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Harris TR, Bhutta ZA, Qureshi I, Kharma N, Raza T, Hssain AA, Pathare AS, D'Silva A, Khatib MY, Mohamedali MGH, Macineira IMG, Garcia Hernandez VR, Garcia JR, Thomas SH, Pathan SA. A randomised clinical trial of awake prone positioning in COVID-19 suspects with acute hypoxemic respiratory failure. Contemp Clin Trials Commun 2024; 39:101295. [PMID: 38689829 PMCID: PMC11059337 DOI: 10.1016/j.conctc.2024.101295] [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] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/22/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
Background Awake prone position (APP) has been reported to improve oxygenation in patients with COVID-19 disease and to reduce the requirement for invasive mechanical ventilation for patients requiring support with high flow nasal cannula. There is conflicting data for patients requiring lower-level oxygen support. Research question Does APP reduce escalation of oxygen support in COVID-19 patients requiring supplementary oxygen?The primary outcome was defined as an escalation of oxygen support from simple supplementary oxygen (NP, HM, NRB) to NIV (CPAP or BiPAP), HFNC or IMV; OR from NIV (CPAP or BiPAP) or HFNC to IMV by day30. Study design Two center, prospective, non-blind, randomised controlled trial. Patients with confirmed or suspected COVID-19 pneumonia requiring ≥ 5 liters/min oxygen to maintain saturations ≥ 94 % were randomised to either APP or control group. The APP group received a 3-h APP session three times per day for three days. Results Between 9 May and July 13, 2021, 89 adults were screened and 61 enrolled, 31 to awake prone position and 30 controls. There was no difference in the primary outcome, 7 (22.6 %) patients randomised to APP and 9 (30.0 %) controls required escalation of oxygen support (OR 0.68 (0.22-2.14), P = 0.51). There were no differences in any secondary outcomes, in APP did not improve oxygenation. Interpretation In COVID-19 patients, the use of APP did not prevent escalation of oxygen support from supplementary to invasive or non-invasive ventilation or improve patient respiratory physiology. Trial registration NCT04853979 (clinicaltrials.gov).
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Affiliation(s)
- Tim R.E. Harris
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar
- Queen Mary University London, United Kingdom
| | - Zain A. Bhutta
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Isma Qureshi
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nadir Kharma
- Corporate Department Medical Intensive Care, Hamad General Hospital, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Tasleem Raza
- Corporate Department Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | - Ali Ait Hssain
- Corporate Department Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | - Ankush Suresh Pathare
- Corporate Department of Emergency Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ashwin D'Silva
- Corporate Department of Emergency Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad Yahya Khatib
- Corporate Medical Intensive Care, Head of Unit, Hazm Mebaireek General Hospital, Doha, Qatar
| | - Mohamed Gafar Hussein Mohamedali
- Corporate Department Internal Medicine, Head of Unit, Hazm Mebaireek General Hospital, Doha, Qatar
- Instructor in Clinical Medicine, Weill Cornell Medicine, Qatar
| | | | | | - Jorge Rosales Garcia
- Corporate Department Medical Intensive Care, The Cuban Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H. Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
- Queen Mary University London, United Kingdom
| | - Sameer A. Pathan
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Steinhoff M, Buddenkotte J, Al-Shafi W, Al-Marri H, Emam F, Iqneibi M, Harris TRE, Thomas SH, Asad SM, Al-Maslamani H, Joy FE, Therachiyil L, Jochebeth A, Leo R, Younis SM, Abu Raddad LJ, Dargham SR, Al-Khawaga S. Retrospective evaluation of a TEN/SJS series managed with a new treatment protocol. J Eur Acad Dermatol Venereol 2024. [PMID: 38713099 DOI: 10.1111/jdv.20060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/16/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Department of Dermatology, Weill Cornell Medicine, New York City, New York, USA
| | - Joerg Buddenkotte
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Wadha Al-Shafi
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Hissa Al-Marri
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Fatima Emam
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Mariam Iqneibi
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Syed Muhammad Asad
- College of Health and Life Sciences, Hamad Bin Khalifa University-Qatar, Ar-Rayyan, Qatar
| | - Hanan Al-Maslamani
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Febu Elizabeth Joy
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Lubna Therachiyil
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Anh Jochebeth
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Rari Leo
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Shahad M Younis
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Sara Al-Khawaga
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University-Qatar, Ar-Rayyan, Qatar
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Levine M, Finkelstein Y, Trautman WJ, Cao D, Schwarz E, Filip A, Cook L, Pathan SA, Obilom C, Liu J, Yanta J, Cohen N, Thomas SH. Is EGD Needed in all Patients after Suicidal or Exploratory Caustic Ingestions? J Med Toxicol 2024:10.1007/s13181-024-01003-2. [PMID: 38647997 DOI: 10.1007/s13181-024-01003-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Caustic ingestions are relatively uncommon, but remain a significant source of morbidity. Patients with caustic injury often undergo an urgent EGD, although it is not clear if an EGD is routinely needed in an asymptomatic patient. The study has two primary objectives; 1) to determine the utility of routine EGD in asymptomatic suicidal caustic ingestions; 2) to determine if asymptomatic unintentional acidic ingestions can be managed with observation alone, similar to basic ingestions. METHODS This retrospective study, which took place at 14 hospitals in three countries evaluated all patients who presented with a caustic ingestion between 2014-2020. The presence of symptoms and esophageal injury, demographic information, pH of ingested substance, reason for the ingestion, and outcome were recorded. RESULTS 409 patients were identified; 203 (46.9%) were male. The median (IQR) age was 18 (4-31) years; overall range 10 months to 78 years. Suicidal ingestions accounted for 155 (37.9%) of cases. Dysphagia or dysphonia were more likely in those with significant esophageal injury compared to those without (59.3% vs. 12.6% respectively; OR 10.1; 95% CI 4.43-23.1). Among 27 patients with significant esophageal injury, 48% were found in suicidal patients, compared with 51.9% in non-suicidal patients (p = NS). On multivariate regression, there was no difference in the rate of significant esophageal injury among suicidal vs. non suicidal patients (aOR 1.55; p = 0.45, 95% CI 0.45-5.33). Most ingestions involved basic substances (332/409; 81.2%). Unknown or mixed ingestions accounted for 25 (6.11%) of the ingestions. Significant esophageal burns were found in 6/52 (11.5%) of acid ingestions, compared with 21/332 (6.3%) of basic ingestions. Of the 42 cases of acidic ingestions without dysphagia or odynophagia, 2 (4.8%; 0.58-16.1%) had significant esophageal burns, compared with 9 (3.2%; 95% CI 1.4-5.9%) of the 284 basic ingestions; p = 0.64). On multivariate logistic regression, patients with acidic ingestions were not more likely to experience a significant burn (aOR 1.7; p = 0.11, 95% CI 0.9-3.1) compared to those with basic ingestions. No patient with significant esophageal burns was asymptomatic. CONCLUSION In this study, there was no statistical differences in the rates of significant burns between acidic and basic caustic ingestions. There were no significant esophageal injuries noted among asymptomatic patients.
