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Rahmatinejad Z, Tohidinezhad F, Rahmatinejad F, Eslami S, Pourmand A, Abu-Hanna A, Reihani H. Internal validation and comparison of the prognostic performance of models based on six emergency scoring systems to predict in-hospital mortality in the emergency department. BMC Emerg Med 2021; 21:68. [PMID: 34112088 PMCID: PMC8194224 DOI: 10.1186/s12873-021-00459-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022] Open
Abstract
Background Medical scoring systems are potentially useful to make optimal use of available resources. A variety of models have been developed for illness measurement and stratification of patients in Emergency Departments (EDs). This study was aimed to compare the predictive performance of the following six scoring systems: Simple Clinical Score (SCS), Worthing physiological Score (WPS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), and Routine Laboratory Data (RLD) to predict in-hospital mortality. Methods A prospective single-center observational study was conducted from March 2016 to March 2017 in Edalatian ED in Emam Reza Hospital, located in the northeast of Iran. All variables needed to calculate the models were recorded at the time of admission and logistic regression was used to develop the models’ prediction probabilities. The Area Under the Curve for Receiver Operating Characteristic (AUC-ROC) and Precision-Recall curves (AUC-PR), Brier Score (BS), and calibration plots were used to assess the models’ performance. Internal validation was obtained by 1000 bootstrap samples. Pairwise comparison of AUC-ROC was based on the DeLong test. Results A total of 2205 patients participated in this study with a mean age of 61.8 ± 18.5 years. About 19% of the patients died in the hospital. Approximately 53% of the participants were male. The discrimination ability of SCS, WPS, RAPS, REMS, MEWS, and RLD methods were 0.714, 0.727, 0.661, 0.678, 0.698, and 0.656, respectively. Additionally, the AUC-PR of SCS, WPS, RAPS, REMS, EWS, and RLD were 0.39, 0.42, 0.35, 0.34, 0.36, and 0.33 respectively. Moreover, BS was 0.1459 for SCS, 0.1713 for WPS, 0.0908 for RAPS, 0.1044 for REMS, 0.1158 for MEWS, and 0.073 for RLD. Results of pairwise comparison which was performed for all models revealed that there was no significant difference between the SCS and WPS. The calibration plots demonstrated a relatively good concordance between the actual and predicted probability of non-survival for the SCS and WPS models. Conclusion Both SCS and WPS demonstrated fair discrimination and good calibration, which were superior to the other models. Further recalibration is however still required to improve the predictive performance of all available models and their use in clinical practice is still unwarranted.
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Affiliation(s)
- Zahra Rahmatinejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Tohidinezhad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Rahmatinejad
- Department of Health Information Technology, Faculty of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. .,Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, AZ, 1105, the Netherlands. .,Pharmaceutical Research Center, Pharmaceutical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ali Pourmand
- Department of Emergency Medicine, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, AZ, 1105, the Netherlands
| | - Hamidreza Reihani
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Hamza M, Alsma J, Kellett J, Brabrand M, Christensen EF, Cooksley T, Haak HR, Nanayakkara PWB, Merten H, Schouten B, Weichert I, Subbe CP. Can vital signs recorded in patients' homes aid decision making in emergency care? A Scoping Review. Resusc Plus 2021; 6:100116. [PMID: 33870237 PMCID: PMC8035051 DOI: 10.1016/j.resplu.2021.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 10/31/2022] Open
Abstract
Aim Use of tele-health programs and wearable sensors that allow patients to monitor their own vital signs have been expanded in response to COVID-19. We aimed to explore the utility of patient-held data during presentation as medical emergencies. Methods We undertook a systematic scoping review of two groups of studies: studies using non-invasive vital sign monitoring in patients with chronic diseases aimed at preventing unscheduled reviews in primary care, hospitalization or emergency department visits and studies using vital sign measurements from wearable sensors for decision making by clinicians on presentation of these patients as emergencies. Only studies that described a comparator or control group were included. Studies limited to inpatient use of devices were excluded. Results The initial search resulted in 896 references for screening, nine more studies were identified through searches of references. 26 studies fulfilled inclusion and exclusion criteria and were further analyzed. The majority of studies were from telehealth programs of patients with congestive heart failure or Chronic Obstructive Pulmonary Disease. There was limited evidence that patient held data is currently used to risk-stratify the admission or discharge process for medical emergencies. Studies that showed impact on mortality or hospital admission rates measured vital signs at least daily. We identified no interventional study using commercially available sensors in watches or smart phones. Conclusions Further research is needed to determine utility of patient held monitoring devices to guide management of acute medical emergencies at the patients' home, on presentation to hospital and after discharge back to the community.
