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1.
BMJ Open ; 11(9): e047246, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493511

RESUMO

OBJECTIVES: Many chronic eye conditions are managed within public hospital ophthalmology clinics resulting in encumbered wait lists. Integrated care schemes can increase system capacity. In order to direct implementation of a public hospital-based integrated eye care model, this study aims to evaluate the quality of referrals for new patients through information content, assess triage decisions of newly referred patients and evaluate the consistency of referral content for new patients referred multiple times. DESIGN: A retrospective and prospective review of all referral forms for new patients referred to a public hospital ophthalmology clinic between January 2016 and September 2017, and September 2017 and August 2018, respectively. SETTING: A referral-only public hospital ophthalmology clinic in metropolitan Sydney, Australia. PARTICIPANTS: 418 new patients on existing non-urgent wait lists waiting to be allocated an initial appointment, and 528 patients who were newly referred. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the information content of referrals for new patients. The secondary outcomes were triage outcomes for new incoming referrals, and the number of new patients with multiple referrals. RESULTS: Of the wait-listed referrals, 0.2% were complete in referral content compared with 9.8% of new incoming referrals (p<0.001). Of new incoming referrals, 56.7% were triaged to a non-urgent clinic. Multiple referrals were received for 49 patients, with no change in the amount of referral content. CONCLUSIONS: Most referrals were incomplete in content, leading to triage based on limited clinical information. Some new patients were referred multiple times with their second referral containing a similar amount of content as their first. Lengthy wait lists could be prevented by improving administrative processes and communication between the referral centre and referrers. The future implementation of an integrated eye care model at the study setting could sustainably cut wait lists for patients with chronic eye conditions.


Assuntos
Oftalmologia , Triagem , Humanos , Estudos Prospectivos , Encaminhamento e Consulta , Estudos Retrospectivos , Listas de Espera
2.
Artigo em Inglês | MEDLINE | ID: mdl-34501861

RESUMO

INTRODUCTION: To reduce the risk of nosocomial transmission, suspected COVID-19 patients entering the Emergency Department (ED) were assigned to a high-risk (ED) or low-risk (acute medical unit, AMU) area based on symptoms, travel and contact history. The objective of this study was to evaluate the performance of our pre-triage screening method and to analyse the characteristics of initially undetected COVID-19 patients. METHODS: This was a retrospective, observational, single centre study. Patients ≥ 18 years visiting the AMU-ED between 17 March and 17 April 2020 were included. Primary outcome was the (correct) number of COVID-19 patients assigned to the AMU or ED. RESULTS: In total, 1287 patients visited the AMU-ED: 525 (40.8%) AMU, 762 (59.2%) ED. Within the ED group, 304 (64.3%) of 473 tested patients were COVID-19 positive, compared to 13 (46.4%) of 28 tested patients in the AMU group. Our pre-triage screening accuracy was 63.7%. Of the 13 COVID-19 patients who were initially assigned to the AMU, all patients were ≥65 years of age and the majority presented with gastro-intestinal or non-specific symptoms. CONCLUSION: Older COVID-19 patients presenting with non-specific symptoms were more likely to remain undetected. ED screening protocols should therefore also include non-specific symptoms, particularly in older patients.


Assuntos
COVID-19 , Triagem , Idoso , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos , SARS-CoV-2
3.
Rev Med Chil ; 149(2): 263-267, 2021 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-34479272

RESUMO

This paper deals with the relevance of bioethical guidelines for the prioritization of patient care. These guidelines should guide health professionals' triage procedures in exceptional situations of resource shortage. Also, they would contribute to evaluate the legal liability of professionals in these situations.


