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Martin-Rodriguez F, Sanz-Garcia A, Lopez-Izquierdo R, Delgado Benito JF, Martínez Fernández FT, Otero de la Torre S, Del Pozo Vegas C. Prehospital Lactate Levels Obtained in the Ambulance and Prediction of 2-Day In-Hospital Mortality in Patients With Traumatic Brain Injury. Neurology 2024; 103:e209692. [PMID: 39088773 DOI: 10.1212/wnl.0000000000209692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To analyze the ability of prehospital lactate levels to predict 2-day in-hospital mortality in patients with traumatic brain injury (TBI), severe TBI (Glasgow Coma Scale (GCS) ≤ 8 points), and mild or moderate TBI (GCS ≥ 9 points). Second, 90-day mortality was also explored. METHODS This was a prospective, multicenter, emergency medical services (EMSs) delivery, ambulance-based, derivation-validation cohort study developed in 5 tertiary hospitals (Spain), from November 1, 2019, to July 31, 2022. Patients were recruited from among all phone requests for emergency assistance among adults who were later evacuated to referral hospitals with acute TBI. The exclusion criteria were minors, pregnancy, trauma patients without TBI, delayed presentations, patients were discharged in situ, participants with cardiac arrest, and unavailability to obtain a blood sample. The primary outcome was all-cause 2-day in-hospital mortality and 90-day mortality in patients with moderate or mild TBI compared with patients with severe TBI. Clinical and analytical parameters (lactate and glucose) were collected. The discriminative power (area under the receiver operating characteristic curve [AUC]) and calibration curve were calculated for 2 geographically separated cohorts. RESULTS A total of 509 patients were ultimately included. The median age was 58 years (interquartile range: 43-75), and 167 patients were female (32.8%). The primary outcome occurred in 9 (2.2%) of 415 patients with moderate or mild TBI and in 42 (44.7%) of 94 patients with severe TBI. The predictive capacity of the lactate concentration was globally validated in our cohort, for which the AUC was 0.874 (95% CI 0.805-0.942) for the validation cohort. The ability of the GCS score to predict lactate concentration was greater in patients with a GCS score ≥9 points, with an AUC of 0.925 (95% CI 0.808-1.000) and a negative predictive value of 99.09 (95% CI 98.55-99.64) in the validation cohort. CONCLUSION Our results show the benefit of using lactate in all patients with TBI, particularly in those with a GCS ≥9 points. Routine incorporation of lactate in the screening of patients with TBI could presumably reduce mortality and deterioration rates because of quicker and better identification of patients at risk.
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Affiliation(s)
- Francisco Martin-Rodriguez
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Ancor Sanz-Garcia
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Raul Lopez-Izquierdo
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Juan F Delgado Benito
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Francisco T Martínez Fernández
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Santiago Otero de la Torre
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Carlos Del Pozo Vegas
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
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2
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López-Izquierdo R, Del Pozo Vegas C, Sanz-García A, Mayo Íscar A, Castro Villamor MA, Silva Alvarado E, Gracia Villar S, Dzul López LA, Aparicio Obregón S, Calderon Iglesias R, Soriano JB, Martín-Rodríguez F. Clinical phenotypes and short-term outcomes based on prehospital point-of-care testing and on-scene vital signs. NPJ Digit Med 2024; 7:197. [PMID: 39048671 PMCID: PMC11269726 DOI: 10.1038/s41746-024-01194-6] [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: 12/27/2023] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
Emergency medical services (EMSs) face critical situations that require patient risk classification based on analytical and vital signs. We aimed to establish clustering-derived phenotypes based on prehospital analytical and vital signs that allow risk stratification. This was a prospective, multicenter, EMS-delivered, ambulance-based cohort study considering six advanced life support units, 38 basic life support units, and four tertiary hospitals in Spain. Adults with unselected acute diseases managed by the EMS and evacuated with discharge priority to emergency departments were considered between January 1, 2020, and June 30, 2023. Prehospital point-of-care testing and on-scene vital signs were used for the unsupervised machine learning method (clustering) to determine the phenotypes. Then phenotypes were compared with the primary outcome (cumulative mortality (all-cause) at 2, 7, and 30 days). A total of 7909 patients were included. The median (IQR) age was 64 (51-80) years, 41% were women, and 26% were living in rural areas. Three clusters were identified: alpha 16.2% (1281 patients), beta 28.8% (2279), and gamma 55% (4349). The mortality rates for alpha, beta and gamma at 2 days were 18.6%, 4.1%, and 0.8%, respectively; at 7 days, were 24.7%, 6.2%, and 1.7%; and at 30 days, were 33%, 10.2%, and 3.2%, respectively. Based on standard vital signs and blood test biomarkers in the prehospital scenario, three clusters were identified: alpha (high-risk), beta and gamma (medium- and low-risk, respectively). This permits the EMS system to quickly identify patients who are potentially compromised and to proactively implement the necessary interventions.
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Affiliation(s)
- Raúl López-Izquierdo
- Faculty of Medicine. Universidad de Valladolid, Valladolid, Spain
- Emergency Department. Hospital Universitario Rio Hortega, Valladolid, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Carlos Del Pozo Vegas
- Faculty of Medicine. Universidad de Valladolid, Valladolid, Spain
- Emergency Department. Hospital Clínico Universitario, Valladolid, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, University of Castilla la Mancha, Talavera de la Reina, Spain.
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina, Spain.
- Evaluación de Cuidados de Salud (ECUSAL), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Talavera de la Reina, Spain.
| | - Agustín Mayo Íscar
- Department of Statistics and Operative Research. Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | | | - Eduardo Silva Alvarado
- Universidad Europea del Atlántico, Santander, Spain
- Universidad Internacional Iberoamericana, Campeche, México
- Universidad de La Romana, La Romana, República Dominicana
| | - Santos Gracia Villar
- Universidad Europea del Atlántico, Santander, Spain
- Universidad Internacional Iberoamericana, Campeche, México
- Universidad Internacional Iberoamericana Arecibo, Puerto Rico, USA
| | - Luis Alonso Dzul López
- Universidad Europea del Atlántico, Santander, Spain
- Universidad Internacional Iberoamericana, Campeche, México
- Universidad Internacional Iberoamericana Arecibo, Puerto Rico, USA
| | - Silvia Aparicio Obregón
- Universidad Europea del Atlántico, Santander, Spain
- Universidad de La Romana, La Romana, República Dominicana
- Fundación Universitaria Internacional de Colombia, Bogotá, Colombia
| | - Rubén Calderon Iglesias
- Universidad Europea del Atlántico, Santander, Spain
- Universidad de La Romana, La Romana, República Dominicana
- Universidade Internacional do Cuanza. Cuito, Bié, Angola
| | - Joan B Soriano
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
- Servicio de Neumología; Hospital Universitario de La Princesa, Madrid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine. Universidad de Valladolid, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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Ettrich RH, Caballero J, Sakharkar P, Ahmed S, Hurlston T, Parmar J, Deb S. Evaluation of agreement between a noninvasive method for real-time measurement of critical blood values with a standard point-of-care device. PLoS One 2024; 19:e0304706. [PMID: 38889168 PMCID: PMC11185484 DOI: 10.1371/journal.pone.0304706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/07/2024] [Indexed: 06/20/2024] Open
Abstract
The purpose of this work was to investigate the degree of agreement between two distinct approaches for measuring a set of blood values and to compare comfort levels reported by participants when utilizing these two disparate measurement methods. Radial arterial blood was collected for the comparator analysis using the Abbott i-STAT® POCT device. In contrast, the non-invasive proprietary DBC methodology is used to calculate sodium, potassium, chloride, ionized calcium, total carbon dioxide, pH, bicarbonate, and oxygen saturation using four input parameters (temperature, hemoglobin, pO2, and pCO2). Agreement between the measurement for a set of blood values obtained using i-STAT and DBC methodology was compared using intraclass correlation coefficients, Passing and Bablok regression analyses, and Bland Altman plots. A p-value of <0.05 was considered statistically significant. A total of 37 participants were included in this study. The mean age of the participants was 42.4 ± 13 years, most were male (65%), predominantly Caucasian/White (75%), and of Hispanic ethnicity (40%). The Intraclass Correlation Coefficients (ICC) analyses indicated agreement levels ranging from poor to moderate between i-STAT and the DBC's algorithm for Hb, pCO2, HCO3, TCO2, and Na, and weak agreement for pO2, HSO2, pH, K, Ca, and Cl. The Passing and Bablok regression analyses demonstrated that values for Hb, pO2, pCO2, TCO2, Cl, and Na obtained from the i-STAT did not differ significantly from that of the DBC's algorithm suggesting good agreement. The values for Hb, K, and Na measured by the DBC algorithm were slightly higher than those obtained by the i-STAT, indicating some systematic differences between these two methods on Bland Altman Plots. The non-invasive DBC methodology was found to be reliable and robust for most of the measured blood values compared to invasive POCT i-STAT device in healthy participants. These findings need further validation in larger samples and among individuals afflicted with various medical conditions.
