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Tran A, Valo P, Rouvier C, Dos Ramos E, Freyssinet E, Baranton E, Haas O, Haas H, Pradier C, Gentile S. Validation of the Computerized Pediatric Triage Tool, pediaTRI, in the Pediatric Emergency Department of Lenval Children's Hospital in Nice: A Cross-Sectional Observational Study. Front Pediatr 2022; 10:840181. [PMID: 35592843 PMCID: PMC9113392 DOI: 10.3389/fped.2022.840181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A reliable pediatric triage tool is essential for nurses working in pediatric emergency departments to quickly identify children requiring priority care (high-level emergencies) and those who can wait (low-level emergencies). In the absence of a gold standard in France, the objective of our study was to validate our 5-level pediatric triage tool -pediaTRI- against the reference tool: the Pediatric Early Warning Score (PEWS) System. MATERIALS AND METHODS We prospectively included 100,506 children who visited the Pediatric Emergency Department at Lenval Children's Hospital (Nice, France) in 2016 and 2017. The performance of pediaTRI to identify high-level emergencies (severity levels 1 and 2) was evaluated in comparison with a PEWS ≥ 4/9. Data from 2018-19 was used as an independent validation cohort. RESULTS pediaTRI agreed with the PEWS score for 84,896 of the patients (84.5%): 15.0% (14.8-15.2) of the patients were over-triaged and 0.5% (0.5-0.6) under-triaged compared with the PEWS score. pediaTRI had a sensitivity of 76.4% (74.6-78.2), a specificity of 84.7% (84.4-84.9), and positive and negative likelihood ratios of 5.0 (4.8-5.1) and 0.3 (0.3-0.3), respectively, for the identification of high-level emergencies. However, the positive likelihood ratios were lower for patients presenting with a medical complaint [4.1 (4.0-4.2) v 10.4 (7.9-13.7 for trauma), and for younger children [1.2 (1.1-1.2) from 0 to 28 days, and 1.9 (1.8-2.0) from 28 days to 3 months]. CONCLUSION pediaTRI has a moderate to good validity to triage children in a Pediatric Emergency Department with a tendency to over-triage compared with the PEWS system. Its validity is lower for younger children and for children consulting for a medical complaint.
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Affiliation(s)
- Antoine Tran
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France.,School of Medicine, Université Côte d'Azur, Nice, France.,Research Team EA 3279 "Santé Publique, Maladies Chroniques et Qualité de Vie", School of Medicine, Aix-Marseille Université, Marseille, France
| | - Petri Valo
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France.,School of Computing, University of Eastern Finland, Joensuu, Finland
| | - Camille Rouvier
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France
| | - Emmanuel Dos Ramos
- Department of Medical Computing, General Hospital "les Palmiers", Hyères, France.,Innovation e-Santé Sud, Groupement d'Intérêt Public, Hyères, France
| | - Emma Freyssinet
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France
| | - Emma Baranton
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France
| | - Olivier Haas
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France
| | - Hervé Haas
- Department of Pediatrics, Centre Hospitalier Princesse-Grace, Monaco, Monaco
| | - Christian Pradier
- School of Medicine, Université Côte d'Azur, Nice, France.,Department of Public Health, Archet University Hospital, Nice, France
| | - Stéphanie Gentile
- Research Team EA 3279 "Santé Publique, Maladies Chroniques et Qualité de Vie", School of Medicine, Aix-Marseille Université, Marseille, France
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Wang A, Swinford C, Zhao A, Ramos ED, Gregory RL, Srinivasan M. A Case-Control Study to Determine the Prognostic Features of Salivary Epithelial Cells in Periodontitis. JDR Clin Trans Res 2016; 1:256-265. [PMID: 30931739 DOI: 10.1177/2380084416653596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Periodontitis-a biofilm-induced immunoinflammatory pathology-often progresses gradually, exhibiting periodic bursts and resolution. Exfoliating oral epithelial cells act as reservoirs for key periodontal pathogens, facilitating reinfection or infection of new sites. Since saliva is a rich source of oral epithelial cells, we hypothesized that the microbial and functional profile of salivary epithelial cells (SECs) will reflect the in situ host response and disease severity. We used a case-control study design. Unstimulated whole saliva was collected from 20 chronic periodontitis patients and 20 healthy controls in accordance with the institutional review board. The isolated SECs were assessed for viability by trypan blue exclusion. Gram-stained SECs were analyzed by ImageJ, and Gram stain index (GSI) per SEC was calculated. Equal numbers of SECs from each sample were exposed to 2 periodontal pathogens- Porphyromonas gingivalis and Fusobacterium nucleatum-in biofilm or planktonic formulations at varying proportions. Cytokines in culture supernatants were assessed by ELISA (enzyme-linked immunosorbent assay). Additionally, soluble Toll-like receptor 2 (sTLR-2)-a pattern recognition receptor capable of binding microbial ligands associated with periodontitis-was measured in clarified saliva by ELISA. An increased number of SECs, a higher GSI/SEC, and a lower sTLR-2 were observed in periodontitis saliva as compared with healthy saliva. SECs from periodontitis saliva secreted higher amounts of interleukin 8 in response to P. gingivalis, and the presence of F. nucleatum dampened the response. Nonsurgical periodontal treatment improved clinical parameters, reduced the number of SECs, decreased GSI/SEC, and increased sTLR-2 in clarified saliva. In conclusion, our data suggest that SECs can provide a phenotypically distinct individualized resource for assessing epithelial response to pathogens in the course of periodontal disease. Furthermore, correlation between the sTLR-2 and GSI/SEC suggests that the expression profile of epithelial and soluble Toll-like receptor could provide an indirect measure of periodontal disease-associated dysbiosis. Knowledge Transfer Statement: The results of this study can be used for prognostic evaluation of chronic periodontitis in response to therapy and provide an opportunity for early identification of poor responders. A chip-based simple test incorporating the identified salivary epithelial cell characteristics can be developed and validated for future clinical applications, especially for monitoring patients with increased susceptibility for refractory and/or recurrent periodontitis.
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Affiliation(s)
- A Wang
- 1 Department of Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - C Swinford
- 1 Department of Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - A Zhao
- 1 Department of Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - E D Ramos
- 2 Department of Periodontics and Allied Health, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - R L Gregory
- 3 Department of Biomedical and Applied Sciences, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - M Srinivasan
- 1 Department of Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry, Indianapolis, IN, USA
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