Effective Triage Research Articles

The Role of Health Cards in Emergency Response: Enhancing Respiratory care, Nursing, and Pharmacist Support in Public Spaces: A Literature Review

Objective: This literature review examines the role of health cards in enhancing emergency medical response, focusing on their impact on respiratory care, nursing interventions, and pharmacist support in public spaces. Health cards provide quick access to essential medical information, enabling healthcare providers to deliver timely and accurate care during emergencies. Methods: A systematic review of recent literature (2016 onward) was conducted, analyzing studies that explored the utility of health cards in improving patient outcomes during emergencies. Key areas of focus included their role in identifying critical medical history, improving communication among healthcare providers, and streamlining interventions in respiratory care, nursing, and pharmacy. Results: The findings highlight that health cards significantly enhance emergency care by reducing response time, preventing medical errors, and facilitating informed decision-making. In respiratory care, health cards enable rapid identification of pre-existing conditions and allergies, ensuring appropriate interventions. For nurses, they support effective triage and first aid. Pharmacists benefit by accessing accurate medication histories, avoiding adverse drug interactions, and recommending suitable treatments. Conclusion: Health cards are indispensable tools for improving emergency medical care in public spaces. Their widespread adoption and integration into healthcare systems could revolutionize patient care and collaboration among healthcare providers. Further research is recommended to address implementation challenges and optimize their use globally.

Development and Implementation of Automated Referral Triaging System for Spinal Cord Stimulation Procedure in Pain Medicine.

Effective referral triaging enhances patient service outcomes, experience and access to care especially for specialized procedures. This study presents the development and implementation of an automated triaging system to predict patients who would benefit from Spinal Cord Stimulation (SCS) procedure for their pain management. The proposed triage system aims to improve the triage process by reducing unnecessary appointments before SCS assessment, ensuring appropriate pain management care. It compares various machine learning techniques for the prediction while addressing the class imbalance and overlap challenges inherent in the data. Both data-level and algorithm-level approaches were explored. Two years of patient data was collected including patient characteristics, diagnosis history, pain symptoms, appointment history, medication history, and concepts from clinical notes extracted using Natural Language Processing. EasyEnsemble with Ada Boosting method, an algorithm-level approach, showed the most promising results. The tenfold validation indicated the average area under curve of 0.82, true positive rate (TPR) of 77.3%, and true negative rate (TNR) of 73.0%. The probability threshold was adjusted to 0.575 to meet practice expectation of 15% or less on false positive rate (FPR). The implementation pipeline for the selected model was designed to be applicable to real clinical settings. The one-year implementation results showed TPR of 64.7% and TNR of 87.2%, which reduced FPR by 12.8% while reduced TPR by 12.6%. The trade-off was acceptable to practice. The proposed triage system demonstrated promising accuracy, leading to the enhancement of scheduling systems, patient care, and the reduction of unnecessary appointments in a pain medicine setting.

Tele-ophthalmology as an effective triaging tool for acute ophthalmic concerns.

The purpose of this study is to determine baseline demographics and utilization trend of an on-demand, synchronous tele-ophthalmology triage program in evaluating acute ophthalmic concerns during the COVID-19 Public Health Emergency. Setting: Single-center retrospective chart review of telemedicine visits conducted by ophthalmologists and optometrists from University of Miami's Bascom Palmer Eye Institute. Patient population: 6227 patients comprised 7138 telehealth encounters. All patient encounters were included in the retrospective review without exclusions and only the primary diagnoses were categorized from October 1, 2020 to April 30, 2023. Main outcomes measures: Descriptive statistics of the telemedicine model, utilization trends, baseline patient demographics, and primary diagnoses were performed for all virtual eye care encounters during the study period. Utilization of the synchronous telemedicine platform increased during the study period. The median age of patients was 51 (IQR, 36-65) years. Patients predominantly self-identified as female (63.27%), White (72.7%), and non-Hispanic/Latino (48.2%). General external adnexa (44.1%), conjunctival disorders (15.5%) and ocular surface symptoms (15.4%), made up 75.0% of the visits during the study period. Furthermore, 63.4% of patients were new to Bascom Palmer Eye Institute, 67.1% had never engaged in telemedicine, and 96.5% of encounters were successfully completed through video conferencing. During the COVID-19 pandemic, there was significant utilization of an on-demand synchronous ocular telemedicine program to address acute concerns. This retrospective chart review demonstrates the utility of telemedicine as an important and effective tool to triage and provide care during the COVID-19 Public Health Emergency.

