Role In Triage Research Articles

Radiology during a war - experience in Ukraine.

Military radiology, an integral part of military medicine, plays a pivotal role in medical triage, diagnosis, and treatment. Its significance lies in providing timely and accurate assessments in challenging situations.The utilization of contemporary sonographic techniques enables rapid identification of life-threatening conditions, ensuring prompt medical aid and facilitating regional anesthesia. Computed tomography emerges as a critical tool for assessing injury extent, planning surgeries, monitoring postoperative phases, and conducting retrospective evaluations, especially when anatomical dissection is complex.Battlefield radiology not only enhances the understanding of injury mechanisms and battlefield traumas but also contributes significantly to the overall improvement of diagnostic and treatment approaches. Ukrainian doctors actively engaged in diverse stages of patient care accumulate a wealth of knowledge, substantially elevating the survival rates of wounded individuals. This experience serves as the foundation for ongoing enhancements and the advancement of military radiology, even during periods of peace. · Military radiology is essential in medical triage, diagnosis, and treatment within military contexts.. · Modern sonographic methods enable swift identification of life-threatening conditions.. · Computed tomography is indispensable for assessing injuries, planning surgeries, and conducting retrospective evaluations.. · Ukrainian doctors actively contribute to the knowledge base, improving diagnostic and treatment practices.. · The acquired experience serves as a foundation for ongoing advancements in military radiology, extending its impact beyond wartime scenarios.. · Nehria N, Nehria Y, Bukharin T. Radiology during a war - experience in Ukraine. Fortschr Röntgenstr 2024; DOI 10.1055/a-2326-7724.

From Psoriasis to Psoriatic Arthritis: Ultrasound Insights Connecting Psoriasis with Subclinical Musculoskeletal Inflammation and the Path to Psoriatic Arthritis.

This review summarizes the literature about the transition from psoriasis to psoriatic arthritis (PsA), focusing on musculoskeletal ultrasound (MSUS) for detecting subclinical inflammation and its role in diagnosis and triage of high-risk patients. MSUS effectively detects subclinical musculoskeletal inflammation in patients with psoriasis; however, some of these lesions are non-specific and can be found in healthy individuals. Preliminary evidence suggest that subclinical sonographic findings may predict progression to PsA in psoriasis patients. MSUS can also improve referrals' accuracy and its integration in the PsA classification criteria may improve early PsA detection. MSUS is a valuable tool for detecting subclinical abnormalities in psoriasis patients, which indicate an increased likelihood of progressing to PsA. Its integration into referral protocols and clinical use could improve PsA diagnosis. We propose an MSUS-inclusive algorithm for PsA referrals and triage, which requires validation. The potential of early intervention in reducing PsA progression in psoriasis patients with subclinical inflammation remains to be established.

Timeliness and accuracy of the 7-Item Japan Urgent Stroke Triage (JUST-7) score, a prehospital stroke triage tool, assessed by emergency medical services.

The prompt initiation of stroke treatment significantly influences patient outcomes, highlighting the crucial role of prehospital triage. This study aimed to assess the implementation of the 7-Item Japan Urgent Stroke Triage (JUST-7) score by emergency medical services (EMS) in our region and its effect on emergency transportation for suspected stroke patients. Data were collected from patients suspected of having an acute stroke with a Cincinnati Prehospital Stroke Scale (CPSS) score of 1 or more who were transferred by ambulance within 24 h of symptom onset. Two prehospital stroke scales were employed during different periods: period 1 with CPSS alone (January to December 2020) and period 2 with both CPSS and JUST-7 (January 2021 to March 2023). On-scene time data were obtained from the EMS crews, and data regarding the final diagnosis of patients and their outcomes were obtained from the respective hospitals to which the patients were transferred. These data were compared between periods 1 and 2 and between the CPSS and JUST-7. The results revealed that additional evaluation with JUST-7 did not affect ambulance transport time. The CPSS+JUST-7 approach demonstrated higher specificity in identifying stroke and major artery occlusion than with the CPSS alone; however, an appropriate cut-off value needs to be considered. The JUST-7 achieved a diagnostic concordance rate of 35.9% for the most likely stroke type and 64.0% for the first two most likely types. This research emphasizes the potential of JUST-7 as a valuable addition to prehospital stroke diagnosis protocols. Its flexibility in adapting cut-off values based on regional factors and available medical resources optimizes its utility in diverse healthcare settings. The JUST-7 score is a promising tool for improving patient outcomes through prompt and accurate prehospital assessments.

