scholarly journals Validation of a Modified Triage Scale in a Norwegian Pediatric Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Mette Engan ◽  
Asle Hirth ◽  
Håvard Trønnes
Keyword(s):  
Emergency Department ◽  
Negative Predictive Value ◽  
Resource Utilization ◽  
Predictive Value ◽  
Intraclass Correlation ◽  
Tertiary Hospital ◽  
Pediatric Emergency ◽  
Interrater Agreement ◽  
Pediatric Emergency Department ◽  
Sensitivity Specificity

Objective. Triage is a tool developed to identify patients who need immediate care and those who can safely wait. The aim of this study was to assess the validity and interrater reliability of a modified version of the pediatric South African triage scale (pSATS) in a single-center tertiary pediatric emergency department in Norway. Methods. This prospective, observational study included all patients with medical conditions, referred to the pediatric emergency department of a tertiary hospital in Norway from September 1, 2015, to November 17, 2015. Their assigned triage priority was compared with rate of hospitalization and resource utilization. Validity parameters were sensitivity, specificity, positive and negative predictive value, and percentage of over- and undertriage. Interrater agreement and accuracy of the triage ratings were calculated from triage performed by nurses on written case scenarios. Results. During the study period, 1171 patients arrived at the hospital for emergency assessment. A total of 790 patients (67 %) were triaged and included in the study. The percentage of hospital admission increased with increasing level of urgency, from 30 % of the patients triaged to priority green to 81 % of those triaged to priority red. The sensitivity was 74 %, the specificity was 48 %, the positive predictive value was 52 %, and the negative predictive value was 70 % for predicting hospitalization. The level of over- and undertriage was 52 % and 26 %, respectively. Resource utilization correlated with higher triage priority. The interrater agreement had an intraclass correlation coefficient of 0.99 by Cronbach’s alpha, and the accuracy was 92 %. Conclusions. The modified pSATS had a moderate sensitivity and specificity but showed good correlation with resource utilization. The nurses demonstrated excellent interrater agreement and accuracy when triaging written case scenarios.

scholarly journals Clinical availability of SNOOP4 in acute non-traumatic headache patients admitted to the emergency department

2020 ◽  
pp. 102490792092868
Author(s):  
Wachira Wongtanasarasin ◽  
Borwon Wittayachamnankul
Keyword(s):  
Emergency Department ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Primary Headache ◽  
Tertiary Hospital ◽  
Adult Patients ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Sensitivity Specificity

Objectives: Non-traumatic headache accounts for up to 4.5% of all patients presenting to the emergency department. Non-traumatic headache is generally classified into two categories: primary and secondary headache disorders. Differentiating secondary from primary headache disorders is essential. SNOOP4 is known as a mnemonic for suggesting clinicians send neuroimaging to rule out serious conditions. Yet, the benefit of using this mnemonic in the emergency department is not well established. This study aimed to assess the significance of SNOOP4 in detecting serious causes of non-traumatic headache in adults presenting to the emergency department. Methods: We conducted a prospective observational study of adult patients presenting to the emergency department of the single tertiary hospital over a period of 12 months. Patients with acute non-traumatic headache presented at the emergency department were included. A standard record form was used. Patients were investigated and treated following the pre-existing protocols. Results were interpreted by attending radiologists. Each factor, according to SNOOP4, was then evaluated for the ability to predict serious causes of non-traumatic headache. Results: A total of 90 patients were included in this study with complete details obtained on 83 (92.2%) patients. Of these, 63 (75.9%) were female. The mean age was 44.5 years (inter-quartile range: 27–58.5). The duration of the headache ranged from 10 min to 7 days. Out of 83, 27 (32.5%) had at least one SNOOP4 criterion. In all, 25 patients (30.1%) underwent neuroimaging. The sensitivity, specificity, positive predictive value, and negative predictive value of SNOOP4 were 77.8%, 73.0%, 25.9%, and 96.4% respectively. Conclusion: SNOOP4 criteria show very high negative predictive value for excluding serious causes of acute non-traumatic headache in adult patients presenting to the emergency department.

