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1.
Ann R Coll Surg Engl ; 102(1): 18-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31233336

RESUMO

INTRODUCTION: Patient flow is the process by which movement of patients and clinical productivity is achieved. The objectives of this study were to implement and evaluate the NHS Improvement SAFER patient flow bundle, evaluate the impact of the Red2Green initiative, and assess the impact of frailty on patient flow. MATERIALS AND METHODS: All patients admitted to a neurosurgery unit from 1 September to 30 November 2017 were included. Using guidance set out by NHS, data were prospectively collected from daily ward lists and patient notes, including demographics, admission and discharge details, length of stay, anticipated discharge date, red days with reasons and frailty (Rockwood Clinical Frailty Scale). NHS reference costs were used for cost analyses. RESULTS: A total of 420 patients (55% elective) were included, totalling 3909 bed days. All patients received daily senior reviews before midday, and anticipated discharge dates were set at daily multidisciplinary team meetings. Ten per cent of patients were discharged before midday. There were 21% (837) red days, significantly more (76%) for emergency patients (639 vs 198 elective; P < 0.001); 63% red days were attributed to awaiting a bed in a local hospital; 25% (106) patients were classed as frail (50 elective), which was associated with a significantly longer length of stay (17.3 vs 6; P < 0.01), and more red days (615 vs 222; p<0.01). Considering excess bed charges and lost revenue (with penalties), red days cost over £1 million per year. CONCLUSIONS: SAFER has identified areas for improvement in patient flow, with obvious cost implications. It has created a platform for discussion within the referral network and identified a role for a geriatric liaison service.


Assuntos
Departamentos Hospitalares/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso , Ocupação de Leitos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Fragilidade/terapia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Segurança do Paciente , Estudos Prospectivos , Estudos Retrospectivos , Triagem/métodos , Triagem/estatística & dados numéricos
2.
Int J Radiat Biol ; 96(1): 22-34, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30605362

RESUMO

Purpose: In a significant nuclear event, hundreds of thousands of individuals will require rapid triage for absorbed radiation to ensure effective medical treatment and efficient use of medical resources. We are developing a rapid screening method to assess whether an individual received an absorbed dose of ≥2 Gy based on the analysis of a specific panel of blood proteins in a fingerstick blood sample.Materials and methods: We studied a data set of 1051 human blood samples obtained from radiotherapy patients, normal healthy individuals, and several special population groups. We compared the findings in humans with those from irradiation studies in non-human primates (NHPs).Results: We identified a panel of three protein biomarkers, salivary alpha amylase (AMY1), Flt3 ligand (FLT3L), and monocyte chemotactic protein 1 (MCP1), which are upregulated in human patients receiving fractionated doses of total body irradiation (TBI) therapy as a treatment for cancer. These proteins exhibited a similar radiation response in NHPs after single acute or fractionated doses of ionizing radiation.Conclusion: Our work provides confidence in this biomarker panel for biodosimetry triage using fingerstick blood samples and in the use of NHPs as a model for irradiated humans.


Assuntos
Proteínas Sanguíneas/análise , Radiometria/métodos , Triagem/métodos , Adolescente , Adulto , Idoso , Animais , Biomarcadores/sangue , Criança , Feminino , Humanos , Imunoensaio , Macaca mulatta , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Medicine (Baltimore) ; 98(52): e18475, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876731

RESUMO

Rapid response system (RRS) efficacy and national early warning score (NEWS) performances have largely been reported in inpatient settings, with few such reports undertaken in outpatient settings.This study aimed to investigate NEWS validity in predicting poor clinical outcomes among outpatients who had activated the RRS using single-parameter criteria.A single-center retrospective cohort studyFrom April 1, 2014 to November 30, 2017 in an urban 350-bed referral hospital in JapanWe collected patient characteristics such as activation triggers, interventions, arrival times, dispositions, final diagnoses, and patient outcomes. Poor clinical outcomes were defined as unplanned intensive care unit transfers or deaths within 24 hours. Correlations between the NEWS and clinical outcomes at the time of deterioration and disposition were analyzed.Among 31 outpatients, the NEWS value decreased significantly after a medical emergency team intervention (median, 8 vs 4, P < .001). The difference in the NEWS at the time of deterioration and at disposition was significantly less in patients with poor clinical outcomes (median 3 vs 1.5, P = .03). The area under the curve (AUC) for the NEWS high-risk patient group at the time of deterioration for predicting hospital admission was 0.85 (95% confidence interval [CI], 0.67-1.0), while the AUC for the NEWS high-risk patient group at disposition for predicting poor clinical outcomes was 0.83 (95% CI, 0.62-1.0).The difference between the NEWS at the time of deterioration and at disposition might usefully predict admissions and poor clinical outcomes in RRS outpatient settings.