Early Triage and Emergency Obstetric Care in High-Risk Pregnancies and Impact on Their Outcome; A Cross-Sectional Study

Objective: To assess the role of early triage and emergency obstetric care for high-risk pregnancies and their outcome. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Bahawalpur Pakistan, from Jan 2021 to Jun 2022. Methodology: Women with high-risk pregnancies, aged 18-40 years, gestational age >28 weeks, were included. Emergency obstetric care was provided to participants of the study. Maternal outcome was assessed regarding their hospital stay duration, morbidity, mortality and mode of delivery. The fetal outcome was in terms of intra-uterine death (IUD), Early neonatal death (ENND), and live births. Results: The mean age of patients was 28.1±3.49 years. Most of the patients belonged to high-order cesarean section and hypertensive disorders of pregnancy. 94.3% were delivered by cesarean section due to obstetric reasons, and hospital stay was an average of> 72 hours in 57.7 %. Maternal mortality and morbidity were not observed. 99.9% of babies were live births, 0.7% ended into ENND, and one received an IUD. Conclusion: Early triage followed by the provision of emergency obstetric emergency care is recommended in high-risk pregnancies for optimum feto-maternal outcome.

MANAGEMENT AND OUTCOMES OF PATIENTS WITH DEGENERATIVE MENISCAL TEARS IN AN ESP PHYSIOTHERAPIST-LED ORTHOPAEDIC CLINIC: AN OBSERVATIONAL COHORT

AbstractObjectiveMeta-analysis of clinical trials highlights that non-operative management of degenerative knee meniscal tears is as effective as surgical management. Surgical guidelines though support arthroscopic partial meniscectomy which remains common in NHS practice. Physiotherapists are playing an increasing role in triage of such patients though it is unclear how this influences clinical management and patient outcomes.MethodsA 1-year cohort (July 2019–June 2020) of patients presenting with MRI confirmed degenerative meniscal tears to a regional orthopaedic referral centre (3× ESP physiotherapists) was identified. Initial clinical management was obtained from medical records alongside subsequent secondary care management and routinely collected outcome scores in the following 2-years. Management options included referral for surgery, conservative (steroid injection and rehabilitation), and no active treatment. Outcome scores collected at 1- and 2-years included the Forgotten Joint Score-12 (FJS-12) questionnaire and 0–10 numerical rating scales for worst and average pain. Treatment allocation is presented as absolute and proportional figures. Change in outcomes across the cohort was evaluated with repeated measures ANOVA, with Bonferroni correction for multiple testing, and post-hoc Tukey pair-wise comparisons. As treatment decision is discrete, no direct contrast is made between outcomes of differing interventions but additional explorative outcome change over time evaluated by group. Significance was accepted at p=0.05 and effect size as per Cohen's values.Results81 patients, 50 (61.7%) male, mean age 46.5 years (SD13.13) presented in the study timeframe. 32 (40.3%) received conservative management and 49 (59.7%) were listed for surgery. Six (18.8%) of the 32 underwent subsequent surgery and nine of the 49 (18.4%) patients switched from planned surgery to receiving non-operative care. Two post-operative complications were noted, one cerebrovascular accident and one deep vein thrombosis. The cohort improved over the course of 2-years in all outcome measures with improved mean FJS-12 (34.36 points), mean worst pain (3.74 points) average pain (2.42 points) scores. Overall change (all patients) was statistically significant for all outcomes (p<0.001), with sequential year-on-year change also significant (p<0.001). Effect size of these changes were large with all Cohen-d values over 1. Controlling for age and BMI, males reported superior change in FJS-12 (p=0.04) but worse pain outcomes (p<0.03). Further explorative analysis highlighted positive outcomes across all surgical, conservative and no active treatment groups (p<0.05). The 15 (18%) patients that switched between surgical and non-surgical management also reported positive outcome scores (p<0.05).Conclusion(s)In a regional specialist physiotherapy-led soft tissue knee clinic around 60% of degenerative meniscal tears assessed were referred for surgery. Over 2-years, surgical, non-operative and no treatment management approaches in this cohort all resulted in clinical improvement suggesting that no single strategy is effective in directly treating the meniscal pathology, and that perhaps none do. Clinical intervention rather is directed at individual symptom management based on clinical preferences.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Role of Venous Blood Gase (VBG) Analysis in Patient Triage in the Adult Emergency Department