scholarly journals MP19: Comparison of the psychometric properties of the VAS, FPS-R and CAS in the pediatric emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S71
Author(s):  
S. Ali ◽  
S. Le May ◽  
A. Plint ◽  
A. Ballard ◽  
C. Khadra ◽  
...  
Keyword(s):  
Emergency Department ◽  
Psychometric Properties ◽  
Acute Pain ◽  
Convergent Validity ◽  
Analogue Scale ◽  
Intraclass Correlation ◽  
Pediatric Emergency ◽  
Rank Test ◽  
Pediatric Emergency Department ◽  
Responsiveness To Change

Introduction: Appropriate pain management relies on the use of valid, reliable and age-appropriate tools that are validated in the setting in which they are intended to be used. The aim of the study was to assess the psychometric properties of pain scales commonly used in children presenting to the pediatric emergency department (PED) with an acute musculoskeletal injury. Methods: Convergent validity was assessed by determining the Spearman’s correlations and the agreement using the Bland-Altman method between the Visual Analogue Scale (VAS), Faces Pain Scale-Revised (FPS-R) and Color Analogue Scale (CAS). Responsiveness to change was determined by performing the Wilcoxon signed-rank test between the pre-post analgesia mean scores. Reliability of the scales was estimated using relative (Spearman’s correlation, Intraclass Correlation Coefficient) and absolute indices (Coefficient of Reliability). Results: A total of 495 participants was included in the analyses. Mean age was 11.9 ±2.7 years and participants were mainly boys (55.3%). Correlation between each pair of scales was 0.79 (VAS/FPS-R), 0.92 (VAS/CAS) and 0.81 (CAS/FPS-R). Limits of agreement (80%CI) were -2.71 to 1.27 (VAS/FPS-R), -1.13 to 1.15 (VAS/CAS) and -1.45 to 2.61 (CAS/FPS-R). Responsiveness to change was demonstrated by significant differences in mean pain scores, among the three scales, between pre- and post-medication administration (p<0.0001). ICC and CR estimates suggested acceptable reliability for the three scales at 0.79 and ±1.49 for VAS, 0.82 and ±1.35 for CAS, and 0.76 and ±1.84 for FPS-R. Conclusion: The scales demonstrated good psychometric properties with a large sample of children with acute pain in the PED. The VAS and CAS showed a stronger convergent validity, while FPS-R was not in agreement with the other scales. Clinically, VAS and CAS scales can be used interchangeably to assess pain intensity of children with acute pain.

Συγκριτική μελέτη της μορφομετρίας κατά τον κλασικό ακτινολογικό έλεγχο (MRX) και της μορφομετρίας με χρήση απορροφησιομετρίας (VFA) στον καθορισμό σπονδυλικών παραμορφώσεων σε οστεοπορωτικούς ασθενείς μετά από κυφοπλαστική

2017 ◽  
Author(s):  
Ευστάθιος Δράμπαλος
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Predictive Value ◽  
Intraclass Correlation ◽  
Sensitivity Specificity