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Affiliation(s)
- Rudi H. Ettrich
- College of Biomedical Sciences, Larkin University, Miami, FL, United States of America
- Wertheim College of Medicine, Florida International University, Miami, FL, United States of America
| | - Joshua Caballero
- College of Pharmacy, University of Georgia, Athens, GA, United States of America
| | - Prashant Sakharkar
- College of Pharmacy, Larkin University, Miami, FL, United States of America
| | - Sultan Ahmed
- College of Biomedical Sciences, Larkin University, Miami, FL, United States of America
| | - Traci Hurlston
- College of Biomedical Sciences, Larkin University, Miami, FL, United States of America
| | - Jayesh Parmar
- College of Pharmacy, Larkin University, Miami, FL, United States of America
| | - Subrata Deb
- College of Pharmacy, Larkin University, Miami, FL, United States of America
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Zalama-Sánchez D, Martín-Rodríguez F, López-Izquierdo R, Benito JFD, Soberón IS, Vegas CDP, Sanz-García A. Prehospital Targeting of 1-Year Mortality in Acute Chest Pain by Cardiac Biomarkers. Diagnostics (Basel) 2023; 13:3681. [PMID: 38132265 PMCID: PMC10743255 DOI: 10.3390/diagnostics13243681] [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: 11/29/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
The identification and appropriate management of patients at risk of suffering from acute chest pain (ACP) in prehospital care are not straightforward. This task could benefit, as occurs in emergency departments (EDs), from cardiac enzyme assessment. The aim of the present work was to derive and validate a scoring system based on troponin T (cTnT), N-terminal pro B-type natriuretic peptide (NT-proBNP), and D-dimer to predict 1-year mortality in patients with ACP. This was a prospective, multicenter, ambulance-based cohort study of adult patients with a prehospital ACP diagnosis who were evacuated by ambulance to the ED between October 2019 and July 2021. The primary outcome was 365-day cumulative mortality. A total of 496 patients fulfilled the inclusion criteria. The mortality rate was 12.1% (60 patients). The scores derived from cTnT, NT-proBNP, and D-dimer presented an AUC of 0.802 (95% CI: 0718-0.886) for 365-day mortality. This AUC was superior to that of each individual cardiac enzyme. Our study provides promising evidence for the predictive value of a risk score based on cTnT, NT-proBNP, and D-dimer for the prediction of 1-year mortality in patients with ACP. The implementation of this score has the potential to benefit emergency medical service care and facilitate the on-scene decision-making process.
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Affiliation(s)
- Daniel Zalama-Sánchez
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain; (D.Z.-S.); (C.d.P.V.)
| | - Francisco Martín-Rodríguez
- Facultad de Medicina, Universidad de Valladolid, Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain
| | - Raúl López-Izquierdo
- Servicio de Urgencias, Hospital Universitario Rio Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain;
| | - Juan F. Delgado Benito
- Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain; (J.F.D.B.); (I.S.S.)
| | - Irene Sánchez Soberón
- Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain; (J.F.D.B.); (I.S.S.)
| | - Carlos del Pozo Vegas
- Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), 47007 Valladolid, Spain; (D.Z.-S.); (C.d.P.V.)
| | - Ancor Sanz-García
- Grupo de Investigación en Innovación Tecnológica Aplicada a la Salud (Grupo ITAS), Facultad de Ciencias de la Salud, Universidad de Castilla la Mancha, 13071 Talavera de la Reina, Spain;
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Kitzman H, Montgomery AH, Khan M, Mamun A, Tecson KM, Allison P, Simoni J, Wesson DE. The Fruit and Veggies for Kidney Health Study: A Prospective Randomized Trial. Kidney Med 2023; 5:100736. [PMID: 38046912 PMCID: PMC10692733 DOI: 10.1016/j.xkme.2023.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Rationale & Objective Providing fruits and vegetables (F&Vs) to health care system patients with elevated urine albumin-creatinine ratio (ACR) reduced ACR, slowed chronic kidney disease (CKD) progression and reduced cardiovascular disease (CVD) risk factors in previous studies. This study evaluated a community-based strategy in lower-income populations to identify African Americans with elevated ACR before health care system involvement and sustain them in a 6-month F&V protocol with (F&V + Cook) and without (F&V Only) cooking instructions, with the hypothesis that adjuvant cooking instructions with F&Vs would further reduce ACR. Study Design Prospective, randomized, parallel 2-arm design. Setting & Participants African American adults with ACR >10 mg/g creatinine randomized to 1 of 2 study arms. Interventions Two cups/day of F&Vs with or without cooking instructions in participants followed 6 months. Outcomes Participants sustaining the F&V protocol and between-group indicators of CVD risk, kidney injury, and dietary intake at 6 weeks and 6 months. Results A total of 142 African American adults (mean age, 57.0 years; ACR, 27.4 mg/g; body mass index, 34.4; 24.9% CKD 1; 24.8% CKD 2; 50.4% CKD 3; 55% female) randomized to F&V Only (n=72) or F&V + Cook (n=70), and 71% were retained at 6 months. Participants received 90% of available F&V pick-ups over 6 weeks and 69% over 6 months. In the adjusted model, 6-month ACR was 31% lower for F&V + Cook than F&V Only (P = 0.02). Net 6-week F&V intake significantly increased and biometric variables improved for participants combined into a single group. Limitations Small sample size, low-baseline ACR, and potential nonresponse bias for 24-hour dietary recall measure. Conclusions These data support the feasibility of identifying community-dwelling African Americans with ACR indicating elevated CVD and CKD risk and sustaining a F&V protocol shown to improve kidney outcomes and CVD risk factors and provides preliminary evidence that cooking instructions adjuvant to F&Vs are needed to lower ACR. Funding National Institute on Diabetes, Digestive, and Kidney Diseases grant "Reducing chronic kidney disease burden in an underserved population" (R21DK113440). Trial Registration NCT03832166. Plain-Language Summary African Americans, particularly those in low-income communities, have increased rates of chronic kidney disease (CKD) with worsening outcomes over time. Giving fruits and vegetables to individuals with CKD identified in health care systems was previously shown to reduce kidney damage, measured by urine protein albumin, and slow kidney function decline. We recruited African Americans in low-income communities with increased urine albumin levels. They received fruits and vegetables for 6 months, and we tested whether added cooking instructions further reduced urine albumin levels. Most participants continued to receive fruits and vegetables throughout the 6 months. Those given cooking instructions had lower urine albumin levels after 6 months, indicating decreased kidney damage. Providing cooking instructions with fruits and vegetables appears to lessen kidney damage more than just fruits and vegetables alone.
