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Espejo T, Riedel HB, Messingschlager S, Sonnleitner W, Kellett J, Brabrand M, Cooksley T, Bingisser R, Nickel CH. Predictive value and interrater reliability of mental status and mobility assessment in the emergency department. Clin Med (Lond) 2024; 24:100027. [PMID: 38369128 DOI: 10.1016/j.clinme.2024.100027] [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] [Indexed: 02/20/2024]
Abstract
AIM To investigate the predictive value of both mental status, assessed with the AVPUC (Alert, responds to Voice, responds to Pain, Unresponsive, and new Confusion) scale, and mobility assessments, and their interrater reliability (IRR) between triage clinicians and a research team. METHOD Prospective study of consecutive patients who presented to an ED. Mental status and mobility were assessed by triage clinicians and by a dedicated research team. RESULTS 4,191 patients were included. After adjustment for age and sex, patients with altered mental status have an odds ratio of 6.55 [4.09-10.24] to be admitted in the ICU and an odds ratio of 21.16 [12.06-37.01] to die within 30 days; patients with impaired mobility have an odds ratio of 7.08 [4.60-11.12] to be admitted in the ICU and an odds ratio of 12.87 [5.93-32.30] to die within 30 days. The kappa coefficient between triage clinicians and the research team for mental status assessment was 0.75, and 0.80 for mobility. CONCLUSION Assessment of mental status by the AVPUC scale, and mobility by a simple dichotomous scale are suitable for ED triage. Both altered mental status and impaired mobility are associated with adverse outcomes. Mental status and mobility assessment have good interrater reliability.
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Affiliation(s)
- Tanguy Espejo
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Henk B Riedel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Wolfram Sonnleitner
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - John Kellett
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Tim Cooksley
- Department of Acute Medicine, University Hospital of South Manchester, Manchester, UK
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian H Nickel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland.
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2
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Asmussen SW, Holme JM, Joensen K, Ibsen S, Bøggild H, Christensen EF, Lindskou TA. Development and inter-rater reliability of a simple prehospital mobility score for use in emergency patients. BMC Emerg Med 2024; 24:27. [PMID: 38360536 PMCID: PMC10868046 DOI: 10.1186/s12873-024-00944-9] [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: 05/29/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Mobility assessment enhances the ability of vital sign-based early warning scores to predict risk. Currently mobility is not routinely assessed in a standardized manner in Denmark during the ambulance transfer of unselected emergency patients. The aim of this study was to develop and test the inter-rater reliability of a simple prehospital mobility score for pre-hospital use in ambulances and to test its inter-rater reliability. METHOD Following a pilot study, we developed a 4-level prehospital mobility score based of the question"How much help did the patient need to be mobilized to the ambulance trolley". Possible scores were no-, a little-, moderate-, and a lot of help. A cross-sectional study of inter-rater agreement among ambulance personnel was then carried out. Paramedics on ambulance runs in the North- and Central Denmark Region, as well as The Fareoe Islands, were included as a convenience sample between July 2020-May 2021. The simple prehospital mobility score was tested, both by the paramedics in the ambulance and by an additional observer. The study outcomes were inter-rater agreements by weighted kappa between the paramedics and between observers and paramedics. RESULTS We included 251 mobility assessments where the patient mobility was scored. Paramedics agreed on the mobility score for 202 patients (80,5%). For 47 (18.7%), there was a deviation of one between scores, in two (< 1%) there was a deviation of two and none had a deviation of three (Table 1). Inter-rater agreement between paramedics in all three regions showed a kappa-coefficient of 0.84 (CI 95%: 0.79;0.88). Between observers and paramedics in North Denmark Region and Faroe Islands the kappa-coefficient was 0.82 (CI 95%: 0.77;0.86). CONCLUSION We developed a simple prehospital mobility score, which was feasible in a prehospital setting and with a high inter-rater agreement between paramedics and observers.
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Affiliation(s)
- Søren Westh Asmussen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg University, Selma Lagerløfs Vej 249, Room 11.03.049, Gistrup, 9260, Denmark.
| | - Jacob Metze Holme
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Kurt Joensen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Stine Ibsen
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - Henrik Bøggild
- Department of Health Science and Technology, Public Health and Epidemiology, Faculty of Medicine, Aalborg and Unit of Clinical Biostatistics, Aalborg University, Aalborg University, Aalborg University Hospital, Aalborg, Denmark
| | - Erika Frischknecht Christensen
- Department of Clinical Medicine, Centre for Prehospital and Emergency Research, , Aalborg University Hospital, Aalborg University, Aalborg, Denmark
- Prehospital Emergency Services, North Denmark Region, Aalborg, Denmark
| | - Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg, Denmark
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3
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Keogh A, Mc Ardle R, Diaconu MG, Ammour N, Arnera V, Balzani F, Brittain G, Buckley E, Buttery S, Cantu A, Corriol-Rohou S, Delgado-Ortiz L, Duysens J, Forman-Hardy T, Gur-Arieh T, Hamerlijnck D, Linnell J, Leocani L, McQuillan T, Neatrour I, Polhemus A, Remmele W, Saraiva I, Scott K, Sutton N, van den Brande K, Vereijken B, Wohlrab M, Rochester L. Mobilizing Patient and Public Involvement in the Development of Real-World Digital Technology Solutions: Tutorial. J Med Internet Res 2023; 25:e44206. [PMID: 37889531 PMCID: PMC10638632 DOI: 10.2196/44206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/09/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023] Open
Abstract
Although the value of patient and public involvement and engagement (PPIE) activities in the development of new interventions and tools is well known, little guidance exists on how to perform these activities in a meaningful way. This is particularly true within large research consortia that target multiple objectives, include multiple patient groups, and work across many countries. Without clear guidance, there is a risk that PPIE may not capture patient opinions and needs correctly, thereby reducing the usefulness and effectiveness of new tools. Mobilise-D is an example of a large research consortium that aims to develop new digital outcome measures for real-world walking in 4 patient cohorts. Mobility is an important indicator of physical health. As such, there is potential clinical value in being able to accurately measure a person's mobility in their daily life environment to help researchers and clinicians better track changes and patterns in a person's daily life and activities. To achieve this, there is a need to create new ways of measuring walking. Recent advancements in digital technology help researchers meet this need. However, before any new measure can be used, researchers, health care professionals, and regulators need to know that the digital method is accurate and both accepted by and produces meaningful outcomes for patients and clinicians. Therefore, this paper outlines how PPIE structures were developed in the Mobilise-D consortium, providing details about the steps taken to implement PPIE, the experiences PPIE contributors had within this process, the lessons learned from the experiences, and recommendations for others who may want to do similar work in the future. The work outlined in this paper provided the Mobilise-D consortium with a foundation from which future PPIE tasks can be created and managed with clearly defined collaboration between researchers and patient representatives across Europe. This paper provides guidance on the work required to set up PPIE structures within a large consortium to promote and support the creation of meaningful and efficient PPIE related to the development of digital mobility outcomes.