Assuntos
Pessoal de Saúde , Pandemias , Atenção à Saúde , Humanos , Responsabilidade Legal , Triagem
4.
Acta Biomed ; 92(4): e2021372, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34487065

RESUMO

The World Health Organization had long warned of the onset of a pandemic that could throw national health systems into a major crisis, even in wealthy developed nations. Nonetheless, almost a year and a half after its appearance, Covid-19 continues to make painful triage choices necessary in granting access intensive care. Based on the opinions of numerous ethics committees and scientific societies, the article aims to illustrate the difference between the utilitarian-collectivist approach and the ethical approach, which inspired the guidelines drawn up in Italy in 2021 by SIAARTI in collaboration with SIMLA. Only medical parameters should be evaluated to establish the prognosis through which to identify the patients to be treated as a priority. Otherwise, the patient's interest is subordinated to that of the community. But moral judgment cannot concern only the choices of doctors. According to the principle of beneficence, hospital directors and national and local health policy managers must also take action, in particular to eliminate waste of economic resources so as to allocate more of them to health protection, especially in consideration of the predictability with which infection rates increase, and in light of the fact that immunization through vaccination is only temporary.


Assuntos
COVID-19 , Atenção à Saúde , Humanos , Pandemias , SARS-CoV-2 , Triagem
5.
Medicina (B Aires) ; 81(4): 508-526, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34453792

RESUMO

Pandemics pose a major challenge for public health preparedness, requiring a coordinated international response and the development of solid containment plans. Early and accurate identification of high-risk patients in the course of the current COVID-19 pandemic is vital for planning and making proper use of available resources. The purpose of this study was to identify the key variables that account for worse outcomes to create a predictive model that could be used effectively for triage. Through literature review, 44 variables that could be linked to an unfavorable course of COVID-19 disease were obtained, including clinical, laboratory, and X-ray variables. These were used for a 2-round modified Delphi processing with 14 experts to select a final list of variables with the greatest predictive power for the construction of a scoring system, leading to the creation of a new scoring system: the COVID-19 Severity Index. The analysis of the area under the curve for the COVID-19 Severity Index was 0.94 to predict the need for ICU admission in the following 24 hours against 0.80 for NEWS-2. Additionally, the digital medical record of the Hospital Italiano de Buenos Aires was electronically set for an automatic calculation and constant update of the COVID-19 Severity Index. Specifically designed for the current COVID-19 pandemic, COVID-19 Severity Index could be used as a reliable tool for strategic planning, organization, and administration of resources by easily identifying hospitalized patients with a greater need of intensive care.


Assuntos
COVID-19 , Escore de Alerta Precoce , Humanos , Pandemias , SARS-CoV-2 , Triagem
6.
Ann R Coll Surg Engl ; 103(8): 576-582, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34464568

RESUMO

OBJECTIVE: The aim of this study was to establish a triaging system for assessment of breast referrals from primary care to ensure safe and effective breast services without compromising breast cancer management. BACKGROUND: COVID-19 was officially declared a global pandemic on 11 March 2020, and with no effective treatment available, preventing spread has been paramount. Previously, all referrals from primary care were seen in the rapid-access breast clinic (RABC). Clinic appointments exposed patients and healthcare professionals to risk. METHOD: Initial triage during the lockdown was in line with national governing body guidance, rejected low risk referrals and streamed remaining patients through a telephone consultation to RABC or discharge. A modified triage pathway streamed all patients through virtual triage to RABC, telephone clinic or discharge with advice and guidance categories. Demographics, reasons for referral and outcomes data were collected and presented as median with range and frequency with percentages. RESULTS: Initial triage (23 March-23 April 2020) found fewer referrals with a higher percentage of breast cancer diagnoses. Modified triage (22 June-17 July 2020) resulted in a 35.1% (99/282) reduction in RABC attendance. Overall cancer detection rate remained similar at 4.2% of all referrals pre-COVID (18/429) and 4.3% (12/282) during modified triage. After six months follow-up of patients not seen in RABC during the modified triage pathway, 18 patients were re-referred to RABC and none were diagnosed with cancer. CONCLUSION: A modified triage pathway has the potential to improve triage efficiency and prevent unnecessary visits during the COVID-19 pandemic. Further refinement of pathway is feasible in collaboration with primary care.