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Affiliation(s)
- Heather Kitzman
- Baylor Scott and White Health and Wellness Center, Dallas, TX
- Robbins Institute for Health Policy and Leadership, Baylor University, Waco, TX
- University of Texas Southwestern Medical Center, Peter O’Donnell Jr. School of Public Health, Dallas, TX
| | | | - Mahbuba Khan
- Baylor Scott and White Health and Wellness Center, Dallas, TX
| | - Abdullah Mamun
- Baylor Scott and White Health and Wellness Center, Dallas, TX
| | - Kristen M. Tecson
- Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, TX
- Texas A&M Health Sciences Center College of Medicine Department of Internal Medicine, Dallas, TX
| | | | - Jan Simoni
- Texas Tech University Health Sciences Center Department of Surgery, Lubbock, TX
| | - Donald E. Wesson
- Dell Medical School – The University of Texas at Austin, Austin, TX
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Taplin JG, Bill L, Blanchard IE, Barnabe CM, Holroyd BR, Healy B, McLane P. Exploring paramedic care for First Nations in Alberta: a qualitative study. CMAJ Open 2023; 11:E1135-E1147. [PMID: 38086557 PMCID: PMC10721334 DOI: 10.9778/cmajo.20230039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Prior work has shown that a greater proportion of First Nations patients than non-First Nations patients arrive by ambulance to emergency departments in Alberta. The objective of this study was to understand First Nations perspectives on transitions in care involving paramedics, and paramedic perspectives on serving First Nations communities. METHODS Participants for this participatory qualitative study were selected by means of purposive sampling through author networks, established relationships and knowledge of the Alberta paramedicine system. First Nations research team members engaged First Nations community organizations to identify and invite First Nations participants. Four sharing circles were held virtually in July 2021 via Zoom by the Alberta First Nations Information Governance Centre. We analyzed the data from the sharing circles using a Western thematic approach. The data were reviewed by Indigenous researchers. RESULTS Forty-four participants attended the 4 sharing circles (8-14 participants per circle), which ranged from 68 to 88 minutes long. We identified 3 major themes: racism, system barriers and solutions. First Nations participants described being stereotyped as misusing paramedic systems and substance using, which led to racial discrimination by paramedics and emergency department staff. Discrimination and lack of options to return home after care sometimes led First Nations patients to avoid paramedic care, and lack of alternative care options drove patients to access paramedic care. First Nations providers described facing racism from colleagues and completing additional work to act as cultural mentors to non-First Nations providers. Paramedics expressed moral distress when called on to handle issues outside their scope of practice and when they observed discrimination that interfered with patient care. Proposed solutions included First Nations self-determination in paramedic service design, cultural training and education for paramedics, and new paramedicine service models. INTERPRETATION First Nations people face discrimination and systemic barriers when accessing paramedicine. Potential solutions include the integration of paramedics in expanded health care roles that incorporate First Nations perspectives and address local priorities, and First Nations should lead in the design of and priority setting for paramedic services in their communities.
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Affiliation(s)
- John G Taplin
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Lea Bill
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Ian E Blanchard
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Cheryl M Barnabe
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Brian R Holroyd
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Bonnie Healy
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta
| | - Patrick McLane
- Alberta First Nations Information Governance Centre (Taplin, Bill); Department of Community Health Sciences (Taplin, Blanchard, Barnabe), University of Calgary; Emergency Medical Services (Taplin, Blanchard), Alberta Health Services; Department of Medicine (Barnabe), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Holroyd, McLane), University of Alberta; Emergency Strategic Clinical Network (Holroyd, McLane), Alberta Health Services, Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Stand Off, Alta.
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7
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Martín-Rodríguez F, Sanz-García A, Martínez Fernández FT, Otero de la Torre S, Delgado Benito JF, Del Pozo Vegas C, Pérez García R, Ingelmo Astorga EA, Sanchez Coalla A, López-Izquierdo R. Association between prehospital lactate categories with short- and long-term mortality: a prospective, observational multicenter study. QJM 2023; 116:835-844. [PMID: 37449904 DOI: 10.1093/qjmed/hcad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Lactate is an already recognized biomarker for short-term mortality in emergency medical services (EMS). However, how different levels of lactate are associated with short-, mid- and long-term outcomes should be unveiled. AIM To determine how different categories of hyperlactatemia are associated with mortality. We also aim to clinically characterize hyperlactatemia groups. DESIGN A multicenter, prospective, observational study performed between January 2019 and February 2022, considering 48 basic life support units and 5 advanced life support units referring to 4 tertiary care hospitals (Spain). Patients were recruited from phone requests for emergency assistance in adults, evacuated to emergency departments. The primary outcome was in-hospital mortality from any cause within the first to the 365-day period following EMS attendance. The main measures were demographical and biochemical variables, prehospital advanced life support techniques used and patient condition categorized in 24 diseases. METHODS Univariate and Cox regression analysis. RESULTS A total of 5072 participants fulfilled inclusion criteria. Group #1 (non-hyperlactatemia) was composed of 2389 subjects (47.1%), Group #2 (mild hyperlactatemia) of 1834 (36.1%), Group #3 (hyperlactatemia) of 333 (6.6%) and, finally, Group #4 (severe hyperlactatemia) of 516 (10.2%). The 1-day mortality was 0.2%, 1.1%, 9% and 22.3% in the four lactate groups, respectively. Long-term mortality (365 days) was 10.2%, 22.7%, 38.7% and 46.7% in the four lactate groups, respectively. Differences between patients' conditions of lactatemia groups were also found. CONCLUSIONS Our results demonstrated that prehospital lactate categories were associated with short- and long-term outcomes in a different manner. These results will allow EMS to establish different risk states according to the prehospital lactate categories.
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Affiliation(s)
- F Martín-Rodríguez
- Medicine, Dermatology and Toxicology Department,, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
| | - A Sanz-García
- Nursing, Physiotherapy and Occupational Therapy Department, Faculty of Health Sciences, University of Castilla la Mancha, Talavera de la Reina, Spain
| | | | - S Otero de la Torre
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
| | - J F Delgado Benito
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
| | - C Del Pozo Vegas
- Medicine, Dermatology and Toxicology Department,, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - R Pérez García
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - A Sanchez Coalla
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - R López-Izquierdo
- Medicine, Dermatology and Toxicology Department,, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
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8
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Donoso-Calero MI, Martín Conty JL, López-Izquierdo R, Sanz-García A, Dileone M, Polonio-López B, Mordillo-Mateos L, Delgado Benito JF, Del Pozo Vegas C, Mohedano-Moriano A, Martín-Rodríguez F. Prehospital seizures: Short-term outcomes and risk stratification based in point-of-care testing. Eur J Clin Invest 2023; 53:e14042. [PMID: 37325996 DOI: 10.1111/eci.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Information for treatment or hospital derivation of prehospital seizures is limited, impairing patient condition and hindering patients risk assessment by the emergency medical services (EMS). This study aimed to determine the associated factors to clinical impairment, and secondarily, to determine risk factors associated to cumulative in-hospital mortality at 2, 7 and 30 days, in patients presenting prehospital seizures. METHODS Prospective, multicentre, EMS-delivery study involving adult subjects with prehospital seizures, including five advanced life support units, 27 basic life support units and four emergency departments in Spain. All bedside variables: including demographic, standard vital signs, prehospital laboratory tests and presence of intoxication or traumatic brain injury (TBI), were analysed to construct a risk model using binary logistic regression and internal validation methods. RESULTS A total of 517 patients were considered. Clinical impairment was present in 14.9%, and cumulative in-hospital mortality at 2, 7 and 30-days was 3.4%, 4.6% and 7.7%, respectively. The model for the clinical impairment indicated that respiratory rate, partial pressure of carbon dioxide, blood urea nitrogen, associated TBI or stroke were risk factors; higher Glasgow Coma Scale (GCS) scores mean a lower risk of impairment. Age, potassium, glucose, prehospital use of mechanical ventilation and concomitant stroke were risk factors associated to mortality; and oxygen saturation, a high score in GCS and haemoglobin were protective factors. CONCLUSION Our study shows that prehospital variables could reflect the clinical impairment and mortality of patients suffering from seizures. The incorporation of such variables in the prehospital decision-making process could improve patient outcomes.