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Affiliation(s)
- Alison Keogh
- Insight Centre Data Analytics, University College Dublin, Dublin4, Ireland
- School of Medicine, Trinity College Dublin, Dublin2, Ireland
| | - Ríona Mc Ardle
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Mara Gabriela Diaconu
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nadir Ammour
- Clinical Science and Operations, Global Development, Sanofi Research & Development, Chilly-Mazarin, France
| | - Valdo Arnera
- Clario, Clario Holdings Inc, Geneva, Switzerland
| | - Federica Balzani
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Gavin Brittain
- Department of Clinical Neurology, Sheffield Teaching Hospitals National Health Service, Foundation Trust, Sheffield, United Kingdom
- Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, United Kingdom
| | - Ellen Buckley
- Department of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Sara Buttery
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Alma Cantu
- School of Computer Science, Newcastle University, Newcastle, United Kingdom
| | | | - Laura Delgado-Ortiz
- Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomedical en Red Epidemiologia y Salud Publica, Barcelona, Spain
| | - Jacques Duysens
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Tom Forman-Hardy
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Tova Gur-Arieh
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | | | - John Linnell
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Letizia Leocani
- Department of Neurology, San Raffele University, Milan, Italy
| | - Tom McQuillan
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Isabel Neatrour
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Ashley Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Werner Remmele
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Isabel Saraiva
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | - Kirsty Scott
- Department of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Norman Sutton
- Mobilise-D Patient and Public Advisory Group, Newcastle, United Kingdom
| | | | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Martin Wohlrab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tuebingen, Tuebingen, Germany
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
- Newcastle Upon Tyne Hospitals National Health Service Foundation Trust, Newcastle, United Kingdom
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4
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Lo RSL, Lyngholm LE, Brabrand M, Leung LY, Hung KKC, Laugesen S, Posth S, Cooksley T, Graham CA, Nickel CH. A tale of two continents: The performance of six early warning scores in two emergency departments. HONG KONG J EMERG ME 2023. [DOI: 10.1177/10249079231153719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Background: Several early warning scores have been designed to optimize acute care by identifying patients at risk of deterioration. Methods: In this post hoc dual center study, we analyzed the performance of six clinical scores (the Goodacre score, Groarke, Worthing Physiological Score, Rapid Acute Physiology Score, Rapid Emergency Medicine Score, United Kingdom National Early Warning Score. The primary outcome is 30-day all-cause mortality after inclusion and data were obtained from previous studies performed at two different emergency departments on two continents (Denmark, Europe, and Hong Kong, Asia). Results: We included 2952 people; 1482 (50.2%) were male, mean age (standard deviation) was 65.7 (18.3) years, and 109 (3.7%) died within 30 days. Mortality rate increased steadily with increasing scores for all six scoring systems in Hong Kong while this was less obvious in Denmark. In all patients, Rapid Acute Physiology Score had the lowest discriminatory power while National Early Warning Score had the highest. National Early Warning Score performed best in Hong Kong while Worthing performed marginally better in Denmark. Discussion: Surprisingly, the performance of the scoring systems varied considerably, but were largely unaffected by location, and none of them performed close to what clinicians would normally require for predicting 30-day all-cause mortality Conclusion: All scores performed similarly across both centers, with poor prediction of 30-day all-cause mortality. Based on these findings, we believe that clinical scores must be supplemented by either biochemical values or global markers of physiological reserve to reflect reality and to be of true value.
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Affiliation(s)
- Ronson Sze Long Lo
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Le Elias Lyngholm
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Sune Laugesen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Stefan Posth
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Tim Cooksley
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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5
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Keogh A, Alcock L, Brown P, Buckley E, Brozgol M, Gazit E, Hansen C, Scott K, Schwickert L, Becker C, Hausdorff JM, Maetzler W, Rochester L, Sharrack B, Vogiatzis I, Yarnall A, Mazzà C, Caulfield B. Acceptability of wearable devices for measuring mobility remotely: Observations from the Mobilise-D technical validation study. Digit Health 2023; 9:20552076221150745. [PMID: 36756644 PMCID: PMC9900162 DOI: 10.1177/20552076221150745] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 12/26/2022] [Indexed: 02/05/2023] Open
Abstract
Background This study aimed to explore the acceptability of a wearable device for remotely measuring mobility in the Mobilise-D technical validation study (TVS), and to explore the acceptability of using digital tools to monitor health. Methods Participants (N = 106) in the TVS wore a waist-worn device (McRoberts Dynaport MM + ) for one week. Following this, acceptability of the device was measured using two questionnaires: The Comfort Rating Scale (CRS) and a previously validated questionnaire. A subset of participants (n = 36) also completed semi-structured interviews to further determine device acceptability and to explore their opinions of the use of digital tools to monitor their health. Questionnaire results were analysed descriptively and interviews using a content analysis. Results The device was considered both comfortable (median CRS (IQR; min-max) = 0.0 (0.0; 0-20) on a scale from 0-20 where lower scores signify better comfort) and acceptable (5.0 (0.5; 3.0-5.0) on a scale from 1-5 where higher scores signify better acceptability). Interviews showed it was easy to use, did not interfere with daily activities, and was comfortable. The following themes emerged from participants' as being important to digital technology: altered expectations for themselves, the use of technology, trust, and communication with healthcare professionals. Conclusions Digital tools may bridge existing communication gaps between patients and clinicians and participants are open to this. This work indicates that waist-worn devices are supported, but further work with patient advisors should be undertaken to understand some of the key issues highlighted. This will form part of the ongoing work of the Mobilise-D consortium.
