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https://www.readbyqxmd.com/read/28538650/consequences-of-pediatric-undertriage-and-overtriage-in-a-statewide-trauma-system
#1
Hilary A Hewes, Mathew Christensen, Peter P Taillac, N Clay Mann, Kammy K Jacobsen, Stephen J Fenton
BACKGROUND: With increasing attention to the quality of health care delivery, evaluating trauma triage decisions in a large system of emergency care can help decision makers reduce mortality, morbidity, unnecessary transfers, and healthcare costs. OBJECTIVES: To quantify the magnitude of pediatric traumatic injury undertriage (hospital mortality risk) and overtriage (early trauma center discharge after transfer) in a statewide trauma system. METHODS: A statewide population-based evaluation of pediatric trauma outcomes and secondary triage (interfacility transfers) patterns from 2001-2013 among 45 hospitals in Utah's statewide trauma system...
May 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28538608/assessing-dehydration-employing-end-tidal-carbon-dioxide-in-children-with-vomiting-and-diarrhea
#2
Stephen B Freedman, David W Johnson, Alberto Nettel-Aguirre, Angelo Mikrogianakis, Sarah Williamson-Urquhart, Nicholas Monfries, Adam Cheng
OBJECTIVE: Serum bicarbonate reflects dehydration severity in children with gastroenteritis. Previous work in children receiving intravenous rehydration has correlated end-tidal carbon dioxide (EtCO2) with serum bicarbonate. We evaluated whether EtCO2 predicts weight change in children with vomiting and/or diarrhea. METHODS: A prospective cohort study was conducted. Eligible children were 3 months to 10 years old and presented for emergency department (ED) care because of vomiting and/or diarrhea...
May 23, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28538607/evaluation-of-highest-level-pediatric-trauma-activation-criteria
#3
Jessica A Zagory, Minna M Wieck, Brooke E Lerner, Suzanne Moody, Richard A Falcone, Rita V Burke
BACKGROUND: Despite the presence of a tiered in-hospital trauma triage system for the past decade, trauma centers still struggle with a definitive list of highest level activation criteria. In 2002, the American College of Surgeons (ACS) mandated 6 criteria for highest level activation. However, it is unknown if pediatric trauma centers follow these criteria. The purpose of this study is to identify and categorize the highest level pediatric trauma criteria used by pediatric trauma centers in the United States...
May 23, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28538139/advanced-musculoskeletal-physiotherapists-are-effective-and-safe-in-managing-patients-with-acute-low-back-pain-presenting-to-emergency-departments
#4
James M Sayer, Rita M Kinsella, Belinda A Cary, Angela T Burge, Lara A Kimmel, Paula Harding
Objective The aim of this study was to compare emergency department (ED) key performance indicators for patients presenting with low back pain and seen by an advanced musculoskeletal physiotherapist (AMP) with those seen by other non-AMP clinicians (ED doctors and nurse practitioners).Methods A retrospective audit (October 2012-September 2013) was performed of data from three metropolitan public hospital EDs to compare patients with low back pain seen by AMP and non-AMP clinicians. Outcome measures included ED length of stay, ED wait time, admission rates and re-presentation to the ED...
May 25, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28537688/prevalence-of-alcohol-and-other-drugs-in-injured-drivers-and-their-association-with-clinical-outcomes
#5
F Cittadini, N De Giovanni, L Caradonna, G Vetrugno, A Oliva, N Fucci, C Zuppi, V L Pascali, M Covino
OBJECTIVE: Driving under the influence of alcohol or drugs is a risk factor for motor vehicle accidents (MVAs). This issue has become an increasing concern for the governments of many European and North American countries, thereby encouraging the adoption of preventive policies. The aim of this study was to investigate the associations between major clinical outcomes and alcohol or drug abuse among drivers involved in MVAs who were referred to an Italian Emergency Department. PATIENTS AND METHODS: The study population consisted of consecutive injured drivers who were admitted to the Emergency Department following an MVA during a period of one year...
