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Affiliation(s)
- James Vassallo
- Ophthalmology department, Mater Dei Hospital, Malta (EU)
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2
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Vassallo J. Acute Isolated Near Vision Difficulty in Patients With COVID-19 Infection: Letter to the Editor. J Neuroophthalmol 2024; 44:e203. [PMID: 36166788 DOI: 10.1097/wno.0000000000001672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- James Vassallo
- Ophthalmology Department, Mater Dei Hospital, Msida, Malta
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3
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Xu Y, Malik N, Chernbumroong S, Vassallo J, Keene D, Foster M, Lord J, Belli A, Hodgetts T, Bowley D, Gkoutos G. Triage in major incidents: development and external validation of novel machine learning-derived primary and secondary triage tools. Emerg Med J 2024; 41:176-183. [PMID: 37751994 PMCID: PMC10894820 DOI: 10.1136/emermed-2022-212440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/12/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Major incidents (MIs) are an important cause of death and disability. Triage tools are crucial to identifying priority 1 (P1) patients-those needing time-critical, life-saving interventions. Existing expert opinion-derived tools have limited evidence supporting their use. This study employs machine learning (ML) to develop and validate models for novel primary and secondary triage tools. METHODS Adults (16+ years) from the UK Trauma Audit and Research Network (TARN) registry (January 2008-December 2017) served as surrogates for MI victims, with P1 patients identified using predefined criteria. The TARN database was split chronologically into model training and testing (70:30) datasets. Input variables included physiological parameters, age, mechanism and anatomical location of injury. Random forest, extreme gradient boosted tree, logistic regression and decision tree models were trained to predict P1 status, and compared with existing tools (Battlefield Casualty Drills (BCD) Triage Sieve, CareFlight, Modified Physiological Triage Tool, MPTT-24, MSTART, National Ambulance Resilience Unit Triage Sieve and RAMP). Primary and secondary candidate models were selected; the latter was externally validated on patients from the UK military's Joint Theatre Trauma Registry (JTTR). RESULTS Models were internally tested in 57 979 TARN patients. The best existing tool was the BCD Triage Sieve (sensitivity 68.2%, area under the receiver operating curve (AUC) 0.688). Inability to breathe spontaneously, presence of chest injury and mental status were most predictive of P1 status. A decision tree model including these three variables exhibited the best test characteristics (sensitivity 73.0%, AUC 0.782), forming the candidate primary tool. The proposed secondary tool (sensitivity 77.9%, AUC 0.817), applicable via a portable device, includes a fourth variable (injury mechanism). This performed favourably on external validation (sensitivity of 97.6%, AUC 0.778) in 5956 JTTR patients. CONCLUSION Novel triage tools developed using ML outperform existing tools in a nationally representative trauma population. The proposed primary tool requires external validation prior to consideration for practical use. The secondary tool demonstrates good external validity and may be used to support decision-making by healthcare workers responding to MIs.
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Affiliation(s)
- Yuanwei Xu
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Health Data Science Centre, University of Birmingham, Birmingham B15 2TT, UK
| | - Nabeela Malik
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - Saisakul Chernbumroong
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
| | - James Vassallo
- Emergency Department, Derriford Hospital, Plymouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Damian Keene
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - Mark Foster
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - Janet Lord
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Douglas Bowley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - George Gkoutos
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Health Data Science Centre, University of Birmingham, Birmingham B15 2TT, UK
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- MRC Health Data Research UK (HDR UK), Birmingham, UK
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Shrimpton AJ, Brown V, Vassallo J, Nolan JP, Soar J, Hamilton F, Cook TM, Bzdek BR, Reid JP, Makepeace CH, Deutsch J, Ascione R, Brown JM, Benger JR, Pickering AE. A quantitative evaluation of aerosol generation during cardiopulmonary resuscitation. Anaesthesia 2024; 79:156-167. [PMID: 37921438 PMCID: PMC10952244 DOI: 10.1111/anae.16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
It is unclear if cardiopulmonary resuscitation is an aerosol-generating procedure and whether this poses a risk of airborne disease transmission to healthcare workers and bystanders. Use of airborne transmission precautions during cardiopulmonary resuscitation may confer rescuer protection but risks patient harm due to delays in commencing treatment. To quantify the risk of respiratory aerosol generation during cardiopulmonary resuscitation in humans, we conducted an aerosol monitoring study during out-of-hospital cardiac arrests. Exhaled aerosol was recorded using an optical particle sizer spectrometer connected to the breathing system. Aerosol produced during resuscitation was compared with that produced by control participants under general anaesthesia ventilated with an equivalent respiratory pattern to cardiopulmonary resuscitation. A porcine cardiac arrest model was used to determine the independent contributions of ventilatory breaths, chest compressions and external cardiac defibrillation to aerosol generation. Time-series analysis of participants with cardiac arrest (n = 18) demonstrated a repeating waveform of respiratory aerosol that mapped to specific components of resuscitation. Very high peak aerosol concentrations were generated during ventilation of participants with cardiac arrest with median (IQR [range]) 17,926 (5546-59,209 [1523-242,648]) particles.l-1 , which were 24-fold greater than in control participants under general anaesthesia (744 (309-2106 [23-9099]) particles.l-1 , p < 0.001, n = 16). A substantial rise in aerosol also occurred with cardiac defibrillation and chest compressions. In a complimentary porcine model of cardiac arrest, aerosol recordings showed a strikingly similar profile to the human data. Time-averaged aerosol concentrations during ventilation were approximately 270-fold higher than before cardiac arrest (19,410 (2307-41,017 [104-136,025]) vs. 72 (41-136 [23-268]) particles.l-1 , p = 0.008). The porcine model also confirmed that both defibrillation and chest compressions generate high concentrations of aerosol independent of, but synergistic with, ventilation. In conclusion, multiple components of cardiopulmonary resuscitation generate high concentrations of respiratory aerosol. We recommend that airborne transmission precautions are warranted in the setting of high-risk pathogens, until the airway is secured with an airway device and breathing system with a filter.
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Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - V. Brown
- Critical Care, South Western Ambulance Service NHS Foundation TrustUK
- Great Western Air Ambulance CharityBristolUK
| | - J. Vassallo
- Institute of Naval MedicineGosportUK
- Academic Department of Military Emergency MedicineRoyal Centre for Defence MedicineBirminghamUK
| | - J. P. Nolan
- University of Warwick, Warwick Medical SchoolCoventryUK
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - J. Soar
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - F. Hamilton
- MRC Integrative Epidemiology UnitUniversity of BristolUK
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - B. R. Bzdek
- School of ChemistryUniversity of BristolBristolUK
| | - J. P. Reid
- School of ChemistryUniversity of BristolBristolUK
| | - C. H. Makepeace
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - J. Deutsch
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - R. Ascione
- Translational Biomedical Research CentreUniversity of BristolBristolUK
- University Hospital Bristol Weston NHS TrustBristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - J. R. Benger
- Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
| | - A. E. Pickering
- Department of AnaesthesiaUniversity Hospitals Bristol and WestonBristolUK
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
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Horne S, Hunt P, Hall B, Jefferys S, Vassallo J, Gurney I. A simple research framework will improve mass casualty responses. Lancet 2023; 402:1417. [PMID: 37865462 DOI: 10.1016/s0140-6736(23)01802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/23/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Simon Horne
- Medical Directorate, Royal Centre for Defence Medicine, Birmingham B15 2SG, UK.
| | | | - Ben Hall
- Medical Directorate, Royal Centre for Defence Medicine, Birmingham B15 2SG, UK
| | | | - James Vassallo
- Medical Directorate, Royal Centre for Defence Medicine, Birmingham B15 2SG, UK
| | - Ian Gurney
- Medical Directorate, Royal Centre for Defence Medicine, Birmingham B15 2SG, UK
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Horne S, Hunt P, Hall B, Jefferys S, Vassallo J, Gurney I. War and disaster are forcing a major rethink around mass casualty management. BMJ Mil Health 2023:e002489. [PMID: 37709506 DOI: 10.1136/military-2023-002489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/24/2023] [Indexed: 09/16/2023]
Abstract
Mass casualty events (MASCAL) do not follow the same rules as typical major incidents. In the West at least, the latter often occur in stable, networked trauma systems, whereas MASCAL are characterised by overwhelming numbers of patients, compounded by protracted scene and transport times, decompensated response systems and significant disruption to infrastructure, command and control.This paper describes the 8Ds approach being taken by the UK Defence Medical Services and the North Atlantic Treaty Organization Emergency Medicine Panel framework to approach MASCAL. The eight domains were derived from literature about management of casualties in the World Wars, and also from approaches taken by civilian health systems as they struggle to manage increasing demand. They are: distribute; decompress; delay; delegate; deliver faster and deliver better; dynamic levels of care; and de-escalate These domains will allow a structured approach to research and innovate around MASCAL, informing better guidelines for their management.
