| 1. |
- Yanagizawa-Drott, Lisa, et al.
(författare)
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Infection prevention practices in Swedish emergency departments : results from a cross-sectional survey
- 2015
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Ingår i: European journal of emergency medicine. - : Lippincott Williams & Wilkins. - 0969-9546 .- 1473-5695. ; 22:5, s. 338-42
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Healthcare-associated infections (HAIs) are a leading cause of preventable morbidity and mortality. Emergency departments (EDs) are a potential source of HAIs as they are the site for large volumes of patients in tight quarters and often focus on immediate life threats over prevention. We aimed to estimate the extent to which Swedish EDs have adopted evidence-based measures to prevent HAIs. The second aim was to identify predictors of high hand hygiene compliance.MATERIALS AND METHODS: We developed a survey on the basis of an instrument used in a US survey in 2011. We modified the survey to reflect Swedish ED practice, and emailed it to ED directors between February and April 2012. We calculated proportions, odds ratios, and 95% confidence intervals, and used logistic regression to adjust for independent variables.RESULTS: We received responses from 59 of Sweden's 72 EDs (82%). Thirty-nine percent of EDs participate in a project to improve hand hygiene compliance. Staff hand hygiene compliance rates were audited at least monthly in 45% of EDs. Forty-three percent reported a compliance rate of 80% or more. The only independent predictor of greater than 80% hand hygiene compliance was auditing compliance frequently - at least monthly (odds ratio 6.3, 95% confidence interval 1.7-24, P=0.01). A majority of Swedish EDs (58%) have a written policy for the appropriate use of urinary catheters. Twenty-one percent participate in a project to reduce catheter-associated urinary tract infections.CONCLUSION: A minority of Swedish EDs are participating in projects to address hand hygiene and catheter-associated urinary tract infection. Frequent auditing of hand hygiene compliance may improve compliance rates.
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| 2. |
- Aspelund, Amalia Liljequist, et al.
(författare)
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Evaluating trauma scoring systems for patients presenting with gunshot injuries to a district-level urban public hospital in Cape Town, South Africa
- 2019
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Ingår i: African journal of emergency medicine. - : Elsevier. - 2211-419X .- 2211-4203. ; 9:4, s. 193-196
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Trauma scoring systems are widely used in emergency settings to guide clinical decisions and to predict mortality. It remains unclear which system is most suitable to use for patients with gunshot injuries at district-level hospitals. This study compares the Triage Early Warning Score (TEWS), Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), Kampala Trauma Score (KTS) and Revised Trauma Score (RTS) as predictors of mortality among patients with gunshot injuries at a district-level urban public hospital in Cape Town, South Africa.Methods: Gunshot-related patients admitted to the resuscitation area of Khayelitsha Hospital between 1 January 2016 and 31 December 2017 were retrospectively analysed. Receiver Operating Characteristic (ROC) analysis were used to determine the accuracy of each score to predict all-cause in-hospital mortality. The odds ratio (with 95% confidence intervals) was used as a measure of association.Results: In total, 331 patients were included in analysing the different scores (abstracted from database n = 431, excluded: missing files n = 16, non gunshot injury n = 10, <14 years n = 1, information incomplete to calculate scores n = 73). The mortality rate was 6% (n = 20). The TRISS and KTS had the highest area under the ROC curve (AUC), 0.90 (95% CI 0.83-0.96) and 0.86 (95% CI 0.79-0.94), respectively. The KTS had the highest sensitivity (90%, 95% CI 68-99%), while the TEWS and RTS had the highest specificity (91%, 95% CI 87-94% each).Conclusions: None of the different scoring systems performed better in predicting mortality in this high-trauma burden area. The results are limited by the low number of recorded deaths and further studies are needed.
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| 3. |
- Bohm, Katarina, et al.