Optimizing mass casualty: an incident report of centralizing patient transport and its impact on triage efficiency

In mass casualty incidents, effective triage, treatment, and transport are critical for efficient management but often deviate from practices and ethical standards. In terms of resource allocation, decentralized transport is the predominant transport method; however, it is not standardized. This report retrospectively analyzed the response to a mass casualty incident at a university emergency center. By centralizing patient transport from the scene, the time to patient transport could be shortened, the burden on the scene related to transport could be reduced, and undertriage at the scene could be avoided. No trauma-related deaths occurred. This case provides a valuable contribution to the understanding of situations in which critical patients may concentrate in emergency centers during future mass-casualty incidents.

A comparison of CXR-CAD software to radiologists in identifying COVID-19 in individuals evaluated for Sars CoV-2 infection in Malawi and Zambia.

AI based software, including computer aided detection software for chest radiographs (CXR-CAD), was developed during the pandemic to improve COVID-19 case finding and triage. In high burden TB countries, the use of highly portable CXR and computer aided detection software has been adopted more broadly to improve the screening and triage of individuals for TB, but there is little evidence in these settings regarding COVID-19 CAD performance. We performed a multicenter, retrospective cross-over study evaluating CXRs from individuals at risk for COVID-19. We evaluated performance of CAD software and radiologists in comparison to COVID-19 laboratory results in 671 individuals evaluated for COVID-19 at sites in Zambia and Malawi between January 2021 and June 2022. All CXRs were interpreted by an expert radiologist and two commercially available COVID-19 CXR-CAD software. Radiologists interpreted CXRs for COVID-19 with a sensitivity of 73% (95% CI: 69%- 76%) and specificity of 49% (95% CI: 40%-58%). One CAD software (CAD2) showed performance in diagnosing COVID-19 that was comparable to that of radiologists, (AUC-ROC of 0.70 (95% CI: 0.65-0.75)), while a second (CAD1) showed inferior performance (AUC-ROC of 0.57 (95% CI: 0.52-0.63)). Agreement between CAD software and radiologists was moderate for diagnosing COVID-19, and agreement was very good in differentiating normal and abnormal CXRs in this high prevalent population. The study highlights the potential of CXR-CAD as a tool to support effective triage of individuals in Malawi and Zambia during the pandemic, particularly for distinguishing normal from abnormal CXRs. These findings suggest that while current AI-based diagnostics like CXR-CAD show promise, their effectiveness varies significantly. In order to better prepare for future pandemics, there is a need for representative training data to optimize performance in key populations, and ongoing data collection to maintain diagnostic accuracy, especially as new disease strains emerge.

KNOWLEDGE AND PRACTICE OF EMERGENCY NURSES REGARDING TRIAGE

Effective triage is essential for prioritizing patients and ensuring optimal resource allocation in emergency departments. Emergency nurses play a vital role in this process, yet gaps in their knowledge and practices can hinder patient outcomes: Objective: To assess the knowledge and practices of emergency nurses regarding triage in a tertiary care hospital in Lahore, Pakistan Methods: A descriptive cross-sectional study was conducted among 150 emergency nurses using a structured questionnaire. Data were analyzed using SPSS version 26, with results presented as frequencies and percentages. Results: The study revealed that 35.3% of nurses had low knowledge, 16% had moderate knowledge, and 34% demonstrated high knowledge of triage. Regarding practices, 54% of participants exhibited poor adherence to triage protocols, while 46% demonstrated good practices. Nurses with higher qualifications and more experience showed significantly better knowledge and practices. Conclusion: This study identifies critical gaps in the knowledge and practices of emergency nurses regarding triage. Targeted training, institutional support, and the implementation of standardized triage guidelines are necessary to enhance the efficiency and effectiveness of emergency care in Pakistan.

