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1.
BMC Emerg Med ; 20(1): 33, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375637

RESUMO

BACKGROUND: The Kingdom of Eswatini, a lower-middle income nation of 1.45 million in southern Africa, has recently identified emergency care as a key strategy to respond to the national disease burden. We aimed to evaluate the current capacity of hospital emergency care areas using the WHO Hospital Emergency Unit Assessment Tool (HEAT) at government referral hospitals in Eswatini. METHODS: We conducted a cross-sectional study of three government referral hospital emergency care areas using HEAT in May 2018. This standardised tool assists healthcare facilities to assess the emergency care delivery capacity in facilities and support in identifying gaps and targeting interventions to strengthen care delivery within emergency care areas. Senior-level emergency care area employees, including senior medical officers and nurse matrons, were interviewed using the HEAT. RESULTS: All sites provided some level of emergency care 24 h a day, 7 days a week, though most had multiple entry points for emergency care. Only one facility had a dedicated area for receiving emergencies and a dedicated resuscitation area; two had triage areas. Facilities had limited capacity to perform signal functions (life-saving procedures that require both skills and resources). Commonly reported barriers included training deficits and lack of access to supplies, medications, and equipment. Sites also lacked formal clinical management and process protocols (such as triage and clinical protocols). CONCLUSIONS: The HEAT highlighted strengths and weaknesses of emergency care delivery within hospitals in Eswatini and identified specific causes of these system and service gaps. In order to improve emergency care outcomes, multiple interventions are needed, including training opportunities, improvement in supply chains, and implementation of clinical and process protocols for emergency care areas. We hope that these findings will allow hospital administrators and planners to develop effective change management plans.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Equipamentos e Provisões Hospitalares/provisão & distribuição , Recursos em Saúde/provisão & distribuição , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Estudos Transversais , Essuatíni , Hospitais Rurais , Humanos , Organização Mundial da Saúde
2.
J R Army Med Corps ; 164(2): 103-106, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29055894

RESUMO

INTRODUCTION: The Modified Physiological Triage Tool (MPTT) is a recently developed primary triage tool and in comparison with existing tools demonstrates the greatest sensitivity at predicting need for life-saving intervention (LSI) within both military and civilian populations. To improve its applicability, we proposed to increase the upper respiratory rate (RR) threshold to 24 breaths per minute (bpm) to produce the MPTT-24. Our aim was to conduct a feasibility analysis of the proposed MPTT-24, comparing its performance with the existing UK Military Sieve. METHOD: A retrospective review of the Joint Theatre Trauma Registry (JTTR) and Trauma Audit Research Network (TARN) databases was performed for all adult (>18 years) patients presenting between 2006-2013 (JTTR) and 2014 (TARN). Patients were defined as priority one (P1) if they received one or more LSIs. Using first recorded hospital RR in isolation, sensitivity and specificity of the ≥24 bpm threshold was compared with the existing threshold (≥22 bpm) at predicting P1 status. Patients were then categorised as P1 or not-P1 by the MPTT, MPTT-24 and the UK Military Sieve. RESULTS: The MPTT and MPTT-24 outperformed existing UK methods of triage with a statistically significant (p<0.001) increase in sensitivity of between 25.5% and 29.5%. In both populations, the MPTT-24 demonstrated an absolute reduction in sensitivity with an increase in specificity when compared with the MPTT. A statistically significant difference was observed between the MPTT and MPTT-24 in the way they categorised TARN and JTTR cases as P1 (p<0.001). CONCLUSIONS: When compared with the existing MPTT, the MPTT-24 allows for a more rapid triage assessment. Both continue to outperform existing methods of primary major incident triage and within the military setting, the slight increase in undertriage is offset by a reduction in overtriage. We recommend that the MPTT-24 be considered as a replacement to the existing UK Military Sieve.


