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Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature125355
Source
Scand J Trauma Resusc Emerg Med. 2012;20:28
Publication Type
Article
Date
2012
Author
Charlotte Barfod
Marlene Mauson Pankoke Lauritzen
Jakob Klim Danker
György Sölétormos
Jakob Lundager Forberg
Peter Anthony Berlac
Freddy Lippert
Lars Hyldborg Lundstrøm
Kristian Antonsen
Kai Henrik Wiborg Lange
Author Affiliation
Department of Anaesthesia and Intensive Care, Hillerød Hospital, Denmark. cbar@hih.regionh.dk
Source
Scand J Trauma Resusc Emerg Med. 2012;20:28
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Denmark
Emergency Service, Hospital - statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Admission - statistics & numerical data
Prognosis
Prospective Studies
Regression Analysis
Triage - methods - statistics & numerical data
Vital Signs
Young Adult
Abstract
Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.
The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, T(vitals), and presenting complaint, T(complaint). The more urgent of the two determines the final triage category, T(final). We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures.
The covariates, T(vitals), T(complaint) and T(final) were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO(2)), respiratory rate (RR), systolic blood pressure (BP) and Glasgow Coma Score (GCS). Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5%) and 'altered level of consciousness' (10.6%). More than half of the patients had a T(complaint) more urgent than T(vitals), the opposite was true in just 6% of the patients.
The HAPT system is valid in terms of predicting in-hospital mortality and ICU admission in the adult acute population. Abnormal vital signs are strongly associated with adverse outcome, while including the presenting complaint in the triage model may result in over-triage.
Notes
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PubMed ID
22490208 View in PubMed
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Access to primary care from the perspective of Aboriginal patients at an urban emergency department.

https://arctichealth.org/en/permalink/ahliterature139323
Source
Qual Health Res. 2011 Mar;21(3):333-48
Publication Type
Article
Date
Mar-2011
Author
Annette J Browne
Victoria L Smye
Patricia Rodney
Sannie Y Tang
Bill Mussell
John O'Neil
Author Affiliation
School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. annette.browne@nursing.ubc.ca
Source
Qual Health Res. 2011 Mar;21(3):333-48
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Adult
Anthropology, Cultural
British Columbia
Canada
Emergency Service, Hospital - statistics & numerical data - utilization
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility - statistics & numerical data
Health services needs and demand
Health Status Disparities
Humans
Indians, North American - statistics & numerical data
Male
Middle Aged
Primary Health Care - statistics & numerical data
Time Factors
Triage
Urban Population - statistics & numerical data
Young Adult
Abstract
In this article, we discuss findings from an ethnographic study in which we explored experiences of access to primary care services from the perspective of Aboriginal people seeking care at an emergency department (ED) located in a large Canadian city. Data were collected over 20 months of immersion in the ED, and included participant observation and in-depth interviews with 44 patients triaged as stable and nonurgent, most of whom were living in poverty and residing in the inner city. Three themes in the findings are discussed: (a) anticipating providers' assumptions; (b) seeking help for chronic pain; and (c) use of the ED as a reflection of social suffering. Implications of these findings are discussed in relation to the role of the ED as well as the broader primary care sector in responding to the needs of patients affected by poverty, racialization, and other forms of disadvantage.
PubMed ID
21075979 View in PubMed
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Accuracy of the ICD-10 discharge diagnosis for syncope.

