Demografi og triage af børn med akutte mavesmerter

Formålet med dette studie var primært at beskrive populationen af børn med mavesmerter i de danske akutmodtagelser. Det sekundære formål var at undersøge, om det danske triagesystem viser en tendens til at kunne detektere, hvem der har potentielt livstruende sygdomme (PLS – appendicitis anvendt som indikator), eller omvendt udelukke, hvem der ikke har. Data for alle børn med ”mave- og flankesmerter” i skadestuen på Aarhus Universitetshospital (AUH) i 2017 er inkluderet i dette retroperspektive kohorte-studie. Børnene kategoriseres efter en række karakteristika (alder, køn mv.), og der er vist grafer over triagefordelingen for hver gruppe. 276 børn er inkluderet. Medianalderen var 12 år, med 46% drenge og 54% piger. De fleste havde stærke smerter (239 patienter; 87%) og 90 børn (33%) havde påvirkede vital-parametre. 148 børn (66%) fik en uspecifik diagnose, mens 94 børn (34%) fik en specifik. Appendicitis blev fundet i alle triagekategorier. Data viser en tendens til, at en lav triagescore ikke udelukker PLS (som appendicitis). Det kan sammenfattes, at børn med mavesmerter præsenterer sig meget forskelligt, og at vitalparametrene ved ankomst ikke altid afspejler alvorligheden af den tilstand, som barnet indlægges med. ENGLISH The main aim of this study was to describe characteristics of children presenting with abdominal pain in a Danish Emergency Department (ED). The secondary aim was to assess if the present triage system in the Danish EDs is indicative of children with potentially life-threatening diseases (PLTD – appendicitis used as indicator). Data of all children with “abdominal and flank pain” in the ED at Aarhus University Hospital (AUH) during 2017 were included in this retrospective cohort study. Patients were classified according to several characteristics (e.g. age, gender) and graphs of triage distribution were shown and compared. A total of 276 children were included. Median age was 12 years, with 46% boys and 54% girls. Most patients had severe pain (239 patients, 87%) and 90 patients (33%) had affected vital parameters. A total of 148 patients (66%) got an unspecific diagnosis at discharge, while 94 patients (34%) got a specific diagnosis. Appendicitis was found in all triage categories. Data show a tendency towards low triage not excluding PLTD (such as appendicitis). Also, data suggest that children with abdominal pain show a great variation in symptoms, and vital parameters at admission does not always reflect the severity of the child’s condition.

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Diagnostic anticipation to reduce emergency department length of stay: a cohort study in Ferrara University Hospital, Italy

10.21203/rs.3.rs-20219/v1 ◽

2020 ◽

Author(s):

Andrea Strada ◽

Niccolò Bolognesi ◽

Lamberto Manzoli ◽

Giorgia Valpiani ◽

Chiara Morotti ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Abdominal Pain ◽

Chest Pain ◽

Length Of Stay ◽

Diagnostic Algorithm ◽

University Hospital ◽

Blood Tests ◽

Traumatic Bleeding ◽

Ed Crowding

Abstract Background : Emergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) - a main cause of overcrowding - remains a major issue worldwide. This cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called “diagnostic anticipation”, which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic algorithm approved by physicians. Methods : In the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the diagnostic anticipation protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. Using ED electronic data, LOS independent predictors were evaluated through multiple regression. Results : During the weeks when diagnostic anticipation was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 minutes for chest pain, but longer by 15.7 minutes for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority and ED crowding, the difference in visit time was significant for chest pain only (p<0.001). Conclusions : The effectiveness of the anticipation of blood testing by nurses varied by patients' condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status

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Diagnostic anticipation to reduce emergency department length of stay: a retrospective cohort study in Ferrara University hospital, Italy

BMC Health Services Research ◽

10.1186/s12913-020-05472-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Andrea Strada ◽

Niccolò Bolognesi ◽

Lamberto Manzoli ◽

Giorgia Valpiani ◽

Chiara Morotti ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Length Of Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

University Hospital

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Development of the “POP” scoring system for predicting obstetric and gynecological diseases in the emergency department: A retrospective cohort study

10.21203/rs.2.19944/v1 ◽

2020 ◽

Author(s):

ASAMI OKADA ◽

Yohei Okada ◽

Hiroyuki Fujita ◽

Ryoji Iiduka

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Abdominal Pain ◽

Likelihood Ratio ◽

Retrospective Cohort Study ◽

Scoring System ◽

Retrospective Cohort ◽

Acute Abdominal Pain ◽

Positive Likelihood Ratio ◽

Female Patients

Abstract Background: Obstetric and gynecological (OBGY) diseases are among the most important differential diagnoses for young women with acute abdominal pain. However, there are few established clinical prediction rules for screening OBGY diseases in the emergency department (ED). This study aimed to develop a prediction model for diagnosing OBGY diseases in the ED.Methods: This single-center retrospective cohort study included female patients with acute abdominal pain who presented to our emergency department. We developed a logistic regression model for predicting OBGY diseases and assessed its diagnostic ability. This study included young female patients aged between 16 and 49 years old, who had abdominal pain and were examined at the ED from April 2017 to March 2018. Trauma patients and patients referred from another hospital or from the OBGY department of our hospital were excluded.Results: Of 27,991 patients, 740 were included. Sixty-five patients were diagnosed with OBGY diseases (8.8%). The "POP" scoring system [past history of OBGY diseases +1, no other symptoms +1, and peritoneal irritation signs +1] was developed. Cut-off values set between 0 and 1 points, sensitivity at 97%, specificity at 39%, and negative likelihood ratio (LR-) of 0.08 were considered for rule-out, while cut-off values set between 2 and 3 points, sensitivity at 23%, specificity at 99%, and positive likelihood ratio (LR+) of 17.29 were suitable for rule-in.Conclusions: Our "POP" scoring system can be useful for screening of OBGY diseases in the ED.

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