Assuntos
Assistência Ambulatorial/métodos , Equipe de Respostas Rápidas de Hospitais , Triagem/métodos , Idoso , Deterioração Clínica , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
5.
Int. j. cardiovasc. sci. (Impr.) ; 32(5): 438-446, Sept-Oct. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1040107

RESUMO

Distress has a potentiating effect on complications of heart disease. Early identification of distress and psychosocial management could help patients to deal with the disease and improve their quality of life. However, in Brazil, there is no specific instrument for evaluation of distress in cardiac patients. Objectives: To describe the validation process of the Screening Tool for Psychosocial Distress (STOP-D) for the Brazilian population. Methods: Cross-sectional, observational study with a quantitative approach. A total of 144 patients (including outpatients and inpatients) were interviewed at the waiting room of the outpatient cardiology clinic or in cardiology wards. Sociodemographic and clinical data were collected, and distress was assessed using two instruments - the Brazilian version of the STOP-D and the Hospital Anxiety and Depression Scale (HADS). First, we performed an exploratory factor analysis and analysis of the accuracy of the STOP-D score by the receiver operating characteristic (ROC) curvet. Results: The factorability analysis of the correlation matrix did not detect any factor that made the factorial solution unfeasible. The instrument showed a single-factor nature, confirmed by the criterion of eigenvalues, with an 85% accuracy in predicting distress. A cut-off point of 15.5 was chosen for distress using the ROC curve. Conclusions: The Brazilian version of the STOP-D is an adequate instrument for the screening of heart disease patient for distress. It can be easily used by any health professional and would contribute to the promotion of a comprehensive support to cardiac patients


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estresse Psicológico , Doenças Cardiovasculares , Estudos de Validação , Ansiedade , Condições Sociais , Fatores Sexuais , Análise Estatística , Inquéritos e Questionários , Curva ROC , Análise Fatorial , Triagem/métodos , Depressão , Estudo Observacional
6.
Rev Col Bras Cir ; 46(4): e2211, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508734

RESUMO

OBJECTIVE: to evaluate the applicability of the "Timing of Acute Care Surgery" (TACS) color classification system in a tertiary public hospital of a developing country. METHODS: we conducted a longitudinal, retrospective study in a single center, from March to August 2016 and the same period in 2017. We opted for the selection of four surgical specialties with high demand for emergencies, previously trained on the TACS system. For comparisons with the previous classifications, we considered emergencies as reds and oranges and urgencies, as yellow, with an ideal time interval for surgery of one hour and six hours, respectively. RESULTS: non-elective procedures accounted for 61% of the total number of surgeries. The red, orange and yellow classifications were predominant. There was a significant improvement in the time before surgery in the yellow color after the TACS system. Day and night periods influenced the results, with better ones during the night. CONCLUSION: this is the first study to use the TACS system in the daily routine of an operating room. The TACS system improved the time of attendance of surgeries classified as yellow.


Assuntos
Tratamento de Emergência/classificação , Triagem/métodos , Brasil , Cor , Emergências , Tratamento de Emergência/estatística & dados numéricos , Humanos , Estudos Longitudinais , Sistemas de Informação em Salas Cirúrgicas , Salas Cirúrgicas , Estudos Retrospectivos , Especialidades Cirúrgicas/classificação , Especialidades Cirúrgicas/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/classificação , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Centros de Atenção Terciária , Fatores de Tempo
7.
Intern Med ; 58(18): 2627-2632, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31527368

