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BACKGROUND: Contemporary surgical practices for traumatic brain injury (TBI) remain unclear. We describe the clinical profile of an 18-centre US TBI cohort with cranial surgery. METHODS: The prospective, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (2014-2018; ClinicalTrials.gov #NCT02119182) enrolled subjects who presented to trauma centre and received head computed tomography within 24-h (h) post-TBI. We performed a secondary data analysis in subjects aged ≥17-years with hospitalisation. Clinical characteristics, surgery type/timing, hospital and six-month outcomes were reported. FINDINGS: Of 2032 subjects (age: mean = 41.4-years, range = 17-89-years; male = 71% female = 29%), 260 underwent cranial surgery, comprising 65% decompressive craniectomy, 23% craniotomy, 12% other surgery. Subjects with surgery (vs. without surgery) presented with worse neurological injury (median Glasgow Coma Scale = 6 vs. 15; midline shift ≥5 mm: 48% vs. 2%; cisternal effacement: 61% vs. 4%; p

The COVID-19 pandemic led to unprecedented challenges to healthcare quality in the emergency department, including directly impacting quality metrics and worsening barriers to the quality improvement process such as burnout, staff turnover, and boarding. We aimed to develop a blueprint for postpandemic quality improvement to address these specific barriers, focused on prioritizing frontline staff engagement from idea generation to implementation and assessment. Drawing from teamwork literature, we constructed a process that emphasized egalitarian conversations, psychological safety, and creating an environment where staff could feel heard at every step of the process. We applied this blueprint to improving rates of patients who leave without being seen and achieved a four percentage point reduction (9% vs. 5%, p

BackgroundNon-sputum-based triage tests for tuberculosis are a priority for ending tuberculosis. We aimed to evaluate the diagnostic accuracy of the late-prototype Xpert MTB Host Response (Xpert HR) blood-based assay.MethodsWe conducted a prospective diagnostic accuracy study among outpatients with presumed tuberculosis in outpatient clinics in Viet Nam, India, the Philippines, Uganda, and South Africa. Eligible participants were aged 18 years or older and reported cough lasting at least 2 weeks. We excluded those receiving tuberculosis treatment in the preceding 12 months and those who were unwilling to consent. Xpert HR was performed on capillary or venous blood. Reference standard testing included sputum Xpert MTB/RIF Ultra and mycobacterial culture. We performed receiver operating characteristic (ROC) analysis to identify the optimal cutoff value for the Xpert HR to achieve the target sensitivity of 90% or more while maximising specificity, then calculated diagnostic accuracy using this cutoff value. This study was prospectively registered with ClinicalTrials.gov, NCT04923958.FindingsBetween July 13, 2021, and Aug 15, 2022, 2046 adults with at least 2 weeks of cough were identified, of whom 1499 adults (686 [45·8%] females and 813 [54·2%] males) had valid Xpert HR and reference standard results. 329 (21·9%) had microbiologically confirmed tuberculosis. Xpert HR had an area under the ROC curve of 0·89 (95% CI 0·86-0·91). The optimal cutoff value was less than or equal to -1·25, giving a sensitivity of 90·3% (95% CI 86·5-93·3; 297 of 329) and a specificity of 62·6% (95% CI 59·7-65·3; 732 of 1170). Sensitivity was similar across countries, by sex, and by subgroups, although specificity was lower in people living with HIV (45·1%, 95% CI 37·8-52·6) than in those not living with HIV (65·9%, 62·8-68·8; difference of 20·8%, 95% CI 13·0-28·6; p

Cough is a common and commonly ignored symptom of lung disease. Cough is often perceived as difficult to quantify, frequently self-limiting, and non-specific. However, cough has a central role in the clinical detection of many lung diseases including tuberculosis (TB), which remains the leading infectious disease killer worldwide. TB screening currently relies on self-reported cough which fails to meet the World Health Organization (WHO) accuracy targets for a TB triage test. Artificial intelligence (AI) models based on cough sound have been developed for several respiratory conditions, with limited work being done in TB. To support the development of an accurate, point-of-care cough-based triage tool for TB, we have compiled a large multi-country database of cough sounds from individuals being evaluated for TB. The dataset includes more than 700,000 cough sounds from 2,143 individuals with detailed demographic, clinical and microbiologic diagnostic information. We aim to empower researchers in the development of cough sound analysis models to improve TB diagnosis, where innovative approaches are critically needed to end this long-standing pandemic.

BackgroundPrediction-based strategies for physiologic deterioration offer the potential for earlier clinical interventions that improve patient outcomes. Current strategies are limited because they operate on inconsistent definitions of deterioration, attempt to dichotomize a dynamic and progressive phenomenon, and offer poor performance.ObjectiveCan a deep learning deterioration prediction model (Deep Learning Enhanced Triage and Emergency Response for Inpatient Optimization [DETERIO]) based on a consensus definition of deterioration (the Adult Inpatient Decompensation Event [AIDE] criteria) and that approaches deterioration as a state "value-estimation" problem outperform a commercially available deterioration score?Derivation cohortThe derivation cohort contained retrospective patient data collected from both inpatient services (inpatient) and emergency departments (EDs) of two hospitals within the University of California San Diego Health System. There were 330,729 total patients; 71,735 were inpatient and 258,994 were ED. Of these data, 20% were randomly sampled as a retrospective "testing set."Validation cohortThe validation cohort contained temporal patient data. There were 65,898 total patients; 13,750 were inpatient and 52,148 were ED.Prediction modelDETERIO was developed and validated on these data, using the AIDE criteria to generate a composite score. DETERIO's architecture builds upon previous work. DETERIO's prediction performance up to 12 hours before T0 was compared against Epic Deterioration Index (EDI).ResultsIn the retrospective testing set, DETERIO's area under the receiver operating characteristic curve (AUC) was 0.797 and 0.874 for inpatient and ED subsets, respectively. In the temporal validation cohort, the corresponding AUC were 0.775 and 0.856, respectively. DETERIO outperformed EDI in the inpatient validation cohort (AUC, 0.775 vs. 0.721; p < 0.01) while maintaining superior sensitivity and a comparable rate of false alarms (sensitivity, 45.50% vs. 30.00%; positive predictive value, 20.50% vs. 16.11%).ConclusionsDETERIO demonstrates promise in the viability of a state value-estimation approach for predicting adult physiologic deterioration. It may outperform EDI while offering additional clinical utility in triage and clinician interaction with prediction confidence and explanations. Additional studies are needed to assess generalizability and real-world clinical impact.

BACKGROUND: Geriatric trauma patients are an increasing population of the United States (US), sustaining a high incidence of falls, and suffer greater morbidity and mortality to their younger counterparts. Significant variation and challenges exist to optimize outcomes for this cohort, while being mindful of available resources. This manuscript provides concise summary of locoregional and national practices, including relevant updates in the triage of geriatric trauma in an effort to synthesize the results and provide guidance for further investigation. METHODS: We conducted a review of geriatric triage in the United States (US) at multiple stages in the care of the older patient, evaluating existing literature and guidelines. Opportunities for improvement or standardization were identified. RESULTS: Opportunities for improved geriatric trauma triage exist in the pre-hospital setting, in the trauma bay, and continue after admission. They may include physiologic criteria, biochemical markers, radiologic criteria and even age. Recent Trauma Quality Improvement Program (TQIP) Best Practices Guidelines for Geriatric Trauma Management published in 2024 support these findings. CONCLUSION: Trauma systems must adjust to provide optimal care for older adults. Further investigation is required to provide pertinent guidance.