Background: In emergency and critical care settings, can a venous blood gas analysis improve clinical decision-making and patient outcomes? Methods: This is a cross-sectional study, conducted between January and June 2022 at a tertiary hospital in Saudi Arabia. Results: A total of 100 patients were included, using a convenience sample technique. Their mean age was 54 years, and theirmain chief complaints were shortness of breath (30%), abdominal pain (15%), and altered level of consciousness (14%). The venous blood gas (VBG) result was abnormal in 86 patients, and predicted the need for early intervention in 69 patients (69.7%). A significant association was found between patients requiring early intervention and those with an abnormal VBG (p=0.0005). Furthermore, the VBG results changed the Canadian Triage and Acuity Scale (CTAS) level in 32 patients (33.68%). A logistic regression analysis revealed that pre-testing factors such as age, gender, comorbidities, and chief complaints were not predictors of VBG results, the need for early intervention, or altered CTAS level. Conclusion: Our study concludes that VBG analysis can play an important role in patient triage in the emergency department (ED), allowing for earlier intervention and potentially improving outcomes.

A point-of-care urine test to predict adverse maternal and neonatal outcomes in Asian women with suspected preeclampsia.

To assess clinical utility of the urine Congo red dot test (CRDT) in predicting composite adverse maternal and neonatal outcomes in women with suspected preeclampsia (PE). CRDT result and pregnancy outcomes were prospectively documented in women with new onset or pre-existing hypertension, new or pre-existing proteinuria, PE symptoms and suspected PE-related fetal growth restriction or abnormal Doppler presenting from 20weeks' gestation between January 2020 and December 2022. Participants and clinicians were blinded to the CRDT result and managed according to internally agreed protocols. Composite maternal outcome was defined as PE, postpartum hemorrhage, intensive care unit admission, and maternal death. Composite neonatal outcome was defined as small for gestational age, preterm birth, 5-min Apgar score < 7, neonatal intensive care unit admission, and neonatal death. Two hundred and forty-four women out of two hundred and fifty-one (97.2%) had a negative CRDT. All seven women with positive CRDT had both adverse maternal and neonatal outcomes, giving positive predictive values (PPV) of 100%. Rates of composite adverse maternal and neonatal outcomes in CDRT negative women were 103/244 [42.2%, 95% confidence interval (CI) 36.2%-48.5%] and 170/244 (69.7%, 95% CI 63.6%-75.1%), respectively. CRDT negative predictive values (NPV) for adverse maternal and neonatal outcomes were, respectively, 141/244 (57.8%, 95% CI 48.6%-68.2%) and 74/244 (30.3%, 95% CI 23.8%-38.1%). CRDT had low NPV but high PPV for adverse maternal and neonatal outcomes in women with suspected PE. Its role in clinical management and triage of women with suspected PE is limited as it cannot identify those at low risk of developing adverse outcomes.

Empowering the Role of Nurse Triage in Radiation Oncology - A Single Center Analysis.