RESUMO

Objective In the management of patients with suspected acute drug poisoning, a screening test using the patient's urine is usually performed. The Triage DOA® and INSTANT-VIEW M-1® kits are two commonly used point-of-care screening kits in Japan. However, the relationship between the results of these screening kits and the blood concentration of the poisoning drug is not clear. In this study, we evaluated which kit is more useful for acute drug poisoning screening based on a comparison of their results with the results of a serum drug analysis. Methods This prospective cross-sectional study investigated all patients with acute drug poisoning admitted to a general hospital in Tokyo, Japan, over a nine-month period. The Triage DOA® and INSTANT-VIEW M-1® screening kits were used, and a qualitative serum analysis was conducted simultaneously in all cases. We compared the kits for use in screening patients with acute drug poisoning and evaluated the utility of the kits. Results For the 117 patients enrolled in this study, the 2 kits showed different sensitivities to benzodiazepines (Triage®, 78.6%; INSTANT-VIEW®, 90.5%). Both kits showed high sensitivity to barbiturates (Triage®, 87.0%; INSTANT-VIEW®, 91.3%) but low sensitivity to tricyclic antidepressants (Triage®, 25.0%; INSTANT-VIEW®, 45.8%). Conclusion Because the sensitivity varies depending on the kind of drug, it is difficult to discuss the superiority of these kits. However, this study compared the results of two types of urinary drug screening kits with the results of qualitative analysis of drugs in serum as a gold standard, providing important reference data.


Assuntos
Programas de Rastreamento/métodos , Kit de Reagentes para Diagnóstico , Transtornos Relacionados ao Uso de Substâncias/sangue , Transtornos Relacionados ao Uso de Substâncias/urina , Triagem/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antidepressivos Tricíclicos/sangue , Antidepressivos Tricíclicos/urina , Barbitúricos/sangue , Barbitúricos/urina , Benzodiazepinas/sangue , Benzodiazepinas/urina , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tóquio , Adulto Jovem
8.
Gynecol Oncol ; 155(1): 58-62, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31402165

RESUMO

OBJECTIVE: To evaluate the impact of an evidence-based triage algorithm to decide between primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT/IDS) for advanced epithelial ovarian cancer (EOC). METHODS: Surgical morbidity and mortality (M/M) after PDS for stage IIIC-IV EOC at Mayo Clinic after implementation of the triage algorithm (contemporary cohort, 2012-July 2016) were compared to that of a historic PDS cohort (2003-2011). RESULTS: Mean age of the 232 women who met inclusion criteria in the contemporary cohort was 63.9 years. We observed a 71% decrease in 90-day mortality from 8.9% to 2.6% (P = 0.002) between the contemporary and historic cohorts. Accordion grade 3+ postoperative complications within 30 days after surgery decreased from 22.3% to 18.3% (P = 0.19). Among those with a grade 3+ complication, 90-day mortality rates decreased from 28.3% in the historic cohort to 2.4% in the contemporary cohort (P < 0.001) suggesting patients were better able to tolerate complex surgery. When compared to the historic PDS cohort, oncologic outcomes were also improved in the contemporary PDS cohort. Complete as well as optimal (residual disease ≤1 cm) cytoreduction rates increased (45.5% vs. 62.5% and 84.5% vs. 95.3%, respectively, P < 0.001), and the proportion of women starting chemotherapy within 42 days of surgery increased (57.4% vs. 69.8%, P = 0.001). Three-year overall survival was 53% in the historic cohort and 66% in the contemporary cohort (P < 0.001). CONCLUSIONS: Use of the Mayo triage algorithm for EOC was associated with reduced 90-day mortality after PDS and improved oncologic outcomes. Surgical risk assessment is a critical aspect of treatment planning in the primary management of EOC and should be incorporated into practice.


Assuntos
Algoritmos , Carcinoma Epitelial do Ovário/tratamento farmacológico , Carcinoma Epitelial do Ovário/cirurgia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Triagem/métodos , Idoso , Carcinoma Epitelial do Ovário/mortalidade , Carcinoma Epitelial do Ovário/patologia , Quimioterapia Adjuvante , Estudos de Coortes , Procedimentos Cirúrgicos de Citorredução , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Estudos Retrospectivos , Análise de Sobrevida
9.
Scand J Trauma Resusc Emerg Med ; 27(1): 71, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382982