Primary objective: To evaluate the accuracy of an innovative machine-learning-powered near-infrared spectroscopy (mNIRS)-based bio-optical sensitivity parameters, namely specific tissue optical index (STOI) and intracranial tissue optical index (ITOI) for effective triaging of patients with suspected traumatic brain injury (TBI) across different age-groups to facilitate timely intervention and curtail the silent epidemic. Research design: Prospective, observational, double-blinded, cross-sectional single-center. Methods: A total of 240 subjects suspected with TBI and recommended for head CT scan were enrolled. Findings of CT were compared with the bio-optical sensitivity parameters (STOI+ITOI) generated by the mNIRS system to detect intracranial hemorrhages (ICHs). Statistical Software used: SPSS (IBM version 21.0) Results Bio-optical sensitivity parameters (STOI+ITOI) analysis of 1288 scanned lobes showed high specificity of 97% (CI 95–98%), sensitivity of 96% (CI 92–99%), and accuracy of 97% (CI 96–98%) across all ages, maintaining robust performance for detecting subdural, epidural, subarachnoid hemorrhages, and contusions. Also, the reliability in the diagnosis of ICH was evidenced by Youden's index of 0.93 and positive and negative likelihood ratios of 29.13 and 0.04, respectively. Conclusion: The mNIRS-based STOI+ITOI proves to be an effective triage tool for TBI, exhibiting superior diagnostic performance across all age-groups. [ABSTRACT FROM AUTHOR]

As coronavirus disease 2019 made its way across the world in 2019, health systems began to develop guidelines to allocate what was expected to be a scarcity of medical resources. Considerable attention was given to triaging intensive care resources such as ventilators. While there was general agreement among bioethicists and policymakers that it may be permissible to withhold life-sustaining interventions from patients with poor prognoses in order to make them available to patients with better prognoses, there was disagreement about the permissibility of withdrawing such interventions for this purpose. Some maintained that the doctrine of double effect (DDE) revealed the intrinsic wrongness of such acts of reallocation. This article argues that so long as there is transparency and effective ongoing communication, the DDE may permit the discontinuation of life-sustaining interventions from patients who may still benefit from them in order to make them available to patients with more favorable prognoses. [ABSTRACT FROM AUTHOR]

Objectives: The demand for ED services, both in terms of patient numbers and complexity has risen over the past decades. According to reports, there has been an increase in the ED patient presentation rate from 330 per 1000 to 334 per 1000 between 2018–2019 and 2022–2023. Consequently, new care models have been introduced to address this surge in demand, mitigate associated risks and improve overall safety. Among these models is the concept of 'front loading' clinical care, involving the initiation of interventions at the point of arrival. The present study evaluates the impact of introducing phlebotomists at triage. Methods: We conducted a cross‐sectional survey using purposive sampling at a single quaternary metropolitan ED with an annual census of greater than 90 000, encompassing all clinical staff in the ED. The survey data were analysed quantitatively and complemented by a thematic analysis. Results: The response rate for the questionnaire was 61% (n = 207), with good representation from all ED craft groups. Nearly all the staff (99.5%) reported being aware of the presence of phlebotomists in the ED, whereas only 57% of the staff reported working in triage (P = 0.05, 0.00 to 0.04). 'Valuable/vital resource' featured as a common response. Early decision‐making, patient safety, staff and patient satisfaction emerged as consistent themes. Conclusions: Staff expressed satisfaction that patient care now begins in the waiting room, especially after extended waiting periods prior to cubicle allocation. They assert that this improvement significantly enhances timely treatment and disposition decisions, as well as overall patient satisfaction. [ABSTRACT FROM AUTHOR]

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Copyright of Notfall & Rettungsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: In 2017 the Swedish public insurance company Löf published national guidelines for in-hospital trauma team activation (TTA), which are now widely adopted in Sweden. No studies have examined triage accuracy at non-trauma-center hospitals in the Stockholm trauma system since the implementation of the new TTA criteria. Aim: To assess trauma triage accuracy at one non-trauma-center hospital in Stockholm. Methods: 3528 trauma patients treated at Södersjukhuset during 2019–2022 were acquired from the Swedish Trauma Registry (SweTrau) to calculate TTA triage accuracy. Undertriage was defined in accordance with national guidelines as patients with a New Injury Severity Score > 15 who did not prompt level 1 TTA on arrival to hospital. Results: In total there were 849 severely injured patients during the study period, of which 2.2% (n = 19) prompted TTA level 1, corresponding to an undertriage of 98% (n = 830). Of the 849 severely injured patients, 41% (n = 348) prompted TTA level 2 whereas the remaining 57% (n = 482) prompted no TTA on arrival to hospital. There were a total of 3046 patients prompting TTA during the study period, but only 19% (n = 19) of level 1 and 12% (n = 348) of level 2 patients were severely injured, and 45% had a NISS ≤ 3. Conclusion: Undertriage of severely injured trauma patients was 98% according to the definition specified by Swedish trauma triage guidelines, higher than reasonably acceptable. There is considerable overtriage with non-severely injured patients prompting TTA. However, the suitability of using NISS > 15 to retrospectively define the need for TTA is debatable as this does not always correlate with the fulfillment of the TTA criteria. Further investigation of adherence to trauma triage guidelines in clinical practice may be of value to improve triage accuracy in organized regional trauma systems. [ABSTRACT FROM AUTHOR]

Background: In healthcare facilities, an efficient triage system is critical to optimize patient care. The main objective of this study was to explore the triage processes and practices in three different tiers of healthcare facilities in the Kathmandu Valley, Nepal. Methods: A mixed-methods approach in this study comprised observations and interviews in ten healthcare settings across primary care centers (PHC; n = 6), secondary care centers (SHC; n = 3), and tertiary care hospital (n = 1). Data were collected from June to November 2023. Semi-structured interviews were conducted among patients (n = 30) including survey questionnaires among 144 healthcare workers (HCWs) focused on triage. The qualitative data were analyzed using Interpretative Phenomenological Analysis and quantitative data were analyzed to explore the median score on the consistent practice of triage based on the Likert scale. Results: PHCs had designated space for triage with less equipped emergency services and outpatient departments (OPDs) and received severely ill patients rarely. Although prioritizing critical patients and prompt care was part of the services, there was a lack of triage protocols with more than half of the HCWs (56.3%; 36/64) from the tertiary hospital reporting the availability of triage guidelines compared to SHCs (28.1%; 9/32) and PHCs (6.3%; 3/48). The majority of HCWs from the tertiary level recognized triage's effectiveness in reducing time lag, and prioritizing patients. Tertiary level had the consistent use of triage (94%; 60/64) compared to only around two-thirds in SHCs (66%; 19/29) and PHCs (62%; 28/45). Patients often attended PHC services for routine check-ups and were motivated by health insurance, affordability, free medicines, referral cards, and proximity. In the SHC, there was a well-equipped emergency department (ED) with specific guidelines, but its use was infrequent. Patients were unaware of the triage process and its utility. In all settings, while most HCWs had a basic knowledge of triage, some were not confident due to limited exposure to the triage process and training. Many HCWs reported the need for triage-related training and its' consistent implementation. Conclusions: Consistent utilization of triage protocols, coupled with improved infrastructure, resource allocation, and training for healthcare workers is critical for the optimization of triage processes in healthcare settings in the Kathmandu Valley, Nepal. [ABSTRACT FROM AUTHOR]

