scholarly journals The accuracy of initial diagnoses in coma: an observational study in 835 patients with non-traumatic disorder of consciousness

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Maximilian Lutz ◽  
Martin Möckel ◽  
Tobias Lindner ◽  
Christoph J. Ploner ◽  
Mischa Braun ◽  
...  
Keyword(s):  
Emergency Care ◽  
Final Diagnosis ◽  
Class I ◽  
Prehospital Emergency Care ◽  
Unknown Etiology ◽  
Care Providers ◽  
Cohen’S Kappa ◽  
Disorder Of Consciousness ◽  
Cohen's Kappa ◽  
Suspected Diagnosis

Abstract Background Management of patients with coma of unknown etiology (CUE) is a major challenge in most emergency departments (EDs). CUE is associated with a high mortality and a wide variety of pathologies that require differential therapies. A suspected diagnosis issued by pre-hospital emergency care providers often drives the first approach to these patients. We aim to determine the accuracy and value of the initial diagnostic hypothesis in patients with CUE. Methods Consecutive ED patients presenting with CUE were prospectively enrolled. We obtained the suspected diagnoses or working hypotheses from standardized reports given by prehospital emergency care providers, both paramedics and emergency physicians. Suspected and final diagnoses were classified into I) acute primary brain lesions, II) primary brain pathologies without acute lesions and III) pathologies that affected the brain secondarily. We compared suspected and final diagnosis with percent agreement and Cohen’s Kappa including sub-group analyses for paramedics and physicians. Furthermore, we tested the value of suspected and final diagnoses as predictors for mortality with binary logistic regression models. Results Overall, suspected and final diagnoses matched in 62% of 835 enrolled patients. Cohen’s Kappa showed a value of κ = .415 (95% CI .361–.469, p < .005). There was no relevant difference in diagnostic accuracy between paramedics and physicians. Suspected diagnoses did not significantly interact with in-hospital mortality (e.g., suspected class I: OR .982, 95% CI .518–1.836) while final diagnoses interacted strongly (e.g., final class I: OR 5.425, 95% CI 3.409–8.633). Conclusion In cases of CUE, the suspected diagnosis is unreliable, regardless of different pre-hospital care providers’ qualifications. It is not an appropriate decision-making tool as it neither sufficiently predicts the final diagnosis nor detects the especially critical comatose patient. To avoid the risk of mistriage and unnecessarily delayed therapy, we advocate for a standardized diagnostic work-up for all CUE patients that should be triggered by the emergency symptom alone and not by any suspected diagnosis.

Comparison of Forceps, Cryoprobe, and Thoracoscopic Lung Biopsy for the Diagnosis of Interstitial Lung Disease − The CHILL Study

Respiration ◽  
2021 ◽  
pp. 1-7
Author(s):  
Momen M. Wahidi ◽  
Angela Christine Argento ◽  
Kamran Mahmood ◽  
Scott L. Shofer ◽  
Coral Giovacchini ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Final Diagnosis ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Invasive Method ◽  
Transbronchial Lung Cryobiopsy ◽  
Multidisciplinary Conference

Rationale: Transbronchial lung cryobiopsy (TBLC) has emerged as a less invasive method to obtain a tissue diagnosis in patients with interstitial lung disease (ILD). The diagnostic yield of TBLC compared to surgical lung biopsy (SLB) remains uncertain. Objectives: The aim of this study was to determine the diagnostic accuracy of forceps transbronchial lung biopsy (TBLB) and TBLC compared to SLB when making the final diagnosis based on multidisciplinary discussion (MDD). Methods: Patients enrolled in the study underwent sequential TBLB and TBLC followed immediately by SLB. De-identified cases, with blinding of the biopsy method, were reviewed by a blinded pathologist and then discussed at a multidisciplinary conference. Main Results: Between August 2013 and October 2017, we enrolled 16 patients. The raw agreement between TBLC and SLB for the MDD final diagnosis was 68.75% with a Cohen’s kappa of 0.6 (95% CI 0.39, 0.81). Raw agreement and Cohen’s kappa of TBLB versus TBLC and TBLB versus SLB for the MDD final diagnosis were much lower (50%, 0.21 [95% CI 0, 0.42] and 18.75%, 0.08 [95% CI −0.03, 0.19], respectively). TBLC was associated with mild bleeding (grade 1 bleeding requiring suction to clear) in 56.2% of patients. Conclusions: In patients with ILD who have an uncertain type based on clinical and radiographic data and require tissue sampling to obtain a specific diagnosis, TBLC showed moderate correlation with SLB when making the diagnosis with MDD guidance. TBLB showed poor concordance with both TBLC and SLB MDD diagnoses.