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Affiliation(s)
- Michael Levine
- Department of Emergency Medicine, University of California, 1100 Glendon Ave. Suite 1200, Los Angeles, CA, 90024, USA.
| | - Yaron Finkelstein
- Department of Emergency Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - William J Trautman
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dazhe Cao
- Department of Emergency Medicine, Division of Medical Toxicology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Evan Schwarz
- Department of Emergency Medicine, University of California, 1100 Glendon Ave. Suite 1200, Los Angeles, CA, 90024, USA
| | - Ari Filip
- Department of Emergency Medicine, Division of Medical Toxicology, Washington University, St. Louis, MO, USA
| | - Leanne Cook
- Department of Emergency Medicine, University of California, 1100 Glendon Ave. Suite 1200, Los Angeles, CA, 90024, USA
| | | | - Cherie Obilom
- Department of Emergency Medicine, Division of Medical Toxicology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jim Liu
- Department of Emergency Medicine, Division of Medical Toxicology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Joseph Yanta
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Neta Cohen
- Department of Emergency Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
- Blizard Institute, Barts and The London School of Medicine, London, UK
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Schoenfeld DW, Rosen CL, Harris T, Thomas SH. Assessing the one-month mortality impact of civilian-setting prehospital transfusion: A systematic review and meta-analysis. Acad Emerg Med 2024. [PMID: 38517320 DOI: 10.1111/acem.14882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Based on convincing evidence for outcomes improvement in the military setting, the past decade has seen evaluation of prehospital transfusion (PHT) in the civilian emergency medical services (EMS) setting. Evidence synthesis has been challenging, due to study design variation with respect to both exposure (type of blood product administered) and outcome (endpoint definitions and timing). The goal of the current meta-analysis was to execute an overarching assessment of all civilian-arena randomized controlled trial (RCT) evidence focusing on administration of blood products compared to control of no blood products. METHOD The review structure followed the Cochrane group's Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Using the Transfusion Evidence Library (transfusionevidencelibrary.com), the multidatabase (e.g. PubMed, EMBASE) Harvard On-Line Library Information System (HOLLIS), and GoogleScholar, we accessed many databases and gray literature sources. RCTs of PHT in the civilian setting with a comparison group receiving no blood products with 1-month mortality outcomes were identified. RESULTS In assessing a single patient-centered endpoint-1-month mortality-we calculated an overall risk ratio (RR) estimate. Analysis of three RCTs yielded a model with acceptable heterogeneity (I2 = 48%, Q-test p = 0.13). Pooled estimate revealed civilian PHT results in a statistically nonsignificant (p = 0.38) relative mortality reduction of 13% (RR 0.87, 95% CI 0.63-1.19). CONCLUSIONS Current evidence does not demonstrate 1-month mortality benefit of civilian-setting PHT. This should give pause to EMS systems considering adoption of civilian-setting PHT programs. Further studies should not only focus on which formulations of blood products might improve outcomes but also focus on which patients are most likely to benefit from any form of civilian-setting PHT.
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Affiliation(s)
- David W Schoenfeld
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Carlo L Rosen
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Tim Harris
- Blizard Institute for Neuroscience, Surgery, and Trauma, Barts and The London School of Medicine, London, UK
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA
- Blizard Institute for Neuroscience, Surgery, and Trauma, Barts and The London School of Medicine, London, UK
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Bhutta ZA, Akhtar N, Pathan SA, Castren M, Harris T, Ganesan GS, Kamran S, Thomas SH, Cameron PA, Azad AM, Puolakka T. Epidemiological profile of stroke in Qatar: Insights from a seven-year observational study. J Clin Neurosci 2024; 123:30-35. [PMID: 38520927 DOI: 10.1016/j.jocn.2024.03.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES Stroke prevalence is progressively increasing in developing countries due to increased vascular risk factors. This study aims to describe the epidemiology, prevalent risk factors, and outcomes of stroke in a multi-ethnic society of Qatar. MATERIALS AND METHODS We conducted a retrospective analysis of all patients with suspected stroke admitted to stroke services between January 2014 and September 2020. RESULTS A total of 11,892 patients were admitted during this period with suspected stroke. Of these, the diagnosis was ischemic stroke (48.8 %), transient ischemic attack (10.3 %), intracerebral hemorrhage (10.9 %), cerebral venous sinus thrombosis (1.3 %), and stroke mimics (28.6 %). The median age was 52 (43-62), with a male-female ratio of 3:1. The study population was predominantly Asian (56.8 %) and Arab (36 %). The majority of the patients were hypertensive (66.8 %), diabetic (47.9 %), and dyslipidemic (45.9 %). A history of prior stroke was observed in 11.7 %, while 0.9 % had prior transient ischemic attack. Among ischemic strokes, 31.7 % arrived within 4.5 h, 12.5 % received thrombolysis, and 4.6 % underwent thrombectomy. Median Door-to-Needle time was 51 (33-72) minutes. The average length of stay was 5.2 ± 9.0 days, with 71.5 % discharged home, 13.8 % transferred to rehabilitation, 9.3 % to other specialties, 3 % to long-term care, and 2.4 % suffered in-hospital mortality. CONCLUSION Stroke in Qatar is characterized by a younger, expatriate-dominant cohort, with notable prevalence of ischemic and hemorrhagic stroke and a distinct risk factor profile. Further analysis of epidemiological differences among different population groups can inform targeted policies for prevention and management to reduce the burden of disease.
