The primary objective of emergency pre-examination and triage is to provide the most appropriate clinical service to patients with acute and critical illnesses while ensuring the optimal utilization of limited medical...The primary objective of emergency pre-examination and triage is to provide the most appropriate clinical service to patients with acute and critical illnesses while ensuring the optimal utilization of limited medical resources.With the advancement of medical information technology,mobile technology,and information management,these features have been gradually incorporated into emergency pre-examination and triage and have shown promising outcomes.In this article,the benefits of implementing mobile technology and the current status of integrated information management to provide a reference for the future development and enhancement of emergency pre-examination and triage are reviewed.展开更多
The heterogeneity of clinical presentations in psychiatric emergencies creates difficulties in the response by interdisciplinary Mental Health teams. This is aggravated and difficult when the care is carried out on pu...The heterogeneity of clinical presentations in psychiatric emergencies creates difficulties in the response by interdisciplinary Mental Health teams. This is aggravated and difficult when the care is carried out on public roads or the patient’s home, that is, it is a pre-hospital context. Our Psychiatric Emergency Hospital, located in the City of Buenos Aires, provides pre-hospital care with a psychiatric ambulance, which is then referred to general hospitals or other health system providers. Not all effectors in the network have the same resources and, at the time of the emergency, the reasons for consultation such as the patient’s clinic are heterogeneous and require the greatest effectiveness in the intervention that is taken. The triage system is a resource that allows the systematization of approaches against the multiplicity of reasons for consultation and presentation of mental pathologies in the emergency room, in addition to providing greater effectiveness in interventions, homogeneity for the health system and consensus among the health effectors. Framed in the Mental Health Law, and especially in the concept of risk, a triage proposal was designed for pre-hospital interventions by the psychiatric ambulance dependent on Hospital Alvear and under current legal regulations with the aim of homogenizing care and referrals with the highest rate of effectiveness to provide quality interdisciplinary medicine.展开更多
Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures ...Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.展开更多
BACKGROUND:Most current triage tools have been tested among hospital nurses groups but there are not similar studies in university setting.In this study we analyzed if a course on a new fourlevel triage model,triage e...BACKGROUND:Most current triage tools have been tested among hospital nurses groups but there are not similar studies in university setting.In this study we analyzed if a course on a new fourlevel triage model,triage emergency method(TEM),could improve the quality of rating in a group of nursing students.METHODS:This observational study was conducted with paper scenarios at the University of Parma,Italy.Fifty students were assigned a triage level to 105 paper scenarios before and after a course on triage and TEM.We used weighted kappa statistics to measure the inter-rater reliability of TEM and assessed its validity by comparing the students' predictions with the triage code rating of a reference standard(a panel of five experts in the new triage method).RESULTS:Inter-rater reliability was K=0.42(95%Cl:0.37-0.46) before the course on TEM,and K=0.61(95%CI:0.56-0.67) after.The accuracy of students' triage rating for the reference standard triage code was good:81%(95%Cl:71-90).After the TEM course,the proportion of cases assigned to each acuity triage level was similar for the student group and the panel of experts.CONCLUSION:Among the group of nursing students,a brief course on triage and on a new inhospital triage method seems to improve the quality of rating codes.The new triage method shows good inter-rater reliability for rating triage acuity and good accuracy in predicting the triage code rating of the reference standard.展开更多
<strong>Background:</strong> With an increasing number of patients who visit emergency outpatient units, a shortage of physicians and nurses in emergency units has become an issue in Japan. Triage nurses w...<strong>Background:</strong> With an increasing number of patients who visit emergency outpatient units, a shortage of physicians and nurses in emergency units has become an issue in Japan. Triage nurses who interview patients and their families before medical examinations feel stressed to determine the triage level in a limited time, necessitating the measures to alleviate stressors. <strong>Objective:</strong> To develop a triage nurse job stressor scale (TNJSS) for Japanese triage nurses in emergency outpatient units and to verify the reliability and validity of this scale. <strong>Methods:</strong> Anonymous, self-administered questionnaires were sent to nursing directors of 180 emergency and critical care centers randomly selected from 251 centers throughout Japan, requesting to distribute the questionnaire to nurses. <strong>Results:</strong> Based on the responses obtained from 363 nurses, the construct validity, internal consistency, and criterion-related validity were verified. A factor analysis of 44 items yielded five factors: “Lack of triage ability”, “Busy triage work”, “Patients without understanding of explanations”, “Complaints from patients waiting for treatment”, and “Lack of support to improve triage ability”. Cronbach’s α was 0.93 for the full scale and significant correlations were observed between the nurses’ stressor scores and scores for the Stress Response Scale-18 (<em>r</em> = 0.409;<em>p</em> < 0.01) and for the Nursing Job Stressor Scale (<em>r</em> = 0.410;<em>p</em> < 0.01). <strong>Conclusions:</strong> The TNJSS with a five-factor structure containing 44 items was determined to be a reliable and valid tool for evaluating Japanese triage nurse job stressors. The findings suggest the necessity to continuously educate and support triage nurses.展开更多
