Home About us Contact
|
Home About us Contact | ||
|
|
||
Common Presentation (common + presentation)
Selected AbstractsPeriungual Basal Cell Carcinoma: Case Report and Literature ReviewDERMATOLOGIC SURGERY, Issue 2 2006PAUL T. MARTINELLI MD BACKGROUND Basal cell carcinoma, the most common malignancy in humans, rarely occurs on the nail unit and may be frequently misdiagnosed clinically. OBJECTIVES To present a case of basal cell carcinoma of the nail unit successfully treated with the mohs technique and to review the literature regarding this unique presentation of this tumor. MATERIALS AND METHODS: Case report and review of the English literature of nail unit basal cell carcinoma. RESULTS In addition to the currently described patient, 17 other patients with nail unit basal cell carcinaoma have been reported. The tumor occurred approximately 3 times more often on the fingers then on the toes and had a slight predilection to occur in men. Ulceration, noted in more than one-half of patients, was the most common presentation of nail unit basal cell carcinoma. Mohs micrographic surgery. Often with second intention healing, was successfully employed in 39% of patients. CONCLUSIONS Basal cell carcinaom infrequently involves the nail unit and often presents as ulceration. Adequate biopsy of the lesion is essential in making a timely diagnosis. Mohs micrographic surgery with second intension healing is an effective treatment that may offer excellent cosmetic and functional results. [source] Review article: Inotrope and vasopressor use in the emergency departmentEMERGENCY MEDICINE AUSTRALASIA, Issue 5 2009Ainslie Senz Abstract Shock is a common presentation to the ED, with the incidence of septic shock increasing in Australasia over the last decade. The choice of inotropic agent is likely dependent on previous experience and local practices of the emergency and other critical care departments. The relatively short duration of stay in the ED before transfer leaves little room for evaluating the appropriateness of and response to the agent chosen. Delays in transfer to inpatient facilities means that patients receive advanced critical care within the ED for longer, requiring initiation and titration of vasoactive agents in the ED. This article discusses the general concepts of shock and the indicators for inotrope and vasopressor use, revises the various agents available and reviews the current evidence for their use. [source] Chronic pain syndromes in the emergency department: Identifying guidelines for managementEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2005Kylie Baker Abstract Objectives:, To explore current literature on chronic pain syndromes and develop ED recommendations for the management and minimalization of chronic non-cancer pain. Methods:, A focused literature review. Results:, Chronic pain is a common presentation to the ED but is poorly understood and managed. Research into the psychophysiology of chronic pain shows that there are definite changes in the receptive and processing pathways in patients suffering chronic pain syndromes. Evidence shows the effectiveness of early recognition with multimodal treatment, however high level evidence is lacking. All experts recommend balanced drug therapy, cognitive and behavioural interventions. Certain interventions are appropriate to the ED setting. Conclusions:, Emergency Medicine lacks a cohesive, informed strategy for management of chronic pain. The proposed guidelines represent the first step toward establishing consistency in the management of patients with chronic pain syndromes. Further work needs to be undertaken at a national level in developing evidence based guidelines. [source] Pseudomigraine With Lymphocytic Pleocytosis: A Calcium Channelopathy?HEADACHE, Issue 8 2003Clinical Description of 10 Cases, Genetic Analysis of the Familial Hemiplegic Migraine Gene CACNA1A Objective.,To report the clinical findings of 10 patients diagnosed with pseudomigraine with lymphocytic pleocytosis and the results of mutational analysis of the CACNA1A gene in 8 of these patients. Background.,Pseudomigraine with lymphocytic pleocytosis, also referred to as headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL), is characterized by episodic transient neurologic dysfunction associated with moderate to severe headache and cerebrospinal fluid lymphocytic pleocytosis. Episodes are recurrent and the condition is self-limiting. The etiology of this sporadic condition remains unknown, but the episodic nature and its ability to be triggered by angiography is somewhat reminiscent of the phenotypic features of familial hemiplegic migraine, a condition caused by mutations in the CACNA1A gene. Design/Methods.,Utilizing retrospective chart review, we describe the clinical features of pseudomigraine with lymphocytic pleocytosis in 10 patients. Whole blood was taken from 8 patients (2 were lost to follow-up) and used for DNA testing. The CACNA1A gene was screened for mutations using heteroduplex analysis and direct DNA sequencing. Results.,Clinical features of pseudomigraine with lymphocytic pleocytosis included transient episodes