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Affiliation(s)
- Zain A Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Naveed Akhtar
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Sameer A Pathan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Maaret Castren
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Tim Harris
- Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK.
| | - Gowrii S Ganesan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Saadat Kamran
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Stephen H Thomas
- Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK; Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
| | - Peter A Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Aftab M Azad
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Tuukka Puolakka
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Schoenfeld D, Thomas CE, McCartin MP, Blumen IJ, Galvagno SM, Thomas SH. Natural Experiment Outcomes Studies in Rotor Wing Air Medical Transport: Systematic Review and Meta-Analysis of Before-and-After and Helicopter-Unavailable Publications From 1970 to 2022. Air Med J 2024; 43:124-132. [PMID: 38490775 DOI: 10.1016/j.amj.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/12/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) is widely used for prehospital and interfacility transport, but there is a paucity of HEMS outcomes data from studies using randomized controlled trial designs. In the absence of robust randomized controlled trial evidence, judgments regarding HEMS potential benefit must be informed by observational data. Within the study design set of observational analyses, the natural experiment (NE) is notable for its high potential methodologic quality; NE designs are occasionally denoted "quasi-experimental." The aim of this study is to examine all NE outcomes studies in the HEMS literature and to discern what lessons can be learned from these potentially high-quality observational data. METHODS HEMS NE studies were identified during the development of a new HEMS Outcomes Assessment Research Database (HOARD). HOARD was constructed using a broad-ranging search of published and gray literature resources (eg, PubMed, Embase, and Google Scholar) that used variations of the terms "helicopter EMS," "air ambulance," and "air medical transport." Among the 221 studies ultimately included in HOARD, 16 NE publications describing 13 sets of observational data comprising myriad diagnostic groups were identified. Of these 16 HEMS NEs, 4 HEMS NE studies assessing trauma outcomes were used in a meta-analysis. A meta-analysis was also performed of 4 HEMS NE studies. RESULTS Although the disparity of studies (in terms of both case mix and end points) precluded the generation of a pooled effect estimate of an adjusted mortality benefit of HEMs versus ground emergency medical services, HEMS was found to be associated with outcomes improvement in 8 of the 13 cohorts. CONCLUSION The weight of the NE evidence supports a conclusion of some form of HEMS-mediated outcomes improvement in a variety of patient types. Meta-analysis of 4 HEMS NE studies assessing trauma outcomes generated a model with acceptable heterogeneity (I2 = 43%, Q test: P = .16), which significantly (P < .01) favored HEMS use with a pooled HEMS survival odd ratio estimate of 1.66 (95% confidence interval, 1.23-2.22).
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Affiliation(s)
- David Schoenfeld
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Caroline E Thomas
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Michael P McCartin
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL.
| | - Ira J Blumen
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL
| | - Samuel M Galvagno
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Stephen H Thomas
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; EMS Division, Department of Emergency Medicine, Harvard Medical School, Boston, MA; Barts & The London School of Medicine, Queen Mary University of London, London, UK
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Hsueh J, Fritz C, Thomas CE, Reimer AP, Reisner AT, Schoenfeld D, Haimovich A, Thomas SH. Applications of Artificial Intelligence in Helicopter Emergency Medical Services: A Scoping Review. Air Med J 2024; 43:90-95. [PMID: 38490791 DOI: 10.1016/j.amj.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Recent systematic reviews of acute care medicine applications of artificial intelligence (AI) have focused on hospital and general prehospital uses. The purpose of this scoping review was to identify and describe the literature on AI use with a focus on applications in helicopter emergency medical services (HEMS). METHODS A literature search was performed with specific inclusion and exclusion criteria. Articles were grouped by characteristics such as publication year and general subject matter with categoric and temporal trend analyses. RESULTS We identified 21 records focused on the use of AI in HEMS. These applications included both clinical and triage uses and nonclinical uses. The earliest study appeared in 2006, but over one third of the identified studies have been published in 2021 or later. The passage of time has seen an increased likelihood of HEMS AI studies focusing on nonclinical issues; for each year, the likelihood of a nonclinical focus had an odds ratio of 1.3. CONCLUSION This scoping review provides overview and hypothesis-generating information regarding AI applications specific to HEMS. HEMS AI may be ultimately deployed in nonclinical arenas as much as or more than for clinical decision support. Future studies will inform future decisions as to how AI may improve HEMS systems design, asset deployment, and clinical care.
