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1.
J Surg Res ; 257: 493-500, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32916502

RESUMO

BACKGROUND: Blood pressure alterations in patients with traumatic brain injury (TBI) have been shown to be associated with increased mortality. However, there is paucity of data describing the optimal emergency department (ED) systolic blood pressure (SBP) target during the initial evaluation. The aim of our study was to assess the association between SBP on presentation and mortality in patients with TBI. METHODS: We performed a retrospective (2015-2016) review of the American College of Surgeons Trauma Quality Improvement Program database and included all adult (age ≥18y) trauma patients who had TBI on presentation. The outcome measure was in-hospital mortality at different ED-SBP values. A subanalysis by age and TBI severity in accordance with the Glasgow Coma Scale (GCS) was performed (mild (GCS ≥13), moderate (GCS 9-12), and severe (≤8)). Multivariate logistic regression analysis was performed. RESULTS: A total of 94,411 adult trauma patients with TBI were included. Mean age was 59 ± 21y, 62% were male, and median GCS was 15 [14-15]. Mean SBP was 147 ± 28 mmHg, and overall mortality was 8.6%. The lowest rate of mortality was noticed at ED SBP between 110 and 149 mmHg, whereas the highest mortality was at admission SBP <90 mmHg and SBP >190 mmHg. On regression analysis, SBP between 130 and 149 mmHg (odds ratio = 0.92; P = 0.68) was not associated with increased odds of mortality relative to SBP between 110 and 129 mmHg. On subanalysis based on severity of TBI (mild 80.9%, moderate 5.3%, and severe 13.8%), patients with SBP between 110 and 149 mmHg were less likely to die across all TBI groups. CONCLUSIONS: The optimal ED-SBP range for patients with TBI seems to be age and severity dependent. The optimum range might guide clinicians in developing resuscitation protocols for managing patients with TBI. LEVEL OF EVIDENCE: Level III Prognostic.


Assuntos
Pressão Sanguínea , Lesões Encefálicas Traumáticas/mortalidade , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/fisiopatologia , Serviço Hospitalar de Emergência/normas , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos/epidemiologia
2.
Medicine (Baltimore) ; 99(52): e23763, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350760

RESUMO

ABSTRACT: Emergency departments receive an increasing amount of musculoskeletal injuries, with the majority referred to a fracture clinic (FCs). A literature review revealed certain orthopaedic injuries can be safely managed away from the FC pathway by general practitioners (GPs) or allied health professionals (AHPs). The present study aims to review all paediatric presentations to FCs at 2 Queensland hospitals, identifying low risk injuries that could potentially be managed by GPs or AHPs. This study is a continuation from Cleary et al in which a primary care pathway (PCP) was proposed for the management of low risk adult orthopaedic injuries. A PCP has the potential to have significant savings to the health system.A retrospective study was conducted looking at paediatric patients (<16 years) referrals to 2 FCs over 8 weeks. Injuries were categorised into those requiring FC care supervised by an orthopaedic surgeon, and those that can be safely managed by GPs or AHPs via a PCP.Four hundred ninety (57.7%) of the 849 patients referred to FC were assessed as suitable for PCP care. The most common upper limb injury deemed suitable was radius and ulna buckle fractures (18.4%), while the most common lower limb injury is ankle sprains (8%). Total failure to attend rate in the PCP group was 6.7%.Adopting the PCP has the potential to significantly reduce FC referrals. With proven success of similar pathways abroad, the PCP may generate significant time and financial savings for both the health care system and patient.


Assuntos
Instituições de Assistência Ambulatorial/normas , Serviço Hospitalar de Emergência/normas , Fraturas Ósseas/terapia , Atenção Primária à Saúde , Criança , Serviços de Saúde da Criança/normas , Humanos , Melhoria de Qualidade , Queensland , Encaminhamento e Consulta , Estudos Retrospectivos
3.
PLoS One ; 15(12): e0242603, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33259508