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Affiliation(s)
- María I Donoso-Calero
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - José L Martín Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Raúl López-Izquierdo
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Michele Dileone
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
- Neurology Department, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | | | | | | | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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9
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Martín-Rodríguez F, Ortega GJ, Castro Villamor MA, Del Pozo Vegas C, Delgado Benito JF, Martín-Conty JL, Sanz-García A, López-Izquierdo R. Development of a prehospital lactic acidosis score for early-mortality. A prospective, multicenter, ambulance-based, cohort study. Am J Emerg Med 2023; 65:16-23. [PMID: 36580696 DOI: 10.1016/j.ajem.2022.12.030] [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: 07/01/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Lactic acidosis is a clinical status related to clinical worsening. Actually, higher levels of lactate is a well-established trigger of emergency situations. The aim of this work is to build-up a prehospital early warning score to predict 2-day mortality and intensive care unit (ICU) admission, constructed with other components of the lactic acidosis besides the lactate. METHODS Prospective, multicenter, observational, derivation-validation cohort study of adults evacuated by ambulance and admitted to emergency department with acute diseases, between January 1st, 2020 and December 31st, 2021. Including six advanced life support, thirty-eight basic life support units, referring to four hospitals (Spain). The primary and secondary outcome of the study were 2-day all-cause mortality and ICU-admission. The prehospital lactic acidosis (PLA) score was derived from the analysis of prehospital blood parameters associated with the outcome using a logistic regression. The calibration, clinical utility, and discrimination of PLA were determined and compared to the performance of each component of the score alone. RESULTS A total of 3334 patients were enrolled. The final PLA score included: lactate, pCO2, and pH. For 2-day mortality, the PLA showed an AUC of 0.941 (95%CI: 0.914-0.967), a better performance in calibration, and a higher net benefit as compared to the other score components alone. For the ICU admission, the PLA only showed a better performance for AUC: 0.75 (95%CI: 0.706-0.794). CONCLUSIONS Our results showed that PLA predicts 2-day mortality better than other lactic acidosis components alone. Including PLA score in prehospital setting could improve emergency services decision-making.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital early warning scoring-system investigation group, Valladolid, Spain
| | - Guillermo J Ortega
- Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain; CONICET, Argentina
| | - Miguel A Castro Villamor
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital early warning scoring-system investigation group, Valladolid, Spain
| | - Carlos Del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital early warning scoring-system investigation group, Valladolid, Spain; Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Juan F Delgado Benito
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital early warning scoring-system investigation group, Valladolid, Spain
| | - José L Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Prehospital early warning scoring-system investigation group, Valladolid, Spain; Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain.
| | - Raúl López-Izquierdo
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital early warning scoring-system investigation group, Valladolid, Spain; Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
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10
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Melero-Guijarro L, Sanz-García A, Martín-Rodríguez F, Lipari V, Mazas Perez Oleaga C, Carvajal Altamiranda S, Martínez López NM, Domínguez Azpíroz I, Castro Villamor MA, Sánchez Soberón I, López-Izquierdo R. Prehospital qSOFA, mSOFA, and NEWS2 performance for sepsis prediction: A prospective, multi-center, cohort study. Front Med (Lausanne) 2023; 10:1149736. [PMID: 37144037 PMCID: PMC10151818 DOI: 10.3389/fmed.2023.1149736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background Nowadays, there is no gold standard score for prehospital sepsis and sepsis-related mortality identification. The aim of the present study was to analyze the performance of qSOFA, NEWS2 and mSOFA as sepsis predictors in patients with infection-suspected in prehospital care. The second objective is to study the predictive ability of the aforementioned scores in septic-shock and in-hospital mortality. Methods Prospective, ambulance-based, and multicenter cohort study, developed by the emergency medical services, among patients (n = 535) with suspected infection transferred by ambulance with high-priority to the emergency department (ED). The study enrolled 40 ambulances and 4 ED in Spain between 1 January 2020, and 30 September 2021. All the variables used in the scores, in addition to socio-demographic data, standard vital signs, prehospital analytical parameters (glucose, lactate, and creatinine) were collected. For the evaluation of the scores, the discriminative power, calibration curve and decision curve analysis (DCA) were used. Results The mSOFA outperformed the other two scores for mortality, presenting the following AUCs: 0.877 (95%CI 0.841-0.913), 0.761 (95%CI 0.706-0.816), 0.731 (95%CI 0.674-0.788), for mSOFA, NEWS, and qSOFA, respectively. No differences were found for sepsis nor septic shock, but mSOFA's AUCs was higher than the one of the other two scores. The calibration curve and DCA presented similar results. Conclusion The use of mSOFA could provide and extra insight regarding the short-term mortality and sepsis diagnostic, backing its recommendation in the prehospital scenario.
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Affiliation(s)
- Laura Melero-Guijarro
- Emergency Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- *Correspondence: Ancor Sanz-García,
| | - Francisco Martín-Rodríguez
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
| | - Vivian Lipari
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Campeche, Mexico
| | - Cristina Mazas Perez Oleaga
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Arecibo, PR, United States
- Universidade Internacional do Cuanza, Cuito, Bié, Angola
| | - Stefanía Carvajal Altamiranda
- Universidad Europea del Atlántico, Santader, Spain
- Universidade Internacional do Cuanza, Cuito, Bié, Angola
- Fundación Universitaria Internacional de Colombia, Bogotá, Colombia
| | - Nohora Milena Martínez López
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Campeche, Mexico
- Fundación Universitaria Internacional de Colombia, Bogotá, Colombia
| | - Irma Domínguez Azpíroz
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Campeche, Mexico
- Universidad de La Romana, La Romana, Dominican Republic
| | - Miguel A. Castro Villamor
- Emergency Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | | | - Raúl López-Izquierdo
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
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11
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Green K, Micocci M, Hicks T, Winter A, Martin JE, Shinkins B, Shaw L, Price C, Davies K, Allen JA. Perceived feasibility, facilitators and barriers to incorporating point-of-care testing for SARS-CoV-2 into emergency medical services by ambulance service staff: a survey-based approach. BMJ Open 2022; 12:e064038. [PMID: 36328389 PMCID: PMC9638752 DOI: 10.1136/bmjopen-2022-064038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This body of work aimed to elicit ambulance service staff's perceptions on the barriers and facilitators to adoption, and clinical utility of incorporating rapid SARS-CoV-2 testing during ambulance assessments. DESIGN A mixed-methods survey-based project using a framework analysis method to organise qualitative data. SETTING Emergency and non-emergency care ambulatory services in the UK were approached to take part. PARTICIPANTS Current, practising members of the UK ambulance service (paramedics, technicians, assistants and other staff) were included in this body of work. RESULTS Survey 1: 226 responses were collected between 3 December 2020 and 11 January 2021, 179 (79.2%) of which were completed in full. While the majority of respondents indicated that an ambulance-based testing strategy was feasible in concept (143/190, 75.3%), major barriers to adoption were noted. Many open-ended responses cited concerns regarding misuse of the service by the general public and other healthcare services, timing and conveyance issues, and increased workloads, alongside training and safety concerns. Survey 2: 26 responses were received between 8 February 2021 and 22 February 2021 to this follow-up survey. Survey 2 revealed conveyance decision-making, and risk stratification to be the most frequently prioritised use cases among ambulance service staff. Optimal test characteristics for clinical adoption according to respondents were; accuracy (above 90% sensitivity and specificity), rapidity (<30 min time to results) and ease of sample acquisition. CONCLUSIONS The majority of commercially available lateral flow devices are unlikely to be supported by paramedics as their duty of care requires both rapid and accurate results that can inform clinical decision making in an emergency situation. Further investigation is needed to define acceptable test characteristics and criteria required for ambulance service staff to be confident and supportive of deployment of a SARS-CoV-2 test in an emergency care setting.