RESUMO

BACKGROUND: In France, the pre-hospital field triage of trauma patients is currently based on the Vittel criteria algorithm. This algorithm was originally created in 2002 before the stratification of trauma centers and, at the national level, has not been revised since. This could be responsible for the overtriage of trauma patients in Level I Trauma Centers. The principal aim of this study was to evaluate the correlation between each Vittel field triage criterion and trauma patients' Injury Severity Score. METHODS: Our Level I Trauma Center receives an average of 300 trauma patients per year. Demographic and physiological data, along with the entire trauma patient management process and Vittel field triage criteria, are recorded in a local trauma registry. The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are calculated after a complete assessment of the trauma victim during their in-hospital management. Results were concerned with the presence of an ISS of greater than 15, which defined a major trauma patient; mortality within 30 days; and admission to the intensive care unit. This study is a registry analysis from January 2013 to September 2017. RESULTS: Of the 1373 patients in the registry, 1151 were included in the analysis with a mean age of 43 years (± 19) and a median ISS of 13 (IQR = 5-22), where 887 (77%) were male. Nine of the 24 Vittel criteria were associated with an ISS > 15. In a multivariate analysis, no criterion related to kinetic elements was significantly correlated with an ISS > 15, mortality within 30 days, or admission to intensive care. Three algorithm categories were predictive of a major trauma patient (ISS > 15): physiological variables, pre-hospital resuscitation, and physical injuries, while kinetic elements were not. CONCLUSIONS: Criteria related to physiological variables, pre-hospital resuscitation, and physical injuries are the most relevant to predicting the severity of a trauma patient's condition. A revision of the VCA could potentially have beneficial effects on the over and undertriage phenomena, which constitute ongoing medical and financial concerns.


Assuntos
Algoritmos , Sistema de Registros , Centros de Traumatologia/organização & administração , Triagem/métodos , Ferimentos e Lesões/diagnóstico , Escala Resumida de Ferimentos , Adulto , Feminino , França/epidemiologia , Hospitalização , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Ferimentos e Lesões/epidemiologia
10.
Am Surg ; 85(7): 721-724, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405415

RESUMO

Despite the incorporation of anticoagulant and antiplatelet (ACAP) drugs in our trauma triage criteria, it is unclear whether trauma team activation (TTA) impacts outcomes in geriatric patients on ACAP drugs sustaining falls. We hypothesized that TTA in this cohort was associated with improved outcomes. The hospital electronic database was queried to identify normotensive, awake patients aged ≥65 years on ACAP agent from 2014 to 2018 presenting to the emergency department after falls. The outcome was in-hospital mortality. The association between TTA and mortality was examined using logistic regression analysis and 1:1 propensity score matching analysis. In this study, 4540 patients on ACAP drugs were analyzed, with TTA occurring in 500 (11%). TTA occurred in younger but more severely injured patients with lower Glasgow Coma Score. Logistic regression revealed that TTA was not associated with mortality (odds ratio [95% confidence intervals], 2.04 [0.89-4.25]). The 1:1 propensity score analysis revealed similar mortality for the matched groups (non-TTA, 1.6% vs TTA, 2.2%, P = 0.64). In the elderly patients on ACAP agents, the current triage criteria resulted in the appropriate use of TTA for more severely injured patients. The lack of outcome benefit suggests that ACAP drug use as a criterion for TTA should be re-evaluated.


Assuntos
Acidentes por Quedas/mortalidade , Anticoagulantes/uso terapêutico , Fibrinolíticos/uso terapêutico , Mortalidade Hospitalar , Centros de Traumatologia/estatística & dados numéricos , Triagem/normas , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Melhoria de Qualidade , Estudos Retrospectivos , Triagem/métodos
11.
Am Surg ; 85(7): 764-767, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405425