Background: Approximately 25% of patients that present to the emergency department (ED) do so after contact with a healthcare professional. Many of these patients could be effectively managed in non-ED ambulatory settings. Aligning patients with safe and appropriate outpatient care has the potential to improve ED overcrowding, patient experience, outcomes, and costs. Little is understood about how healthcare providers approach triage decision-making and what factors influence their choices. Objectives: To evaluate how providers think about patient triage, and what factors influence their decision-making when triaging patient calls. Design: Cross-sectional survey-based study in which participants make triage decisions for hypothetical clinical scenarios. Participants: Healthcare providers in the specialties of internal medicine, family medicine, or emergency medicine within a large integrated healthcare system in the Southeast. Main Measures: Differences in individual training and practice characteristics were used to compare observed differences in triage outcomes. Free-response data were evaluated to identify themes and factors affecting triage decisions. Key Results: Out of 72 total participants, substantial variability in triage decision-making was observed among all patient cases. Attending physicians triaged 1.4 fewer cases to ED care compared with resident physicians (p < 0.001, 95% CI 0.62–2.1). Academic attendings demonstrated a trend toward fewer cases to ED care compared with community attendings (0.61, p = 0.188, 95% CI − 0.31–1.5). Qualitative data highlighted the complex considerations in provider triage and led to the development of a novel conceptual model to describe the cognitive triage process and the main influencing factors. Conclusions: Triage decision-making for healthcare providers is influenced by many factors related to clinical resources, care coordination, patient factors, and clinician factors. The complex considerations involved yield variability in triage decisions that is largely unexplained by descriptive physician factors. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic generated overflow of healthcare systems in several countries. As the ethical debates focused on prioritisation for access to care with scarce medical resources, numerous recommendations were created. Late 2021, the emergence of the Omicron variant whose transmissibility was identified but whose vaccine sensitivity was still unknown, reactivated debates. Fears of the need to prioritise patients arose, particularly in France. Especially, a debate began about the role of vaccination status in the prioritisation strategy. Material and methods: The Ethics Committee (EC) of the University Hospital of Bordeaux (UHB), France, identified prioritisation criteria in the literature (some recommended, such as being a healthcare worker (HCW) or having consented to research, while others were discouraged, such as age with a threshold effect or vaccination status). A survey was sent within the institution in January 2022 to explore frontline physicians' adherence to these prioritisation criteria. The decision making conditions were also surveyed. Results: In 15 days, 78/165 (47.3%) frontline physicians responded, and more widely 1286/12946 (9.9%) professionals. A majority of frontline physicians were opposed to prioritising HCWs (54/75, 72%) and even more opposed to participating in research (69/76, 89.6%). Conversely, the results were very balanced for non-recommended criteria (respectively 39/77, 50.7% and 34/69 49.3% in favour for age with a threshold effect and for vaccination status). Decisions were considered to be multi-professional and multi-disciplinary for 65/76, 85.5% and 53/77, 68.8% of frontline physicians. Responders expressed opposition to extending decision-making to representatives of patients, civil society or HCWs not involved in care. Discussion: Prioritisation recommendations in case of scarce medical resources were not necessarily approved by the frontline physicians, or by the other HCWs. This questions the way ethical recommendations should be communicated and discussed at a local scale, but it also questions these recommendations themselves. The article also reports the experience of seeking HCWs opinions on a sensitive ethical debate in a period of crisis. [ABSTRACT FROM AUTHOR]

Introduction and objective: Modern and intelligent triage systems are used today due to the growing trend of disasters and emergencies worldwide and the increase in the number of injured people facing the challenge of using traditional triage methods. The main objective of this study is to investigate the application of artificial intelligence and Technology in the triage of patients injured by disasters and emergencies and the challenges of the implementation of intelligent triage systems. Method: The present study is a systematic review and follows PRISMA guidelines. The protocol of this study was registered in PROSPERO with the code CRD42023471415. To find relevant studies, the databases PubMed, Scopus and Web of Science (ISI) were searched without a time limit until September 2024. The scientific search engine Google Scholar and the references of the final articles were read manually for the final review. Results: The search identified 2,630 articles, narrowing down to 19 high-quality studies on AI in triage, which improved patient care through optimized resource management and real-time data transmission. AI algorithms like OpenPose and YOLO enhanced efficiency in mass casualty incidents, while e-triage systems allowed for continuous vital sign monitoring and faster triaging. AI tools demonstrated high accuracy in diagnosing COVID-19 (94.57%). Implementing intelligent triage systems faced challenges such as trust issues, training needs, equipment shortages, and data privacy concerns. Conclusion: Developing assessment systems using artificial intelligence enables timely treatment and better resuscitation services for people injured in disasters. For future studies, we recommend designing intelligent triage systems to remove the obstacles in triaging children and disabled people in disasters. [ABSTRACT FROM AUTHOR]

Background Despite many studies evaluating lung ultrasound (LUS) for coronavirus disease 2019 (COVID-19) prognostication, the generalizability and utility across clinical settings are uncertain. Methods Adults (≥18 years of age) with COVID-19 were enrolled at 2 military hospitals, an emergency department, home visits, and a homeless shelter in the United States, and in a referral hospital in Uganda. Participants had a 12-zone LUS scan performed at time of enrollment and clips were read off-site. The primary outcome was progression to higher level of care after the ultrasound scan. We calculated the cross-validated area under the curve for the validation cohort for individual LUS features. Results We enrolled 191 participants with COVID-19 (57.9% female; median age, 45.0 years [interquartile range, 31.5–58.0 years]). Nine participants clinically deteriorated. The top predictors of worsening disease in the validation cohort measured by cross-validated area under the curve were B-lines (0.88 [95% confidence interval {CI},.87–.90]), discrete B-lines (0.87 [95% CI,.85–.88]), oxygen saturation (0.82 [95%, CI,.81–.84]), and A-lines (0.80 [95% CI,.78–.81]). Conclusions In an international multisite point-of-care ultrasound cohort, LUS parameters had high discriminative accuracy. Ultrasound can be applied toward triage across a wide breadth of care settings during a pandemic. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusions Reporting Method Patient and Public Contribution Although there has been a significant amount of research on nurse workloads in hospital environments, there has been a lack of comprehensive investigation of the workload of triage nurses. This study assesses the workload fluctuations of triage nurses in various emergency departments in the same region and examines how workload varies based on emergency department visit volumes and seasonal fluctuations.The study is a retrospective, multicentre, observational study from January 1, 2019, to December 31, 2023, in seven Italian emergency departments, gathering information on all patients who went through the triage process.We documented the number of nurses present throughout each shift and adjusted the data to account for the number of patients attended to by each triage nurse per shift. The EDs were classified into high‐inflow, medium‐inflow and low‐inflow categories according to the annual number of patients they served.The study included 1,223,331 emergency department triage assessments. During daytime shifts, triage nurses in high‐inflow emergency departments assessed a median of 74 patients, while those in medium‐inflow and low‐inflow emergency departments assessed 63 and 32 patients, respectively. During nighttime shifts, triage nurses in high‐inflow emergency departments assessed 26 patients, compared to 14 in medium‐inflow and 5 in low‐inflow emergency departments. Significant seasonal fluctuations in the workload of triage nurses were observed.This study reveals substantial disparities in the number of patients triage nurses assess, which vary according to emergency department patient inflow volumes and seasonal factors. The findings emphasise the need for more standardised and equitable workload distribution among triage nurses. Future research should aim to establish a systematic nurse staffing model for triage to ensure manageable workloads and maintain patient safety.The Strengthening the Reporting of Observational Studies in Epidemiology was used.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: The ageing of the population is leading to an increase in the number of traumatic injuries and represents a major challenge for the future. Falls represent the leading cause of Emergency department admission in older people, with injuries ranging from minor to severe multiple injuries. Older injured patients are more likely to be undertriaged than younger patients. The aim of this study was to investigate the extent of undertriage in older patients with particular emphasis on access to trauma centres and resuscitation rooms. Methods: Retrospective observational cross-sectional study based on data prospectively collected from prehospital electronic records including all patients ≥ 18 years for whom an ambulance or helicopter was dispatched between 1 January 2018 and 31 April 2023 due to a trauma. The primary outcome, admission to the resuscitation room of the regional trauma centre with trauma team activation, was assessed by age. Multivariate logistic regression was used to control for known confounders and to test for plausible effect modifiers. Results: Emergency Medical Services treated 37,906 injured patients. Older patients ≥ 75 years represented 17,719 patients (47%). Admission to trauma centre with trauma team activation was lower in older patients, N = 121 (1%) compared to N = 599 (5%) in younger patients, p < 0.001; adjusted odds ratio: 0.33 (0.24–0.45); p < 0.001. Undertriage increased by twofold with age ≥ 75; OR: 1.81 (1.04–3.15); p value < 0.001. Undertriaged patients were older, more likely to be female, to have low energy trauma and to be located farther from the regional trauma centre. Conclusion: Older injured patients were at increased risk of undertriage and non-trauma team activation admission, especially if they were older, female, had head injury without altered consciousness and greater distance to regional trauma centre. [ABSTRACT FROM AUTHOR]