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Affiliation(s)
- Simon Horne
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - P Hunt
- 16 Medical Regiment, Colchester, UK
| | - B Hall
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | | | - J Vassallo
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - I Gurney
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Vassallo J, Cowburn P, Park C, Bull D, Harris S, Moran C, Smith J. Ten second triage: A novel and pragmatic approach to major incident triage. Trauma 2023. [DOI: 10.1177/14604086231156219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Triage is a key principle in the effective management of major incidents and has traditionally been performed using an assessment of a casualty's physiology. However, it has become apparent from recent experiences of major incidents that physiological triage may practically not be possible, especially in the early stages of an incident. A key factor is the speed with which it is possible to perform triage, and subsequently, the speed at which key life-saving interventions (e.g., management of external haemorrhage and airway opening manoeuvres) are able to be performed simultaneously as part of the triage process. Addressing this issue was a priority for the review of major incident triage undertaken by NHS England and culminated in the development of the Ten Second Triage (TST) tool.
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Affiliation(s)
- J. Vassallo
- Institute of Naval Medicine, Gosport, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - P. Cowburn
- Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- South Western Ambulance Service NHS Foundation Trust, North Bristol Operations Centre, Bristol, UK
- National Ambulance Resilience Unit (NARU), College of Policing, UK
| | - C. Park
- Academic Department of Military Anaesthesia & Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
- Department of Anaesthesia and Critical Care, Kings College Hospital, London, UK
| | - D. Bull
- National Ambulance Resilience Unit (NARU), College of Policing, UK
| | - S. Harris
- London Ambulance Service, London, UK
| | - C.G. Moran
- NHS England London, London, UK
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J.E. Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Vassallo J, Blakey S, Cowburn P, Surridge J, Smith JE, Scholefield B, Lyttle MD. Paediatric major incident triage: A Delphi process to determine clinicians' attitudes and beliefs within the United Kingdom and Ireland. Acta Paediatr 2023; 112:154-161. [PMID: 36219507 DOI: 10.1111/apa.16567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/14/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
AIM Triage is key to effective management of major incidents, yet there is scarce evidence surrounding the optimal method of paediatric major incident triage (MIT). This study aimed to derive consensus on key components of paediatric MIT among healthcare professionals responsible for triage during paediatric major incidents. METHODS Two-round online Delphi consensus study delivered July 2021-October 2021, including participants from pre-hospital and hospital specialities responsible for triage during paediatric major incidents. A 5-point Likert scale was used to determine consensus, set a priori at 70%. RESULTS 111 clinicians completed both rounds; 13 of 17 statements reached consensus. Positive consensus was reached on rescue breaths in mechanisms associated with hypoxia or asphyxiation, mobility assessment as a crude discriminator and use of adult physiology for older children. Whilst positive consensus was reached on the benefits of a single MIT tool across all adult and paediatric age ranges, there was negative consensus in relation to clinical implementation. CONCLUSIONS This Delphi study has established consensus among a large group of clinicians involved in the management of major incidents on several key elements of paediatric major incident triage. Further work is required to develop a triage tool that can be implemented based on emerging and ongoing research and which is acceptable to clinicians.
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Affiliation(s)
- James Vassallo
- Institute of Naval Medicine, Gosport, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - Sarah Blakey
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Research in Emergency Care, Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| | - Philip Cowburn
- Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.,South Western Ambulance Service NHS Foundation Trust, North Bristol Operations Centre, Bristol, UK.,National Ambulance Resilience Unit (NARU), College of Policing, Ryton on Dunsmore, UK
| | - Julia Surridge
- Emergency Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Jason E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK.,Emergency department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Barney Scholefield
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Paediatric Intensive Care, Birmingham Women & Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | - Mark D Lyttle
- Research in Emergency Care, Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK.,Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Vella K, Vella S, Savona-Ventura C, Vassallo J. Thyroid dysfunction in pregnancy - a retrospective observational analysis of a Maltese cohort. BMC Pregnancy Childbirth 2022; 22:941. [PMID: 36522704 PMCID: PMC9756451 DOI: 10.1186/s12884-022-05266-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Thyroid dysfunction is known to adversely affect pregnancy. This study evaluates the prevalence of thyroid disorders and explores their association with pregnancy complications/comorbidities and modes of delivery in the Maltese pregnant population over a ten year period. DESIGN A population based observational study. METHOD We analysed data from the National Obstetrics Information Service of the Department of Health Informations and Research (NOIS) for all births delivered in Malta between 2006 and 2016. Cases identified and recorded by NOIS to have had some form of thyroid dysfunction during pregnancy were confirmed by cross-referencing with laboratory results found in patients' medical records and/or iSOFT® database system. Using the Statistical Package for the Social sciences (SPSS®) demographic data, past obstetric and medical history and obstetric outcomes were analysed for pregnancies with thyroid dysfunction and compared to data pertaining to pregnancies in euthyroid patients, that is those with no recorded thyroid dysfunction on NOIS. Chi square/Fisher's exact test were used to compare categorical variables while ANOVA/Mann-Whitney U test was used to compare continuous variables. Statistical significance was defined by a two-sided p value <0.05. RESULTS Data was available for 46,283 women (mean [SD] age = 29.2 [5.4] years). 587 pregnancies (1.3%) suffered from thyroid dysfunction. Of these, 67.3% were hypothyroid, 3.2% had hyperthyroidism, 28.3% had isolated hypothyroxinaemia (IHT) while 1.2% had a history of thyroid carcinoma. Patients with IHT and hypothyroidism were older than euthyroid patients (p < 0.001). IHT and hypothyroid patients had a statistically significant higher body mass index (BMI) than euthyroid women (p=0.001 for hypothyroid women, p = 0.035 for IHT). Hypothyroid and IHT women were more likely to have had a previous lower segment caesarean section (p=0.043, and 0.006 respectively). Type 1 diabetes and gestational diabetes p = 0.012) were more common associated comorbidities in hypothyroid pregnancies. Offspring of patients with IHT had a higher birth weight than those born to euthyroid patients (p=0.009). Patients with hyperthyroidism were found to have a significantly increased risk of early preterm delivery before 34 weeks of gestation and were also more likely to have suspected intrauterine growth restriction and low mean birth weight. We report no significant differences in past history of obstetric loss, antenatal complications, mode of delivery, gestational age at delivery and postpartum haemorrhage rates across thyroid categories. CONCLUSIONS Available evidence suggests that thyroid dysfunction is more likely in the setting of older age, and higher body mass index. Moreover, it impacts on neonatal birth weight, rates of early preterm delivery and intrauterine growth restriction.
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Affiliation(s)
- Katia Vella
- grid.416552.10000 0004 0497 3192Department of Obstetrics and Gynaecology, Mater Dei Hospital, Msida, Malta ,grid.4462.40000 0001 2176 9482Department of Obstetrics and Gynaecology, Faculty of Medicine and Surgery, University of Malta Medical School, Msida, Malta
| | - Sandro Vella
- grid.4462.40000 0001 2176 9482Department of Medicine, Faculty of Medicine and Surgery, University of Malta Medical School, Msida, Malta ,grid.416552.10000 0004 0497 3192Department of Medicine, Division of Endocrinology, Mater Dei Hospital, Msida, Malta
| | - C. Savona-Ventura
- grid.4462.40000 0001 2176 9482Department of Obstetrics and Gynaecology, Faculty of Medicine and Surgery, University of Malta Medical School, Msida, Malta
| | - J. Vassallo
- grid.4462.40000 0001 2176 9482Department of Medicine, Faculty of Medicine and Surgery, University of Malta Medical School, Msida, Malta ,grid.416552.10000 0004 0497 3192Department of Medicine, Division of Endocrinology, Mater Dei Hospital, Msida, Malta
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Vassallo J, Moran CG, Cowburn P, Smith J. New NHS Prehospital Major Incident Triage Tool: from MIMMS to MITT. Emerg Med J 2022; 39:800-802. [PMID: 36244685 PMCID: PMC9613863 DOI: 10.1136/emermed-2022-212569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022]
Abstract
Triage is a key principle in the effective management of major incidents and is the process by which patients are prioritised on the basis of their clinical acuity. However, work published over the last decade has demonstrated that existing methods of triage perform poorly when trying to identify patients in need of life-saving interventions. As a result, a review of major incident triage was initiated by NHS England with the remit to determine the optimum way in which to triage patients of all ages in a major incident for the UK. This article describes the output from this review, the changes being undertaken to UK major incident triage and the introduction of the new NHS Major Incident Triage Tool from the Spring of 2023.
