scholarly journals Antipsychotics for delirium in the general hospital setting in consecutive 2453 inpatients: a prospective observational study

2013 ◽  
Vol 29 (3) ◽  
pp. 253-262 ◽  
Author(s):  
Kotaro Hatta ◽  
Yasuhiro Kishi ◽  
Ken Wada ◽  
Toshinari Odawara ◽  
Takashi Takeuchi ◽  
...  
Keyword(s):  
Observational Study ◽  
General Hospital ◽  
Prospective Observational Study ◽  
Hospital Setting

scholarly journals The performance of the EMS triage (RETTS-p) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children < 16 years

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carl Magnusson ◽  
Johan Herlitz ◽  
Thomas Karlsson ◽  
Maria Jiménez-Herrera ◽  
Christer Axelsson
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Hospital Setting ◽  
Risk Of Death ◽  
Computerised Decision Support System ◽  
Field Assessment ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Life Threatening ◽  
Triage Level

Abstract Background The rapid triage and treatment system for paediatrics (RETTS-p) has been used by the emergency medical services (EMS) in the west of Sweden since 2014. The performance of the RETTS-p in the pre-hospital setting and the agreement between the EMS nurse’s field assessment and the hospital diagnosis is unknown. The aim of this study was to evaluate the performance of the RETTS-p in the EMS and the agreement between the EMS field assessment and the hospital diagnosis. Methods A prospective observational study was conducted among 454 patients < 16 years of age who were assessed and transported to the PED. Two instruments were used for comparison: 1) Classification of an emergent patient according to predefined criteria as compared to the RETTS-p and 2) Agreement between the EMS nurse’s field assessment and the hospital diagnosis. Results Among all children, 11% were identified as having vital signs associated with an increased risk of death and 7% were diagnosed in hospital with a potentially life-threatening condition. Of the children triaged with RETTS-p (85.9%), 149 of 390 children (38.2%) were triaged to RETTS-p red or orange (life-threatening, potentially life-threatening), of which 40 (26.8%) children were classified as emergent. The hospitalised children were triaged with the highest frequency to level yellow (can wait; 41.5%). In children with RETTS-p red or orange, the sensitivity for a defined emergent patient was 66.7%, with a corresponding specificity of 67.0%. The EMS field assessment was in agreement with the final hospital diagnosis in 80% of the cases. Conclusions The RETTS-p sensitivity in this study is considered moderate. Two thirds of the children triaged to life threatening or potentially life threatening were later identified as non-emergent. Of those, one in six was discharged from the PED without any intervention. Further, one third of the children were under triaged, the majority were found in the yellow triage level (can wait). The highest proportion of hospitalised patients was found in the yellow triage level. Our result is in agreement with previous studies using other triage instruments. A computerised decision support system might help the EMS triage to increase sensitivity and specificity.

scholarly journals Pre-hospital suPAR, lactate and CRP measurements for decision-making: a prospective, observational study of patients presenting non-specific complaints

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Milla Jousi ◽  
Marja Mäkinen ◽  
Johanna Kaartinen ◽  
Leena Meriläinen ◽  
Maaret Castrén
Keyword(s):  
Decision Making ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Point Of Care ◽  
Vital Signs ◽  
Hospital Setting ◽  
Medical Systems ◽  
Urokinase Plasminogen Activator Receptor ◽  
Support Tool ◽  
Chief Complaints

Abstract Background In the pre-hospital setting, non-urgent patients with non-specific chief complaints pose assessment challenges for the emergency medical systems (EMS). Severely ill patients should be identified among these patients, and unnecessary transport to the emergency department (ED) should be avoided. Unnecessary admissions burden EDs, deplete EMS resources and can even be harmful to patients, especially elderly patients. Therefore, tools for facilitating pre-hospital decision-making are needed. They could be based on vital signs or point-of-care laboratory biomarkers. In this study, we examined whether the biomarker soluble urokinase plasminogen activator receptor (suPAR), either alone or combined with C-reactive protein (CRP) and/or lactate, could predict discharge from the ED and act as a pre-hospital support tool for non-conveyance decision-making. Methods This was a prospective, observational study of adult patients with normal or near-normal vital signs transported by an EMS to an ED with a code referring to deteriorated general condition. The levels of suPAR, CRP and lactate in the patients’ pre-hospital blood samples were analysed. The values of hospitalized patients were compared to those of discharged patients to determine whether these biomarkers could predict direct discharge from the ED. Results A total of 109 patients (median age: 81 years) were included in the study. Of those, 52% were hospitalized and 48% were discharged from the ED. No statistically significant association was found between suPAR and the ED discharge vs hospitalization outcome (OR: 1.04, 95% CI 0.97–1.13, AUROC: 0.58, 95% CI 0.47–0.69). Adding CRP (AUROC: 0.64, 95% CI 0.54–0.75) or lactate (AUROC: 0.60, 95% CI 0.49–0.71) to the regression models did not improve their diagnostic accuracy. None of the patients with a suPAR value of less than 2 ng/ml were admitted to hospital, while 64% of the patients with a suPAR value of more than 6 ng/ml were hospitalized. Conclusion Pre-hospital suPAR measurements alone or combined with CRP and/or lactate measurements could not predict the ED discharge or hospital admission of 109 non-urgent EMS patients with non-specific chief complaints and normal or near-normal vital signs.