Objective:To evaluate the efficiency of p16/Ki-67 dual stain used as a triage in cervical cancer screening.Methods:In this study,we did 468 p16/Ki-67 dual stain in human papillomavirus(HPV)16/18-positive or 12 other h...Objective:To evaluate the efficiency of p16/Ki-67 dual stain used as a triage in cervical cancer screening.Methods:In this study,we did 468 p16/Ki-67 dual stain in human papillomavirus(HPV)16/18-positive or 12 other high-risk HPV(OHR-HPV)positive Thinprep cytologic test(TCT)atypical squamous cells of undetermined significance(ASCUS)/lower-grade squamous intraepithelial lesion(LSIL)women.We evaluated the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the triage test.Results:The sensitivity,specificity,PPV and NPV of p16/Ki-67 dual stain in HPV 16/18-positive women were91.5%/68.4%,77.0%/75.0%,73.9%/59.1%and 92.8%/81.8%.In 12 OHR-HPV positive TCT ASCUS/LSIL women,the results were 79.1%/95.0%,88.5%/66.7%,88.5%/70.4%and 89.2%/94.1%.The risk of precancerous lesions in p16/Ki-67 dual stain positive cases was much higher than before,and the negative cases had lower risk.Besides,there was no cervical intraepithelial neoplasia(CIN)III case missed after triaged by p16/Ki-67 dual-stained cytology.In p16/Ki-67 dual-stained cytology positive women with benign pathology or CIN I,the 1-year progression rate is 20.5%and in p16/Ki-67 dual-stained cytology negative women,the 1-year progression rate is5.6%.Conclusions:hr-HPV genotyping test plays an important role in cervical cancer screening.p16/Ki-67 dual stain may be a promising triage test.As for chronic cervicitis or CIN I patients,a positive p16/Ki-67 dual-stained cytology suggests a high risk in progression and need to be followed up closely.展开更多
BACKGROUND:It is not clear whether Emergency Severity Index(ESI)is valid to triage heart failure(HF)patients and if HF patients benefi t more from a customized triage scale or not.The aim of study is to compare the ef...BACKGROUND:It is not clear whether Emergency Severity Index(ESI)is valid to triage heart failure(HF)patients and if HF patients benefi t more from a customized triage scale or not.The aim of study is to compare the effect of Heart Failure Triage Scale(HFTS)and ESI on mistriage among patients with HF who present to the emergency department(ED).METHODS:A randomized clinical trial was conducted from April to June 2017.HF patients with dyspnea were randomly assigned to HFTS or ESI groups.Triage level,used resources and time to electrocardiogram(ECG)were compared between both groups among HF patients who were admitted to coronary care unit(CCU),cardiac unit(CU)and discharged patients from the ED.Content validity was examined using Kappa designating agreement on relevance(K*).Reliability of both scale was evaluated using inter-observer agreement(Kappa).RESULTS:Seventy-three and 74 HF patients were assigned to HFTS and ESI groups respectively.Time to ECG in HFTS group was signifi cantly shorter than that of ESI group(2.05 vs.16.82 minutes).Triage level between HFTS and ESI groups was signifi cantly different among patients admitted to CCU(1.0 vs.2.8),cardiac unit(2.26 vs.3.06)and discharged patients from the ED(3.53 vs.2.86).Used resources in HFTS group was significantly different among triage levels(H=25.89;df=3;P<0.001).CONCLUSION:HFTS is associated with less mistriage than ESI for triaging HF patients.It is recommended to make use of HFTS to triage HF patients in the ED.展开更多
BACKGROUND: Although the Australasian Triage Scale(ATS) has been developed two decades ago, its reliability has not been def ined; therefore, we present a meta-analyis of the reliability of the ATS in order to reveal ...BACKGROUND: Although the Australasian Triage Scale(ATS) has been developed two decades ago, its reliability has not been def ined; therefore, we present a meta-analyis of the reliability of the ATS in order to reveal to what extent the ATS is reliable.DATA SOURCES: Electronic databases were searched to March 2014. The included studies were those that reported samples size, reliability coefficients, and adequate description of the ATS reliability assessment. The guidelines for reporting reliability and agreement studies(GRRAS) were used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was done based on the method of moment's estimator.RESULTS: Six studies were included in this study at last. Pooled coefficient for the ATS was substantial 0.428(95%CI 0.340–0.509). The rate of mis-triage was less than fifty percent. The agreement upon the adult version is higher than the pediatric version.CONCLUSION: The ATS has shown an acceptable level of overall reliability in the emergency department, but it needs more development to reach an almost perfect agreement.展开更多
Objective:We aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus(hrHPV)-positive women in primary healthcare settings in China.Methods:This study was undertaken in 11 ...Objective:We aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus(hrHPV)-positive women in primary healthcare settings in China.Methods:This study was undertaken in 11 rural and 9 urban sites.Women aged 35-64 years old were enrolled.HrHPV-positive women were randomly allocated to liquid-based cytology(LBC),visual inspection with acetic acid and Lugol’s iodine(VIA/VILI)(rural only)triage,or directly referred to colposcopy(direct COLP).At 24 months,hrHPV testing,LBC and VIA/VILI were conducted for combined screening.Results:In rural sites,1,949 hrHPV-positive women were analyzed.A total of 852,218 and 480 women were randomly assigned to direct COLP,LBC and VIA/VILI.At baseline,colposcopy referral rates of LBC or VIA/VILI triage could be reduced by 70%-80%.LBC(n=3 and n=7)or VIA/VILI(n=8 and n=26)could significantly decrease the number of colposcopies needed to detect one cervical intraepithelial neoplasia(CIN)2 or worse and CIN3+compared with direct COLP(n=14 and n=23).For the 24-month cumulative detection rate of CIN2+,VIA/VILI triage was 0.50-fold compared with LBC triage and 0.46-fold with the direct COLP.When stratified by age,baseline LBC triage+performed best(P<0.001),peaking among women aged 35-44 years(Ptrend=0.002).In urban sites,1,728 women were hrHPV genotyping test positive.A total of 408,571 and 568women were randomly assigned to direct COLP for HPV16/18+,direct COLP for other hrHPV subtypes+,and LBC triage for other hrHPV subtypes+.LBC(n=12 and n=31)significantly decreased the number of colposcopies needed to detect one CIN2+and CIN3+compared with direct COLP(n=14 and n=44).HPV16/18+increased the 24-month cumulative detection rate of CIN2+(17.89%,P<0.001).Conclusions:LBC triage for hrHPV-positive women in rural settings and direct COLP for HPV16/18+women and LBC triage for other hrHPV subtype+women in urban settings might be feasible strategies.展开更多