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Affiliation(s)
- Jennifer Hsueh
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Christie Fritz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Andrew P Reimer
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, OH; Cleveland Clinic Critical Care Transport, Cleveland, OH
| | - Andrew T Reisner
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Schoenfeld
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Adrian Haimovich
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Blizard Institute, Barts and The London School of Medicine, London, United Kingdom
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Schoenfeld DW, Thomas CE, Palmer L, Justice W, Hwang E, Zimmerman KD, Goodloe JM, Shecter JD, Thomas SH. Nation-Wide Variation in Presence of Legislation or Protocols for EMS Care of Operational Canines. Prehosp Disaster Med 2024; 39:59-64. [PMID: 38356384 DOI: 10.1017/s1049023x24000074] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND & AIMS Deployment of law enforcement operational canines (OpK9s) risks injuries to the animals. This study's aim was to assess the current status of states' OpK9 (veterinary Emergency Medical Services [VEMS]) laws and care protocols within the United States. METHODS Cross-sectional standardized review of state laws/regulations and OpK9 VEMS treatment protocols was undertaken. For each state and for the District of Columbia (DC), the presence of OpK9 legislation and/or care protocols was ascertained. Information was obtained through governmental records and from stakeholders (eg, state EMS medical directors and state veterinary boards).The main endpoints were proportions of states with OpK9 laws and/or treatment protocols. Proportions are reported with 95% confidence intervals (CIs). Fisher's exact test (P <.05) assessed whether presence of an OpK9 law in a given jurisdiction was associated with presence of an OpK9 care protocol, and whether there was geographic variation (based on United States Census Bureau regions) in presence of OpK9 laws or protocols. RESULTS Of 51 jurisdictions, 20 (39.2%) had OpK9 legislation and 23 (45.1%) had state-wide protocols for EMS treatment of OpK9s. There was no association (P = .991) between presence of legislation and presence of protocols. There was no association (P = .144) between presence of legislation and region: Northeast 66.7% (95% CI, 29.9-92.5%), Midwest 50.0% (95% CI, 21.1-78.9%), South 29.4% (95% CI, 10.3-56.0%), and West 23.1% (95% CI, 5.0-53.8%). There was significant (P = .001) regional variation in presence of state-wide OpK9 treatment protocols: Northeast 100.0% (95% CI, 66.4-100.0%), Midwest 16.7% (95% CI, 2.1-48.4%), South 47.1% (95% CI, 23.0-72.2%), and West 30.8% (95% CI, 9.1-61.4%). CONCLUSION There is substantial disparity with regard to presence of OpK9 legal and/or clinical guidance. National collaborative guidelines development is advisable to optimize and standardize care of OpK9s. Additional attention should be paid to educational and training programs to best utilize the limited available training budgets.
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Affiliation(s)
- David W Schoenfeld
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MassachusettsUSA
| | - Caroline E Thomas
- BS Candidate, Department of Chemistry, Georgetown University, Washington, DCUSA
| | - Lee Palmer
- Auburn University College of Veterinary Medicine, Auburn, AlabamaUSA
| | - William Justice
- Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OklahomaUSA
| | - Esther Hwang
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GeorgiaUSA
| | - Kate D Zimmerman
- Department of Emergency Medicine, Maine Medical Center and Tufts University School of Medicine, Portland, MaineUSA
| | - Jeffrey M Goodloe
- Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OklahomaUSA
| | - Jonathan D Shecter
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MassachusettsUSA
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MassachusettsUSA
- Barts & The London School of Medicine, London, United Kingdom
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Thomas CE, Pathan SA, Bhutta ZA, Qureshi I, Thomas SH. Standard vs. modified vestibular/ocular motor screening for emergency department prediction of symptom persistence 1 week after minor head injury. Eur J Emerg Med 2023; 30:450-452. [PMID: 37883241 DOI: 10.1097/mej.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Caroline E Thomas
- B.S. candidate, Department of Chemistry, Georgetown University, Washington, DC, USA
| | - Sameer A Pathan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Barts & The London School of Medicine and Barts Health NHS Trust, London, UK
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Zain A Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Isma Qureshi
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H Thomas
- Barts & The London School of Medicine and Barts Health NHS Trust, London, UK
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
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10
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Price J, Rudman J, Schoenfeld D, Thomas SA, Rees P, Bloom B, McCartin M, Blumen I, Thomas SH. Survivorship With Incrementally Faster Times to Primary Percutaneous Coronary Intervention (SWIFT-PPCI): A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 207:356-362. [PMID: 37776583 DOI: 10.1016/j.amjcard.2023.08.178] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 10/02/2023]
Abstract
In the United States, there are approximately 750,000 ST-elevation myocardial infarction cases each year. Streamlined care and rapid delivery for primary percutaneous coronary intervention (PPCI) is associated with improved survival. This systematic review and meta-analysis aimed to generate a practical estimate of mortality savings for every notional 30-minute decrease in the time to achieving PPCI. Included studies were those that provided a specific absolute risk reduction for a specific reduction in pre-PPCI time. The eligible studies evaluated the survival benefit from pre-PPCI time savings measured in any interval ending with PPCI and commencing with objectively recorded timing, such as initial emergency call, first medical contact, or hospital arrival. Study planning called for the reporting of data as individual study results, with a pooled effect estimate of relative risk calculated with random-effects meta-analysis. A total of 1,088 records were eligible for review; 52 were reviewed in full text, with 4 studies (total patient n = 235,814, overall mortality 4.7% to 7.8%) included in the final analysis. All 4 studies reported significant time-related survival benefit over the study focus window of 60 to 180 minutes pre-PPCI. The number of lives saved per 100 cases for each 30-minute pre-PPCI time savings ranged from 0.8 to 1.9. The overall effect estimate generated was 0.753 (95% confidence interval 0.712 to 0.796), with acceptable heterogeneity (I2 = 36%). In conclusion, a pooled effect calculation estimated a 24.7% relative risk reduction for each 30 minutes of time savings. For cases that underwent PPCI within 60 to 180 minutes of initial presentation with known baseline mortality risk, the time savings in 30-minute epochs can be leveraged to estimate a specific number of lives saved; this may be useful for those involved in the organization of medical care who make systemwide plans and individual patient triage decisions.