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Affiliation(s)
- James Vassallo
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - Chris G Moran
- Department of Orthopaedic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Philip Cowburn
- Emergency Department, Bristol Royal Infirmary, Bristol, UK
| | - Jason Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Vassallo J. Comment on: 'Peripapillary hyperreflective ovoid mass-like structures-a novel entity as frequent cause of pseudopapilloedema in children'. Eye (Lond) 2022; 36:2067. [PMID: 35046549 PMCID: PMC9500004 DOI: 10.1038/s41433-021-01907-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/14/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- James Vassallo
- Ophthalmology Department, Mater Dei Hospital, Triq Id-Donaturi tad-Demm, Msida, MSD2090, Malta.
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Vassallo J, Chernbumroong S, Malik N, Xu Y, Keene D, Gkoutos G, Lyttle M, Smith J. 834 Comparative analysis of major incident triage tools in children – a UK population-based analysis. Emerg Med J 2022. [DOI: 10.1136/emermed-2022-rcem.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims/Objectives/BackgroundTriage is a key principle in the effective management of major incidents. There is currently a paucity of evidence to guide the triage of children. The aim of this study was to perform a comparative analysis of nine adult and paediatric triage tools, including the novel ‘Sheffield Paediatric Triage Tool’ (SPTT), assessing their ability in identifying patients needing life-saving interventions (LSI).Methods/DesignA ten-year retrospective database review of TARN data for paediatric patients (<16years) was performed. Primary outcome was identification of patients receiving one or more LSIs from a previously defined list. Secondary outcomes included mortality and prediction of ISS>15. Primary analysis was conducted on patients with complete pre-hospital physiological data with planned secondary analyses using first recorded physiological data. Performance characteristics were evaluated using sensitivity, specificity, under and over-triage.Results15133 patients met TARN inclusion criteria. 4962 (32.8%) had complete pre-hospital physiological data and 8255 (54.5%) had complete first recorded data. Male patients predominated (69.5%), sustaining blunt trauma (95.4%) with a median ISS of 9. 875 patients (17.6%) received at least one LSI.The SPTT demonstrated the greatest sensitivity of all triage tools at identifying need for LSI (92.2%) but was associated with the highest rate of over-triage (75.0%). Both the PTT (sensitivity 34.1%) and JumpSTART (sensitivity 45.0%) performed less well at identifying LSI. By contrast, the adult MPTT-24 triage tool had the second highest sensitivity (80.8%) with tolerable rates of over-triage (70.2%).ConclusionThe SPTT and MPTT-24 outperform existing paediatric triage tools at identifying those patients requiring LSIs. This may necessitate a change in recommended practice. Further work is needed to determine the optimum method of paediatric major incident triage, but consideration should be given to simplifying major incident triage by the use of one generic tool (the MPTT-24) for adults and children.
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Vassallo J, Chernbumroong S, Malik N, Xu Y, Keene D, Gkoutos G, Lyttle MD, Smith J. Comparative analysis of major incident triage tools in children: a UK population-based analysis. Emerg Med J 2021; 39:emermed-2021-211706. [PMID: 34706900 PMCID: PMC9510399 DOI: 10.1136/emermed-2021-211706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/08/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Triage is a key principle in the effective management of major incidents. There is currently a paucity of evidence to guide the triage of children. The aim of this study was to perform a comparative analysis of nine adult and paediatric triage tools, including the novel 'Sheffield Paediatric Triage Tool' (SPTT), assessing their ability in identifying patients needing life-saving interventions (LSIs). METHODS A 10-year (2008-2017) retrospective database review of the Trauma Audit Research Network (TARN) Database for paediatric patients (<16 years) was performed. Primary outcome was identification of patients receiving one or more LSIs from a previously defined list. Secondary outcomes included mortality and prediction of Injury Severity Score (ISS) >15. Primary analysis was conducted on patients with complete prehospital physiological data with planned secondary analyses using first recorded data. Performance characteristics were evaluated using sensitivity, specificity, undertriage and overtriage. RESULTS 15 133 patients met TARN inclusion criteria. 4962 (32.8%) had complete prehospital physiological data and 8255 (54.5%) had complete first recorded physiological data. The majority of patients were male (69.5%), with a median age of 11.9 years. The overwhelming majority of patients (95.4%) sustained blunt trauma, yielding a median ISS of 9 and overall, 875 patients (17.6%) received at least one LSI. The SPTT demonstrated the greatest sensitivity of all triage tools at identifying need for LSI (92.2%) but was associated with the highest rate of overtriage (75.0%). Both the Paediatric Triage Tape (sensitivity 34.1%) and JumpSTART (sensitivity 45.0%) performed less well at identifying LSI. By contrast, the adult Modified Physiological Triage Tool-24 (MPTT-24) triage tool had the second highest sensitivity (80.8%) with tolerable rates of overtriage (70.2%). CONCLUSION The SPTT and MPTT-24 outperform existing paediatric triage tools at identifying those patients requiring LSIs. This may necessitate a change in recommended practice. Further work is needed to determine the optimum method of paediatric major incident triage, but consideration should be given to simplifying major incident triage by the use of one generic tool (the MPTT-24) for adults and children.
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Affiliation(s)
- James Vassallo
- Institute of Naval Medicine, Gosport, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - Saisakul Chernbumroong
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nabeela Malik
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Yuanwei Xu
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Damian Keene
- Department of Anaesthesia, University Hospitals Birmingham, Birmingham, UK
| | - George Gkoutos
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- MRC Health Data Research UK (HDR UK), Birmingham, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Children's Hospital, Bristol, UK
| | - Jason Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Malik NS, Chernbumroong S, Xu Y, Vassallo J, Lee J, Moran CG, Newton T, Arul GS, Lord JM, Belli A, Keene D, Foster M, Hodgetts T, Bowley DM, Gkoutos GV. Paediatric major incident triage: UK military tool offers best performance in predicting the need for time-critical major surgical and resuscitative intervention. EClinicalMedicine 2021; 40:101100. [PMID: 34746717 PMCID: PMC8548919 DOI: 10.1016/j.eclinm.2021.101100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Children are frequently injured during major incidents (MI), including terrorist attacks, conflict and natural disasters. Triage facilitates healthcare resource allocation in order to maximise overall survival. A critical function of MI triage tools is to identify patients needing time-critical major resuscitative and surgical intervention (Priority 1 (P1) status). This study compares the performance of 11 MI triage tools in predicting P1 status in children from the UK Trauma Audit and Research Network (TARN) registry. METHODS Patients aged <16 years within TARN (January 2008-December 2017) were included. 11 triage tools were applied to patients' first recorded pre-hospital physiology. Patients were retrospectively assigned triage categories (P1, P2, P3, Expectant or Dead) using predefined intervention-based criteria. Tools' performance in <16s were evaluated within four-yearly age subgroups, comparing tool-predicted and intervention-based priority status. FINDINGS Amongst 4962 patients, mortality was 1.1% (n = 53); median Injury Severity Score (ISS) was 9 (IQR 9-16). Blunt injuries predominated (94.4%). 1343 (27.1%) met intervention-based criteria for P1, exhibiting greater intensive care requirement (60.2% vs. 8.5%, p < 0.01) and ISS (median 17 vs 9, p < 0.01) compared with P2 patients. The Battlefield Casualty Drills (BCD) Triage Sieve had greatest sensitivity (75.7%) in predicting P1 status in children <16 years, demonstrating a 38.4-49.8% improvement across all subgroups of children <12 years compared with the UK's current Paediatric Triage Tape (PTT). JumpSTART demonstrated low sensitivity in predicting P1 status in 4 to 8 year olds (35.5%) and 0 to 4 year olds (28.5%), and was outperformed by its adult counterpart START (60.6% and 59.6%). INTERPRETATION The BCD Triage Sieve had greatest sensitivity in predicting P1 status in this paediatric trauma registry population: we recommend it replaces the PTT in UK practice. Users of JumpSTART may consider alternative tools. We recommend Lerner's triage category definitions when conducting MI evaluations.