Σκοπός: H εφαρμογή για πρώτη φορά διεθνώς της μορφομετρίας της σπονδυλικής στήλης με χρήση απορροφησιομετρίας (VFA) σε ασθενείς με κυφοπλαστική. Αναλύονται τα πλεονεκτήματα και μειονεκτήματα της μεθόδου, ελέγχεται η αξιοπιστία της και συγκρίνεται με την μορφομετρία κατά τον κλασσικό ακτινολογικό έλεγχο (ΜRΧ) στην εκτίμηση των σπονδυλικών παραμορφώσεων στους συγκεκριμένους ασθενείς.Υλικά και Μέθοδος: Πραγματοποιήθηκαν μετρήσεις σε 42 ασθενείς με κυφοπλαστική λόγω οστεοπορωτικών σπονδυλικών καταγμάτων και αναλύθηκαν οι σπόνδυλοι από τον T4 μέχρι τον L4 με την VFA και την MRX. Μετρήθηκαν το πρόσθιο (ha), μέσο (hm) και οπίσθιο (hp) ύψος του σπονδυλικού σώματος και προσδιορίσθηκαν οι λόγοι ha/hp και hm/hp. Αναλύθηκαν για την VFA η συμφωνία αποτελεσμάτων του ίδιου παρατηρητή (IOA) και η συμφωνία αποτελεσμάτων μεταξύ ανεξάρτητων παρατηρητών (INA) για τους λόγους ha/hp και hm/hp καθώς και για την μέθοδο Genant σε επίπεδο σπονδύλου, ‘περιοχής της σπονδυλικής στήλης (θωρακική/ΘΜΣΣ ή οσφυϊκή/ΟΜΣΣ), σε επίπεδο ‘γειτονικών προς την κυφοπλαστική σπονδύλων’, και σε επίπεδο ‘σπονδύλων με κυφοπλαστική’. Σε κάθε επίπεδο χρησιμοποιήθηκε η μέση τιμή ha/hp και hm/hp. Στη συνέχεια, αναλύσαμε την συμφωνία μεταξύ VFA και MRX στον καθορισμό των λόγων ha/hp και hm/hp καθώς και μετά την διχοτόμηση των λόγων ha/hp περί της τιμής όριο που συνήθως χρησιμοποιείται για τον καθορισμό ενός κατάγματος. Αποτελέσματα: Οι IOA και INA για τους λόγους ha/hp και hm/hp στην VFA ήταν ‘σχεδόν τέλεια’ σε όλα τα επίπεδα (ICC 0.94-0.98). Η εφαρμογή της μεθόδου Genant κατά την VFA ανέδειξε επίσης ‘σχεδόν τέλεια’ INA (ICC=0.833). Η ανάλυση σε επίπεδο σπονδύλου έδειξε ‘σχεδόν τέλεια’ συμφωνία μεταξύ VFA και MRX για τον λόγο ha/hp [intraclass correlation coefficient, ICC=0.85], και ‘ισχυρή συμφωνία’ για τον λόγο hm/hp (ICC=0.78). Για τον λόγο ha/hp η συμφωνία ήταν ‘σχεδόν τέλεια’ τόσο στην ΘΜΣΣ (ICC=0.82) όσο και στην ΟΜΣΣ (ICC=0.87), ενώ για τον λόγο hm/hp η συμφωνία ήταν ‘ισχυρή’ στην ΘΜΣΣ (ICC=0.75) και ‘σχεδόν τέλεια’ στην ΟΜΣΣ (ICC=0.80). Η συμφωνία ήταν εξίσου ‘σχεδόν τέλεια’ σε επίπεδο ‘σπονδύλων με κυφοπλαστική’ (ICC=0.83) όσο και σε επίπεδο ‘γειτονικών προς την κυφοπλαστική σπονδύλων’ (ICC=0.80) για τον λόγο ha/hp. Όταν οι λόγοι ha/hp μετατράπηκαν σε κατάγματα (ναι ή όχι κάταγμα) χρησιμοποιώντας διαφορετικές τιμές κατώφλι για την διάγνωση κατάγματος (λόγοι ha/hp 0.75, 0.80 και 0.85) η συμφωνία μεταξύ των μεθόδων ήταν λιγότερο καλή, από μέτρια έως ουσιώδης (κ 0.52-0.63 στην ΟΜΣΣ και 0.53-0.66 στην ΘΜΣΣ). Χρησιμοποιώντας την κατάταξη Genant οι διαφορές στην ταξινόμηση των σπονδύλων ήταν περισσότερο προς την κατεύθυνση της MRX με 32 αναγνωρισμένα κατάγματα μόνο από την MRX και μόνο 5 μόνο από την VFA. Στη μελέτη αυτή, με επιπολασμό σφηνοειδών σπονδυλικών καταγμάτων 9.3%, οι δείκτες ακρίβειας sensitivity, specificity, positive predictive value (PPV) και negative predictive value (NPV) υπολογίστηκαν σε 0.522, 0.97, 0.87 και 0.92 αντίστοιχα. Συμπεράσματα: Η εφαρμογή της VFA σε ασθενείς με κυφοπλαστική έχει υψηλή επαναληψιμότητα και αναπαραγωγιμότητα. Η συμφωνία μεταξύ VFA και MRX στην εκτίμηση των λόγων ha/hp και hm/hm ήταν από ‘ισχυρή’ έως ‘σχεδόν τέλεια’ ανάλογα με το επίπεδο εξέτασης. Η συμφωνία στην αναγνώριση των σπονδυλικών καταγμάτων ήταν μέτρια. Οι διαφορές ήταν περισσότερο προς την κατεύθυνση της MRX. Η υψηλή τιμή του δείκτη NPV της VFA στους ασθενείς με κυφοπλαστική, δείχνει ότι η μέθοδος θα μπορούσε να χρησιμοποιηθεί για τον εντοπισμό αυτών που χρήζουν περαιτέρω ακτινολογικού ελέγχου.

