African Journal of Emergency Medicine最新文献

{"title":"Understanding the factors that influence CT utilization for mild traumatic brain injury in a low resource setting - a qualitative study using the Theoretical Domains Framework","authors":"Harriet Nalubega Kisembo ,&nbsp;Richard Malumba ,&nbsp;Henry Sematimba ,&nbsp;Racheal Ankunda ,&nbsp;Irene Dorothy Nalweyiso ,&nbsp;Elsie-Kiguli Malwadde ,&nbsp;Elizeus Rutebemberwa ,&nbsp;Simon Kasasa ,&nbsp;Dina Husseiny Salama ,&nbsp;Michael Grace Kawooya","doi":"10.1016/j.afjem.2024.04.004","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.04.004","url":null,"abstract":"<div><h3>Introduction</h3><p>In low resource settings (LRS), utilization of Computed Tomography scan (CTS) for mild traumatic brain injuries (mTBIs) presents unique challenges and considerations given the limited infrastructure, financial resources, and trained personnel. The Theoretical Domains Framework (TDF) offers a comprehensive theoretical lens to explore factors influencing the decision-making to order CTS for mTBI by imaging referrers (IRs).</p></div><div><h3>Objectives</h3><p>The primary objective was to explore IRs’ beliefs about factors influencing CT utilization in mTBIs using TDF in Uganda.</p><p>Differences in the factors influencing CTS ordering behavior across specialties, levels of experience, and hospital category were also explored.</p></div><div><h3>Materials and Methods</h3><p>In-depth semi-structured interviews guided by TDF were conducted among purposively selected IRs from 6 tertiary public and private hospitals with functional CTS services. A thematic analysis was performed with codes and emerging themes developed based on the TDF.</p></div><div><h3>Results</h3><p>Eleven IRs including medical officers, non-neurosurgeon specialists and neurosurgeons aged on average 42 years (SD+/-12.3 years) participated.</p><p>Identified factors within <em>skills</em> domain involved IRs’ clinical assessment and decision-making abilities, while beliefs about <em>capabilities</em> and <em>consequences</em> encompassed their confidence in diagnostic abilities and perceptions of CTS risks and benefits. The <em>environmental context and resources</em> domain addressed the availability of CT scanners and financial constraints. The <em>knowledge</em> domain elicited IRs’ understanding of clinical guidelines and evidence-based practices while social influences considered peer influence and institutional culture. For <em>memory, attention &amp; decision processes</em> domain, IRs adherence to guidelines and intentions to order CT scans were cited.</p></div><div><h3>Conclusion</h3><p>Using TDF, IRs identified several factors believed to influence decision making to order CTS in mTBI in a LRS. The findings can inform stakeholders to develop targeted strategies and evidence-based interventions to optimize CT utilization in mTBI such as; educational programs, workflow modifications, decision support tools, and infrastructure improvements, among others.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 2","pages":"Pages 103-108"},"PeriodicalIF":1.3,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000120/pdfft?md5=bcf712a589e4166da0cbc988fae08e03&pid=1-s2.0-S2211419X24000120-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140842985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Health research abstracts: December ‘23","authors":"Dr. Jonathan Kajjimu","doi":"10.1016/j.afjem.2024.04.002","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.04.002","url":null,"abstract":"<div><p>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 2","pages":"Pages 100-102"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000144/pdfft?md5=6f1a370e9bc4ea0c9a3416ecc3b7ca26&pid=1-s2.0-S2211419X24000144-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140816358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed tomography benefits and cost in hemodynamically stable patients with blunt abdominal trauma at an Egyptian University Hospital","authors":"Mohamed A. Abdel Hamid ,&nbsp;Mohammad A. Abd-erRazik ,&nbsp;Mostafa Nagy ,&nbsp;Mohamed El-Shinawi ,&nbsp;Jon M. Hirshon ,&nbsp;Maged El-Setouhy","doi":"10.1016/j.afjem.2023.11.006","DOIUrl":"https://doi.org/10.1016/j.afjem.2023.11.006","url":null,"abstract":"<div><h3>Background</h3><p>Trauma is a significant cause of mortality, especially among individuals aged between 15 and 44 years, with a substantial burden falling on economically active populations. Low- and middle-income countries (LMICs) bear the burden of trauma-related deaths, accounting for over 90 % globally. In Egypt, trauma rates are increasing, primarily due to road traffic crashes (RTC), affecting males disproportionately. Blunt abdominal trauma, often caused by RTC, can lead to missed intra-abdominal injuries (IAIs) due to atypical symptoms. Computed Tomography (CT) offers high sensitivity and specificity in detecting IAIs, but concerns about cost and radiation exposure exist.