in triage field or inside the ED.


Assuntos
Estado Terminal/mortalidade , Dedos/irrigação sanguínea , Hospitalização/estatística & dados numéricos , Triagem/métodos , Gasometria , Pressão Sanguínea , Temperatura Corporal , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Frequência Cardíaca , Humanos , Ácido Láctico/sangue , Masculino , Oximetria , Prognóstico , Estudos Prospectivos , Taxa Respiratória
10.
J Emerg Med ; 48(2): 247-53, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25440459

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with high mortality and morbidity. OBJECTIVE: The aim of the present study was to determine the role of nitric oxide (NO) and other possible factors in predicting the revisit of patients with COPD exacerbation to the emergency department (ED). METHODS: This is a prospective cohort study on patients with exacerbated COPD in the ED setting. Bedside nasal NO values were measured with a hand-held analyzer device. Revisit to the ED has been defined as any unscheduled visit to an ED or to primary physician's office within 2 weeks of the initial ED visit for worsening COPD symptoms. A follow-up survey via telephone was conducted on all patients at the end of 2 weeks. RESULTS: The data from 64 patients who visited the ED once was compared to 28 revisits. Total of 92 patients were analyzed and variables were compared. The rate of revisits to the ED was 30%. Nasal NO measurement could not predict the revisits of patients with COPD exacerbation to the ED. The mean respiratory rate, exacerbations in previous year, home nebulizer therapy, prescribed antibiotic at discharge, home oxygen therapy, and abnormal chest x-ray studies were associated with increased rate of revisits to ED in univariate analysis. After multivariate analysis, only the mean respiratory rate at presentation and the prescribed antibiotic at discharge were significant determinants. CONCLUSIONS: There was no statistically significant difference measured in NO level at presentation or before discharge between the groups. The mean respiratory rate at presentation and the prescribed antibiotic at discharge may predict the return of a COPD-exacerbated patient within 14 days to ED.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Óxido Nítrico/metabolismo , Readmissão do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/metabolismo , Adulto , Idoso , Biomarcadores/metabolismo , Testes Respiratórios/métodos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Estudos Prospectivos
11.
Eur J Emerg Med ; 20(6): 402-7, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23274716

RESUMO

STUDY OBJECTIVE: Although electroencephalography (EEG) is a useful diagnostic tool for patients with a suspected seizure, its value in informing the acute care of patients in the emergency department (ED) remains unclear. The aim of this study is to determine the effects of EEG results on subsequent patient management in or from the ED. MATERIALS AND METHODS: This prospective observational study was carried out in the ED of a tertiary-care university hospital. All patients presenting to the ED with seizure or seizure-mimicking symptoms were included in the study. EEG was advised for all patients after an initial evaluation. Before EEG, the ED physician and neurologist were asked clinical questions about the patient. The consistency between the clinical decision of emergency physicians before the EEG report and the final management of patients determined by the consultant neurologist was analyzed. The interobserver reliability of the physicians was determined. RESULTS: Overall, 110 patients were enrolled in the study. The sensitivity and specificity of ED physicians' diagnosis of the presence of seizure were both 88% (95% confidence interval, 79-93 and 62-97%). The interobserver reliabilities and κ values of ED physicians and neurologists were found to be 'moderate'. Patients with abnormal EEG results were prescribed new medication (P=0.003) and changes in therapy (P=0.59) were more than for patients with normal results. CONCLUSION: As seizure is a clinical event, EEG is not essential for diagnosing the presence of a seizure clinically in the ED. However, the results of EEG provide useful information especially for treatment choices. As the timing of the study affects the diagnostic efficacy of the test, EEG recordings should be performed within 24 h either in ED or in the epilepsy clinic.


Assuntos
Eletroencefalografia/estatística & dados numéricos , Serviço Hospitalar de Emergência , Convulsões/diagnóstico , Procedimentos Desnecessários , Adulto , Idoso , Anticonvulsivantes/uso terapêutico , Distribuição de Qui-Quadrado , Estado Terminal , Tomada de Decisões , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Convulsões/tratamento farmacológico , Sensibilidade e Especificidade , Índice de Gravidade de Doença
12.
Emerg Med J ; 29(4): 301-5, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21511976