Hours spent on the increasing volume of electronic medical record (EMR) messages and phone calls is a significant contributor to clinician burnout1. Within radiation oncology, nurses often serve a critical team role in patient education and EMR and phone call response. With the goal of maintaining high quality care and rapid EMR and phone response, our clinic utilizes a rotating triage nurse position; patterns of practice and team member perspectives are investigated. A retrospective chart review was conducted analyzing EMR messages and phone calls to the RO department between Sept-Dec 2021. Messages were identified for theme, author of message recorded (patient, family, provider), number of message iterations, and message pathway. Separately, an online survey was administered via REDCap to physicians (50% response rate), nurses (57% response rate), and radiation therapist (60% response rate) to assess nurse triage efficacy and efficiency. Four of the most common message themes were scheduling (26%), medications (21%), side effects/symptoms (15%), and treatment decision making (13%). Only 12% of messages were resolved by the RO triage nurse without further message forwarding. The average number of message iterations by healthcare personnel was 2.93 with mode of 2 (i.e., RN -> patient -> MD is a 2 message iteration). Across all themes physicians concluded 67% of the routed messages and nursing concluded 29%. By theme, physicians concluded 95% of treatment questions, 77% of medication questions, 69% of side effect/symptom questions, and 57% of scheduling questions. Survey results indicated average satisfaction with 'effectiveness of triage' was 3 (max 5), perceived triage nurse preparedness to resolve encounters was 3 (max 5), and perception of the overall EMR triage program by physicians was 2.2 (max 5). Staff survey established clear opportunity to improve effectiveness of RN triage through better alignment of nurse and physician expectations and improving nurse preparedness. Two-thirds of patient messages were ultimately concluded by physician response whereas 12% were resolved by nurse triage alone. Preparing nursing staff about common patient messages should increase autonomy to resolve patient queries and may improve work satisfaction for all providers through enhanced multidisciplinary collaboration and empowering individuals to practice at top of his/her license.

A descriptive study to assess the knowledge regarding emergency triage among student nurses in Selected Institutions, Jalandhar

Background of the study: TRIAGE comes from French trier, meaning to sort. Patient acuity is quickly determined via triage. A triage system prioritizes essential patients by identifying and categorizing them. It classifies patients by kind and urgency to bring the right patient to the right place at the right time with the right care provider. Student nurses are future quality care providers, thus they play a unique role in hospital emergency triage and treatment. They should learn more about emergency triage so they can make precise judgments for early detection, successful referral, and patient prevention. To minimize emergency department morbidity and mortality, staff and student nurses should participate in in-service education, teaching, demonstration, and self-learning. Methodology: The study setting was conducted at MHR DAV Institute of Nursing and LalaLajpatRai Institute of Nursing Education, Jalandhar, Punjab. The study sample comprised of 100 student nurses from selected Nursing Institutions. Non probability purposive sampling technique was used to collect the data. Written consent was taken from the student nurses who were selected as sample. Self-structured knowledge questionnaire was used to evaluate the knowledge regarding emergency triage among student nurses. Information booklet was prepared and distributed among student nurses. Results and conclusion: The mean knowledge score regarding emergency triage among student nurses was 20.16 (±3.62) with mean percentage of 50.4%. Hence, it revealed that the student nurses were having average knowledge regarding emergency triage.

The Role of Virtual Triage in Improving Clinician Experience and Satisfaction: A Narrative Review.

This review examines the literature on improving clinician satisfaction with a focus on what has been most effective in improving experience from the perspective of clinicians, and the potential role that virtual triage (VT) technology can play in delivering positive clinician experiences that improve clinical care, and bring value to health care delivery organizations (HDOs). Review and synthesis of evidence on clinician satisfaction indicating a potential for VT to favorably impact clinician experience, sense of effectiveness, efficiency, and reduction of administrative task burden. Analysis considers how to conceptualize and the value of improving clinician experience, leading clinician dissatisfiers, and the potential role of VT in improving clinician experience/satisfaction. Contributors to poor clinician experience/satisfaction where VT could have a beneficial impact include better managing resource limitations, administrative workload, lack of care coordination, information overload, and payer interactions. VT can improve clinician experience through the technology's ability to leverage real-time actionable data clinicians can use, streamlining patient-clinician communications, personalizing care delivery, optimizing care coordination, and better aligning digital/virtual services with clinical practice. From an organizational perspective, improvements in clinician experience and satisfaction derive from establishing an effective digital back door, increasing the clinical impact of and satisfaction derived from telemedicine and virtual care, and enhancing clinician centricity. By embracing digital transformation and implementing solutions such as VT that focus on improving patient and clinician experience, HDOs can address barriers to delivery of high-quality, efficient, and cost-effective care. VT is a digital health tool that can create a more streamlined and satisfying experience for clinicians and the patients they care for. VT is a technology solution that can help clinicians make faster more informed decisions, reduces avoidable care, improves communication with patients and within care teams, and lowers their administrative burden so they have more quality time to care for patients.