Does bladder outflow obstruction obfuscate the traditional clinical factors that are used to assess the risk of prostate cancer at rapid-access diagnostic clinics?

To understand whether bladder outflow obstruction influences the association between traditional clinical predictive factors, particularly prostate-specific antigen (PSA) density and clinically significant prostate cancer (csPCa). This will help facilitate effective and evidence-based triaging of patients in rapid-access clinics. We retrospectively analysed prospectively collected data from 307 suspected prostate cancer patients who underwent diagnostic biopsy from 2019 to 2023 at a single, high-volume, specialist cancer centre. Uroflowmetry testing generated two cohorts: patients with bladder outflow obstruction and non-obstructed patients. The cohort characteristics between the groups were compared and logistic regression analyses were performed to assess associations between clinical predictive factors (age, PSA density, ethnicity, family history, digital rectal examination, urinary symptom severity and magnetic resonance imaging using the PI-RADS scoring system) and clinically significant prostate cancer (csPCa) on biopsy (defined as International Society of Urological Pathology grade of greater than or equal to two). The obstructed group (n = 80) had significantly larger prostates and worse symptom severity (p < 0.05). There was no significant difference between the other predictive factors or csPCa compared to the non-obstructed (n = 227) cohort. Multivariable logistic regression analysis showed age, PSA density, an abnormal digital rectal examination and scoring PI-RADS 4-5 on magnetic resonance imaging were all significantly associated with csPCa in the non-obstructed cohort (p < 0.05). Contrastingly, only symptom severity and scoring PI-RADS 5 were significantly associated with csPCa for the obstructed patients (p < 0.05). In the presence of bladder outflow obstruction, traditional predictive variables such as age, PSA density, digital rectal examination and scoring PI-RADS 4 are not associated with csPCa. This study suggests that using these predictive variables to triage patients in rapid-access clinics with a patient who has bladder outflow obstruction could lead to the overuse of invasive biopsy.

Prediction of prolonged mechanical ventilation in the intensive care unit via machine learning: a COVID-19 perspective

Early recognition of risk factors for prolonged mechanical ventilation (PMV) could allow for early clinical interventions, prevention of secondary complications such as nosocomial infections, and effective triage of hospital resources. This study tested the hypothesis that an ensemble machine learning (ML) analysis of clinical data at time of intubation could identify patients at risk of PMV, using a COVID-19 dataset to classify patients into PMV (> 14 days) and non-PMV (≤ 14 days) groups. While several factors are known to cause PMV, including acid-base, weakness, and delirium, lesser-utilized but routinely measured parameters such as platelet count, glucose levels and fevers may also be relevant. Patient data from a single University Hospital were analyzed via the ML workflow to predict patients at risk of PMV and identify key clinical markers. Model performance was evaluated on a chronologically distinct cohort. The ML workflow identified patients at risk of PMV with AUROCTRAIN=0.960 (F1TRAIN = 0.935) and AUROCTEST=0.804 (F1TEST = 0.800). Top key features for classification included glucose, platelet count, temperature, LVEF, bicarbonate (arterial blood gas), and BMI. Data analysis at intubation time via the proposed workflow offers the potential to accurately predict patients at risk of PMV, with the goal to improve patient management and triage of hospital resources.