Assuntos
Medicina Militar/métodos , Taxa Respiratória , Triagem/métodos , Ferimentos e Lesões/classificação , Algoritmos , Estudos de Viabilidade , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Ferimentos e Lesões/terapia
3.
J R Army Med Corps ; 163(6): 383-387, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28739579

RESUMO

INTRODUCTION: Triage is a key principle in the effective management of major incidents. There is limited evidence to support existing triage tools, with a number of studies demonstrating poor performance at predicting the need for a life-saving intervention. The Modified Physiological Triage Tool (MPTT) is a novel triage tool derived using logistic regression, and in retrospective data sets has shown optimum performance at predicting the need for life-saving intervention. MATERIALS AND METHODS: Physiological data and interventions were prospectively collected for consecutive adult patients with trauma (>18 years) presenting to the emergency department at Camp Bastion, Afghanistan, between March and September 2011. Patients were considered priority 1 (P1) if they received one or more interventions from a previously defined list. Patients were triaged using existing triage tools and the MPTT. Performance was measured using sensitivity and specificity, and a McNemar test with Bonferroni calculation was applied for tools with similar performance. RESULTS: The study population comprised 357 patients, of whom 214 (59.9%) were classed as P1. The MPTT (sensitivity: 83.6%, 95% CI 78.0% to 88.3%; specificity: 51.0%, 95% CI 42.6% to 59.5%) outperformed all existing triage tools at predicting the need for life-saving intervention, with a 19.6% absolute reduction in undertriage compared with the existing Military Sieve. The improvement in undertriage comes at the expense of overtriage; rates of overtriage were 11.6% higher with the MPTT than the Military Sieve. Using a McNemar test, a statistically significant (p<0.001) improvement in overall performance was demonstrated, supporting the use of the MPTT over the Military Sieve. DISCUSSION AND CONCLUSIONS: The MPTT outperforms all existing triage tools at predicting the need for life-saving intervention, with the lowest rates of undertriage while maintaining acceptable levels of overtriage. Having now been validated on both military and civilian cohorts, we recommend that the major incident community consider adopting the MPTT for the purposes of primary triage.


Assuntos
Serviço Hospitalar de Emergência , Triagem/métodos , Ferimentos e Lesões/epidemiologia , Adulto , Campanha Afegã de 2001- , Tomada de Decisão Clínica , Feminino , Humanos , Modelos Logísticos , Masculino , Medicina Militar , Estudos Prospectivos , Sensibilidade e Especificidade , Triagem/normas , Reino Unido , Ferimentos e Lesões/terapia , Adulto Jovem
4.
S Afr J Surg ; 49(4): 174-7, 2011 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-22353266

RESUMO

The International Society for Burns Injuries (ISBI) has published guidelines for the management of multiple or mass burns casualties, and recommends that 'each country has or should have a disaster planning system that addresses its own particular needs.' The need for a national burns disaster plan integrated with national and provincial disaster planning was discussed at the South African Burns Society Congress in 2009, but there was no real involvement in the disaster planning prior to the 2010 World Cup; the country would have been poorly prepared had there been a burns disaster during the event. This article identifies some of the lessons learnt and strategies derived from major burns disasters and burns disaster planning from other regions. Members of the South African Burns Society are undertaking an audit of burns care in South Africa to investigate the feasibility of a national burns disaster plan. This audit (which is still under way) also aims to identify weaknesses of burns care in South Africa and implement improvements where necessary.


Assuntos
Queimaduras/cirurgia , Planejamento em Desastres , Incidentes com Feridos em Massa , Programas Nacionais de Saúde , Humanos , Guias de Prática Clínica como Assunto , Sociedades Médicas , África do Sul
5.
Ann Glob Health ; 87(1): 31, 2021 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-33816136