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Affiliation(s)
- James Price
- Department of Emergency Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Research, Audit, Innovation & Development, East Anglian Air Ambulance, Norwich, United Kingdom.
| | - Jordan Rudman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts
| | - David Schoenfeld
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts
| | - Sarah Alice Thomas
- Department of Molecular Microbiology & Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Paul Rees
- Department of Research, Audit, Innovation & Development, East Anglian Air Ambulance, Norwich, United Kingdom; Blizard Institute for Neuroscience, Surgery, & Trauma, Barts & the London School of Medicine, London, United Kingdom; Department of Cardiology, St Bartholomew's Hospital and Barts Health NHS Trust, London, United Kingdom
| | - Ben Bloom
- Blizard Institute for Neuroscience, Surgery, & Trauma, Barts & the London School of Medicine, London, United Kingdom; Department of Emergency Medicine, The Royal London Hospital and Barts Health NHS Trust, London, United Kingdom
| | - Michael McCartin
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois
| | - Ira Blumen
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts; Blizard Institute for Neuroscience, Surgery, & Trauma, Barts & the London School of Medicine, London, United Kingdom
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11
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Qureshi I, Harris T, Pathan SA, Qureshi RS, Al-Bakri F, Thomas SH, Azad AM. What adult patients prefer for reporting their pain levels, and frequency of reassessment when in the emergency department. Am J Emerg Med 2023; 73:11-16. [PMID: 37573661 DOI: 10.1016/j.ajem.2023.08.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVES This study interviewed adult patients presenting to the emergency department (ED) for various pain conditions enquiring about their preferred tool for reporting pain severity and preferred time interval between initial assessment and subsequent pain reassessments. METHODS A prospective observational (cross-sectional) study was conducted in adult patients with acute pain in a tertiary care hospital ED setting. Patients' initial pain score was recorded using NRS (numerical rating scale) pain scale, and appropriate analgesia offered. Once the patient had been evaluated by an attending physician, a research team member interviewed the patient regarding the pain reassessment time and preferred pain assessment tool. The pain assessment tools evaluated in this study were NRS, PS (picture scale or face pain scale), VRS (verbal rating scale), and VAS (visual analogue scale). The patients were presented with the four pain assessment tools (in their primary language) through an audio-visual on an electronic tablet display. RESULTS 200 (138 male, mean age 36.5 ± 11.17) patients participated in the study. With increasing age, pain reassessment interval increased by 0.19 min (95% CI 0.03-0.36 min). Males requested pain reassessment 6.7 min (95% CI 2.2-10.8) faster than females. In this study, the preferred interval for pain reassessment was reported as a mean of 22.8 (SD + -13.6) minutes. There was no relationship reported between time reassessment and pain severity (P = 0.22). Out of 200 subjects, irrespective of the initial pain scores, 100 preferred NRS. NRS was preferred by patients with mild to moderated pain due to the perception of being faster. However, patients with severe pain choose a non-NRS scale to prioritize accuracy. CONCLUSION There was no influence found between the initial pain severity scores and the desired frequency of pain reassessment. However, associations were identified between the time for pain reassessment interval and age, sex, and geographical region. Patients with severe pain preferred PS or VRS while patients with mild/moderate pain preferred the NRS.
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Affiliation(s)
- Isma Qureshi
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Tim Harris
- Blizard Institute, Queen Mary University London, UK
| | - Sameer A Pathan
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Blizard Institute, Queen Mary University London, UK; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Raheel S Qureshi
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Faten Al-Bakri
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H Thomas
- Blizard Institute, Queen Mary University London, UK; Beth Israel Deaconess Medical Center and Harvard Medical School, United States of America
| | - Aftab M Azad
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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12
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Rudman JS, Fritz CL, Thomas SA, McCartin M, Price J, Blumen IJ, Thomas SH. Helicopter Emergency Medical Services Outcomes Research 1983 to 2022: Evidence Overview and Longitudinal Trends. Air Med J 2023; 42:429-435. [PMID: 37996177 DOI: 10.1016/j.amj.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) literature has been assessed in reviews focusing on various diagnoses, but there are few, if any, summaries of the entire body of HEMS outcomes evidence. Our goal was to summarize the existing research addressing patient-centered outcomes potentially accrued with HEMS. METHODS As part of the Critical Care Transport Collaborative Outcomes Research Effort, we generated the HEMS Outcomes Assessment Research Database and executed descriptive analyses of longitudinal trends from 1983 to 2022. Both indexed and gray literature sources were incorporated in the HEMS Outcomes Assessment Research Database. Studies were reviewed by at least 2 authors to select those that addressed a patient-centered outcome. Studies addressing solely HEMS logistics were excluded. Categoric analyses were executed with the Fisher exact test, and continuous variables were evaluated for normality with normal quantile plotting and a comparison of medians and 95% confidence intervals. RESULTS We found that HEMS outcomes study sample sizes increased steadily from 1983 to 2012, with the most recent decade demonstrating a marked increase in the rate of publication of HEMS outcomes studies. Most research (70.6%) addressed trauma patient outcomes, but recent decades have seen a significant increase in non-trauma studies. Recent decades have also been characterized by an increase in the production of HEMS outcomes research outside of North America and Europe. CONCLUSION This study summarizes the current state of the HEMS outcome literature. We highlight increasing contributions from worldwide researchers and increasing focus on HEMS benefits in non-trauma cases, particularly time-critical cases such as cardiac or stroke diagnoses. This provides a basis for further investigations into patient-oriented benefits potentially accrued with HEMS.
