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Chhabra S, Cameron A, Thavorn K, Sikora L, Yadav K. Quality of health economic evaluations in emergency medicine journals: a systematic review. CAN J EMERG MED 2023; 25:676-688. [PMID: 37389770 DOI: 10.1007/s43678-023-00535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/28/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Health economic evaluations are used in decision-making regarding resource allocation and it is imperative that they are completed with rigor. The primary objectives were to describe the characteristics and assess the quality of economic evaluations published in emergency medicine journals. METHODS Two reviewers independently searched 19 emergency medicine-specific journals via Medline and Embase from inception until March 3, 2022. Quality assessment was completed using the Quality of Health Economic Studies (QHES) tool, and the primary outcome was the QHES score out of 100. Additionally, we identified factors that may contribute to higher-quality publications. RESULTS 7260 unique articles yielded 48 economic evaluations that met inclusion criteria. Most studies were cost-utility analyses and of high quality, with a median QHES score of 84 (interquartile range, IQR: 72, 90). Studies based on mathematical models and those primarily designed as an economic evaluation were associated with higher quality scores. The most commonly missed QHES items were: (i) providing and justifying the perspective of the analysis, (ii) providing justification for the primary outcome, and (iii) selecting an outcome that was long enough to allow for relevant events to occur. CONCLUSIONS The majority of health economic evaluations in the emergency medicine literature are cost-utility analyses and are of high quality. Decision analytic models and studies primarily designed as economic analyses were positively correlated with higher quality. To improve study quality, future EM economic evaluations should justify the choice of the perspective of the analysis and the selection of the primary outcome.
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Affiliation(s)
- Shawn Chhabra
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Austin Cameron
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Neonatal-Perinatal Medicine, IWK Health Centre, Halifax, NS, Canada
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Kazmierczak SC, Morosyuk S, Rajkumar R. Evaluation of Preanalytical Point-of-Care Testing Errors and Their Impact on Productivity in the Emergency Department in the United States. J Appl Lab Med 2022; 7:650-660. [PMID: 35015866 DOI: 10.1093/jalm/jfab158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/22/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Preanalytical errors due to poor sample quality or improper sample handling may occur with point-of-care testing (POCT). METHODS A retrospective analysis was conducted using deidentified records for 15 479 i-STAT® cartridges run at the Oregon Health & Science University Emergency Department (ED) between December 2015 and August 2016. Data were collected from electronic health records and device middleware for CG4+, CHEM8+, and Troponin cartridges. The frequency of POCT errors was evaluated by cartridge type. The effect of user experience on error frequency, impact of error on hospital length of stay (LOS), and test turnaround time (TAT) were all evaluated. Direct costs incurred due to Chem8+ and Troponin cartridge waste and indirect costs as avoidable nursing staff labor were estimated over 2 years. RESULTS A total of 935 erroneous results were identified (6.0% of all cartridges). Three hundred seventy-two (2.4%) were unusable results, and 563 (3.6%) were cartridge errors, of which 163 were classified by device error codes as poor sample quality/improper sample handling. Error rates were inversely correlated with user experience based on number of tests performed during the 9-month period. Compared to nonerroneous results, test TATs and LOS were significantly longer with erroneous results (P < 0.01). Over 2 years, direct costs incurred due to cartridge waste was $45 000, and indirect cost was estimated between 486 and 729 h in avoidable nursing labor. CONCLUSIONS Preanalytical POCT errors were inversely correlated with user experience and significantly impacted clinical productivity in the ED based on LOS and test TAT.
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Slajus B, Brailovsky Y, Darwish I, Fareed J, Darki A. Utility of Blood Cellular Indices in the Risk Stratification of Patients Presenting with Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2021; 27:10760296211052292. [PMID: 34846193 PMCID: PMC8649084 DOI: 10.1177/10760296211052292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary embolism (PE) clinical manifestations vary widely, and that scope is not fully captured by current all-cause mortality risk models. PE is associated with inflammatory, coagulation, and hemostatic imbalances so blood cellular indices may be prognostically useful. Complete blood count (CBC) data may improve current risk models like the simplified pulmonary embolism severity index (sPESI) for all-cause mortality, offering greater accuracy and analytic ability. Acute PE patients (n = 228) with confirmatory diagnostic imaging were followed for all-cause mortality. Blood cellular indices were assessed for association to all-cause mortality and were supplemented into sPESI using multivariate logistic regression. Multiple blood cellular indices were found to be significantly associated with all-cause mortality in acute PE. sPESI including red cell distribution width, hematocrit and neutrophil-lymphocyte ratio had better predictive ability as compared to sPESI alone (AUC: 0.852 vs 0.754). Blood cellular indices contribute an inflammatory and hemodynamic perspective not currently included in sPESI. CBC with differential is a widely used, low-cost test that can augment current risk stratification tools for all-cause mortality in acute PE patients.