BACKGROUND: Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors. This study aimed to determine the best triage syst...BACKGROUND: Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors. This study aimed to determine the best triage system in the pediatric emergency department.METHODS: This was a prospective observational study. This study was divided into two phases. The fi rst phase determined the inter-rater reliability of fi ve triage systems: Manchester Triage System(MTS), Emergency Severity Index(ESI) version 4, Pediatric Canadian Triage and Acuity Scale(CTAS), Australasian Triage Scale(ATS), and Ramathibodi Triage System(RTS) by triage nurses and pediatric residents. In the second phase, to analyze the validity of each triage system, patients were categorized as two groups, i.e., high acuity patients(triage level 1, 2) and low acuity patients(triage level 3, 4, and 5). Then we compared the triage acuity with actual admission.RESULTS: In phase I, RTS illustrated almost perfect inter-rater reliability with kappa of 1.0(P<0.01). ESI and CTAS illustrated good inter-rater reliability with kappa of 0.8–0.9(P<0.01). Meanwhile, ATS and MTS illustrated moderate to good inter-rater reliability with kappa of 0.5–0.7(P<0.01). In phase II, we included 1 041 participants with average age of 4.7±4.2 years, of which 55% were male and 45% were female. In addition 32% of the participants had underlying diseases, and 123(11.8%) patients were admitted. We found that ESI illustrated the most appropriate predicting ability for admission with sensitivity of 52%, specifi city of 81%, and AUC 0.78(95%CI 0.74–0.81).CONCLUSION: RTS illustrated almost perfect inter-rater reliability. Meanwhile, ESI and CTAS illustrated good inter-rater reliability. Finally, ESI illustrated the appropriate validity for triage system.展开更多
BACKGROUND Emerging infectious diseases are a constant threat to the public’s health and health care systems around the world.Coronavirus disease 2019(COVID-2019),which was defined by the World Health Organization as...BACKGROUND Emerging infectious diseases are a constant threat to the public’s health and health care systems around the world.Coronavirus disease 2019(COVID-2019),which was defined by the World Health Organization as pandemic,has rapidly emerged as a global health threat.Outbreak evolution and prevention of international implications require substantial flexibility of frontline health care facilities in their response.AIM To explore the effect of the implementation and management strategy of prescreening triage in children during COVID-19.METHODS The standardized triage screening procedures included a standardized triage screening questionnaire,setup of pre-screening triage station,multi-point temperature monitoring,extensive screenings,and two-way protection.In order to ensure the implementation of the pre-screening triage,the prevention and control management strategies included training,emergency exercise,and staff protection.Statistical analysis was performed on the data from all the children hospitalized from January 20,2020 to March 20,2020 at solstice during the pandemic period.Data were obtained from questionnaires and electronic medical record systems.RESULTS A total of 17561 children,including 2652 who met the criteria for screening,192 suspected cases,and two confirmed cases without omission,were screened from January 20,2020 to March 20,2020 at solstice during the pandemic period.There was zero transmission of the infection to any medical staff.CONCLUSION The effective strategies for pre-screening triage have an essential role in the prevention and control of hospital infection.展开更多
Traditional triage cannot meet the needs of modern warfare. This paper describes the design of triage and evacuation equipment for casualties at sea that can quickly address mass-casualty triage and store and transmit...Traditional triage cannot meet the needs of modern warfare. This paper describes the design of triage and evacuation equipment for casualties at sea that can quickly address mass-casualty triage and store and transmit information during battlefield treatment and medical evacuation. This equipment consists of a high-capacity medical information card, a simulated patient generator, a triage classifier and a multifunctional airbag triage vest.展开更多
BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self ...BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to "wrong triage" in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more lives.METHODS: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a paramedic.RESULTS: By using the proportion test, we found that correct triaging was significantly different(P=0.005) in proportion between the two groups: group B(80%) with triage tool performed better in triaging the bomb blast victims than group A(50%) without the bombing specific triage tool performed.CONCLUSION: Development of bombing specific triage tool can reduce under triaging.展开更多
AIM:To evaluate the performance of the specific French Vittel "Pre-Hospital(PH) resuscitation" criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positi...AIM:To evaluate the performance of the specific French Vittel "Pre-Hospital(PH) resuscitation" criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value(PPV) of pre-hospital trauma triage.METHODS: This was a monocentric prospective cohort study of injured adults transported by emergency medi-cal service to a trauma center. Patients who met any of the field trauma triage criteria were considered "triage positive". Hospital data was statistically linked to prehospital records. The primary outcome of defining a "major trauma patient" was Injury Severity Score(ISS) > 16. RESULTS: There were a total of 200 injured patients evaluated over a 2 years period who met at least 1 triage criterion. The number of false positives was 64 patients(ISS < 16). The PPV was 68%. The sensitivity and the negative predictive value could not be evaluated in this study since it only included patients with positive Vittel criteria. The criterion of "PH resuscitation" was present for 64 patients(32%),but 10 of them had an ISS < 16. This was statistically significant in correlation with the severity of the trauma in univariate analysis(OR = 7.2; P = 0.005; 95%CI: 1.6-31.6). However,despite this correlation the overall PPV was not significantly increased by the use of the criterion "PH resuscitation"(68% vs 67.8%).CONCLUSION: The criterion of "pre-hospital resuscitation" was statistically significant with the severity of the trauma,but did not increase the PPV. The use of "prehospital resuscitation" criterion could be re-considered if these results are confirmed by larger studies.展开更多