scholarly journals A Comparison Between Differently Skilled Prehospital Emergency Care Providers in Major-Incident Triage in South Africa

2018 ◽  
Vol 33 (6) ◽  
pp. 575-580 ◽  
Author(s):  
Annet Ngabirano Alenyo ◽  
Wayne P. Smith ◽  
Michael McCaul ◽  
Daniel J. Van Hoving
Keyword(s):  
South Africa ◽  
Emergency Care ◽  
Life Support ◽  
Major Incident ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Publication Type ◽  
Cross Sectional ◽  
Prehospital Emergency ◽  
Level Of Training

AbstractIntroductionMajor-incident triage ensures effective emergency care and utilization of resources. Prehospital emergency care providers are often the first medical professionals to arrive at any major incident and should be competent in primary triage. However, various factors (including level of training) influence their triage performance.Hypothesis/ProblemThe aim of this study was to determine the difference in major-incident triage performance between different training levels of prehospital emergency care providers in South Africa utilizing the Triage Sieve algorithm.MethodsThis was a cross-sectional study involving differently trained prehospital providers: Advanced Life Support (ALS); Intermediate Life Support (ILS); and Basic Life Support (BLS). Participants wrote a validated 20-question pre-test before completing major-incident training. Two post-tests were also completed: a 20-question written test and a three-question face-to-face evaluation. Outcomes measured were triage accuracy and duration of triage. The effect of level of training, gender, age, previous major-incident training, and duration of service were determined.ResultsA total of 129 prehospital providers participated. The mean age was 33.4 years and 65 (50.4%) were male. Most (n=87; 67.4%) were BLS providers. The overall correct triage score pre-training was 53.9% (95% CI, 51.98 to 55.83), over-triage 31.4% (95% CI, 29.66 to 33.2), and under-triage 13.8% (95% CI, 12.55 to 12.22). Post-training, the overall correct triage score increased to 63.6% (95% CI, 61.72 to 65.44), over-triage decreased to 17.9% (95% CI, 16.47 to 19.43), and under-triage increased to 17.8% (95% CI, 16.40 to 19.36). The ALS providers had both the highest likelihood of a correct triage score post-training (odds ratio 1.21; 95% CI, 0.96-1.53) and the shortest duration of triage (median three seconds, interquartile range two to seven seconds; P=.034). Participants with prior major-incident training performed better (P=.001).ConclusionAccuracy of major-incident triage across all levels of prehospital providers in South Africa is less than optimal with non-significant differences post-major-incident training. Prior major-incident training played a significant role in triage accuracy indicating that training should be an ongoing process. Although ALS providers were the quickest to complete triage, this difference was not clinically significant. The BLS and ILS providers with major-incident training can thus be utilized for primary major-incident triage allowing ALS providers to focus on more clinical roles.AlenyoAN, SmithWP, McCaulM, Van HovingDJ. A comparison between differently skilled prehospital emergency care providers in major-incident triage in South Africa. Prehosp Disaster Med. 2018;33(6):575–580.

scholarly journals Dicere Non Nocere: Public Disclosure of Identifiable Patient Information by Health Professionals on Social Media

2020 ◽  
Author(s):  
Matthew S. Katz ◽  
Wasim Ahmed ◽  
Thomas G. Gutheil ◽  
Reshma Jagsi
Keyword(s):  
Social Media ◽  
Health Care Providers ◽  
Health Professionals ◽  
Kappa Statistic ◽  
Time Frame ◽  
Care Providers ◽  
Patient Privacy ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Privacy Breaches