(författare)
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Descriptions and presentations of sepsis : A qualitative content analysis of emergency calls
- 2015
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Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 23:4, s. 294-298
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sepsis is a serious condition which requires early treatment. We often fail to recognize sepsis patients in the chain of prehospital care. Knowledge of how sepsis is expressed in calls to the emergency medical communication centre (EMCC) is limited. An increased understanding could lead to earlier identification of patients with sepsis.OBJECTIVE: The aim of this study was to describe the descriptions of sepsis used during communication between the caller and the emergency medical dispatcher (EMD).METHODS: To achieve the aim of the study, an inductive approach of qualitative content analysis was used. In total, 29 consecutive patients, who arrived at the emergency department by ambulance and received a diagnosis of sepsis according to the International Classification of Diseases (ICD)-10, were included in the study. For each case, the corresponding emergency call recording from the EMCC was transcribed verbatim. Main categories and subcategories from the text were abstracted.RESULTS: From fifteen subcategories, three main categories were abstracted: "Deterioration", "Physical signs and symptoms" and "Difficulties establishing satisfactory contact with the patient." The way laymen and professionals expressed themselves seemed to differ.CONCLUSIONS: Sepsis was described in terms of the physical symptoms, changes of condition and communication abilities of the patient. This knowledge could lead to the identification of keywords which could be incorporated in the decision tool used by the EMD to increase sepsis identification, but further research is required.
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| 4. |
- Bohm, K., et al.
(författare)
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The accuracy of medical dispatch : a systematic review
- 2018
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 26:1
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: It is a challenge to dispatch Emergency medical Services (EMS) appropriately with limited resources and maintaining patient safety; this requires accurate dispatching systems. The objective of the current systematic review was to examine the evidence, according to GRADE, for medical dispatching systems to accurately dispatch EMS according to level of acuity and in recognition of specific conditions.A systematic search was performed trough PubMed, Web of Science, Embase (free text in all fields), Centre for Reviews and Dissemination (CRD), and Cochrane Central Register of Controlled Trials up to 16th of May, 2017. A combination of keywords and Medical Subject Heading (MeSH) terms relevant to "emergency medical dispatch criteria" were used, to search for articles published between 2012 and 2017. Publications were included according to the inclusion/exclusion criteria using the Systematic Reviews and Meta-Analyses (PRISMA) protocol. Level of evidence was evaluated in accordance with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Articles included were those that provided evidence for at least one of the measures of dispatch system accuracy; i.e. sensitivity, specificity, positive and negative predictive and/or over- and under-triage. The search identified 1445 articles. After the removal of duplicates, 382 titles were reviewed for relevance and an additional 359 articles were excluded based on manuscript title and abstract. An additional five articles were excluded after review of the full text versions of the remaining articles. The current review included 18 publications which all were based on primary research.CONCLUSIONS: The 18 articles addressed the identification of cardiac arrest, stroke, medical priority and major trauma using different dispatching systems. The results of the current review show that there is a very low to low overall level of evidence for the accuracy of medical dispatching systems. We suggest that it is necessary to create a consensus on common standards for reporting before consensus can be reached for the level of accuracy in medical dispatching systems.
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| 5. |
- Bowden, John A., et al.
(författare)
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Harmonizing lipidomics : NIST interlaboratory comparison exercise for lipidomics using SRM 1950-Metabolites in Frozen Human Plasma
- 2017
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Ingår i: Journal of Lipid Research. - 0022-2275 .- 1539-7262. ; 58:12, s. 2275-2288
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Tidskriftsartikel (refereegranskat)abstract
- As the lipidomics field continues to advance, self-evaluation within the community is critical. Here, we performed an interlaboratory comparison exercise for lipidomics using Standard Reference Material (SRM) 1950-Metabolites in Frozen Human Plasma, a commercially available reference material. The interlaboratory study comprised 31 diverse laboratories, with each laboratory using a different lipidomics workflow. A total of 1,527 unique lipids were measured across all laboratories and consensus location estimates and associated uncertainties were determined for 339 of these lipids measured at the sum composition level by five or more participating laboratories. These evaluated lipids detected in SRM 1950 serve as community-wide benchmarks for intra-and interlaboratory quality control and method validation. These analyses were performed using nonstandardized laboratory-independent workflows. The consensus locations were also compared with a previous examination of SRM 1950 by the LIPID MAPS consortium.jlr While the central theme of the interlaboratory study was to provide values to help harmonize lipids, lipid mediators, and precursor measurements across the community, it was also initiated to stimulate a discussion regarding areas in need of improvement.
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| 6. |
- Brink, Magnus, et al.
(författare)
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New definition of and diagnostic criteria for sepsis - : Swedish use of Sepsis-3
- 2018
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- A working group representing the Swedish Society for Infectious Diseases, the Swedish Society for Anaesthesiology and Intensive Care, the Swedish Society for Emergency Medicine, and the Swedish Intensive Care Registry have reached consensus on how to adopt the new sepsis definition, Sepsis-3, in Sweden. The recommendation is to implement the new definitions and diagnostic criteria for sepsis and septic shock, but not the use of the new screening tool for sepsis, quick-SOFA, as it needs prospective validation and since it is not clear if quick-SOFA is more useful than the currently used general triage and early warning score systems. The group recommends the use of the sfollowing ICD-10 codes: R65.1 for sepsis and R57.2 for septic shock.