May 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28535991/predictors-and-delays-associated-with-the-need-for-advanced-techniques-for-intravenous-access
#6
Michael D Witting, Siamak Moayedi, Latoya A Brown, Ammar Ismail
BACKGROUND: The need for advanced techniques for intravenous access (ATIVA) can lead to delays in care and contribute to emergency department (ED) crowding. OBJECTIVE: In this article, we estimate the delay and predictors associated with the need for ATIVA. METHODS: In this case-control study, we collected data from ED cases requiring ATIVA and control patients in whom i.v. access was gained by traditional inspection and palpation. We included two control groups-a random retrospective sample and a prospective limited convenience sample...
May 20, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28533826/a-novel-triage-tool-optic-nerve-sheath-diameter-in-traumatic-brain-injury-and-its-correlation-to-rotterdam-computed-tomography-ct-scoring
#7
Sudha Kiran Das, Sachin P Shetty, Kamal Kumar Sen
BACKGROUND: Optic nerve sheath diameter (ONSD) evaluated in CT imaging as well as Rotterdam CT Score (RCTS) are proven independent predictors of outcome in patients with traumatic brain injury (TBI). To date, no study has correlated ONSD on admission CT scan with RCTS. MATERIAL/METHODS: Retrospective cohort study comprised of consecutive patients undergoing CT imaging for traumatic brain injury recruited between January and October 2015. Bilateral ONSD was measured 3 mm behind the eyeball in axial and sagittal planes and mean value was calculated...
2017: Polish Journal of Radiology
https://www.readbyqxmd.com/read/28530772/characteristics-of-the-injuries-of-syrian-refugees-sustained-during-the-civil-war
#8
Betül Kocamer Şimşek, Mehmet Dokur, Erdal Uysal, Necdet Çalıker, Oruç Numan Gökçe, İbrahim Kürşat Deniz, Murat Uğur, Murat Geyik, Mehmet Kaya, Güner Dağlı
BACKGROUND: During a war, many civilians are severely injured by firearms, bombs, and shrapnel. The triage of war injuries involves difficult and complicated processes requiring surgical procedures and patient monitoring in the Intensive Care Unit (ICU) of hospitals. In this study, we examine the demographic, traumatic, and critical care characteristics of cases injured during the civil war in Syria and requiring emergency surgery. METHODS: Electronic data of the traumatic, surgical, and ICU monitoring features of 707 patients admitted to Kilis Public Hospital between March 2012 and January 2013 were analyzed retrospectively RESULTS: Most of the patients reported having been injured due to firearms (83...
May 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28530457/-patient-turnover-in-a-multidisciplinary-emergency-department
#9
Csaba Varga, Zsuzsanna Lelovics, Viktor Soós, Tibor Oláh
INTRODUCTION: More than twenty emergency departments were opened across Hungary in the past years. Data deficiency on patient flow, trends and lack of knowledge of indicators could raise numerous logistical and organisational problems. AIM: Collection, analysis and provision of data to facilitate successful operations of emergency medical care services. METHOD: During a three-year period investigated, at the multidisciplinary Emergency Department of "Moritz Kaposi" Teaching Hospital, data on patient flow (n = 106,203), epidemiology, triage and international classification of diseases were analysed...
May 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/28524036/-reliability-and-validity-of-four-level-and-three-district-triage-standards-in-emergency-department-a-randomized-sampling-cross-sectional-study-of-1-106-adult-patients
#10
Aiqun Zhu, Jingping Zhang, Huilin Zhang, Yanhui Zhang
OBJECTIVE: To evaluate the reliability and validity of three-district and four-level triage standards in adult emergency department. METHODS: A randomized sampling cross-sectional study was conducted. A total of 1 106 emergency adult patients admitted to the Second Xiangya Hospital of Central South University in Hunan Province from December 2015 to April 2016 were enrolled. The triage was independently performed by 12 nurses according to the emergency triage criteria...