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Affiliation(s)
- Kile Green
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Massimo Micocci
- NIHR London In Vitro Diagnostics Co-operative, Imperial College London, London, UK
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Amanda Winter
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Joanne E Martin
- Centre for Genomics and Child Health, Barts and The London NHS Trust, Blizard Institute, London, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Price
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Kerrie Davies
- Healthcare Associated Infections Research Group, University of Leeds, Leeds, UK
| | - Joy A Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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12
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Füzéry AK, Elian FA, Kost GJ. A review of temperature-related challenges and solutions for the Abbott i-STAT and Siemens Healthineers epoc devices. Clin Biochem 2022; 115:49-66. [PMID: 36067872 DOI: 10.1016/j.clinbiochem.2022.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/09/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
The Abbott i-STAT and Siemens Healthineers epoc are commonly used in the provision of care during emergency medical services calls and other settings. Maintaining these systems within manufacturer's temperature claims in these settings poses challenges across the world. This review summarizes solutions that have been reported in the peer-reviewed literature and proposes additional strategies to further address these challenges. A literature search was performed with Clarivate's Web of Science from inception to August 3, 2022. Search terms included i-STAT, epoc, temperature, cold, hot, heat, freeze, frozen, prehospital, disaster, POCT, point of care, blood gas, helicopter, airplane, and ambulance. One author also reviewed manually every issue of the Journal of Paramedic Practice. The search identified 17 solutions for addressing temperature-related challenges with the i-STAT device, nine solutions for i-STAT cartridges, one solution for the epoc device, and one solution for the epoc test card. The majority of solutions were highly portable and consisted of widely available, inexpensive components. The solutions demonstrated only partial or entirely questionable effectiveness in achieving temperature control. The search also identified five reports on the impact of storage temperatures on cartridges and test cards. The reports suggested that these reagents may be able to withstand storage at temperatures outside of manufacturer's claims with only minimal deterioration in performance. The heterogeneity of solutions and the paucity of evidence on their effectiveness suggest that additional strategies are needed to better understand and further address temperature-related challenges with these systems. A collaborative approach and shared decision making are recommended.
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Affiliation(s)
- Anna K Füzéry
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Alberta Precision Laboratories Point of Care Testing, Edmonton, Alberta, Canada.
| | - Fahed A Elian
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Gerald J Kost
- Fulbright Scholar 2020-2022, ASEAN Program, USA; Point-of-Care Testing Center for Teaching and Research (POCT∙CTR), Department of Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, CA, USA; Knowledge Optimization, Davis, CA, USA
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13
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Collopy KT, Westmoreland A, Powers WF. Patient Care Alterations After Point-of-Care Laboratory Testing During Critical Care Transport. Air Med J 2022; 41:370-375. [PMID: 35750443 DOI: 10.1016/j.amj.2022.04.008] [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: 10/11/2021] [Revised: 04/16/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Point-of-care laboratory testing (POCT) is associated with a reduced time to testing results and critical decision making within emergency departments. POCT is an essential clinical assessment tool because laboratory data are used to support timely critical decisions regarding acute medical conditions onditions ; however, there is currently limited research to support the use of POCT in the critical care transport environment. Few studies have evaluated the changes in patient care that occur after POCT during critical care transport. This study aims to contribute to the limited data available correlating prehospital POCT and changes in patient care. METHODS After institutional review board approval, a retrospective review of patients transported by a critical care transport team between October 1, 2013 and September 31, 2015 was completed. During the study period, 11,454 patients were transported, and 632 (5.51%) received POCT testing. RESULTS Patient care changes were noted in 244 (38.6%) patient tests. The most frequent patient care alterations were ventilator settings (10.9%), electrolyte changes (10.4%), and unit bed upgrades (7.1%). POCT most frequently altered care for patients with post-cardiac arrest syndrome (64.7%), sepsis/septic shock (61.8%), diabetic ketoacidosis (54.5%), or pneumonia (49.3%). CONCLUSION Patient care alterations occurred in 38.6% of patients undergoing POCT. Patient care was most frequently changed when patients were diagnosed with post-arrest, sepsis/septic shock, diabetic ketoacidosis, and pneumonia.
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Affiliation(s)
- Kevin T Collopy
- AirLink/VitaLink Critical Care Transport, Novant Health New Hanover Regional Medical Center, Wilmington, NC.
| | - Abigail Westmoreland
- AirLink/VitaLink Critical Care Transport, Novant Health New Hanover Regional Medical Center, Wilmington, NC; Department of General Surgery, Novant Health New Hanover Regional Medical Center, Wilmington, NC
| | - William F Powers
- Department of General Surgery, Novant Health New Hanover Regional Medical Center, Wilmington, NC
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14
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Comparison of the Agreement and Accuracy Between Paramedic and Hospital Diagnosis. Air Med J 2022; 41:228-232. [PMID: 35307148 DOI: 10.1016/j.amj.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/06/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Making an accurate clinical diagnosis in the field of prehospital is of great challenge in medical services. This study aimed to determine agreement between prehospital and in-hospital diagnoses. METHODS The diagnostic agreement was determined by a comparison of the discharge diagnosis with the prehospital emergency technicians in a period of 6 months at the emergency medical services in northwest Azerbaijan. The diagnostic agreement of discharge diagnoses was compared with the fist diagnosis by the paramedics. The results were analyzed using the kappa agreement coefficient and the chi-square test. RESULTS The overall agreement between the diagnosis made by the emergency medical technicians and the hospital's first diagnosis was 67% (95% confidence interval [CI], 61%-77%; k = 0.61; 95% CI, 0.56-0.67), whereas the agreement between the first diagnosis made by the emergency medical technicians and the hospital discharge diagnosis was 58% (95% CI, 49%-65%; k = 0.42; 95% CI, 0.37-0.48).There was a high proportion of diagnostic agreement for pregnancy (100%), poisoning by drugs (88%), essential (primary) hypertension (86%), and ischemic heart diseases (72%). There was a low proportion of diagnostic agreement for weakness (39%), mixed anxiety and depressive disorder (43%), and cerebellar stroke syndrome (59%). CONCLUSION Our attention in practice and emergency medical courses should be directed to diseases that have a subjective history, such as weakness and anxiety, due to the high proportion of incorrect diagnoses by the prehospital emergency technician. It should be noted that most of the incorrectly diagnosed cases were overestimated with another coronary syndrome.
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15
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Batte A, Murphy KJ, Namazzi R, Co K, Opoka RO, Ssenkusu JM, John CC, Conroy AL. Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study. BMC Nephrol 2021; 22:369. [PMID: 34742257 PMCID: PMC8572470 DOI: 10.1186/s12882-021-02573-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background Acute kidney injury (AKI) disproportionately affects individuals in low-and middle-income countries (LMIC). However, LMIC—particularly countries in sub-Saharan Africa— are under-represented in global AKI research. A critical barrier in diagnosing AKI is access to reliable serum creatinine results. We evaluated the utility of a point-of-care test to measure creatinine and diagnose AKI in Ugandan children with malaria. Methods Paired admission creatinine was assessed in 539 Ugandan children 6 months to 4 years of age hospitalized with severe malaria based on blood smear or rapid diagnostic test. Creatinine levels were measured using isotope dilution mass spectrometry (IDMS)-traceable methods. The reference creatinine was measured using the modified Jaffe method by a certified laboratory and the point-of-care testing was conducted using an i-STAT blood analyzer (i-STAT1, with and without adjustment for the partial pressure of carbon dioxide). AKI was defined and staged using the Kidney Disease: Improving Global Outcomes criteria. Results The mean age of children was 2.1 years, and 21.6% of children were stunted. Mortality was 7.6% in-hospital. Over the entire range of measured creatinine values (<0.20mg/dL-8.4mg/dL), the correlation between the reference creatinine and adjusted and unadjusted point-of-care creatinine was high with R2 values of 0.95 and 0.93 respectively; however, the correlation was significantly lower in children with creatinine values <1mg/dL (R2 of 0.44 between the reference and adjusted and unadjusted i-STAT creatinine). The prevalence of AKI was 45.5% using the reference creatinine, and 27.1 and 32.3% using the unadjusted and adjusted point-of-care creatinine values, respectively. There was a step-wise increase in mortality across AKI stages, and all methods were strongly associated with mortality (p<0.0001 for all). AKI defined using the reference creatinine measure was the most sensitive to predict mortality with a sensitivity of 85.4% compared to 70.7 and 63.4% with the adjusted and unadjusted point-of-care creatinine values, respectively. Conclusions Point-of-care assessment of creatinine in lean Ugandan children <4 years of age underestimated creatinine and AKI compared to the clinical reference. Additional studies are needed to evaluate other biomarkers of AKI in LMIC to ensure equitable access to AKI diagnostics globally.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Kristin J Murphy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, 1044 W. Walnut St., Indianapolis, IN, 46202, USA
| | - Ruth Namazzi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Katrina Co
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, 1044 W. Walnut St., Indianapolis, IN, 46202, USA
| | - Robert O Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - John M Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Chandy C John
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, 1044 W. Walnut St., Indianapolis, IN, 46202, USA
| | - Andrea L Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, 1044 W. Walnut St., Indianapolis, IN, 46202, USA.
