EP.FRI.574 Screening tool to improve patient referral to acute surgical care from Emergency Department

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Humayun Razzaq ◽  
Ahsan Rao ◽  
Sharlini Sathananthan ◽  
Michael Dworkin ◽  
Ben Panamarenko
Keyword(s):  
Emergency Department ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Screening Tool ◽  
Surgical Care ◽  
Ambulatory Clinic ◽  
Actual Patient ◽  
Urological Symptoms ◽  
Hernia Complication

Abstract Introduction The study aimed to audit the appropriateness of surgical referrals to general surgery; and, secondly, to devise a screening tool for use in the emergency department  to screen patients that are safe to be discharged and to be seen in surgical ambulatory clinics. Methods The first phase of the study was an audit to check appropriateness of the surgical referrals (1st-18th February 2020). In the second part, a screening tool questionnaire was prospectively tested (1st February-24th March 2020) on the surgical referrals. The accuracy of the screening tool outcome was compared to actual patient consultation outcomes. The sensitivity and specificity of the questionnaire was assessed using an ROC curve. Results In the first audit, 68.9% patients were discharged on the same day with or without follow up in the ambulatory surgical clinic.  In the prospective questionnaire phase of the study, there were 98 patients and the most common presentation was abdominal pain (n = 60) followed by urological symptoms (n = 11), symptoms of hernia complication (n = 10), abscess (n = 7) and testicular pain (n = 2). The sensitivity and specificity of the screening tool was 60.7% and 100%, respectively with overall accuracy being 88.82%. The area under the ROC curve was 0.80. Conclusion A large proportion of the patients referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool has the potential to screen patients who can be seen in the ambulatory clinic and safe to identify patients who require urgent surgical admission.

scholarly journals Sensitivity and specificity of waist circumference as a single screening tool for assessment of overweight and obesity

2017 ◽  
Vol 4 (11) ◽  
pp. 4254
Author(s):  
Anubrata Karmakar ◽  
Shobhit Garg ◽  
Aparajita Dasgupta ◽  
Bobby Paul ◽  
Swanya P. Maharana
Keyword(s):  
Waist Circumference ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Screening Tool ◽  
Cross Sectional Study ◽  
Overweight And Obesity ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Public Health Perspective ◽  
Cross Sectional

Background: Generalised and central obesity are established risk factors for metabolic syndrome and cardiovascular diseases. Easy assessment of overweight or obesity is the need of the hour from public health perspective. Waist circumference (WC) can be a simple screening tool for identifying overweight individuals since measuring WC is simple, inexpensive, less time consuming, convenient for self-monitoring and needs no complicated calculation as BMI.Methods: A community based cross-sectional study was conducted in January-February 2017 among 338 adults, in a village of Singur Block, West Bengal. Height, weight and WC were measured for each subject. Receiver Operating Characteristic (ROC) curve analysis was used to estimate the cut-off values of WC.Results: The sensitivity and specificity of WC ≥90 centimeters for men for identifying overweight (BMI ≥25) were 78.8% and 75.6% respectively, whereas those of WC ≥80 cm for women were 80.3% and 44% respectively. ROC curve analysis revealed good diagnostic accuracy at 88.5 cm for WC cut-off for men (area under curve (AUC) 0.854, sensitivity 86.5%, specificity 67.6%) and fair accuracy (AUC 0.744, sensitivity 80.3%, specificity 44%) for WC cut-off for 80 cm for women.Conclusions: This study shows, WC can be used for screening of overweight individual infield practice as measuring tape is inexpensive and easy-to-carry compared to a weighing scale. More research may be done on larger sample size to establish an optimal WC cut-off value for Indian population. 