May 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28515106/direct-comparison-of-2-rule-out-strategies-for-acute-myocardial-infarction-2-h-accelerated-diagnostic-protocol-vs-2-h-algorithm
#11
Karin Wildi, Louise Cullen, Raphael Twerenbold, Jaimi H Greenslade, William Parsonage, Jasper Boeddinghaus, Thomas Nestelberger, Zaid Sabti, Maria Rubini-Giménez, Christian Puelacher, Janosch Cupa, Lukas Schumacher, Patrick Badertscher, Karin Grimm, Nikola Kozhuharov, Claudia Stelzig, Michael Freese, Katharina Rentsch, Jens Lohrmann, Wanda Kloos, Andreas Buser, Tobias Reichlin, John Pickering, Martin Than, Christian Mueller
BACKGROUND: We compared 2 high-sensitivity cardiac troponin (hs-cTn)-based 2-h strategies in patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED): the 2-h accelerated diagnostic protocol (2h-ADP) combining hs-cTn, electrocardiogram, and a risk score, and the 2-h algorithm exclusively based on hs-cTn concentrations and their absolute changes. METHODS: Analyses were performed in 2 independent diagnostic cohorts [European Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) study, Australian-New Zealand 2-h Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker (ADAPT) study] employing hs-cTnT (Elecsys) and hs-cTnI (Architect)...
May 17, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28513890/risk-of-hospitalisation-after-early-revisit-in-the-emergency-department
#12
Giorgio Cozzi, Sergio Ghirardo, Ilaria Fiorese, Ilaria Proietti, Lorenzo Monasta, Marta Minute, Egidio Barbi, Lorenzo Calligaris
AIM: Early-revisits are frequent in the paediatric emergency department (ED) setting, but few data are available about early-revisited patients. The aim of this study was to investigate the hospitalisation rate of a population of early-revisited patients and to detect if an early-revisited patient was at risk of a more severe disease. METHODS: Between June 2014 and January 2015, we conducted a retrospective cohort study, considering all patients presented to the ED of a tertiary level children's hospital in Italy...
May 17, 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/28508236/an-exploratory-analysis-of-the-geographical-distribution-of-trauma-incidents-in-shenzhen-china
#13
Gui Xi Zhang, Joe King Man Fan, Fion Siu Yin Chan, Gilberto Ka Kit Leung, Chung Mao Lo, Yi Min Yu, Hong Zhang, Susan I Brundage, Jan O Jansen
BACKGROUND: The city of Shenzhen, China, is planning to establish a trauma system. At present, there are few data on the geographical distribution of incidents, which is key to deciding on the location of trauma centres. The aim of this study was to perform a geographical analysis in order to inform the development of a trauma system in Shenzhen. METHODS: Retrospective analysis of trauma incidents attended by Shenzhen Emergency Medical Services (EMS) in 2014. Data were obtained from Shenzhen EMS...
May 15, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28507997/recognizing-sudden-cardiac-arrest-may-require-more-than-two-questions-during-telephone-triage-developing-a-complementary-checklist
#14
Amir Mirhaghi, Hojjat Shafaee, Javad Malekzadeh, Farzaneh Hasanzadeh
OBJECTIVE: To develop decision-support tools to identify patients experiencing sudden cardiac arrest (SCA). METHODS: Eighty calls related to SCA were content analyzed, and the contextual patterns that emerged were organized into a checklist. Two researchers independently analyzed the recorded calls and compared their findings. Eighteen dispatchers scored 20 cases (which included SCA and non-SCA cases) both with and without the checklist. Correct responses for each case and agreement among dispatchers have been reported...
April 2017: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/28506470/coronary-ct-angiography-in-the-emergency-department-utilizing-second-and-third-generation-dual-source-ct
#15
Nandini M Meyersohn, Balint Szilveszter, Pedro V Staziaki, Jan-Erik Scholtz, Richard A P Takx, Udo Hoffmann, Brian B Ghoshhajra
BACKGROUND: Coronary computed tomography angiography (coronary CTA) allows efficient triage of low to intermediate risk patients with suspected acute coronary syndrome (ACS) in the emergency department (ED). Techniques for coronary CTA acquisition in the ED continue to evolve with the establishment of standardized scan protocols and the introduction of newer generations of CT hardware. OBJECTIVES: To evaluate qualitative and quantitative image quality and radiation dose exposure of coronary CTA acquired on 2nd versus 3rd generation dual source CT (DSCT) scanners using a standardized institutional scan protocol designed for the ED...