RESUMO

BACKGROUND: Providing high quality care is important and has gained more attention since the introduction of value-based healthcare. Value should be measured by outcomes achieved, relevant for patients. Patient-centeredness is one domain for quality improvement determined by the Institute of Medicine, aiming to deliver care responsive to the patient. The development and implementation of patient reported outcome- and experience measures can be used for this goal. Recently, we developed the Patient Reported Measure (PRM)-acute care, based on five relevant domains to evaluate and improve the quality of care in the Emergency Department (ED). OBJECTIVE: To validate the PRM-acute care, in order to evaluate and improve patient-centered care in the ED. METHODS: We performed a prospective questionnaire-based study. Patients ≥18 years presenting for internal medicine in the ED were eligible. The validity of the PRM-acute care was evaluated according to the COSMIN-criteria. We performed hypotheses testing to evaluate construct validity. The perceived quality of care was evaluated by statistical analysis. RESULTS: Face- and content validity was evaluated based on previously performed research and deemed good. Construct validity was supported by demonstrated differences between subgroups; patients with severe symptoms had a higher perceived quality of care. The correlation between overall satisfaction and the total mean score of the PRM-acute care (r = 0,447, p = 0.01) was significant. Overall, patients reported a mean perceived quality of care of 4.67/6.0. CONCLUSION: The PRM-acute care is a valid instrument to measure the perceived quality of care in an acute setting for internal medicine patients. Additionally, patients reported a good perceived quality of care in the ED with scores ranging from moderate to well for each of the relevant domains. Therefore, we believe that the PRM-acute care can be implemented in daily practice to evaluate the perceived quality of care and to improve the quality of acute care.


Assuntos
Serviço Hospitalar de Emergência/normas , Medicina Interna/tendências , Medidas de Resultados Relatados pelo Paciente , Assistência Centrada no Paciente/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Psicometria/tendências , Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas , Qualidade de Vida , Inquéritos e Questionários
9.
J Med Vasc ; 45(6): 326-333, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33248535

RESUMO

AIMS: To evaluate the implementation of the European Society of Cardiology (ESC) guidelines concerning the diagnostic management of deep vein thrombosis (DVT) in emergency departments (ED); and to estimate the additional financial cost and the increase in the time spent in the ED if the guidelines are not followed. PATIENTS AND METHODS: Retrospective, bi-centric study including all patients directly admitted or referred to the ED for a suspected isolated DVT, between April 1, 2019, and July 30, 2019. The diagnostic management was compared to the 2017 ESC's guidelines. RESULTS: 107 patients were included, 13 had DVT (12%) and three had superficial venous thrombosis (3%). A total of 26 patients (24%) had a diagnostic management according to guidelines. In 72 patients (67%), no assessment of clinical probability score was found. Among the 35 patients in whom a clinical probability score was calculated, 5 patients had an unnecessary D-dimer assay and 2 patients had unjustified imaging. The median time spent in the ED was 185minutes when the recommendations were followed, and 250minutes when they were not (P=0.317). The total estimated additional cost was €232.20. CONCLUSION: The rate of adherence to the guidelines is low, mainly due to the absence of calculation of a clinical probability. This leads, in addition to the risk of diagnostic error, to an increase in the time spent in the EDs and inappropriate use of the technical platform, resulting in additional costs of care.


Assuntos
Serviço Hospitalar de Emergência/normas , Fidelidade a Diretrizes/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Trombose Venosa/terapia , Idoso , Redução de Custos , Análise Custo-Benefício , Serviço Hospitalar de Emergência/economia , Feminino , França , Custos Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/economia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Procedimentos Desnecessários/economia , Trombose Venosa/diagnóstico , Trombose Venosa/economia
10.
Taiwan J Obstet Gynecol ; 59(6): 795-800, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33218391

RESUMO

The spread of COVID-19 has resulted in a high risk of infection in hospitals worldwide. The medical staff in emergency rooms, in particular, have borne the brunt of the pandemic, and strict protection measures are needed to avoid infection in these units. Taiwan as a whole has performed extremely well in this epidemic, an achievement that has been acknowledged internationally. This success can be attributed to the Taiwan Epidemic Prevention Management Center's extensive experience and courageous strategy. The emergency department professionals of all hospitals, in conjunction with the outstanding performance of the center's policy, have also done much to control the infection's spread. However, excessive protection can also negatively affect patients' safety and the quality of medical care, especially for pregnant and parturient women. This article uses two actual cases from a medical center in northern Taiwan to discuss the impact of COVID-19 on pregnant women. This case study serves to highlight that, to ensure more effective coordination during severe epidemics, a comprehensive infection prevention plan should be formulated. In addition, pregnant women's human rights must be safeguarded so that various protective mechanisms can be effectively used to achieve win-win solutions. Hospitals need to plan their production methods and timing in advance for when pregnant patients are in critical condition. The findings include that obstetricians recommend caesarean sections as a safer method in during epidemics. Emergency room physicians and obstetricians should also actively assist mothers prepare for birth to enhance maternal and fetal safety.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Serviço Hospitalar de Emergência/normas , Pandemias/prevenção & controle , Assistência Perinatal/normas , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Adulto , Betacoronavirus , Cesárea/normas , Infecção Hospitalar/virologia , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Humanos , Obstetrícia/normas , Gravidez , Complicações Infecciosas na Gravidez/virologia , Taiwan/epidemiologia
12.
Medicine (Baltimore) ; 99(44): e22910, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126347