scholarly journals Treatment outcome and associated factors of bacterial meningitis at pediatric wards of southwestern Ethiopian hospital: a prospective observational study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Firomsa Bekele ◽  
Anuwar Ahmed ◽  
Abas Kedir ◽  
Tadesse Sheleme
Keyword(s):  
Treatment Outcome ◽  
Bacterial Meningitis ◽  
Observational Study ◽  
General Hospital ◽  
Prospective Observational Study ◽  
Pediatric Patients ◽  
Acute Bacterial Meningitis ◽  
Good Treatment Outcome ◽  
Poor Treatment ◽  
Poor Treatment Outcome

Abstract Background Meningitis is a common infectious cause of morbidity and mortality in pediatric age-groups. Acute bacterial meningitis is considered a medical emergency, because it is a life-threatening infection that requires immediate treatment. Therefore the study was aimed to assess the magnitude and predictors of poor treatment outcome among pediatric patients admitted to Bedele General Hospital. Methods A prospective observational study was conducted at pediatric wards of Bedele General Hospital from February 12, 2020 to August 11, 2020. Lumbar puncture, in the absence of contraindications, was performed under aseptic conditions for all patients with suspected bacterial meningitis to collect cerebrospinal fluid specimen. Multivariable logistic regression was used to determine the predictors of poor treatment outcome. Result Of the 196 pediatric patients involved, 112(57.1%) were male and the mean and standard deviation of their age was 6.09 ± 4.46. Regarding to their clinical profile, a total of 101(51.5%) were completely immunized and 115(58.7%) were given corticosteroid during their treatment. In our study the most frequently occurred clinical manifestation of meningitis was fever 164(83.67%), neck rigidity149 (76.02%), and irritability 122(62.24%). Regarding to their pharmacotherapy, the most commonly prescribed antibiotics were Ampicillin 104(24.82%), and Gentamycin 102(24.34%). The magnitude of good treatment outcome was 132(67.35%) whereas 64(32.65%) were poorly controlled. The presence of comorbidity (AOR = 3.64, 95CI%:1.83–7.23,P = < 0.001),corticosteroid use (AOR = 2.37, 95CI%:1.17–4.81,P = 0.017) and oxygen administration (AOR = 3.12, 95CI%: 1.34–7.25, P = 0.008) was a predictor of meningitis treatment outcome. Conclusion The treatment outcome of meningitis was good in of two-third of the patients. It was found that the presence of comorbidity, the administration of oxygen and use of corticosteroid was predictors of the treatment outcomes of bacterial meningitis in children. Therefore, in patients with these factors, appropriate meningitis treatment should be encouraged and locally applicable treatment guidelines should be prepared to improve patient outcome. Finally, the meningitis patients should be given corticosteroid and oxygen as treatment and special attention should be given for patients having co-morbidities.

scholarly journals Evaluation of the Effect of Triclosan Coated Sutures in the Prevention of Surgical Site Infections in a Spanish Hospital Setting: A Prospective, Observational Study

2021 ◽  
pp. 100154
Author(s):  
Manuel Bustamante Montalvo ◽  
Miguel Cainzos ◽  
Luis Prieto Carreiras ◽  
Andrea Castiñeira Piñeiro ◽  
Adrián García Iglesias ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Hospital Setting ◽  
Surgical Site Infections ◽  
Spanish Hospital

scholarly journals Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Carl Magnusson ◽  
Johan Herlitz ◽  
Christer Axelsson
Keyword(s):  
Observational Study ◽  
Emergency Medical Services ◽  
Prospective Observational Study ◽  
Hospital Setting ◽  
Early Warning Score ◽  
Medical Services ◽  
Emergency Medical ◽  
Field Assessment ◽  
High Acuity ◽  
Sensitive Conditions

Abstract Background In Sweden, the rapid emergency triage and treatment system (RETTS-A) is used in the pre-hospital setting. With RETTS-A, patients triaged to the lowest level could safely be referred to a lower level of care. The national early warning score (NEWS) has also shown promising results internationally. However, a knowledge gap in optimal triage in the pre-hospital setting persists. This study aimed to evaluate RETTS-A performance, compare RETTS-A with NEWS and NEWS 2, and evaluate the emergency medical service (EMS) nurse’s field assessment with the physician’s final hospital diagnosis. Methods A prospective, observational study including patients (≥16 years old) transported to hospital by the Gothenburg EMS in 2016. Three comparisons were made: 1) Combined RETTS-A levels orange and red (high acuity) compared to a predefined reference emergency, 2) RETTS-A high acuity compared to NEWS and NEWS 2 score ≥ 5, and 3) Classification of pre-hospital nurse’s field assessment compared to hospital physician’s diagnosis. Outcomes of the time-sensitive conditions, mortality and hospitalisation were examined. The statistical tests included Mann–Whitney U test and Fisher’s exact test, and several binary classification tests were determined. Results Overall, 4465 patients were included (median age 69 years; 52% women). High acuity RETTS-A triage showed a sensitivity of 81% in prediction of the reference patient with a specificity of 64%. Sensitivity in detecting a time-sensitive condition was highest with RETTS-A (73%), compared with NEWS (37%) and NEWS 2 (35%), and specificity was highest with NEWS 2 (83%) when compared with RETTS-A (54%). The negative predictive value was higher in RETTS-A (94%) compared to NEWS (91%) and NEWS 2 (92%). Eleven per cent of the final diagnoses were classified as time-sensitive while the nurse’s field assessment was appropriate in 84% of these cases. Conclusions In the pre-hospital triage of EMS patients, RETTS-A showed sensitivity that was twice as high as that of both NEWS and NEWS 2 in detecting time-sensitive conditions, at the expense of lower specificity. However, the proportion of correctly classified low risk triaged patients (green/yellow) was higher in RETTS-A. The nurse’s field assessment of time-sensitive conditions was appropriate in the majority of cases.

Sign in / Sign up

Export Citation Format

Share Document