Development and validation of an early warning score to identify COVID-19 in the emergency department based on routine laboratory tests: a multicentre case-control study.

OBJECTIVES: Identifying patients with a possible SARS-CoV-2 infection in the emergency department (ED) is challenging. Symptoms differ, incidence rates vary and test capacity may be limited. As PCR-testing all ED patients is neither feasible nor effective in most centres, a rapid, objective, low-cost early warning score to triage ED patients for a possible infection is developed. DESIGN: Case-control study. SETTING: Secondary and tertiary hospitals in the Netherlands. PARTICIPANTS: The study included patients presenting to the ED with venous blood sampling from July 2019 to July 2020 (n=10 417, 279 SARS-CoV-2-positive). The temporal validation cohort covered the period from July 2020 to October 2021 (n=14 080, 1093 SARS-CoV-2-positive). The external validation cohort consisted of patients presenting to the ED of three hospitals in the Netherlands (n=12 061, 652 SARS-CoV-2-positive). PRIMARY OUTCOME MEASURES: The primary outcome was one or more positive SARS-CoV-2 PCR test results within 1 day prior to or 1 week after ED presentation. RESULTS: The resulting 'CoLab-score' consists of 10 routine laboratory measurements and age. The score showed good discriminative ability (AUC: 0.930, 95% CI 0.909 to 0.945). The lowest CoLab-score had high sensitivity for COVID-19 (0.984, 95% CI 0.970 to 0.991; specificity: 0.411, 95% CI 0.285 to 0.520). Conversely, the highest score had high specificity (0.978, 95% CI 0.973 to 0.983; sensitivity: 0.608, 95% CI 0.522 to 0.685). The results were confirmed in temporal and external validation. CONCLUSIONS: The CoLab-score is based on routine laboratory measurements and is available within 1 hour after presentation. Depending on the prevalence, COVID-19 may be safely ruled out in over one-third of ED presentations. Highly suspect cases can be identified regardless of presenting symptoms. The CoLab-score is continuous, in contrast to the binary outcome of lateral flow testing, and can guide PCR testing and triage ED patients.

Effect of acute and chronic job demands on effective individual teamwork behaviour in medical emergencies.

AIM: This paper is a report of a study conducted to determine the combined effect of acute and chronic job demands on acute job strains experienced during medical emergencies, and its consequences for individual teamwork behaviour. BACKGROUND: Medical emergency personnel have to cope with high job demands, which may cause considerable work stress (i.e. job strains), particularly when both acute and chronic job demands are experienced to be high. This may interfere with effective individual teamwork behaviour. METHODS: A cross-sectional survey study was conducted in 2008, involving 48 members (doctors and nurses) of medical emergency teams working in the emergency department of a Dutch general hospital. Data were analyzed by means of hierarchical regression analyses. RESULTS: High acute job demands impeded effective teamwork behaviour, but only when they resulted in acute job strain. Acute emotional demands were more likely to result in acute job strain when chronic emotional job demands were also experienced as high. Although acute cognitive and physical strains were also detrimental, effective teamwork behaviour was particularly impeded by acute emotional strain. CONCLUSION: Acute job strains impair effective individual teamwork behaviour during medical emergencies, and there is urgent need to prevent or reduce a build-up of job strain from high acute and chronic demands, particularly of the emotional kind.

[Implementation of the curriculum for specialist training in Emergency Medicine: room for improval on details]. / Implementatie van het curriculum voor de opleiding tot Spoedeisende Hulp(SEH)-arts: zoektocht naar het verborgen curriculum.

OBJECTIVE: To investigate what aspects of the new curriculum for specialist training in Emergency Medicine are actually implemented in daily practice. DESIGN: Descriptive study. METHOD: The curriculum was implemented as a pilot in 4 teaching hospitals, where a total of 32 residents in training in Emergency Medicine and 20 Emergency Medicine Program directors and Emergency physicians were surveyed using a web-based questionnaire querying the use of the different aspects of the curriculum in daily practice. RESULTS: Responses were received from 29 residents in training and 15 program directors and Emergency physicians. Both residents in training and program directors rated the patient mix seen during the training programme adequate to excellent. No great differences were observed in how residents in training, trainers and physicians working in the Emergency Department assessed the curriculum. However, the results showed that the training plan should be discussed explicitly with each residents in training. More attention should be focussed on the Society Awareness, Knowledge and Science and Organisation competencies and the Disability and Dermatology themes. Competence-based assessment methods, such as multi-source feedback, specific to this type of curriculum have not yet been sufficiently implemented. CONCLUSION: The responses to the questionnaire demonstrated how the curriculum is handled in daily practice and provided information on the progress of the implementation of the curriculum. This will enable focussed feedback to teaching hospitals.