Triage is a method for determining the priority of patients’treatment to improve survival rates.Different triage methods are used in hospitals,and they are applied after performing an evaluation based on standard met...Triage is a method for determining the priority of patients’treatment to improve survival rates.Different triage methods are used in hospitals,and they are applied after performing an evaluation based on standard methods such as the Japan Triage Acuity Scale(JTAS)or Emergency Severity Index(ESI).It is important to consider the characteristics of all the hospitals when assigning triage methods and emergency levels to them;the hospital managers make these decisions.We propose a multi-agent simulation method to support the hospital managers in employing the triage protocols according to their environment.We developed a prototype simulation system called TRISim to explore and assess the triage operations.In this paper,we provide an overview of TRISim and present our experimental results to validate the system.展开更多
When the troops are attacked by nuclear weapons, the number of the wounded and thetype and the condition of the wounds will change with the equivalence and the way of explosion, thenumber of soldiers taking part, the ...When the troops are attacked by nuclear weapons, the number of the wounded and thetype and the condition of the wounds will change with the equivalence and the way of explosion, thenumber of soldiers taking part, the area of the disposition of the troops, and the conditions of protectionof the personnel. Whether the wounded by nuclear weapons who is pouring in enormous amountcan be correctly classified in time has a very important relation in enhancing the effect of the first-aidand the treatment later on. We worked out a programme about the defined types and criteria of thewounded by nuclear weapons beforehand to be stored into the microcomputer. After nuclear cxplo-sion, it is necessary only to input the known data into the microcomputer from the key-board, thecomputer will immediately tell the number of the wounded of various types, the number of peopleand the time needed to perform the triage task and the surgical personnel needed to performthe operations, so that medical supporting programme can be selected or adjusted on time and the ef-ficiency and quality of the triage and first-aid work can be improved.展开更多
AIM: To determine the association of unstable pelvic ring injuries with trauma code status.METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was perfor...AIM: To determine the association of unstable pelvic ring injuries with trauma code status.METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was performed. The trauma registry was used to identify level 1 and level 2 trauma codes for each injury. The computed tomography scans in all patients were classified as stable or unstable using the Abbreviated Injury Scale. Pelvic injury classifications in level 1 and level 2 groups were compared. Patient disposition at discharge in level 1 and level 2 groups were also compared.RESULTS: There were 108 level 1 and 130 level 2 blunt trauma admissions. In the level 1 group, 67% of pelvic injuries were classified as stable fracture patterns and 33% were classified as unstable. In the level 2 group, 62% of pelvic injuries were classified as stable fracture patterns and 38% were classified as unstable. level 1 trauma code was not associated with odds of having an unstable fracture pattern(OR = 0.83, 95%CI: 0.48-1.41, P = 0.485). In the level 1 group with unstable pelvic injuries, 33% were discharged to home, 36% to a rehabilitation facility, and 32% died. In the level 2 group with unstable pelvic injuries, 65% were discharged to home, 31% to a rehabilitation facility, and 4% died. For those with unstable pelvic fractures(n = 85), assignment of a level 2 trauma code was associated with reduced odds of death(OR = 0.07, 95%CI: 0.01-0.35, P = 0.001) as compared to being discharged to home.CONCLUSION: Trauma code level assignment is not correlated with severity of pelvic injury. Because an unstable pelvis can lead to hemodynamic instability, these injuries may be undertriaged.展开更多
Objective:To investigate the effect of the use of color codes for patient triage on physicians’clinical decision.Methods:This prospective study was conducted among female patients aged 18-65 years who visited the eme...Objective:To investigate the effect of the use of color codes for patient triage on physicians’clinical decision.Methods:This prospective study was conducted among female patients aged 18-65 years who visited the emergency department(ED)with complaints of acute abdominal pain.A 3-level of triage system[red(very urgent),yellow(urgent)and green(less urgent)]was used in our ED.All patients were green level.Half of these patients remained at the green level(the green group),and the remaining patients were re-labeled as false yellow(the false yellow group)in the order of ED visits.Ordering tests,consultation requests,intravenous treatment,length of hospital stay,and cost were compared between the two groups of patients.Results:In total 393 patients were included with 198 patients in the green group and 195 in the false yellow group.There was no statistically significant difference between the two groups in age,temperature,systolic blood pressure,diastolic blood pressure,pulse and oxygen saturation(P>0.05).It was observed that more tests(P=0.001),consultations(P<0.001),and intravenous treatment were requested(P<0.001),and the duration of stay in the ED was longer(P<0.001)and cost(P<0.001)was higher in the false yellow group.Conclusions:Triage do affect the decisions of physicians on female patients with acute abdominal pain.展开更多
文摘The primary objective of emergency pre-examination and triage is to provide the most appropriate clinical service to patients with acute and critical illnesses while ensuring the optimal utilization of limited medical resources.With the advancement of medical information technology,mobile technology,and information management,these features have been gradually incorporated into emergency pre-examination and triage and have shown promising outcomes.In this article,the benefits of implementing mobile technology and the current status of integrated information management to provide a reference for the future development and enhancement of emergency pre-examination and triage are reviewed.