https://arctichealth.org/en/permalink/ahliterature119178
Source
Europace. 2013 Apr;15(4):595-600
Publication Type
Article
Date
Apr-2013
Author
Martin Huth Ruwald
Morten Lock Hansen
Morten Lamberts
Søren Lund Kristensen
Mads Wissenberg
Anne-Marie Schjerning Olsen
Stefan Bisgaard Christensen
Michael Vinther
Lars Køber
Christian Torp-Pedersen
Jim Hansen
Gunnar Hilmar Gislason
Author Affiliation
Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark. mruwald@hotmail.com
Source
Europace. 2013 Apr;15(4):595-600
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Denmark - epidemiology
Emergency Service, Hospital - statistics & numerical data
Female
Humans
International Classification of Diseases - statistics & numerical data
Male
Middle Aged
Patient Discharge - statistics & numerical data
Predictive value of tests
Reproducibility of Results
Retrospective Studies
Risk factors
Syncope - diagnosis - epidemiology
Abstract
Administrative discharge codes are widely used in epidemiology, but the specificity and sensitivity of this coding is unknown and must be validated. We assessed the validity of the discharge diagnosis of syncope in administrative registers and reviewed the etiology of syncope after workup.
Two samples were investigated. One sample consisted of 5262 randomly selected medical patients. The other sample consisted of 750 patients admitted or seen in the emergency department (ED) for syncope (ICD-10: R55.9) in three hospitals in Denmark. All charts were reviewed for baseline characteristics and to confirm the presence/absence of syncope and to compare with the administrative coding. In a sample of 600 admitted patients 570 (95%) and of 150 patients from ED 140 (93%) had syncope representing the positive predictive values. Median age of the population was 69 years (IQR: ± 14). In the second sample of 5262 randomly selected medical patients, 75 (1.4%) had syncope, of which 47 were coded as R55.9 yielding a sensitivity of 62.7%, a negative predictive value of 99.5%, and a specificity of 99.9%.
ED and hospital discharge diagnostic coding for syncope has a positive predictive value of 95% and a sensitivity of 63%.
PubMed ID
23129545 View in PubMed
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[A community short-term crisis unit does not reduce acute admissions to psychiatric wards]

https://arctichealth.org/en/permalink/ahliterature95020
Source
Tidsskr Nor Laegeforen. 2009 Oct 8;129(19):1973-6
Publication Type
Article
Date
Oct-8-2009
Author
Bergerud Tone
Møller Paul
Larsen Frode
Veenstra Marijke
Ruud Torleif
Author Affiliation
Allmennpsykiatrisk døgnseksjon, Psykiatrisk Senter Asker, Sykehuset Asker og Baerum, Postboks 83, 1309 Rud, Norway. tone.bergerud@sabhf.no
Source
Tidsskr Nor Laegeforen. 2009 Oct 8;129(19):1973-6
Date
Oct-8-2009
Language
Norwegian
Publication Type
Article
Keywords
Adult
Community Mental Health Centers
Community Mental Health Services - organization & administration
Crisis Intervention - organization & administration
Emergency Service, Hospital - statistics & numerical data
Female
Humans
Male
Mental Disorders - diagnosis - therapy
Middle Aged
Norway
Patient Admission - statistics & numerical data
Psychiatric Department, Hospital - statistics & numerical data
Abstract
BACKGROUND: Due to long-term capacity problems in the psychiatric acute ward, we tried to canalise acute admissions due to life crises (and not serious mental disease) to a new short-term in-patient crisis unit. Our hypothesis was that the opening of this unit would lead to fewer admissions to the psychiatric acute ward and that this change would be reflected by an increase of patients with a more severe psychopathology. MATERIAL AND METHODS: The study had a quasi-experimental design. Two patient groups in a psychiatric acute ward (from separate catchment areas) were compared before (2.1.2003-1.6.2003) and after (2.1.2004-1.6.2004) establishment of a community based short-term inpatient crisis unit in one of the catchment areas. RESULTS: 234 patients were included in the study. Admissions to the psychiatric acute ward did not decline from any of the catchment areas from the first to the second time-period . The second time-period was associated with less psychopathology, but only for men in the area with a crisis unit. The reduction was largest for self-harm and suicidal behaviour (p = 0.02) and depression (p = 0.01). INTERPRETATION: None of our hypotheses were confirmed. Our main conclusion is that patient flow in acute mental health services involves a multitude of complex and unpredictable factors. The services continuously reorganise. Different ways of organising mental health services are rarely studied systematically, and such studies are difficult and resource demanding.
PubMed ID
19823199 View in PubMed
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[Activities of the Norwegian field hospital in Bosnia-Herzegovina. Survey of a 3-year material].