RESUMO

Patient physiology and crash characteristics are essential components of field triage for motor vehicle crashes. We aimed to identify prehospital information that predicted high injury severity or critical patient condition on hospital arrival. The association of demographics, shock index (SI), Glasgow Coma Scale, and 10 crash characteristics of trauma activations for motor vehicle crashes with injury severity score (ISS) ≥ 16 and a composite of hypotension, need for blood transfusions, or immediate operation was determined using univariate and multivariate analyses. A total of 133 of 498 patients (27%) had ISS ≥ 16; SI ≥ 0.9, Glasgow Coma Scale ≤ 8, speed ≥ 55 mph, seatbelt use, airbag deployment, ambulatory patient, severe vehicle damage, ejection, and extrication were associated with ISS ≥ 16. Only abnormal SI and high speed remained independent predictors for ISS ≥ 16 with Odds Ratio (OR) = 10.76 (95% confidence interval (CI), 1.14-101, P = 0.04) and OR = 10.37 (95% CI, 1.48-72.93, P = 0.02), respectively. SI ≥ 0.9 predicted the composite outcome with OR = 5.92 (95% CI, 2.32-15.08, P < 0.01). Many commonly reported crash characteristics did not predict clinically important outcomes. Improvements in road and vehicle safety may be resulting in lower injury severity despite major crash mechanisms.


Assuntos
Acidentes de Trânsito , Triagem/métodos , Ferimentos e Lesões/diagnóstico , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Hipotensão/diagnóstico , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Razão de Chances , Cintos de Segurança , Choque/diagnóstico , Centros de Traumatologia/estatística & dados numéricos , Adulto Jovem
12.
Am Surg ; 85(7): 772-777, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405427

RESUMO

Trauma in pregnancy is a leading cause of poor fetal and obstetric outcomes. Trauma team activation (TTA) criteria include injury with ≥ 20 weeks gestational age (GA). A retrospective analysis was performed on pregnant patients evaluated at a Level 1 trauma center. Patients were characterized by TTA: full, partial, or non-TTA, and TTA criteria independent of pregnancy. Index trauma and delayed delivery hospitalization outcomes were examined. Bivariate analysis, t test, and logistic regression were used when appropriate. From 2010 to 2015, 216 full, 50 partial, and 50 non-TTAs presented. Independent of pregnancy, 79 per cent of patients did not meet the TTA criteria. Fourteen (4%) had a pregnancy-related complication during index hospitalization (eight fetal and two maternal deaths). Nine of ten deaths occurred in patients meeting TTA independent of pregnancy. Delivery complications were greater in the index (52%, 13/25) versus subsequent (5%, 17/155) hospitalizations and were predicted by the respiratory rate (P = 0.016) and injury severity score (P < 0.001). Poor delayed delivery outcomes were associated with earlier GA (P < 0.002) and longer index hospitalization (P < 0.024). Odds of complication are higher in patients meeting the physiologic and anatomic criteria criteria for TTA versus GA criteria alone, signifying overtriage. Trauma activation protocols should be adapted based on the physiologic and anatomic criteria criteria in pregnant patients.


Assuntos
Complicações na Gravidez/etiologia , Centros de Traumatologia/estatística & dados numéricos , Triagem/métodos , Ferimentos e Lesões , Adulto , Feminino , Idade Gestacional , Hospitalização/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Gravidez , Estudos Retrospectivos , Ferimentos e Lesões/classificação , Adulto Jovem
13.
Am J Disaster Med ; 14(1): 9-15, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441024

RESUMO

OBJECTIVE: Improve documentation during a mass casualty incident (MCI). DESIGN: This is a retrospective chart review. SETTING: This chart review was done in the Major Incident Hospital (MIH). The MIH is a highly prepared back-up hospital in the center of the Netherland that can be deployed in case of a major incident. PATIENTS, PARTICIPANTS: Until recently, the MIH used an extensive paper medical record: the hospital in special circumstances medical record (HSCMR). A concise primary survey form was developed and attached to the HSCMR, forming the pilot disaster medical record (pDMR). In this retrospective chart review, primary survey data documented in the HSCMR (during a MCI) were compared to the pDMR (during a drill exercise). Three triage categories were used: T1, immediate; T2, urgent; and T3, delayed. MAIN OUTCOME: The MIH hypothesized that a dedicated, concise, and practical primary survey form could improve quantitative patient documentation during an MCI. Significant differences were tested with the chi square and Fisher exact test (p < 0.05). RESULTS: The pDMR was used significantly more often 61 percent vs 89 percent (p = 0.001), especially in T1 and T2 patients. Quantitative documentation in the pDMR improved significantly on airway, breathing, breathing frequency, saturation, circulation, heart rate, blood pressure, Glasgow Coma Score, exposure, and medication given but not in cervical spine and temperature. CONCLUSION: Significantly more primary survey forms were used and more data were documented using the pDMR, especially in the most critical patients. An MCI medical record should be simple and concise and should not deviate from daily routine.