文摘The heterogeneity of clinical presentations in psychiatric emergencies creates difficulties in the response by interdisciplinary Mental Health teams. This is aggravated and difficult when the care is carried out on public roads or the patient’s home, that is, it is a pre-hospital context. Our Psychiatric Emergency Hospital, located in the City of Buenos Aires, provides pre-hospital care with a psychiatric ambulance, which is then referred to general hospitals or other health system providers. Not all effectors in the network have the same resources and, at the time of the emergency, the reasons for consultation such as the patient’s clinic are heterogeneous and require the greatest effectiveness in the intervention that is taken. The triage system is a resource that allows the systematization of approaches against the multiplicity of reasons for consultation and presentation of mental pathologies in the emergency room, in addition to providing greater effectiveness in interventions, homogeneity for the health system and consensus among the health effectors. Framed in the Mental Health Law, and especially in the concept of risk, a triage proposal was designed for pre-hospital interventions by the psychiatric ambulance dependent on Hospital Alvear and under current legal regulations with the aim of homogenizing care and referrals with the highest rate of effectiveness to provide quality interdisciplinary medicine.
文摘Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.
文摘BACKGROUND:Most current triage tools have been tested among hospital nurses groups but there are not similar studies in university setting.In this study we analyzed if a course on a new fourlevel triage model,triage emergency method(TEM),could improve the quality of rating in a group of nursing students.METHODS:This observational study was conducted with paper scenarios at the University of Parma,Italy.Fifty students were assigned a triage level to 105 paper scenarios before and after a course on triage and TEM.We used weighted kappa statistics to measure the inter-rater reliability of TEM and assessed its validity by comparing the students' predictions with the triage code rating of a reference standard(a panel of five experts in the new triage method).RESULTS:Inter-rater reliability was K=0.42(95%Cl:0.37-0.46) before the course on TEM,and K=0.61(95%CI:0.56-0.67) after.The accuracy of students' triage rating for the reference standard triage code was good:81%(95%Cl:71-90).After the TEM course,the proportion of cases assigned to each acuity triage level was similar for the student group and the panel of experts.CONCLUSION:Among the group of nursing students,a brief course on triage and on a new inhospital triage method seems to improve the quality of rating codes.The new triage method shows good inter-rater reliability for rating triage acuity and good accuracy in predicting the triage code rating of the reference standard.
文摘<strong>Background:</strong> With an increasing number of patients who visit emergency outpatient units, a shortage of physicians and nurses in emergency units has become an issue in Japan. Triage nurses who interview patients and their families before medical examinations feel stressed to determine the triage level in a limited time, necessitating the measures to alleviate stressors. <strong>Objective:</strong> To develop a triage nurse job stressor scale (TNJSS) for Japanese triage nurses in emergency outpatient units and to verify the reliability and validity of this scale. <strong>Methods:</strong> Anonymous, self-administered questionnaires were sent to nursing directors of 180 emergency and critical care centers randomly selected from 251 centers throughout Japan, requesting to distribute the questionnaire to nurses. <strong>Results:</strong> Based on the responses obtained from 363 nurses, the construct validity, internal consistency, and criterion-related validity were verified. A factor analysis of 44 items yielded five factors: “Lack of triage ability”, “Busy triage work”, “Patients without understanding of explanations”, “Complaints from patients waiting for treatment”, and “Lack of support to improve triage ability”. Cronbach’s α was 0.93 for the full scale and significant correlations were observed between the nurses’ stressor scores and scores for the Stress Response Scale-18 (<em>r</em> = 0.409;<em>p</em> < 0.01) and for the Nursing Job Stressor Scale (<em>r</em> = 0.410;<em>p</em> < 0.01). <strong>Conclusions:</strong> The TNJSS with a five-factor structure containing 44 items was determined to be a reliable and valid tool for evaluating Japanese triage nurse job stressors. The findings suggest the necessity to continuously educate and support triage nurses.