AbstractBackgroundRespecting patient privacy and confidentiality is critical for doctor-patient relationships and public trust in medical professionals. The frequency of potentially identifiable disclosures online during periods of active engagement is unknown. Our aim was to quantify potentially identifiable content shared by physicians and other health care providers on social media using the hashtag #ShareAStoryInOneTweet.MethodsWe used Symplur Signals software to access Twitter’s API and searched for tweets including the hashtag. We identified 1206 tweets by doctors, nurses, and other health professionals out of 43,374 tweets shared May 1-31, 2018. We evaluated tweet content in January 2019, eight months after the study period. To determine the incidence of sharing names or potentially identifiable information about patients, we performed a content analysis of the 754 tweets in which tweets disclosed information about others. We also evaluated whether participants raised concerns about privacy breaches and estimated the frequency of deleted tweets. We used dual, blinded coding for a 10% sample to estimate inter-coder reliability for potential identifiability of tweet content using Cohen’s kappa statistic.Results656 participants, including 486 doctors (74.1%) and 98 nurses (14.9%), shared 754 tweets disclosing information about others rather than themselves. Professional participants sharing stories about patient care disclosed the time frame in 95 (12.6%) and included patient names in 15 (2.0%) of tweets. We estimated that friends or families could likely identify the clinical scenario described in 32.1% of the 754 tweets. Among 348 tweets about potentially living patients, we estimated 162 (46.6%) were likely identifiable by patients. Inter-coder reliability in rating the potential identifiability demonstrated 86.8% agreement, with a Cohen’s Kappa of 0.8 suggesting substantial agreement Of the 1206 tweets we identified, 78 (6.5%) had been deleted on the website but were still viewable in the analytics software dataset.ConclusionsDuring periods of active sharing online, nurses, physicians, and other health professionals may sometimes share more information than patients or families might expect. More study is needed to determine whether similar events arise frequently online and to understand how to best ensure that patients’ rights are adequately respected.

scholarly journals Self-Reported Violence Experienced by Swiss Prehospital Emergency Care Providers

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Simon Savoy ◽  
Pierre-Nicolas Carron ◽  
Nathalie Romain-Glassey ◽  
Nicolas Beysard
Keyword(s):  
Health Care ◽  
Sexual Harassment ◽  
Emergency Care ◽  
Workplace Violence ◽  
Online Survey ◽  
Demographic Data ◽  
Prehospital Emergency Care ◽  
Physical Assault ◽  
Care Providers ◽  
Prehospital Emergency

Background. Workplace violence is a serious and increasing problem in health care. Nevertheless, only few studies were carried out concerning this topic and then mainly in English-speaking countries. The objectives were to describe the acts of violence experienced by prehospital emergency care providers (PECPs) in the western part of Switzerland between January and December 2016 and to assess the consequences for subsequent PECPs behaviors. Methods. An observational cross-sectional study, carried out using an online survey, has been sent to all 416 PECPs in the Canton of Vaud, in the western, French-speaking, part of Switzerland. The survey contained items of demographic data and items to assess the type and consequence of violence sustained. This was classified as five types: verbal assault, intimidation, physical assault, sexual harassment, and sexual assault. Results. 273 (65.6%) PECPs participated in the survey. During 2016, workplace violence was reported by 229 survey participants (83.9%). Most declared to be the victim of such violence between one and three times during the year. In all cases of violence described, the patient and/or a relative initiated aggressive behavior in 96% of cases. Verbal assaults were the most common (99.2% of all acts), followed by intimidation (72.8%), physical assault (69.6%), and sexual harassment (16.3%). Concerning physical assault, PECPs were predominantly victims of spitting and/or jostling (50%). After a violent event, in 50% of cases, the PECPs modified their behavior owing to the experience of workplace violence; 82% now wear protective vests, and 16% carry weapons for self-defense, such as pepper sprays. Seventy-five percent changed their intervention strategies, acting more carefully and using verbal de-escalation techniques or physical restraints for violent patients. Conclusions. Workplace violence is frequent and has significant consequences for PECPs. In order to increase their own security, they increased their protection. These results illustrate their feelings of insecurity, which may have deleterious effects on work satisfaction and motivation. Trial Registration. Our article does not report the results of a health care intervention on human participants.