of weakness, sensory and visual symptoms, aphasia, and confusion lasting minutes up to 4 hours. Sensory symptoms, typically affecting the face and arm, were the most common presentation. Localization of symptoms did not conform to vascular territories. Headache was typically throbbing and most often bilateral. Genetic analysis did not identify any mutations in the CACNA1A gene. Conclusions.,Similarities between familial hemiplegic migraine and pseudomigraine with lymphocytic pleocytosis include recurrent headache with reversible neurologic deficit, cerebrospinal fluid lymphocytic pleocytosis, and triggers such as angiography. Even so, heteroduplex analysis and DNA sequencing failed to identify any sporadic mutations or shared polymorphisms in the exons or the intron/exon boundaries of the CACNA1A gene. These results do not support a role of the CACNA1A gene in the etiology of pseudomigraine with lymphocytic pleocytosis. [source] How Historians Begin: Openings in Historical DiscourseHISTORY, Issue 320 2010TREVOR DEAN Why is the problem of beginning , much discussed in literary scholarship , not dealt with in similar depth by historians? This article attempts an answer to this question, and does so in three ways. First, it examines literary scholarship on textual openings, showing the various ways in which the beginning is given significance. Then, it examines and challenges the common presentation of historical discourse as distinct from fiction. Finally, it examines two sets of data: the openings of 100 historical monographs are analysed for their ,fictionality', and the openings of 200 research articles are analysed for their rhetorical structures. [source] Clinical Experience with a Novel Intracoronary Perfusion Catheter to Treat No-Reflow Phenomenon in Acute Coronary SyndromesJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2010GABRIEL MALUENDA M.D. Background:,The no-reflow phenomenon is an often seen complication in patients presenting with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This event is associated with poor prognosis and poses a therapeutic challenge. Methods:,This retrospective study cohort was composed of 30 patients who presented with ACS between September 2007 and April 2009, and developed no-reflow during subsequent PCI. The primary end-point was defined as normal Thrombolysis In Myocardial Infarction (TIMI) 3 flow with myocardial blush grade (MBG) ,2 or an increase in TIMI flow by ,2 grades with a MBG ,2 after intracoronary drug infusion via the ClearWay (CW) RX perfusion catheter. Results:,The population presented with a relatively high prevalence of cardiovascular risk factors. ST-elevation myocardial infarction was the most common presentation (60.0%), while 20% of the patients presented with cardiogenic shock. After intracoronary infusion of nicardipine or nitroprusside using the CW catheter, TIMI flow improved from the baseline in 19 cases (63.3%, P < 0.001), and 16 patients (53.3%, P < 0.001) achieved normal coronary flow at the end of the procedure. The rate of in-hospital death was 6.7% (2 cases). No clinical differences were noted between those patients who successfully achieved normal coronary flow and those with persistent no-reflow. Conclusion:,The infusion of intracoronary drugs using the novel perfusion CW RX catheter seems to be safe and could help to improve myocardial perfusion in a selected group of patients presenting with ACS who developed no-reflow during PCI. (J Interven Cardiol 2010;23:109-113) [source] Congestive heart failure caused by intracardiac tumours in two dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 8 2006S. M. Warman Congestive heart failure is a common presentation in small animal practice. Cardiac tumours are an unusual cause of congestive heart failure and, when they occur, usually cause clinical signs associated with pericardial effusion and cardiac tamponade. This case report outlines the clinical and histological findings in two dogs presented with clinical signs of congestive heart failure caused by obstruction of blood flow by intracavitary cardiac tumours. Case 1 showed signs of left-sided heart failure caused by osteosarcoma within the left atrial lumen, and case 2 presented with clinical signs of right-sided heart failure due to haemangiosarcoma occupying the right atrial and ventricular lumens. This case report provides further evidence for the inclusion of intracardiac neoplasia in the differential diagnosis for dogs with clinical signs of congestive heart failure. [source] Paederus dermatitis in Egypt: a clinicopathological and ultrastructural studyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2010M Assaf Abstract Background, Outbreaks of paederus dermatitis (PD) have been observed in different parts of the world, yet the histopathological and ultrastructural changes and their relationship to pederin toxin have not been described. Objective, To describe the clinical presentations of PD in Egypt and to study the effects of pederin toxin on the skin by evaluating the histopathological and ultrastructural changes of some representative cases. Methods, One hundred and thirteen