O003. Validity and acceptability of the Swahili pGALS screening tool at a tertiary referral hospital in Kenya

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Kawishe Jacqueline ◽  
Ngugi Anthony ◽  
Migowa Angela
Keyword(s):  
Median Time ◽  
Sensitivity And Specificity ◽  
Gold Standard ◽  
Screening Tool ◽  
Clinical Skills ◽  
Lower Sensitivity ◽  
African Countries ◽  
Tertiary Referral Hospital ◽  
Paediatric Rheumatologist

Abstract Background A common reason implicated in the severity of presentation and mortality caused by most rheumatic conditions among children is the delay of presentation to a paediatric rheumatologist. Evidence suggests poor practice of paediatric musculoskeletal clinical skills could be a cause for delay and that history suggestive of musculoskeletal disease alone has poor sensitivity in detecting rheumatological conditions. The paediatrics gait, arms, legs and spine (pGALS) musculoskeletal screening tool was therefore developed to encourage early detection of paediatric rheumatological conditions. It has been validated and translated successfully in other countries. Swahili is well understood and spoken in Kenya and other East African countries and for the pGALS to be incorporated in our setting, we needed to translate and asses its validity in Swahili. The objective is todetermine the sensitivity and specificity of the translated Swahili pGALS screening tool in detecting abnormal joints among children aged 5-16 years. To measure the acceptability of the Swahili pGALS screening tool with reference to time taken performing the examination and the discomfort as perceived by the children and their guardians. Methods We conducted a diagnostic utility study. The three English pGALS screening questions were translated into Swahili according to the WHO standard of translation of a tool and the manoeuvres were performed by a ‘copy me’ approach. The ‘copy me’ approach entailed asking the participants to imitate the research assistants as various manoeuvres were done. Children between the ages of 5–16 years seen at the Aga Khan University Accident and emergency department and family medicine clinic who spoke Swahili and had symptoms suggestive of musculoskeletal conditions were enrolled using systematic random sampling. Children who were already on follow up with the Aga Khan paediatric rheumatologist were excluded. Children had the Swahili pGALS and gold standard review (with the paediatric rheumatologist) on the same day. Guardians were asked to answer questions on acceptability with regards to time taken to perform the tool and level of discomfort. Those with possible rheumatological condition as per the gold standard were offered follow up. Results We enrolled one hundred children with a median age of the children was nine years (IQR 7–11). The sensitivity and specificity of the Swahili pGALS screening tool were 76.8% (CI 63.6–87.0%) and 40.0% (CI 23.9–57.9%). The diagnostic accuracy was 62.7% (CI 52.1–72.1%) and the ROC area was 0.58 (CI 0.48–0.68). The median time taken to perform the Swahili pGALS was 5.0 minutes (IQR 3.5-6.0 minutes). Ninety percent of the guardians found the practice of pGALS to have ‘no’ to ‘some’ discomfort. Conclusions This study had a lower sensitivity and specificity than what was seen with similar studies. Although the sensitivity seen was low, it was still within acceptable range for a screening tool and may still be applicable in Kenya and other Swahili speaking countries if used in conjunction with good rheumatological history to refer early the 76% of children picked up by the screening tool. However, the low specificity implies that relatively large number of false positives would still need to be reviewed by a rheumatologist if the tool is adapted for use. The median time taken to perform the tool was also longer than observed in previous studies but the tool was overall deemed acceptable by majority of the guardians/ parents. Keywords pGALS, Kenya, Swahili, Paediatric, Rheumatology

scholarly journals Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers

2019 ◽  
Vol 49 (1) ◽  
pp. 130-134
Author(s):  
Krishan Yadav ◽  
Valérie Boucher ◽  
Pierre-Hugues Carmichael ◽  
Philippe Voyer ◽  
Debra Eagles ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sensitivity And Specificity ◽  
Primary Outcome ◽  
Screening Tool ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Multicenter Cohort Study ◽  
Delirium Assessment ◽  
Lengths Of Stay ◽  
History Of

Abstract Background delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. Objectives to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. Design a prospective observational multicenter cohort study. Setting four Quebec EDs. Participants independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation. Measurements eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. Results we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval—CI 69.3–96.2%) and a specificity of 44.3% (95%; CI 38.3–50.4%). Conclusion serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.

scholarly journals Implementation of Mobile Audiometry During the COVID-19 Pandemic

2021 ◽  
pp. 019459982110515
Author(s):  
Alejandro Garcia ◽  
Divya A. Chari ◽  
Konstantina M. Stankovic ◽  
Daniel J. Lee ◽  
Elliott D. Kozin ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Hearing Loss ◽  
Sensitivity And Specificity ◽  
Health Care Providers ◽  
Screening Tool ◽  
Care Providers ◽  
Air Conduction