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Affiliation(s)
- Muhammad Hamza
- Department of Acute Medicine, Ysbyty Gwynedd Hospital, Bangor, United Kingdom
| | - Jelmer Alsma
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - John Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Erika F Christensen
- Center for Prehospital and Emergency Research, Clinic of Internal and Emergency Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Tim Cooksley
- Department of Acute Medicine, University Hospital of South Manchester, Manchester, United Kingdom
| | - Harm R Haak
- Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Prabath W B Nanayakkara
- Section of Acute Medicine, Department of Internal Medicine, Amsterdam Public Health research institute, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Bo Schouten
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Immo Weichert
- Department of Acute Medicine, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, United Kingdom
| | - Christian P Subbe
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
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Introduction of a standardised protocol, including systematic use of tranexamic acid, for management of severe adult trauma patients in a low-resource setting: the MSF experience from Port-au-Prince, Haiti. BMC Emerg Med 2019; 19:56. [PMID: 31627715 PMCID: PMC6798378 DOI: 10.1186/s12873-019-0266-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/12/2019] [Indexed: 12/04/2022] Open
Abstract
Background Bleeding is an important cause of death in trauma victims. In 2010, the CRASH-2 study, a multicentre randomized control trial on the effect of tranexamic acid (TXA) administration to trauma patients with suspected significant bleeding, reported a decreased mortality in randomized patients compared to placebo. Currently, no evidence on the use of TXA in humanitarian, low-resource settings is available. We aimed to measure the hospital outcomes of adult patients with severe traumatic bleeding in the Médecins Sans Frontières Tabarre Trauma Centre in Port-au-Prince, Haiti, before and after the implementation of a Massive Haemorrhage protocol including systematic early administration of TXA. Methods Patients admitted over comparable periods of four months (December2015- March2016 and December2016 - March2017) before and after the implementation of the Massive Haemorrhage protocol were investigated. Included patients had blunt or penetrating trauma, a South Africa Triage Score ≥ 7, were aged 18–65 years and were admitted within 3 h from the traumatic event. Measured outcomes were hospital mortality and early mortality rates, in-hospital time to discharge and time to discharge from intensive care unit. Results One-hundred and sixteen patients met inclusion criteria. Patients treated after the introduction of the Massive Haemorrhage protocol had about 70% less chance of death during hospitalization compared to the group “before” (adjusted odds ratio 0.3, 95%confidence interval 0.1–0.8). They also had a significantly shorter hospital length of stay (p = 0.02). Conclusions Implementing a Massive Haemorrhage protocol including early administration of TXA was associated with the reduced mortality and hospital stay of severe adult blunt and penetrating trauma patients in a context with poor resources and limited availability of blood products.
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Dalwai MK, Tayler-Smith K, Trelles M, Jemmy JP, Maikéré J, Twomey M, Wakeel M, Iqbal M, Zachariah R. Implementation of a triage score system in an emergency room in Timergara, Pakistan. Public Health Action 2015; 3:43-5. [PMID: 26392995 DOI: 10.5588/pha.12.0083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/10/2012] [Indexed: 11/10/2022] Open
Abstract
Following implementation of the South African Triage Scale (SATS) system in the emergency department (ED) at the District Headquarter Hospital in Timergara, Pakistan, we 1) describe the implementation process, and 2) report on how accurately emergency staff used the system. Of the 370 triage forms evaluated, 320 (86%) were completed without errors, resulting in the correct triage priority being assigned. Fifty completed forms displayed errors, but only 16 (4%) resulted in an incorrect triage priority being assigned. This experience shows that the SATS can be implemented successfully and used accurately by nurses in an ED in Pakistan.