RESUMO

Background: In many low- and middle-income countries, where vaccinations will be delayed and healthcare systems are underdeveloped, the COVID-19 pandemic will continue for the foreseeable future. Mortality scales can aid frontline providers in low-resource settings (LRS) in identifying those at greatest risk of death so that limited resources can be directed towards those in greatest need and unnecessary loss of life is prevented. While many prognostication tools have been developed for, or applied to, COVID-19 patients, no tools to date have been purpose-designed for, and validated in, LRS. Objectives: This study aimed to develop a pragmatic tool to assist LRS frontline providers in evaluating in-hospital mortality risk using only easy-to-obtain demographic and clinical inputs. Methods: Machine learning was used on data from a retrospective cohort of Sudanese COVID-19 patients at two government referral hospitals to derive contextually appropriate mortality indices for COVID-19, which were then assessed by C-indices. Findings: Data from 467 patients were used to derive two versions of the AFEM COVID-19 Mortality Scale (AFEM-CMS), which evaluates in-hospital mortality risk using demographic and clinical inputs that are readily obtainable in hospital receiving areas. Both versions of the tool include age, sex, number of comorbidities, Glasgow Coma Scale, respiratory rate, and systolic blood pressure; in settings with pulse oximetry, oxygen saturation is included and in settings without access, heart rate is included. The AFEM-CMS showed good discrimination: the model including pulse oximetry had a C-statistic of 0.775 (95% CI: 0.737-0.813) and the model excluding it had a C-statistic of 0.719 (95% CI: 0.678-0.760). Conclusions: In the face of an enduring pandemic in many LRS, the AFEM-CMS serves as a practical solution to aid frontline providers in effectively allocating healthcare resources. The tool's generalisability is likely narrow outside of similar extremely LRS settings, and further validation studies are essential prior to broader use.


Assuntos
COVID-19/mortalidade , Países em Desenvolvimento , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , COVID-19/diagnóstico , COVID-19/terapia , Estudos de Coortes , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Hospitalização , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Taxa Respiratória , Sudão , Taxa de Sobrevida
6.
S Afr Med J ; 111(5): 416-420, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-34852881

RESUMO

Digital technologies continue to penetrate the South African (SA) healthcare sector at an increasing rate. Clinician-to-clinician diagnostic and management assistance through mHealth is expanding rapidly, reducing professional isolation and unnecessary referrals, and promoting better patient outcomes and more equitable healthcare systems. However, the widespread uptake of mHealth use raises ethical concerns around patient autonomy and safety, and guidance for healthcare workers around the ethical use of mHealth is needed. This article presents the results of a multi-stakeholder workshop at which the 'dos and don'ts' pertaining to mHealth ethics in the SA context were formulated and aligned to seven basic recommendations derived from the literature and previous multi-stakeholder, multi-country meetings.


Assuntos
Atenção à Saúde/organização & administração , Pessoal de Saúde/organização & administração , Telemedicina/organização & administração , Atenção à Saúde/ética , Humanos , Autonomia Pessoal , Encaminhamento e Consulta , África do Sul , Telemedicina/ética
7.
Afr J Emerg Med ; 10(Suppl 1): S12-S17, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33318896

RESUMO

INTRODUCTION: In order to allocate resources in an effective manner, emergency medical services (EMS) systems use dispatch-based triaging to prioritise patients by acuity. Over-triage, wherein patients are assigned a higher priority level than necessary, can serve as a safety measure. However, it places strain on EMS systems, a problem believed to be experienced by South Africa's Western Cape Government EMS system, with almost half of its calls designated at the highest priority level.To begin improving dispatch within WCG EMS, we aimed to describe the current system by identifying the most common conditions dispatched, and those most perceived to be suffering from over-triage. METHODS: A multi-methods approach was taken: First, a quantitative chart review was used to analyse all calls assigned a dispatch priority by WCG EMS between December 2016 and November 2017. These descriptive data then informed qualitative focus groups to further investigate emergency medical dispatch (EMD). Three focus groups were conducted, each with a convenience sample of staff from: WCG EMS staff, call takers/dispatchers, and call centre managers. Data were reviewed and coded, after which the lead researcher aggregated coded transcripts and conducted thematic content analysis. RESULTS: Seventy-nine condition categories were identified from 649,544 completed patient records for the study period. Non-specific pain accounted for the greatest proportion of dispatched complaints (16.88%), followed by assault with a weapon (10.00%) and respiratory complaints (9.71%).Sixteen WCG EMS personnel took part in focus groups, highlighting challenges of the current EMD system, including time constraints, legal risks, communication, overuse of the system, and lack of training. Chest pain, collapsed/unresponsive patients, and vomiting and diarrhoea were frequently noted to be potentially over-triaged conditions. To improve this, participants suggested trainings, modifications to the electronic EMD system, additional protocols, and public education. CONCLUSION: This study identified where over-triage is possibly occurring in the WCG EMS dispatch system, as well as potential solutions proposed by those working within the system.