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16
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Mohammed-Ali Z, Bagherpoor S, Diker P, Hoang T, Vidovic I, Cursio C, Leung F, Brinc D. Performance evaluation of all analytes on the epoc® Blood Analysis System for use in hospital surgical and intensive care units. Pract Lab Med 2021; 22:e00190. [PMID: 34589568 PMCID: PMC8461111 DOI: 10.1016/j.plabm.2020.e00190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the performance of the epoc hand-held analyzer against the RAPIDPoint 500 blood gas analyzer and laboratory analyzers where applicable. Methods Venous or arterial whole blood samples collected in balanced heparinized syringes were obtained from 69 patients (35 females, 34 males) predominantly (77%) from the surgical unit and intensive care unit (ICU). Method comparison was performed for all analytes on the epoc System against the RAPIDPoint 500 Blood gas analyzer or laboratory analyzers where applicable. Results: Mean bias was <5% for blood gases, electrolytes, lactate and glucose. Hematocrit showed a bias of -6.76% (95% CI = -8.91, - 4.61) compared to the HemataSTAT-II method, whereas calculated total hemoglobin showed a bias of 1.51% (95% CI = -1.04, 4.06) against the Sysmex XN-10 hematology analyzer. Creatinine showed the largest bias relative to laboratory analyzers, Abbott Architect c8000 Jaffe method (13.54%, 95% CI = 5.43, 21.65) and Roche Cobas c702 enzymatic method (30.01%, 95% CI = 12.64, 47.38). Conclusions: The epoc system is fit for use in the surgical and ICU setting for the measurement of all analytes except for creatinine.
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Affiliation(s)
- Zahraa Mohammed-Ali
- Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, ON, Canada
| | | | | | - Thuy Hoang
- Michener Institute for Applied Health Sciences, Toronto, ON, Canada
| | | | | | - Felix Leung
- Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, ON, Canada.,Mount Sinai Hospital, Toronto, ON, Canada
| | - Davor Brinc
- Department of Laboratory Medicine and Pathobiology University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
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17
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Amin MS, Wozniak M, Barbaric L, Pickard S, Yerrabelli RS, Christensen A, Coiado OC. Experimental Technologies in the Diagnosis and Treatment of COVID-19 in Patients with Comorbidities. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 6:48-71. [PMID: 34541448 PMCID: PMC8442516 DOI: 10.1007/s41666-021-00106-7] [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] [Received: 08/24/2020] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic has impacted the whole world and raised concerns about its effects on different human organ systems. Early detection of COVID-19 may significantly increase the rate of survival; thus, it is critical that the disease is detected early. Emerging technologies have been used to prevent, diagnose, and manage COVID-19 among the populace in the USA and globally. Numerous studies have revealed the growing implementation of novel engineered systems during the intervention at various points of the disease’s pathogenesis, especially as it relates to comorbidities and complications related to cardiovascular and respiratory organ systems. In this review, we provide a succinct, but extensive, review of the pathogenesis of COVID-19, particularly as it relates to angiotensin-converting enzyme 2 (ACE2) as a viral entry point. This is followed by a comprehensive analysis of cardiovascular and respiratory comorbidities of COVID-19 and novel technologies that are used to diagnose and manage hospitalized patients. Continuous cardiorespiratory monitoring systems, novel machine learning algorithms for rapidly triaging patients, various imaging modalities, wearable immunosensors, hotspot tracking systems, and other emerging technologies are reviewed. COVID-19 effects on the immune system, associated inflammatory biomarkers, and innovative therapies are also assessed. Finally, with emphasis on the impact of wearable and non-wearable systems, this review highlights future technologies that could help diagnose, monitor, and mitigate disease progression. Technologies that account for an individual’s health conditions, comorbidities, and even socioeconomic factors can drastically reduce the high mortality seen among many COVID-19 patients, primarily via disease prevention, early detection, and pertinent management.
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Affiliation(s)
- Md Shahnoor Amin
- Carle Illinois College of Medicine, University of Illinois At Urbana-Champaign, Champaign, IL 61820 USA
| | - Marcin Wozniak
- Beckman Institute for Advanced Science and Technology, Urbana, IL 61801 USA.,Department of Medical Laboratory Diagnostics - Biobank, Medical University of Gdansk, Gdansk, Poland
| | - Lidija Barbaric
- Carle Illinois College of Medicine, University of Illinois At Urbana-Champaign, Champaign, IL 61820 USA
| | - Shanel Pickard
- Carle Illinois College of Medicine, University of Illinois At Urbana-Champaign, Champaign, IL 61820 USA
| | - Rahul S Yerrabelli
- Carle Illinois College of Medicine, University of Illinois At Urbana-Champaign, Champaign, IL 61820 USA
| | - Anton Christensen
- Carle Illinois College of Medicine, University of Illinois At Urbana-Champaign, Champaign, IL 61820 USA
| | - Olivia C Coiado
- Carle Illinois College of Medicine, University of Illinois At Urbana-Champaign, Champaign, IL 61820 USA.,Department of Bioengineering, University of Illinois At Urbana-Champaign, Urbana, IL 61801 USA.,Carle Illinois College of Medicine, 1406 W. Green St, Urbana, IL 61801 USA
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18
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Rasku T, Helminen M, Kaunonen M, Thyer E, Paavilainen E, Joronen K. A Retrospective Review of Patient Records and Factors Associated with Decisions Made by Community Nurse-Paramedics' in Finland. NURSING REPORTS 2021; 11:690-701. [PMID: 34968343 PMCID: PMC8608054 DOI: 10.3390/nursrep11030065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
Community paramedicine (CP) has extended the role of paramedics and the main goal is to provide non-emergency care, which reduces the visits to emergency departments. The aim of this study was to describe the Finnish CP and examine the factors that were involved in CNPs' decision-making processes. The study was based on data from 450 consecutive CP patient records from three hospital districts. A more detailed analysis was carried out on 339 cases in patients' homes and elderly care homes, and the data analysis included multivariate logistic regression to examine the impact of variables on the CNPs' decisions. These patients' most common health issues were general weakness (15.9%) and fever (10.6%), and over half (58.7%) could remain at home after the CP visit. There were five independent factors associated with the CNPs' decisions of the patient's care continuum: the hospital district, if the patient could walk, whether the troponin test was performed, a physician was consulted, and the nature of the task. CP units played a valuable role in non-emergency care. Understanding the factors associated with CNP decision-making can increase the safety and effectiveness of reducing hospital visits, by providing patient care at home, or in elderly care facilities.
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Affiliation(s)
- Tuija Rasku
- Faculty of Social Sciences, Health Sciences, Tampere University, Kuntokatu 3, 33520 Tampere, Finland; (M.H.); (M.K.); (E.P.)
| | - Mika Helminen
- Faculty of Social Sciences, Health Sciences, Tampere University, Kuntokatu 3, 33520 Tampere, Finland; (M.H.); (M.K.); (E.P.)