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Affiliation(s)
- M K Dalwai
- Médecins Sans Frontières (MSF), Islamabad, Pakistan ; Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - K Tayler-Smith
- Medical Department, Operational Research, Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - M Trelles
- MSF, Brussels Operational Centre, Brussels, Belgium
| | - J-P Jemmy
- MSF, Brussels Operational Centre, Brussels, Belgium
| | - J Maikéré
- Médecins Sans Frontières (MSF), Islamabad, Pakistan
| | - M Twomey
- Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - M Wakeel
- Ministry of Health, Timergara, Lower Dir, Pakistan
| | - M Iqbal
- Médecins Sans Frontières (MSF), Islamabad, Pakistan
| | - R Zachariah
- Medical Department, Operational Research, Operational Centre Brussels, MSF-Luxembourg, Luxembourg
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Murray A, Kellett J, Huang W, Woodworth S, Wang F. Trajectories of the averaged abbreviated Vitalpac™ early warning score (AbEWS) and clinical course of 44,531 consecutive admissions hospitalized for acute medical illness. Resuscitation 2014; 85:544-8. [DOI: 10.1016/j.resuscitation.2013.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/28/2013] [Accepted: 12/11/2013] [Indexed: 12/01/2022]
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Kellett J, Woodworth S, Wang F, Huang W. Changes and their prognostic implications in the abbreviated Vitalpac™ early warning score (ViEWS) after admission to hospital of 18,853 acutely ill medical patients. Resuscitation 2013; 84:13-20. [DOI: 10.1016/j.resuscitation.2012.08.331] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 08/26/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
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Hickey A, Gleeson M, Kellett J. READS: the Rapid Electronic Assessment Documentation System. ACTA ACUST UNITED AC 2012; 21:1333-6, 1338-40. [DOI: 10.12968/bjon.2012.21.22.1333] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Affiliation(s)
- John Kellett
- Nenagh Hospital, Department of Medicine, Nenagh, Co. Tipperary, Ireland.
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Kellett J, Emmanuel A, Deane B. Who will be sicker in the morning? Changes in the Simple Clinical Score the day after admission and the subsequent outcomes of acutely ill unselected medical patients. Eur J Intern Med 2011; 22:375-81. [PMID: 21767755 DOI: 10.1016/j.ejim.2011.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 03/06/2011] [Accepted: 03/14/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND All doctors are haunted by the possibility that a patient they reassured yesterday will return seriously ill tomorrow. We examined changes in the Simple Clinical Score (SCS) the day after admission, factors that might influence these changes and the relationship of these changes to subsequent clinical outcome. METHOD The SCS was recorded in 1165 patients on admission and again the following day (i.e. 25.0±15.8 h later). The abilities of 51 variables that might predict changes in the SCS were examined. RESULTS The day after admission 16.1% of patients had been discharged home, 31.4% had decreased their SCS by 2.4±1.6 points, 38.6% had an unchanged SCS, 12.0% had increased their SCS by 2.1±1.7 points and 1.2% had died. Patients with an increased SCS had higher in-hospital mortality (10% vs. 1.1%, OR 10.1, p<.001) and a longer length of stay (9.4±9.6 vs. 5.6±7.0 days, p<.001). There was no consistent association between the SCS recorded at admission and SCS increase. Only nursing home residence, heart failure and a Medical Admission Risk System laboratory data score>0.09 were found to be independent predictors of SCS increase. CONCLUSION The SCS of 12% of patients increases the day after admission to hospital, which is associated with a ten-fold increase of in-hospital mortality. Low SCS risk patients are just as likely to have a SCS increase as high risk patients.
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Affiliation(s)
- John Kellett
- Department of Medicine, Nenagh Hospital, Nenagh, County Tipperary, Ireland.
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