https://arctichealth.org/en/permalink/ahliterature206805
Source
Tidsskr Nor Laegeforen. 1997 Nov 30;117(29):4234-7
Publication Type
Article
Date
Nov-30-1997
Author
G. Andreassen
R. Søberg
P I Reitehaug
Author Affiliation
Ortopedisk avdeling, Ullevål sykehus, Oslo.
Source
Tidsskr Nor Laegeforen. 1997 Nov 30;117(29):4234-7
Date
Nov-30-1997
Language
Norwegian
Publication Type
Article
Keywords
Bosnia-Herzegovina
Emergency Service, Hospital - statistics & numerical data
Hospitals, Military - statistics & numerical data
Humans
Norway
Wounds and Injuries - diagnosis - surgery - therapy
Abstract
In November, 1993 the UN opened a Norwegian field hospital in Bosnia-Herzegovina. The hospital was handed over to the American IFOR forces in November, 1996. In the present study, we analyse the activities at the hospital and the results achieved by the Norwegian management. While under Norwegian supervision 2,593 patients were admitted, and 67% of them were civilians. Almost two thirds of military personnel admitted were non-surgical cases. The war-related surgical activity was low, corresponding to the low number of war-related injuries. In the period in question 135 emergency operations were performed on military persons. There was considerable out-patient activity at the hospital, covering both military personnel and civilians. Altogether, 12,921 out-patients were treated, 40% of which were civilians. The hospital was well-equipped and well-run. This experience will be helpful in planning future Norwegian task forces abroad.
Notes
Comment In: Tidsskr Nor Laegeforen. 1998 Jan 10;118(1):1019481922
PubMed ID
9441468 View in PubMed
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[Acute abdomen calls for considerable care resources. Analysis of 3727 in-patients in the county of Stockholm during the first quarter of 1995]

https://arctichealth.org/en/permalink/ahliterature72078
Source
Lakartidningen. 2000 Sep 13;97(37):4008-12
Publication Type
Article
Date
Sep-13-2000
Author
G. Fenyö
M. Boijsen
L. Enochsson
M. Goldinger
S. Gröndal
P. Lundquist
I. Meldahl
M. Nilsson
U. Wenger
Author Affiliation
Kirurgiska kliniken, Södersjukhuset g.fenyo@telia.com
Source
Lakartidningen. 2000 Sep 13;97(37):4008-12
Date
Sep-13-2000
Language
Swedish
Publication Type
Article
Keywords
Abdomen, Acute - diagnosis - epidemiology - surgery
Abdominal Pain - etiology
Adolescent
Adult
Aged
Emergency Service, Hospital - statistics & numerical data - trends
English Abstract
Female
Health Services Needs and Demand - statistics & numerical data - trends
Humans
Male
Medical Illustration
Middle Aged
Retrospective Studies
Surgery Department, Hospital - statistics & numerical data - trends
Sweden - epidemiology
Workload
Abstract
A total of 3,727 in-patients with acute abdominal symptoms were identified during the first quarter of 1995 at the surgical clinics of the nine hospitals with emergency departments in the county of Stockholm. The diagnoses were: non-specific abdominal pain 24%; cholecystitis 9%; appendicitis 8%; bowel obstruction 7%; intra-abdominal malignancy, diseases of the urinary tract and peptic ulcer 6% each; gastrointestinal hemorrhage, diverticulitis of the colon and pancreatitis 5% each; other diseases as a cause of abdominal symptoms, 19%. 1,601 operations were performed of which 47% were endoscopic procedures. The mean duration of hospital stay was 4.8 days. The length of stay increased significantly with age. The age-related relative frequency of hospitalization due to acute abdominal pain was also dramatically higher in the elderly cohorts. These facts and the prognosis of an 18% increase of inhabitants 50 years of age or older until 2010 in Greater Stockholm signal an increased need of hospital resources for this large group of patients in the coming years.
PubMed ID
11036359 View in PubMed
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Acute alcohol consumption and motivation to reduce drinking among injured patients in a Swedish emergency department.