文摘Objective:To evaluate the efficiency of p16/Ki-67 dual stain used as a triage in cervical cancer screening.Methods:In this study,we did 468 p16/Ki-67 dual stain in human papillomavirus(HPV)16/18-positive or 12 other high-risk HPV(OHR-HPV)positive Thinprep cytologic test(TCT)atypical squamous cells of undetermined significance(ASCUS)/lower-grade squamous intraepithelial lesion(LSIL)women.We evaluated the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the triage test.Results:The sensitivity,specificity,PPV and NPV of p16/Ki-67 dual stain in HPV 16/18-positive women were91.5%/68.4%,77.0%/75.0%,73.9%/59.1%and 92.8%/81.8%.In 12 OHR-HPV positive TCT ASCUS/LSIL women,the results were 79.1%/95.0%,88.5%/66.7%,88.5%/70.4%and 89.2%/94.1%.The risk of precancerous lesions in p16/Ki-67 dual stain positive cases was much higher than before,and the negative cases had lower risk.Besides,there was no cervical intraepithelial neoplasia(CIN)III case missed after triaged by p16/Ki-67 dual-stained cytology.In p16/Ki-67 dual-stained cytology positive women with benign pathology or CIN I,the 1-year progression rate is 20.5%and in p16/Ki-67 dual-stained cytology negative women,the 1-year progression rate is5.6%.Conclusions:hr-HPV genotyping test plays an important role in cervical cancer screening.p16/Ki-67 dual stain may be a promising triage test.As for chronic cervicitis or CIN I patients,a positive p16/Ki-67 dual-stained cytology suggests a high risk in progression and need to be followed up closely.
基金the Vice Chancellor of Research in Mashhad University of Medical Sciences(Grant No.950170)
文摘BACKGROUND:It is not clear whether Emergency Severity Index(ESI)is valid to triage heart failure(HF)patients and if HF patients benefi t more from a customized triage scale or not.The aim of study is to compare the effect of Heart Failure Triage Scale(HFTS)and ESI on mistriage among patients with HF who present to the emergency department(ED).METHODS:A randomized clinical trial was conducted from April to June 2017.HF patients with dyspnea were randomly assigned to HFTS or ESI groups.Triage level,used resources and time to electrocardiogram(ECG)were compared between both groups among HF patients who were admitted to coronary care unit(CCU),cardiac unit(CU)and discharged patients from the ED.Content validity was examined using Kappa designating agreement on relevance(K*).Reliability of both scale was evaluated using inter-observer agreement(Kappa).RESULTS:Seventy-three and 74 HF patients were assigned to HFTS and ESI groups respectively.Time to ECG in HFTS group was signifi cantly shorter than that of ESI group(2.05 vs.16.82 minutes).Triage level between HFTS and ESI groups was signifi cantly different among patients admitted to CCU(1.0 vs.2.8),cardiac unit(2.26 vs.3.06)and discharged patients from the ED(3.53 vs.2.86).Used resources in HFTS group was significantly different among triage levels(H=25.89;df=3;P<0.001).CONCLUSION:HFTS is associated with less mistriage than ESI for triaging HF patients.It is recommended to make use of HFTS to triage HF patients in the ED.
文摘BACKGROUND: Although the Australasian Triage Scale(ATS) has been developed two decades ago, its reliability has not been def ined; therefore, we present a meta-analyis of the reliability of the ATS in order to reveal to what extent the ATS is reliable.DATA SOURCES: Electronic databases were searched to March 2014. The included studies were those that reported samples size, reliability coefficients, and adequate description of the ATS reliability assessment. The guidelines for reporting reliability and agreement studies(GRRAS) were used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was done based on the method of moment's estimator.RESULTS: Six studies were included in this study at last. Pooled coefficient for the ATS was substantial 0.428(95%CI 0.340–0.509). The rate of mis-triage was less than fifty percent. The agreement upon the adult version is higher than the pediatric version.CONCLUSION: The ATS has shown an acceptable level of overall reliability in the emergency department, but it needs more development to reach an almost perfect agreement.