patients with PD were studied clinically and epidemiologically. Skin biopsies were taken from 40 patients for histopathological examination and from 20 patients for electron microscopic (EM) examination. Results, Clinically, the most common presentation comprised erythematous plaques with micropustules. Blisters exhibited a linear configuration in 40% of the patients and kissing lesions were observed in 13%. Multiple lesions occurred in 78% of the patients and the face was the most commonly involved site (48%). The insect was identified as Paederus alfierii. Histopathological examination revealed features of acute irritant dermatitis in the upper epidermis. Mitotic figures and apoptotic changes such as chromatin condensation and DNA fragmentation were identified in the basal and suprabasal layers. These features were confirmed by EM. Conclusions, Clinical, histopathological and, for the first time, ultrastructural characteristics of paederus dermatitis are described. The pathological abnormalities of the upper epidermis are caused by the irritant effect of pederin toxin. The presence of apoptosis within the lower epidermis can be related to this toxin, a point that needs further research, hoping for its future implications in the management of hyperproliferative disorders. [source] Cutaneous mastocytosis: demographic aspects and clinical features of 55 patientsJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 8 2006G Akoglu Abstract Background, Mastocytosis is a rare, heterogeneous group of disorder with abnormal increase of mast cells in one or more organ systems. Objective, To evaluate the demographic and clinical features of cutaneous mastocytosis (CM). Methods, Records of 55 patients with cutaneous mastocytosis were retrospectively analysed. Results, Of the 22 females and 33 males, 80% had urticaria pigmentosa/maculopapular CM and 20% had mastocytoma. Of all cases, 81.8% had first lesions in childhood. The most common presentation was involvement of trunk together with extremities. Thirteen (23.6%) patients had history of bulla; Darier's sign was positive in 34 of 38 patients. Itching was the most common complaint, provocated by hot weather/bath. Conclusion, Clinical presentations of urticaria pigmentosa/maculopapular CM and mastocytoma are similar regarding gender, age of onset, age of diagnosis, and presence of Darier's sign and history of bulla. In contrast to mastocytoma, urticaria pigmentosa/maculopapular CM lesions were frequently located on trunk together with extremities. [source] Familial Currarino syndrome presenting with peripheral primitive neuroectodermal tumour arising with a sacral teratomaPEDIATRIC BLOOD & CANCER, Issue 1 2008G. Sen MD Abstract This report illustrates a rare genetic disorder, Currarino syndrome, in association with an unusual malignant transformation to a peripheral primitive neuroectodermal tumour within a sacral teratoma. The triad of features consists of a presacral mass, partial sacral agenesis and anorectal anomalies. The most common presentation is constipation. In this case there was a history of constipation, teratomas and spinal abnormalities in many of the family members over three generations. Detailed family history taken at time of initial presentation may have prevented delay in diagnosis and averted the need for intensive treatment, which may well cause late sequelae. Pediatr Blood Cancer 2008;50:172,175. © 2006 Wiley-Liss, Inc. [source] Otitis externa: features and recommended managementPRESCRIBER, Issue 4 2006Debbie Shipley MRCP Otitis externa is a common presentation and is usually treated in general practice. Our review describes the clinical features and current recommended management. Copyright © 2006 Wiley Interface Ltd [source] Four faces of a parapneumonic effusion: Pathophysiology and varied radiographic presentationsRESPIROLOGY, Issue 4 2007Jay HEIDECKER Abstract: We report a patient methicillin-resistant Staphylococcus aureus pneumonia who developed fluid collections in three spaces in the thorax, the pleural space, the pericardial space, and a pre-existing bulla, in addition to mediastinal oedema. We discuss the universal pathogenesis for the development of these fluid collections and the explanation for the most common presentation being a parapneumonic effusion. [source] PILONIDAL DISEASE IN SINGAPORE: CLINICAL FEATURES AND MANAGEMENTANZ JOURNAL OF SURGERY, Issue 3 2000H. C. Lee Background: Pilonidal disease has not been well documented in Asian people. The aims of the present study were to investigate any variations in the clinical features and effectiveness of various surgical treatments in such a population. Methods: A prospectively collected computerized database of 61 consecutive patients admitted to a specialist colorectal unit over a 9-year period was studied. The five methods of surgical treatment used during this period (incision and drainage; laying open; marsupialization; primary closure; and the flap procedure) were compared. Results: There were 38 men and 23 women with a mean age of 27 ± 1.02 years. Pilonidal disease was significantly more common among the Indian people (52.5% of