SPECTRUM OF ORAL AND MAXILLOFACIAL SURGERY PATIENTS SEEN AT TRIAGE WITH SUBSEQUENT EMERGENCY TREATMENT PROVIDED – A CLINICAL STUDY AT SMBBIT

Oral and maxillofacial injuries constitute a significant portion of trauma cases in emergency departments, often resulting in life-threatening complications and sometimes death. Effective triage is crucial for prioritizing care, especially in resource-limited settings. Despite the importance of standard protocols, many institutions lack uniform guidelines for managing these complex injuries, which can lead to adverse patient outcomes. Objectives: To explore the clinical presentation patterns of oral and maxillofacial trauma patients at triage, focusing on injury types and patient demographics while documenting initial emergency interventions administered. Methods: This descriptive cross-sectional study was conducted at SMBBIT over six months, involving patients presenting with OMFS Trauma sustained at Emergency Room. Data were collected using a pre-designed pro forma and analyzed using SPSS software for descriptive statistics. Results: A total of 73 patients were included, predominantly male (84.94%), with a mean age of 35.2 years. Road traffic accidents were the leading cause of injury (68.5%). Most patients were self-referred (37%), and 82.2% had no significant co-morbidities. Imaging revealed comminuted pan-facial fractures (37.5%) as the most common diagnosis. Following triage assessment, 80.8% required hospitalization, with 32.2% undergoing immediate surgical interventions, including open reduction internal fixation, closed reduction and soft tissue closure. Conclusion: This study underscores the importance of effective triage in managing oral and maxillofacial surgical patients, particularly in polytrauma cases, with a focus on a multidisciplinary team (MDT) approach. Our findings suggest that incorporating oral and maxillofacial surgical emergency care into triage protocols and resource allocation can improve care quality and reduce patients’ complications. Inclusion of oral and maxillofacial surgeons in Emergency Trauma teams in Pakistan is essential for enhancing collaboration and improving patient survival outcomes.

Extended HPV genotyping by the BD Onclarity assay: concordance with screening HPV-DNA assays, triage biomarkers, and histopathology in women from the NTCC2 study.

Large randomized clinical trials have demonstrated that human papillomavirus (HPV) testing for high-risk types is more effective than cytology in detecting pre-cancerous lesions and preventing cervical cancer. Its use is being implemented in cervical cancer screening in several countries. The most recent guidelines recommend a risk-based management. It is therefore important to assess the individual risk of having/developing high-grade lesions of women testing high-risk HPV-positive. A crucial viral factor influencing the risk is the HPV genotype since different types are associated to different carcinogenetic risks. Understanding the degree of concordance among different assays targeting either HPV presence/type(s) or cellular morphology and proteins' expression provides knowledge useful to better define how these tests can be used in screening protocols for an effective triage and to anticipate the possible implementation issues. Our study shows that the concordance between tests is higher when the infections have a higher probability of producing a clinically relevant lesion.

Cervical cancer screening: efficacy of PAX1 and JAM3 methylation assay in the triage of atypical squamous cell of undetermined significance (ASC-US)

BackgroundAtypical squamous cells of undetermined significance (ASC-US) often present diagnostic challenges with cytology-based results, leading to potential underdiagnosis or overdiagnosis. An effective triage method is essential for managing these cases to reduce unnecessary referrals and treatment.MethodsA total of 322 women diagnosed with ASC-US were tested for HPV-DNA and the PAX1 and JAM3 methylation (PAX1m/JAM3m) test in the study.ResultsMethylation levels of PAX1 and JAM3 were significantly elevated in cervical lesions classified as CIN2 or more severe lesions (CIN2+). The methylation assay demonstrated a sensitivity of 83.8% and a specificity of 95.8%, outperforming HPV-DNA testing in differentiating high-grade cervical lesions among women with ASC-US. Moreover, PAX1m/JAM3m testing significantly reduced the colposcopy referral rate for further diagnostic procedures in high-risk HPV-positive women by 79.5%.ConclusionsPAX1m/JAM3m testing shows promise as a reliable supplemental method to HPV-DNA testing for the triage of women with cytologic ASC-US. In addition, the molecular triage based on the CISCER assay or single PAX1 or JAM3 methylation, had better effects in the women with non-HPV16/18 group. This approach could potentially minimize overtreatment and unnecessary referrals in clinical practice, enhancing patient management and resource utilization.