基金National Health Commission(formerly Health and Family Planning Commission)of China(No.201502004)CAMS Innovation Fund for Medical Sciences(CIFMS)(No.2021-I2M-1-004)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(No.2019PT320010 and No.2018PT32025)。
文摘Objective:We aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus(hrHPV)-positive women in primary healthcare settings in China.Methods:This study was undertaken in 11 rural and 9 urban sites.Women aged 35-64 years old were enrolled.HrHPV-positive women were randomly allocated to liquid-based cytology(LBC),visual inspection with acetic acid and Lugol’s iodine(VIA/VILI)(rural only)triage,or directly referred to colposcopy(direct COLP).At 24 months,hrHPV testing,LBC and VIA/VILI were conducted for combined screening.Results:In rural sites,1,949 hrHPV-positive women were analyzed.A total of 852,218 and 480 women were randomly assigned to direct COLP,LBC and VIA/VILI.At baseline,colposcopy referral rates of LBC or VIA/VILI triage could be reduced by 70%-80%.LBC(n=3 and n=7)or VIA/VILI(n=8 and n=26)could significantly decrease the number of colposcopies needed to detect one cervical intraepithelial neoplasia(CIN)2 or worse and CIN3+compared with direct COLP(n=14 and n=23).For the 24-month cumulative detection rate of CIN2+,VIA/VILI triage was 0.50-fold compared with LBC triage and 0.46-fold with the direct COLP.When stratified by age,baseline LBC triage+performed best(P<0.001),peaking among women aged 35-44 years(Ptrend=0.002).In urban sites,1,728 women were hrHPV genotyping test positive.A total of 408,571 and 568women were randomly assigned to direct COLP for HPV16/18+,direct COLP for other hrHPV subtypes+,and LBC triage for other hrHPV subtypes+.LBC(n=12 and n=31)significantly decreased the number of colposcopies needed to detect one CIN2+and CIN3+compared with direct COLP(n=14 and n=44).HPV16/18+increased the 24-month cumulative detection rate of CIN2+(17.89%,P<0.001).Conclusions:LBC triage for hrHPV-positive women in rural settings and direct COLP for HPV16/18+women and LBC triage for other hrHPV subtype+women in urban settings might be feasible strategies.
文摘BACKGROUND: Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors. This study aimed to determine the best triage system in the pediatric emergency department.METHODS: This was a prospective observational study. This study was divided into two phases. The fi rst phase determined the inter-rater reliability of fi ve triage systems: Manchester Triage System(MTS), Emergency Severity Index(ESI) version 4, Pediatric Canadian Triage and Acuity Scale(CTAS), Australasian Triage Scale(ATS), and Ramathibodi Triage System(RTS) by triage nurses and pediatric residents. In the second phase, to analyze the validity of each triage system, patients were categorized as two groups, i.e., high acuity patients(triage level 1, 2) and low acuity patients(triage level 3, 4, and 5). Then we compared the triage acuity with actual admission.RESULTS: In phase I, RTS illustrated almost perfect inter-rater reliability with kappa of 1.0(P<0.01). ESI and CTAS illustrated good inter-rater reliability with kappa of 0.8–0.9(P<0.01). Meanwhile, ATS and MTS illustrated moderate to good inter-rater reliability with kappa of 0.5–0.7(P<0.01). In phase II, we included 1 041 participants with average age of 4.7±4.2 years, of which 55% were male and 45% were female. In addition 32% of the participants had underlying diseases, and 123(11.8%) patients were admitted. We found that ESI illustrated the most appropriate predicting ability for admission with sensitivity of 52%, specifi city of 81%, and AUC 0.78(95%CI 0.74–0.81).CONCLUSION: RTS illustrated almost perfect inter-rater reliability. Meanwhile, ESI and CTAS illustrated good inter-rater reliability. Finally, ESI illustrated the appropriate validity for triage system.
文摘BACKGROUND Emerging infectious diseases are a constant threat to the public’s health and health care systems around the world.Coronavirus disease 2019(COVID-2019),which was defined by the World Health Organization as pandemic,has rapidly emerged as a global health threat.Outbreak evolution and prevention of international implications require substantial flexibility of frontline health care facilities in their response.AIM To explore the effect of the implementation and management strategy of prescreening triage in children during COVID-19.METHODS The standardized triage screening procedures included a standardized triage screening questionnaire,setup of pre-screening triage station,multi-point temperature monitoring,extensive screenings,and two-way protection.In order to ensure the implementation of the pre-screening triage,the prevention and control management strategies included training,emergency exercise,and staff protection.Statistical analysis was performed on the data from all the children hospitalized from January 20,2020 to March 20,2020 at solstice during the pandemic period.Data were obtained from questionnaires and electronic medical record systems.RESULTS A total of 17561 children,including 2652 who met the criteria for screening,192 suspected cases,and two confirmed cases without omission,were screened from January 20,2020 to March 20,2020 at solstice during the pandemic period.There was zero transmission of the infection to any medical staff.CONCLUSION The effective strategies for pre-screening triage have an essential role in the prevention and control of hospital infection.
基金the funding from the Military Program during the 12th Five-year Plan Period,Proposal No.2011YY027
文摘Traditional triage cannot meet the needs of modern warfare. This paper describes the design of triage and evacuation equipment for casualties at sea that can quickly address mass-casualty triage and store and transmit information during battlefield treatment and medical evacuation. This equipment consists of a high-capacity medical information card, a simulated patient generator, a triage classifier and a multifunctional airbag triage vest.
文摘BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to "wrong triage" in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more lives.METHODS: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a paramedic.RESULTS: By using the proportion test, we found that correct triaging was significantly different(P=0.005) in proportion between the two groups: group B(80%) with triage tool performed better in triaging the bomb blast victims than group A(50%) without the bombing specific triage tool performed.CONCLUSION: Development of bombing specific triage tool can reduce under triaging.