</p></div><div><h3>Methodology</h3><p>This study investigates the roles of Focused Assessment with Sonography for Trauma (FAST) and CT in managing blunt abdominal trauma. A retrospective cohort study was conducted on hemodynamically stable patients. Data included patient demographics, trauma details, healthcare decisions, costs, and outcomes.</p></div><div><h3>Results</h3><p>Computed tomography significantly reduced unnecessary laparotomies (12.3% vs. 24.8 %, <em>p</em> = 0.001), shortened hospital stays (4.83±0.71 days vs. 6.15±1.28 days, <em>p</em> = 0.005), and reduced ICU admissions (8 vs. 32, <em>p</em> = 0.023) compared to FAST alone. Overall costs were lower in the CT &amp; FAST Group ($2055.95 vs. $3488.7, <em>p</em> = 0.0001), with no significant difference in missed IAIs.</p></div><div><h3>Conclusion</h3><p>This study highlights the limitations of relying solely on FAST for IAIs and underscores the value of CT in guiding healthcare decisions. Incorporating CT led to reduced negative laparotomies, shorter hospital stays, and fewer ICU admissions. While CT incurs initial costs, its long-term benefits outweigh expenditures, particularly in LMICs. This study provides insights into optimizing diagnostic approaches for blunt abdominal trauma in low-resource settings.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 2","pages":"Pages 96-99"},"PeriodicalIF":1.3,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X23000617/pdfft?md5=282182147af9964f47da121b2d5f308a&pid=1-s2.0-S2211419X23000617-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140816205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheterized chicken for training on ultrasound-guided vascular access: A simple, cost-effective, and effective model","authors":"Olfa Chakroun-Walha ,&nbsp;Rim Karray ,&nbsp;Mouna Jerbi ,&nbsp;Houcem Affes ,&nbsp;Abdennour Nasri ,&nbsp;Imen Salem ,&nbsp;Fadhila Issaoui ,&nbsp;Mahdi Ben Dhaou ,&nbsp;Noureddine Rekik","doi":"10.1016/j.afjem.2024.03.005","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.03.005","url":null,"abstract":"<div><p>Ultrasound-guided vascular access is a medical procedure that is becoming increasingly common in daily practice and is recommended to avoid iatrogenic complications. One of the procedures with a high-risk rate of complications is the vascular puncture. However, training on this technique can be challenging due to the limited availability of simulation models. We propose a simple, cost-effective, and effective ultrasound-guided vascular access simulation model that utilizes chicken breast and a urine catheter to address this need.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 2","pages":"Pages 91-95"},"PeriodicalIF":1.3,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000090/pdfft?md5=c77ca4b866e9b15371dfc4bf60f8a261&pid=1-s2.0-S2211419X24000090-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140559247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is non-operative treatment of acute appendicitis possible: A narrative review","authors":"Hani Bendib","doi":"10.1016/j.afjem.2024.03.006","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.03.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Acute appendicitis (AA) represents the most frequent surgical emergency. Perforation was long considered the ultimate outcome of AA, prompting appendectomy; which remains the standard treatment. New data have clarified the role of the appendix, justifying conservative treatment. This narrative review aims to summarize the evidence regarding the non-operative treatment (NOT) of AA in adults.</p></div><div><h3>Methods</h3><p>The literature search was performed via the PubMed Medline database. Our criteria-based selection resulted in a total of 48 articles for review.</p></div><div><h3>Results</h3><p>Recent trials and meta-analyses have assessed NOT, which support primary antibiotic treatment of uncomplicated AA. Although it has a significant recurrence and failure rate, NOT does not appear to increase the risk of appendicular perforation. Moreover, NOT compared with appendectomy, seems to be associated with less morbidity, lower cost of care and preserved quality of life.