Aim: To develop and psychometrically test the triage decision‐making instrument, a tool to measure Emergency Department Registered Nurses decision‐making. Design: Five phases: (1) defining the concept, (2) item generation, (3) face validity, (4) content validity and (5) pilot testing. Methods: Concept definition informed by a grounded theory study from which four domains emerged. Items relevant to the four domains were generated and revised. Face validity was established using three focus groups. The target population upon which the reliability and validity of the triage decision‐making instrument was explored were triage registered nurses in emergency departments. Three expert judges assessed 89 items for content and domain designation using a 4‐point scale. Psychometric properties were assessed by exploratory factor analysis, following which the names of the four domains were modified. Results: The triage decision‐making instrument is a 22‐item tool with four factors: clinical judgement, managing acuity, professional collaboration and creating space. Focus group data indicated support for the domains. Expert review resulted in 46 items with 100% agreement and 13 with 66% agreement. Fifty‐nine items were distributed to a convenience sample of 204 triage nurses from six hospitals in 2019. The Kaiser–Meyer–Olkin measures indicated that the data were sufficient for exploratory factor analysis. Bartlett's test indicated patterned relationships among the items (X2 (231) = 1156.69). An eigenvalue of >1.0 was used and four factors explained 48.64% of the variance. All factor loadings were ≥0.40. Internal consistency was demonstrated by Cronbach's alphas of.596 factor 1,.690 factor 2,.749 factor 3 and.822 for factor 4. Conclusion: The triage decision‐making instrument meets the criteria for face validity, content validity and internal consistency. It is suitable for further testing and refinement. Impact: The instrument is a first step in quantifying triage decision‐making in real‐world clinical environments. The triage decision‐making instrument can be used for targeted triage interventions aimed at improving throughput and staff education. Statistical Support: Dr. Tak Fung who is a member of the research team is a statistician. Statistical Methods: Development, validation and assessment of instruments/scales. Descriptive statistics. Reporting Method: STROBE cross‐sectional checklist. Implications for the Profession and/or Patient Care: The TDI makes the complexity of triage decision‐making visible. Identifying the influence of decision‐making factors in addition to acuity that affect triage decisions will enable nurse managers and educators to develop targeted interventions and staff development initiatives. By extension, this will enhance patient care and safety. [ABSTRACT FROM AUTHOR]

Purpose: To identify the predictors and outcomes of ICU triage decisions in patients with solid malignancies (SM) and to investigate the usefulness of the National Early Warning Score (NEWS) and quick Sequential Organ Failure Assessment (qSOFA) score at triage. Methods: All patients with SM for whom ICU admission was requested between July 2019 and December 2021 in a French university-affiliated hospital were included prospectively. Results: Of the 6262 patients considered for ICU admission, 410 (6.5%) had SM (age, 66 [58–73] years; metastases, 60.1%; and performance status 0–2, 81%). Of these 410 patients, 176 (42.9%) were admitted to the ICU, including 141 (80.1%) subsequently discharged alive. Breast cancer, hemoptysis, and pneumothorax were associated with ICU admission; whereas older age, performance status 3–4, metastatic disease, and request at night were associated with denial of ICU admission. The NEWS, and the qSOFA score in patients with suspected infection, determined at triage performed poorly for predicting hospital mortality (area under the receiver operating characteristics curve, 0.52 and 0.62, respectively). Performance status 3–4 was independently associated with higher 6-month mortality and first-line anticancer treatment with lower 6-month mortality. Hospital mortality was 33.3% in patients admitted to the ICU after refusal of the first request. Conclusion: Patients with SM were frequently denied ICU admission despite excellent in-ICU survival. Poor performance status was associated with ICU admission denial and higher 6-month mortality, but none of the other reasons for denying ICU admission predicted 6-month mortality. Physiological scores had limited usefulness in this setting. [ABSTRACT FROM AUTHOR]

We aimed to (1) identify existing triage approaches for referral of patients with suspected inflammatory arthritis (IA) from primary care physicians (PCP) to rheumatologists, (2) describe their characteristics and methodologies for clinical use, and (3) report their level of validation for use in a publicly funded healthcare system. The comprehensive search strategy of multiple databases up to October 2023 identified relevant literature and focussed on approaches applied at the PCP–Rheumatologist referral stage. Primary, quantitative studies, reported in English were included. Triage approaches were grouped into patient conditions as defined by the authors of the reports, including IA, its subtypes and combinations. 13952 records were identified, 425 full text reviewed and 55 reports of 53 unique studies were included. Heterogeneity in disease nomenclature and study sample pretest probability was found. The number of published studies rapidly increased after 2012. Studies were mostly from Europe and North America, in IA and Axial Spondyloarthritis (AxSpa). We found tools ranging the continuum of development with those best performing, indicated by the area under the receiver operating curve (AUC) >0.8), requiring only patient-reported questions. There were AUCs for some tools reported from multiple studies, these were in the outstanding to excellent range for the Early IA Questionnaire (EIAQ) (0.88 to 0.92), acceptable for the Case Finding AxSpa (CaFaSpa) (0.70 to 0.75), and poor to outstanding for the Psoriasis Epidemiology Screening Tool (PEST) (0.61 to 0.91). Given the clinical urgency to improve rheumatology referrals and considering the good [ABSTRACT FROM AUTHOR]