文摘AIM:To evaluate the performance of the specific French Vittel "Pre-Hospital(PH) resuscitation" criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value(PPV) of pre-hospital trauma triage.METHODS: This was a monocentric prospective cohort study of injured adults transported by emergency medi-cal service to a trauma center. Patients who met any of the field trauma triage criteria were considered "triage positive". Hospital data was statistically linked to prehospital records. The primary outcome of defining a "major trauma patient" was Injury Severity Score(ISS) > 16. RESULTS: There were a total of 200 injured patients evaluated over a 2 years period who met at least 1 triage criterion. The number of false positives was 64 patients(ISS < 16). The PPV was 68%. The sensitivity and the negative predictive value could not be evaluated in this study since it only included patients with positive Vittel criteria. The criterion of "PH resuscitation" was present for 64 patients(32%),but 10 of them had an ISS < 16. This was statistically significant in correlation with the severity of the trauma in univariate analysis(OR = 7.2; P = 0.005; 95%CI: 1.6-31.6). However,despite this correlation the overall PPV was not significantly increased by the use of the criterion "PH resuscitation"(68% vs 67.8%).CONCLUSION: The criterion of "pre-hospital resuscitation" was statistically significant with the severity of the trauma,but did not increase the PPV. The use of "prehospital resuscitation" criterion could be re-considered if these results are confirmed by larger studies.
文摘Triage is a method for determining the priority of patients’treatment to improve survival rates.Different triage methods are used in hospitals,and they are applied after performing an evaluation based on standard methods such as the Japan Triage Acuity Scale(JTAS)or Emergency Severity Index(ESI).It is important to consider the characteristics of all the hospitals when assigning triage methods and emergency levels to them;the hospital managers make these decisions.We propose a multi-agent simulation method to support the hospital managers in employing the triage protocols according to their environment.We developed a prototype simulation system called TRISim to explore and assess the triage operations.In this paper,we provide an overview of TRISim and present our experimental results to validate the system.
文摘When the troops are attacked by nuclear weapons, the number of the wounded and thetype and the condition of the wounds will change with the equivalence and the way of explosion, thenumber of soldiers taking part, the area of the disposition of the troops, and the conditions of protectionof the personnel. Whether the wounded by nuclear weapons who is pouring in enormous amountcan be correctly classified in time has a very important relation in enhancing the effect of the first-aidand the treatment later on. We worked out a programme about the defined types and criteria of thewounded by nuclear weapons beforehand to be stored into the microcomputer. After nuclear cxplo-sion, it is necessary only to input the known data into the microcomputer from the key-board, thecomputer will immediately tell the number of the wounded of various types, the number of peopleand the time needed to perform the triage task and the surgical personnel needed to performthe operations, so that medical supporting programme can be selected or adjusted on time and the ef-ficiency and quality of the triage and first-aid work can be improved.
文摘AIM: To determine the association of unstable pelvic ring injuries with trauma code status.METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was performed. The trauma registry was used to identify level 1 and level 2 trauma codes for each injury. The computed tomography scans in all patients were classified as stable or unstable using the Abbreviated Injury Scale. Pelvic injury classifications in level 1 and level 2 groups were compared. Patient disposition at discharge in level 1 and level 2 groups were also compared.RESULTS: There were 108 level 1 and 130 level 2 blunt trauma admissions. In the level 1 group, 67% of pelvic injuries were classified as stable fracture patterns and 33% were classified as unstable. In the level 2 group, 62% of pelvic injuries were classified as stable fracture patterns and 38% were classified as unstable. level 1 trauma code was not associated with odds of having an unstable fracture pattern(OR = 0.83, 95%CI: 0.48-1.41, P = 0.485). In the level 1 group with unstable pelvic injuries, 33% were discharged to home, 36% to a rehabilitation facility, and 32% died. In the level 2 group with unstable pelvic injuries, 65% were discharged to home, 31% to a rehabilitation facility, and 4% died. For those with unstable pelvic fractures(n = 85), assignment of a level 2 trauma code was associated with reduced odds of death(OR = 0.07, 95%CI: 0.01-0.35, P = 0.001) as compared to being discharged to home.CONCLUSION: Trauma code level assignment is not correlated with severity of pelvic injury. Because an unstable pelvis can lead to hemodynamic instability, these injuries may be undertriaged.
文摘Objective:To investigate the effect of the use of color codes for patient triage on physicians’clinical decision.Methods:This prospective study was conducted among female patients aged 18-65 years who visited the emergency department(ED)with complaints of acute abdominal pain.A 3-level of triage system[red(very urgent),yellow(urgent)and green(less urgent)]was used in our ED.All patients were green level.Half of these patients remained at the green level(the green group),and the remaining patients were re-labeled as false yellow(the false yellow group)in the order of ED visits.Ordering tests,consultation requests,intravenous treatment,length of hospital stay,and cost were compared between the two groups of patients.Results:In total 393 patients were included with 198 patients in the green group and 195 in the false yellow group.There was no statistically significant difference between the two groups in age,temperature,systolic blood pressure,diastolic blood pressure,pulse and oxygen saturation(P>0.05).It was observed that more tests(P=0.001),consultations(P<0.001),and intravenous treatment were requested(P<0.001),and the duration of stay in the ED was longer(P<0.001)and cost(P<0.001)was higher in the false yellow group.Conclusions:Triage do affect the decisions of physicians on female patients with acute abdominal pain.