</p></div><div><h3>Conclusion</h3><p>First-line NOT seems to be a reasonable approach for the treatment of uncomplicated CT-confirmed AA. Careful patient screening would definitely enhance the success rate.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 2","pages":"Pages 84-90"},"PeriodicalIF":1.3,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000107/pdfft?md5=5f88724ff5585c25f76646bc601c0ae1&pid=1-s2.0-S2211419X24000107-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140535226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A consensus-based tool for capability benchmarking of emergency medical services in South Africa","authors":"Ashleigh Vincent-Lambert,&nbsp;Christopher Stein","doi":"10.1016/j.afjem.2024.03.003","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.03.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Standards for Emergency Medical Services [EMS] have recently been introduced in South Africa in a movement towards the promotion of quality improvement. While these standards identify a minimum set of criteria for EMS quality they do not differentiate between services just meeting them and those exceeding them. Benchmarking may be a helpful exercise in beginning to address the question of comparative levels of capability in EMS beyond a set of minimum standards. The aim of this study was to develop a consensus-based capability benchmarking tool for EMS organizations within the South African context.</p></div><div><h3>Methods</h3><p>A total of 12 experts in the field of EMS in South Africa consented to participate in two Delphi Surveys in order to achieve consensus on the core components of an EMS organization as well as relevant level descriptors for those components. The resulting data was used to develop a consensus-based capability benchmarking tool for EMS organizations in South Africa.</p></div><div><h3>Results</h3><p>A consensus-based capability benchmarking tool was developed that allows organizations to distinguish whether the organization's capability, as a whole, is underdeveloped, developing, or well-developed. This is in addition to identifying how capable they are in all individual components or sub-components.</p></div><div><h3>Conclusion</h3><p>It is recommended that further research be conducted to assess this tool's implementation within different EMS organizations in South Africa, and that this study is used as a stepping-stone for additional research into meaningful quality improvement in emergency medical services in South Africa.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 2","pages":"Pages 75-83"},"PeriodicalIF":1.3,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000077/pdfft?md5=67239731ae6b961417a6a0e3389f8092&pid=1-s2.0-S2211419X24000077-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140341253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and practices of epistaxis in Eastern Tanzania: A cross-sectional study of an emergency in otorhinolaryngology","authors":"Zephania Saitabau Abraham ,&nbsp;Onesmo Cyprian Fussi ,&nbsp;Aveline Aloyce Kahinga","doi":"10.1016/j.afjem.2024.03.002","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.03.002","url":null,"abstract":"<div><h3>Introduction</h3><p>It's approximated that 60% of the population globally experience epistaxis during lifetime. Despite epistaxis being prevalent in Tanzania, there are limited studies that have explored experience of participants on epistaxis. This study aims to determine knowledge on the causes, first aid management and practices of epistaxis among patients attending a health facility in Eastern Tanzania</p></div><div><h3>Methods</h3><p>A descriptive cross-sectional study was conducted where 371 participants aged 15 years and above were interviewed using structured questionnaires. Data was analyzed using Statistical Package of Social Sciences version 23. Chi-square tests were performed and a p-value &lt;0.05 was considered to be statistically significant</p></div><div><h3>Results</h3><p>About two-thirds (60.9%) of the study participants had good knowledge of the causes of epistaxis. Majority of participants knew excessive nose manipulation (95.1%) to be the commonest cause of epistaxis and the least cause mentioned was chronic liver disease (24.8%). On the other hand, 77.6% of the participants had good knowledge while 22.4% had poor knowledge regarding first aid management of epistaxis. In this study, 328(88.4%) participants knew pressing the nose could stop epistaxis, while 164(44.2%) knew the best position to stop epistaxis and that is to tilt the head forward and those who had history of epistaxis, 150 (73.2%) out of 205 pinched the nose as the first aid. Similarly, 133(35.8%) participants thought cessation of smoking has effect on decreasing the occurrence of epistaxis. A significant association was noted between knowledge of first aid management of epistaxis and some socio-demographic characteristics such as age and educational level. There was also a significant association between knowledge of the causes of epistaxis and educational level.