Assessing patient frailty in the Emergency Department (ED) is crucial; however, triage frailty and comorbidity assessment scores developed in recent years are unsatisfactory. The underlying causes of this phenomenon could reside in the nature of the tools used, which were not designed specifically for the emergency context and, thus, are difficult to adapt to the emergency environment. The objective of this study was to create and internally validate a nomogram for identifying different levels of patient frailty during triage. Multicenter, prospective, observational exploratory study conducted in two ED. The study was conducted from April 1 to October 31, 2022. Following the triage assessment, the nurse collected variables related to the patient's comorbidities and chronic conditions using a predefined form. The primary outcome was the 90-day mortality rate. A total of 1345 patients were enrolled in this study; 6% died within 90 days. In the multivariate analysis, the Charlson Comorbidity Index, an altered motor condition, an altered cognitive condition, an autonomous chronic condition, arrival in an ambulance, and a previous hospitalization within 90 days were independently associated with death. The internal validation of the nomogram reported an area under the receiver operating characteristic of 0.91 (95% CI 0.884–0.937). A nomogram was created for assessing comorbidity and frailty during triage and was demonstrated to be capable of determining comorbidity and frailty in the ED setting. Integrating a tool capable of identifying frail patients at the first triage assessment could improve patient stratification. [ABSTRACT FROM AUTHOR]

The proper evaluation of abortion specimens and placentas from stillbirth and post-partum cases is important for adequate clinical care of post-abortion and post-partum patients. The following topics will be reviewed: (1) the importance of evaluation of both fetal and placental tissue in first trimester abortions to confirm an intrauterine pregnancy versus an ectopic pregnancy; (2) the clinical history associated with an abortion specimen or retained products of conception (POC) influences how the pathologist should triage the specimen; (3) the criteria for diagnosis of a molar pregnancy, which is critical for clinicians to know which patients need follow-up; (4) the utility of genetic studies for both diagnosis and appropriate follow-up of the patient; and (5) the pathologic evaluation of specimens from patients with post-partum hemorrhage for placenta accreta spectrum and subinvolution of maternal vessels. [ABSTRACT FROM AUTHOR]

Copyright of Análisis Filosófico is the property of Sociedad Argentina de Analisis Filosofico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Despite the fact that several triage tools have been implemented globally, emergency care, including the triage system, is often one of the weakest parts of the health system in developing countries, as compared to developed countries. Moreover, emergency centers in African countries are very busy, often flooded by high load of trauma patients, chronic medical conditions, acute medical emergencies, and HIV‐related conditions. These disease conditions precipitate the reasons for the prioritization of patients. In South Africa, studies conducted on the use of triage by nurses revealed that most patients are satisfied with the Nurse‐led triage service provided in emergency departments (EDs). At the same time, some Nurses also see the South African Triage Scale (SATS) as one of the easiest Nurse‐led triage tools. Aim: The study aimed at identifying the factors hindering the effective process of triage during care provision at a selected public hospital in KwaZulu‐Natal (KZN). Methods: This study utilized a cross‐sectional survey, employing a nonprobability convenience sampling to recruit its respondents. The recognition primed decision model formed the framework of the study. Ethical clearance was obtained from the University of KwaZulu‐Natal Ethics Review Board, and ethics principles were carefully observed throughout the study. Results: Out of the 100 respondents, 89% (89) of the respondents perceived that various factors still impede the progress of triage, while 11% (11) of the respondents perceived that no factor impedes the progress of triage. Conclusion: The study indicates that several factors still hinder the effective process of triage. Based on the findings of the study, factors like overcrowding, Nurses waiting for doctors when they know what to do, lack of continuous professional development on triage system, inadequate experience, lack of confidence, and lack of adequate training on triage still impede the efficient triage system. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aims Methods Results Conclusion Identifying patients with chest pain potentially due to acute coronary syndrome (ACS) early is crucial for triage nurses. They need a reliable, validated screening tool.This study aims to develop an initial screening scale to detect ACS in patients presenting with chest pain in the emergency department.We analyzed electronic medical records of 3131 chest pain patients from 103,041 emergency department visits between January 2018 and December 2019. ACS diagnosis was confirmed by cardiologists through clinical symptoms, electrocardiograms, and cardiac enzyme levels. The study proceeded in four stages: (1) identifying potential ACS predictors through a literature review, (2) validating these predictors with experts, (3) comparing data between ACS and non‐ACS patients and (4) developing a screening scale based on identified predictors. Statistical methods included univariate analysis and binary logistic regression. The scale's accuracy was assessed using ROC curve analysis and compared to existing tools.Eight significant ACS predictors were identified: male sex, age over 49 for males and over 65 for females, typical symptoms, initial pain scale score of 6 or higher, pain duration of at least 10 min, history of ACS, hypertension, and dyslipidemia. Each predictor was scored, with typical symptoms and severe pain receiving higher scores, totaling up to 10 points. A score of 6 or more indicated high ACS risk, demonstrating accuracy comparable to the HEART and TIMI score systems.This study developed a new ACS screening scale for use by triage nurses in emergency departments. This scale can facilitate early detection and intervention for patients at high risk of ACS. [ABSTRACT FROM AUTHOR]

The article discusses a feasibility study on using artificial intelligence (AI) for telephone triage of patients with suspected head and neck cancer. The study showed that most patients referred to secondary care for suspected head and neck cancer do not have cancer. Ufonia, a digital health company, developed an AI-driven clinical assistant named 'Dora' for this purpose, which was well-received by patients. The study demonstrated high data capture and accuracy levels with AI-led telephone calls, offering a promising solution for triaging suspected head and neck cancer patients remotely. [Extracted from the article]

Background: Vital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). In most EDs, triage of patients takes place with vital signs and admission complaints only. Comorbidities are generally underestimated when determining the patient's status at the triage area. This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED. Methods: This prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 h, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 h, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered "medical emergency conditions". The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression. Results: A total of 10,022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. Six hundred four patients presented with an MEC. All vital signs -except diastolic hypertension and tachycardia- and comorbidities were found statistically significant. Hypoxia (Odd's Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, an MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities. Conclusion: Among the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of an MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs. [ABSTRACT FROM AUTHOR]

Emergency departments, crucial in managing patient emergencies, are often challenged by overcrowding and diagnostic errors during triage—the process that assesses the urgency of patients' conditions. Traditional triage systems, heavily dependent on human judgement, are prone to errors like under‐triage, where severe conditions are missed, delaying treatment, and over‐triage, where less severe conditions are overly prioritized, causing unnecessary resource use and morbidity. This thesis presents a novel multi‐model machine‐learning framework designed to enhance triage accuracy by evaluating multiple medical conditions concurrently, including chronic illnesses like heart disease. The framework employs various machine‐learning techniques—such as logistic regression, support vector machines, random forests, deep neural networks, and decision trees—to analyze different medical conditions in two comprehensive phases. In the first phase, patients' conditions are categorized, and a multi‐tiered analysis using multiple classifiers refines the assessment by considering probabilistic outcomes from each classifier. The second phase synthesizes these insights into a unified and precise triage decision, distinguishing between patients who require critical care and those needing less urgent hospitalization. This integration of diverse machine learning models allows for a fused and precise triage decision, overcoming traditional triage systems' limitations that usually focus on single conditions and rely on isolated model predictions. A hybrid feature selection method is also utilized to identify critical predictors, enhancing the decision‐making process. The framework is validated through a specially curated dataset that simulates multiple triage scenarios, evaluated by medical experts for efficacy. Comparative analysis with traditional triage methods demonstrates significant improvements in decision accuracy, as evidenced by higher area under curve (AUC) values—0.95 for critical care and 0.90 for hospitalization. The implementation of this data‐driven approach substantially reduces human error, boosts operational efficiency, and aids medical staff in making rapid, informed decisions. This research represents a significant advancement in emergency medical care, illustrating the benefits of integrating sophisticated machine learning techniques to improve patient outcomes and resource management. [ABSTRACT FROM AUTHOR]