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Affiliation(s)
- Nabeela S. Malik
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom
- 212 (Yorkshire) Field Hospital, Endcliffe Hall, Endcliffe Vale Road, Sheffield S10 3EU, United Kingdom
- Corresponding author at: NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom.
| | - Saisakul Chernbumroong
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Yuanwei Xu
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - James Vassallo
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Justine Lee
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
- NHS England London, Skipton House, 80 London Road, London SE1 6LH, United Kingdom
| | - Christopher G. Moran
- NHS England London, Skipton House, 80 London Road, London SE1 6LH, United Kingdom
- Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, United Kingdom
| | - Tina Newton
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom
| | - G. Suren Arul
- 212 (Yorkshire) Field Hospital, Endcliffe Hall, Endcliffe Vale Road, Sheffield S10 3EU, United Kingdom
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom
| | - Janet M. Lord
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Damian Keene
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Mark Foster
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Timothy Hodgetts
- Headquarters Defence Medical Services, Coltman House, Lichfield WS14 9PY, United Kingdom
| | - Douglas M. Bowley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, United Kingdom
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Georgios V. Gkoutos
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, United Kingdom
- MRC Health Data Research UK (HDR UK), Midlands Site, Birmingham B15 2TT, United Kingdom
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Malik NS, Chernbumroong S, Xu Y, Vassallo J, Lee J, Bowley DM, Hodgetts T, Moran CG, Lord JM, Belli A, Keene D, Foster M, Gkoutos GV. The BCD Triage Sieve outperforms all existing major incident triage tools: Comparative analysis using the UK national trauma registry population. EClinicalMedicine 2021; 36:100888. [PMID: 34308306 PMCID: PMC8257989 DOI: 10.1016/j.eclinm.2021.100888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Natural disasters, conflict, and terrorism are major global causes of death and disability. Central to the healthcare response is triage, vital to ensure the right care is provided to the right patient at the right time. The ideal triage tool has high sensitivity for the highest priority (P1) patients with acceptably low over-triage. This study compared the performance of major incident triage tools in predicting P1 casualty status in adults in the prospective UK Trauma Audit and Research Network (TARN) registry. METHODS TARN patients aged 16+ years (January 2008-December 2017) were included. Ten existing triage tools were applied using patients' first recorded pre-hospital physiology. Patients were subsequently assigned triage categories (P1, P2, P3, Expectant or Dead) based on pre-defined, intervention-based criteria. Tool performance was assessed by comparing tool-predicted and intervention-based priority status. FINDINGS 195,709 patients were included; mortality was 7·0% (n=13,601); median Injury Severity Score (ISS) was 9 (IQR 9-17); 97·1% sustained blunt injuries. 22,144 (11·3%) patients fulfilled intervention-based criteria for P1 status, exhibiting higher mortality (12·8% vs. 5·0%, p<0.001), increased intensive care requirement (52·4% vs 5·0%, p<0.001), and more severe injuries (median ISS 21 vs 9, p<0.001) compared with P2 patients.In 16-64 year olds, the highest performing tool was the Battlefield Casualty Drills (BCD) Triage Sieve (Prediction of P1 status: 70·4% sensitivity, over-triage 70·9%, area under the receiver operating curve (AUC) 0·068 [95%CI 0·676-0·684]). The UK National Ambulance Resilience Unit (NARU) Triage Sieve had sensitivity of 44·9%; over-triage 56·4%; AUC 0·666 (95%CI 0·662-0·670). All tools performed poorly amongst the elderly (65+ years). INTERPRETATION The BCD Triage Sieve performed best in this nationally representative population; we recommend it supersede the NARU Triage Sieve as the UK primary major incident triage tool. Validated triage category definitions are recommended for appraising future major incidents. FUNDING This study is funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre. GVG also acknowledges support from the MRC Heath Data Research UK (HDRUK/CFC/01). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care, or the Ministry of Defence.
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Affiliation(s)
- Nabeela S. Malik
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- 212 (Yorkshire) Field Hospital, Endcliffe Hall, Endcliffe Vale Road, Sheffield S10 3EU, UK
- Corresponding author at: NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK.
| | - Saisakul Chernbumroong
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Yuanwei Xu
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - James Vassallo
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Justine Lee
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- NHS England London, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Douglas M. Bowley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Timothy Hodgetts
- Army Health, Army Headquarters, Monxton Road, Andover SP11 8HT, UK
| | - Christopher G Moran
- NHS England London, Skipton House, 80 London Road, London SE1 6LH, UK
- Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK
| | - Janet M Lord
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Damian Keene
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Mark Foster
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
- University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Georgios V Gkoutos
- NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC), Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
- MRC Health Data Research UK (HDR UK), Midlands Site, B15 2TT UK
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Vassallo J, Smith J. Reply to: Assessment of the mass casualty triage during the November 2015 Paris area terrorist attacks: towards a simple triage rule. Eur J Emerg Med 2021; 28:162. [PMID: 33674520 DOI: 10.1097/mej.0000000000000798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- James Vassallo
- Emergency Department, Bristol Royal Infirmary, Bristol
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham
| | - Jason Smith
- Emergency Department, Bristol Royal Infirmary, Bristol
- Emergency Department, Derriford Hospital, Plymouth, UK
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Agius D, Vassallo J, Grech R. The Role of MRI in Ophthalmic Arteritis. J Clin Rheumatol 2021; 27:e6-e7. [PMID: 31524847 DOI: 10.1097/rhu.0000000000001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Reuben Grech
- Medical Imaging, Mater Dei Hospital, Msida, Malta
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Chiattone C, Delamain M, Miranda E, Castro N, Brasil S, Bellesso M, Pereira J, Cunha-Junior A, Gonzaga Y, Nabhan S, Ribeiro G, Lyrio R, Zing N, Carneiro T, Berg A, Nogueira D, Schaffel R, Cecyn K, Souto-Filho J, Hamerschlak N, Gaiolla R, Dias M, Pont M, Hallack-Neto A, Rabelo Y, Duarte F, Sousa R, Mo S, Silveira T, Cury P, Vassallo J, Federico M, Souza C. ATUALIZAÇÃO DO ESTUDO AMBISPECTIVO DO REGISTRO DE LINFOMA DE CÉLULAS-T, NAS CINCO MACRORREGIÕES BRASILEIRAS. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Vassallo J, Fuller G, Smith JE. Relationship between the Injury Severity Score and the need for life-saving interventions in trauma patients in the UK. Emerg Med J 2020; 37:502-507. [PMID: 32748796 DOI: 10.1136/emermed-2019-209092] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 04/12/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Major trauma is the third leading cause of avoidable mortality in the UK. Defining which patients require care in a major trauma centre is a critical component of developing, evaluating and enhancing regional major trauma systems. Traditionally, trauma patients have been classified using the Injury Severity Score (ISS), but resource-based criteria have been proposed as an alternative. The aim of this study was to investigate the relationship between ISS and the use of life-saving interventions (LSI). METHODS Retrospective cohort study using the Trauma Audit Research Network database for all adult patients (aged ≥18 years) between 2006 and 2014. Patients were categorised as needing an LSI if they received one or more interventions from a previously defined list determined by expert consensus. RESULTS 193 290 patients met study inclusion criteria: 56.9% male, median age 60.0 years (IQR 41.2-78.8) and median ISS 9 (IQR 9-16). The most common mechanism of injury was falls <2 m (52.1%), followed by road traffic collisions (22.2%). 15.1% received one or more LSIs. The probability of a receiving an LSI increased with increasing ISS, but only a low to moderate correlation was evident (0.334, p<0.001). A clinically significant number of cases (5.3% and 7.6%) received an LSI despite having an ISS ≤8 or <15, respectively. CONCLUSIONS A clinically significant number of adult trauma patients requiring LSIs have an ISS below the traditional definition of major trauma. The traditional definition should be reconsidered and either lowered, or an alternative metric should be used.