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Affiliation(s)
- Brett Slajus
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Yevgeniy Brailovsky
- Advanced Heart Failure, Mechanical Circulatory Support, Heart Transplant, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Iman Darwish
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Amir Darki
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
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Jimenez-Barragan M, Rodriguez-Oliva M, Sanchez-Mora C, Navarro-Bustos C, Fuentes-Cantero S, Martin-Perez S, Garrido-Castilla JM, Undabeytia-Lopez L, Luque-Cid A, de Miguel-Melendez J, Leon-Justel A. Emergency severity level-3 patient flow based on point-of-care testing improves patient outcomes. Clin Chim Acta 2021; 523:144-151. [PMID: 34537218 DOI: 10.1016/j.cca.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Overcrowding of the Emergency Department is rapidly becoming a global challenge and a major source of concern for emergency physicians. The desire to improve Emergency Department throughput requires novel approaches to patient flow. MATERIALS AND METHODS We conducted a prospective and cluster-randomized study, to evaluate the impact in patient outcomes of a new patient flow based on Point-of-Care Testing (POCT). A total of 380 Emergency Severity Level-3 patients were enrolled and studied in two different groups, interventional arm (laboratory analyses performed on POCT analyzers implemented in the Emergency Department) or control arm (central laboratory). The primary outcome was the Emergency Department length of stay. Secondary outcome included the time to first medical intervention, the laboratory turnaround time and the time to disposition decision. Readmission within the 7 days after discharge was also calculated. RESULTS Length of stay significantly decreased by 88.50 min (from 247.00 to 158.50), time to disposition decision by 89.00 min (from 192.00 to 103.00) and laboratory turnaround time by 67.11 min (from 89.84 to 22.73) in the POCT group. No increase in readmission was found. CONCLUSION Our strategy based on POCT represents a good approach to optimize patient flow in the Emergency Department and it should be seen as a starting point for further studies focusing on improving throughput.
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Affiliation(s)
- Marta Jimenez-Barragan
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Manuel Rodriguez-Oliva
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Catalina Sanchez-Mora
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Carmen Navarro-Bustos
- Emergency Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Sandra Fuentes-Cantero
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Salomon Martin-Perez
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | | | - Luisa Undabeytia-Lopez
- Emergency Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Antonio Luque-Cid
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Juan de Miguel-Melendez
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain
| | - Antonio Leon-Justel
- Laboratory Medicine Department Macarena University Hospital, Dr. Fedriani n°3, 41009 Seville, Spain.
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Lingervelder D, Koffijberg H, Kusters R, IJzerman MJ. Health Economic Evidence of Point-of-Care Testing: A Systematic Review. PHARMACOECONOMICS - OPEN 2021; 5:157-173. [PMID: 33405188 PMCID: PMC8160040 DOI: 10.1007/s41669-020-00248-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Point-of-care testing (POCT) has become an essential diagnostic technology for optimal patient care. Its implementation, however, still falls behind. This paper reviews the available evidence on the health economic impact of introducing POCT to assess if poor POCT uptake may be related to lacking evidence. STUDY DESIGN The Scopus and PubMed databases were searched to identify publications describing a health economic evaluation of a point-of-care (POC) test. Data were extracted from the included publications, including general and methodological characteristics as well as the study results summarized in either cost, effects or an incremental cost-effectiveness ratio. Results were sorted into six groups according to the POC test's purpose (diagnosis, screening or monitoring) and care setting (primary care or secondary care). The reporting quality of the publications was determined using the CHEERS checklist. RESULTS The initial search resulted in 396 publications, of which 44 met the inclusion criteria. Most of the evaluations were performed in a primary care setting (n = 31; 70.5%) compared with a secondary care setting (n = 13; 29.5%). About two thirds of the evaluations were on POC tests implemented with a diagnostic purpose (n = 28; 63.6%). More than 75% of evaluations concluded that POCT is recommended for implementation, although in some cases only under specific circumstances and conditions. Compliance with the CHEERS checklist items ranged from 20.8% to 100%, with an average reporting quality of 72.0%. CONCLUSION There were very few evaluations in this review that advised against the implementation of POCT. However, the uptake of POCT in many countries remains low. Even though the evaluations included in this review did not always include the full long-term benefits of POCT, it is clear that health economic evidence across a few dimensions of value already indicate the benefits of POCT. This suggests that the lack of evidence on POCT is not the primary barrier to its implementation and that the low uptake of these tests in clinical practice is due to (a combination of) other barriers. In this context, aspects around organization of care, support of clinicians and quality management may be crucial in the widespread implementation of POCT.
