Decision-making for children requiring interhospital transport: assessment of a novel triage tool.

OBJECTIVE: The use of specialist retrieval teams to transport critically ill children is associated with reduced risk-adjusted mortality and morbidity; however, there is a paucity of data to guide decision-making related to retrieval team activation. We aimed to assess the accuracy of a novel triage tool designed to identify critically ill children at the time of referral for interhospital transport. DESIGN: Prospective observational study. SETTING: Regional paediatric retrieval and transport services. PATIENTS: Data were collected for 1815 children referred consecutively for interhospital transport from 87 hospitals in Queensland and northern New South Wales. INTERVENTION: Implementation of the Queensland Paediatric Transport Triage Tool. MAIN OUTCOME MEASURES: Accuracy was assessed by calculating the sensitivity, specificity and negative predictive value for predicting transport by a retrieval team, or admission to intensive care following transport. RESULTS: A total of 574 (32%) children were transported with a retrieval team. Prediction of retrieval (95% CIs): sensitivity 96.9% (95% CI 95.1% to 98.1%), specificity 91.4% (95% CI 89.7% to 92.9%), negative predictive value 98.4% (95% CI 97.5% to 99.1%). There were 412 (23%) children admitted to intensive care following transport. Prediction of intensive care admission: sensitivity 96.8% (95% CI 94.7% to 98.3%), specificity 81.2% (95% CI 79.0% to 83.2%), negative predictive value 98.9% (95% CI 98.1% to 99.4%). CONCLUSIONS: The triage tool predicted the need for retrieval or intensive care admission with high sensitivity and specificity. The high negative predictive value indicates that, in our setting, children categorised as acutely ill rather than critically ill are generally suitable for interhospital transport without a retrieval team.

Use of glycoprotein IIb/IIIa inhibitors in unstable angina and non-ST-elevation myocardial infarction.

Acute coronary syndromes (ACS) are a major cause of morbidity and mortality in Western society. The commonest underlying pathology is the coronary atherosclerotic plaque complicated by thrombosis. Platelets play a central role. As the glycoprotein IIb/IIIa receptor is involved in the final step of platelet thrombus formation development and investigation of its blockage in ACS is at the fore. Initial hospital management of ACS occur in the ED setting. The present article outlines the above topics and clarifies the place of glycoprotein IIb/IIIa receptor inhibition in ED.