Assuntos
Doenças Mamárias/diagnóstico , COVID-19 , Pandemias , Encaminhamento e Consulta , Triagem/organização & administração , Adulto , Estudos de Coortes , Controle de Doenças Transmissíveis , Feminino , Humanos , Pessoa de Meia-Idade , Atenção Primária à Saúde , Estudos Retrospectivos , Reino Unido/epidemiologia
7.
Scand J Trauma Resusc Emerg Med ; 29(1): 127, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461976

RESUMO

BACKGROUND: Pre-hospital identification of major trauma in elderly patients is key for delivery of optimal care, however triage of this group is challenging. Elderly-specific triage criteria may be valuable. This systematic review aimed to summarise the published pre-hospital elderly-specific trauma triage tools and evaluate their sensitivity and specificity and associated clinical outcomes. METHODS: MEDLINE and EMBASE databases were searched using predetermined criteria (PROSPERO: CRD42019140879). Two authors independently assessed search results, performed data extraction, risk of bias and quality assessments following the Grading of Recommendations, Assessment, Development and Evaluation system. RESULTS: 801 articles were screened and 11 studies met eligibility criteria, including 1,332,300 patients from exclusively USA populations. There were eight unique elderly-specific triage criteria reported. Most studies retrospectively applied criteria to trauma databases, with few reporting real-world application. The Ohio Geriatric Triage Criteria was reported in three studies. Age cut-off ranged from 55 to 70 years with ≥ 65 most frequently reported. All reported existing adult criteria with modified physiological parameters using higher thresholds for systolic blood pressure and Glasgow coma scale, although the values used varied. Three criteria added co-morbidity or anti-coagulant/anti-platelet use considerations. Modifications to anatomical or mechanism of injury factors were used by only one triage criteria. Criteria sensitivity ranged from 44 to 93%, with a median of 86.3%, whilst specificity was generally poor (median 54%). Scant real-world data showed an increase in patients meeting triage criteria, but minimal changes to patient transport destination and mortality. All studies were at risk of bias and assessed of "very low" or "low" quality. CONCLUSIONS: There are several published elderly-specific pre-hospital trauma triage tools in clinical practice, all developed and employed in the USA. Consensus exists for higher thresholds for physiological parameters, however there was variability in age-cut offs, triage criteria content, and tool sensitivity and specificity. Although sensitivity was improved over corresponding 'adult' criteria, specificity remained poor. There is a paucity of published real-world data examining the effect on patient care and clinical outcomes of elderly-specific triage criteria. There is uncertainty over the optimal elderly triage tool and further study is required to better inform practice and improve patient outcomes.


Assuntos
Triagem , Ferimentos e Lesões , Adulto , Idoso , Comorbidade , Escala de Coma de Glasgow , Hospitais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
8.
BMJ Open ; 11(8): e048356, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408048

RESUMO

BACKGROUND: The study aimed to compare the predictive values of the thrombolysis in myocardial infarction (TIMI); History, Electrocardiography, Age, Risk factors and Troponin (HEART) and Global Registry in Acute Coronary Events (GRACE) scoring systems for major adverse cardiovascular events (MACEs) in acute chest pain (ACP) patients admitted to the emergency department (ED). METHODS: We systematically searched PubMed, Embase and the Cochrane Library from their inception to June 2020; we compared the following parameters: sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic OR (DOR) and area under the receiver operating characteristic curves (AUC). RESULTS: The pooled sensitivity and specificity for TIMI, HEART and GRACE were 0.95 and 0.36, 0.96 and 0.50, and 0.78 and 0.56, respectively. The pooled PLR and NLR for TIMI, HEART and GRACE were 1.49 and 0.13, 1.94 and 0.08, and 1.77 and 0.40, respectively. The pooled DOR for TIMI, HEART and GRACE was 9.18, 17.92 and 4.00, respectively. The AUC for TIMI, HEART and GRACE was 0.80, 0.80 and 0.70, respectively. Finally, the results of indirect comparison suggested the superiority of values of TIMI and HEART to those of GRACE for predicting MACEs, while there were no significant differences between TIMI and HEART for predicting MACEs. CONCLUSIONS: TIMI and HEART were superior to GRACE for predicting MACE risk in ACP patients admitted to the ED.


