scholarly journals Interrater Agreement of The Copenhagen Triage Algorithm

2020 ◽  
Author(s):  
Julie Inge-Marie Helene Borchsenius ◽  
Rasmus Hasselbalch ◽  
Morten Lind ◽  
Lisbet Ravn ◽  
Thomas Kallemose ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Incomplete Data ◽  
Interrater Agreement ◽  
Evidence Based ◽  
Triage Category ◽  
Hospital Patients ◽  
Kappa Value ◽  
Interrater Variability ◽  
Triage Algorithm

Abstract Introduction Systematic triage is performed in the Emergency Department (ED) to assess the urgency of care for each patient. The Copenhagen Triage Algorithm (CTA) is a newly developed, evidence-based triage system, however the interrater agreement remains unknown. Method This was a prospective cohort study. The collection of data was conducted in the three sections (Acute/Cardiology, Medicine and Surgery) of the ED of Herlev Hospital. Patients were assessed independently by two different nurses using CTA. The interrater variability of CTA was calculated using Fleiss kappa. The analysis was stratified according to less or more than 2 years of ED experience. Results A total of 110 patients were included of which 10 were excluded due to incomplete data. The raters agreed on triage category 80 % of the time corresponding to a kappa value of 0.70 (95% confidence interval 0.57-0.83). Stratified on ED sections, the agreement was 83 % in the Acute/Cardiology section corresponding to a kappa value of 0.73 (0.55-0.91), 79 % in the Medicine section corresponding to a kappa value of 0.64 (0.39-0.89) and 0.56 % in the Surgery section corresponding to a kappa value of 0.56 (0.21-0.90). The experienced raters had an interrater agreement of 0.73 (0.56-0.90), while the less experienced raters had an agreement of 0.76, (0.28-1.24). Conclusion A substantial interrater agreement was found for the Copenhagen triage algorithm.

scholarly journals The Hanging Chin Sign As A Mortality Predictor In Geriatric Patients At The Emergency Department: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Anneloes NJ Huijgens ◽  
Laurens J van Baardewijk ◽  
Carolina JPW Keijsers
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Geriatric Patients ◽  
Lateral View ◽  
X Ray ◽  
Hospital Patients ◽  
Chest X Ray

Abstract BACKGROUND: At the emergency department, there is a need for an instrument which is quick and easy to use to identify geriatric patients with the highest risk of mortality. The so- called ‘hanging chin sign’, meaning that the mandibula is seen to project over one or more ribs on the chest X-ray, could be such an instrument. This study aims to investigate whether the hanging chin sign is a predictor of mortality in geriatric patients admitted through the emergency department. METHODS: We performed an observational retrospective cohort study in a Dutch teaching hospital. Patients of ≥ 65 years who were admitted to the geriatric ward following an emergency department visit were included. The primary outcome of this study was mortality. Secondary outcomes included the length of admission, discharge destination and the reliability compared to patient-related variables and the APOP screener.RESULTS: 396 patients were included in the analysis. Mean follow up was 300 days; 207 patients (52%) died during follow up. The hanging chin sign was present in 85 patients (21%). Patients with the hanging chin sign have a significantly higher mortality risk during admission (OR 2.94 (1.61 to 5.39), p < 0.001), within 30 days (OR 2.49 (1.44 to 4.31), p = 0.001), within 90 days (OR 2.16 (1.31 to 3.56), p = 0.002) and within end of follow up (OR 2.87 (1.70 to 4.84),p < 0.001). A chest X-ray without a PA view or lateral view was also associated with mortality. This technical detail of the chest x-ray and the hanging chin sign both showed a stronger association with mortality than patient-related variables or the APOP screener. CONCLUSIONS: The hanging chin sign and other details of the chest x-ray were strong predictors of mortality in geriatric patients presenting at the emergency department. Compared to other known predictors, they seem to do even better in predicting mortality.

scholarly journals Suitability of the German version of the Manchester Triage System to redirect emergency department patients to general practitioner care: a prospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e024896 ◽  
Author(s):  
Anna Slagman ◽  
Felix Greiner ◽  
Julia Searle ◽  
Linton Harriss ◽  
Fintan Thompson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
General Practitioner ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
German Version ◽  
Triage System ◽  
Manchester Triage System ◽  
General Practitioner Care ◽  
Triage Category