RESUMO

BACKGROUND AND AIM: Seizure-related visits are common in the emergency department (ED) but the clinical situations for ordering emergency electroencephalography (EEG) are unclear. The aim of this study is to identify which clinical conditions meet with the pathological EEG and whether patient management is changed by abnormal results. METHODS: A retrospective chart review study of all patients visiting the ED with a seizure or symptoms mimicking a seizure was performed. Patients who recorded an EEG within 16 h after the initial event were enrolled. Demographic data and EEG results of patients with provoked and unprovoked seizures were recorded and related factors were analysed. RESULTS: A total of 449 patients (219 men) of mean ± SD age of 45.48 ± 21.83 years were evaluated. The seizure was thought to be provoked in 98 patients (21.8%) and unprovoked in 352 (78.2%) patients (31.2% remote symptomatic and 47.4% idiopathic). The EEG results of 281 patients (62.6%) revealed an abnormality, and the abnormal EEG ratio was high in patients with presumed seizure (p<0.001). One hundred and thirty-eight patients (30.7%) were hospitalised and the remainder (n=311, 69.3%) were discharged from the ED. An abnormal EEG was found in 98 (71%) of the hospitalised patients and in 183 (59.5%) of those discharged (p=0.019). CONCLUSION: EEG provides useful diagnostic information and should be considered in all patients presenting to the ED with a seizure. Since the timing of the study affects the diagnostic efficacy of the test, EEG recordings might be done within 24 h either in the ED or epilepsy clinic.


Assuntos
Eletroencefalografia , Serviço Hospitalar de Emergência , Convulsões/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
13.
Eur J Emerg Med ; 18(1): 9-12, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20224417

RESUMO

We aimed to determine the value of sidestream end-tidal carbon dioxide (SS-ETCO2) measurement in patients with chronic obstructive pulmonary disease (COPD) in the emergency department. Cross-sectional associations between ETCO2 and PaCO2 were examined in the study. This prospective cross-sectional study has been carried out over a 3-month period in a tertiary care university hospital emergency department with an annual census of 75 000 visits. During the study period, simultaneous SS-ETCO2 measurement using a Medlab Cap 10 sidestream capnograph was performed on every COPD patient requiring arterial blood gas analysis. The demographics, diagnosis, vital signs, laboratory test results and clinical outcomes of the patients were recorded. SS-ETCO2 measurement and arterial blood gas analysis were carried out on 118 patients. Mean arterial PCO2 levels were 43.24±14.73 and mean ETCO2 levels were 34.23±10.86 mmHg. Agreement between PCO2 and ETCO2 measurements was 8.4 mmHg and a precision of 11.1 mmHg.As there is only a moderate correlation between PCO2 and ETCO2 levels in COPD patients, ETCO2 measurement should not be considered as a part of the decision-making process to predict PaCO2 level in COPD patients.


Assuntos
Dióxido de Carbono/análise , Serviços Médicos de Emergência , Doença Pulmonar Obstrutiva Crônica/sangue , Índice de Gravidade de Doença , Adulto , Idoso , Gasometria/métodos , Capnografia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Volume de Ventilação Pulmonar
14.
Am J Emerg Med ; 29(1): 65-9, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20825776

RESUMO

OBJECTIVES: The purpose of this study is to examine the relation between end-tidal carbon dioxide (ETCO2) measurement and bicarbonate (HCO3) level reflecting the patient's metabolic status. METHOD: This prospective cross-sectional study has been carried out during a 3-month period in a tertiary care university hospital's emergency department (ED). During the study period, every spontaneously ventilating ED patient requiring arterial blood gas analysis for any medical indication, regardless of presenting symptoms, had a simultaneous ETCO2 measurement using a Medlab Cap 10 side stream capnograph. The demographics and clinical outcomes of the patients were recorded. RESULTS: Of 399 eligible patients, 240 with possible metabolic disturbance were enrolled into the study. There was a statistically significant correlation between the value of ETCO2 and HCO3 levels (r = 0.506). The mean ET(CO)2 level was statistically significantly lower in patients who died (26.5 ± 7.2, 95% confidence interval [CI], 24.2-28.6, vs 30 ± 7.5, 95% CI, 29-31; P = .007) and who had low bicarbonate levels (25.7 ± 6.7, 95% CI, 24.3-27.1, vs 31.6 ± 7.1, 95% CI, 30.4-32.8; P = .000). The value of ET(CO)2 measurement to detect low bicarbonate level was found to be significant. The area under the receiver operating characteristic curve was 0.734, the (+) likelihood ratio for ETCO2 less than or equal to 25 was 2.7, and the (-) likelihood ratio for ETCO2 greater than or equal to 36 was 0.05. CONCLUSION: ETCO2 values correlate moderately with HCO3 levels and thus might predict mortality and metabolic acidosis. Therefore, side stream capnograph can be used as a noninvasive diagnostic tool for ruling out suspected severe metabolic disturbance in the ED.