8.
Emerg Med J ; 26(9): 635-40, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19700577

RESUMO

OBJECTIVES: To describe the demographics, referral mechanism and outcome of the emergency consultation in patients presenting to a secondary hospital emergency centre (EC). DESIGN: An observational study of patients presenting to an EC in a 1-month period from 19 November to 20 December 2007. SETTING: New Somerset Hospital, Cape Town, South Africa. SUBJECTS: All patients presenting alive to the EC during the study period who were seen by an EC doctor. OUTCOME MEASURES: A data collection form was completed by EC doctors at the time of the initial EC consultation documenting patient demographics, time and delay periods, South African Triage Score (SATS), initial diagnosis, transport and referral mechanisms and outcome of EC consultation. RESULTS: Data on 2646 patient presentations were described with a mix of SATS acuity levels (green: routine care; yellow: urgent; orange: very urgent; red: immediate), with more than one-third of presentations scoring an orange or red SATS. Most patients presented in the daytime, with an increase in more ill patients (higher SATS) later in the day and at night. The peak age group was 20-40 years, with 39% resident in informal settlements within 15 km of the hospital. The initial diagnosis was trauma in 26% of presentations, with a wide spread of other presentations. Patients were transported by ambulance to the EC in 39% of presentations, 41% were self-referred and 41% were referred by a primary health care practitioner. Fifty-three percent of presentations were either admitted to hospital or kept in the EC for further investigations, and the remainder were discharged from the EC. CONCLUSIONS: Clear trends are seen for patient demographics and temporal attendance patterns which are important for resource allocation and planning. Many low-acuity patients, largely non-referred, are being seen in the EC and should be managed by primary health care level staff outside the EC.


Assuntos
Emergências/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Encaminhamento e Consulta , Características de Residência , África do Sul/epidemiologia , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos , Resultado do Tratamento , Serviços Urbanos de Saúde/estatística & dados numéricos , Adulto Jovem
9.
Emerg Med J ; 25(7): 398-402, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18573947

RESUMO

BACKGROUND: Until recently South Africa had no triage system for emergency department (ED) use. The Cape triage group developed a triage scale called the Cape triage score (CTS). This system consists of a basic physiology score, mobility score and a short list of important discriminators that cannot be accurately triaged on a physiological score alone. Highest priority is given to a red colour code, followed by orange, yellow and green. AIM: The purpose was to evaluate the components of the CTS and identify amendments that would improve the quality of the scale in terms of its accuracy to identify patients more likely to require admission or at high risk of death in the ED. METHODS: Data were prospectively collected over a 4-month period. Data captured included the parameters of a basic physiological score (respiratory rate, pulse rate, systolic blood pressure, temperature and a simplified score measuring level of consciousness), mobility, a list of selected clinical conditions (discriminator list), final clinical diagnosis and final outcome in the ED (admission to hospital or death). RESULTS: 798 patients were triaged and analyzed. The CTS undertriaged 24% (overtriage 25%) of cases who required admission. By altering the colour code parameters, amending the discriminator list as well as the addition of a trauma factor, undertriage was reduced to 12% (with an overtriage of 45%). CONCLUSIONS: The amended CTS has an acceptably low undertriage rate and is capable of predicting patient disposal over a wide spectrum of ED presentations.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Triagem/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , África do Sul , Adulto Jovem
10.
Emerg Med J ; 25(7): 395-7, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18573946

RESUMO

BACKGROUND: In a resource poor setting with poverty, a high burden of disease and critically low medical staff numbers, triage could potentially improve the long waiting times experienced at South African public hospital emergency departments (ED) and render timely emergency care to those in most need. AIM: To evaluate the impact of introducing nurse triage (using the Cape Triage Score (CTS)) on waiting times for patients presenting to a South African public hospital ED. METHODS: Pre-triage waiting times were collected retrospectively through accessing hospital records of four randomly chosen months of the preceding year. This was compared with data collected prospectively over a 3 month period using nurse triage and the CTS triage tool. Captured data included CTS priority category, time of nurse triage and time of attendance by ED doctor. RESULTS: Waiting times were significantly reduced in all but the lowest priority category. The introduction of nurse triage, using the CTS, resulted in an overall reduction in waiting time from 237 min to 146 min (p<0.001). Patients triaged "red" (highest priority) demonstrated a mean reduction in waiting time from 216 min to 38 min (p<0.001). CONCLUSIONS: The results demonstrate that use of the CTS, as implemented by trained nurses, dramatically reduced the waiting time of patients attending a busy public hospital ED in South Africa.