It was conducted to evaluate the triage decision-making skills of emergency care nurses. A descriptive cross- sectional study was conducted with 97 nurses working in the adult emergency department in a city hospital in February and March 2023. Sociodemographic Data Form and Triage Decision Making Inventory were used to collect data. Data were collected by researchers using face-to-face interviews. Number, percentage, mean, standard deviation, minimum-maximum parameters, Mann-Whitney U test and Kruskal-Wallis Test were used to evaluate the data. STROBE checklist was used. In the study, the average age of the nurses was 28.69±5.86 years, 61.9% were women, 68.0% were single, and 78.4% had a bachelor's degree. In the study, the total score average of the nurses in the Triage Decision Making Inventory was determined as 177.78±27.53. When the total score averages of the Triage Decision Making Inventory subscales are evaluated; Cognitive Features sub-dimension was found to be 33.83±5.69, Experience sub-dimension was 55.25±8.52, Intuition sub-dimension was 32.40±6.14 and Critical Thinking sub-dimension was 56.35±10.12. In our research, it can be said that emergency care nurses' triage decision-making skills are high. It is recommended to conduct studies on this subject with different samples and to create training programs to improve the triage decision-making skills of nurses. [ABSTRACT FROM AUTHOR]

Background: Long specialist outpatient waiting lists are a source of clinical risk. Triage assignment is based on subjective assessment of referrals and fails to account for dynamic changes in disease status while patients await clinical review. Aims: To pilot an innovative triage method using a trifold approach to conduct noninvasive assessment of fibrosis and to determine the feasibility of reflex hepatitis C virus (HCV) polymerase chain reaction (PCR) testing. Methods: A total of 1006 patients awaiting an initial liver clinic appointment at a tertiary Australian hospital were sent a short message service (SMS) requesting a blood test be completed. The first 60 patients received an SMS only, and the subsequent 946 patients also received a phone call from a Liver Care Guide (LCG), a nonclinician employed to increase patient engagement. Liver fibrosis assessment through noninvasive testing was performed using an aspartate aminotransferase to platelet ratio index (APRI) and fibrosis‐4 (FIB4) score. Patients with an APRI ≥1, FIB4 ≥3.25 or positive HCV PCR were retriaged to Category 1. Results: Four hundred ninety (49%) patients completed testing and 40 (4%) were triaged to Category 1. Subanalyses demonstrated increased response rates with LCG input (P = 0.012). Retriaged patients had been on the waitlist for a median of 216 days, exceeding initial category recommendations. Conclusion: This study successfully implemented a semiautomated strategy that prioritises patients with probable advanced liver disease or active HCV, demonstrating enhanced patient engagement with LCG support. It highlights the burden of patients referred for specialist care and the need for innovative strategies for monitoring and objective risk stratification. [ABSTRACT FROM AUTHOR]

Background: Telehealth services were used by healthcare centers during the COVID-19 pandemic in order to identify and manage patients at the forefront of the healthcare system. As one of these technologies, tele-triage refers to the assessment of a patient's health status through telephone or another means of communication and recommending treatment or providing appropriate referrals in emergency rooms and primary care offices. This study aimed to perform a systematic review of the evidence on the effectiveness of tele-triage, as one of these technologies, during the COVID-19 pandemic. Methods: Medline (via PubMed), Scopus, and Web of Science databases were searched for relevant English articles published since the pandemic's onset until December 30, 2021. Studies investigating the tele-triage's effect on patient safety, clinical outcomes, and patient satisfaction were included. Data on study characteristics, intervention characteristics, and their effects on study outcomes were extracted separately by two authors. A narrative synthesis of the included studies was ultimately performed. Results: Out of the 6312 retrieved studies, 14 met the inclusion criteria. The tele-triage intervention was offered by an algorithm-based system in eight studies (57.14%) and by healthcare providers in six other studies (42.86%) to determine the patient's level of care. According to the results, tele-triage interventions during COVID-19 can reduce unnecessary emergency room visits (by 1.2–22.2%), improve clinical outcomes after intervention (such as would closure in diabetic feet), reduce mortality and injuries, and ensure patient satisfaction with tele-triage (53–98%). Conclusions: This study found that tele-triage interventions reduced unnecessary visits, improved clinical outcomes, reduced mortality, and injuries, increased patient satisfaction, reduced healthcare provider workload, improved access to primary care consultation, and increased patient safety and satisfaction. Therefore, tele-triage systems are not only suitable for providing acute and emergency care remotely but they are also recommended as an alternative tool to monitor and diagnose COVID-19. [ABSTRACT FROM AUTHOR]

Background: Triage is pivotal in intensive care for patient safety and resource allocation. The admission algorithm has been shown to correlate with the appropriateness of ICU admission and offer decision aid when facing challenges in times of scarce critical care resources. This study aimed to explore the development of a reference tool to support triage decisions for admission to the ICU. Methods: In this retrospective observational study, the Intensive Care Triage Score (ICTS) was generated as a reference to correlate with the triage decision made by clinical judgment. ICU admission would be advised for ICTS below 6. The primary outcome was ICU admission. The secondary outcomes included ICU, hospital, 90- day, and 1-year mortality. The receiver operating characteristic curve was used to assess the performance of ICTS. Results: A total of 1664 patients were included in the analysis. There were 1204 patients (72.4%) admitted to the ICU; 680 of 738 (92%) with ICTS below 6 were admitted to the ICU. The hospital mortality of the whole cohort was 25.1%; there was a positive correlation between ICTS and hospital mortality. The area under the receiver operating characteristic curve (AUC) of ICTS in predicting hospital mortality for all patients was 0.754 (95% CI 0.728-0.780). The correlation between ICTS and hospital mortality was observed in patients admitted and not admitted to the ICU. Conclusion: Developing a scoring system as a reference tool would be useful for ICU triage. [ABSTRACT FROM AUTHOR]

Animal owners may increasingly rely on large language models for gathering animal health information alongside internet sources in the future. This study therefore aims to provide initial results on the accuracy of ChatGPT-4o in triage and tentative diagnostics, using horses as a case study. Ten test vignettes were used to prompt situation assessments from the tool, which were then compared to original assessments made by a veterinary specialist for horses. The most probable diagnosis suggested by ChatGPT-4o was found to be quite accurate in most cases, with the urgency to contact a veterinarian sometimes assessed as higher than necessary. When provided with all relevant information, the tool does not seem to compromise horse health by recommending excessively long waiting times, although there is still potential for improving the relief of veterinarians' workload. [ABSTRACT FROM AUTHOR]

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Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and objective: Patients struggle to classify symptoms, which hinders timely medical presentation. With 35–75% of patients seeking information online before consulting a health care professional, generative language–based artificial intelligence (AI), exemplified by ChatGPT-3.5 (GPT-3.5) from OpenAI, has emerged as an important source. The aim of our study was to evaluate the role of GPT-3.5 in triaging acute urological conditions to address a gap in current research. Methods: We assessed GPT-3.5 performance in providing urological differential diagnoses (DD) and recommending a course of action (CoA). Six acute urological pathologies were identified for evaluation. Lay descriptions, sourced from patient forums, formed the basis for 472 queries that were independently entered by nine urologists. We evaluated the output in terms of compliance with the European Association of Urology (EAU) guidelines, the quality of the patient information using the validated DISCERN questionnaire, and a linguistic analysis. Key findings and limitations: The median GPT-3.5 ratings were 4/5 for DD and CoA, and 3/5 for overall information quality. English outputs received higher median ratings than German outputs for DD (4.27 vs 3.95; p