Impact of an automated large vessel occlusion detection tool on clinical workflow and patient outcomes.

Automated large vessel occlusion (LVO) tools allow for prompt identification of positive LVO cases, but little is known about their role in acute stroke triage when implemented in a real-world setting. The purpose of this study was to evaluate the automated LVO detection tool's impact on acute stroke workflow and clinical outcomes. Consecutive patients with a computed tomography angiography (CTA) presenting with suspected acute ischemic stroke were compared before and after the implementation of an AI tool, RAPID LVO (RAPID 4.9, iSchemaView, Menlo Park, CA). Radiology CTA report turnaround times (TAT), door-to-treatment times, and the NIH stroke scale (NIHSS) after treatment were evaluated. A total of 439 cases in the pre-AI group and 321 cases in the post-AI group were included, with 62 (14.12%) and 43 (13.40%) cases, respectively, receiving acute therapies. The AI tool demonstrated a sensitivity of 0.96, a specificity of 0.85, a negative predictive value of 0.99, and a positive predictive value of 0.53. Radiology CTA report TAT significantly improved post-AI (mean 30.58 min for pre-AI vs. 22 min for post-AI, p < 0.0005), notably at the resident level (p < 0.0003) but not at higher levels of expertise. There were no differences in door-to-treatment times, but the NIHSS at discharge was improved for the pre-AI group adjusted for confounders (parameter estimate = 3.97, p < 0.01). Implementation of an automated LVO detection tool improved radiology TAT but did not translate to improved stroke metrics and outcomes in a real-world setting.

Inclusion health patient perspectives on remote access to general practice: a qualitative study.

The COVID-19 pandemic has led to rapid and widespread adoption of remote consultations and triage-first pathways in general practice. However, there is a lack of evidence on how these changes have been perceived by patients from inclusion health groups. To explore the perspectives of individuals from inclusion health groups on the provision and accessibility of remote general practice services. A qualitative study with individuals from Gypsy, Roma and Traveller communities, sex workers, vulnerable migrants, and those experiencing homelessness, recruited by Healthwatch in east London. The study materials were co-produced with people with lived experience of social exclusion. Semi-structured interviews with 21 participants were audiorecorded, transcribed, and analysed using the framework method. Analysis identified barriers to access owing to lack of translation availability, digital exclusion, and a complex healthcare system, which is difficult to navigate. The role of triage and general practice in emergencies often seemed unclear to participants. Other themes identified included the importance of trust, face-to-face consultation options for ensuring safety, and the benefits of remote access, particularly in terms of convenience and saving time. Themes on reducing barriers included improving staff capacity and communication, offering tailored options and continuity of care, and simplifying care processes. The study highlighted the importance of a tailored approach for addressing the multiple barriers to care for inclusion health groups and the need for clearer and inclusive communication on the available triage and care pathways.

Impact of primary care physicians’ education about easy skin lesion diagnosis algorithm on skin cancers screening effects

Introduction and purpose: Number of new cases of skin cancers grows every year. Melanoma malignum is responsible for approximately 75 percent of death from skin cancer. General practitioners are often first medical professionals who see patients with suspicious skin lesions. Early diagnosis can benefit in improving survival rates. Dermoscopy is a useful tool for dermatological diagnostic purposes not only for dermatologists, but also for Primary Care Physicians.This review aims to analyze the role of easy 3-step Triage Amalgamated Dermoscopy Algorithm performed by family medicine physicians in skin cancers detection. Material and methods: We searched PubMed database in order to collect relevant studies about skin cancers diagnoses by family medicine physicians using dermoscopy algorithms. Results: An analysis of multiple studies shows that short Triage Amalgamated Dermoscopy Algorithm training taken by primary care physicians resulted in better diagnosis accuracy of skin cancer identification. After education about 3 benign skin lesion patterns and 7 signs of potential malignancy general practitioners reported more confidence in the diagnostic process and both sensitivity and specificity of examination increased post-training. Conclusion: Teaching Primary Care Physicians how to diagnose patients with suspicious skin lesions using Triage Amalgamated Dermoscopy Algorithm may have a beneficial effect on increasing the number of early-diagnosed skin cancers which may result in improving survival rates.

