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2. Drinking from the Holy Grail—Does a Perfect Triage System Exist? And Where to Look for It?

Author

Ingielewicz, Anna, Rychlik, Piotr, and Sieminski, Mariusz

Subjects
*MEDICAL triage, *MEDICAL personnel, *MEDICAL assistance, *ARTIFICIAL intelligence, *PATIENT selection
Abstract

The Emergency Department (ED) is a facility meant to treat patients in need of medical assistance. The choice of triage system hugely impactsed the organization of any given ED and it is important to analyze them for their effectiveness. The goal of this review is to briefly describe selected triage systems in an attempt to find the perfect one. Papers published in PubMed from 1990 to 2022 were reviewed. The following terms were used for comparison: "ED" and "triage system". The papers contained data on the design and function of the triage system, its validation, and its performance. After studies comparing the distinct means of patient selection were reviewed, they were meant to be classified as either flawed or non-ideal. The validity of all the comparable segregation systems was similar. A possible solution would be to search for a new, measurable parameter for a more accurate risk estimation, which could be a game changer in terms of triage assessment. The dynamic development of artificial intelligence (AI) technologies has recently been observed. The authors of this study believe that the future segregation system should be a combination of the experience and intuition of trained healthcare professionals and modern technology (artificial intelligence). [ABSTRACT FROM AUTHOR]

Published
2024
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3. Opieka paliatywna na Szpitalnym Oddziale Ratunkowym.

Author

Ingielewicz, Anna and Brunka, Zuzanna

Abstract

Due to the increasing number of terminally ill patients in emergency departments (EDs), there is a need to provide them with appropriate care, treat end of life symptoms and support in obtaining targeted palliative care. A review of scientific articles available in global databases such as Google Scholar, Medline/Pubmed and Cochrane Library from 2014-2023 was performed. Systematic reviews, meta-analyses and case series were considered. 24 articles were selected, and their content critically analyzed. Most of them indicate the need for palliative intervention initiated in the emergency department as an element that can both change the trajectory of life of patients and improve its quality. Global scientific trends indicate the need to implement elements of palliative care in hospital emergency departments in order to improve the quality of care for patients with terminal diseases. Palliative intervention is mentioned as improving the quality of life without shortening it. Further research on this topic is necessary, especially in the Polish population. [ABSTRACT FROM AUTHOR]

Published
2024
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4. Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians