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Affiliation(s)
- Jordan S Rudman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Christie L Fritz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sarah A Thomas
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael McCartin
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL
| | - James Price
- Department of Emergency Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Norwich, United Kingdom
| | - Ira J Blumen
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
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13
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Fritz CL, Thomas SA, Galvagno SM, Thomas SH. Survival benefit of helicopter scene response for patients with an Injury Severity Score of at least nine: A systematic review and meta-analysis. PREHOSP EMERG CARE 2023:1-15. [PMID: 37406174 DOI: 10.1080/10903127.2023.2232453] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
Background and AimHelicopter EMS (HEMS) is a well-established mode of rapid transportation for patients with need for time-sensitive interventions, especially in patients with significant traumatic injuries. Traditionally in the setting of trauma, HEMS is often considered appropriate when used for patients with "severe" injury as defined by Injury Severity Score (ISS) >15. This may be overly conservative, and patients with a lower ISS may benefit from HEMS-associated speed or care quality. Our objective was to perform a meta-analysis of trauma HEMS transports to evaluate for possible mortality benefit in injured cases defined by an ISS score >8, lower than the customary ISS cutoff of >15.MethodsA broad search of the literature was performed including PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials, and Google Scholar from the years 1970 to 2022. The gray literature and reference lists of included publications were also examined. We included studies with the outcome of mortality in HEMS vs control in trauma transports from scene of injury for patients (adult or pediatric) with ISS > 8.ResultsNine eligible studies were used in the final analysis: six in the primary analysis and three in sensitivity analysis due to patient overlap. All studies reported statistically significant survival benefit in HEMS compared to control group. The minimum survival odds ratio (OR) benefit observed was OR 1.15 (95% CI 1.06-1.25) and maximum was OR 2.04 (95% CI 1.18-3.57). Risk of bias tool (ROBINS-I) application yielded moderate to low risk of bias, mainly due to the observational nature of the studies included.ConclusionsThere was a statistically significant survival benefit in patients with ISS > 8 when HEMS was used over traditional ground ambulance transportation, although novel and more inclusive trauma triage criteria may be more appropriate in the future to guide HEMS utilization decision-making. Restricting HEMS to trauma patients with ISS >15 likely misses survival benefit that could be afforded to the subset of trauma patients with serious injury.
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Affiliation(s)
- Christie L Fritz
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts USA
| | - Sarah Alice Thomas
- Department of Molecular Microbiology & Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
| | - Samuel M Galvagno
- Department of Anesthesiology, University of Maryland School of Medicine & R. Adams Cowley Shock Trauma Center, Baltimore, Maryland USA
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK
| | - Stephen H Thomas
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts USA
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK
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14
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Qureshi I, Abdulrashid K, Thomas SH, Abdel-Rahman ME, Pathan SA, Harris T. Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis. Emerg Med J 2023; 40:499-508. [PMID: 37173122 DOI: 10.1136/emermed-2022-212869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opiates/opioids, administered parenterally via intravenous or intramuscular route, are widely used to provide analgesia for patients with moderate to severe pain. This systematic review and meta-analysis evaluated the level of analgesia provided by intravenous paracetamol (IVP) alone compared with NSAIDs (intravenous or intramuscular), or opioids (intravenous) alone in adults attending the ED with acute pain. METHODS Two authors independently searched PubMed (MEDLINE), Web of Science, Embase (OVID), Cochrane Library, SCOPUS and Google Scholar (3 March 2021-20 May 2022) for randomised trials without any language or date restriction. Clinical trials were evaluated using the Risk of Bias V.2 tool. The primary outcome was mean difference (MD) for pain reduction at 30 min (T30) post analgesia delivery. The secondary outcomes were MD in pain reduction at 60, 90 and 120 min; the need for rescue analgesia; and the occurrence of adverse events (AEs). RESULTS Twenty-seven trials (5427 patients) were included in the systematic review and 25 trials (5006 patients) in the meta-analysis. There was no significant difference in pain reduction at T30 between the IVP group and opioids (MD -0.13, 95% CI -1.49 to 1.22) or IVP and NSAIDs (MD -0.27, 95% CI -1.0 to 1.54. There was also no difference at 60 min, IVP group versus opioid group (MD -0.09, 95% CI -2.69 to 2.52) or IVP versus NSAIDs (MD 0.51, 95% CI 0.11 to 0.91). The quality of the evidence using Grading of Recommendations, Assessments, Development and Evaluations methodology was low for MD in pain scores.The need for rescue analgesia at T30 was significantly higher in the IVP group compared with the NSAID group (risk ratio (RR): 1.50, 95% CI 1.23 to 1.83), with no difference found between the IVP group and the opioid group (RR: 1.07, 95% CI 0.67 to 1.70). AEs were 50% lower in the IVP group compared with the opioid group (RR: 0.50, 95% CI 0.40 to 0.62), whereas no difference was observed in the IVP group compared with the NSAID group (RR: 1.30, 95% CI 0.78 to 2.15). CONCLUSION In patients presenting to the ED with a diverse range of pain conditions, IVP provides similar levels of pain relief compared with opiates/opioids or NSAIDs at T30 post administration. Patients treated with NSAIDs had lower risk of rescue analgesia, and opioids cause more AEs, suggesting NSAIDs as the first-choice analgesia and IVP as a suitable alternative. PROSPERO REGISTRATION NUMBER CRD42021240099.