patients) than the other ethnic races in the Singaporean community (P < 0.001). Chronic discharging sinuses were the most common presentation (93.4%). There were no differences between the various surgical techniques employed with regard to the time required for wound healing (mean: 48 ± 21 days) and recurrence rates (4/61, 6.6%). Wound dehiscence after primary wound closure (10%) and flap procedures (42%) meant that the overall healing rate was not faster than when the wound was just laid open. Furthermore, flap procedures required a longer hospitalization than other procedures (P = 0.005). Conclusion: Pilonidal disease was more common among Indian people, the more hirsute among the Singaporean population. Primary closure and flap procedure did not improve overall wound healing because of dehiscence. [source] Persistence and malignant sequelae of gestational trophoblastic disease: Clinical presentation, diagnosis, treatment and outcomeAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Soo-Keat KHOO Background:, The major concern in gestational trophoblastic disease is management of persistent disease and malignant sequelae. However, prediction of response to treatment is difficult and methods used controversial. Aim and methods:, To evaluate the usefulness of clinical presentation, methods of diagnosis and categorisation of risk in determining clinical outcomes, by analysis of a database of 705 registered patients collected over 30 years. Results:, From the database, there were 97 patients who developed persistent disease and malignant sequelae on the basis of defined criteria , 80.4% had molar pregnancy and 19.6% non-molar pregnancy. Vaginal bleeding was not a common presentation; 59.8% had no clinical symptoms. According to protocol, monitoring by serial human chorion gonadotrophin (HCG) levels followed by imaging screen was used in all patients; histology was also available in 41.2% from hysterectomy and curettage specimens. There were 16 of 76 patients with persisting disease who had metastases (21.1%), and 2 of 20 patients with choriocarcinoma who had an antecedent molar pregnancy (10.0%). Based on five risk factors, 25 patients were categorised as ,high risk' and assigned to receive multi-drug chemotherapy. There were two deaths (2.1% for all malignant sequelae); both were from molar pregnancies. One patient failed to respond and the other suffered a complication of intensive chemotherapy. Conclusion:, Serial HCG levels remain the best monitor to determine therapeutic response. Categorisation of ,high risk' by five factors is useful in treatment. Albeit a small series, clinical outcome is favourable with a five-year survival of 89.7%. [source] Vasculitic neuropathy , electrodiagnostic findings and association with malignanciesACTA NEUROLOGICA SCANDINAVICA, Issue 6 2007S. A., ivkovi Background,,, Vasculitic neuropathies occur in the context of systemic disorders or in isolation. Histopathologic evaluation remains the gold standard for diagnosis, but certain electrodiagnostic findings may heighten suspicion of vasculitic neuropathy and improve the yield of nerve and muscle biopsy. Aim of the study,,, Description of electrodiagnostic patterns associated with vasculitic neuropathies, and a report of a possible association with malignancies. Methods,,, Retrospective review of medical records of patients with histopathologically proven vasculitic and non-vasculitic axonal neuropathies evaluated at the University of Pittsburgh Medical Center from November 1995 to November 2003. Results,,, The most distinctive electrodiagnostic patterns associated with vasculitic neuropathy were mononeuritis multiplex (27.5% vs 4% in controls; P = 0.003) and axonal sensorimotor polyneuropathy with side-to-side amplitude asymmetry (50% vs 32%, P > 0.05). Additionally, six patients (15% vs 2%; P = 0.034) developed various malignancies within 2 years of onset of vasculitic neuropathy. Conclusions,,, While generalized polyneuropathy was the most common presentation of nerve vasculitis, our study affirms side-to-side amplitude asymmetry and mononeuritis multiplex as the most distinctive electrodiagnostic features. The frequent occurrence of malignancies suggests a possible association with the vasculitic neuropathy and warrants additional investigation. [source] Ocular manifestations of molluscum contagiosumCLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 6 2006Muriel M Schornack OD FAAO Purpose:, Two cases of molluscum contagiosum (MC) are presented to illustrate the range of potential anterior segment complications of this condition. Methods:, Clinical records for two patients diagnosed with MC are retrospectively reviewed. Diagnosis and management of both cases are presented. Results:, The first patient demonstrates a classic presentation of ocular MC. The patient was young and had several dermal lid lesions at the time of presentation. The second case represents a less common presentation. The patient was an adult and had a single lid lesion that was not apparent at the initial examination. Both patients had follicular conjunctivitis that resolved with excision of the concomitant