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Affiliation(s)
- Deon Lingervelder
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Ron Kusters
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
- Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands.
- Cancer Health Services Research Unit, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.
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Trehan I, Kivlehan SM, Balhara KS, Hexom BJ, Pousson AY, Quao NSA, Rybarczyk MM, Selvam A, Bonney J, Bhaskar N, Becker TK. Global Emergency Medicine: A Review of the Literature From 2019. Acad Emerg Med 2021; 28:117-128. [PMID: 32772445 DOI: 10.1111/acem.14107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The annual systematic search of the peer-reviewed and gray literature relevant to global emergency medicine (EM) was conducted by the Global Emergency Medicine Literature Review (GEMLR) to screen, evaluate, and review the most rigorously conducted and relevant research in global EM published in 2019. METHODS After a broad search of PubMed and websites of organizations publishing relevant gray literature, all articles that were deemed relevant to the fields of disaster and humanitarian response, emergency care in resource-limited settings, and EM development by at least one reviewer, an editor, and the managing editors were then scored by two different reviewers using a 20-point scoring template relevant to either original research (OR) or review (RE) articles. This scoring system rates articles on their clarity, research design, ethics, importance to global EM, and breadth of impact. Articles that then scored in the top 5% were then critiqued in depth. RESULTS A total of 23,321 article titles and abstracts were screened by 22 reviewers with a wide swath of clinical and research experience in global EM. From these, a total of 356 articles underwent full-text review and scoring on the 20-point scale; 26% were categorized as disaster and humanitarian response, 58% as emergency care in resource-limited settings, and 15% as EM development. Of these 356 articles, 276 (77.5%) were OR articles and 80 (22.5%) were RE articles. The 16 articles that scored in the top 5% (>17.5 of 20 points) received full in-depth narrative summaries. CONCLUSIONS In 2019, the overall number of studies relevant to global EM that were identified by our search decreased from the prior year, but more high-scoring articles related to the development of EM clinical practice and as a specialty in resource-constrained settings were identified.
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Affiliation(s)
- Indi Trehan
- From the Departments of Pediatrics and Global Health University of Washington Seattle WAUSA
| | - Sean M. Kivlehan
- the Department of Emergency Medicine Brigham and Women’s Hospital Boston MAUSA
- the Harvard Humanitarian Initiative Cambridge MAUSA
| | - Kamna S. Balhara
- the Department of Emergency Medicine Johns Hopkins University Baltimore MDUSA
| | - Braden J. Hexom
- the Department of Emergency Medicine Rush University Medical Center Chicago ILUSA
| | - Amelia Y. Pousson
- the Department of Emergency Medicine Johns Hopkins University Baltimore MDUSA
| | | | - Megan M. Rybarczyk
- the Department of Emergency Medicine Brigham and Women’s Hospital Boston MAUSA
| | - Anand Selvam
- the Department of Emergency Medicine Yale University New Haven CTUSA
| | - Joseph Bonney
- the Department of Emergency Medicine Komfo Anokye Teaching Hospital Kumasi Ghana
| | | | - Torben K. Becker
- and the Department of Emergency Medicine University of Florida Gainesville FLUSA
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Hausfater P, Hajage D, Bulsei J, Canavaggio P, Lafourcade A, Paquet AL, Arock M, Durand‐Zaleski I, Riou B, Oueidat N. Impact of Point-of-care Testing on Length of Stay of Patients in the Emergency Department: A Cluster-randomized Controlled Study. Acad Emerg Med 2020; 27:974-983. [PMID: 32621374 DOI: 10.1111/acem.14072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Crowding is a frequent concern in the emergency department (ED). Laboratory point-of-care testing (POCT) has been proposed to decrease patients' length of stay (LOS). Our objective was to determine whether an extended panel of POCT solutions could reduce LOS. METHODS This was a single-center, prospective, open-label, controlled cluster-randomized study. Blood test processing was randomized into 1-week inclusion periods: interventional arm (laboratory analyses performed on POCT analyzers implemented in the ED) or control arm (central laboratory). The primary endpoint was LOS of patients in the ED. Secondary endpoints were time to result (TTR), ED crowding surrogates, and average total cost of an ED visit in each arm. RESULTS A total of 23,231 patients were included and 20,923 were analyzed for the main outcome measure. Mean ± SD age was 46 ± 20 years, and 7,905 (36%) underwent blood sampling. Mean ± SD LOSs were 203 ± 161 and 210 ± 168 minutes in the POCT and control arms, respectively. LOS reduction for the entire ED population was -9 minutes (95% confidence interval [CI] = -22 to 5, p = 0.22) compared to the control arm and -17 minutes (95% CI = -34.0 to 0.6, p = 0.06) for patients undergoing blood sampling. The mean ± SD TTRs were 28 ± 31 and 79 ± 34 minutes in the POCT and control arms, respectively (TTR reduction = -51 minutes, 95% CI = -54 to -48 minutes, p < 0.001). CONCLUSIONS The implementation of an extended panel of POCT solutions in an ED did not significantly reduce the LOS, but reduced the TTR.