- Tays Research Services, Tampere University Hospital, 33520 Tampere, Finland
| | - Marja Kaunonen
- Faculty of Social Sciences, Health Sciences, Tampere University, Kuntokatu 3, 33520 Tampere, Finland; (M.H.); (M.K.); (E.P.)
- General Administration, Pirkanmaa Hospital District, Tampere University, 33014 Tampere, Finland
| | - Elizabeth Thyer
- Dean’s Unit School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2750, Australia;
| | - Eija Paavilainen
- Faculty of Social Sciences, Health Sciences, Tampere University, Kuntokatu 3, 33520 Tampere, Finland; (M.H.); (M.K.); (E.P.)
- General Administration, The Hospital District of South Ostrobothnia, 60220 Seinäjoki, Finland
| | - Katja Joronen
- Department of Nursing Science, University of Turku, Joukahaisenkatu 3-5, 20520 Turku, Finland;
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19
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Gruebl T, Ploeger B, Wranze-Bielefeld E, Mueller M, Schmidbauer W, Kill C, Betz S. Point-of-care testing in out-of-hospital cardiac arrest: a retrospective analysis of relevance and consequences. Scand J Trauma Resusc Emerg Med 2021; 29:128. [PMID: 34461967 PMCID: PMC8406837 DOI: 10.1186/s13049-021-00943-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background Metabolic and electrolyte imbalances are some of the reversible causes of cardiac arrest and can be diagnosed even in the pre-hospital setting with a mobile analyser for point-of-care testing (POCT).
Methods We conducted a retrospective observational study, which included analysing all pre-hospital resuscitations in the study region between October 2015 and December 2016. A mobile POCT analyser (Alere epoc®) was available at the scene of each resuscitation. We analysed the frequency of use of POCT, the incidence of pathological findings, the specific interventions based on POCT as well as every patient’s eventual outcome. Results N = 263 pre-hospital resuscitations were included and in n = 98 of them, the POCT analyser was used. Of these measurements, 64% were performed using venous blood and 36% using arterial blood. The results of POCT showed that 63% of tested patients had severe metabolic acidosis (pH < 7.2 + BE < − 5 mmol/l). Of these patients, 82% received buffering treatment with sodium bicarbonate. Potassium levels were markedly divergent normal (> 6.0 mmol/l/ < 2.5 mmol/l) in 17% of tested patients and 14% of them received a potassium infusion. On average, the pre-hospital treatment time between arrival of the first emergency medical responders and the beginning of transport was 54 (± 20) min without POCT and 60 (± 17) min with POCT (p = 0.07). Overall, 21% of patients survived to hospital discharge (POCT 30% vs no POCT 16%, p = 0.01, Φ = 0.16). Conclusions Using a POCT analyser in pre-hospital resuscitation allows rapid detection of pathological acid–base imbalances and potassium concentrations and often leads to specific interventions on scene and could improve the probability of survival.
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Affiliation(s)
- Tobias Gruebl
- Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bundeswehr Central Hospital, Ruebenacher Straße 170, 56072, Koblenz, Germany. .,Center of Emergency Medicine, University Hospital of Marburg, Baldingerstraße, 35043, Marburg, Germany.
| | - B Ploeger
- Center of Emergency Medicine, University Hospital of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - E Wranze-Bielefeld
- Department of Hazard Prevention and Emergency Service, District of Vogelsberg, Goldhelg 20, 36341, Lauterbach, Germany
| | - M Mueller
- German Red Cross Emergency Service of Mittelhessen gGmbH, Am Krekel 41, 35039, Marburg, Germany
| | - W Schmidbauer
- Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bundeswehr Central Hospital, Ruebenacher Straße 170, 56072, Koblenz, Germany
| | - C Kill
- Center of Emergency Medicine, University Hospital of Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - S Betz
- Center of Emergency Medicine, University Hospital of Marburg, Baldingerstraße, 35043, Marburg, Germany
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20
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Füzéry AK, Kost GJ. Point-of-Care Testing Practices, Failure Modes, and Risk-Mitigation Strategies in Emergency Medical Services Programs in the Canadian Province of Alberta. Arch Pathol Lab Med 2020; 144:1352-1371. [PMID: 33106860 DOI: 10.5858/arpa.2020-0268-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Emergency medical services (EMS) programs have been using point-of-care testing (POCT) for more than 20 years. However, only a handful of reports have been published in all of that time on POCT practices in field settings. OBJECTIVE.— To provide an overview of POCT practices and failure modes in 3 of Alberta's EMS programs, and to propose risk-mitigation strategies for reducing or eliminating these failure modes. DESIGN.— Details about POCT practices, failure modes, and risk-mitigation strategies were gathered through (1) conversations with personnel, (2) in-person tours of EMS bases, (3) accompaniment of EMS personnel on missions, (4) internet searches for publicly available information, and (5) a review of laboratory documents. RESULTS.— Practices were most standardized and robust in the community paramedicine program (single service provider, full laboratory oversight), and least standardized and robust in the air ambulance program (4 service providers, limited laboratory oversight). Common failure modes across all 3 programs included device inoperability due to cold weather, analytical validation procedures that failed to consider the unique challenges of EMS settings, and a lack of real-time electronic transmission of results into the health care record. CONCLUSIONS.— A provincial framework for POCT in EMS programs is desirable. Such a framework should include appropriate funding models, laboratory oversight of POCT, and relevant expertise on POCT in EMS settings. The framework should also incorporate specific guidance on quality standards that are needed to address the unique challenges of performing POCT in field settings.
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Affiliation(s)
- Anna K Füzéry
- From the Point of Care Testing Department, Alberta Precision Laboratories, Edmonton, Alberta, Canada (Füzéry).,the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada (Füzéry)
| | - Gerald J Kost
- and the Point-of-Care Testing Center for Teaching and Research (POCT·CTR), Department of Pathology and Laboratory Medicine, School of Medicine, University of California, Davis (Kost)
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21
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Martín-Rodríguez F, López-Izquierdo R, Medina-Lozano E, Ortega Rabbione G, Del Pozo Vegas C, Carbajosa Rodríguez V, Castro Villamor MÁ, Sánchez-Soberon I, Sanz-García A. Accuracy of prehospital point-of-care lactate in early in-hospital mortality. Eur J Clin Invest 2020; 50:e13341. [PMID: 32648960 DOI: 10.1111/eci.13341] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/21/2020] [Accepted: 07/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Emergency medical services (EMS) routinely face complex scenarios where decisions should be taken with limited clinical information. The development of fast, reliable and easy to perform warning biomarkers could help in such decision-making processes. The present study aims at characterizing the validity of point-of-care lactate (pLA) during prehospital tasks for predicting in-hospital mortality within two days after the EMS assistance. MATERIALS AND METHODS Prospective, multicentric, ambulance-based and controlled observational study without intervention, including six advanced life support and five hospitals. The pLA levels were recorded during EMS assistance of adult patients. The validity of pLA to determine the in-hospital mortality was assessed by the area under the curve (AUC) of the receiver operating curve (ROC). RESULTS A total of 2997 patients were considered in the study, with a median of 69 years (IQR 54-81) and 41.4% of women. The median pLA value was 2.7 mmol/L (1.9-3.8) in survivors and 5.7 mmol/L (4.4-7.6) in nonsurvivors. The global discrimination level of pLA reached an AUC of 0.867, being 1.9 mmol/L and 4 mmol/L the cut-off point for low and high mortality. The discrimination value of pLA was not affected by sex, age or pathology. CONCLUSIONS Our results highlight the clinical importance of prehospital pLA to determine the in-hospital risk of mortality. The incorporation of pLA into the EMS protocols could improve the early identification of risky patients, leading to a better care of such patients.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Clinical Simulation Center, School of Medicine, Valladolid University, Valladolid, Spain.,Emergency Medical Services-SACYL, Paseo Hospital Militar, Valladolid, Spain
| | - Raúl López-Izquierdo
- Advanced Clinical Simulation Center, School of Medicine, Valladolid University, Valladolid, Spain.,Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Elena Medina-Lozano
- Advanced Clinical Simulation Center, School of Medicine, Valladolid University, Valladolid, Spain
| | - Guillermo Ortega Rabbione
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa (IIS-IP), Madrid, Spain.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), CABA, Argentina
| | | | | | | | | | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa (IIS-IP), Madrid, Spain
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22
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Venner AA, Beach LA, Shea JL, Knauer MJ, Huang Y, Fung AWS, Dalton J, Provencal M, Shaw JLV. Quality assurance practices for point of care testing programs: Recommendations by the Canadian society of clinical chemists point of care testing interest group. Clin Biochem 2020; 88:11-17. [PMID: 33264650 DOI: 10.1016/j.clinbiochem.2020.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Abstract
Point of Care Testing (POCT) refers to clinical laboratory testing performed outside the central laboratory, nearer to the patient and sometimes at the patient bedside. The testing is usually performed by clinical staff, such as physicians or nurses, who are not laboratory trained. This document was developed by the POCT Interest group of the Canadian Society of Clinical Chemists (CSCC) as practical guidance for quality assurance practices related to POCT performed in hospital and outside hospital environments. The aspects of quality assurance addressed in this document include: (1) device selection, (2) initial device verification, (3) ongoing device verification, (4) ongoing quality assurance including reagent and quality control (QC) lot changes, and (5) quality management including operator and document management.