Assuntos
Infarto do Miocárdio , Troponina , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Infarto do Miocárdio/diagnóstico , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Triagem
9.
Community Dent Health ; 38(3): 161-164, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34369114

RESUMO

This paper aims to explore the outcome of a telephone triage system used by different team members to run an Urgent Dental Care Hub (UDCH) during the first wave of the COVID-19 pandemic. It will also look at the adjustments made to the system because of the challenges faced. Data were collected from the telephone triage proforma and clinical notes of patients that were triaged from 2nd April to 10th June 2020. With 65% of telephone triaged and accepted patients receiving definitive treatment that alleviated the presenting complaint, the value of telephone triage is highlighted in streamlining an urgent dental care service during a viral pandemic. Public health competencies being illustrated: Dental public health intelligence, Developing and monitoring quality dental services.


Assuntos
COVID-19 , Pandemias , Assistência Odontológica , Humanos , Saúde Pública , SARS-CoV-2 , Telefone , Triagem
10.
Artigo em Inglês | MEDLINE | ID: mdl-34444029

RESUMO

This study examined the factors associated with triage competency among school nurses in South Korea. Using a convenience sampling method, 386 school nurses employed in elementary, middle, or high schools completed a cross-sectional survey that included a modified version of the Triage Competency Scale for emergency room nurses. Information regarding experience working in schools and hospitals, education level, school types, age, emergency nursing care certifications, school locations, and serious emergency experience at school was collected. Analyses were performed using SPSS version 25.0, independent t-tests, analyses of variance, Spearman's correlation, and ordinal logistic regression. Triage competency was higher for school nurses who were employed in metropolitan regions (odds ratio [OR] = 1.63, p = 0.017) and had serious emergency experience (OR = 1.76, p = 0.008). As the participants' experience at schools or hospitals increased by one year, their triage competency score increased by 2% (OR = 1.02, p = 0.037) and 14% (OR = 1.14, p < 0.001), respectively. These findings could be used to develop policies and educational programs that promote school nurses' triage competency. Further, they suggest the importance of establishing an organizational support system to develop guidelines and a feedback system to improve school nurses' triage competency.


Assuntos
Enfermeiras e Enfermeiros , Triagem , Competência Clínica , Estudos Transversais , Humanos , República da Coreia , Instituições Acadêmicas , Inquéritos e Questionários
11.
Am J Law Med ; 47(2-3): 264-290, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34405783

RESUMO

As the coronavirus pandemic intensified, many communities in the United States experienced shortages of ventilators, intensive care beds, and other medical supplies and treatments. Currently, there is no single national response to provide guidance on allocation of scarce health care resources. Accordingly, states have formulated various "triage protocols" to prioritize those who will receive care and those who may not have the same access to health care services when the population demand exceeds the supply. Triage protocols address general concepts of "fairness" under accepted medical ethics rules and the consensus is that limited medical resources "should be allocated to do the greatest good for the greatest number of people."1 The actual utility of this utilitarian ethics approach is questionable, however, leaving many questions about what is "fair" unanswered. Saving as many people as possible during a health care crisis is a laudable goal but not at the expense of ignoring patients's legal rights, which are not suspended during the crisis. This Article examines the triage protocols from six states to determine whose rights are being recognized and whose rights are being denied, answering the pivotal question: If there is potential for disparate impact of facially neutral state triage protocols against Black Americans and other ethnic groups, is this legally actionable discrimination? This may be a case of first impression for the courts to resolve."[B]lack Americans are 3.5 times more likely to die of COVID-19 than [W]hite Americans … . Latinx people are almost twice as likely to die of the disease, compared with [W]hite people." 2 "Our civil rights laws protect the equal dignity of every human life from ruthless utilitarianism … . HHS is committed to leaving no one behind during an emergency, and this guidance is designed to help health care providers meet that goal." - Roger Severino, Office of Civil Rights Director, U.S. Department of Health and Human Services. 3.