Assuntos
Planejamento em Desastres , Incidentes com Feridos em Massa , Registros Médicos/normas , Triagem/métodos , Humanos , Estudos Retrospectivos
14.
Medicine (Baltimore) ; 98(34): e16962, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441900

RESUMO

The emergency department (ED) serves as the first point of hospital contact for most septic patients. Early mortality risk stratification using a quick and accurate triage tool would have great value in guiding management. The mortality in emergency department sepsis (MEDS) score was developed to risk stratify patients presenting to the ED with suspected sepsis, and its performance in the literature has been promising. We report in this study the first utilization of the MEDS score in a Singaporean cohort.In this retrospective observational cohort study, adult patients presenting to the ED with suspected sepsis and fulfilling systemic inflammatory response syndrome (SIRS) criteria were recruited. Primary outcome was 30-day in-hospital mortality (IHM) and secondary outcome was 72-hour mortality. MEDS, acute physiology and chronic health evaluation II (APACHE II), and sequential organ failure assessment (SOFA) scores were compared for prediction of primary and secondary outcomes. Receiver operating characteristic (ROC) analysis was conducted to compare predictive performance.Of the 249 patients included in the study, 46 patients (18.5%) met 30-day IHM. MEDS score achieved an area under the ROC curve (AUC) of 0.87 (95% confidence interval [CI], 0.82-0.93), outperforming the APACHE II score (0.77, 95% CI 0.69-0.85) and SOFA score (0.78, 95% CI 0.71-0.85). On secondary analysis, MEDS score was superior to both APACHE II and SOFA scores in predicting 72-hour mortality, with AUC of 0.88 (95% CI 0.82-0.95), 0.81 (95% CI 0.72-0.89), and 0.79 (95% CI 0.71-0.87), respectively. In predicting 30-day IHM, MEDS score ≥12, APACHE II score ≥23, and SOFA score ≥5 performed at sensitivities of 76.1%, 67.4%, and 76.1%, and specificities of 83.3%, 73.9%, and 65.0%, respectively.The MEDS score performed well in its ability for mortality risk stratification in a Singaporean ED cohort.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Sepse/mortalidade , Triagem/métodos , Área Sob a Curva , Mortalidade Hospitalar , Humanos , Medição de Risco , Índice de Gravidade de Doença , Singapura/epidemiologia
15.
BMC Health Serv Res ; 19(1): 531, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362748

RESUMO

BACKGROUND: In France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre. The quality of a systematic physician-led triage has not been determined in France and may affect the efficiency of the OOH-HV process. The objectives of this study were first, to evaluate the quality of reporting in the electronic patient's file after such triage and second, to analyse the factors associated with altered reporting. METHODS: Cross-sectional study in a French urban emergency call centre (district of Paris area) from January to December 2015. For a random selection of 30 days, data were collected from electronic medical files that ended with an OOH-HV decision. Missing key quality criteria (medical interrogation, diagnostic hypothesis or ruled-out severity criteria) were analysed by univariate then multivariate logistic regression, adjusted on patient, temporal and organizational data. RESULTS: Among 10,284 OOH-HVs performed in 2015, 748 medical files were selected. Reasons for the encounter were digestive tract symptoms (22%), fever (19%), ear nose and throat symptoms, and cardiovascular and respiratory problems (6% each). Medical interrogation was not reported in 2% of files (n = 16/748) and a diagnostic hypothesis in 58% (n = 432/748); ruled-out severity criteria were not reported in 60% (n = 449/748). On multivariate analysis, altered reporting was related to the work overload of triage assistants (number of incoming calls, call duration, telephone occupation rate; p < 0.03). CONCLUSION: In the electronic files of patients requiring an OOH-HV by a GP in a French urban area, quality in medical reporting appeared to depend on organizational factors only, especially the triage assistants-related work factors. Corrective measures are needed to ensure good quality of triage and care.