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Affiliation(s)
- Isma Qureshi
- Emergency Medicine, Hamad General Hospital, Doha, Qatar
| | - Khadiga Abdulrashid
- Public Health, Qatar University College of Health Sciences, Doha, Qatar
- Primary Health Care Corporation, Doha, Qatar
| | - Stephen H Thomas
- Emergency Medicine, Hamad General Hospital, Doha, Qatar
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | | | - Sameer A Pathan
- Emergency Medicine, Hamad General Hospital, Doha, Qatar
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
- School of Public health and Preventive medicine, Monash University, Melbourne, Victoria, Australia
| | - Tim Harris
- Emergency Medicine, Hamad General Hospital, Doha, Qatar
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
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15
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Thomas CE, Thomas SH, Bloom B. Vestibular/ocular motor screening (VOMS) score for identification of concussion in cases of non-severe head injury: A systematic review. Journal of Concussion 2023. [DOI: 10.1177/20597002231160941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background and importance Each year, 1.4 million patients attend a UK ED with a head injury. Mild traumatic brain injury affects up to 300/100 000 admitted patients/year and a greater number of non-admitted patients. Identifying those patients with a head injury that have concussion, and of those, which will have a prolonged recovery, is critical for discharge planning. The Vestibular/Ocular Motor Screening test (VOMS) has been reported as a useful “sideline tool” to evaluate for sports-related concussion (SRC). VOMS has been assessed for utility primarily for predicting in head-injured, which cases will have concussion, and secondarily in predicting in concussed patients, which will have prolonged recovery. Originally described in 2014, VOMS has not been subject to systematic review or meta-analysis, with regard to its predictive performance for concussion. Objective To assess the state of VOMS evidence for dichotomously classifying concussion status in patients with non-severe head injury Design Systematic review. Setting and participants Studies comprising the review enrolled ambulatory head-injured adults and children, usually from sports-related settings, in Europe or the USA. Exposure VOMS. Outcome measures Presence of concussion, presence of prolonged recovery in concussed patients Main results The review identified 17 studies, characterized by a wide variety of specific approaches to administering and scoring VOMS. While VOMS showed promise as a screening tool for concussion, marked study heterogeneity precluded generation of a pooled effect estimate for VOMS performance. Conclusion VOMS is potentially useful as a concussion screening tool. Available evidence from the SRC arena suggests sensitivity ranging from 58–96%, with specificity 46−92%. Directions for future VOMS research should include evaluation of standardized administration and scoring, potentially of a simpler VOMS (with fewer components), in a general head-injured population. Further analysis of precisely defined VOMS application may be useful to determine the proper place of VOMS screening for the head-injured.
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Affiliation(s)
| | - Stephen H. Thomas
- Blizard Institute Centre for Neuroscience, Surgery, & Trauma; Barts & The London School of Medicine, London, UK
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Ben Bloom
- Blizard Institute Centre for Neuroscience, Surgery, & Trauma; Barts & The London School of Medicine, London, UK
- Barts Health NHS Trust, London UK
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16
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Albaroudi O, Albaroudi B, Basharat K, Haddad M, Talal Basrak M, Elmelliti H, Thomas SH, Harris T. Awake prone position for COVID-19 pneumonia patients: A prospective analysis at a tertiary care center. Journal of Emergency Medicine, Trauma and Acute Care 2022. [DOI: 10.5339/jemtac.2022.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Omar Albaroudi
- Trauma and Emergency Center, Hamad General Hospital, HMC, Qatar E-mail:
| | - Bilal Albaroudi
- Trauma and Emergency Center, Hamad General Hospital, HMC, Qatar E-mail:
| | - Kaleem Basharat
- Trauma and Emergency Center, Hamad General Hospital, HMC, Qatar E-mail:
| | - Mahmoud Haddad
- Trauma and Emergency Center, Hamad General Hospital, HMC, Qatar E-mail:
| | | | - Hussam Elmelliti
- Trauma and Emergency Center, Hamad General Hospital, HMC, Qatar E-mail:
| | - Stephen H. Thomas
- Trauma and Emergency Center, Hamad General Hospital, HMC, Qatar E-mail:
| | - Tim Harris
- Barts Health NHS Trust and Queen Mary University of London, UK
- Trauma and Emergency Center, Hamad General Hospital, HMC, Qatar E-mail:
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17
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Bhutta ZA, AKHTAR NAVEED, Pathan SA, Puolakka T, Harris T, Ganesan GSS, Kamran S, Thomas SH, Cameron P, Castren MK. Abstract TP195: A Comprehensive Epidemiology Of Stroke In A Multi Ethnic Society: An Analysis Of A Nationwide Stroke Data From 2014 - 2020. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The prevalence of stroke is progressively increasing in developing countries owing to the increase in vascular risk factors in the population. Risk factors vary significantly in different population groups leading to variations in disease progression, management and outcomes. This study aims to describe the epidemiology, prevalent risk factors and outcomes in a multi ethnic society of Qatar.
Methods:
We conducted a retrospective cohort study that included all patients with suspected stroke admitted to Hamad General Hospital, Doha Qatar between April 30, 2014 till September 15, 2020.
Results:
A total of 11,892 patients were admitted during this period with suspected stroke. Of these, Ischemic stroke (IS; 48.8%), Transient ischemic attack (TIA; 10.3%), Intracerebral hemorrhage (ICH; 10.9%), Stroke mimics (28.6%) and Cerebral venous sinus thrombosis (CVST; 1.3%). Mean age was 53.1
+
14.1 and a male to female ratio of 3:1. Study population was majorly Asian (56.8%) and Arab (36%); while African (4.5%), Caucasian (2.6%) and Others (0.1%) formed minority of the population. Asian population (South Asian; 49.7
+
11.6 and Far Eastern; 47.4
+
9.9) were younger as compared to Arabs (58.9
+
15.9). Majority of the patients were hypertensive (66.8%), diabetic (47.9%) and dyslipidemic (45.9%) on admission, while cardiac diseases (14.7%) and DVT (0.3%) were observed in fewer patients. Patients with a history of prior stroke were 11.7%, while 0.9% had a prior TIA. In IS patients, 31.7% of the patients arrived ED within the 4.5-hour thrombolysis window, 12.5% received thrombolysis and 4.6% received thrombectomy. The average Door-to-Needle time for IS patients was 58.9
+
39.5 minutes. The average length of stay was 5.2
+
9.0 days with 71.5% discharged home, 13.8% transferred to rehabilitation, 9.3% to other specialties, 3% to long term care and 2.4% suffered in-hospital mortality.