Understanding Regional Trauma Centers and managing a trauma care system in South Korea: a systematic review.

The Korean government initiated a plan to designate and establish Regional Trauma Centers to reduce the preventable trauma death rate to <20% so as to be on par with advanced countries by 2020. This initiative was undertaken because the reported preventable trauma death rate was close to 40% in South Korea from 1997 to 2009. This review aimed to provide an overview of these Regional Trauma Centers and discuss further development of the trauma care system to assess its performance. As of September 2021, 15 Regional Trauma Centers had been established through a metropolitan-based designation process. Each center has been equipped with Level-I facilities. These Regional Trauma Centers have had 2 positive effects; namely, an increase in the number of severely injured patients attending these centers and a decrease in the national preventable trauma death rate from 30.5% in 2015 to 19.9% in 2017. The establishment of Regional Trauma Centers can lead to improved performance, maximal efficiency, and reduction of preventable deaths in trauma patients. They can also play a key role in prehospital triage and transportation in the trauma care system.

Abstract 15858: Increased T Wave Amplitude in Lead Avr is a Strong Predictor of Reduced Left Ventricular Ejection Fraction in Suspected Acute Coronary Syndrome

Introduction: Non-invasive screening tools of cardiac function can play a significant role in the initial triage of patients with suspected acute coronary syndrome. Numerous ECG features have been previously linked with cardiac contractility in the general population. We sought to examine the prognostic value of positive T wave in lead aVR as a simple marker for real-time screening of reduced left ventricular ejection fraction (LVEF) in suspected acute coronary syndrome. Methods: We performed a secondary analysis of a prospective, observational cohort study of patients evaluated for suspected acute coronary syndrome. The parent study recruited consecutive patients evaluated at the emergency department of three UPMC-affiliated tertiary care hospitals. We included consecutive patients in whom an echocardiogram was performed during indexed encounter. LVEF were retrieved from the cardiologist-signed report. Baseline 12-lead ECGs were preprocessed using manufacturer specific algorithms. Amplitude of T wave in lead aVR were automatically measured at T peak in millivolts. Data analysis was performed using SPSS and alpha was set at 0.05 for two-sided hypothesis testing. Results: Our sample included 313 patients (aged 63 ± 15, 45% females, 35% Black). The mean LVEF was 57±13%. Most patients were in normal sinus rhythm (87%) or atrial fibrillation (13%). In Bivariate analysis, there was a significant and negative correlation between T wave amplitude in lead aVR and LVEF (Pearson r = -0.173, p = 0.002). T wave amplitude in lead aVR was significantly larger in patients with LVEF &lt; 35% compared to their counterparts (-65±185 vs. -165±180, t(311) = -3.18, p = 0.002). Conclusions: Increasing T wave amplitude in lead aVR indicates lower LVEF in suspected acute coronary syndrome. This feature constitutes a simple visual marker to aid clinicians in identifying those with impaired cardiac function during emergency care.