AI-Assisted Triage Using CT Head Scans For Emergency Diagnosis

The main goal of CT-based triage is to shorten the time it takes to reach the expert opinion for patients in emergency situations, especially in cases of cranial fractures and intracranial hemorrhage. Increasing the performance in this regard may be possible with the use of artificial intelligence-supported software that may pre-scan the images and put them in order of urgency before the human triage officer is able to evaluate them. The project involves the development software that quickly classifies cases into one of two groups, urgent or non-urgent, by analysing the computerized tomography (CT) image of the brain taken without the administration of intravenous contrast material. In this way, more effective triage is aimed. The software developed for this purpose was observed to have high performances in two separate machine learning models. Additionally, a visual interface that allows viewing DICOM files was developed within the scope of the project.

Fastidious adherence to 0/1-hour high-sensitivity troponin T testing reduces emergency department length of stay in patients presenting with suspected acute coronary syndromes

Abstract Background High-sensitivity cardiac troponins (hs-cTn) are key clinical biomarkers in patients presenting with suspected acute coronary syndromes (ACS) to Emergency Departments (EDs). They have facilitated rapid 0h/1h troponin testing protocols, leading to safe, effective, and efficient triage of patients. However, early distinction of myocardial infarction (MI), which has a reported frequency of less than 10% in most cohorts, from the apparently stable hs-cTn elevations of chronic myocardial injury (CMI) remains a challenge. Often CMI patients require confirmation by further testing and observation, prolonging patient length of stay. Further, reliably obtaining serial hs-cTn samples at 60-minutes in a busy ED setting may be difficult. A potential explanation for only 5-6% of Australian sites adopting 0h/1h hs-cTn testing. Methods and Results We undertook a case-control study between March and August 2023 among patients with suspected ACS presenting to Liverpool Hospital ED (Sydney, Australia). 185 patients (cases) underwent hs-cTnT sampling at 30- and 60-minutes (± 5 minutes) after baseline. Diagnosis of MI was made in 8.6%, 35.7% were placed into a further observation group and MI ruled-out in 55.7%. The latter two groups were matched to 169 patients (controls) who received ‘usual’ care, which was a 0h/1h hs-cTnT testing protocol. The case and control arms were matched by age, gender, time from symptom onset and main presenting symptom. Control patients had a median sampling interval of 118 [85 to 174] minutes, rather 60 minutes as the protocol directs. When comparing the paired differences between the case and control arms, there was a mean reduction in length of stay of 104 (95% CI: 41 to 186, P = 0.01) and 47 (95% CI: 11 to 84, P = 0.01) minutes, for the observation and rule-out MI groups respectively. The figure shows the distribution of lengths of stay by group. Among the rule-out group, Wilcoxon signed rank test indicated the control arm had a longer median length of stay of 6.3 [5.1 to 8.4] hours, compared to 5.0 [4.5 to 7.1] hours in the case arm (P=0.005). Similarly, in the further observation group, control patients also had a longer median length of stay of 9.2 [6.9 to 10.4] hours compared to case patients of 8.1 [5.1 to 10.3] hours (P = 0.009). At 30-days, ED representation rates were 10.7% in controls and 8.3% in cases, rehospitalisation 3.6% in controls and 5.3% in cases, cardiac death 0% in both arms and non-cardiac death 1% in both arms. There were no differences in event rates between each arm (P &amp;gt; 0.05). Conclusion Accurate 0h/1h hs-cTnT testing reduces patient length of stay in ED and offers more personalised prediction of MI risk. The importance of adherence to protocol-directed sampling times is clear, where further studies are required regarding routine implementation in a busy ED setting.Exact 60 min TnT and LOSOutcomes at 30 days

Application of FISH based G2-PCC assay for the cytogenetic assessment of high radiation dose exposures: Potential implications for rapid triage biodosimetry.