ObjectivesTo investigate the suitability of the German version of the Manchester Triage System (MTS) as a potential tool to redirect emergency department (ED) patients to general practitioner care. Such tools are currently being discussed in the context of reorganisation of emergency care in Germany.DesignProspective cohort study.SettingSingle centre University Hospital Emergency Department.ParticipantsAdult, non-surgical ED patients.ExposureA non-urgent triage category was defined as a green or blue triage category according to the German version of the MTS.Primary and secondary outcome measuresSurrogate parameters for short-term risk (admission rate, diagnoses, length of hospital stay, admission to the intensive care unit, in-hospital and 30-day mortality) and long-term risk (1-year mortality).ResultsA total of 1122 people presenting to the ED participated in the study. Of these, 31.9% (n=358) received a non-urgent triage category and 68.1% (n=764) were urgent. Compared with non-urgent ED presentations, those with an urgent triage category were older (median age 60 vs 56 years, p=0.001), were more likely to require hospital admission (47.8% vs 29.6%) and had higher in-hospital mortality (1.6% vs 0.8%). There was no significant difference observed between non-urgent and urgent triage categories for 30-day mortality (1.2% [n=4] vs 2.2% [n=15]; p=0.285) or for 1-year mortality (7.9% [n=26] vs 10.5% [n=72]; p=0.190). Urgency was not a significant predictor of 1-year mortality in univariate (HR=1.35; 95% CI 0.87 to 2.12; p=0.185) and multivariate regression analyses (HR=1.20; 95% CI 0.77 to 1.89; p=0.420).ConclusionsThe results of this study suggest the German MTS is unsuitable to safely identify patients for redirection to non-ED based GP care.Trial registration numberU1111-1119-7564; Post-results

scholarly journals Physician follow-up and long-term use of evidence-based medication for patients with hypertension who were discharged from an emergency department: a prospective cohort study

CMAJ Open ◽  
2018 ◽  
Vol 6 (2) ◽  
pp. E151-E161 ◽  
Author(s):  
Clare L. Atzema ◽  
Bing Yu ◽  
Michael J. Schull ◽  
Cynthia A. Jackevicius ◽  
Noah M. Ivers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Evidence Based

scholarly journals Development and Validation of a Practical Machine-learning Triage Algorithm for the Detection of Patients in Need of Critical Care in the Emergency Department

2021 ◽  
Author(s):  
Yecheng Liu ◽  
Jiandong Gao ◽  
Jihai Liu ◽  
Joseph Harold Walline ◽  
Xiaoying Liu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Emergency Department ◽  
Cohort Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Characteristic Curve ◽  
Learning System ◽  
Validation Dataset ◽  
Development And Validation ◽  
Triage Algorithm

Abstract Identifying critically ill patients is a key challenge in emergency department (ED) triage. Mis-triage errors are still widespread in triage systems around the world. Here, we present a machine learning system (MLS) to assist ED triage officers better recognize critically ill patients and provide a text-based explanation of the MLS recommendation. To derive the MLS, an existing dataset of 20,272 patient encounters from 2012 to 2019 from our institution’s electronic emergency triage system (EETS) was used for algorithm training. We then conducted a prospective randomized cohort study of ED patients between March and April 2020. The area under the receiver operating characteristic curve (AUC) was 0.86 in a retrospective validation dataset of 2,000 randomized database cases. In the prospective cohort study, compared to the traditional triage system’s 1.2% mis-triage rate, the mis-triage rate in the MLS-assisted group was 0.9%. This MLS method with a real-time explanation for triage officers was able to lower the mis-triage rate of critically ill ED patients.

The Red Legs RATED tool to improve diagnosis of lower limb cellulitis in the emergency department

2021 ◽  
Vol 30 (12) ◽  
pp. S22-S29
Author(s):  
Gillian O'Brien ◽  
Patricia White
Keyword(s):  
Emergency Department ◽  
Lower Limb ◽  
Treatment Guidelines ◽  
Positive Impact ◽  
Data Gathering ◽  
Pilot Project ◽  
Accurate Diagnosis ◽  
Evidence Based ◽  
Significant Burden ◽  
User Friendly

Background: Lower limb cellulitis poses a significant burden for the Irish healthcare system. Accurate diagnosis is difficult, with a lack of validated evidence-based tools and treatment guidelines, and difficulties distinguishing cellulitis from its imitators. It has been suggested that around 30% of suspected lower limb cellulitis is misdiagnosed. An audit of 132 patients between May 2017 and May 2018 identified a pattern of misdiagnosis in approximately 34% of this cohort. Objective: The aim of this pilot project was to develop a streamlined service for those presenting to the emergency department with red legs/suspected cellulitis, through introduction of the ‘Red Leg RATED’ tool for clinicians. Method: The tool was developed and introduced to emergency department clinicians. Individuals (n=24) presenting with suspected cellulitis over 4 weeks in 2018 were invited to participate in data gathering. Finally, clinician questionnaire feedback regarding the tool was evaluated. Results: Fourteen participants consented, 6 female and 8 male with mean age of 65 years. The tool identified 50% (n=7) as having cellulitis, of those 57% (n=4) required admission, 43% (n=3) were discharged. The remainder who did not have cellulitis (n=7) were discharged. Before introduction of the tool, all would typically have been admitted to hospital for further assessment and management of suspected lower limb cellulitis. Overall, 72% (n=10) of patients who initially presented with suspected cellulitis were discharged, suggesting positive impact of the tool. Clinician feedback suggested all were satisfied with the tool and contents. Conclusion: The Red Leg RATED tool is user friendly and impacts positively on diagnosis treatment and discharge. Further evaluation is warranted.