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Affiliation(s)
- Alison Keogh
- Insight Centre for Data Analytics, O’Brien Science Centre,
University
College Dublin, Dublin, Ireland,School of Public Health, Physiotherapy and Sports Science,
University
College Dublin, Dublin, Ireland,Alison Keogh, Insight Centre for Data
Analytics, 3rd Floor Science Centre East, University College Dublin, Ireland
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical
Sciences, Newcastle
University, Newcastle upon Tyne, UK
| | - Philip Brown
- Physiotherapy
Department, The Newcastle Upon Tyne Hospitals NHS Foundation
Trust, Newcastle Upon Tyne, UK
| | - Ellen Buckley
- INSIGNEO Institute for in silico Medicine,
The University
of Sheffield, Sheffield, UK,Department of Mechanical Engineering,
The University
of Sheffield, Sheffield, UK
| | - Marina Brozgol
- Center for the Study of Movement, Cognition and Mobility,
Neurological Institute, Tel Aviv Sourasky Medical
Center, Tel Aviv, Israel
| | - Eran Gazit
- Center for the Study of Movement, Cognition and Mobility,
Neurological Institute, Tel Aviv Sourasky Medical
Center, Tel Aviv, Israel
| | - Clint Hansen
- Department of Neurology, University Medical Center Schleswig-Holstein
Campus Kiel, Kiel, Germany
| | - Kirsty Scott
- INSIGNEO Institute for in silico Medicine,
The University
of Sheffield, Sheffield, UK,Department of Mechanical Engineering,
The University
of Sheffield, Sheffield, UK
| | - Lars Schwickert
- Gesellschaft für Medizinische Forschung,
Robert-Bosch
Foundation GmbH, Stuttgart, Germany
| | - Clemens Becker
- Gesellschaft für Medizinische Forschung,
Robert-Bosch
Foundation GmbH, Stuttgart, Germany
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility,
Neurological Institute, Tel Aviv Sourasky Medical
Center, Tel Aviv, Israel,Department of Physical Therapy, Sackler Faculty of Medicine &
Sagol School of Neuroscience, Tel Aviv
University, Tel Aviv, Israel
| | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein
Campus Kiel, Kiel, Germany
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical
Sciences, Newcastle
University, Newcastle upon Tyne, UK,Physiotherapy
Department, The Newcastle Upon Tyne Hospitals NHS Foundation
Trust, Newcastle Upon Tyne, UK
| | - Basil Sharrack
- Department of Neuroscience and Sheffield NIHR Translational
Neuroscience BRC, Sheffield
Teaching Hospitals NHS Foundation Trust,
Sheffield, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation,
Northumbria
University Newcastle, Newcastle upon Tyne,
UK
| | - Alison Yarnall
- Translational and Clinical Research Institute, Faculty of Medical
Sciences, Newcastle
University, Newcastle upon Tyne, UK
| | - Claudia Mazzà
- INSIGNEO Institute for in silico Medicine,
The University
of Sheffield, Sheffield, UK,Department of Mechanical Engineering,
The University
of Sheffield, Sheffield, UK
| | - Brian Caulfield
- Insight Centre for Data Analytics, O’Brien Science Centre,
University
College Dublin, Dublin, Ireland,School of Public Health, Physiotherapy and Sports Science,
University
College Dublin, Dublin, Ireland
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6
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Delgado-Ortiz L, Polhemus A, Keogh A, Sutton N, Remmele W, Hansen C, Kluge F, Sharrack B, Becker C, Troosters T, Maetzler W, Rochester L, Frei A, Puhan MA, Garcia-Aymerich J. Listening to the patients' voice: a conceptual framework of the walking experience. Age Ageing 2023; 52:7008636. [PMID: 36729471 PMCID: PMC9894103 DOI: 10.1093/ageing/afac233] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND walking is crucial for an active and healthy ageing, but the perspectives of individuals living with walking impairment are still poorly understood. OBJECTIVES to identify and synthesise evidence describing walking as experienced by adults living with mobility-impairing health conditions and to propose an empirical conceptual framework of walking experience. METHODS we performed a systematic review and meta-ethnography of qualitative evidence, searching seven electronic databases for records that explored personal experiences of walking in individuals living with conditions of diverse aetiology. Conditions included Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture, heart failure, frailty and sarcopenia. Data were extracted, critically appraised using the NICE quality checklist and synthesised using standardised best practices. RESULTS from 2,552 unique records, 117 were eligible. Walking experience was similar across conditions and described by seven themes: (i) becoming aware of the personal walking experience, (ii) the walking experience as a link between individuals' activities and sense of self, (iii) the physical walking experience, (iv) the mental and emotional walking experience, (v) the social walking experience, (vi) the context of the walking experience and (vii) behavioural and attitudinal adaptations resulting from the walking experience. We propose a novel conceptual framework that visually represents the walking experience, informed by the interplay between these themes. CONCLUSION a multi-faceted and dynamic experience of walking was common across health conditions. Our conceptual framework of the walking experience provides a novel theoretical structure for patient-centred clinical practice, research and public health.
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Affiliation(s)
| | | | - Alison Keogh
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | | | | | - Clint Hansen
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Felix Kluge
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Basil Sharrack
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, UK
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Judith Garcia-Aymerich
- Address correspondence to: J. Garcia-Aymerich, ISGlobal, Dr. Aiguader 88, PRBB. Barcelona, Spain. Tel: (+34) 93 214 73 80;
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7
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Smith S, Seoane J, Emerson L, Rainey A, Smith HG. Relationship Between Preexisting Functional Mobility Impairments and Burn Treatment Outcomes. J Burn Care Res 2023; 44:70-74. [PMID: 35660915 DOI: 10.1093/jbcr/irac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Indexed: 01/11/2023]
Abstract
Burn severity is determined by total body surface area affected, temperature of source, and duration of exposure. Patients with impaired mobility are less capable of avoiding hazards and escaping traumatic injuries. Additionally, patients with impaired mobility frequently suffer from other comorbid conditions and have specialized needs, which can complicate their acute treatment. This study was a retrospective electronic medical records review of all adult patients, aged 18 years and older with a preexisting mobility impairment, admitted as inpatients to a single burn center for treatment of burn-related injuries from January 1, 2009, to December 31, 2019. The 10-year review of 1520 adult burn admissions meeting the initial criteria of inpatient admission and burn injury revealed 174 patients with documentation supporting preexisting functional mobility impairment (11%). Surprisingly, patients' overall lengths of stays were consistent with all burn populations at 0.81 days per % TBSA, with the average length of stay being 6.7 days. The demographic data were consistent with national burn registry data as male, Caucasian, and older, with mean age of 61.1 years. Demographic data and details of hospital course focusing on treatment, complications, and outcomes were extracted and analyzed. There is a paucity of literature describing the needs of this unique burn population. Burn-injured patients with preexisting mobility impairments suffer from similar mechanisms of injury. By identifying attributes unique to this population, we hope to develop specialized prevention education and treatment protocols.