Assuntos
Capnografia/métodos , Doenças Metabólicas/diagnóstico , Acidose/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Bicarbonatos/sangue , Gasometria , Dióxido de Carbono/análise , Dióxido de Carbono/sangue , Estudos Transversais , Cetoacidose Diabética/diagnóstico , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Doenças Metabólicas/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Adulto Jovem
15.
Cutan Ocul Toxicol ; 28(1): 37-40, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19514924

RESUMO

Calcium hypochlorite is a yellow-white powder widely used as a disinfectant in swimming pools. It releases chlorine gas when added to water and can cause respiratory effects. Dermal and eye injury can occur because of the caustic nature of chlorine. We report a case of chlorine toxicity and burns on a man's face due to the explosion of calcium hypochlorite while he was mixing it into the water.


Assuntos
Queimaduras Químicas/etiologia , Compostos de Cálcio/intoxicação , Transtornos Respiratórios/induzido quimicamente , Adulto , Explosões , Humanos , Masculino
16.
Int J Emerg Med ; 2(2): 99-105, 2009 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-20157451

RESUMO

BACKGROUND: Logistic regression is the most common statistical model for processing multivariate data in the medical literature. Artificial intelligence models like an artificial neural network (ANN) and genetic algorithm (GA) may also be useful to interpret medical data. AIMS: The purpose of this study was to perform artificial intelligence models on a medical data sheet and compare to logistic regression. METHODS: ANN, GA, and logistic regression analysis were carried out on a data sheet of a previously published article regarding patients presenting to an emergency department with flank pain suspicious for renal colic. RESULTS: The study population was composed of 227 patients: 176 patients had a diagnosis of urinary stone, while 51 ultimately had no calculus. The GA found two decision rules in predicting urinary stones. Rule 1 consisted of being male, pain not spreading to back, and no fever. In rule 2, pelvicaliceal dilatation on bedside ultrasonography replaced no fever. ANN, GA rule 1, GA rule 2, and logistic regression had a sensitivity of 94.9, 67.6, 56.8, and 95.5%, a specificity of 78.4, 76.47, 86.3, and 47.1%, a positive likelihood ratio of 4.4, 2.9, 4.1, and 1.8, and a negative likelihood ratio of 0.06, 0.42, 0.5, and 0.09, respectively. The area under the curve was found to be 0.867, 0.720, 0.715, and 0.713 for all applications, respectively. CONCLUSION: Data mining techniques such as ANN and GA can be used for predicting renal colic in emergency settings and to constitute clinical decision rules. They may be an alternative to conventional multivariate analysis applications used in biostatistics.

17.
Eur J Emerg Med ; 16(1): 29-36, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19106717

RESUMO

BACKGROUND: The Glasgow Coma Scale (GCS) is the most widely used tool for the evaluation of the level of consciousness. The Full Outline of Unresponsiveness (FOUR) Score is a new coma Scale that was developed considering the limitations of the GCS, and has been found to be useful in an intensive care setting. We aimed to compare FOUR Score and GCS in the emergency setting. METHODS: All patients older than 17 years who presented with an altered level of consciousness, after any trauma to the head or with neurological complaints were included in this study. Three-month mortality, in-hospital mortality, and poor outcome using a Modified Rankin Scale (MRS) of 3-6 points were used as the primary outcome measures. RESULTS: A total of 185 patients were included in the study. Area under the curve (AUC) values in predicting 3-month mortality for GCS was 0.726 [P=0.0001 and 95% confidence interval (CI): 0.656-0.789] and 0.776 (P=0.0001 and 95% CI: 0.709-834) for FOUR Score. AUC in predicting hospital mortality for GCS was 0.735 (P=0.0001 and 95% CI: 0.655-0.797) and 0.788 (P=0.0001 and 95% CI: 0.722-0.844) for FOUR Score. AUC in predicting poor outcome (Modified Rankin Scale: 3-6) was 0.720 (P=0.001 and 95% CI: 0.650-784) for GCS and 0.751 (P=0.0001 and 95% CI: 0.682-0.812) for FOUR Score. CONCLUSION: The new coma Scale, FOUR Score, is not superior to the GCS. However, the combination of the eye and motor components of FOUR Score is a valuable tool that can be used instead of either the FOUR Score or GCS.