Abstract Background In healthcare facilities, an efficient triage system is critical to optimize patient care. The main objective of this study was to explore the triage processes and practices in three different tiers of healthcare facilities in the Kathmandu Valley, Nepal. Methods A mixed-methods approach in this study comprised observations and interviews in ten healthcare settings across primary care centers (PHC; n = 6), secondary care centers (SHC; n = 3), and tertiary care hospital (n = 1). Data were collected from June to November 2023. Semi-structured interviews were conducted among patients (n = 30) including survey questionnaires among 144 healthcare workers (HCWs) focused on triage. The qualitative data were analyzed using Interpretative Phenomenological Analysis and quantitative data were analyzed to explore the median score on the consistent practice of triage based on the Likert scale. Results PHCs had designated space for triage with less equipped emergency services and outpatient departments (OPDs) and received severely ill patients rarely. Although prioritizing critical patients and prompt care was part of the services, there was a lack of triage protocols with more than half of the HCWs (56.3%; 36/64) from the tertiary hospital reporting the availability of triage guidelines compared to SHCs (28.1%; 9/32) and PHCs (6.3%; 3/48). The majority of HCWs from the tertiary level recognized triage's effectiveness in reducing time lag, and prioritizing patients. Tertiary level had the consistent use of triage (94%; 60/64) compared to only around two-thirds in SHCs (66%; 19/29) and PHCs (62%; 28/45). Patients often attended PHC services for routine check-ups and were motivated by health insurance, affordability, free medicines, referral cards, and proximity. In the SHC, there was a well-equipped emergency department (ED) with specific guidelines, but its use was infrequent. Patients were unaware of the triage process and its utility. In all settings, while most HCWs had a basic knowledge of triage, some were not confident due to limited exposure to the triage process and training. Many HCWs reported the need for triage-related training and its’ consistent implementation. Conclusions Consistent utilization of triage protocols, coupled with improved infrastructure, resource allocation, and training for healthcare workers is critical for the optimization of triage processes in healthcare settings in the Kathmandu Valley, Nepal.

Abstract Background In 2017 the Swedish public insurance company Löf published national guidelines for in-hospital trauma team activation (TTA), which are now widely adopted in Sweden. No studies have examined triage accuracy at non-trauma-center hospitals in the Stockholm trauma system since the implementation of the new TTA criteria. Aim To assess trauma triage accuracy at one non-trauma-center hospital in Stockholm. Methods 3528 trauma patients treated at Södersjukhuset during 2019–2022 were acquired from the Swedish Trauma Registry (SweTrau) to calculate TTA triage accuracy. Undertriage was defined in accordance with national guidelines as patients with a New Injury Severity Score > 15 who did not prompt level 1 TTA on arrival to hospital. Results In total there were 849 severely injured patients during the study period, of which 2.2% (n = 19) prompted TTA level 1, corresponding to an undertriage of 98% (n = 830). Of the 849 severely injured patients, 41% (n = 348) prompted TTA level 2 whereas the remaining 57% (n = 482) prompted no TTA on arrival to hospital. There were a total of 3046 patients prompting TTA during the study period, but only 19% (n = 19) of level 1 and 12% (n = 348) of level 2 patients were severely injured, and 45% had a NISS ≤ 3. Conclusion Undertriage of severely injured trauma patients was 98% according to the definition specified by Swedish trauma triage guidelines, higher than reasonably acceptable. There is considerable overtriage with non-severely injured patients prompting TTA. However, the suitability of using NISS > 15 to retrospectively define the need for TTA is debatable as this does not always correlate with the fulfillment of the TTA criteria. Further investigation of adherence to trauma triage guidelines in clinical practice may be of value to improve triage accuracy in organized regional trauma systems.

Abstract Introduction The COVID-19 pandemic generated overflow of healthcare systems in several countries. As the ethical debates focused on prioritisation for access to care with scarce medical resources, numerous recommendations were created. Late 2021, the emergence of the Omicron variant whose transmissibility was identified but whose vaccine sensitivity was still unknown, reactivated debates. Fears of the need to prioritise patients arose, particularly in France. Especially, a debate began about the role of vaccination status in the prioritisation strategy. Material and methods The Ethics Committee (EC) of the University Hospital of Bordeaux (UHB), France, identified prioritisation criteria in the literature (some recommended, such as being a healthcare worker (HCW) or having consented to research, while others were discouraged, such as age with a threshold effect or vaccination status). A survey was sent within the institution in January 2022 to explore frontline physicians' adherence to these prioritisation criteria. The decision making conditions were also surveyed. Results In 15 days, 78/165 (47.3%) frontline physicians responded, and more widely 1286/12946 (9.9%) professionals. A majority of frontline physicians were opposed to prioritising HCWs (54/75, 72%) and even more opposed to participating in research (69/76, 89.6%). Conversely, the results were very balanced for non-recommended criteria (respectively 39/77, 50.7% and 34/69 49.3% in favour for age with a threshold effect and for vaccination status). Decisions were considered to be multi-professional and multi-disciplinary for 65/76, 85.5% and 53/77, 68.8% of frontline physicians. Responders expressed opposition to extending decision-making to representatives of patients, civil society or HCWs not involved in care. Discussion Prioritisation recommendations in case of scarce medical resources were not necessarily approved by the frontline physicians, or by the other HCWs. This questions the way ethical recommendations should be communicated and discussed at a local scale, but it also questions these recommendations themselves. The article also reports the experience of seeking HCWs opinions on a sensitive ethical debate in a period of crisis.

Abstract Introduction and objective Modern and intelligent triage systems are used today due to the growing trend of disasters and emergencies worldwide and the increase in the number of injured people facing the challenge of using traditional triage methods. The main objective of this study is to investigate the application of artificial intelligence and Technology in the triage of patients injured by disasters and emergencies and the challenges of the implementation of intelligent triage systems. Method The present study is a systematic review and follows PRISMA guidelines. The protocol of this study was registered in PROSPERO with the code CRD42023471415. To find relevant studies, the databases PubMed, Scopus and Web of Science (ISI) were searched without a time limit until September 2024. The scientific search engine Google Scholar and the references of the final articles were read manually for the final review. Results The search identified 2,630 articles, narrowing down to 19 high-quality studies on AI in triage, which improved patient care through optimized resource management and real-time data transmission. AI algorithms like OpenPose and YOLO enhanced efficiency in mass casualty incidents, while e-triage systems allowed for continuous vital sign monitoring and faster triaging. AI tools demonstrated high accuracy in diagnosing COVID-19 (94.57%). Implementing intelligent triage systems faced challenges such as trust issues, training needs, equipment shortages, and data privacy concerns. Conclusion Developing assessment systems using artificial intelligence enables timely treatment and better resuscitation services for people injured in disasters. For future studies, we recommend designing intelligent triage systems to remove the obstacles in triaging children and disabled people in disasters.