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Affiliation(s)
- Susan Smith
- Warden Burn Center, Orlando Health, Orlando, FL, USA
| | | | - Lisa Emerson
- Department of Microbiology and Cell Science, University of Florida, Gainesville, FL, USA
| | - Andrew Rainey
- Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA
| | - Howard G Smith
- Director of Burn Surgery, Warden Burn Center, Orlando Health, Orlando, FL, USA
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8
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Nieves-Ortega R, Brabrand M, Dutilh G, Kellett J, Bingisser R, Nickel CH. Assessment of patient mobility improves the risk stratification of triage with the Emergency Severity Index: a prospective cohort study. Eur J Emerg Med 2021; 28:456-462. [PMID: 34149009 DOI: 10.1097/mej.0000000000000845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND IMPORTANCE Formal triage may assign a low acuity to patients at high risk of deterioration and mortality. A patient's mobility can be easily assessed at triage. OBJECTIVE To investigate if a simple assessment of mobility at triage can improve the Emergency Severity Index's (ESI) prediction of adverse outcomes. DESIGN, SETTING AND PARTICIPANTS Prospective observational study of all patients attending the emergency department (ED) of a single academic hospital in Switzerland over a period of 3 weeks. OUTCOME MEASURES AND ANALYSIS Triage clinicians classified participants as having normal or impaired mobility at triage. Impaired mobility was defined as the lack of a stable independent gait, regardless of its cause or duration (e.g. any patient who needed help to walk). The primary outcome was 30-day mortality. We performed a survival analysis stratified by mobility and ESI level. We compared the performance of regression models including the ESI alone or in combination with mobility as predictors of mortality using the Bayesian information criterion (BIC). MAIN RESULTS 2523 patients were included in the study and 880 (34.9%) had impaired mobility. Patients with impaired mobility had a lower median 30-day survival in ESI levels 1-3. Survival of patients with normal mobility was similar regardless of their ESI level. CONCLUSION The assessment of mobility at triage improves the ESI algorithm's risk stratification.
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Affiliation(s)
| | - Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Gilles Dutilh
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - John Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
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9
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The Impact of Age on Predictive Performance of National Early Warning Score at Arrival to Emergency Departments: Development and External Validation. Ann Emerg Med 2021; 79:354-363. [PMID: 34742589 DOI: 10.1016/j.annemergmed.2021.09.434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE To investigate how age affects the predictive performance of the National Early Warning Score (NEWS) at arrival to the emergency department (ED) regarding inhospital mortality and intensive care admission. METHODS International multicenter retrospective cohorts from 2 Danish and 3 Dutch ED. Development cohort: 14,809 Danish patients aged ≥18 years with at least systolic blood pressure or pulse measured from the Danish Multicenter Cohort. External validation cohort: 50,448 Dutch patients aged ≥18 years with all vital signs measured from the Netherlands Emergency Department Evaluation Database (NEED). Multivariable logistic regression was used for model building. Performance was evaluated overall and within age categories: 18 to 64 years, 65 to 80 years, and more than 80 years. RESULTS In the Danish Multicenter Cohort, a total of 2.5% died inhospital, and 2.8% were admitted to the ICU, compared with 2.8% and 1.6%, respectively, in the NEED. Age did not add information for the prediction of intensive care admission but was the strongest predictor for inhospital mortality. For NEWS alone, severe underestimation of risk was observed for persons above 80 while overall Area Under Receiver Operating Characteristic (AUROC) was 0.82 (confidence interval [CI] 0.80 to 0.84) in the Danish Multicenter Cohort versus 0.75 (CI 0.75 to 0.77) in the NEED. When combining NEWS with age, underestimation of risks was eliminated for persons above 80, and overall AUROC increased significantly to 0.86 (CI 0.85 to 0.88) in the Danish Multicenter Cohort versus 0.82 (CI 0.81 to 0.83) in the NEED. CONCLUSION Combining NEWS with age improved the prediction performance regarding inhospital mortality, mostly for persons aged above 80, and can potentially improve decision policies at arrival to EDs.
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Keogh A, Argent R, Anderson A, Caulfield B, Johnston W. Assessing the usability of wearable devices to measure gait and physical activity in chronic conditions: a systematic review. J Neuroeng Rehabil 2021; 18:138. [PMID: 34526053 PMCID: PMC8444467 DOI: 10.1186/s12984-021-00931-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The World Health Organisation's global strategy for digital health emphasises the importance of patient involvement. Understanding the usability and acceptability of wearable devices is a core component of this. However, usability assessments to date have focused predominantly on healthy adults. There is a need to understand the patient perspective of wearable devices in participants with chronic health conditions. METHODS A systematic review was conducted to identify any study design that included a usability assessment of wearable devices to measure mobility, through gait and physical activity, within five cohorts with chronic conditions (Parkinson's disease [PD], multiple sclerosis [MS], congestive heart failure, [CHF], chronic obstructive pulmonary disorder [COPD], and proximal femoral fracture [PFF]). RESULTS Thirty-seven studies were identified. Substantial heterogeneity in the quality of reporting, the methods used to assess usability, the devices used, and the aims of the studies precluded any meaningful comparisons. Questionnaires were used in the majority of studies (70.3%; n = 26) with a reliance on intervention specific measures (n = 16; 61.5%). For those who used interviews (n = 17; 45.9%), no topic guides were provided, while methods of analysis were not reported in over a third of studies (n = 6; 35.3%). CONCLUSION Usability of wearable devices is a poorly measured and reported variable in chronic health conditions. Although the heterogeneity in how these devices are implemented implies acceptance, the patient voice should not be assumed. In the absence of being able to make specific usability conclusions, the results of this review instead recommends that future research needs to: (1) Conduct usability assessments as standard, irrespective of the cohort under investigation or the type of study undertaken. (2) Adhere to basic reporting standards (e.g. COREQ) including the basic details of the study. Full copies of any questionnaires and interview guides should be supplied through supplemental files. (3) Utilise mixed methods research to gather a more comprehensive understanding of usability than either qualitative or quantitative research alone will provide. (4) Use previously validated questionnaires alongside any intervention specific measures.
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Affiliation(s)
- Alison Keogh
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.
| | - Rob Argent
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | | | - Brian Caulfield
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - William Johnston
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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Mansella G, Rueegg M, Widmer AF, Tschudin-Sutter S, Battegay M, Hoff J, Søgaard KK, Egli A, Stieltjes B, Leuzinger K, Hirsch HH, Meienberg A, Burkard T, Mayr M, Bingisser R, Nickel CH. COVID-19 Triage and Test Center: Safety, Feasibility, and Outcomes of Low-Threshold Testing. J Clin Med 2020; 9:E3217. [PMID: 33036445 PMCID: PMC7601442 DOI: 10.3390/jcm9103217] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/26/2020] [Accepted: 10/03/2020] [Indexed: 01/06/2023] Open
Abstract
This prospective observational study evaluated the safety and feasibility of a low threshold testing process in a Triage and Test Center (TTC) during the early course of the coronavirus disease 19 (COVID-19) pandemic. In addition, we aimed to identify clinical predictors for a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab result. Patients underwent informal triage, standardized history taking, and physician evaluation, only where indicated. Patients were observed for 30 days. Safety was the primary outcome and was defined as a COVID-19-related 30 day re-presentation rate <5% and mortality rate <1% in patients presenting to the TTC. Feasibility was defined as an overruling of informal triage <5%. Among 4815 presentations, 572 (11.9%) were tested positive for SARS-CoV-2, and 4774 were discharged. Mortality at 30-days was 0.04% (2 patients, one of which related to COVID-19). Fever (OR 2.03 [95% CI 1.70;2.42]), myalgia (OR 1.94 [1.63;2.31]), chills (OR 1.77 [1.44;2.16]), headache (OR 1.61 [1.34;1.94]), cough (OR 1.50 [1.24;1.83]), weakness (OR 1.46 [1.21;1.76]), and confusion (OR 1.39 [1.06;1.80]) were associated with test positivity. Re-presentation rate was 8% overall and 1.4% in COVID-19 related re-presentation (69 of 4774). The overruling rate of informal triage was 1.5%. According to our study, a low-threshold testing process in a TTC appeared to be safe (low re-presentation and low mortality) and is feasible (low overruling of informal triage). A COVID-19 diagnosis based on clinical parameters only does not appear possible.