Comparison of Fourteen Rapid Point-of-Care Antigen Tests for SARS-CoV-2: Use and Sensitivity

Fast, sensitive techniques are advisable for SARS-CoV-2 detection. Various rapid SARS-CoV-2 antigen detection tests have been developed, but type and quality of the sample, stage of the disease and viral load can all have an impact on their sensitivity. For this study, a total of 486 swabs were processed and checked with various commercially available tests and then compared with q(RT)-PCR (the gold-standard method). Total sensitivity varied considerably; for example, 42.10% (nal von minden and Tody Laboratories), 68.42% (Cahnos) and 84.78% (PCL). Sensitivity reached 100% when the cycle threshold (Ct) was lower than 22 in almost all tests, although this dropped considerably when the Ct was higher above 30, where only 3 tests identified 40% or more positive samples and in 5 cases it was 0%. What is more, only 2 cases were 100% accurate when viral load was higher than 5 log/103 cells and accuracy was 0% in 12 cases when viral load was lower than 4 log/103 cells. These results, particularly taking into consideration the fact that they used normalized viral load, suggest that antigen detection tests have their role in the fast triage of positive patients, but that considerable care should be taken with negative results, which is even more important if they are used for massive screening.

Baseline laboratory parameters for preliminary diagnosis of COVID-19 among children: a cross-sectional study.

ABSTRACTBACKGROUND:Clinical judgment of initial baseline laboratory tests plays an important role in triage and preliminary diagnosis among coronavirus disease 2019 (COVID-19) patients.OBJECTIVES:To determine the differences in laboratory parameters between COVID-19 and COVID-like patients, and between COVID-19 and healthy children. Additionally, to ascertain whether healthy children or patients with COVID-like symptoms would form a better control group.DESIGN AND SETTING:Cross-sectional study at the Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia.METHODS:A retrospective study was conducted on 42 pediatric patients of both sexes with COVID-19. Hematological parameters (white blood cell count, absolute lymphocyte count and platelet count) and biochemical parameters (natremia, kalemia, chloremia, aspartate aminotransferase [AST], alanine aminotransferase [ALT], lactate dehydrogenase [LDH] and C-reactive protein [CRP]) were collected. The first control group was formed by 80 healthy children and the second control group was formed by 55 pediatric patients with COVID-like symptoms.RESULTS:Leukocytosis, lymphopenia, thrombocytosis, elevated systemic inflammatory index and neutrophil-lymphocyte ratio, hyponatremia, hypochloremia and elevated levels of AST, ALT, LDH and CRP were present in COVID patients, in comparison with healthy controls, while in comparison with COVID-like controls only lymphopenia was determined.CONCLUSIONS:The presence of leukocytosis, lymphopenia, thrombocytosis, elevated systemic inflammatory index and neutrophil-lymphocyte ratio, hyponatremia, hypochloremia and elevated levels of AST, ALT, LDH and CRP may help healthcare providers in early identification of COVID-19 patients. Healthy controls were superior to COVID-like controls since they provided better insight into the laboratory characteristics of children with novel betacoronavirus (SARS-CoV-2) infection.

Risk factors for enucleation or evisceration in endophthalmitis

ABSTRACT Purpose To identify clinical risk factors for enucleation or evisceration in patients with endophthalmitis at an academic institution. Methods A retrospective review of patients diagnosed with endophthalmitis at Wilmer Eye Institute from 2010 to 2019 was conducted. Clinical characteristics, including demographics, cause for endophthalmitis, microbial culture results, salvaging procedures and surgical intervention were recorded. In patients who underwent enucleation or evisceration, type of surgery and placement of a primary implant were recorded. Chi-squared, Student’s t-tests and multivariate analysis were used to identify clinical factors that predicted enucleation or evisceration. Results Two hundred and fifty three patients treated for endophthalmitis over the study period were identified, of which 25 (9.88%) underwent enucleation or evisceration. Risk factors for enucleation or evisceration included poor presenting visual acuity (OR 7.86, CI: 2.26, 27.3), high presenting intraocular pressure (OR 1.07, CI: 1.03, 1.12), presence of relative afferent pupillary defect (OR 3.69, CI: 1.20, 11.37) and positive vitreous culture for methicillin-resistant staphylococcus aureus (MRSA) (OR 18.3, CI: 1.54, 219.2) on multivariate analysis. Patients undergoing enucleation or evisceration were also more likely to have trauma, corneal ulcer or combined causes for endophthalmitis and underwent fewer salvaging surgical and procedural interventions. There were no significant differences in characteristics of those receiving enucleation versus evisceration in our cohort. Conclusion Patients with endophthalmitis who underwent enucleation or evisceration had more severe disease on presentation compared to those treated with eye sparing therapy. Presenting clinical characteristics may have a role in triage and management decisions for patients presenting with severe endophthalmitis.

