Search

Increasing complexity due to an ageing population, a shortage of healthcare professionals and the rising costs are major concerns for the acute care in the coming years. Innovative triage methods in the ambulance could improve appropriate care for patients with subacute undifferentiated syndromes. A proportion of these patients should not be transferred to an emergency department. We conducted a systematic literature search on prehospital triage in the ambulance and evaluated the results relevant to the Dutch acute care system. Consultation of primary care or hospital physicians by paramedics to decide on the optimal strategy for the individual patient seems promising. Adding a video connection could increase the potential benefits. Point-of-care testing in well-defined syndromes does improve prehospital triage and may therefore be of benefit in undifferentiated syndromes. Both techniques may keep ambulances away from presenting specific patients on emergency departments, enabling appropriate use of scarce acute care facilities.

Currently, two treatment options for ruptured abdominal aortic aneurysms (AAA) are available: conventional open surgical repair and endovascular minimally invasive repair. Open repair carries a significant morbidity and mortality rate, most probably due to the combined effects of general anaesthesia and surgical exposure. Based on anatomical characteristics as assessed by CT scan, approximately half of the patients with a ruptured AAA are eligible for endovascular minimally invasive repair. The majority of comparative studies show a clear trend towards a lower perioperative mortality rate for endovascular repair compared to open surgery (18-24% and 34-38%, respectively) and more rapid recovery. However, these mainly observational studies show considerable heterogeneity. Furthermore, potential selection bias, where patients with a more favourable anatomic and haemodynamic profile are more likely to be selected for endovascular repair, makes a proper comparison barely possible.The potential benefits of endovascular repair over open surgery are currently being evaluated in a large randomised study.