The main goal of this study is to test the utility of calyculin A induced G2-PCC assay as a biodosimetry triage tool for assessing a wide range of low and acute high radiation dose exposures of photons. Towards this initiative, chromosome aberrations induced by low and high doses of x-rays were evaluated and characterized in G2-prematurely condensed chromosomes (G2-PCCs) by fluorescence in situ hybridization (FISH) using human centromere and telomere specific PNA (peptide nucleic acid) probes. A dose dependent increase in the frequency of dicentric chromosomes was observed in the G2-PCCs up to 20 Gy of x-rays. The combined yields of dicentrics and rings in the G2-PCCs showed a clear dose dependency up to 20 Gy from 0.02/cell for 0.1 Gy to 14.98/cell for 20 Gy. Centric rings were observed more frequently than acentric ring chromosomes in the G2-PCCs at all the radiation doses from 1 Gy to 20 Gy. A head-to-head comparison was also performed by FISH on the yields of chromosome aberrations induced by different doses of x-rays (0 Gy -7.5 Gy) in colcemid arrested metaphase chromosomes and calyculin A induced G2-PCCs. In general, the frequencies of dicentrics, rings and acentric fragments were slightly higher in G2-PCCs than in colcemid arrested metaphase chromosomes at all the radiation doses, but the differences were not statistically significant. To reduce the turnaround time for absorbed radiation dose estimation, attempt was made to obtain G2-PCCs by reducing the culture time to 36 hrs. The absorbed doses estimated in x-rays irradiated (0,1,2 and 4 Gy) G2-PCCs after 36 hrs of culture were grossly like that of G2-PCCs and colcemid arrested metaphase chromosomes prepared after 48 hrs of culture. Our study indicates that the shortened version of calyculin A induced G2-PCC assay coupled with the FISH staining technique can serve as an effective triage biodosimetry tool for large-scale radiological/nuclear incidents.

Effectiveness of the Emergency Severity Index in Early Identification of Sepsis in a Tertiary Care Hospital of a Low-resource Setting

Background: Sepsis is life-threatening organ dysfunction, and a global issue, with incidence and mortality are around 49 M cases in 2017. Annual sepsis incidence from Pakistan is around 1600-2500 per 100, 000 cases with high mortality of approx. 30%. This huge mortality among sepsis and septic shock cases from low-income settings it is necessary to implement a focused and effective triage tool to prioritize and categorize the sick patients from huge bulk of sick patients who attend the ED and to identify those who need to be seen and manage accordingly. Emergency severity index (ESI), a widely acceptable tool that was developed to assess illness severity, hence able to identify the sick patients that need immediate attention at triage. Objectives: Our objective is to determine the effectiveness of ESI triage acuity in early recognition of patient with sepsis and septic shock at triage in a busy ED. Methods: This was a single center, cross sectional and observational study, we include 240 cases who present to the ED of a tertiary care hospital. We follow ESI v. 4.0. All cases presenting to the ED with suspected diagnosis of sepsis or septic shock were included. Data was collected on a predesigned data sheet. Participants were followed by their electronic medical record number through patient care information software where patient’s medical diagnosis and discharge diagnosis are present. Results: Total of 240 patients in the inclusion criteria, area under curve (AUC) for the ESI score I, for septic shock was 0.943 [0.921 - 0.964] with the optimal cutoff value of 2.0, sensitivity of 88.5% and specificity 100%. Similarly, the receiver operating curve (ROC) with area under the curve of ESI Score II for sepsis is found 0.2 [0.129-0.270] with sensitivity 23% and specificity was 12.7%. Conclusion: ESI is a reliable tool which is both sensitive and specific in screening patients with septic shock in a busy emergency department.