Author

Druwe, Patrick, Benoit, Dominique D., Monsieurs, Koen, Gagg, James, Nakahara, Shinji, Alpert, Evan Avraham, van Schuppen, Hans, Elo, Gabor, Huybrechts, Sofie A., Mpotos, Nicolas, Joly, Luc-Marie, Xanthos, Theodoros, Roessler, Markus, Paal, Peter, Cocchi, Michael N., Bjorshol, Conrad, Nurmi, Jouni, Salmeron, Pascual Pinera, Owczuk, Radoslaw, Svavarsdottir, Hildigunnur, Cimpoesu, Diana, Raffay, Violetta, Pachys, Gal, De Paepe, Peter, Piers, Ruth, Hill, Michael, Spottl, Peter, Gemes, Geza, Grander, Wilhelm, Rugg, Christopher, Likar, Rudolf, von Lutterotti, Theresa, Mitterndorfer, Walter, Baumgartner, Karl, Trimmel, Helmut, Sator, Florian, Pogatschnigg, Michael, Rastner, Verena, Luger, Markus, Schinnerl, Adi, Fleischmann, Wolfgang, Predl, Barbara, Aigner, Patrick, Adler, Rene, Huybrechts, Sofie, Verbeeck, Kris, Van den Broeck, Jan, Vandereyken, Frederik, Leach, Robert, De Kock, Kurt, Raveel, Geert, Van Damme, Erwin, Riahi, Sami, Meuris, David, Engels, Jorge, Fabien, Guerisse, Vranckx, Marc, Kreps, Bernard, Imbo, Filip, Vantroyen, Barbara, Maules, Yves, Sabbe, Marc, Jensen, Peter, Tabrizi, Nima Hosseinpour, Vanelderen, Pascal, Beaune, Sebastien, Ageron, Francois-Xavier, Wargon, Mathias, Roupie, Eric, Gosse, Pierre, Faour, Ali, Duncan, Gregory, Dumas, Florence, Wiel, Eric, Fort, Pierre Arnaud, Jacquin, Laurent, Duval, Arnaud Depil, Boishardy, Fabrice, Freund, Yonathan, Broche, Claire, Giolito, Didier, Herve, Thierry, Rozenberg, Alain, Jardel, Benoit, Flemming, Andreas, Wiegand, Nicolai, Hagemann, Wolfgang, Mueller, Thorsten, Selis, Melanie, Deussen, Marc, Callies, Andreas, Schiffner, Jens, Strickmann, Bernd, Schwille, Ulrich, Christenhusz, Arjan, Weijschede, Frits, Juffermans, Erwin, Nienhuis, Angelique, Breeman, Wim, Landman, Esther, Vrusch, Rob, Wouters, Sven, Winkel, Steven, den Boer, Eugene, Ketelaar, Aart, Hutten, Albert, Fokker, Katinka, van Ree, Karin, Mulder, Peter Jan, Lambregts, Rini, Deasy, Conor, Gilligan, Peadar, Breslin, Tomas, Kennedy, Una, O'Connor, Gabrielle, Doyle, Mark, Fallon, Hilary, McDaid, Fiona, Yeung, Davy, Benger, Jonathan, Stacey, Victoria, Dorrian, Susan, Haig, Stephen, Byers, Sonia, McLauchlan, Chris, Watson, David, Robinson, Maria, Kendall, Jason, Whitfield, Richard, Foster, Theresa, Truhla, Anatolij, Skulec, Roman, Smrzova, Eva, Lejsek, Jan, Gregor, Roman, Sin, Robin, Kubalova, Jana, Kratochvil, Jaroslav, Zika, Jiri, Fiala, Hynek, Koci, Jaromir, Jelen, Stanislav, Galgoczy, Peter, Szabados, Gyorgy, Temesvari, Peter, Kalman, Attila, Zubek, Laszlo, Kovacs, Eniko, Kiss, Domonkos, Valent, Mihaly, Kanizsai, Peter, Wilanowski, Tomasz, Zemojtel, Lukasz, Dubieniecki, Maciej, Ingielewicz, Anna, Wozniak, Piotr, Galazkowski, Robert, Sirbu, Fernando, Milenkovic, Dusan, Trenkler, Stefan, Dobias, Viliam, Ilavsky, Michal, Bajerovska, Lubica, Kubova, Dana, Patras, Juraj, Ioannides, Marios, Georgiou, Marios, Venetsanos, Philipos, Adamos, Georgios, Barouxis, Dimitrios, Karlis, Georgios, Chalkias, Athanasios, Lecinena, Maria Angelez, Suero, Coral, Herrero, Pablo, Sanchez, Miquel, del Castillo, Juan Gonzalez, del