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Affiliation(s)
- Gregory Mansella
- Emergency Department, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (G.M.); (M.R.); (J.H.); (C.H.N.)
| | - Marco Rueegg
- Emergency Department, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (G.M.); (M.R.); (J.H.); (C.H.N.)
| | - Andreas F. Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (A.F.W.); (S.T.-S.); (M.B.); (H.H.H.)
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (A.F.W.); (S.T.-S.); (M.B.); (H.H.H.)
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (A.F.W.); (S.T.-S.); (M.B.); (H.H.H.)
| | - Julia Hoff
- Emergency Department, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (G.M.); (M.R.); (J.H.); (C.H.N.)
| | - Kirstine K. Søgaard
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (K.K.S.); (A.E.)
- Applied Microbiology Research, Department Biomedicine, University of Basel, CH-4031 Basel, Switzerland
| | - Adrian Egli
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (K.K.S.); (A.E.)
- Applied Microbiology Research, Department Biomedicine, University of Basel, CH-4031 Basel, Switzerland
| | - Bram Stieltjes
- Department of Radiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland;
| | - Karoline Leuzinger
- Division of Clinical Virology, University Hospital Basel, CH-4031 Basel, Switzerland;
- Transplantation and Clinical Virology, Department Biomedicine, University of Basel, CH-4031 Basel, Switzerland
| | - Hans H. Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (A.F.W.); (S.T.-S.); (M.B.); (H.H.H.)
- Division of Clinical Virology, University Hospital Basel, CH-4031 Basel, Switzerland;
- Transplantation and Clinical Virology, Department Biomedicine, University of Basel, CH-4031 Basel, Switzerland
| | - Andrea Meienberg
- Medical Outpatient Department, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (A.M.); (T.B.); (M.M.)
| | - Thilo Burkard
- Medical Outpatient Department, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (A.M.); (T.B.); (M.M.)
| | - Michael Mayr
- Medical Outpatient Department, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (A.M.); (T.B.); (M.M.)
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (G.M.); (M.R.); (J.H.); (C.H.N.)
| | - Christian H. Nickel
- Emergency Department, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland; (G.M.); (M.R.); (J.H.); (C.H.N.)
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12
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Freiberger E, Sieber CC, Kob R. Mobility in Older Community-Dwelling Persons: A Narrative Review. Front Physiol 2020; 11:881. [PMID: 33041836 PMCID: PMC7522521 DOI: 10.3389/fphys.2020.00881] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/29/2020] [Indexed: 12/21/2022] Open
Abstract
Due to the demographic changes and the increasing awareness of the role of physical function, mobility in older age is becoming an important topic. Mobility limitations have been reported as increasingly prevalent in older persons affecting about 35% of persons aged 70 and the majority of persons over 85 years. Mobility limitations have been associated with increased fall risk, hospitalization, a decreased quality of life, and even mortality. As concepts of mobility are multifactorial and complex, in this narrative review, definitions, physical factors, and their age-related changes associated with mobility will be presented. Also, areas of cognitive decline and their impact on mobility, as well as neuromuscular factors related to mobility will be addressed. Another section will relate psychological factors such as Fall-related psychological concerns and sedentary behavior to mobility. Assessment of mobility as well as effective exercise interventions are only shortly addressed. In the last part, gaps and future work on mobility in older persons are discussed.
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Affiliation(s)
- Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
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Blomaard LC, Speksnijder C, Lucke JA, de Gelder J, Anten S, Schuit SCE, Steyerberg EW, Gussekloo J, de Groot B, Mooijaart SP. Geriatric Screening, Triage Urgency, and 30-Day Mortality in Older Emergency Department Patients. J Am Geriatr Soc 2020; 68:1755-1762. [PMID: 32246476 PMCID: PMC7497167 DOI: 10.1111/jgs.16427] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/20/2020] [Accepted: 03/05/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Urgency triage in the emergency department (ED) is important for early identification of potentially lethal conditions and extensive resource utilization. However, in older patients, urgency triage systems could be improved by taking geriatric vulnerability into account. We investigated the association of geriatric vulnerability screening in addition to triage urgency levels with 30‐day mortality in older ED patients. DESIGN Secondary analysis of the observational multicenter Acutely Presenting Older Patient (APOP) study. SETTING EDs within four Dutch hospitals. PARTICIPANTS Consecutive patients, aged 70 years or older, who were prospectively included. MEASUREMENTS Patients were triaged using the Manchester Triage System (MTS). In addition, the APOP screener was used as a geriatric screening tool. The primary outcome was 30‐day mortality. Comparison was made between mortality within the geriatric high‐ and low‐risk screened patients in every urgency triage category. We calculated the difference in explained variance of mortality by adding the geriatric screener (APOP) to triage urgency (MTS) by calculating Nagelkerke R2. RESULTS We included 2,608 patients with a median age of 79 (interquartile range = 74‐84) years, of whom 521 (20.0%) patients were categorized as high risk according to geriatric screening. Patients were triaged on urgency as standard (27.2%), urgent (58.5%), and very urgent (14.3%). In total, 132 (5.1%) patients were deceased within a period of 30 days. Within every urgency triage category, 30‐day mortality was threefold higher in geriatric high‐risk compared to low‐risk patients (overall = 11.7% vs 3.4%; P < .001). The explained variance of 30‐day mortality with triage urgency was 1.0% and increased to 6.3% by adding the geriatric screener. CONCLUSION Combining triage urgency with geriatric screening has the potential to improve triage, which may help clinicians to deliver early appropriate care to older ED patients. J Am Geriatr Soc 68:1755‐1762, 2020.