An optimized siamese neural network with deep linear graph attention model for gynaecological abdominal pelvic masses classification.

An adnexal mass, also known as a pelvic mass, is a growth that develops in or near the uterus, ovaries, fallopian tubes, and supporting tissues. For women suspected of having ovarian cancer, timely and accurate detection of a malignant pelvic mass is crucial for effective triage, referral, and follow-up therapy. While various deep learning techniques have been proposed for identifying pelvic masses, current methods are often not accurate enough and can be computationally intensive. To address these issues, this manuscript introduces an optimized Siamese circle-inspired neural network with deep linear graph attention (SCINN-DLGN) model designed for pelvic mass classification. The SCINN-DLGN model is intended to classify pelvic masses into three categories: benign, malignant, and healthy. Initially, real-time MRI pelvic mass images undergo pre-processing using semantic-aware structure-preserving median morpho-filtering to enhance image quality. Following this, the region of interest (ROI) within the pelvic mass images is segmented using an EfficientNet-based U-Net framework, which reduces noise and improves the accuracy of segmentation. The segmented images are then analysed using the SCINN-DLGN model, which extracts geometric features from the ROI. These features are classified into benign, malignant, or healthy categories using a deep clustering algorithm integrated into the linear graph attention model. The proposed system is implemented on a Python platform, and its performance is evaluated using real-time MRI pelvic mass datasets. The SCINN-DLGN model achieves an impressive 99.9% accuracy and 99.8% recall, demonstrating superior efficiency compared to existing methods and highlighting its potential for further advancement in the field.

Host Response Markers of Inflammation and Endothelial Activation Associated with COVID-19 Severity and Mortality: A GeoSentinel Prospective Observational Cohort.

The effect of the COVID-19 pandemic on healthcare systems emphasized the need for rapid and effective triage tools to identify patients at risk of severe or fatal infection. Measuring host response markers of inflammation and endothelial activation at clinical presentation may help to inform appropriate triage and care practices in patients with SARS-CoV-2 infection. We enrolled patients with COVID-19 across five GeoSentinel clinical sites (in Italy, Belgium, Canada, and the United States) from September 2020 to December 2021, and analyzed the association of plasma markers, including soluble urokinase-type plasminogen activator receptor (suPAR), soluble tumor necrosis factor receptor-1 (sTREM-1), interleukin-6 (IL-6), interleukin-8 (IL-8), complement component C5a (C5a), von Willebrand factor (VWF-a2), and interleukin-1 receptor antagonist (IL-1Ra), with 28-day (D28) mortality and 7-day (D7) severity (discharged, hospitalized on ward, or died/admitted to the ICU). Of 193 patients, 8.9% (16 of 180) died by D28. Higher concentrations of suPAR were associated with increased odds of mortality at D28 and severity at D7 in univariable and multivariable regression models. The biomarkers sTREM-1 and IL-1Ra showed bivariate associations with mortality at D28 and severity at D7. IL-6, VWF, C5a, and IL-8 were not as indicative of progression to severe disease or death. Conclusions: Our findings confirm previous studies' assertions that point-of-care tests for suPAR and sTREM-1 could facilitate the triage of patients with SARS-CoV-2 infection, which may help guide hospital resource allocation.