Abstract Background Digitalization in the healthcare sector offers several organizational advantages, ranging from enhanced service quality to cost savings. However, its adoption often progresses slowly and faces challenges, especially in critical settings like emergency departments, requiring prompt, clear, and efficient communication. As such, this study aims to comprehensively assess the factors influencing the preference for digitalized tools over traditional methods from the perspectives of both service providers and users. Methods We employ two ad hoc stated preference surveys in which we ask respondents to reveal their preference in simulated triage scenarios. Three main alternatives are proposed: traditional procedures, a fully digitalized solution with no direct patient-professional interaction, and a hybrid option that combines traditional and digital aspects. Scenarios and alternatives vary according to predetermined attributes, selected among the features acknowledged to impact the triage efficiency and efficacy: the possibility to communicate in a known language, the completeness of information retrieved from the patient, the time dedicated to triage activity, and the level of privacy. Responses are analyzed by means of discrete choice models. Results Our findings reveal a preference for the hybrid approach, wherein patients use digital tools to input relevant information, followed by an interview with healthcare professionals. Nevertheless, distinct alternative- and case-specific features can favor the preference toward other kinds of triage. Respondents prefer shorter triage times and the opportunity to interact in a known language, while the level of privacy does not significantly impact their choices. Interestingly, the presence of an algorithm assigning urgency code diminishes the probability that healthcare professionals select the fully digitalized option. Conclusions This study provides important insight into the utilization of digital tools in emergency departments. The results can be used by hospital managers and policy makers to develop digital tools that meet the needs of both users and healthcare professionals. This, in turn, may result in cost savings and improved quality of service.

The low specificity of Ebola virus disease clinical signs increases the risk for nosocomial transmission to patients and healthcare workers during outbreaks. Reducing this risk requires identifying patients with a high likelihood of Ebola virus infection. Analyses of retrospective data from patients suspected of having Ebola virus infection identified 13 strong predictors and time from disease onset as constituents of a prediction score for Ebola virus disease. We also noted 4 highly predictive variables that could distinguish patients at high risk for infection, independent of their scores. External validation of this algorithm on retrospective data revealed the probability of infection continuously increased with the score.

Abstract Background Vital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). In most EDs, triage of patients takes place with vital signs and admission complaints only. Comorbidities are generally underestimated when determining the patient’s status at the triage area. This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED. Methods This prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 h, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 h, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered “medical emergency conditions”. The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression. Results A total of 10,022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. Six hundred four patients presented with an MEC. All vital signs -except diastolic hypertension and tachycardia- and comorbidities were found statistically significant. Hypoxia (Odd’s Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, an MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities. Conclusion Among the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of an MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs.

Abstract Background The ageing of the population is leading to an increase in the number of traumatic injuries and represents a major challenge for the future. Falls represent the leading cause of Emergency department admission in older people, with injuries ranging from minor to severe multiple injuries. Older injured patients are more likely to be undertriaged than younger patients. The aim of this study was to investigate the extent of undertriage in older patients with particular emphasis on access to trauma centres and resuscitation rooms. Methods Retrospective observational cross-sectional study based on data prospectively collected from prehospital electronic records including all patients ≥ 18 years for whom an ambulance or helicopter was dispatched between 1 January 2018 and 31 April 2023 due to a trauma. The primary outcome, admission to the resuscitation room of the regional trauma centre with trauma team activation, was assessed by age. Multivariate logistic regression was used to control for known confounders and to test for plausible effect modifiers. Results Emergency Medical Services treated 37,906 injured patients. Older patients ≥ 75 years represented 17,719 patients (47%). Admission to trauma centre with trauma team activation was lower in older patients, N = 121 (1%) compared to N = 599 (5%) in younger patients, p

We report on the identification of extracellular miRNA (ex-miRNA) biomarkers for early diagnosis and prognosis of preeclampsia (PE). Small RNA sequencing of maternal serum prospectively collected from participants undergoing evaluation for suspected PE revealed distinct patterns of ex-miRNA expression among different categories of hypertensive disorders in pregnancy. Applying an iterative machine learning method identified three bivariate miRNA biomarkers (miR-522-3p/miR-4732-5p, miR-516a-5p/miR-144-3p, and miR-27b-3p/let-7b-5p) that, when applied serially, distinguished between PE cases of different severity and differentiated cases from controls with a sensitivity of 93%, specificity of 79%, positive predictive value (PPV) of 55%, and negative predictive value (NPV) of 89%. In a small independent validation cohort, these ex-miRNA biomarkers had a sensitivity of 91% and specificity of 57%. Combining these ex-miRNA biomarkers with the established sFlt1:PlGF protein biomarker ratio performed better than either set of biomarkers alone (sensitivity of 89.4%, specificity of 91.3%, PPV of 95.5%, and NPV of 80.8%).

Abstract Background Comprehensive understanding of emergency referrals (EmR), encompassing reasons for encounters (RFEs) and diagnoses, is crucial for primary care physicians (PCPs). Comparing EmR rates and subsequent admission rates can potentially enhance the quality of primary care for EmR practice. However, no study has evaluated RFEs among patients with EmRs. This study aimed to identify RFE/diagnosis in relation to subsequent admission among patients receiving EmR. Methods We conducted a retrospective cohort study at an urban family physician teaching clinic in Kawasaki City, Japan. Our cohort recruited consecutive EmR episodes with their medical records and admissions confirmed through response letters from receiving hospitals. Using the 2nd edition of the International Classification of Primary Care, we explored the frequency of RFEs and diagnoses, calculating EmR rates and admission rates as primary outcomes. Bivariate analyses were employed to compare admission and non‐admission cases. Results The present study encompassed 162 EmR episodes out of 47,901 visits, yielding an EmR rate of 3.38/1000 visits. Among 153 completely followed episodes, 99 patients were emergently admitted, resulting in a 64.7% admission rate. The admission group exhibited significantly higher age and a greater prevalence of dementia. Descriptive analysis revealed fever and pneumonia as the most frequent RFE and diagnosis, respectively, with significant differences between admission and non‐admission groups. Conclusions The present study reports EmR and admission rates following EmR, highlighting differences in patient characteristics, RFEs, and diagnoses. The findings offer insights to enhance PCPs' EmR practices and serve as a benchmark for the scope of EmR practice.

Objective Effective triage of febrile patients in the emergency department is crucial during times of overcrowding to prioritize care and allocate resources, especially during pandemics. However, available triage tools often require laboratory data and lack accuracy. We aimed to develop a simple and accurate triage tool for febrile patients by modifying the quick Sequential Organ Failure Assessment (qSOFA) score. Methods We retrospectively analyzed data from 7,303 febrile patients and created modified versions of qSOFA using factors identified through multivariable analysis. The performance of these modified qSOFAs in predicting in-hospital mortality and intensive care unit (ICU) admission was compared using the area under the receiver operating characteristic curve (AUROC). Results Through multivariable analysis, the identified factors were age (“A” factor), male sex (“M” factor), oxygen saturation measured by pulse oximetry (SpO2; “S” factor), and lactate level (“L” factor). The AUROCs of ASqSOFA (in-hospital mortality: 0.812 [95% confidence interval, 0.789–0.835]; ICU admission: 0.794 [95% confidence interval, 0.771–0.817]) were simple and not inferior to those of other more complex models (e.g., ASMqSOFA, ASLqSOFA, and ASMLqSOFA). ASqSOFA also displayed significantly higher AUROC than other triage scales, such as the Modified Early Warning Score and Korean Triage and Acuity Scale. The optimal cutoff score of ASqSOFA for the outcome was 2, and the score for redistribution to a lower level emergency department was 0. Conclusion We demonstrated that ASqSOFA can be employed as a simple and efficient triage tool for emergency febrile patients to aid in resource distribution during overcrowding. It also may be applicable in prehospital settings for febrile patient triage.