RESUMO

INTRODUCTION: Using mobile phones for communication in emergency departments is a common practice; however, several studies have demonstrated that they may act as vectors for bacteria and viruses. This study evaluated the effectiveness of plastic wrapping in decreasing bacterial contamination on mobile phone surfaces. METHOD: We used culture dishes and a luminometer to detect bacterial colonies and contamination on the phone surfaces. RESULT: Our experiment showed that bacterial colonies exist on mobile phones before and after work. We found that wiping with 75% alcohol sanitizers effectively reduces the number of colonies on either a mobile phone or a temporary plastic covering. In addition, we found that bacterial colonies do not contaminate or adhere to plastic wrap any easier than to mobile phones. CONCLUSION: These results demonstrated the effectiveness of plastic wrap for protecting mobile phone surfaces against bacterial colonization. In addition, applying a layer of plastic wrap protects the phone from potential damage due to the alcohol.


Assuntos
Bactérias , Telefone Celular , Infecção Hospitalar , Desinfecção/métodos , Serviço Hospitalar de Emergência , Contaminação de Equipamentos/prevenção & controle , Equipamentos e Provisões Hospitalares , Etanol/farmacologia , Anti-Infecciosos Locais/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Equipamentos e Provisões Hospitalares/microbiologia , Equipamentos e Provisões Hospitalares/normas , Humanos , Administração de Materiais no Hospital/métodos , Plásticos , Equipamentos de Proteção/microbiologia
13.
Obstet Gynecol ; 136(5): 912-921, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030878

RESUMO

OBJECTIVE: To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments. METHODS: We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care. A prospective case-cohort study in the spring of 2015 then assessed the prevalence of these potentially life-threatening emergencies and near misses among women of reproductive age presenting for acute pelvic pain. Women in the case group were identified at 21 participating centers. The control group consisted of a sample of women hospitalized for acute pelvic pain not caused by a potentially life-threatening condition and a 10% random sample of outpatients. RESULTS: Eight gynecologic emergencies and 17 criteria for near misses were identified using the Delphi procedure. Among the 3,825 women who presented for acute pelvic pain, 130 (3%) were considered to have a potentially life-threatening condition. The most common diagnoses were ectopic pregnancies with severe bleeding (n=54; 42%), complex pelvic inflammatory disease (n=30; 23%), adnexal torsion (n=20; 15%), hemorrhagic miscarriage (n=15; 12%), and severe appendicitis (n=6; 5%). The control group comprised 225 hospitalized women and 381 outpatients. Diagnostic errors occurred more frequently among women with potentially life-threatening emergencies than among either hospitalized (odds ratio [OR] 1.7, 95% CI 1.1-2.7) or outpatient (OR 14.7, 95% CI 8.1-26.8) women in the control group. Of the women with potentially life-threatening conditions, 26 met near-miss criteria compared with six with not potentially life-threatening conditions (OR 25.6, 95% CI 10.9-70.7). CONCLUSIONS: Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Dor Pélvica/terapia , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Bélgica/epidemiologia , Estudos de Casos e Controles , Técnica Delfos , Emergências , Serviço Hospitalar de Emergência/normas , Feminino , França/epidemiologia , Ginecologia/normas , Humanos , Near Miss/normas , Dor Pélvica/epidemiologia , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde/normas
14.
WMJ ; 119(3): 202-204, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33091290

RESUMO

BACKGROUND: The COVID-19 pandemic has forced many practices to completely change the interface between health care providers and patients. Patients presenting with facial trauma present a special risk for COVID-19 transmission, as contact with respiratory and ocular secretions is common, and so special precautions must be taken in managing them. METHODS: We created guidelines and a triage/management algorithm for patients presenting with facial trauma to decrease the risk of COVID-19 transmission. CONCLUSIONS: In this paper, we present a set of guidelines and a triage algorithm we have successfully implemented to mitigate the spread of COVID-19 while managing facial trauma. We believe that these guidelines can help other providers restructure their practices during this pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Serviço Hospitalar de Emergência/normas , Traumatismos Faciais/terapia , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Triagem/normas , Algoritmos , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Humanos , Telemedicina , Universidades , Wisconsin/epidemiologia
15.
Emerg Med J ; 37(12): 778-780, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33051275