Assuntos
COVID-19/etnologia , Direitos Civis/legislação & jurisprudência , Ética Médica , Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Responsabilidade Legal , Triagem/legislação & jurisprudência , Teoria Ética , Humanos , Escores de Disfunção Orgânica , Racismo , SARS-CoV-2 , Discriminação Social , Estados Unidos/epidemiologia
13.
BMC Health Serv Res ; 21(1): 781, 2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34364370

RESUMO

OBJECTIVE: Oral surgery referrals from NHS dental practices are rising, increasing the pressures on available hospital resources. We assess if an electronic referral system with consultant or peer (general dental practitioner) led triage of patient referrals from general dental practices can effectively divert patients requiring minor oral surgery into specialist led primary care settings at a reduced cost whilst providing care of the same or enhanced quality. One year of no triage (all referrals treated in secondary care) was followed by one-year of consultant led triage, which in turn was followed by year of peer-led triage. METHOD: A health economic evaluation of all patient referrals from 27 UK dental practices for oral surgery procedures. The follow-up is over a three-year period at hospital dental services in two general hospitals, one dental hospital, and a single specialist oral surgeon based in two primary care practices. The evaluation is a comparison of mean outcomes in the hospitals and in specialist primary care dental services between the study periods (i.e. periods with and without the triage system). The main outcomes of interest are mean NHS cost saving per referral (costs to the NHS and costs to broader society), proportion of diverted referrals, case-mix of referrals and patient reports of the quality of dentistry services received at their referral destination. RESULTS: The proportion of referrals diverted to specialist primary care was similar during both periods (45% under consultant-led triage and 43% under GDP-led triage). Statistically significant savings per referral diverted were found (£116.11 under consultant-led triage, £90.25 under GDP-led triage). There were no statistically significant changes in the case-mix of referrals. Cost savings varied according to the coding (and hence tariff) of referred cases by the provider hospitals. Patients reported similarly high levels of satisfaction scores for treatment in specialist primary care and secondary care settings. CONCLUSIONS: Implementation of electronic referral management in primary care, when combined with triage, led to appropriate diversions to specialist primary care. Although cost savings were realised by referral diversion these savings are dependent on the particular tariff allocation (coding) practices of provider hospitals.


Assuntos
Procedimentos Cirúrgicos Bucais , Triagem , Análise Custo-Benefício , Odontólogos , Humanos , Atenção Primária à Saúde , Papel Profissional , Encaminhamento e Consulta
14.
Comput Methods Programs Biomed ; 209: 106357, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34438223