Evaluation of patients who re-admitted to the emergency department within 24 hours

Aim: It was conducted to investigate the demographic and clinical characteristics of patients who re-admitted to the emergency department within 24 hours and to contribute to studies on reducing the re-admission rate. Methods: The data of patients who re-admitted to the emergency department within 24 hours between November 2021 and September 2023 in a secondary level public hospital were retrospectively examined. Data regarding the patients' demographic information, admission dates and times, clinical characteristics, examinations, diagnoses, consultations, hospitalization and referral status were obtained from the hospital automation system. Results: 496270 patients admitted to the emergency department during the study period. 6991 (1.4%) of the patients were admitted to the emergency department again within 24 hours. 40.3% of these patients were between the ages of 19-35 and 52.4% were women. The most common reason for re-admission to the emergency department was upper respiratory tract diseases. It was determined that 66.7% of the patients applied to the emergency department again 13-24 hours after their first admission. In their second admission, 43 patients were hospitalized or transferred for various reasons; It was determined that 1 of these patients died 5 months after being admitted to the intensive care unit. Conclusion: Effective triage practices, directing green area patients to family physicians, making the referral chain effective, increasing health literacy, making an accurate diagnosis, allocating appropriate time to patients and explaining the treatment and expectations from treatment, ensuring that patients referred to polyclinics are evaluated as soon as possible and returned to the emergency department will significantly reduce applications.

Teledermoscopic triage of melanoma-suspicious skin lesions is safe: A retrospective comparative diagnostic accuracy study with multiple assessors.

The rising incidence of melanoma and the high number of benign lesions excised due to diagnostic uncertainty highlight the need for effective patient triage. This study assesses the safety and accuracy of teledermoscopic triage on a high-prevalence case set with pre-triaged, challenging, melanoma-suspicious lesions. Five dermatologists independently reviewed 250 retrospectively extracted patient cases. Teledermoscopy assessments were simulated for panels of 1, 2, 3 and 5 assessors using two distinct consensus strategies, Caution Protocol and Majority Vote, and the sensitivity and specificity of the patient triages were calculated. Triage by a single teledermatologist showed a sensitivity of 92.3% and a specificity of 58.7%. Sensitivity improved with the number of assessors, particularly when using the Caution Protocol, though with a considerable drop in specificity. The Majority Vote showed a more balanced improvement in sensitivity and specificity. Safety analyses indicated that diagnostic accuracy decreased with poor image quality and increased case difficulty. Expert teledermoscopic triage of melanocytic skin lesions is highly sensitive and lowers the need for unnecessary excision procedures by half while dismissing as few as 0.4% (95% confidence interval 0-0.6%) of melanomas, even when applied to a high-prevalence pre-triaged subpopulation. Implementation of safety procedures increases accuracy. Using multiple teledermatologists increases sensitivity but at the cost of specificity unless a Majority Vote consensus strategy is applied. Future teledermoscopy guidelines should encompass safety procedures and protocols for disagreement between assessors.

International Burn Disaster Nursing: Care, Commitment, Compassion, and Cost.

Burn mass casualty incidents can overwhelm local resources, challenging effective communication, triage, and provision of care. International responders can help by providing education and direct patient care. On November 5, 2021, a fuel tanker truck exploded in Freetown, Sierra Leone, killing or injuring hundreds of people. The needs of the severely burned survivors overwhelmed local resources, requiring an international response. Burn specialist teams from several countries, including the United States, were deployed to provide assistance. Members of the US burn care team educated local health care practitioners about wound care, physical therapy, and fluid and pain management. Educational content was delivered through lecture and discussion, case studies, clinical application, and bedside teaching. Demonstration of cultural competence and humility, as well as attentiveness to nuances of local communication, helped avoid ethnocentrism and other barriers to collaboration. Public congratulations and formal completion certificates were used to provide meaningful recognition of successful class participation. Before the lecture and discussion intervention, 57 students participating in a pretest assessment had an average score of 53.9% (high, 80%; low, 27.5%). After the intervention, 38 students participating in a posttest assessment had an average score of 79.3% (high, 95%; low, 55%), and local health care providers delivered care with more attention to patient comfort and shared new knowledge with colleagues. Providing optimal burn care and education under austere conditions requires cultural humility and a spirit of inquiry. Attentiveness to communication and cultural nuances promotes collaboration, improves educational effectiveness, and builds local burn care capacity.