Assuntos
Enfermagem em Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Triagem/organização & administração , Listas de Espera , Métodos Epidemiológicos , Humanos , Avaliação de Programas e Projetos de Saúde , África do Sul
11.
Emerg Med J ; 25(3): 136-9, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18299358

RESUMO

BACKGROUND: The South African setting lends itself to the extensive use of air transport. There is a perception with healthcare providers that flight crews spend too much time with a patient before departure. The main advantage of aero medical transport is to minimise the delay to definitive care and prolonged on-scene time defies this objective. A study was carried out to examine the mean on-scene times of aero medical and road transport of critically ill patients in the Western Cape of South Africa. METHODS: In this retrospective observational study, all critically ill patients transported in the Western Cape between September 2005 and May 2006 were evaluated. The mean on-scene time for each transport mode was calculated. Road transport was compared with air transport (rotor and fixed wing). Every transport mode was further divided into mission types: "scene" missions (scene to a healthcare facility) or "inter-facility" missions (from one healthcare facility to another). RESULTS: A total of 7924 transports were included in the study, 7580 of which (95.7%) were road transports. The air transport group spent 53.2 min (95% CI 51.1 to 55.4) at the scene compared with 27.9 min (95% CI 27.5 to 28.4) for the road transport group. There was a significant difference between scene and inter-facility missions in the air transport group (mean 31.7 min for scene missions vs 58.7 min for inter-facility missions; p<0.001). A significant difference was also found in the road transport (mean 24.6 min for scene missions vs 31.9 min for inter-facility missions; p<0.001). CONCLUSION: The on-scene time for transport missions by road is significantly less than for those done by air. There are significant differences between scene and inter-facility missions in both transport modes. Capacity building programmes with ongoing education and training of staff at referring facilities should be implemented.


Assuntos
Resgate Aéreo , Ambulâncias , Estado Terminal , Serviços Médicos de Emergência , Análise de Variância , Humanos , Garantia da Qualidade dos Cuidados de Saúde , Estudos Retrospectivos , África do Sul , Estatísticas não Paramétricas , Fatores de Tempo , Estudos de Tempo e Movimento
13.
Afr J Emerg Med ; 8(3): 110-117, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30456159

RESUMO

OBJECTIVES: Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury. METHODS: We undertook a multi-step consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final in-person consensus process. RESULTS: The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential, and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (e.g. district hospitals), and an additional 78 for advanced facilities (e.g. tertiary centres). CONCLUSION: The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation, and will be a useful tool for practical expansion of emergency care delivery in Africa.

14.
Resuscitation ; 132: 85-89, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30171975

RESUMO

INTRODUCTION: The Global Resuscitation Alliance (GRA) was established in 2015 to improve survival for Out- of-Hospital Cardiac Arrest (OHCA) using the best practices developed by the Seattle Resuscitation Academy. However, these 10 programs were recommended in the context of developed Emergency Care Systems (ECS). Implementing these programs can be challenging for ECS at earlier stages of development. We aimed to explore barriers faced by developing ECS and to establish pre-requisites needed. We also developed a framework by which developing ECS may use to build their emergency response capability. METHOD: A consensus meeting was held in Singapore on 1st-2nd August 2017. The 74 participants were key stakeholders from 26 countries, including Emergency Medical Services (EMS) directors, physicians and academics, and two Physicians who sit on the World Health Organisation (WHO) panel for development of Emergency Care Systems. Five discussion groups examined the chain of survival: community, dispatch, ambulance and hospital; a separate group considered perinatal resuscitation. Discussion points were voted upon to reach a consensus. RESULTS: The answers and discussion points from each groupwere classified into a table adapted from WHO's framework of development for Emergency Services. After which, it was used to construct the modified survival framework with the chain of survival as the backbone. Eleven key statements were then derived to describe the pre-requisites for achieving the GRA 10 programs. The participants eventually voted on the importance and feasibility of these 11 statements as well as the GRA 10 programs using a matrix that is used by organisations to prioritise their action steps. CONCLUSION: In this paper, we propose a modified framework of survival for developing ECS systems. There are barriers for developing ECS systems to improve OHCA survival rates. These barriers may be overcome by systematic prioritisation and cost-effective innovative solutions.