</p></div><div><h3>Conclusion</h3><p>Majority of the participants had good knowledge of the causes and first aid management of epistaxis.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 2","pages":"Pages 70-74"},"PeriodicalIF":1.3,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000065/pdfft?md5=e1703eb6869dab486a6697163fb79e58&pid=1-s2.0-S2211419X24000065-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140161088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism: A cross sectional analysis","authors":"Nishen Raghubeer ,&nbsp;Sa'ad Lahri ,&nbsp;Clint Hendrikse","doi":"10.1016/j.afjem.2024.01.004","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.01.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Pulmonary embolism (PE) is a significant global cause of mortality, ranking third after myocardial infarction and stroke. ECG findings may play a valuable role in the prognostication of patients with PE, with various ECG abnormalities proving to be reasonable predictors of haemodynamic decompensation, cardiogenic shock, and even mortality. This study aims to assess the value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism, as diagnosed with computed tomography pulmonary angiogram.</p></div><div><h3>Method</h3><p>This study was a cross sectional analysis based at Tygerberg Hospital, Cape Town, South Africa. Eligible patients were identified from all CT-PA performed between 1 January 2017 and 31 December 2019 (2 years). The ECGs were independently screened by two blinded emergency physicians for predetermined signs that are associated with right heart strain and higher pulmonary artery pressures, and these findings were analysed to in-hospital mortality.</p></div><div><h3>Results</h3><p>Of the included 81 patients, 61 (75 %) were female. Of the 41 (51 %) patients with submassive PE and 8 (10 %) with massive PE, 7 (17 %) and 3 (38 %) suffered inpatient mortality (<em>p</em> = 0.023) respectively. Univariate ECG analysis revealed that complete right bundle branch block (OR, 8.6; 95 % CI, 1.1 to 69.9; <em>p</em> = 0.044) and right axis deviation (OR, 5.6; 95 % CI, 1.4 to 22.4; <em>p</em> = 0.015) were significant predictors of inpatient mortality.</p></div><div><h3>Conclusion</h3><p>Early identification of patients with pulmonary embolism at higher risk of clinical deterioration and in-patient mortality remains a challenge. Even though no clinical finding or prediction tool in isolation can reliably predict outcomes in patients with pulmonary embolism, this study demonstrated two ECG findings at presentation that were associated with a higher likelihood of inpatient mortality. This single-centre observational study with a small sample precludes concrete conclusions and a large follow-up multi-centre study is advised.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 2","pages":"Pages 65-69"},"PeriodicalIF":1.3,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X24000041/pdfft?md5=5563968696a127057ee73d0e42cb469f&pid=1-s2.0-S2211419X24000041-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139936608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency care capacity in Sierra Leone: A multicentre analysis","authors":"Zosia Bredow ,&nbsp;Zoe Corbett ,&nbsp;Moses Mohamed Tarawally ,&nbsp;Lucy Jackson ,&nbsp;Foday Tejan Mansaray ,&nbsp;Santigie Sesay ,&nbsp;Andrew Leather","doi":"10.1016/j.afjem.2024.01.003","DOIUrl":"https://doi.org/10.1016/j.afjem.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p>The Disease Control Priorities Project estimates that over 50 % of annual mortality in low- and middle-income countries can be addressed by improved emergency care. Sierra Leone's Ministry of Health and Sanitation has highlighted emergency care as a national priority. We conducted the first multicentre analysis of emergency care capacity in Sierra Leone, using the Hospital Emergency Unit Assessment Tool (HEAT) to analyse 14 government hospitals across the country.