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Affiliation(s)
- James Vassallo
- Emergency Department, Derriford Hospital, Plymouth, UK .,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - Gordon Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jason E Smith
- Emergency Department, Derriford Hospital, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Vassallo J, Webster M, Barnard EBG, Lyttle MD, Smith JE. Epidemiology and aetiology of paediatric traumatic cardiac arrest in England and Wales. Arch Dis Child 2019; 104:437-443. [PMID: 30262513 DOI: 10.1136/archdischild-2018-314985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/19/2018] [Accepted: 08/23/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the epidemiology and aetiology of paediatric traumatic cardiac arrest (TCA) in England and Wales. DESIGN Population-based analysis of the UK Trauma Audit and Research Network (TARN) database. PATIENTS AND SETTING All paediatric and adolescent patients with TCA recorded on the TARN database for a 10-year period (2006-2015). MEASURES Patient demographics, Injury Severity Score (ISS), location of TCA ('prehospital only', 'in-hospital only' or 'both'), interventions performed and outcome. RESULTS 21 710 paediatric patients were included in the database; 129 (0.6%) sustained TCA meeting study inclusion criteria. The majority, 103 (79.8%), had a prehospital TCA. 62.8% were male, with a median age of 11.7 (3.4-16.6) years, and a median ISS of 34 (25-45). 110 (85.3%) had blunt injuries, with road-traffic collision the most common mechanism (n=73, 56.6%). 123 (95.3%) had severe haemorrhage and/or traumatic brain injury. Overall 30-day survival was 5.4% ((95% CI 2.6 to 10.8), n=7). 'Pre-hospital only' TCA was associated with significantly higher survival (n=6) than those with TCA in both 'pre-hospital and in-hospital' (n=1)-13.0% (95% CI 6.1% to 25.7%) and 1.2% (95% CI 0.1% to 6.4%), respectively, p<0.05. The greatest survival (n=6, 10.3% (95% CI 4.8% to 20.8%)) was observed in those transported to a paediatric major trauma centre (MTC) (defined as either a paediatric-only MTC or combined adult-paediatric MTC). CONCLUSIONS Survival is possible from the resuscitation of children in TCA, with overall survival comparable to that reported in adults. The highest survival was observed in those with a pre-hospital only TCA, and those who were transported to an MTC. Early identification and aggressive management of paediatric TCA is advocated.
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Affiliation(s)
- James Vassallo
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.,Institute of Naval Medicine, Gosport, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
| | - Melanie Webster
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Edward B G Barnard
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Jason E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
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Vassallo J, Smith J. Major incident triage and the evaluation of the Triage Sort as a secondary triage method. Emerg Med J 2019; 36:281-286. [PMID: 30877263 DOI: 10.1136/emermed-2018-207986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/16/2019] [Accepted: 02/08/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION A key principle in the effective management of major incidents is triage, the process of prioritising patients on the basis of their clinical acuity. In many countries including the UK, a two-stage approach to triage is practised, with primary triage at the scene followed by a more detailed assessment using a secondary triage process, the Triage Sort. To date, no studies have analysed the performance of the Triage Sort in the civilian setting. The primary aim of this study was to determine the performance of the Triage Sort at predicting the need for life-saving intervention (LSI). METHODS Using the Trauma Audit Research Network (TARN) database for all adult patients (>18 years) between 2006 and 2014, we determined which patients received one or more LSIs using a previously defined list. The first recorded hospital physiology was used to categorise patient priority using the Triage Sort, National Ambulance Resilience Unit (NARU) Sieve and the Modified Physiological Triage Tool-24 (MPTT-24). Performance characteristics were evaluated using sensitivity and specificity with statistical analysis using a McNemar's test. RESULTS 127 233patients (58.1%) had complete data and were included: 55.6% men, aged 61.4 (IQR 43.1-80.0 years), ISS 9 (IQR 9-16), with 24 791 (19.5%) receiving at least one LSI (priority 1). The Triage Sort demonstrated the lowest accuracy of all triage tools at identifying the need for LSI (sensitivity 15.7% (95% CI 15.2 to 16.2) correlating with the highest rate of under-triage (84.3% (95% CI 83.8 to 84.8), but it had the greatest specificity (98.7% (95% CI 98.6 to 98.8). CONCLUSION Within a civilian trauma registry population, the Triage Sort demonstrated the poorest performance at identifying patients in need of LSI. Its use as a secondary triage tool should be reviewed, with an urgent need for further research to determine the optimum method of secondary triage.
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Affiliation(s)
- James Vassallo
- Emergency Department, Derriford Hospital, Plymouth, UK.,Institute of Naval Medicine, Gosport, Hampshire, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
| | - Jason Smith
- Emergency Department, Derriford Hospital, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
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Smith J, Vassallo J, Lyttle MD. Authors' response to letter entitled 'During a paediatric traumatic cardiac arrest, is ventricular fibrillation a reversible cause like any other?'. Emerg Med J 2019; 36:191. [PMID: 30630843 DOI: 10.1136/emermed-2018-208370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Jason Smith
- Emergency Department, Derriford Hospital, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
| | | | - Mark D Lyttle
- Emergency Department, Bristol Royal Children's Hospital, Bristol, UK
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Vassallo J, Smith JE. Authors response: Marsden MER, Mossadegh S, Marsh W, et al. J R Army Med Corps Epub ahead of print. doi:10.1136/jramc-2018-001057. BMJ Mil Health 2018; 166:205. [PMID: 30455391 DOI: 10.1136/jramc-2018-001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/04/2022]
Affiliation(s)
- James Vassallo
- Institute of Naval Medicine, Hampshire, UK .,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - J E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Vassallo J, Besinis A, Boden R, Handy RD. The minimum inhibitory concentration (MIC) assay with Escherichia coli: An early tier in the environmental hazard assessment of nanomaterials? Ecotoxicol Environ Saf 2018; 162:633-646. [PMID: 30033160 DOI: 10.1016/j.ecoenv.2018.06.085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 06/08/2023]
Abstract
There are now over a thousand nano-containing products on the market and the antibacterial properties of some nanomaterials has created interest in their use as cleaning agents, biocides and disinfectants. Engineered nanomaterials (ENMs) are being released into the environment and this raises concerns about their effects on microbes in the receiving ecosystems. This study evaluated the bacterial toxicity of a wide range of nanomaterials with different surface coatings on Escherichia coli K-12 MG1655. The minimum inhibitory concentration (MIC) assay, which quantifies the threshold for growth inhibition in suspensions of bacteria, was used to rank the toxicity of silver (Ag), cupric oxide (CuO), cadmium telluride (CdTe) quantum dots, titanium dioxide (TiO2), nanodiamonds and multi-walled carbon nanotubes (MWCNTs). Bacteria were exposed for 12 h at 37 °C to a dilution series of the test suspensions in 96-well plates. The precision and accuracy of the method was good with coefficients of variation < 10%. In terms of the measured MIC values, the toxicity order of the ENMs was as follows: CdTe quantum dots ammonium-coated, 6 mg L-1 > Ag nanoparticles, 12 mg L-1 > CdTe quantum dots carboxylate-coated, 25 mg L-1 > CdTe quantum dots polyethylene glycol-coated, 100 mg L-1. The MIC values were above the highest test concentration used (100 mg L-1) for CuO, TiO2, nanodiamonds and MWCNTs, indicating low toxicity. The MIC assay can be a useful tool for the initial steps of ENMs hazard assessment.
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Affiliation(s)
- J Vassallo
- School of Biological and Marine Sciences, Faculty of Science and Engineering, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; Sustainable Earth Institute, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - A Besinis
- School of Biological and Marine Sciences, Faculty of Science and Engineering, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; School of Engineering, Faculty of Science and Engineering, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; Plymouth University Peninsula Schools of Medicine and Dentistry, University of Plymouth, John Bull Building, Tamar Science Park, Plymouth PL6 8BU, UK
| | - R Boden
- School of Biological and Marine Sciences, Faculty of Science and Engineering, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; Sustainable Earth Institute, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - R D Handy
- School of Biological and Marine Sciences, Faculty of Science and Engineering, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; Sustainable Earth Institute, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK.
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Vassallo J, Nutbeam T, Rickard AC, Lyttle MD, Scholefield B, Maconochie IK, Smith JE. Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation. Emerg Med J 2018; 35:669-674. [PMID: 30154141 DOI: 10.1136/emermed-2018-207739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/26/2018] [Accepted: 08/04/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Paediatric traumatic cardiac arrest (TCA) is a high acuity, low frequency event. Traditionally, survival from TCA has been reported as low, with some believing resuscitation is futile. Within the adult population, there is growing evidence to suggest that with early and aggressive correction of reversible causes, survival from TCA may be comparable with that seen from medical out-of-hospital cardiac arrests. Key to this survival has been the adoption of a standardised approach to resuscitation. The aim of this study was, by a process of consensus, to develop an algorithm for the management of paediatric TCA for adoption in the UK. METHODS A modified consensus development meeting of UK experts involved in the management of paediatric TCA was held. Statements discussed at the meeting were drawn from those that did not reach consensus (positive/negative) from a linked three-round online Delphi study. 19 statements relating to the diagnosis, management and futility of paediatric TCA were initially discussed in small groups before each participant anonymously recorded their agreement with the statement using 'yes', 'no' or 'don't know'. In keeping with our Delphi study, consensus was set a priori at 70%. Statements reaching consensus were included in the proposed algorithm. RESULTS 41 participants attended the meeting. Of the 19 statements discussed, 13 reached positive consensus and were included in the algorithm. A single statement regarding initial rescue breaths reached negative consensus and was excluded. Consensus was not reached for five statements, including the use of vasopressors and thoracotomy for haemorrhage control in blunt trauma. CONCLUSION In attempt to standardise our approach to the management of paediatric TCA and to improve outcomes, we present the first consensus-based algorithm specific to the paediatric population. While this algorithm was developed for adoption in the UK, it may be applicable to similar healthcare systems internationally.