scholarly journals Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 46
Author(s):  
Tina Hansen ◽  
Rikke Lundsgaard Nielsen ◽  
Morten Baltzer Houlind ◽  
Juliette Tavenier ◽  
Line Jee Hartmann Rasmussen ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Cohort Study ◽  
Systemic Inflammation ◽  
Older Patients ◽  
Time Course ◽  
Assessment Tool ◽  
Handgrip Strength ◽  
Secondary Analysis ◽  
Disease Status

There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.

scholarly journals The hospital telemedicine TELEMED database: Providing information on evidence-based telemedicine services to hospital managers and healthcare professionals

2021 ◽  
pp. 1357633X2110155
Author(s):  
Kristian Kidholm ◽  
Ida W Svendsen ◽  
Knud Yderstræde ◽  
Anne M Ølholm ◽  
Kathrine Rayce ◽  
...  
Keyword(s):  
Literature Search ◽  
Healthcare Professionals ◽  
Economic Effects ◽  
Control Group ◽  
Evidence Based ◽  
Implementation Challenges ◽  
Hospital Managers ◽  
Pubmed Database ◽  
Significant Difference ◽  
Hospital Patients

Background Increased use of telemedicine in the healthcare system is a political goal in Denmark. Although the number of hospital patients using interventions such as the video consultation has increased in recent years only a small proportion of the outpatient and inpatient visits involve telemedicine. The TELEMED database ( https://telemedicine.cimt.dk/ ) has been launched at the Center for Innovative Medical Technologies in Denmark to ensure that hospital managers and healthcare professionals have access to information about telemedicine services and their effectiveness. This article describes the development and the content of the TELEMED database. Methods A structured literature search was made in the PubMed Database for randomised controlled trials or observational studies with a control group that investigated the effect of telemedicine interventions for hospital patients. Data were extracted from each article on the clinical effectiveness, patient perceptions, economic effects and implementation challenges. As the database should only provide inspiration to healthcare professionals regarding possibilities for use of telemedicine, the risk of bias in the studies was not assessed. Results The literature search resulted in 2825 hits. Based on full text assessment, 331 articles were included for data extraction and assessment. These articles present telemedicine services used in 22 different medical specialities. Forty-eight percent of the studies found a positive, statistically significant clinical effect, while 47% showed no statistically significant difference. In 48% of the studies, patients’ experiences were examined and of these 68% found positive patient experiences. Fifty-four percent of the articles included information on the economic effects and, of these, 51% found reduction in healthcare utilization. In the majority of studies between two and four types of implementation challenges were found. Conclusions and recommendations: The TELEMED database provides an easily accessible overview of existing evidence-based telemedicine services for use by hospital managers and health professionals, who whish to to implement telemedicine. The database is freely available and expected to be continuously improved and broadened over time.

scholarly journals Electronic cigarettes in standard smoking cessation treatment by tobacco counselors in Flanders: E-cigarette users show similar if not higher quit rates as those using commonly recommended smoking cessation aids

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Karolien Adriaens ◽  
Eline Belmans ◽  
Dinska Van Gucht ◽  
Frank Baeyens
Keyword(s):  
Smoking Cessation ◽  
Cohort Study ◽  
Replacement Therapy ◽  
Electronic Cigarettes ◽  
Evidence Based ◽  
Smoking Abstinence ◽  
Smoking Cessation Treatment ◽  
Cessation Treatment ◽  
Point Prevalence Abstinence

Abstract Background This interventional-cohort study tried to answer if people who smoke and choose an e-cigarette in the context of smoking cessation treatment by tobacco counselors in Flanders are achieving smoking abstinence and how they compare to clients who opt for commonly recommended (or no) aids (nicotine replacement therapy, smoking cessation medication). Methods Participants were recruited by tobacco counselors. They followed smoking cessation treatment (in group) for 2 months. At several times during treatment and 7 months after quit date, participants were asked to fill out questionnaires and to perform eCO measurements. Results One third of all participants (n = 244) achieved smoking abstinence 7 months after the quit date, with e-cigarette users having higher chances to be smoking abstinent at the final session compared to NRT users. Point prevalence abstinence rates across all follow-up measurements, however, as well as continuous and prolonged smoking abstinence, were similar in e-cigarette users and in clients having chosen a commonly recommended (or no) smoking cessation aid. No differences were obtained between smoking cessation aids with respect to product use and experiences. Conclusions People who smoke and choose e-cigarettes in the context of smoking cessation treatment by tobacco counselors show similar if not higher smoking cessation rates compared to those choosing other evidence-based (or no) smoking cessation aids.

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