RESUMO

BACKGROUND: With the remarkable increasing in the numbers of patients, the triaging and prioritizing patients into multi-emergency level is required to accommodate all the patients, save more lives, and manage the medical resources effectively. Triaging and prioritizing patients becomes particularly challenging especially for the patients who are far from hospital and use telemedicine system. To this end, the researchers exploiting the useful tool of machine learning to address this challenge. Hence, carrying out an intensive investigation and in-depth study in the field of using machine learning in E-triage and patient priority are essential and required. OBJECTIVES: This research aims to (1) provide a literature review and an in-depth study on the roles of machine learning in the fields of electronic emergency triage (E-triage) and prioritize patients for fast healthcare services in telemedicine applications. (2) highlight the effectiveness of machine learning methods in terms of algorithms, medical input data, output results, and machine learning goals in remote healthcare telemedicine systems. (3) present the relationship between machine learning goals and the electronic triage processes specifically on the: triage levels, medical features for input, outcome results as outputs, and the relevant diseases. (4), the outcomes of our analyses are subjected to organize and propose a cross-over taxonomy between machine learning algorithms and telemedicine structure. (5) present lists of motivations, open research challenges and recommendations for future intelligent work for both academic and industrial sectors in telemedicine and remote healthcare applications. METHODS: An intensive research is carried out by reviewing all articles related to the field of E-triage and remote priority systems that utilise machine learning algorithms and sensors. We have searched all related keywords to investigate the databases of Science Direct, IEEE Xplore, Web of Science, PubMed, and Medline for the articles, which have been published from January 2012 up to date. RESULTS: A new crossover matching between machine learning methods and telemedicine taxonomy is proposed. The crossover-taxonomy is developed in this study to identify the relationship between machine learning algorithm and the equivalent telemedicine categories whereas the machine learning algorithm has been utilized. The impact of utilizing machine learning is composed in proposing the telemedicine architecture based on synchronous (real-time/ online) and asynchronous (store-and-forward / offline) structure. In addition to that, list of machine learning algorithms, list of the performance metrics, list of inputs data and outputs results are presented. Moreover, open research challenges, the benefits of utilizing machine learning and the recommendations for new research opportunities that need to be addressed for the synergistic integration of multidisciplinary works are organized and presented accordingly. DISCUSSION: The state-of-the-art studies on the E-triage and priority systems that utilise machine learning algorithms in telemedicine architecture are discussed. This approach allows the researchers to understand the modernisation of healthcare systems and the efficient use of artificial intelligence and machine learning. In particular, the growing worldwide population and various chronic diseases such as heart chronic diseases, blood pressure and diabetes, require smart health monitoring systems in E-triage and priority systems, in which machine learning algorithms could be greatly beneficial. CONCLUSIONS: Although research directions on E-triage and priority systems that use machine learning algorithms in telemedicine vary, they are equally essential and should be considered. Hence, we provide a comprehensive review to emphasise the advantages of the existing research in multidisciplinary works of artificial intelligence, machine learning and healthcare services.


Assuntos
Telemedicina , Triagem , Inteligência Artificial , Eletrônica , Humanos , Aprendizado de Máquina , Motivação , Tecnologia
15.
Rev Med Suisse ; 17(746): 1367-1369, 2021 Aug 04.
Artigo em Francês | MEDLINE | ID: mdl-34397183

RESUMO

The Swiss rescue system is based on a collaboration of two trades (ambulance and emergency physician). Paramedic provide independent support for most urgent medical situations under the cover of three years of training and a medical delegation. For more complex situations, the prehospital physician retains his place (triage, severe trauma, airway management, respiratory distress, medico-legal emergencies, specialized procedures or exceptional situations). This collaboration is the foundation of the Swiss prehospital system. One does not go without the other.


Assuntos
Serviços Médicos de Emergência , Médicos , Ambulâncias , Emergências , Humanos , Triagem
16.
BMJ Open ; 11(8): e049179, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373308