https://arctichealth.org/en/permalink/ahliterature120290
Source
J Addict Nurs. 2012 Oct;23(3):152-8
Publication Type
Article
Date
Oct-2012
Author
Anna Trinks
Karin Festin
Preben Bendtsen
Cheryl J Cherpitel
Per Nilsen
Author Affiliation
Anna Trinks, MSc, Karin Festin, PhD, Preben Bendtsen, PhD, and Per Nilsen, PhD, Department of Medical and Health Sciences, Linköping, Sweden. Cheryl J. Cherpitel, DrPH, Alcohol Research Group, Berkeley, California.
Source
J Addict Nurs. 2012 Oct;23(3):152-8
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Binge Drinking - epidemiology - psychology
Emergency Service, Hospital - statistics & numerical data
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Motivation
Prevalence
Risk factors
Sweden - epidemiology
Wounds and Injuries - epidemiology
Young Adult
Abstract
Injuries constitute a major public health problem. Millions of people are injured each year, and acute drinking is a well-known risk factor for injuries. Research suggests that acknowledgment of alcohol as a factor in an injury enhances willingness to change drinking behavior, possibly because the patient becomes aware of the negative consequences of their drinking. This study aims to investigate the prevalence of acute alcohol consumption (drinking before the event) among injury patients and to examine the importance of factors potentially associated with motivation to reduce alcohol consumption among these patients. All patients aged 18-69 years were requested to answer alcohol-related questions on a touchscreen computer. Fifteen percent of injured patients were categorized as acute drinkers, and of these, 64% reported that their injury was connected to alcohol. There were significant differences for all sociodemographic and drinking characteristics between acute drinkers and nonacute drinkers. Acute drinkers were categorized as risky drinkers to a much higher extent than nonacute drinkers. Acute drinkers had a considerably higher average weekly alcohol consumption and engaged far more frequently in heavy episodic drinking than nonacute drinkers. Acute drinkers were motivated to reduce their alcohol intake to a greater extent than nonacute drinkers; 51% were in the action, preparation, and contemplation stages, compared with 19% of the nonacute drinkers. Acute drinkers had considerably more detrimental alcohol consumption than nonacute drinkers, and the acute drinkers were more motivated to reduce their drinking than the nonacute drinkers.
Notes
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PubMed ID
24335731 View in PubMed
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Acute asthma among adults presenting to the emergency department: the role of race/ethnicity and socioeconomic status.

https://arctichealth.org/en/permalink/ahliterature183689
Source
Chest. 2003 Sep;124(3):803-12
Publication Type
Article
Date
Sep-2003
Author
Edwin D Boudreaux
Stephen D Emond
Sunday Clark
Carlos A Camargo
Author Affiliation
Department of Emergency Medicine, Cooper Hospital, One Cooper Plaza, Camden, NJ 08103-1489, USA. boudreaux-edwin@cooperhealth.edu
Source
Chest. 2003 Sep;124(3):803-12
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Asthma - epidemiology - ethnology
Canada - epidemiology
Cohort Studies
Emergency Service, Hospital - statistics & numerical data
Ethnic Groups - statistics & numerical data
Female
Health Services Accessibility - statistics & numerical data
Humans
Male
Middle Aged
Patient Admission - statistics & numerical data
Primary Health Care - statistics & numerical data
Prospective Studies
Socioeconomic Factors
United States - epidemiology
Abstract
To investigate racial/ethnic differences in acute asthma among adults presenting to the emergency department (ED), and to determine whether observed differences are attributable to socioeconomic status (SES).
Prospective cohort studies performed during 1996 to 1998 by the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers provided 24-h coverage for a median duration of 2 weeks per year. Adults with acute asthma were interviewed in the ED and by telephone 2 weeks after hospital discharge.
Sixty-four North American EDs.
A total of 1,847 patients were enrolled into the study. Black and Hispanic asthma patients had a history of more hospitalizations than did whites (ever-hospitalized patients: black, 66%; Hispanic, 63%; white, 54%; p
PubMed ID
12970001 View in PubMed
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Acute chest pain - a prospective population based study of contacts to Norwegian emergency medical communication centres.