P304 Performance of the Southend GCA Probability Score on the NHS Lanarkshire fast track pathway

Abstract Background/Aims Fast track GCA pathways (GCA FTP) with use of confirmatory ultrasound are growing in popularity, but the burden of referrals can overwhelm services and represents a barrier to timely assessment. The Southend GCA Probability Score (GCAPS) has shown promise in determining pre-test probability and may have a role in triage, but there is limited data supporting its use in external cohorts. We evaluated the performance of GCAPS in patients assessed on the NHS Lanarkshire GCA FTP. Methods Consecutive patients assessed on the GCA FTP between November 2018 and August 2021 were included. All underwent GCAPS assessment as part of routine care. GCAPS risk groups were defined as follows: low risk ≤8, medium risk 9-12, high risk ≥13. GCA diagnoses were supported by USS +/- TAB and confirmed at 6 months. Overall performance of GCAPS in distinguishing GCA / non-GCA final diagnoses was assessed by ROC analysis. Test characteristics for different GCAPS binary cut-offs were also determined. Results 176 patients were included in total; mean age 69.0 years (SD 9.8), 63.6% female, median GCAPS 10 (IQR 8, 14). 54 patients were diagnosed with GCA, including 0/57 low risk patients, 3/60 medium risk patients (5.0%), and 51/59 high risk patients (86.4%). ROC analysis for total GCAPS in distinguishing GCA/non-GCA gave an AUC of 0.973 (95% CI 0.951 - 0.999). A GCAPS cut-off of ≥ 13 had the highest accuracy for GCA diagnosis (93.8%), with 94.4% sensitivity and 93.4% specificity. A GCAPS cut-off of ≥ 10 captured all cases of GCA (100.0% sensitivity), with 64.8% specificity. Conclusion Performance of GCAPS as a risk stratification tool in our cohort was excellent. GCAPS may have additional roles in screening FTP referrals and guiding empirical glucocorticoid therapy. No patients with GCAPS &amp;lt;10 had GCA; this is consistent with previously published data and suggests specialist review and/or USS may not be required in this group. By contrast, most patients with GCAPS ≥13 had GCA, and this group is most likely to benefit from empirical glucocorticoid treatment while awaiting confirmation. Patients with GCAPS between these values should undergo prompt assessment to minimise the risk of missed diagnoses, or overtreatment. Disclosure A.R. Melville: Other; Dr Melville is a Medical Research Council and GlaxoSmithKline Experimental Medicine Initiative to Explore New Therapies clinical training fellow, with project funding outside the submitted work. K. Donaldson: Other; Speaker fees from Menarini Pharma UK. A. Ciechomska: Other; Speaker, travel and registration fee sponsorship from Novartis, Abbvie, Chugai Pharma, Colgene, Roche and Lilly.

Present and Future Status of Cardiovascular Emergency Care System in Urban Areas of Japan - Importance of Prehospital 12-Lead Electrocardiogram.

Acute cardiovascular disease, such as acute myocardial infarction and aortic disease, can lead to a serious life-threatening state within minutes to hours, so early accurate diagnosis, and appropriate treatment without delay are essential. To provide high-quality and timely treatment, 24-h availability of medical staff and cardiologists, as well as a cardiac catheterization laboratory are needed. In Japan, the number of patients with acute cardiovascular disease is increasing with the aging population and westernization of lifestyle; however, workstyle reforms for physicians, including a policy to limit overtime work, have been legislated. Under these conditions, it is necessary to centralize hospitals that treat cardiovascular emergency diseases as high-volume centers and build a patient triage system for allocating patients before hospital arrival. The prehospital 12-lead electrocardiogram (ECG) plays a central role in prehospital diagnosis and triage, and its importance will increase in future. We discuss the current and future state of the cardiovascular emergency medical care system utilizing prehospital 12-lead ECG in urban areas of Japan.