RESUMO

OBJECTIVE: To evaluate a triage algorithm used to identify and isolate patients with suspected COVID-19 among medical patients needing admission to hospital using simple clinical criteria and the FebriDx assay. DESIGN: Retrospective observational cohort. SETTING: Large acute National Health Service hospital in London, UK. PARTICIPANTS: All medical admissions from the emergency department between 10 August 2020 and 4 November 2020 with a valid SARS-CoV-2 RT-PCR result. INTERVENTIONS: Medical admissions were triaged as likely, possible or unlikely COVID-19 based on clinical criteria. Patients triaged as possible COVID-19 underwent FebriDx lateral flow assay on capillary blood, and those positive for myxovirus resistance protein A (a host response protein) were managed as likely COVID-19. PRIMARY OUTCOME MEASURES: Diagnostic accuracy (sensitivity, specificity and predictive values) of the algorithm and the FebriDx assay using SARS-CoV-2 RT-PCR from nasopharyngeal swabs as the reference standard. RESULTS: 4.0% (136) of 3443 medical admissions had RT-PCR confirmed COVID-19. Prevalence of COVID-19 was 46% (80/175) in those triaged as likely, 4.1% (50/1225) in possible and 0.3% (6/2033) in unlikely COVID-19. Using a SARS-CoV-2 RT-PCR reference standard, clinical triage had sensitivity of 96% (95% CI 91% to 98%) and specificity of 61.5% (95% CI 59.8% to 63.1%), while the triage algorithm including FebriDx had sensitivity of 93% (95% CI 87% to 96%) and specificity of 86.4% (95% CI 85.2% to 87.5%). While 2033 patients were deemed not to require isolation using clinical criteria alone, the addition of FebriDx to clinical triage allowed a further 826 patients to be released from isolation, reducing the need for isolation rooms by 9.5 per day, 95% CI 8.9 to 10.2. Ten patients missed by the algorithm had mild or asymptomatic COVID-19. CONCLUSIONS: A triage algorithm including the FebriDx assay had good sensitivity and was useful to 'rule-out' COVID-19 among medical admissions to hospital.


Assuntos
COVID-19 , Algoritmos , Estudos de Coortes , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos , SARS-CoV-2 , Sensibilidade e Especificidade , Medicina Estatal , Triagem
17.
Lancet Digit Health ; 3(9): e543-e554, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34446265

RESUMO

BACKGROUND: Artificial intelligence (AI) algorithms can be trained to recognise tuberculosis-related abnormalities on chest radiographs. Various AI algorithms are available commercially, yet there is little impartial evidence on how their performance compares with each other and with radiologists. We aimed to evaluate five commercial AI algorithms for triaging tuberculosis using a large dataset that had not previously been used to train any AI algorithms. METHODS: Individuals aged 15 years or older presenting or referred to three tuberculosis screening centres in Dhaka, Bangladesh, between May 15, 2014, and Oct 4, 2016, were recruited consecutively. Every participant was verbally screened for symptoms and received a digital posterior-anterior chest x-ray and an Xpert MTB/RIF (Xpert) test. All chest x-rays were read independently by a group of three registered radiologists and five commercial AI algorithms: CAD4TB (version 7), InferRead DR (version 2), Lunit INSIGHT CXR (version 4.9.0), JF CXR-1 (version 2), and qXR (version 3). We compared the performance of the AI algorithms with each other, with the radiologists, and with the WHO's Target Product Profile (TPP) of triage tests (≥90% sensitivity and ≥70% specificity). We used a new evaluation framework that simultaneously evaluates sensitivity, proportion of Xpert tests avoided, and number needed to test to inform implementers' choice of software and selection of threshold abnormality scores. FINDINGS: Chest x-rays from 23 954 individuals were included in the analysis. All five AI algorithms significantly outperformed the radiologists. The areas under the receiver operating characteristic curve were 90·81% (95% CI 90·33-91·29) for qXR, 90·34% (89·81-90·87) for CAD4TB, 88·61% (88·03-89·20) for Lunit INSIGHT CXR, 84·90% (84·27-85·54) for InferRead DR, and 84·89% (84·26-85·53) for JF CXR-1. Only qXR (74·3% specificity [95% CI 73·3-74·9]) and CAD4TB (72·9% specificity [72·3-73·5]) met the TPP at 90% sensitivity. All five AI algorithms reduced the number of Xpert tests required by 50% while maintaining a sensitivity above 90%. All AI algorithms performed worse among older age groups (>60 years) and people with a history of tuberculosis. INTERPRETATION: AI algorithms can be highly accurate and useful triage tools for tuberculosis detection in high-burden regions, and outperform human readers. FUNDING: Government of Canada.