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Affiliation(s)
- Pierre Hausfater
- From the Emergency DepartmentHôpital Pitié‐SalpêtrièreAPHP ParisFrance
- the UMR INSERM 1166 IHU ICAN Sorbonne Université, GRC‐14 BIOSFAST ParisFrance
| | - David Hajage
- the Département Biostatistique Santé Publique et Information Médicale Centre de Pharmacoépidémiologie (Cephepi) Sorbonne UniversitéAPHP ParisFrance
| | - Julie Bulsei
- the AP‐HP URC Eco Ile de France Hôpital de l'Hôtel Dieu ParisFrance
- the CRESS INSERM INRA Université de Paris ParisFrance
| | | | | | - Anne Laure Paquet
- From the Emergency DepartmentHôpital Pitié‐SalpêtrièreAPHP ParisFrance
| | - Michel Arock
- the Sorbonne Université ParisFrance
- and the Biochemisty and Emergency Biology Department Hôpital Pitié‐SalpêtrièreAPHP Paris France
| | - Isabelle Durand‐Zaleski
- the AP‐HP URC Eco Ile de France Hôpital de l'Hôtel Dieu ParisFrance
- the CRESS INSERM INRA Université de Paris ParisFrance
| | - Bruno Riou
- From the Emergency DepartmentHôpital Pitié‐SalpêtrièreAPHP ParisFrance
- the UMR INSERM 1166 IHU ICAN Sorbonne Université, GRC‐14 BIOSFAST ParisFrance
| | - Nathalie Oueidat
- and the Biochemisty and Emergency Biology Department Hôpital Pitié‐SalpêtrièreAPHP Paris France
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Werner K, Risko N, Burkholder T, Munge K, Wallis L, Reynolds T. Cost-effectiveness of emergency care interventions in low and middle-income countries: a systematic review. Bull World Health Organ 2020; 98:341-352. [PMID: 32514199 PMCID: PMC7265944 DOI: 10.2471/blt.19.241158] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To systematically review and appraise the quality of cost-effectiveness analyses of emergency care interventions in low- and middle-income countries. METHODS Following the PRISMA guidelines, we systematically searched PubMed®, Scopus, EMBASE®, Cochrane Library and Web of Science for studies published before May 2019. Inclusion criteria were: (i) an original cost-effectiveness analysis of emergency care intervention or intervention package, and (ii) the analysis occurred in a low- and middle-income setting. To identify additional primary studies, we hand searched the reference lists of included studies. We used the Consolidated Health Economic Evaluation Reporting Standards guideline to appraise the quality of included studies. RESULTS Of the 1674 articles we identified, 35 articles met the inclusion criteria. We identified an additional four studies from the reference lists. We excluded many studies for being deemed costing assessments without an effectiveness analysis. Most included studies were single-intervention analyses. Emergency care interventions evaluated by included studies covered prehospital services, provider training, treatment interventions, emergency diagnostic tools and facilities and packages of care. The reporting quality of the studies varied. CONCLUSION We found large gaps in the evidence surrounding the cost-effectiveness of emergency care interventions in low- and middle-income settings. Given the breadth of interventions currently in practice, many interventions remain unassessed, suggesting the need for future research to aid resource allocation decisions. In particular, packages of multiple interventions and system-level changes represent a priority area for future research.
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Affiliation(s)
- Kalin Werner
- Department of Surgery, Division of Emergency Medicine, F51-62, Old Main Building, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Nicholas Risko
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, United States of America (USA)
| | - Taylor Burkholder
- Department of Emergency Medicine, University of Southern California, Los Angeles, USA
| | - Kenneth Munge
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Lee Wallis
- Department of Surgery, Division of Emergency Medicine, F51-62, Old Main Building, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Teri Reynolds
- Department for Clinical Services and Systems, Integrated Health Services, World Health Organization, Geneva, Switzerland
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