RESUMO

BACKGROUND: It has been reported that patients attending the emergency department with other pathologies may not have received optimal medical care due to the lockdown measures in the early phase of the COVID-19 pandemic. METHODS: This was a retrospective study of patients presenting with cardiovascular emergencies to four tertiary regional emergency departments in western India during the government implementation of complete lockdown. RESULTS: 25.0% of patients during the lockdown period and 17.4% of patients during the pre-lockdown period presented outside the window period (presentation after 12 hours of symptom onset) compared with only 6% during the pre-COVID period. In the pre-COVID period, 46.9% of patients with ST elevation myocardial infarction underwent emergent catheterisation, while in the pre-lockdown and lockdown periods, these values were 26.1% and 18.8%, respectively. The proportion of patients treated with intravenous thrombolytic therapy increased from 18.4% in the pre-COVID period to 32.3% in the post-lockdown period. Inhospital mortality for acute coronary syndrome (ACS) increased from 2.69% in the pre-COVID period to 7.27% in the post-lockdown period. There was also a significant decline in emergency admissions for non-ACS conditions, such as acute decompensated heart failure and high degree or complete atrioventricular block. CONCLUSION: The COVID-19 pandemic has led to delays in patients seeking care for cardiac problems and also affected the use of optimum therapy in our institutions.


Assuntos
Doenças Cardiovasculares/terapia , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Pandemias/prevenção & controle , Admissão do Paciente/normas , Pneumonia Viral/prevenção & controle , Idoso , Angioplastia/normas , Angioplastia/estatística & dados numéricos , Betacoronavirus/patogenicidade , Doenças Cardiovasculares/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Emergências , Serviço Hospitalar de Emergência/normas , Tratamento de Emergência/normas , Tratamento de Emergência/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Trombectomia/normas , Trombectomia/estatística & dados numéricos
16.
Cir. Esp. (Ed. impr.) ; 98(8): 433-441, oct. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194164

RESUMO

New coronavirus SARS-CoV-2 infection (coronavirus disease 2019 [COVID-19]) has determined the necessity of reorganization in many centers all over the world. Spain, as an epicenter of the disease, has been forced to assume health policy changes in all the territory. However, and from the beginning of the pandemic, every center attending surgical urgencies had to guarantee the continuous coverage adopting correct measures to maintain the excellence of quality of care. This document resumes general guidelines for emergency surgery and trauma care, obtained from the available bibliography and evaluated by a subgroup of professionals designated from the general group of investigators Cirugía-AEC-COVID-19 from the Spanish Association of Surgeons, directed to minimize professional exposure, to contemplate pandemic implications over different urgent perioperative scenarios and to adjust decision making to the occupational pressure caused by COVID-19 patients


La infección por el nuevo coronavirus SARS-COV-2 (enfermedad por coronavirus 2019 [COVID-19]) ha determinado la necesidad de la reorganización de muchos centros hospitalarios en el mundo. España, como uno de los epicentros de la enfermedad, ha debido asumir cambios en la práctica totalidad de su territorio. Sin embargo, y desde el inicio de la pandemia, en todos los centros que atienden urgencias quirúrgicas ha sido necesario el mantenimiento de su cobertura, aunque igualmente ha sido inevitable introducir directrices especiales de ajuste al nuevo escenario que permitan el mantenimiento de la excelencia en la calidad asistencial. Este documento desarrolla una serie de indicaciones generales para la cirugía de urgencias y la atención al politraumatizado desarrolladas desde la literatura disponible y consensuadas por un subgrupo de profesionales desde el grupo general Cirugía-AEC-COVID-19. Estas medidas van encaminadas a contemplar un riguroso control de la exposición en pacientes y profesionales, a tener en cuenta las implicaciones de la pandemia sobre diferentes escenarios perioperatorios relacionados con la urgencia y a una adaptación ajustada a la situación del centro en relación con la atención a pacientes infectados


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Cirurgia Torácica/normas , Sociedades Médicas , Procedimentos Cirúrgicos Operatórios/normas , Serviço Hospitalar de Emergência/normas , Ferimentos e Lesões/cirurgia , Espanha/epidemiologia
17.
Acta Biomed ; 91(3): e2020005, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921703

RESUMO

ackground: During the pandemic of COVID-19, the overwhelm of infected patients created an exponential surge for ICU and ward beds. As a result, a major proportion of elective surgeries was postponed. However, various emergency and urgent procedures were allowed. Due to the mortality complications of hepatopancreatobiliary issues, we decided to afford urgent procedures under intensive protective arrangements. Method and results: In our ward (liver transplant), 4 ICU beds and 16 ward beds were allocated to non-COVID-19 patients. A total of 36 hepatopancreatobiliary procedures were managed for one month. All the surgeries were afforded under personal protective equipment and other intensive protective arrangements for personnel and patients. During 6 weeks following the surgery, all patients were followed up through telemedicine and no new case of COVID-19 was detected. Conclusion: In general, it appears that intensive protections could significantly reduce the number of COVID-19 incidence among patients with co-morbidities who undergo invasive procedures.