Assuntos
Transtornos da Consciência/diagnóstico , Serviço Hospitalar de Emergência , Escala de Coma de Glasgow , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Adulto Jovem
18.
Pain Manag Nurs ; 9(4): 150-3, 153.e1-3, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19041612

RESUMO

The aim of this study was to reveal the effects of anxiety and depression on pain perception in the emergency setting. This randomized prospective study was performed in an urban tertiary care hospital emergency department (ED). Consecutive patients presenting to the ED with pain who had an intramuscular injection of diclofenac sodium were enrolled in the study. The prevalence of anxiety and depressive disorders in study subjects was determined by using the Hospital Anxiety and Depression Scale. A total of 302 patients were included. Study subjects had a mean age of 41.3 +/- 13.7 years and 35.4% (n = 107) were male. Pain perception in women was significantly higher than in men (median 8.5 vs. 5, respectively; p = .033). Pain perception in elderly patients, >/=65 years old, was found to be lower than in patients <65 years old (median 1 vs. 6.5, respectively; p = .02). Anxiety was found to be related to higher pain perception after adjusting for confounding variables (13.8 vs. 7.6, respectively; adjusted p = .022). Gender, age, and anxiety, but not depression, are possible factors related to pain perception in the emergency setting. Further studies are needed to reveal the factors affecting pain perception and the complex relationship between psychiatric status and pain.


Assuntos
Ansiedade/complicações , Atitude Frente a Saúde , Transtorno Depressivo/complicações , Serviço Hospitalar de Emergência , Dor/psicologia , Adulto , Fatores Etários , Idoso , Análise de Variância , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Causalidade , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Injeções Intramusculares/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pesquisa Metodológica em Enfermagem , Dor/diagnóstico , Dor/etiologia , Medição da Dor , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Turquia/epidemiologia
19.
Eur J Emerg Med ; 15(4): 214-7, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19078817

RESUMO

BACKGROUND: Tourists are exposed to traditional health problems of the host country, such as trauma and the exacerbation of previously existing illnesses during their travels. OBJECTIVE: The purpose of this study is to determine the clinical characteristics of tourist patients and any predictors of hospital admission. MATERIAL AND METHOD: This retrospective observational study was carried out in the tertiary care hospital emergency department (ED) of a Mediterranean destination city, Antalya, Turkey. Hospital data from all tourist patients presenting or transferred to the ED between August 2003 and September 2004 were evaluated. Tourist patients were defined as all non-Turkish citizens. RESULTS: A total of 961 tourist patients was studied, of whom 295 (31%) were admitted and 666 (69%) were discharged. Fifteen patients died in the hospital, 49 critically ill patients were transferred back to their home country, and 153 patients underwent a surgical intervention. The most common discharge diagnoses were trauma (405, 42%), nonspecific symptoms (106, 11%), and circulatory disorders (108, 11%). Admitted tourist patients were significantly older than those discharged; however, there were no differences in sex among the groups. Applying a logistic regression model, age, tachycardia, mode of arrival, and triage category were all found to be significant predictors of admission, but only the initial Glasgow Coma Scale was found to be a significant predictor of mortality. In total, 347 patients were from European Union (EU) countries, and 614 were from non-EU countries. A significant difference was found between the EU and non-EU patient groups according to age, mortality, admission rate, exposure to trauma, ED length of stay, hospital length of stay. Tourist patients from EU countries were older, had higher mortality, lesser trauma exposure, longer ED, and hospital length of stay. CONCLUSION: EDs can be expected to manage tourist patients presenting for traumatic injuries and circulatory disorders. Clinical differences relating to patients' nationality might help in the development of targeted patient education and injury-prevention programs. Emergency physicians and the tourism industry should recognize the challenges of caring for this growing and aged patient population.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Viagem/estatística & dados numéricos , Estado Terminal , Humanos , Internacionalidade , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Prontuários Médicos , Estudos Retrospectivos , Turquia
20.
Clin Toxicol (Phila) ; 46(3): 257-8, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18344108

RESUMO

Ecbalium elaterium or squirting cucumber is a plant growing in the Mediterranean region, belong to Cucurbitaceae family. Its juice has been used as an herbal medicine since ancient times because of its cathartic and anti-inflammatory effects. It has been reported to cause upper airway edema, especially after the administration of its undiluted form. It has generally been attributed to allergic reaction. In this case report we aimed to interrogate this anticipation by presenting a case of severe uvular edema and nasal mucosal necrosis after dripping undiluted Ecbalium elaterium juice that did not improved by anti-allergic therapies.


Assuntos
Cucumis sativus/intoxicação , Edema/induzido quimicamente , Hipersensibilidade Alimentar/patologia , Mucosa Nasal/patologia , Úvula/patologia , Administração Intranasal , Adulto , Edema/patologia , Humanos , Masculino , Necrose/patologia
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