During the COVID-19 pandemic, the utility of portable audiometry became more apparent as elective procedures were deferred in an effort to limit exposure to health care providers. Herein, we retrospectively evaluated mobile-based audiometry in the emergency department and outpatient otology and audiology clinics. Air conduction thresholds with mobile audiometry were within 5 dB in 66% of tests (95% CI, 62.8%-69.09%) and within 10 dB in 84% of tests (95% CI, 81.4%-86.2%) as compared with conventional audiometry. No significant differences were noted between mobile-based and conventional audiometry at any frequencies, except 8 kHz ( P < .05). The sensitivity and specificity for screening for hearing loss were 94.3% (95% CI, 91.9%-96.83%) and 92.3% (95% CI, 90.1%-94.4%), respectively. While automated threshold audiometry does not replace conventional audiometry, mobile audiometry is a promising screening tool when conventional audiometry is not available.

scholarly journals Comparison of Proposed Modified and Original Sequential Organ Failure Assessment Scores in Predicting ICU Mortality: A Prospective, Observational, Follow-Up Study

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Afshin Gholipour Baradari ◽  
Hassan Sharifi ◽  
Abolfazl Firouzian ◽  
Maryam Daneshiyan ◽  
Mohsen Aarabi ◽  
...  
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Diagnostic Odds Ratio ◽  
Icu Mortality ◽  
Icu Admission ◽  
Assessment Scores ◽  
Failure Assessment

Background. The sequential organ failure assessment (SOFA) score has been recommended to triage critically ill patients in the intensive care unit (ICU). This study aimed to compare the performance of our proposed MSOFA and original SOFA scores in predicting ICU mortality. Methods. This prospective observational study was conducted on 250 patients admitted to the ICU. Both tools scores were calculated at the beginning, 24 hours of ICU admission, and 48 hours of ICU admission. Diagnostic odds ratio and receiver operating characteristic (ROC) curve were used to compare the two scores. Results. MSOFA and SOFA predicted mortality similarly with an area under the ROC curve of 0.837, 0.992, and 0.977 for MSOFA 1, MSOFA 2, and MSOFA 3, respectively, and 0.857, 0.988, and 0.988 for SOFA 1, SOFA 2, and SOFA 3, respectively. The sensitivity and specificity of MSOFA 1 in cut-off point 8 were 82.9% and 68.4%, respectively, MSOFA 2 in cut-off point 9.5 were 94.7% and 97.1%, respectively, and MSOFA 3 in cut-off point of 9.3 were 97.4% and 93.1%, respectively. There was a significant positive correlation between the MSOFA 1 and the SOFA 1 (r: 0.942), 24 hours (r: 0.972), and 48 hours (r: 0.960). Conclusion. The proposed MSOFA and the SOFA scores had high diagnostic accuracy, sensitivity, and specificity for predicting mortality.

I Kneed help!

2020 ◽  
pp. 89-94
Author(s):  
Kristol Das
Keyword(s):  
Emergency Department ◽  
Natural History ◽  
Sensitivity And Specificity ◽  
Knee Pain ◽  
Physical Exam ◽  
Imaging Modalities ◽  
X Rays ◽  
Case Presentation ◽  
History Of

This chapter reviews a case of an adolescent presenting to the emergency department with unilateral knee pain after a traumatic fall. This chapter reviews key history questions, physical exam maneuvers including special tests to examine the knee, the workup and management of this case presentation based on pediatric literature. Specifically, the chapter reviews indications to obtain x-rays versus other imaging modalities and the sensitivity and specificity of special tests based on recent data. Follow-up and subspecialty referral indications for knee pain are also reviewed. Lastly, the epidemiology, pathophysiology, management and natural history of this patient’s unique diagnosis are briefly discussed.

scholarly journals Sensitivity and specificity of a Middle East respiratory syndrome screening tool used in the emergency department

2020 ◽  
Vol 3 (1) ◽  
pp. 44
Author(s):  
Anas Khan ◽  
Sami Alsolamy ◽  
Sami Yousef ◽  
Faisal Alghusen ◽  
Ahmad Alsalman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Middle East ◽  
Sensitivity And Specificity ◽  
Screening Tool ◽  
Middle East Respiratory Syndrome

scholarly journals MP14: Prospective external validation of the Ottawa 3DY screening tool for the detection of altered mental status of elderly patients presenting to the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S69-S70
Author(s):  
B. Kim ◽  
Q. Salehmohamed ◽  
R. Stenstrom ◽  
S. Barbic ◽  
D. Barbic
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Inner City ◽  
Sensitivity And Specificity ◽  
Mental Status ◽  
Screening Tool ◽  
External Validation ◽  
Altered Mental Status ◽  
Primary Objective ◽  
Convenience Sample