Assuntos
Call Centers , Documentação/estatística & dados numéricos , Clínicos Gerais , Telefone , Triagem/métodos , Adolescente , Adulto , Plantão Médico , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , França , Visita Domiciliar , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Crit Care Clin ; 35(4): 575-589, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31445606

RESUMO

This review provides an overview of triaging critically ill or injured patients during mass casualty incidents due to events such as disasters, pandemics, or terrorist incidents. Questions clinicians commonly have, including "what is triage?," "when to triage?," "what are the types of disaster triage?," "how to triage?," "what are the ethics of triage?," "how to govern triage?," and "what research is required on triage?," are addressed.


Assuntos
Planejamento em Desastres , Triagem , Planejamento em Desastres/métodos , Planejamento em Desastres/organização & administração , Desastres , Humanos , Incidentes com Feridos em Massa , Triagem/métodos , Triagem/organização & administração
17.
Prehosp Disaster Med ; 34(4): 401-406, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389327

RESUMO

INTRODUCTION: The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control. METHODS: School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm. RESULTS: Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n = 104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD = 10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE. CONCLUSIONS: After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population's baseline knowledge of medical care, among others.


Assuntos
Simulação por Computador , Emergências , Socorristas , Hemorragia/prevenção & controle , Instituições Acadêmicas/organização & administração , Triagem/métodos , Adulto , Algoritmos , Criança , Feminino , Hemorragia/terapia , Humanos , Masculino , Incidentes com Feridos em Massa , Pessoa de Meia-Idade , Competência Profissional , Estudos Prospectivos , Estudantes/estatística & dados numéricos , Torniquetes
18.
Rev Col Bras Cir ; 46(3): e20192163, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389523

RESUMO

OBJECTIVE: to describe the teaching strategy based on the Multiple Victims Incident (MVI) simulation, discussing and evaluating the performance of the students involved in the initial care of trauma victims. METHODS: a cross-sectional, and quantitative study was performed. A realistic MVI simulation involving students, and professionals from nursery and medical schools, as well as a prehospital care team was performed. RESULTS: it was possible to notice that the classification according to the START method (Simple Triage and Rapid Treatment) was correct in 94.1% of the time from the analysis of 17 preestablished checklists. Following the primary evaluation with the ABCDE mnemonic, all steps were performed correctly in 70%. However, there was only supply of oxygen in high flow in 64.7% of the examination. The search for visible and hidden bleeding was performed in 70.6% of the examination. The neurological evaluation with the Glasgow coma scale and pupillary evaluation occurred in 70.6% of the victims. The victims exposure was performed in 70.6% of the examination. CONCLUSION: a simulated environment allows the consolidation and improvement of professional skills, especially when we are talking about a poorly trained area during the undergraduate program, such as the MVI. Early training and teamwork encourage clinical thinking, integration and communication, essential abilities when facing chaotic situations.


Assuntos
Competência Clínica , Serviços Médicos de Emergência/métodos , Simulação de Paciente , Treinamento por Simulação/métodos , Triagem/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Estudantes de Medicina , Estudantes de Enfermagem , Universidades
19.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 257-260, ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182767

RESUMO

Objetivos: Analizar las características de las teleconsultas y triajes telefónicos pediátricos atendidos por CatSalut Respon y describir su impacto sobre la actitud y la decisión final de los padres-usuarios de acudir o no a urgencias. Método: Estudio observacional transversal. Durante la teleconsulta los pacientes se clasificaron según los niveles del sistema español de triaje. Aquellos que fueron derivados a urgencias se volvieron a clasificar en el hospital, y se compararon los niveles de triaje. Posteriormente, se realizó una llamada de verificación. Se recogieron variables sociodemográficas y clínicas. Resultados: Se analizaron 370 teleconsultas, fundamentalmente no urgentes (n = 300; 81%). Un 20,3% (n = 75) fueron derivadas a urgencias. La fiebre (p = 0,002) y las dudas de medicación (p < 0,001) fueron motivos significativos de teleconsulta no urgente. Casi un 46% de los casos con niveles de gravedad altos en el triaje de la llamada también fueron clasificados con niveles de gravedad altos en el triaje posterior realizado en el servicio de urgencias hospitalario, mostrando una concordancia moderada. Más del 50% de los padres tenían intención de acudir a urgencias antes de la teleconsulta y un 46% cambiaron de actitud tras realizar esta llamada. Conclusiones: Fiebre y dudas de medicación fueron motivos estadísticamente significativos de teleconsulta no urgente. La consulta telefónica produjo un cambio de actitud en casi la mitad de los padres