March 22, 2017: Journal of Cardiovascular Computed Tomography
https://www.readbyqxmd.com/read/28506282/under-triage-in-telephone-consultation-is-related-to-non-normative-symptom-description-and-interpersonal-communication-a-mixed-methods-study
#16
Hejdi Gamst-Jensen, Freddy K Lippert, Ingrid Egerod
BACKGROUND: Telephone consultation and triage are used to limit the workload on emergency departments. Lack of visual cues and clinical tests put telephone consultations to a disadvantage compared to face-to-face consultations increasing the risk of under-triage. Under-triage occurs in telephone triage; however why under-triage happens is not explored yet. The aim of the study was to describe situations of under-triage in context, to assess the quality of under-triaged calls, and to identify communication patterns contributing to under-triage in a regional OOH service in the capital region of Denmark...
May 15, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28499354/patient-and-care-characteristics-of-self-referrals-treated-by-the-general-practitioner-cooperative-at-emergency-care-access-points-in-the-netherlands
#17
Martijn Rutten, Fieke Vrielink, Marleen Smits, Paul Giesen
BACKGROUND: In the Netherlands, out-of-hours primary care is provided in general practitioner-cooperatives (GPCs). These are increasingly located on site and in collaboration with emergency departments of hospitals (ED). At such sites, also called emergency-care-access-points (ECAP), the GPC is generally responsible for the triage and treatment of self-referrals who used to attend the ED. To evaluate the effects and safety of this novel organisation, we studied the characteristics and the quality of care given by GPCs to self-referrals at ECAPs...
May 12, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28495830/establishing-recommendations-for-stroke-systems-in-the-thrombectomy-era-the-upstate-new-york-stakeholder-proceedings
#18
Zainab Magdon-Ismail, Curtis Benesch, Jeremy T Cushman, Ian Brissette, Andrew M Southerland, Ethan S Brandler, Cemal B Sozener, Sue Flor, Roseanne Hemmitt, Kathleen Wales, Krystal Parrigan, Steven R Levine
BACKGROUND AND PURPOSE: The American Heart Association/American Stroke Association and Department of Health Stroke Coverdell Program convened a stakeholder meeting in upstate NY to develop recommendations to enhance stroke systems for acute large vessel occlusion. METHODS: Prehospital, hospital, and Department of Health leadership were invited (n=157). Participants provided goals/concerns and developed recommendations for prehospital triage and interfacility transport, rating each using a 3-level impact (A [high], B, and C [low]) and implementation feasibility (1 [high], 2, and 3 [low]) scale...
May 11, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28492918/association-of-a-primary-stroke-center-protocol-for-suspected-stroke-by-large-vessel-occlusion-with-efficiency-of-care-and-patient-outcomes
#19
Ryan A McTaggart, Shadi Yaghi, Shawna M Cutting, Morgan Hemendinger, Grayson L Baird, Richard A Haas, Karen L Furie, Mahesh V Jayaraman
Importance: While prehospital triage to the closest comprehensive stroke center (CSC) may improve the delivery of care for patients with suspected emergent large-vessel occlusion (ELVO), efficient systems of care must also exist for patients with ELVO who first present to a primary stroke center (PSC). Objective: To describe the association of a PSC protocol focused on 3 key steps (early CSC notification based on clinical severity, vessel imaging at the PSC, and cloud-based image sharing) with the efficiency of care and the outcomes of patients with suspected ELVO who first present to a PSC...
May 8, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28489556/modeling-the-length-of-stay-of-respiratory-patients-in-emergency-department-using-coxian-phase-type-distributions-with-covariates
#20
Ting Zhu, Li Luo, Xinli Zhang, Wenwu Shen
Variability and unpredictability are typical features of emergency departments (EDs) where patients randomly arrive with diverse conditions. Patient length of stay (LOS) represents the consumption level of hospital resources, and it is positively skewed and heterogeneous. Both accurate modeling of patient ED LOS and analysis of potential blocking causes are especially useful for patient scheduling and resource management. To tackle the uncertainty of ED LOS, this research introduces two methods: statistical modeling and distribution fitting...
May 5, 2017: IEEE Journal of Biomedical and Health Informatics
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