scholarly journals Fast Track and the Pediatric Emergency Department: Resource Utilization and Patient Outcomes

1999 ◽  
Vol 6 (11) ◽  
pp. 1153-1159 ◽  
Author(s):  
Louis C. Hampers ◽  
Susie Cha ◽  
David J. Gutglass ◽  
Helen J. Binns ◽  
Steven E. Krug
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Resource Utilization ◽  
Fast Track ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department

scholarly journals Σύγκριση της δοκιμασίας σύνδεσης κοβαλτίου - αλβουμίνης και του υπερηχογραφήματος καρδιάς στην διαγνωστική ασθενών με θωρακικό πόνο

2013 ◽  
Author(s):  
Ευαγγελία Κουντάνα
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Unstable Angina ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Stress Test ◽  
Acute Chest Pain ◽  
Developed Countries ◽  
Coronary Syndrome ◽  
Sensitivity Specificity

Cardiovascular disease is the leading cause of mortality in developed countries andplaces a massive burden on healthcare services. Thousands of patients visit every yearthe Emergency Department (ED) with acute chest pain and a considerable proportionhas an acute coronary syndrome (ACS). In most cases, the electrocardiogram and thecommonly used biomarkers are not helpful in the early diagnosis of myocardialischemia.ObjectiveTo assess the role of ischemia modified albumin (IMA), a novel cardiac biomarker, inexcluding unstable angina (UA) in patients visiting the ED with acute chest pain. Thepredictive value of serum IMA concentrations were evaluated in comparison toechocardiogram.MethodsWe studied 33 patients (84.8% males, age 59.8±10.8 years) who presented at theAccident and Emergency Department with acute chest pain lasting < 3 h, normal ornon-diagnostic electrocardiogram and normal serum troponin and CK-MB levels.Serum IMA levels were determined and a comprehensive echocardiographic studywas performed. All patients were admitted to our Department of Cardiology and thediagnosis of UA was established with exercise or thallium stress test or with coronaryangiography.ResultsFive patients were eventually diagnosed with UA. The area under the curve for thediagnosis of unstable angina based on serum IMA levels was 0.193 (95% confidenceinterval 0.047-0.339, p < 0.05). Serum IMA levels ≥ 31,95 IU/ml had a sensitivity,specificity, positive and negative predictive value for the diagnosis of UA of 40.0%,28.6%, 9.1% and 72.7%, respectively. The sensitivity, specificity, positive andnegative predictive value of echocardiography for the diagnosis of UA was 60.0%,89.3%, 50.0% and 92.6%, respectively.Conclusion: Assessment of serum IMA levels in patients presenting with suspectedUA has comparable negative predictive value with echocardiography for excludingthe diagnosis of UA. Therefore, this biomarker appears to be useful in the diagnosisand stratification of risk in patients with ACS.

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