Objectives: To analyze the characteristics of remote telephone consultations (televisits) and triage of pediatric emergencies attended by the 24-hour emergency service of Catalonia (CatSalut Respon), and to describe the impact of televisits on callers' decisions about whether or not to come to the emergency department and their opinion of the call service. Methods: Observational cross-sectional study. During the call, cases were classified according the Spanish and Andorran triage system. Patients who were sent to the hospital underwent triage again, and the 2 assigned triage levels were compared. The families were later called to check data and ask their opinion of the service. Sociodemographic and clinical data related to the cases were recorded. Results: A total of 370 televisits were made. Most cases (300, 81%) were not emergencies. Seventy-five callers (20.3%) were advised to go to an emergency department. Fever (P = .002) and questions about medication (P < .001) were the problems significantly associated with nonurgent cases. Nearly 46% of the cases classified as serious during telephone triage were also considered serious when the child was brought to the emergency department. The rate of agreement between the 2 triage levels was moderate. Over half the parents stated they had intended to go to the hospital before calling the service; 46% changed their mind based on the call. Conclusions: Fever and questions about medication were significantly associated with televisits for nonurgent cases. Nearly half the parents changed their mind about going to the emergency department after a televisit


Assuntos
Humanos , Criança , Adolescente , Triagem/métodos , Consulta Remota/instrumentação , Medicina de Emergência Pediátrica/métodos , Triagem/estatística & dados numéricos , Consulta Remota/métodos , Consulta Remota/estatística & dados numéricos , Medicina de Emergência Pediátrica/estatística & dados numéricos , Febre/epidemiologia , Estudos Transversais , Consulta Remota/classificação
20.
Prehosp Disaster Med ; 34(4): 363-369, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31340871

RESUMO

INTRODUCTION: Triaging plays an important role in providing suitable care to a large number of casualties in a disaster setting. A Pediatric Physiological and Anatomical Triage Score (PPATS) was developed as a new secondary triage method. This study aimed to validate the accuracy of the PPATS in identifying injured pediatric patients who are admitted at a high frequency and require immediate treatment in a disaster setting. The PPATS method was also compared with the current triage methods, such as the Triage Revised Trauma Score (TRTS). METHODS: A retrospective review of pediatric patients aged ≤15 years, registered in the Japan Trauma Data Bank (JTDB) from 2012 through 2016, was conducted and PPATS was performed. The PPATS method graded patients from zero to 22, and was calculated based on vital signs, anatomical abnormalities, and the need for life-saving interventions. It categorized patients based on their priority, and the intensive care unit (ICU)-indicated patients were assigned a PPATS ≥six. The accuracy of PPATS and TRTS in predicting the outcome of ICU-indicated patients was compared. RESULTS: Of 2,005 pediatric patients, 1,002 (50%) were admitted to the ICU. The median age of the patients was nine years (interquartile range [IQR]: 6-13 years). The sensitivity and specificity of PPATS were 78.6% and 43.7%, respectively. The area under the receiver-operating characteristic (ROC) curve (AUC) was larger for PPATS (0.61; 95% confidence interval [CI], 0.59-0.63) than for TRTS (0.57; 95% CI, 0.56-0.59; P <.01). Regression analysis showed a significant correlation between PPATS and the Injury Severity Score (ISS; r2 = 0.353; P <.001), predicted survival rate (r2 = 0.396; P <.001), and duration of hospital stay (r2 = 0.252; P <.001). CONCLUSION: The accuracy of PPATS for injured pediatric patients was superior to that of current secondary triage methods. The PPATS method is useful not only for identifying high-priority patients, but also for determining the priority ranking for medical treatments and evacuation.


Assuntos
Serviços Médicos de Emergência/organização & administração , Sistema de Registros , Triagem/métodos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade , Adolescente , Criança , Seguimentos , Escala de Coma de Glasgow , Hospitalização/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Japão , Tempo de Internação , Masculino , Curva ROC , Estudos Retrospectivos , Análise de Sobrevida , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/terapia
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