Assuntos
Algoritmos , Inteligência Artificial , Interpretação de Imagem Radiográfica Assistida por Computador , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Bangladesh/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Radiografia , Radiologistas , Estudos Retrospectivos , Sensibilidade e Especificidade , Triagem , Adulto Jovem
18.
Soc Sci Med ; 285: 114238, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34364159

RESUMO

The question of how to implement medical triages has become highly salient during the COVID-19 pandemic and continues to be actively discussed. It is important to know how members of the general public think about this issue. For one, knowledge about the public's standpoint can help resolve important questions where ethical considerations are by themselves not sufficient, for instance whether the patient's age should matter. It can also help identify if more communication with the public about medical ethics is needed. We study how members of the Swiss public would allocate intensive medical care among COVID-19 patients using data from two original conjoint survey experiments conducted in Switzerland in the context of the first and second pandemic waves in 2020 (N = 1457 & N = 1450). We find that our participants would not base triage decisions on the patient's age. However, they do give much importance to the patient's behavior prior and during illness, discriminate against non-nationals, and assign only a relatively small and inconsistent role to medical considerations. Our findings suggest that there is a need for more communication with the public about the ethics of medical triage.


Assuntos
COVID-19 , Pandemias , Atitude , Humanos , SARS-CoV-2 , Suíça/epidemiologia , Triagem
19.
Adv Emerg Nurs J ; 43(3): 178-185, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34397492

RESUMO

The Research to Practice column is intended to improve the research critique skills of the advanced practice registered nurse and the emergency nurse and to assist with the translation of research into practice. A topic and a research study are selected for each column. A patient scenario is presented as a vehicle, in which to review and critique, the findings of the selected research study. In this column, we review the conclusions of A. Malinovska, L. Pitasch, N. Geigy, C. H. Nickel, and R. Bingisser (2019) from their article, titled "Modification of the Emergency Severity Index Improves Mortality Prediction in Older Patients."


Assuntos
Serviço Hospitalar de Emergência/normas , Mortalidade Hospitalar , Índice de Gravidade de Doença , Triagem/normas , Idoso , Idoso de 80 Anos ou mais , Humanos , Segurança do Paciente , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Tempo para o Tratamento/normas
20.
Washington; OPS; 26 Ago. 2021. 25 p. (OPS/IMS/EIH/COVID-19/21-024).
Não convencional em Espanhol | LILACS | ID: biblio-1284283

RESUMO

Estas directrices de práctica clínica se elaboraron con el objetivo de proveer recomendaciones para el manejo de pacientes con COVID-19 leve y moderada, así como de personas en riesgo de infección por el SARS-COV-2 en América Latina y el Caribe. La población diana está constituida por personas en riesgo de infección por COVID-19, pacientes leves o moderados con sospecha diagnóstica o confirmada de COVID-19 Estas directrices de práctica clínica proveen recomendaciones basadas en la evidencia para la profilaxis de personas en riesgo de infección por el SARS-COV-2; para la identificación de marcadores y factores de riesgo de mortalidad de los pacientes con COVID-19 leve o moderado; el tamizaje de COVID-19; el manejo en el domicilio; el uso de imágenes diagnósticas para orientar el manejo; el tratamiento farmacológico; el uso de suplementos; la anticoagulación profiláctica, y los criterios de seguimiento y alta médica. Las recomendaciones se dirigen a todo el personal de salud que atiende a los pacientes en el servicio de urgencias y en atención primaria (médicos generales, especialistas en medicina de urgencias, en neumología, en medicina interna, en medicina familiar y en infectología, así como terapeutas respiratorios y físicos, personal de enfermería y químicos farmacéuticos, entre otros). Las recomendaciones se dirigen a tomadores de decisiones y miembros de entidades gubernamentales relacionados con el manejo de pacientes con COVID-19


Assuntos
Humanos , COVID-19/diagnóstico , COVID-19/terapia , Índice de Gravidade de Doença , Triagem , Região do Caribe , América Latina
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