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- Iversen, Anne Kristine Servais, et al.
(författare)
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A simple clinical assessment is superior to systematic triage in prediction of mortality in the emergency department
- 2019
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Ingår i: Emergency Medicine Journal. - : BMJ. - 1472-0213 .- 1472-0205. ; 36:2, s. 66-71
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare the Danish Emergency Process Triage (DEPT) with a quick clinical assessment (Eyeball triage) as predictors of short-term mortality in patients in the emergency department (ED).Methods The investigation was designed as a prospective cohort study conducted at North Zealand University Hospital. All patient visits to the ED from September 2013 to December 2013 except minor injuries were included. DEPT was performed by nurses. Eyeball triage was a quick non-systematic clinical assessment based on patient appearance performed by phlebotomists. Both triage methods categorised patients as green (not urgent), yellow, orange or red (most urgent). Primary analysis assessed the association between triage level and 30-day mortality for each triage method. Secondary analyses investigated the relation between triage level and 48-hour mortality as well as the agreement between DEPT and Eyeball triage.Results A total of 6383 patient visits were included. DEPT was performed for 6290 (98.5%) and Eyeball triage for 6382 (~100%) of the patient visits. Only patients with both triage assessments were included. The hazard ratio (HR) for 48-hour mortality for patients categorised as yellow was 0.9 (95% CI 0.4 to 1.9) for DEPT compared with 4.2 (95% CI 1.2 to 14.6) for Eyeball triage (green is reference). For orange the HR for DEPT was 2.2 (95% CI 1.1 to 4.4) and 17.1 (95% CI 5.1 to 57.1) for Eyeball triage. For red the HR was 30.9 (95% CI 12.3 to 77.4) for DEPT and 128.7 (95% CI 37.9 to 436.8) for Eyeball triage. For 30-day mortality the HR for patients categorised as yellow was 1.7 (95% CI 1.2 to 2.4) for DEPT and 2.4 (95% CI 1.6 to 3.5) for Eyeball triage. For orange the HR was 2.6 (95% CI 1.8 to 3.6) for DEPT and 7.6 (95% CI 5.1 to 11.2) for Eyeball triage, and for red the HR was 19.1 (95% CI 10.4 to 35.2) for DEPT and 27.1 (95% CI 16.9 to 43.5) for Eyeball triage. Agreement between the two systems was poor (kappa 0.05).Conclusion Agreement between formalised triage and clinical assessment is poor. A simple clinical assessment by phlebotomists is superior to a formalised triage system to predict short-term mortality in ED patients.
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- Mokhtari, Arash, et al.
(författare)
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A multicenter evaluation of the safety and effectiveness of a 0h/1h protocol in the assessment of emergency department chest pain patients.
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundIn emergency department (ED) chest pain patients, the European Society of Cardiology recommends the use of a 0h/1h high-sensitivity cardiac Troponin (hs-cTn) protocol. However, the recommendation is based on observational studies and the effects of the protocol when implemented in routine care is unknown. The aim of this study is to determine the safety and effectiveness of the ESC 0h/1h hs-cTnT protocol, supplemented with clinical assessment and ECG, when implemented in routine careMethodsIn this before-and-after implementation study with concurrent controls, all patients ≥18 years with a chief complaint of non-traumatic chest pain and possible acute coronary syndrome (ACS) will be included at the EDs of Skåne University Hospital at Lund and Malmö, Helsingborg Hospital, Ystad Hospital and Kristianstad Hospital in southern Sweden. Patients with STEMI, patients leaving against medical advice and non-Swedish residents will be excluded. The 0h/1h protocol identifies low-risk patients suitable for early discharge home, high-risk patients suitable for immediate hospital admission, and intermediate risk patients suitable for further diagnostic assessment. The protocol will be implemented at the Lund, Helsingborg and Ystad EDs but not at the Malmö and Kristianstad EDs which will be concurrent controls. Patient outcomes will be compared in the 10-month periods before and after the implementation (starting February 1, 2018) both at the protocol-implementing and control hospitals. The primary outcomes are the 30-day rate of acute myocardial infarction/all-cause death and the ED length of stay (LOS) in patients discharged from the ED. Secondary outcomes include the proportion of patients discharged from the ED and of non-ACS-patients admitted to the cardiac care unit, further cardiac testing within 30 days and health care costs.ResultsNo results are available at this time (April 23, 2018). The main results of the study will be presented in 2019. ConclusionIf a 0h/1h protocol implemented in routine care can rapidly identify a large proportion of chest pain patients suitable for early discharge with no need for further cardiac testing, this may reduce ED and hospital crowding, objective testing, health care costs and will benefit both patients and the health care system.
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- Nygren, David, et al.
(författare)
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Goda resultat när akutläkare diagnostiserade djup ventrombo : DVT-diagnostik kan utföras med ultraljud på akuten, enligt pilotstudie vid Lasarettet i Ystad
- 2018
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Ingår i: Läkartidningen. - 0023-7205. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- Good outcomes when emergency physicians diagnosed deep vein thrombosis Deep vein thrombosis of the lower limb is best diagnosed with ultrasound. Internationally, several studies have shown promising and often equal results when emergency physicians have been compared with radiologists in diagnosing thrombosis. Our results confirm these findings in a non-academic hospital and for the first time in a Swedish setting. Our findings form the basis for a multi-centre study on new diagnostic routines in patients with suspected proximal deep vein thrombosis in the emergency department, potentially resulting in faster and more resource-effective management.
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