eyelid lesions. Conclusion:, MC is a treatable cause of chronic conjunctivitis or keratoconjunctivitis. Eye-care providers should be mindful that MC could present as a follicular keratoconjunctivitis with or without obvious dermal lid lesions. The possibility of immuno-compromise must be considered in patients with multiple large lesions, cutaneous lesions that do not respond to standard therapy, or recurrent lesions. [source] Mycobacterium tuberculosis at a comprehensive cancer centre: active disease in patients with underlying malignancy during 1990,2000CLINICAL MICROBIOLOGY AND INFECTION, Issue 8 2004G. R. De La Rosa Abstract Thirty HIV-seronegative cancer patients with active tuberculosis were evaluated. Eighteen (60%) were immigrants, 19 (63%) had haematological malignancy, and fever was the most common presentation (97%). Of 19 (63%) patients with pulmonary tuberculosis, 11 (58%) were misdiagnosed initially as suffering from cancer following radiography. Death was attributed to tuberculosis for six (21%) of 29 patients who received anti-mycobacterial therapy. All four patients who had received high-dose systemic corticosteroids within 4 weeks of diagnosis of infection died, whereas two (8%) deaths occurred in 25 individuals without corticosteroid exposure (p < 0.001; OR 8.67). At this institution, active tuberculosis was rare, and was seen mostly in immigrants. Recent high-dose corticosteroid therapy is a significant predictor of mortality in cancer patients with tuberculosis. [source] Hoarse voice in adults: an evidence-based approach to the 12 minute consultationCLINICAL OTOLARYNGOLOGY, Issue 1 2009I. Syed Background:, The hoarse voice is a common presentation in the adult ENT clinic. It is estimated that otolaryngology/voice clinics receive over 50 000 patients with dysphonia each year. Good vocal function is estimated to be required for around 1/3 of the labour force to fulfil their job requirements. The assessment and management of the patient with a hoarse voice is potentially a complex and protracted process as the aetiology is often multi-factorial. This article provides a guide for the clinician in the general ENT clinic to make a concise, thorough assessment of the hoarse patient and engage in an evidence based approach to investigation and management. Method:, Literature search performed on 4 October 2008 using EMBASE, MEDLINE, Cochrane databases using subject headings hoarse voice or dysphonia in combination with diagnosis, management, investigation, treatment, intervention and surgery. Results:, General vocal hygiene is beneficial for non organic dysphonia but the evidence base for individual components is poor. There is a good evidence base for the use of voice therapy as first line treatment of organic dysphonia such as vocal fold nodules and polyps. There is little evidence for surgical intervention as first line therapy for most common benign vocal fold lesions. Surgery is, however, the treatment of choice for hoarseness due to papillomatosis. Both CO2 laser and microdissection are equally acceptable modalities for surgical resection of common benign vocal fold lesions. Laryngopharyngeal reflux is commonly cited as a cause of hoarseness but the evidence base for treatment with gastric acid suppression is poor. Despite the widespread use of proton pump inhibitors for treating laryngopharyngeal reflux, there is high quality evidence to suggest that they are no more effective than placebo. Conclusion:, A concise and thorough approach to assessment in the general ENT clinic will provide the diagnosis and facilitate the management of the hoarse voice in the majority of cases. Voice therapy is an important tool that should be utilised in the general ENT clinic and should not be restricted to the specialist voice clinic. If there is no improvement after initial measures, the larynx appears normal and/or the patient has failed initial speech & language therapy, referral to a specialist voice clinic may be helpful. More research is still required particularly with regard to laryngopharyngeal reflux which is often cited as an important cause of hoarseness but is still poorly understood. [source] Incidence and diagnostic diversity in first-episode psychosisACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2010R. Reay Reay R, Mitford E, McCabe K, Paxton R, Turkington D. Incidence and diagnostic diversity in first-episode psychosis. Objective:, To investigate the incidence and range of diagnostic groups in patients with first-episode psychosis (FEP) in a defined geographical area. Method:, An observational database was set up on all patients aged 16 years and over presenting with FEP living in a county in Northern England between 1998 and 2005. Results:, The incidence of all FEP was 30.95/100 000. The largest diagnostic groups were psychotic depression (19%) and acute and transient psychotic disorder (19%). Fifty-four per cent of patients were aged 36 years and over. Patients with schizophrenia spectrum disorder only accounted for 55% of cases. Conclusion:, This clinical database revealed marked diversity in age and diagnostic groups in FEP with implications