Arco, Carmen, Ezponda, Francisco, Llorens, Pere, Boque, Carmen, Millan, Javier, Fernandez, Pablo, Mozota, Julian, Povar, Javier, Juarez, Ricardo, Puiguriguer, Jordi, Navarro, Carmen, Aguero, Clotilde, Gorjon, Esther, Monteagudo, Tania, Saenz, Fernando, Gomez, Ignacio, Picabea, Alberto, Espinosa, Salvador, Palviainen, Jan-Erik, Tavasti, Juhani, Hallikainen, Juhana, Suonpera, Ville, Suonsyrja, Timo, Kaartinen, Johanna, Hoppu, Sanna, Carrasco, Anton Berg, Jonsdottir, Hrafnhildur Lilja, Palsson, Njall, Petursdottir, Sigrun, Palmadottir, Helga, Oskarsson, Jon Palmi, Olafsson, Oddur, Acterberg, Joseph, Blindheim-Rodal, Lillyanne, Hauge, Martin, Ytreland, Sven, Steen-Hansen, Jon Erik, Wilson, Thomas, Naess, Kristoffer, Kurland, Lisa, Malmquist, Pia, Forberg, Jakob Lundager, Djarv, Therese, Fuenzalida, Pablo Aguilera, Lara, Barbara, Zalut, Todd, Weiser, Giora, Strugo, Refael, Jaffe, Eli, Krispil, David, Schwartz, Dagan, Raitter, Ravit, Zimmerman, Deena, Tzadik, Efrat, Markowitz, Samuel, Wacht, Oren, Inagaki, Nobuhiro, Hanada, Hiroyuki, Takahoko, Ken-ichi, Negishi, Masatoshi, Matsushima, Hisao, Kano, Hideki, Koyama, Teppei, Takegami, Tetsuro, Yanagawa, Youichi, Harada, Masahiro, Yasuda, Mitsuhiro, Inaba, Kensuke, Sakamoto, Yuichiro, Yamashita, Hisashi, Honma, Masato, Tanabe, Seizan, Nachi, Sho, Nodagashira, Tatsuya, Matoh, Fumitaka, Takahashi, Tomohiro, Sode, Yoshihisa, Liu, Keibun, Yonekawa, Chikara, Inoue, Teruhiro, Sumi, Tatsunori, Kan'o, Tomomichi, Shoko, Tomohisa, Ishikura, Ken, Suzuki, Shuichi, Kishimoto, Masafumi, Katsuhara, Kazuhiro, Yumoto, Tetsuya, Nishimura, Tetsuro, Yamada, Tomoki, Otani, Takayuki, Yoshida, Kosuke, Nakamura, Motohiro, Uemura, Shuji, Umezawa, Kougaku, Nakamura, Shunsuke, Sugino, Takahiko, Tsunoyama, Taichiro, Endo, Tomoyuki, Nishida, Masamichi, Yagi, Masaharu, Fujita, Motoki, Arends, Jack, Buonadonna, Michael, Narikawa, Kenji, Sakamoto, Tetsuya, Callaway, Clifton, Goldberg, Scott, Wilcox, Susan, Gaieski, David, Sanko, Stephen, Kang, Tarina, HUS Emergency Medicine and Services, Staff Services, Clinicum, Department of Diagnostics and Therapeutics, University of Helsinki, Kimmo Kontula Research Group, Graduate School, ACS - Diabetes & metabolism, APH - Quality of Care, ACS - Heart failure & arrhythmias, ACS - Amsterdam Cardiovascular Sciences, Anesthesiology, and REAPPROPRIATE Study Grp

Subjects
Male, medicine.medical_specialty, Resuscitation, media_common.quotation_subject, medicine.medical_treatment, education, 030204 cardiovascular system & hematology, Out of hospital cardiac arrest, 03 medical and health sciences, 0302 clinical medicine, AGE, Older patients, Japan, Perception, Physicians, Hospital discharge, Medicine, Humans, Cardiopulmonary resuscitation, media_common, Resuscitation Orders, Aged, 80 and over, business.industry, OF-LIFE, HOSPITAL CARDIAC-ARREST, 030208 emergency & critical care medicine, CARE, inappropriate care, Cardiopulmonary Resuscitation, United States, 3. Good health, Nursing Homes, Europe, Cross-Sectional Studies, 3121 General medicine, internal medicine and other clinical medicine, Emergency medicine, SURVIVAL, Female, Human medicine, Geriatrics and Gerontology, adults 80 and older, business, Nursing homes, ETHICS, Out-of-Hospital Cardiac Arrest
Abstract

OBJECTIVES: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN: Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE). SETTING: Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39–45, 2019

Published
2019

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