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Affiliation(s)
- James Vassallo
- Emergency Department, Derriford Hospital, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
| | - Tim Nutbeam
- Emergency Department, Derriford Hospital, Plymouth, UK.,University of Plymouth, Plymouth, UK
| | | | - Mark D Lyttle
- Emergency Department, Bristol Royal Children's Hospital, Bristol, UK.,Faculty of Health and Applied Sciences, University of West England, Bristol, UK
| | | | - Ian K Maconochie
- Emergency Department, St Marys Hospital, London, UK.,Trauma Audit and Research Network, University of Manchester, Manchester, UK
| | - Jason E Smith
- Emergency Department, Derriford Hospital, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
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Rickard AC, Vassallo J, Nutbeam T, Lyttle MD, Maconochie IK, Enki DG, Smith JE. Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management. Emerg Med J 2018; 35:434-439. [PMID: 29705730 DOI: 10.1136/emermed-2017-207226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/07/2018] [Accepted: 04/17/2018] [Indexed: 11/04/2022]
Abstract
AIMS Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients. METHODS An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. Participants were invited from paediatric and adult emergency medicine, paediatric anaesthetics, paediatric ICU and paediatric surgery, as well as Paediatric Major Trauma Centre leads and representatives from the Resuscitation Council UK. Statements were informed by literature reviews and were based on elements of APLS resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy. RESULTS 73 experts completed all three rounds between June and November 2016. Consensus was reached on 14 statements regarding the diagnosis and management of paediatric TCA; oxygenation and ventilatory support, along with rapid volume replacement with warmed blood, improve survival. The duration of cardiac arrest and the lack of a response to intervention, along with cardiac standstill on ultrasound, help to guide the decision to terminate resuscitation. CONCLUSION This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians.
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Affiliation(s)
- Annette C Rickard
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - James Vassallo
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK
| | - Tim Nutbeam
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Ian K Maconochie
- Emergency Department, Imperial College NHS Healthcare Trust, London, UK
| | - Doyo G Enki
- Medical Statistics Group, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Jason E Smith
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK
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Vassallo J, Horne S, Smith JE. Triage and the Modified Physiological Triage Tool-24 (MPTT-24). BMJ Mil Health 2018; 166:33-36. [PMID: 29301857 DOI: 10.1136/jramc-2017-000878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/03/2022]
Abstract
Major incidents occur on a regular basis. So far in 2017, England has witnessed five terrorism-related major incidents, resulting in approximately 40 fatalities and 400 injured. Triage is a key principle in the effective management of a major incident and involves prioritising patients on the basis of their clinical acuity. This paper describes the limitations associated with existing methods of primary major incident triage and the process of developing a new and improved triage tool-the Modified Physiological Triage Tool-24 (MPTT-24). Whilst the MPTT-24 is likely to be the optimum physiological method for primary major incident triage, it needs to be accompanied by an appropriate secondary triage process. The existing UK military and civilian secondary triage tool, the Triage Sort, is described, which offers little advantage over primary methods for identifying patients who require life-saving intervention. Further research is required to identify the optimum method of secondary triage.
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Affiliation(s)
- James Vassallo
- Division of Emergency Medicine, University of Cape Town, South Africa .,Institute of Naval Medicine, Hampshire, UK
| | - S Horne
- Emergency Department, Derriford Hospital, Plymouth, UK
| | - J E Smith
- Emergency Department, Derriford Hospital, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Ataide EC, Perales SR, Silva MG, Filho FC, Sparapani AC, Latuf Filho PF, Stucchi RSB, Vassallo J, Escanhoela CAF, Boin IFSF. Immunoexpression of Heat Shock Protein 70, Glypican 3, Glutamine Synthetase, and Beta-Catenin in Hepatocellular Carcinoma After Liver Transplantation: Association Between Positive Glypican 3 and Beta-Catenin With the Presence of Larger Nodules. Transplant Proc 2018; 49:858-862. [PMID: 28457411 DOI: 10.1016/j.transproceed.2017.01.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the 6th leading cause of cancer worldwide. Its recurrence ranges from 6% to 26%. In the literature, many factors are associated with higher risk of recurrence, without a clear definition of the best method that could predict this highly lethal event. OBJECTIVE The aim of this study was to evaluate the immunoexpression of immunohistochemical markers: HSP70, glypican 3, glutamine synthetase, and beta-catenin, as well as studying their association with tumor characteristics and prognosis of patients undergoing liver transplantation for HCC. METHODS We studied 90 patients who underwent liver transplantation from 1998 to 2012. Afterwards we evaluated factors related to survival, tumor recurrence, and the correlation of expression of the immunohistochemical markers. RESULTS Immunohistochemical marker glutamine synthetase showed a positive trend toward better survival. HSP70-positive patients had a higher prevalence of histologic grade III. Patients with positive glypican 3 showed larger lesions and a higher number with AFP >200 ng/mL. Patients with positive beta-catenin showed larger nodules and more with histologic grade III. The association between beta-catenin and glypican 3 showed positive association with larger nodules. CONCLUSIONS Most of the markers studied had a correlation with at least one of the variables studied, confirming our hypothesis that these markers can indeed assist in assessing the prognosis of patients undergoing liver transplantation for HCC.
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Affiliation(s)
- E C Ataide
- Unit of Liver Transplantation, State University of Campinas, São Paulo, Brazil.
| | - S R Perales
- Unit of Liver Transplantation, State University of Campinas, São Paulo, Brazil
| | - M G Silva
- Unit of Liver Transplantation, State University of Campinas, São Paulo, Brazil
| | - F C Filho
- Unit of Liver Transplantation, State University of Campinas, São Paulo, Brazil
| | - A C Sparapani
- Department of Pathologic Anatomy, State University of Campinas, São Paulo, Brazil
| | - P F Latuf Filho
- Department of Pathologic Anatomy, State University of Campinas, São Paulo, Brazil
| | - R S B Stucchi
- Unit of Liver Transplantation, State University of Campinas, São Paulo, Brazil
| | - J Vassallo
- Department of Pathologic Anatomy, State University of Campinas, São Paulo, Brazil
| | - C A F Escanhoela
- Department of Pathologic Anatomy, State University of Campinas, São Paulo, Brazil
| | - I F S F Boin
- Unit of Liver Transplantation, State University of Campinas, São Paulo, Brazil
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Prada PO, Hirabara SM, de Souza CT, Schenka AA, Zecchin HG, Vassallo J, Velloso LA, Carneiro E, Carvalheira JBC, Curi R, Saad MJ. Retraction Note to: L-glutamine supplementation induces insulin resistance in adipose tissue and improves insulin signalling in liver and muscle of rats with diet-induced obesity. Diabetologia 2018; 61:253. [PMID: 29119243 DOI: 10.1007/s00125-017-4477-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In light of forensic evidence indicating duplication and/or manipulation of western blot images the Editor-in-Chief is retracting the article cited above.