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| 7. |
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| 8. |
- Castrén, Maaret, et al.
(författare)
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Non-specific complaints in the ambulance; predisposing structural factors
- 2015
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Ingår i: BMC Emergency Medicine. - : BioMed Central. - 1471-227X .- 1471-227X. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The pre-hospital assessment non-specific complaint (NSC) often applies to patients whose diagnosis does not match any other specific assessment correlating to particular symptoms or diseases, though some previous studies have found them to be related to serious underlying conditions. The aim was to identify whether the structural factors such as urgency according to the dispatch priority of the Emergency Medical Communication Centre (EMCC) or work load in the Emergency Medical Services (EMS) are predisposing factors for the assessment of NSC instead of a specific assessment.METHODS: All patients with assessed condition NSCs by the EMS to Södersjukhuset during 2011 (n = 493) were compared with gender- and age-matched controls (n = 493), which were randomly drawn from all patients with specific conditions in the EMS, regarding day of week, time of day and priority set by EMCC with chi-squared tests and multivariate logistic regression models.RESULTS: Among patients with NSCs, more were females (58 %) and the median age was 82. Almost all patients were categorized with NSCs during the daytime (8 a.m. to 9 p.m.), i.e. 450 (91 %) as compared to 373 (75 %) of those with specific conditions (p < 0.01). The risk of having an EMS dispatched as low priority by the EMCC was almost doubled among patients with NSCs compared to controls (OR 1.97, 95 % CI 1.38-2.79).CONCLUSIONS: Since patients with NSCs appear most frequently during the hours with most transportations for the EMS, i.e. 10 a.m. to 2 p.m., and the risk of having the assessment NSC was doubled if the EMCC dispatched EMS as low priority, structural factors might be predisposing factors for the assessment.
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| 9. |
- Celik, Daniel H., et al.
(författare)
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Triage Performance of School Personnel Using the SALT System
- 2019
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:4, s. 401-406
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 10. |
- Cone, David C, et al.
(författare)
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Pilot Test of the SALT Mass Casualty Triage System
- 2019
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Ingår i: Prehospital Emergency Care. - : Taylor & Francis. - 1090-3127 .- 1545-0066. ; 13:4, s. 536-40
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: No existing mass casualty triage system has been scientifically scrutinized or validated. A recent work group sponsored by the Centers for Disease Control and Prevention, using a combination of expert opinion and the extremely limited research data available, created the SALT (sort-assess-lifesaving interventions-treat/transport) triage system to serve as a national model. An airport crash drill was used to pilot test the SALT system.OBJECTIVE: To assess the accuracy and speed with which trained paramedics can triage victims using this new system.METHODS: Investigators created 50 patient scenarios with a wide range of injuries and severities, and two additional uninjured victims were added at the time of the drill. Students wearing moulage and coached on how to portray their injuries served as "victims." Assuming proper application of the SALT system, the patient scenarios were designed such that 16 patients would be triaged as T1/red/immediate, 12 as T2/yellow/delayed, 14 as T3/green/minimal, and 10 as T4/black/dead. Paramedics were trained to proficiency in the SALT system one week prior to the drill using a 90-minute didactic/practical session, and were given "flash cards" showing the triage algorithm to be used if needed during the drill. Observers blinded to the study purpose timed and recorded the triage process for each patient during the drill. Simple descriptive statistics were used to analyze the data.RESULTS: The two paramedics assigned to the role of triage officers applied the SALT algorithm correctly to 41 of the 52 patients (78.8% accuracy). Seven patients intended to be T2 were triaged as T1, and two patients intended to be T3 were triaged as T2, for an overtriage rate of 13.5%. Two patients intended to be T2 were triaged as T3, for an undertriage rate of 3.8%. Triage times were recorded by the observers for 42 of the 52 patients, with a mean of 15 seconds per patient (range 5-57 seconds).CONCLUSIONS: The SALT mass casualty triage system can be applied quickly in the field and appears to be safe, as measured by a low undertriage rate. There was, however, significant overtriage. Further refinement is needed, and effect on patient outcomes needs to be evaluated.
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