for services and guidelines. These common presentations of psychoses are grossly under researched, and no treatment guidelines currently exist for them. [source] Review article: Paediatric supracondylar humeral fractures: Emergency assessment and managementEMERGENCY MEDICINE AUSTRALASIA, Issue 5 2010Stephen R Allen Abstract Supracondylar humeral fractures in children are common presentations to the ED but might be challenging to both diagnose and assess clinically. The ED has a critical role in accurately assessing the child, the limb's neurovascular status and initiating treatment. A specific approach to the clinical assessment of such a child is required as failure to detect neurovascular compromise can delay appropriate treatment and result in serious consequences. Most children can be investigated with X-ray radiograph alone with further treatment directed by severity of the fracture, commonly described using the Gartland classification. Our review article provides an overview of supracondylar humeral fractures and a suggested clinical approach to leave the emergency physician better equipped to assess and manage these fractures. [source] Amphetamine-induced movement disorderEMERGENCY MEDICINE AUSTRALASIA, Issue 3 2005Michael A Downes Abstract Recreational use of amphetamines is common in Australia and New Zealand when compared with other developed nations. The clinical effects are variable because of the potential of these drugs to increase the proportion of different biogenic amines in the central nervous system (CNS). The substances affected are adrenaline, noradrenaline, serotonin and dopamine. Movement disorders represent one of the less common presentations of amphetamine toxicity but one that health care workers should be aware of nonetheless. [source] Community-acquired methicillin-resistant Staphylococcus aureus skin infections: a review of epidemiology, clinical features, management, and preventionINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2007Philip R. Cohen MD Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is a global problem of epidemic proportions. Many of the patients who develop CAMRSA skin lesions do not have infection-associated risk factors. Abscess, abscess with accompanying cellulitis, and cellulitis are the most common presentations of cutaneous CAMRSA infection; occasionally, these CARMSA-related lesions are misinterpreted as spider or insect bites. Other manifestations of cutaneous CAMRSA infection include impetigo, folliculitis, and acute paronychia. The management of CAMRSA skin infection includes incision and drainage, systemic antimicrobial therapy, and adjuvant topical antibacterial treatment. In addition, at the initial visit, bacterial culture of the lesion should be considered. Direct skin-to-skin contact, damage to the skin surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of cutaneous CAMRSA infection. Measures that strive to eliminate these causes are useful for preventing the spread of CAMRSA skin infection. [source] Effects of a Triage Process Conversion on the Triage of High-risk PresentationsACADEMIC EMERGENCY MEDICINE, Issue 10 2008Phillip V. Asaro MD Abstract Objectives:, The objective was to determine effects of a modification in triage process on triage acuity distribution in general and among patients with conditions requiring time-sensitive therapy. Methods:, The authors retrospectively reviewed triage acuity distributions before and after modification of their triage process that entailed conversion from the Canadian Triage and Acuity Scale (CTAS) to the Emergency Severity Index (ESI). The authors calculated the ratio of the odds of being triaged to a nonemergent level (3, 4, or 5) under ESI to the odds of being triaged as nonemergent under CTAS. The authors calculated sensitivity and specificity of triage to an emergent acuity level (1 or 2) for identifying patients with common presentations who required time-sensitive care. Results:, There were shifts from higher to lower acuity levels for all subsets, with odds ratios ranging from 2.80 (95% confidence interval [CI] = 2.75 to 2.86) for all patients to 21.39 (95% CI = 14.66 to 31.21) for patients over 55 years of age with a chief complaint of chest pain. The sensitivity of triage for identifying abdominal pain patients requiring admission to an intensive care unit (ICU) or operating room (OR) or emergency department (ED) death was 80.7% (95% CI = 73.2 to 86.5) before versus 50.8% (95% CI = 43.5 to 58.1) following the transition to ESI. Specificity under CTAS, 55.2% (95% CI = 54.0 to 56.4), was significantly lower than under ESI, 83.6% (95% CI = 82.7 to 84.4). The authors found similar effects for patients presenting with chest pain. Conclusions:, Monitoring for changes in the sensitivity of the triage process for detecting patients with potentially time-sensitive conditions should be considered when modifying triage processes. Further work should be done to determine if the decreased sensitivity seen in this study occurs in other institutions converting to ESI, and potential causative factors should be explored. [source] | |||||||||||||||||||||||||