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Affiliation(s)
- P O Prada
- Departamento de Clínica Médica da Universidade Estadual de Campinas, Rua Tessália Viera de Camargo 126, Campinas, San Paulo, 13083-887, Brazil
| | - S M Hirabara
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biomédicas da Universidade de São Paulo, San Paulo, Brazil
| | - C T de Souza
- Departamento de Clínica Médica da Universidade Estadual de Campinas, Rua Tessália Viera de Camargo 126, Campinas, San Paulo, 13083-887, Brazil
| | - A A Schenka
- Departamento de Patologia, Universidade Estadual de Campinas, Campinas, San Paulo, Brazil
| | - H G Zecchin
- Departamento de Clínica Médica da Universidade Estadual de Campinas, Rua Tessália Viera de Camargo 126, Campinas, San Paulo, 13083-887, Brazil
| | - J Vassallo
- Departamento de Patologia, Universidade Estadual de Campinas, Campinas, San Paulo, Brazil
| | - L A Velloso
- Departamento de Clínica Médica da Universidade Estadual de Campinas, Rua Tessália Viera de Camargo 126, Campinas, San Paulo, 13083-887, Brazil
| | - E Carneiro
- Departamento de Fisiologia, Instituto Biomédico da Universidade Estadual de Campinas, Campinas, San Paulo, Brazil
| | - J B C Carvalheira
- Departamento de Clínica Médica da Universidade Estadual de Campinas, Rua Tessália Viera de Camargo 126, Campinas, San Paulo, 13083-887, Brazil
| | - R Curi
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biomédicas da Universidade de São Paulo, San Paulo, Brazil
| | - M J Saad
- Departamento de Clínica Médica da Universidade Estadual de Campinas, Rua Tessália Viera de Camargo 126, Campinas, San Paulo, 13083-887, Brazil.
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Vassallo J. Torpedo Maculopathy. J Pediatr Ophthalmol Strabismus 2018; 55:72. [PMID: 29378083 DOI: 10.3928/01913913-20171116-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 07/20/2017] [Indexed: 11/20/2022]
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Vassallo J, Nutbeam T, Rickard A, Lyttle M, Smith J. 49 Paediatric traumatic cardiac arrest – the development of a treatment algorithm. Arch Emerg Med 2017. [DOI: 10.1136/emermed-2017-207308.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vassallo J, Webster M, Barnard E, Iniguez MF, Lyttle M, Smith J. 54 Paediatric traumatic cardiac arrest in England and Wales a 10 year epidemiological study. Emerg Med J 2017. [DOI: 10.1136/emermed-2017-207308.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vassallo J, Smith JE, Wallis LA. Major incident triage and the implementation of a new triage tool, the MPTT-24. J ROY ARMY MED CORPS 2017; 164:103-106. [PMID: 29055894 PMCID: PMC5969370 DOI: 10.1136/jramc-2017-000819] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 11/12/2022]
Abstract
Introduction The Modified Physiological Triage Tool (MPTT) is a recently developed primary triage tool and in comparison with existing tools demonstrates the greatest sensitivity at predicting need for life-saving intervention (LSI) within both military and civilian populations. To improve its applicability, we proposed to increase the upper respiratory rate (RR) threshold to 24 breaths per minute (bpm) to produce the MPTT-24. Our aim was to conduct a feasibility analysis of the proposed MPTT-24, comparing its performance with the existing UK Military Sieve. Method A retrospective review of the Joint Theatre Trauma Registry (JTTR) and Trauma Audit Research Network (TARN) databases was performed for all adult (>18 years) patients presenting between 2006–2013 (JTTR) and 2014 (TARN). Patients were defined as priority one (P1) if they received one or more LSIs. Using first recorded hospital RR in isolation, sensitivity and specificity of the ≥24 bpm threshold was compared with the existing threshold (≥22 bpm) at predicting P1 status. Patients were then categorised as P1 or not-P1 by the MPTT, MPTT-24 and the UK Military Sieve. Results The MPTT and MPTT-24 outperformed existing UK methods of triage with a statistically significant (p<0.001) increase in sensitivity of between 25.5% and 29.5%. In both populations, the MPTT-24 demonstrated an absolute reduction in sensitivity with an increase in specificity when compared with the MPTT. A statistically significant difference was observed between the MPTT and MPTT-24 in the way they categorised TARN and JTTR cases as P1 (p<0.001). Conclusions When compared with the existing MPTT, the MPTT-24 allows for a more rapid triage assessment. Both continue to outperform existing methods of primary major incident triage and within the military setting, the slight increase in undertriage is offset by a reduction in overtriage. We recommend that the MPTT-24 be considered as a replacement to the existing UK Military Sieve.
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Affiliation(s)
- James Vassallo
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.,Institute of Naval Medicine, Gosport, UK
| | - J E Smith
- Emergency Department, Derriford Hospital, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Birmingham, UK
| | - L A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Follows A, Phillips R, Vassallo J. Identifying trauma centre need in adult patients sustaining injury. Trauma 2017. [DOI: 10.1177/1460408617697818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew Follows
- Emergency Department, Derriford Hospital, Plymouth, UK
- Peninsula College of Medicine and Dentistry, Plymouth, UK
| | - Ryan Phillips
- Emergency Department, Derriford Hospital, Plymouth, UK
- Peninsula College of Medicine and Dentistry, Plymouth, UK
| | - James Vassallo
- Emergency Department, Derriford Hospital, Plymouth, UK
- Institute of Naval Medicine, Gosport, UK
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Vassallo J, Smith J, Bouamra O, Lecky F, Wallis LA. The civilian validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to primary major incident triage. Emerg Med J 2017; 34:810-815. [DOI: 10.1136/emermed-2017-206647] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/11/2017] [Accepted: 07/22/2017] [Indexed: 11/04/2022]
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Abstract
Pituitary adenomas (PA) represent the largest group of intracranial neoplasms and yet the molecular mechanisms driving this disease remain largely unknown. The aim of this study was to use a high-throughput screening method to identify molecular pathways that may be playing a significant and consistent role in PA. RNA profiling using microarrays on eight local PAs identified the aryl hydrocarbon receptor (AHR) signalling pathway as a key canonical pathway downregulated in all PA types. This was confirmed by real-time PCR in 31 tumours. The AHR has been shown to regulate cell cycle progression in various cell types; however, its role in pituitary tissue has never been investigated. In order to validate the role of AHR in PA behaviour, further functional studies were undertaken. Over-expression of AHR in GH3 cells revealed a tumour suppressor potential independent of exogenous ligand activation by benzo α-pyrene (BαP). Cell cycle analysis and quantitative PCR of cell cycle regulator genes revealed that both unstimulated and BαP-stimulated AHR reduced E2F-driven transcription and altered expression of cell cycle regulator genes, thus increasing the percentage of cells in G0/G1 phase and slowing the proliferation rate of GH3 cells. Co-immunoprecipitation confirmed the interaction between AHR and retinoblastoma (Rb1) protein supporting this as a functional mechanism for the observed reduction. Endogenous Ahr reduction using silencing RNA confirmed the tumour suppressive function of the Ahr. These data support a mechanistic pathway for the putative tumour suppressive role of AHR specifically in PA, possibly through its role as a cell cycle co-regulator, even in the absence of exogenous ligands.
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Affiliation(s)
- R Formosa
- Department of MedicineFaculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - J Borg
- Department of Applied Biomedical ScienceFaculty of Health Sciences, University of Malta, Msida, Malta
| | - J Vassallo
- Department of MedicineFaculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of MedicineNeuroendocrine Clinic, Mater Dei Hospital, Msida, Malta
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Vassallo J, Horne S, Smith JE, Wallis LA. The prospective validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to major incident triage. J ROY ARMY MED CORPS 2017; 163:383-387. [DOI: 10.1136/jramc-2017-000771] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/06/2017] [Accepted: 05/21/2017] [Indexed: 11/04/2022]
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Carvalho BM, Guadagnini D, Tsukumo DML, Schenka AA, Latuf-Filho P, Vassallo J, Dias JC, Kubota LT, Carvalheira JBC, Saad MJA. Expression of Concern: Modulation of gut microbiota by antibiotics improves insulin signalling in high-fat fed mice. Diabetologia 2017:10.1007/s00125-017-4293-4. [PMID: 28508093 DOI: 10.1007/s00125-017-4293-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- B M Carvalho
- Internal Medicine Department-Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887, Brazil
| | - D Guadagnini
- Internal Medicine Department-Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887, Brazil
| | - D M L Tsukumo
- Internal Medicine Department-Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887, Brazil
| | - A A Schenka
- Internal Medicine Department-Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887, Brazil
| | - P Latuf-Filho
- Internal Medicine Department-Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887, Brazil
| | - J Vassallo
- Internal Medicine Department-Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887, Brazil
| | - J C Dias
- Chemistry Institute, State University of Campinas, Campinas, São Paulo, Brazil
| | - L T Kubota
- Chemistry Institute, State University of Campinas, Campinas, São Paulo, Brazil
| | - J B C Carvalheira
- Internal Medicine Department-Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887, Brazil
| | - M J A Saad
- Internal Medicine Department-Faculty of Medical Sciences, State University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, 13083-887, Brazil.