Assuntos
Doenças Biliares/cirurgia , Infecções por Coronavirus/complicações , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Serviço Hospitalar de Emergência/normas , Hepatopatias/cirurgia , Pancreatopatias/cirurgia , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/complicações , Betacoronavirus , Doenças Biliares/complicações , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Humanos , Hepatopatias/complicações , Masculino , Pessoa de Meia-Idade , Pancreatopatias/complicações , Pandemias , Pneumonia Viral/epidemiologia
18.
J Healthc Qual ; 42(5): 294-302, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32868517

RESUMO

INTRODUCTION: Emergency department (ED) wait time is an important health system quality indicator. Prolonged consult to decision time (CTDT), the time it takes to reach a disposition decision after receiving a specialty consultation request, can contribute to increased overall length of stay in the ED. OBJECTIVE: To identify delays in the consultation process for general internal medicine (GIM) and trial interventions to reduce CTDT. METHODS: The study was conducted at a large tertiary teaching hospital with GIM inpatient wards at two campuses. Four interventions were trialed over sequential Plan-Do-Study-Act cycles: (1) process mapping, (2) resident education sessions, (3) audit and feedback of CTDT, and (4) adding a swing shift during peak consult volume. MEASUREMENTS: The primary outcome measures were mean CTDT for patients admitted to GIM and the proportion of admitted patients with CTDT of less than 3 hours. RESULTS: Mean CTDT decreased from 4.61 hours before intervention to 4.18 hours after intervention (p < .0001). The proportion of GIM patients with CTDT less than 3 hours increased from 25% to 33% (p < .0001). CONCLUSIONS: The interventions trialed led to a sustained reduction in CTDT over a 12-month period and demonstrated the effectiveness of education in influencing physician performance.


Assuntos
Serviço Hospitalar de Emergência/normas , Medicina Interna/organização & administração , Medicina Interna/estatística & dados numéricos , Admissão do Paciente/normas , Melhoria de Qualidade/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Encaminhamento e Consulta/normas , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Currículo , Educação Médica Continuada , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos
19.
J Stroke Cerebrovasc Dis ; 29(10): 105151, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912531

RESUMO

BACKGROUND: Understanding and improving EMS stroke care requires linking data from both the prehospital and hospital settings. In the US, such data is collected in separate de-identified registries that cannot be directly linked due to lack of a common, unique patient identifier. In the absence of unique patient identifiers two common approaches to linking databases are deterministic matching, which uses combinations of non-unique matching variables to define matches, and probabilistic matching, which generates estimates of match probability based on the degree of similarity between records. This analysis seeks to compare these two approaches for matching EMS and stroke registry data. METHODS: Stroke cases transported by EMS to Michigan hospitals participating in the Michigan Coverdell Acute Stroke Registry were linked to records from Michigan's EMS Information System (MI-EMSIS) between January 2018 and June 2019. Destination hospital, date-of-service, patient age, date-of-birth, and sex were used to perform deterministic and probabilistic linkages. Match rates and representativeness of the matched samples were compared between the two matching strategies. Multivariable logistic regression was used to identify characteristics associated with successful matching. RESULTS: During the 18-month study period there were 8,828 EMS transported confirmed stroke cases in the registry and 620,907 EMS transports to 38 Coverdell registry-participating hospitals. The probabilistic match linked 5985 (67.7%) strokes to EMS records; the deterministic match linked 4012 (45.5%). Within each strategy the characteristics of matched and unmatched cases were similar, with the exception that deterministically matched cases were less likely to be older than 89 (adjusted odds ratio [aOR]=0.3), white (aOR=0.8), and more likely to have subarachnoid hemorrhage (aOR=1.4) than unmatched cases. CONCLUSION: Probabilistic matching resulted in higher match rates and a more representative sample of EMS transported strokes, suggesting it may be superior in assessing EMS stroke care compared to a deterministic approach.


Assuntos
Mineração de Dados/métodos , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Registro Médico Coordenado , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Ambulâncias/normas , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Probabilidade , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento
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