Changes in Coagulation in Standard Laboratory Tests and ROTEM in Trauma Patients Between On-Scene and Arrival in the Emergency Department

2015 ◽  
Vol 120 (3) ◽  
pp. 627-635 ◽  
Author(s):  
Oliver M. Theusinger ◽  
Werner Baulig ◽  
Burkhardt Seifert ◽  
Stefan M. Müller ◽  
Sergio Mariotti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Laboratory Tests ◽  
Trauma Patients ◽  
Standard Laboratory

scholarly journals Using Unsupervised Machine Learning to Identify Severity Subgroups Among COVID-19 Patients in the Emergency Department (Preprint)

2020 ◽  
Author(s):  
Julián Benito-León ◽  
Mª Dolores del Castillo ◽  
Alberto Estirado ◽  
Ritwik Ghosh ◽  
Souvki Dubey ◽  
...  
Keyword(s):  
Machine Learning ◽  
Emergency Department ◽  
Mortality Rate ◽  
Laboratory Tests ◽  
Vital Signs ◽  
Serum Levels ◽  
Standard Laboratory ◽  
Cluster Assignment ◽  
Unsupervised Machine Learning ◽  
Monocytes And Lymphocytes

BACKGROUND Early detection and intervention are the key factors for improving outcomes in COVID-19. OBJECTIVE To detect severity subgroups among COVID-19 patients, based only on clinical data and standard laboratory tests obtained during the assessment at the emergency department. METHODS We applied unsupervised machine learning to a dataset of 853 COVID-19 patients from HM hospitals in Spain. RESULTS From a total of 850 variables, four tests, the serum levels of aspartate transaminase (AST), lactate dehydrogenase (LDH) and C-reactive protein (CRP), and the number of neutrophils, were enough to segregate the entire patient pool into three separate clusters. Further, the percentage of monocytes and lymphocytes and the levels of alanine transaminase (ALT) distinguished the cluster 3 from the other two clusters. The cluster 1 was characterized by the higher mortality rate and higher levels of AST, ALT, LDH, CRP and number of neutrophils, and low percentage of monocytes and lymphocytes. The cluster 2 included patients with a moderate mortality rate and medium levels of the previous laboratory determinations. The cluster 3 was characterized by the lower mortality rate and lower levels of AST, ALT, LDH, CRP and number of neutrophils, and higher percentage of monocytes and lymphocytes. Age, sex, comorbidities, and vital signs did not allow us to separate the three clusters. An online cluster assignment tool can be found at https://g-nec.car.upm-csic.es/COVID19-severity-group-assessment/. CONCLUSIONS A few standard laboratory tests, deemed to be available in all emergency departments, have shown far discriminative power for characterization of severity subgroups among COVID-19 patients.

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

2021 ◽  
pp. 084653712110238
Author(s):  
Francesco Macri ◽  
Bonnie T. Niu ◽  
Shannon Erdelyi ◽  
John R. Mayo ◽  
Faisal Khosa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Major Trauma ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Trauma Patients ◽  
Linear Regression Models ◽  
High Acuity ◽  
Time Series Approach ◽  
Comparison Series ◽  
The Impact

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

Effective Triage Can Ameliorate the Deleterious Effects of Delayed Transfer of Trauma Patients from the Emergency Department to the ICU

2009 ◽  
Vol 208 (5) ◽  
pp. 671-678 ◽  
Author(s):  
J. David Richardson ◽  
Glen Franklin ◽  
Ariel Santos ◽  
Brian Harbrecht ◽  
Dan Danzl ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Patients

scholarly journals Defining criteria to choose appropriate destination hospital for trauma patients: Piacenza Local Health Authority’s Piacenza trauma algorithm protocol

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Fabio Mozzarelli ◽  
Stefano Nani ◽  
Enrica Rossi ◽  
Mario Pizzamiglio
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Observational Study ◽  
Electronic Device ◽  
Local Health ◽  
Trauma Patients ◽  
Medical Facility ◽  
Provincial Hospital ◽  
Trauma Algorithm ◽  
Data Context

Ambulance crew’s choosing of appropriate destination hospital for trauma patients can affect survival and morbidity outcomes. Aim of the present study is to devise a decision-making algorithm in order to allow the best choice of destination hospital for trauma patients and to apply it on an electronic device able to facilitate the decision made by ambulance staff. The method used was analysis of literature data, context and workload with a retrospective observational study. A comparison between the destination hospitals actually chosen and those that could have been chosen with the <em>Piacenza trauma algorithm</em> has been applied. The data shows a 9.5% (P&gt;0.10) more advantageous change in appropriateness in the choice of medical facility and a 1.4% increase in admissions to the Emergency Department of the provincial hospital. The creation and use of a medical protocol and its consequent installation on an electronic device (tablet) that can be shared over a computer platform could help medical staff make appropriate pre-hospital choices as regards the destination hospital for trauma patients.

scholarly journals Factors Affecting the Likelihood of Presentation to the Emergency Department of Trauma Patients After Discharge

2011 ◽  
Vol 58 (5) ◽  
pp. 431-437 ◽  
Author(s):  
Karim S. Ladha ◽  
J. Hunter Young ◽  
Derek K. Ng ◽  
David T. Efron ◽  
Adil H. Haider
Keyword(s):  
Emergency Department ◽  
Trauma Patients ◽  
Factors Affecting

scholarly journals Recém-nascido com deficiência de glicerol quinase: um caso clínico

2018 ◽  
Vol 28 (3) ◽  
pp. 31385
Author(s):  
Cristina Duarte P. V. G. Madureira ◽  
Cláudia Teles-Silva ◽  
Cláudia Melo ◽  
Susana Gama de Sousa
Keyword(s):  
Emergency Department ◽  
Metabolic Acidosis ◽  
Birth Weight ◽  
Physical Examination ◽  
Laboratory Tests ◽  
Neonatal Period ◽  
Glycerol Kinase ◽  
Glutamic Pyruvic Transaminase ◽  
Glycerol Kinase Deficiency ◽  
Hypernatremic Dehydration

AIMS: To report the case of a newborn with glycerol kinase deficiency, in which an isolated mutation not yet described in the GK gene was identified.CASE DESCRIPTION: A neonate with 10 days of age was brought to the emergency department for refusal to feed with 24 hours of evolution. Physical examination showed a loss of 31% of birth weight and signs of dehydration. Laboratory tests revealed a metabolic acidosis with increased anion gap, creatinine 2.41 mg/dL, urea 306 mg/dL, hypernatremia (182 mEq/L), hyperkalemia (6.8 mEq/L), hyperchloremia (151 mEq/L), glutamic-oxalacetic transaminase 879 U/L, glutamic-pyruvic transaminase 243 U/L, triglycerides 725 mg/dL. Chromotagraphy of organic acids revealed hyperglycerolemia and glyceroluria compatible with glycerol kinase deficiency. The genetic study revealed a mutation not yet described: c.187T> C (p.S63P) as hemizygote status in the GK gene.CONCLUSIONS: The most frequent cause of hypernatremic dehydration in the neonatal period is maternal hypogalactia. In more severe cases of dehydration, other etiologies should be considered, including metabolic causes such as glycerol kinase deficiency. In this case a mutation not yet described in the GK gene was found.

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