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Vassallo J, Beavis J, Smith JE, Wallis LA. Major incident triage: Derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT). Injury 2017; 48:992-999. [PMID: 28131484 DOI: 10.1016/j.injury.2017.01.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/10/2017] [Accepted: 01/20/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Triage is a key principle in the effective management at a major incident. There are at least three different triage systems in use worldwide and previous attempts to validate them, have revealed limited sensitivity. Within a civilian adult population, there has been no work to develop an improved system. METHODS A retrospective database review of the UK Joint Theatre Trauma Registry was performed for all adult patients (>18years) presenting to a deployed Military Treatment Facility between 2006 and 2013. Patients were defined as Priority One if they had received one or more life-saving interventions from a previously defined list. Using first recorded hospital physiological data (HR/RR/GCS), binary logistic regression models were used to derive optimum physiological ranges to predict need for life-saving intervention. This allowed for the derivation of the Modified Physiological Triage Tool-MPTT (GCS≥14, HR≥100, 12<RR≥22). A comparison of the MPTT and existing triage tools was then performed using sensitivities and specificities with 95% confidence intervals. Differences in performance were assessed for statistical significance using a McNemar test with Bonferroni correction. RESULTS Of 6095 patients, 3654 (60.0%) had complete data and were included in the study, with 1738 (47.6%) identified as priority one. Existing triage tools had a maximum sensitivity of 50.9% (Modified Military Sieve) and specificity of 98.4% (Careflight). The MPTT (sensitivity 69.9%, 95% CI 0.677-0.720, specificity 65.3%, 95% CI 0.632-0.675) showed an absolute increase in sensitivity over existing tools ranging from 19.0% (Modified Military Sieve) to 45.1% (Triage Sieve). There was a statistically significant difference between the performance (p<0.001) between the MPTT and the Modified Military Sieve. DISCUSSION & CONCLUSION The performance characteristics of the MPTT exceed existing major incident triage systems, whilst maintaining an appropriate rate of over-triage and minimising under-triage within the context of predicting the need for a life-saving intervention in a military setting. Further work is required to both prospectively validate this system and to identify its performance within a civilian environment, prior to recommending its use in the major incident setting.
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Affiliation(s)
- James Vassallo
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa; Institute of Naval Medicine, Gosport PO12 2DL, United Kingdom.
| | - John Beavis
- Faculty of Science and Technology, Bournemouth University, Bournemouth, United Kingdom.
| | - Jason E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Joint Medical Command, Birmingham, United Kingdom.
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
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Follows A, Phillips R, Vassallo J. IDENTIFYING TRAUMA CENTRE NEED (TCN) IN ADULTS SUSTAINING INJURY: A NARRATIVE REVIEW. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cuschieri S, Vassallo J, Calleja N, Camilleri R, Borg A, Bonnici G, Zhang Y, Pace N, Mamo J. Prevalence of obesity in Malta. Obes Sci Pract 2016; 2:466-470. [PMID: 28090352 PMCID: PMC5192534 DOI: 10.1002/osp4.77] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/18/2016] [Accepted: 09/22/2016] [Indexed: 12/03/2022] Open
Abstract
Background Obesity is a global epidemic with the Mediterranean island of Malta being no exception. The World Health Organization (WHO) has identified Malta as one of the European countries with the highest obesity prevalence. Method A cross‐sectional study was conducted (2014–2016) under the auspices of the University of Malta. The prevalence of overweight‐obesity in Malta was calculated and then age stratified for comparisons with previous studies. Results The study identified 69.75% (95% CI: 68.32–71.18) of the Maltese population to be either overweight or obese. The men overweight/obese prevalence (76.28% 95% CI: 74.41–78.14) was statistically higher than that for women (63.06% 95% CI: 60.92–65.20) (p = 0.0001). Age stratification revealed that both genders had the highest overweight prevalence rates between 55 and 64 years (Men = 23.25% 95% CI: 20.43–26.33; Women = 24.68% 95% CI: 21.44–28.22). Men obesity prevalence rates were highest in the 35 to 44 years group (22.52% 95% CI: 19.65–25.68) while for women it was highest in the 55 to 64 years group (28.90%, 95% CI: 25.44–30.63). Conclusion Over a 35‐year period, an overall decrease in the normal and overweight BMI categories occurred with an increase in the prevalence of obesity. An exception was observed in the women, where the prevalence of normal BMI increased over this time period. Also, it appears that while the total population obesity prevalence increased (for 2016), a percentage of the women have shifted from an obese to an overweight status.
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Affiliation(s)
- S Cuschieri
- Department of Anatomy, Faculty of Medicine and Surgery University of Malta Malta
| | - J Vassallo
- Department of Medicine, Faculty of Medicine and Surgery University of Malta Malta
| | - N Calleja
- Department of Public Health, Faculty of Medicine and Surgery University of Malta Malta; Director of Health Information and Research Ministry of Health Malta
| | - R Camilleri
- Faculty of Medicine and Surgery University of Malta Malta
| | - A Borg
- Faculty of Medicine and Surgery University of Malta Malta
| | - G Bonnici
- Faculty of Medicine and Surgery University of Malta Malta
| | - Y Zhang
- Faculty of Medicine and Surgery University of Malta Malta
| | - N Pace
- Department of Anatomy, Faculty of Medicine and Surgery University of Malta Malta
| | - J Mamo
- Department of Public Health, Faculty of Medicine and Surgery University of Malta Malta
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Lopes-Aguiar L, Delamain M, Brito A, Lourenço G, Costa E, Oliveira G, Vassallo J, De Souza C, Lima C. VEGF, VEGFR2 and GSTM1 polymorphisms in outcome of multiple myeloma patients in the thalidomide era. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw375.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vassallo J, Smith JE, Bruijns SR, Wallis LA. Major incident triage: A consensus based definition of the essential life-saving interventions during the definitive care phase of a major incident. Injury 2016; 47:1898-902. [PMID: 27375012 DOI: 10.1016/j.injury.2016.06.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 05/16/2016] [Accepted: 06/17/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Triage is a key principle in the effective management of major incidents. The process currently relies on algorithms assigning patients to specific triage categories; there is, however, little guidance as to what these categories represent. Previously, these algorithms were validated against injury severity scores, but it is accepted now that the need for life-saving intervention is a more important outcome. However, the definition of a life-saving intervention is unclear. The aim of this study was to define what constitutes a life-saving intervention, in order to facilitate the definition of an adult priority one patient during the definitive care phase of a major incident. METHODS We conducted a modified Delphi study, using a panel of subject matter experts drawn from the United Kingdom and Republic of South Africa with a background in Emergency Care or Major Incident Management. The study was conducted using an online survey tool, over three rounds between July and December 2013. A four point Likert scale was used to seek consensus for 50 possible interventions, with a consensus level set at 70%. RESULTS 24 participants completed all three rounds of the Delphi, with 32 life-saving interventions reaching consensus. CONCLUSIONS This study provides a consensus definition of what constitutes a life-saving intervention in the context of an adult, priority one patient during the definitive care phase of a major incident. The definition will contribute to further research into major incident triage, specifically in terms of validation of an adult major incident triage tool.
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Affiliation(s)
- James Vassallo
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa; Institute of Naval Medicine, Alverstoke, Gosport, UK.
| | - Jason E Smith
- Emergency Department, Derriford Hospital, Plymouth, UK; Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Joint Medical Command, Birmingham, UK
| | - Stevan R Bruijns
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Affiliation(s)
| | - Julia Gauci
- Foundation Programme, Mater Dei Hospital, Msida, Malta
| | - Kelvin Cortis
- Department of Radiology, Mater Dei Hospital, Msida, Malta
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Maia F, Vassallo J, Pinto G, Pavin E, Matos P, Zantut-Wittmann D. Expression of Mcl-1 and Ki-67 in Papillary Thyroid Carcinomas. Exp Clin Endocrinol Diabetes 2016; 124:209-14. [DOI: 10.1055/s-0035-1569363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- F. Maia
- Endocrinology Division, Department of Internal Medicine, University of Campinas, São Paulo, Brazil
| | - J. Vassallo
- Department of Pathology, Medical Science School, University of Campinas, São Paulo, Brazil
| | - G. Pinto
- Laboratory of Specialized Pathology, CAISM, University of Campinas, São Paulo, Brazil
| | - E. Pavin
- Endocrinology Division, Department of Internal Medicine, University of Campinas, São Paulo, Brazil
| | - P. Matos
- Department of Pathology, Medical Science School, University of Campinas, São Paulo, Brazil
| | - D. Zantut-Wittmann
- Endocrinology Division, Department of Internal Medicine, University of Campinas, São Paulo, Brazil
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