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Affiliation(s)
- Laura C Blomaard
- Department of Internal Medicine, Section Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Corianne Speksnijder
- Department of Internal Medicine, Section Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacinta A Lucke
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Jelle de Gelder
- Department of Internal Medicine, Section Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Sander Anten
- Department of Internal Medicine, Section Acute Care, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Stephanie C E Schuit
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.,Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jacobijn Gussekloo
- Department of Internal Medicine, Section Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Internal Medicine, Section Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.,Institute of Evidence-Based Medicine in Old Age, Leiden, The Netherlands
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Lyngholm L, Nickel CH, Kellett J, Chang S, Cooksley T, Brabrand M. Normal gait, albumin and d-dimer levels identify low risk emergency department patients: a prospective observational cohort study with 365-day 100% follow-up. QJM 2020; 113:86-92. [PMID: 31504931 DOI: 10.1093/qjmed/hcz226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND If survival could be reliably predicted many patients could be safely managed outside of hospital in an ambulatory care setting. AIM Comparison of common laboratory findings, co-morbidities, mobility and vital signs as predictors of mortality of acutely ill emergency department (ED) attendees. DESIGN Prospective observational study. METHODS Secondary analysis of 1334 consenting acutely ill patients attending a Danish ED. RESULTS 67 (5%) out of 1334 patients died within 100 days. After logistic regression seven predictors of 100 days mortality remained significant: an albumin level ≤34 gm/l, D-dimer level >0.51 mg/l, an Asadollahi score (based on admission laboratory data and age) ≥12, a platelet count <159 X 1000/ml, impaired mobility on presentation, a respiratory rate ≥30 bpm and a Charlson co-morbidity index ≥3. Only 5 of the 442 without any of these variables died within 365 days. Only one of the 517 patients with a stable independent gait and normal d-dimer and albumin levels died within 100 days, none died within 30 days of assessment and 12 died within 365 days. Of the remaining 817 patients 66 (8%) died within 100 days. CONCLUSION These findings suggest that normal gait, albumin and d-dimer levels are the most parsimonious way of identifying low risk ED patients.
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Affiliation(s)
- L Lyngholm
- From the Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - C H Nickel
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - J Kellett
- From the Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - S Chang
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
- Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark
| | - T Cooksley
- Department of Acute Medicine, University Hospital of South Manchester, Manchester, UK
| | - M Brabrand
- From the Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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15
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Nakitende I, Nabiryo J, Namujwiga T, Wasingya-Kasereka L, Kellett J. Do different patient populations need different early warning scores? The performance of nine different early warning scores used on acutely ill patients admitted to a low-resource hospital in sub-Saharan Africa. Clin Med (Lond) 2019; 20:67-73. [PMID: 31704729 DOI: 10.7861/clinmed.2019-0196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Early warning scores (EWS) generated in a developed healthcare setting may not perform as well in low-resource settings in sub-Saharan Africa. METHOD The performance of EWS used in developed world was compared with those generated in low-resource settings in sub-Saharan Africa. RESULTS When tested on 1,266 acutely ill patients consecutively admitted to a low-resource Ugandan hospital there was no statistical difference in the performance of any of the EWS tested. The performance of all the scores appeared to be improved by the addition of mobility assessment. Although statistically insignificant, the National Early Warning Score with extra points added for impaired mobility had the highest discrimination and sensitivity. CONCLUSION There were only marginal and no statistical differences in the performance of EWS generated in low- and high-resource healthcare settings in a cohort of unselected acutely ill medical patients admitted to a low-resource hospital in sub-Saharan Africa.
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Affiliation(s)
| | | | | | | | - John Kellett
- Hospital of South West Jutland, Esbjerg, Denmark; on behalf of the Kitovu Hospital Study Group
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16
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Kellett J, Nickel CH, Skyttberg N, Brabrand M. Is it possible to quickly identify acutely unwell patients who can be safely managed as outpatients? The need for a "Universal Safe to Discharge Score". Eur J Intern Med 2019; 67:e13-e15. [PMID: 31351762 DOI: 10.1016/j.ejim.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/15/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022]
Abstract
If scores or algorithms were developed that quickly identified patients who are bound to have 100% survival, if even only for a few days, more patients could be safely discharged from emergency department, this eliminating the risks of hospitalization for many patients. This hypothesis proposes that it is possible to develop a "Universal Safe to Discharge Score", and suggests how it might be developed and validated.
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Affiliation(s)
- John Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Denmark.
| | | | - Niclas Skyttberg
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Stockholm, Sweden.
| | - Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Denmark; Department of Emergency Medicine, Odense University Hospital, Denmark.
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Theou O, Kehler DS, Godin J, Mallery K, MacLean MA, Rockwood K. Upright time during hospitalization for older inpatients: A prospective cohort study. Exp Gerontol 2019; 126:110681. [PMID: 31382011 DOI: 10.1016/j.exger.2019.110681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/28/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to examine: a) how long and how frequently older hospitalized patients spend upright; b) whether duration and frequency of upright time change by time of the day, the day of the week, and during hospitalization; and c) whether these relationships differ based on the mobility level of patients at admission. METHODS This prospective cohort study included 111 patients (82.2 ± 8 years old, 52% female) from the Emergency Department and a Geriatric Assessment Unit who were at least 60 years old and had an anticipated length of stay of at least three days. The main outcomes were accelerometer-measured total upright time and number of bouts of upright time during awake hours. RESULTS Patients were upright 15.9 times/day (interquartile range (IQR): 8.4-27.4) for a total of 54.2 min/day (IQR: 17.8-88.9) during awake hours. Time of day and day of week had little impact on the outcomes. Patients who walked independently at admission had 151.5 min (95% CI: 87.7-215.3) of upright time on hospital day 1 and experienced a decline of 4.5 min/day (-7.2 to -1.8). Those who needed personal mobility assistance or were bedridden had 29.5 min (-38.5-97.4) and 25 min (-48.3-100.3) of upright time on day 1, and demonstrated an increase of 3.6 (1.3-5.9) and 2.4 (0.05-4.5) min/day, respectively. CONCLUSION Hospitalized older adults spend only 6% of their awake hours upright while in hospital. Patients who can walk independently are more active but experience a decline in their upright time during hospitalization.
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Affiliation(s)
- Olga Theou
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - D Scott Kehler
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Judith Godin
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kayla Mallery
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mark A MacLean
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
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Inability to Walk Predicts Death among Adult Patients in Hospitals in Malawi. Emerg Med Int 2019; 2019:6586891. [PMID: 31360550 PMCID: PMC6642788 DOI: 10.1155/2019/6586891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/26/2019] [Indexed: 01/09/2023] Open
Abstract
Objective Vital signs are often used in triage, but some may be difficult to assess in low-resource settings. A patient's ability to walk is a simple and rapid sign that requires no equipment or expertise. This study aimed to determine the predictive performance for death of an inability to walk among hospitalized Malawian adults and to compare its predictive value with the vital signs-based National Early Warning Score (NEWS). Methods It is a prospective cohort study of adult in-patients on selected days in two hospitals in Malawi. Patients were asked to walk five steps with close observation and their vital signs were assessed. Sensitivities, specificities, and predictive values for in-patient death of an inability to walk were calculated and an inability to walk was compared with NEWS. Results Four-hundred and forty-three of the 1094 participants (40.5%) were unable to walk independently. In this group, 70 (15.8 %) died in-hospital compared to 16 (2.5%) among those who could walk: OR 7.4 (95% CI 4.3-13.0 p<0.001). Inability to walk had a sensitivity for death of 81.4%, specificity of 63.0%, positive predictive value (PPV) of 15.8%, and negative predictive value (NPV) of 97.5%. NEWS>6 had sensitivity 70.9%, specificity 70.6%, PPV 17.1%, and NPV 96.6%. An inability to walk had a fair concordance with NEWS>6 (kappa 0.21). Conclusion Inability to walk predicted mortality as well as NEWS among hospitalized adults in Malawi. Patients who were able to walk had a low risk of death. Walking ability could be considered an additional vital sign and may be useful for triage.