Apart from the Medical Complaints, Why do Patients Use Emergency Medical Services? Results of a Patient Survey

2021 ◽  
Author(s):  
Silke Piedmont ◽  
Anna Katharina Reinhold ◽  
Jens-Oliver Bock ◽  
Janett Rothhardt ◽  
Enno Swart ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Medical Services ◽  
Emergency Care ◽  
Logistic Models ◽  
Patient Survey ◽  
Insurance Companies ◽  
Medical Services ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Emergency Medical

Abstract Introduction Many countries face an increased use of emergency medical services (EMS) with a decreasing percentage of life-threatening complaints. Though there is a broad discussion among experts about the cause, patients' self-perceived, non-medical reasons for using EMS remain largely unknown. Methods The written survey included EMS patients who had≥1 case of prehospital emergency care in 2016. Four German health insurance companies sent out postal questionnaires to 1312 insured patients. The response rate was 20%; 254 questionnaires were eligible for descriptive and interferential analyses (t-tests, chi2-tests, logistic models). Results The majority of respondents indicated that their EMS use was due to an emergency or someone else’s decision (≥84%; multiple checks allowed); 56% gave need for a quick transport as a reason. Other frequently stated reasons addressed the health care system (e. g., complaints outside of physicians’ opening hours) and insecurity/anxiety about one’s state of health (>45% of the respondents). “Social factors” were similarly important (e. g., 42% affirming, “No one could give me a ride to the emergency department or doctor’s office.”). Every fifth person had contact with other emergency care providers prior to EMS use. Respondents negating an emergency as a reason were less likely to confirm wanting immediate medical care on site or quick transports compared to those affirming an emergency. Patients using EMS at night more often denied having an emergency compared to patients with access to care during the day. Conclusion The study identified a bundle of reasons leading to EMS use apart from medical complaints. Attempts for needs-oriented EMS use should essentially include optimization of the health care and social support system and measures to reduce patients’ insecurity.

Withholding CPR in the Prehospital Setting

1990 ◽  
Vol 5 (1) ◽  
pp. 45-46 ◽  
Author(s):  
Samuel J. Stratton
Keyword(s):  
Emergency Care ◽  
Prehospital Care ◽  
Prehospital Setting ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Care Community ◽  
Social And Emotional ◽  
Number Of Factors ◽  
Prehospital Emergency ◽  
Law And Science

The expansion of hospices and recognition of living wills have made it necessary for emergency care providers to re-evaluate the appropriateness of universal application of cardiopulmonary resuscitation (CPR) in the field. The prehospital care community is coming to realize that CPR is beneficial only in certain specific situations. Some believe that when CPR is not likely to be beneficial, it should be withheld. Withholding CPR seems to be a simple matter of law and science, but a number of factors complicate the issue, especially in the prehospital setting: What are the definitive signs of irreversible, sudden death? When is the application of CPR futile? What are the responsibilities of the prehospital emergency care provider who announce someone dead? What is the lay public's perception of stopping or withholding CPR? Withholding CPR in this environment is a complicated social and emotional issue as well as a scientific and legal one.

Identification of Elder Abuse through Out-of-Hospital Emergency Care Providers

2021 ◽  
pp. RTNP-D-20-00074
Author(s):  
Mari Salminen-Tuomaala ◽  
Juha Tiainen ◽  
Riitta Mikkola ◽  
Eija Paavilainen
Keyword(s):  
Home Environment ◽  
Emergency Care ◽  
Elder Abuse ◽  
Continuing Professional Development ◽  
Risk Groups ◽  
Screening Tools ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Hospital Emergency ◽  
Prehospital Emergency

Background and purposeElder abuse, neglect, and exploitation are under-detected and under-reported. The purpose of this qualitative study was to describe out-ofhospital emergency care providers' experiences of identifying elder abuse.MethodsIndividual theme interviews were conducted with nine prehospital emergency care providers and three community paramedics in spring 2019. The transcribed data were analyzed using inductive content analysis.ResultsAlthough the short duration of care contacts made the identification of elder abuse challenging, the emergency care providers detected indicators of physical, psychological and social abuse, unethical action, material exploitation, and self-neglect/self-abuse. The professionals based their observations on patient and family interviews, on clues in the home environment, on caregiving quality combined with the patient's medical history, and on physical signs, which were the easiest to identify.Implications for PracticeThe identification of elder abuse may be improved by multiprofessional collaboration, by increased attention given to risk groups and common indicators of abuse, and by adoption or creation of screening tools to assist detection and reporting. Training on the detection of elder abuse should be included in nursing and social work curricula and in the continuing professional development of emergency care providers.

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