https://arctichealth.org/en/permalink/ahliterature132799
Source
BMC Emerg Med. 2011;11:9
Publication Type
Article
Date
2011
Author
Robert Anders Burman
Erik Zakariassen
Steinar Hunskaar
Author Affiliation
National Centre for Emergency Primary Health Care, Uni Health, Kalfarveien 31, 5018 Bergen, Norway. robert.burman@uni.no
Source
BMC Emerg Med. 2011;11:9
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Angina Pectoris - epidemiology - etiology - therapy
Child
Child, Preschool
Decision Trees
Emergency Service, Hospital - statistics & numerical data
Female
Health Services Needs and Demand - statistics & numerical data
Humans
Male
Middle Aged
Norway - epidemiology
Prospective Studies
Registries
Triage - statistics & numerical data
Young Adult
Abstract
Acute chest pain is a frequently occurring symptom in patients with medical emergencies and imposes potentially life threatening situations outside hospitals. Little is known about the epidemiology of patients with acute chest pain in a primary care setting in Norway, and we aimed to obtain more representative data on such patients using data from emergency medical communication centres (EMCCs).
Data were collected prospectively during three months in 2007 from three EMCCs, covering 816 000 inhabitants. The EMCCs gathered information on every situation that was triaged as a red response (defined as an "acute" response, with the highest priority), according to the Norwegian Index of Medical Emergencies. Records from ambulances and primary care doctors were subsequently collected. International Classification of Primary Care - 2 symptom codes and The National Committee on Aeronautics (NACA) System scores were assigned retrospectively. Only chest pain patients were included in the study.
5 180 patients were involved in red response situations, of which 21% had chest pain. Estimated rate was 5.4 chest pain cases per 1000 inhabitants per year. NACA-scores indicated that 26% of the patients were in a life-threatening medical situation. Median prehospital response time was 13 minutes; an ambulance reached the patient in less than 10 minutes in 30% of the cases. Seventy-six per cent of the patients with chest pain were admitted to a hospital for further investigation, 14% received final treatment at a casualty clinic, while 10% had no further investigation by a doctor ("left at the scene").
The majority of patients with acute chest pain were admitted to a hospital for further investigation, but only a quarter of the patients were assessed prehospitally to have a severe illness. This sheds light on the challenges for the EMCCs in deciding the appropriate level of response in patients with acute chest pain. Overtriage is to some extent both expected and desirable to intercept all patients in need of immediate help, but it is also well known that overtriage is resource demanding. Further research is needed to elucidate the challenges in the diagnosis and management of chest pain outside hospitals.
Notes
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Cites: Resuscitation. 2008 Sep;78(3):298-30618562077
PubMed ID
21777448 View in PubMed
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Acute heart failure in the emergency department: short and long-term outcomes of elderly patients with heart failure.

https://arctichealth.org/en/permalink/ahliterature158738
Source
Eur J Heart Fail. 2008 Mar;10(3):308-14
Publication Type
Article
Date
Mar-2008
Author
Justin A Ezekowitz
Jeffery A Bakal
Padma Kaul
Cynthia M Westerhout
Paul W Armstrong
Author Affiliation
Division of Cardiology, Department of Medicine University of Alberta, Canada. justin.ezekowitz@ualberta.ca
Source
Eur J Heart Fail. 2008 Mar;10(3):308-14
Date
Mar-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alberta - epidemiology
Comorbidity
Emergency Service, Hospital - statistics & numerical data
Female
Heart Failure - mortality
Hospital Mortality
Humans
Male
Patient Discharge - statistics & numerical data
Risk assessment
Time Factors
Treatment Outcome
Abstract
Previous epidemiologic studies of acute heart failure (AHF) have involved patients admitted to hospital and fail to account for that unknown proportion discharged directly from the emergency department (ED). We examined discharge rates, and whether outcomes, including mortality, differed based on admission status in AHF.
This population-based cohort included all patients > or =65 years presenting to an Alberta ED with HF (ICD9-CM 428.x; 1998 to 2001). Patients were either not admitted (Not-ADM) or directly admitted to hospital (ADM) and followed for one-year. Of 10,415 AHF patients evaluated in the ED, 35% were Not-ADM whereas 65% were ADM. Thirty days after ED presentation the rates of death, re-ED or initial/re-hospitalisation were 3.3%, 44% and 19% for Not-ADM, and 10.9%, 33% and 21% for the ADM patients, respectively (all p
Notes
Comment In: Eur J Heart Fail. 2008 Mar;10(3):222-318331965
PubMed ID
18280788 View in PubMed
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368 records – page 1 of 37.