Assuntos
Serviços Médicos de Emergência/organização & administração , Parada Cardíaca Extra-Hospitalar/mortalidade , Reanimação Cardiopulmonar/normas , Participação da Comunidade , Conferências de Consenso como Assunto , Saúde Global , Humanos , Parada Cardíaca Extra-Hospitalar/terapia
15.
Emerg Med J ; 23(1): 47-50, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16373803

RESUMO

INTRODUCTION: The Paediatric Triage Tape (PTT) is an easy to use major incident primary triage tool, based upon a modification of the Triage Sieve. The purpose of this study was to prospectively validate the PTT for use in paediatric major incidents. METHODS: A database of children presenting the Trauma Unit of the Red Cross Children's Hospital, Cape Town, was developed over a nine month period. Each child was triaged using the PTT, and had an Injury Severity Score (ISS) calculated. Additionally, the New Injury Severity Score (NISS) was calculated, and the presence of interventions that may occur to the children ("Garner criteria") was documented. The sensitivity, specificity, overtriage, and undertriage rates were calculated. RESULTS: 3461 children were entered into the database. For identifying children with an ISS of over 15, the PTT had a sensitivity of 37.8%, specificity of 98.6%, overtriage rate of 38.8%, and an undertriage rate of 3.5%. Against the NISS and Garner criteria, the results were comparable. CONCLUSION: The PTT has poor sensitivity at identifying immediate priority children by these criteria. Specificity (the ability to identify non-T1 patients) is excellent, and the overtriage and undertriage rates are within the range deemed unavoidable by the American College of Surgeons.


Assuntos
Algoritmos , Pediatria/instrumentação , Triagem/métodos , Estatura , Criança , Pré-Escolar , Desastres , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Pediatria/métodos , Estudos Prospectivos , Sensibilidade e Especificidade , Centros de Traumatologia
16.
Emerg Med J ; 23(6): 475-8, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16714518

RESUMO

OBJECTIVES: To determine the sensitivity and specificity of paediatric major incident triage scores. The Paediatric Triage Tape (PTT), Careflight, Simple Triage and Rapid Treatment (START), and JumpSTART systems were tested. METHODS: In total, 3461 children presenting to a South African emergency department with trauma were scored using the four different methods. The sensitivity and specificity of the four scores was calculated against the Injury Severity Score (ISS), New ISS (NISS), and a modification of the Garner criteria (a measure of need for urgent clinical intervention). We also performed a Bayesian analysis of the scores against three different types of major incident. RESULTS: None of the tools showed high sensitivity and specificity. Overall, the Careflight score had the best performance in terms of sensitivity and specificity. The performance of the PTT was very similar. In contrast, the JumpSTART and START scores had very low sensitivities, which meant that they failed to identify patients with serious injury, and would have missed the majority of seriously injured casualties in the models of major incidents. CONCLUSION: The Careflight or PTT methods of triage should be used in paediatric major incidents in preference to the jumpSTART or START methods.


Assuntos
Algoritmos , Serviços Médicos de Emergência/organização & administração , Traumatismo Múltiplo/classificação , Pediatria/instrumentação , Triagem/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Traumatismo Múltiplo/diagnóstico , Pediatria/métodos , Estudos Prospectivos , Sensibilidade e Especificidade , Índices de Gravidade do Trauma
17.
Emerg Med J ; 23(2): 149-53, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16439753

RESUMO

The Cape Triage Group (CTG) convened with the intention of producing a triage system for the Western Cape, and eventually South Africa. The group includes in-hospital and prehospital staff from varied backgrounds. The CTG triage protocol is termed the Cape Triage Score (CTG), and has been developed by a multi-disciplinary panel, through best available evidence and expert opinion. The CTS has been validated in several studies, and was launched across the Western Cape on 1 January 2006. The CTG would value feedback from readers of this journal, as part of the ongoing monitoring and evaluation process.