Introduction: Altered mental status (AMS) and cognitive impairment are common problems in elderly patients presenting to the emergency department (ED). The primary objective of this study was to test the diagnostic accuracy of the Ottawa 3DY (O3DY) screening tool for the detection of AMS in the ED. Methods: This was a prospective cohort study conducted at an inner city, academic ED with an annual census of 85,000 visits. Study investigators and trained research assistants screened and approached a convenience sample of patients for informed written consent. Patients completed the O3DY, Short Blessed Test (SBT) and Mini-Mental Status Exam (MMSE). Descriptive statistics using counts, medians, means and interquartile ranges (IQR) were calculated. Sensitivity and specificity of the O3DY compared to the MMSE were calculated in STATA (version 11.2). Results: We screened 163 patients for inclusion, 150 were eligible to participate, and 116 patients were enrolled in the final study. The median age of participants was 81 (IQR 77-85), 44.8% were female, and the most common pre-existing comorbidity was hypertension. The median ED LOS at the time of O3DY completion was 1:40 (IQR 1:34-1:46). Characteristics of patients eligible, yet who declined to participate, were similar to the study population. The sensitivity of the O3DY for AMS was 71.4% (95%CI 47.8-95.1), and specificity was 56.3% (46.7-65.9). Sensitivity of the SBT was 85.7% (67.4-99.9) and specificity was 58.3% (48.7-67.8). Inter-rater reliability for the O3DY (k=0.64) and SBT (k=0.63) were moderate. Conclusion: In a cohort of geriatric patients presenting to an inner-city, academic ED the O3DY and SBT tools demonstrate moderate sensitivity and specificity for the detection of AMS.

scholarly journals Exploring the prevalence of personality disorder and the feasibility of using the SAPAS as a screening tool for personality disorder in an emergency department in India

2021 ◽  
pp. 002580242110113
Author(s):  
Piyal Sen ◽  
Kirsten Barnicot ◽  
Priyanka Podder ◽  
Indraneel Dasgupta ◽  
Mariko Gormley
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Sensitivity And Specificity ◽  
Screening Tool ◽  
Screening Tools ◽  
Reference Standard ◽  
Trade Off ◽  
Ed Visits

Background Personality disorders (PD) lead to frequent emergency department (ED) visits. Existing studies have evaluated high-risk ED populations in Western settings. PD screening tools, such as the Standardized Assessment of Personality – Abbreviated Scale (SAPAS), have thus far only been validated in Western populations. Aims This study aimed to establish the screened prevalence of PD, and to evaluate the performance of the SAPAS as a screening tool within an ED setting in India. Methods The study took place in the ED of a private multi-speciality hospital in Kolkata, India. All attendees were approached during two days per week over three months, except those who were medically unfit to participate. The SAPAS and the International Personality Disorder Examination (IPDE) were translated into Bengali and then used as screening tools for PD and as the reference standard for PD diagnosis. Results Out of 120 ED attendees approached, 97 participated (48 men and 49 women), of whom 24% met the criteria for a diagnosis of PD. A cut-off score of 4 on the SAPAS provided the best trade-off between sensitivity and specificity for detecting PD. Conclusion The prevalence of PD was similar to Western samples, and the SAPAS showed promise for use in a non-Western setting.

Emergency Department Admission and Mortality Rate for Suicidal Behavior

Crisis ◽  
2014 ◽  
Vol 35 (6) ◽  
pp. 406-414 ◽  
Author(s):  
Raimondo Maria Pavarin ◽  
Angelo Fioritti ◽  
Francesca Fontana ◽  
Silvia Marani ◽  
Alessandra Paparelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Metropolitan Area ◽  
Suicidal Behavior ◽  
Mortality Risk ◽  
Illicit Drugs ◽  
Attempted Suicide ◽  
Cox Model ◽  
Emergency Department Admission ◽  
Completed Suicide

Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.

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