</p></div><div><h3>Methods</h3><p>HEAT is a standardised assessment that is recommended in the World Health Organisation Emergency Care Toolkit. It has been used comparably elsewhere. To analyse Sierra Leone's emergency care capacity with the HEAT data, we created the HEAT-adjusted Emergency Care Capacity Score. Purposeful sampling was used to select 14 government facilities nationwide. A multidisciplinary team was interviewed over a 2-day in-person visit to each facility.</p></div><div><h3>Results</h3><p>Human Resources was the strongest parameter, scoring 49 %. All hospitals provided emergency cover 24/7. Emergency Diagnostic Services was the most severely limited parameter, scoring 29 %. 3 hospitals had no access to basic radiography. Infrastructure scored 47 %. 2 hospitals had adequate electricity supply; 5 had adequate clean, running water. No hospitals had adequate oxygen supply. Clinical services scored 39 %. 10 hospitals had no designated Emergency Unit, only 2 triaged to stratify severity. Signal functions scored 38 %. No hospitals had reliable access to emergency drugs such as adrenaline. The total HEAT-adjusted Emergency Care Capacity Score across all hospitals was 40 %.</p></div><div><h3>Conclusions</h3><p>These data identify gaps that have already led to local interventions, including focussing emergency resources to a resuscitation area, and training multidisciplinary teams in emergency care skills. This facility-level analysis could feed into wider assessment of Sierra Leone's emergency care systems at every level, which may help prioritise government strategy to target sustainable strengthening of national emergency care.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 1","pages":"Pages 58-64"},"PeriodicalIF":1.3,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X2400003X/pdfft?md5=64d6a42fd7211696a1b8acd92f0bebab&pid=1-s2.0-S2211419X2400003X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139694749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic accuracy of eight triage scores in suspected COVID-19 in an Emergency Department low-income setting: An observational cohort study","authors":"Carl Marincowitz ,&nbsp;Madina Hasan ,&nbsp;Yasein Omer ,&nbsp;Peter Hodkinson ,&nbsp;David McAlpine ,&nbsp;Steve Goodacre ,&nbsp;Peter A. Bath ,&nbsp;Gordon Fuller ,&nbsp;Laura Sbaffi ,&nbsp;Lee Wallis","doi":"10.1016/j.afjem.2023.12.004","DOIUrl":"https://doi.org/10.1016/j.afjem.2023.12.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Previous studies deriving and validating triage scores for patients with suspected COVID-19 in Emergency Department settings have been conducted in high- or middle-income settings. We assessed eight triage scores’ accuracy for death or organ support in patients with suspected COVID-19 in Sudan.</p></div><div><h3>Methods</h3><p>We conducted an observational cohort study using Covid-19 registry data from eight emergency unit isolation centres in Khartoum State, Sudan. We assessed performance of eight triage scores including: PRIEST, LMIC-PRIEST, NEWS2, TEWS, the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS in suspected COVID-19. A composite primary outcome included death, ventilation or ICU admission.</p></div><div><h3>Results</h3><p>In total 874 (33.84 %, 95 % CI:32.04 % to 35.69 %) of 2,583 patients died, required intubation/non-invasive ventilation or HDU/ICU admission . All risk-stratification scores assessed had worse estimated discrimination in this setting, compared to studies conducted in higher-income settings: C-statistic range for primary outcome: 0.56–0.64. At previously recommended thresholds NEWS2, PRIEST and LMIC-PRIEST had high estimated sensitivities (≥0.95) for the primary outcome. However, the high baseline risk meant that low-risk patients identified at these thresholds still had a between 8 % and 17 % risk of death, ventilation or ICU admission.</p></div><div><h3>Conclusion</h3><p>None of the triage scores assessed demonstrated sufficient accuracy to be used clinically. This is likely due to differences in the health care system and population (23 % of patients died) compared to higher-income settings in which the scores were developed. Risk-stratification scores developed in this setting are needed to provide the necessary accuracy to aid triage of patients with suspected COVID-19.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"14 1","pages":"Pages 51-57"},"PeriodicalIF":1.3,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211419X2300068X/pdfft?md5=0e0b47420954b050f7c121755e37a371&pid=1-s2.0-S2211419X2300068X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139653509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}