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Affiliation(s)
- Allison A Venner
- Division of Biochemistry and Director for POCT, The Ottawa Hospital and the Eastern Ontario Regional Laboratories Association, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Lori A Beach
- Division of Biochemistry and Director for POCT, The Ottawa Hospital and the Eastern Ontario Regional Laboratories Association, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Jennifer L Shea
- Division of Biochemistry and Director for POCT, The Ottawa Hospital and the Eastern Ontario Regional Laboratories Association, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Michael J Knauer
- Division of Biochemistry and Director for POCT, The Ottawa Hospital and the Eastern Ontario Regional Laboratories Association, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Yun Huang
- Division of Biochemistry and Director for POCT, The Ottawa Hospital and the Eastern Ontario Regional Laboratories Association, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Angela W S Fung
- Division of Biochemistry and Director for POCT, The Ottawa Hospital and the Eastern Ontario Regional Laboratories Association, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - James Dalton
- Division of Biochemistry and Director for POCT, The Ottawa Hospital and the Eastern Ontario Regional Laboratories Association, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Mathieu Provencal
- Division of Biochemistry and Director for POCT, The Ottawa Hospital and the Eastern Ontario Regional Laboratories Association, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Julie L V Shaw
- Division of Biochemistry and Director for POCT, The Ottawa Hospital and the Eastern Ontario Regional Laboratories Association, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
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23
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Koivulahti O, Tommila M, Haavisto E. The accuracy of preliminary diagnoses made by paramedics - a cross-sectional comparative study. Scand J Trauma Resusc Emerg Med 2020; 28:70. [PMID: 32703267 PMCID: PMC7376915 DOI: 10.1186/s13049-020-00761-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Clinical decision-making skills of paramedics have been emphasized because of the growing complexity of emergency medicine nursing. A preliminary diagnosis made by a paramedic has an essential role in directing the subsequent care. An accurate preliminary diagnosis improves the patient’s outcome. The research in this area is relatively scarce and there are no previous studies in Finland describing the accuracy of preliminary diagnoses made by paramedics. The aim of this study was to evaluate whether paramedics are making accurate preliminary diagnoses for the patients they are transporting to hospital. In addition, the aim was to describe the variables related to an accurate preliminary diagnosis. Methods A cross-sectional comparative approach was used and conducted through a questionnaire to gather data from the paramedics. A total of 71 paramedics participated in the study and 378 patient cases were included. The paramedics were asked to describe the basic information of a case, to state their preliminary diagnosis, and give their own educational background. The accuracy of the paramedic’s preliminary diagnosis was compared with the discharge diagnosis of the ED physicians retrieved from hospital’s patient records. Logistic regression analysis and a binomial test were used to test the statistical significance. Results The agreement between the paramedics’ preliminary diagnosis vs. hospital diagnosis was 70% (n = 261). Diagnostic accuracy varied according to the medical condition from mental diseases and intoxication (86%, p = 0,000), cerebral strokes (81%, p = 0,007) to infections (31% p = 0,029). The educational background of a bachelor-degree-level paramedic (p = 0,016, 95% Cl 1,7-139,6) and a good self-assessment value (p = 0,003, 95% Cl 1,2-2,7) were related to making a correct diagnosis. Conclusions Paramedics are able to determine preliminary diagnoses at satisfactory level. The relationship between educational background and diagnostic accuracy suggests that there is a definitive need for a specific pre-hospital nursing education.
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Affiliation(s)
- Outi Koivulahti
- Department of Nursing Science, University of Turku, Department of Nursing Science 20014 University of Turku, Turku Finland and Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland.
| | - Miretta Tommila
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, University of Turku and Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Elina Haavisto
- Department of Nursing Science, University of Turku, Department of Nursing Science 20014 University of Turku, Turku Finland and Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland
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24
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Wesson DE, Kitzman H, Montgomery A, Mamun A, Parnell W, Vilayvanh B, Tecson KM, Allison P. A population health dietary intervention for African American adults with chronic kidney disease: The Fruit and Veggies for Kidney Health randomized study. Contemp Clin Trials Commun 2020; 17:100540. [PMID: 32090186 PMCID: PMC7026290 DOI: 10.1016/j.conctc.2020.100540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/23/2020] [Accepted: 02/02/2020] [Indexed: 01/28/2023] Open
Abstract
Background Chronic kidney disease (CKD) is commonly asymptomatic until its late stages, reduces life quality and length, is costly to manage, and is disproportionately prevalent in low-income, African American (AA) communities. Traditional health system strategies that engage only patients with symptomatic CKD limit opportunities to prevent progression to end stage kidney disease (ESKD) with the need for expensive kidney replacement therapy and to reduce risk for their major mortality cause, cardiovascular disease (CVD). Published studies show that giving fruits and vegetables (F&V) to AA with early-stage CKD along with preparation instructions slowed CKD progression. This effective, evidenced-based, and potentially scalable dietary intervention might be a component of a community-based strategy to prevent CKD progression. Design This study supported by NIH grant (R21DK113440) will test the feasibility of an innovative screening strategy conducted at community-based institutions in low-income AA communities and the ability to intervene in individuals identified to have CKD and increased CVD risk with F&V, with or without preparation instructions. Objectives The study will prospectively compare changes in urine indices predictive of CKD progression and CVD in participants receiving, compared to those not receiving, preparation instructions along with F&V, six months after the intervention. Discussion Addressing the challenge of increasing progression of early to more advanced stages of CKD with its increased CVD risk requires development of effective strategies to screen, identify, and intervene with individuals found to have CKD with effective, comparatively inexpensive, community-based, and scalable strategies to prevent CKD progression, particularly in low-income, AA communities.
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Affiliation(s)
- Donald E. Wesson
- Texas A&M Health Sciences Center College of Medicine Department of Internal Medicine, Dallas, TX, USA
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA
- Corresponding author. Baylor Scott and White Health and Wellness Center, Texas A&M College of Medicine, 4500 Spring Avenue, Dallas, TX, 75210, USA.
| | - Heather Kitzman
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA
- Robbins Institute for Health Policy and Leadership, Baylor University, Waco, TX, USA
- School of Public Health, University of North Texas Health Sciences Center, Fort Worth, TX, USA
| | - Aisha Montgomery
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA
| | - Abdullah Mamun
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA
| | - Winfred Parnell
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA
| | - Brian Vilayvanh
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA
| | - Kristen M. Tecson
- Texas A&M Health Sciences Center College of Medicine Department of Internal Medicine, Dallas, TX, USA
- Baylor Heart and Vascular Institute, Dallas, TX, USA
| | - Patricia Allison
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA
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