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Abstract
PURPOSE OF REVIEW With a continuously growing number of older patients undergoing major surgical procedures, reliable parameters practicable in perioperative routine revealing those patients at risk are urgently needed. Recently, the concept of 'prehabilitation' with its key elements exercise, nutrition and psychological stress reduction especially in frail patients is attracting increasing attention. RECENT FINDINGS Literature search revealed a huge amount of publications in particular within the last 12 months. Although a single definition of both frailty and prehabilitation is still to be made, various players in the perioperative setting obviously are becoming increasingly convinced about a possible benefit of the program - referring to different components and measures performed. Although physiologically advantages seem obvious, there is hardly any reliable data on clinical outcomes resulting from properly performed studies. This applies especially to octogenarians; thus those at risk for adverse events the concept originally addresses. SUMMARY Identifying high-risk patients at the earliest possible stage and increasing their physiological reserve prior to surgery is a promising approach that seems to result in remarkable improvements for older patients. However, further studies on effectiveness in a highly heterogeneous population and agreement on a common concept are mandatory before a final judgement can be given.
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Nickel CH, Kellett J, Nieves Ortega R, Lyngholm L, Wasingya-Kasereka L, Brabrand M. Mobility Identifies Acutely Ill Patients at Low Risk of In-Hospital Mortality: A Prospective Multicenter Study. Chest 2019; 156:316-322. [PMID: 30981722 DOI: 10.1016/j.chest.2019.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/17/2019] [Accepted: 04/02/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A retrospective study has reported that impaired mobility on presentation (IMOP) enhanced the ability of vital signs to predict mortality in acutely ill patients. This study was designed to further examine the association between IMOP and in-hospital mortality. METHODS Prospective observational study of three different cohorts of acutely ill patients admitted to hospitals in Esbjerg, Denmark (998 patients), Basel, Switzerland (743 patients), and Kitovu, Uganda (1,622 patients). RESULTS There were significant differences in age, sex, length of stay, proportion of medical and surgical patients, and in-hospital mortality between the three cohorts. Yet in all three cohorts a National Early Warning Score (NEWS) ≥ 3 when first recorded and IMOP increased the risk of in-hospital mortality to approximately the same extent. IMOP and NEWS ≥ 3 when first recorded were, therefore, used for risk categorization: patients with a NEWS < 3 when first recorded and normal mobility on presentation had the lowest in-hospital mortality risk and those with NEWS ≥ 3 when first recorded and IMOP had the highest risk. The number of these low risk patients ranged from 26% in Kitovu to 42% in Esbjerg, and their in-hospital mortality rates did not significantly differ in all three cohorts, ranging from 0.2% in Esbjerg to 0.4% in Basel. CONCLUSIONS In this prospective multicenter study IMOP enhanced the risk categorization of acutely ill patients from very different clinical settings. The combination normal mobility on presentation and first recorded NEWS identified a substantial proportion of patients in all cohorts with a low risk of dying while in hospital. TRIAL REGISTRY The Esbjerg data were collected as part of a trial registered with the US National Library of Medicine (ClinicalTrials.gov; No.: NCT03108807; URL: www.clinicaltrials.gov).
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Affiliation(s)
| | - John Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.
| | | | - Le Lyngholm
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | | | - Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark; Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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Laugesen SKN, Nissen SK, Kellett J, Brabrand M, Cooksley T, Nickel CH. Impaired Mobility, Rather Than Frailty, Should Be a Vital Sign. Chest 2019; 155:877-878. [PMID: 30955577 DOI: 10.1016/j.chest.2018.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sune K N Laugesen
- Department of Emergency Medicine, Odense University Hospital, Odense.
| | | | - John Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg
| | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense; Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg
| | - Tim Cooksley
- Department of Acute Medicine, University Hospital of South Manchester
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Nissen SK, Brabrand M, Nickel CH, Kellett J, Cooksley T. Impaired mobility is associated with risk of ICU admission but not outcome after ICU treatment. Acta Anaesthesiol Scand 2019; 63:418. [PMID: 30397911 DOI: 10.1111/aas.13286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Søren K. Nissen
- Department of Geriatric Medicine; Odense University Hospital; Svendborg Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine; Hospital of South West Jutland; Esbjerg Denmark
- Department of Emergency Medicine; Odense University Hospital; Odense Denmark
- Institute of Regional Health Research; University of Southern Denmark; Esbjerg Denmark
| | - Christian H. Nickel
- Department of Emergency Medicine; Basel University Hospital; Basel Switzerland
| | - John Kellett
- Department of Emergency Medicine; Hospital of South West Jutland; Esbjerg Denmark
| | - Tim Cooksley
- Department of Acute Medicine; The Christie; Manchester UK
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23
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Kellett J, Wasingya-Kasereka L, Brabrand M. Are changes in objective observations or the patient’s subjective feelings the day after admission the best predictors of in-hospital mortality? An observational study in a low-resource sub-Saharan hospital. Resuscitation 2019; 135:130-136. [DOI: 10.1016/j.resuscitation.2018.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/17/2018] [Accepted: 10/25/2018] [Indexed: 12/21/2022]
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Brabrand M, Knudsen T, Hallas J, Graham CA, Kellett J. The PARIS score can reliably predict 7-day all-cause mortality for both acute medical and surgical patients: an international validation study. QJM 2018; 111:721-725. [PMID: 30124965 DOI: 10.1093/qjmed/hcy174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We believe errors in the risk assessment of acutely ill patients occur because only vital signs without concurrent functional capacity are considered. We, therefore, developed the PARIS risk score based on blood pressure, age, respiratory rate, loss of independence and oxygen saturation. AIM Validation of the PARIS score in four independent cohorts from three countries. METHODS Retrospective cohort study of acutely ill patients admitted to hospitals in Denmark, Ireland and Uganda. Vital signs and functional capacity (registered as ability to stand or walk or get into bed unaided) was recorded upon arrival. Patients were followed up for 7 days (Denmark and Ireland) or until discharge (Uganda) and mortality recorded. The discriminatory power (ability to identify patients at increased risk) was determined using area under the receiver operating characteristics curve (AUROC) and calibration (precision) using Hosmer-Lemeshow goodness of fit test. RESULTS Out of 14 447 patients, 327 (2.3%) died within 7 days: median age was 59 (39-75) years and 7458 (51.8%) were female. Seven-day mortality increased from 0.3% with a score of 0-26.7% with a score of 5. The score's AUROC as 0.833 [95% confidence interval (95% CI) 0.811-0.856], 0.817 (95% CI 0.792-0.842) and 0.894 (95% CI 0.813-0.974) for all patients, medical patients and surgical patients, respectively. However, except for surgical patients, calibration of the score was poor. CONCLUSION The PARIS score can identify both high and low risk acutely admitted medical and surgical patients, but calibration was poor for medical patients.