Assuntos
Índices de Gravidade do Trauma , Triagem/métodos , Atitude do Pessoal de Saúde , Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Tratamento de Emergência/métodos , Humanos , Dor/etiologia , África do Sul , Centros de Traumatologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia
18.
Afr J Emerg Med ; 6(1): 54-55, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30456066

RESUMO

The African Federation for Emergency Medicine's Out-of-Hospital Emergency Care (OHEC) Committee convened 15 experts from various OHEC systems in Africa to participate in a consensus process to define levels of care within which providers in African OHEC systems should safely and effectively function. The expert panel concluded that four provider levels were relevant for African OHEC systems: (i) first aid, (ii) basic life support, (iii) intermediate life support, and (iv) advanced life support. Definitions for each provider level were also created to aid standardisation of providers across Africa and to help advance the practice of OHEC.


Le Comité de la Fédération africaine pour les Soins d'urgence hors de l'hôpital (OHEC, Out-of-Hospital Emergency Care) a invité 15 experts issus de divers systèmes d'OHEC en Afrique à participer à un processus consensuel visant à définir les niveaux de soins au sein desquels les fournisseurs de soins des systèmes d'OHEC africains devraient fonctionner en toute sécurité et de façon efficace. Le groupe d'experts a conclu que quatre niveaux de fournisseurs de soins étaient pertinents pour les systèmes d'OHEC africains: (i) les premiers secours, (ii) la réanimation de base, (iii) la réanimation intermédiaire, et (iv) la réanimation intensive. Des définitions pour chaque niveau de fournisseur de soins ont également été créées afin de faciliter la normalisation des fournisseurs de soins dans toute l'Afrique et de contribuer à faire progresser la pratique des OHEC.

19.
S Afr Med J ; 103(10): 723-7, 2013 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-24079622

RESUMO

BACKGROUND: Patients with first-onset seizures commonly present to emergency centres (ECs). The differential diagnosis is broad, potentially life-threatening conditions need to be excluded, and these patients need to be correctly diagnosed and appropriately referred. There are currently no data on adults presenting with first-onset seizures to ECs in South Africa. OBJECTIVE: To review which investigations were performed on adults presenting with first-onset seizures to six ECs in the Western Cape Province. METHODS: A prospective, cross-sectional study was conducted from 1 July 2011 to 31 December 2011. All adults with first-onset seizures were included; children and trauma patients were excluded. Subgroup analyses were conducted regarding HIV status and inter-facility variation. RESULTS: A total of 309 patients were included. Computed tomography (CT) scans were planned in 218 (70.6%) patients, but only performed in 169; 96 (56.8%) showed abnormalities judged to be causative (infarction, intracerebral haemorrhage and atrophy being the most common). At least 80% of patients (n=247) received a full renal and electrolyte screen, blood glucose testing and a full haematological screen. Lumbar puncture (LP) was performed in 67 (21.7%) patients, with normal cerebrospinal fluid findings in 51 (76.1%). Only 27 (8%) patients had an electroencephalogram, of which 5 (18%) were abnormal. There was a statistically significant difference in the number of CT scans (p=0.002) and LPs (p<0.001) performed in the HIV-positive group (n=49). CONCLUSION: This study demonstrated inconsistency and wide local variance for all types of investigations done. It emphasises the need for a local guideline to direct doctors to appropriate investigations, ensuring better quality patient care and potential cost-saving.


Assuntos
Serviço Hospitalar de Emergência , Convulsões/diagnóstico , Adolescente , Adulto , Idoso , Estudos Transversais , Diagnóstico Diferencial , Eletroencefalografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , África do Sul/epidemiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
20.
Artigo em Inglês | AIM | ID: biblio-1258687

RESUMO

Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications.The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury.Methods:We undertook a multi-step consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final in-person consensus process.Results:The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential, and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (e.g. district hospitals), and an additional 78 for advanced facilities (e.g. tertiary centres).Conclusion:The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation, and will be a useful tool for practical expansion of emergency care delivery in Africa


Assuntos
Atenção à Saúde , Medicamentos Essenciais , Medicamentos Essenciais/provisão & distribuição , Medicamentos Essenciais/uso terapêutico , Serviços Médicos de Emergência , Medicina de Emergência , Tratamento de Emergência , Formulários Farmacêuticos como Assunto
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