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Affiliation(s)
- M Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Denmark
- Centre South West Jutland, Institute of Regional Health Research, University of Southern Denmark, Finsensgade 35, Esbjerg, Denmark
- Department of Emergency Medicine, Odense University Hospital, Sdr. Boulevard 29, Odense C, Denmark
| | - T Knudsen
- Centre South West Jutland, Institute of Regional Health Research, University of Southern Denmark, Finsensgade 35, Esbjerg, Denmark
- Department of Medicine, Hospital of South West Jutland, Finsensgade 35, Esbjerg, Denmark
| | - J Hallas
- Department of Clinical Pharmacology, Odense University Hospital, J. B. Winsløws Vej 19, 2., Odense C, Denmark
| | - C A Graham
- Centre South West Jutland, Institute of Regional Health Research, University of Southern Denmark, Finsensgade 35, Esbjerg, Denmark
- Emergency Medicine Academic Unit, Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - J Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Denmark
- Centre South West Jutland, Institute of Regional Health Research, University of Southern Denmark, Finsensgade 35, Esbjerg, Denmark
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Kellett J, Opio MO. QRS voltage is a predictor of in-hospital mortality of acutely ill medical patients. Clin Cardiol 2018; 41:1069-1074. [PMID: 30022511 DOI: 10.1002/clc.23030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/02/2018] [Accepted: 07/16/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Low QRS voltage has been shown to be associated with increased mortality in the general population and in a small pilot study the combined QRS voltage of ECG leads I and II was found to be associated with in-hospital mortality. HYPOTHESIS Confirm that low QRS voltage predicts the in-hospital mortality of acutely ill patients, and compare QRS voltage with other predictors of mortality that can be easily, quickly and cheaply obtained at the bedside. METHODS Prospective observational study of vital signs, QRS voltage and simple tools used to assess mental, functional and nutritional status at the bedside in unselected acutely ill patients admitted to a resource-poor hospital in sub-Saharan Africa. RESULTS Out of 1486 patients, 77 died (5.2%) in hospital. A combined lead I + II voltage <1.8 mV was present in 789 (53.1%) of patients, and significantly associated with in-hospital mortality (odds ratio 3.6, 95% CI 2.0-6.5, χ2 21.2, P < 0.00001). On logistic regression impaired mobility, the National Early Warning Score, male gender and lead I + II voltage were the only independent predictors of mortality. None of the 445 patients who were mobile on admission with a lead I + II voltage ≥ 1.8 mV died in hospital. CONCLUSIONS Low QRS voltage, male gender, NEWS, and impaired mobility were independent predictors of in-hospital mortality in the study population. These four variables, which are easily obtained at the bedside, could potentially provide a rapid, easy, and cheap risk stratification system.
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Affiliation(s)
- John Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
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Hillman KM. Predicting outcome in the seriously ill-A new approach. Acta Anaesthesiol Scand 2018; 62:878-879. [PMID: 29978462 DOI: 10.1111/aas.13121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- K. M. Hillman
- Liverpool Hospital and the Simpson Centre for Health Services Research; South West Sydney Clinical School; University of New South Wales: Ingham Institute for Applied Medical Research; Liverpool BC NSW Australia
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Sauter TC, Capaldo G, Hoffmann M, Birrenbach T, Hautz SC, Kämmer JE, Exadaktylos AK, Hautz WE. Non-specific complaints at emergency department presentation result in unclear diagnoses and lengthened hospitalization: a prospective observational study. Scand J Trauma Resusc Emerg Med 2018; 26:60. [PMID: 30012186 PMCID: PMC6048907 DOI: 10.1186/s13049-018-0526-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/03/2018] [Indexed: 11/16/2022] Open
Abstract
Background Up to 20% of patients admitted to an emergency department present with non-specific complaints. Retrospective studies suggest an increased risk of misdiagnosis and hospital admission for these patients, but prospective comparisons of the outcomes of emergency patients with non-specific complaints versus specific complaints are lacking. Methods All consecutive patients ≥18 years of age admitted to any internal medicine ward at Bern University Hospital via the emergency department from August 15th 2015 to December 7th 2015 were prospectively included and followed up upon. Patients with non-specific complaints were compared against those with specific complaints regarding the quality of their emergency department diagnosis, length of hospital stay and in-hospital mortality. Results Seven hundred and-eleven patients, 165 (23.21%) with non-specific complaints and 546 with specific complaints, were included in this study. No differences between patient groups regarding age, gender or initial severity of the medical problem (deducted from triage category and treatment in a resuscitation bay) were found. Patients with non-specific complaints received more unspecific diagnoses (30.3% vs. 23.1%, p = 0.001, OR = 1.82 [95% CI 1.159–2.899]), were hospitalized significantly longer (Median = 6.51 (IQR = 5.85) vs. 5.22 (5.83) days, p = 0.025, d = 0.2) but did not have a higher mortality than patients with specific complaints (7.3% vs. 3.7%, p = 0.087, OR 1.922 [95% CI 0.909–4.065]). Conclusions Non-specific complaints in patients admitted to an emergency department result in low-quality diagnoses and lengthened hospitalization, despite the patients being comparable to patients with specific complaints at admission.
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Affiliation(s)
- Thomas C Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Giuliana Capaldo
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michele Hoffmann
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tanja Birrenbach
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefanie C Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Juliana E Kämmer
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany.,AG Progress Test Medizin, Charité Universitätsmedizin, Berlin, Germany
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Atkins TEH, Öhman MC, Cooksley T, Brabrand M. Acute medical risk scores: is MARS out of this world? QJM 2018; 111:511. [PMID: 29660075 DOI: 10.1093/qjmed/hcy085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- T E H Atkins
- From the Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, 6700 Esbjerg, Denmark
| | - M C Öhman
- From the Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, 6700 Esbjerg, Denmark
| | - T Cooksley
- Department of Acute Medicine, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, Manchester
| | - M Brabrand
- From the Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade 35, 6700 Esbjerg, Denmark
- Department of Emergency Medicine, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
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