Conclusion:
The patients suffering Stroke in Qatar are relatively younger than western population. Highly prevalent vascular risk factors could explain younger presentation and relatively high burden of stroke. Further analysis of epidemiological differences between ethnic subgroups can help tailoring effective preventive and management policies to reduce the burden of disease.
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Affiliation(s)
| | | | | | - Tuukka Puolakka
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
| | - Tim Harris
- Emergency Medicine, Hamad Med Corp, Doha, Qatar
| | | | - Saadat Kamran
- Hamad General Hosp, Weil Cornell Sch of Medicine, Qatar, Doha, Qatar
| | | | - Peter Cameron
- The Alfred Hosp, Emergency and Trauma Cntr , Monash Univ, Melbourne, Australia
| | - Maaret K Castren
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
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18
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Bhutta ZA, AKHTAR NAVEED, Pathan SA, Puolakka T, Harris T, Ganesan GSS, Kamran S, Thomas SH, Cameron P, Castren MK. Abstract TP71: Characteristics And Demographics Of Patients Using Emergency Medical Services For Suspected Acute Stroke And Its Impact On Long-term Outcomes In A Multi Ethnic Population. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Acute ischemic stroke (IS) patients who receive IV thrombolysis are more likely to have good long-term prognosis. Unfortunately, more than two-third of IS patients present outside the therapeutic window. The use of emergency medical services (EMS) can reduce pre-hospital delay and increase likelihood of treatment with t-PA. We aim to determine the characteristic variations amongst the suspected acute stroke patients using EMS.
Methods:
In this retrospective observational study, all suspected acute stroke patients admitted to Hamad General Hospital from April 30, 2014 to September 15, 2020 were included. We evaluated demographics, clinical features, impact on treatment and associated factors in EMS versus non-EMS group.
Results:
During the study period, 11892 patients presented as suspected acute stroke. Of these, 65.1% used EMS (EMS-group). Mean age in EMS group was 53.4
+
14.1 versus 52.6
+
14.0 in non-EMS group (p = 0.003). Male to female ratio in both groups was 3:1. The proportion of patients who used EMS were higher in the Asian (66.8%), African (66.8%) and Caucasian (66.6%) population as compared to Arabs (61.9%). EMS use in Qatari population (59.2%) was relatively low. Intracerebral hemorrhage patients (82.4%) had a significantly higher EMS use followed by IS (65.7%) and cerebral venous thrombosis (64.7%); p<0.001. Symptom onset time of less than 4.5 hours at presentation was reported by 41% in EMS-group versus 24.3% in Non-EMS group. Patients with prior stroke (65.5%) and transient ischemic attack (58.4%) preferred EMS as compared to Non-EMS group (34.5% and 41.5%). Patients with unilateral weakness (66.4%) aphasia (78.2%), neglect (78.2%), dysarthria (68.4%), loss of consciousness (83.3%) and seizures (83.9%) had a higher use of EMS versus non-EMS group. The thrombolysis rate in EMS group was high vs non-EMS (82.4% vs 17.6%; p<0.001) with a door-to-needle time significantly lower in the EMS group (56.4
+
38.2 vs 75.7
+
43.8; p<0.001).
Conclusion:
EMS use facilitate rapid transfer, timely stroke evaluation and management of patients who need time-critical care. Patient characteristics and demographics, clinical symptoms and stroke type are associated with early stroke recognition and EMS use leading to higher recanalization rate.
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Affiliation(s)
| | | | | | - Tuukka Puolakka
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
| | - Tim Harris
- Emergency Medicine, Hamad Med Corp, Doha, Qatar
| | | | - Saadat Kamran
- Hamad General Hosp, Weil Cornell Sch of Medicine, Qatar, Doha, Qatar
| | | | - Peter Cameron
- Emergency Medicine, The Alfred Hosp, Emergency and Trauma Cntr , Monash Univ, Melbourne, Australia
| | - Maaret K Castren
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
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19
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Pathan SA, Moinudheen J, Simon K, Thomas SH. COVID-19 cases presenting to the Emergency Department predict Qatar National COVID-19 trends and numbers. Qatar Med J 2021; 2021:56. [PMID: 34733709 PMCID: PMC8542101 DOI: 10.5339/qmj.2021.56] [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] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022] Open
Abstract
In this short communication, we summarized the analyses, models, and interpretations of the corporate department of emergency medicine's (CDEM) COVID-19 numbers and their relationship to predict the national COVID-19 trends and numbers in Qatar. Data included in this analysis were obtained between March 1, 2020 and July 31, 2021. It included the number of COVID-19 cases that presented to four major EDs under the Hamad Medical Corporation CDEM umbrella and published data from the Qatar Ministry of public health (MoPH). On plotting weighted scatterplot smoothing (lowess) trend lines, there were striking similarities between CDEM and national COVID-19 n curves for overall trends and peaks. In conclusion, CDEM COVID-19 spike may be useful to predict national COVID-19 spike in 2-3 weeks.
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Affiliation(s)
| | - Jibin Moinudheen
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar E-mail:
| | - Katie Simon
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar E-mail:
| | - Stephen H Thomas
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar E-mail: .,Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
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20
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Kodumayil SA, Kodumayil A, Thomas SA, Pathan SA, Bhutta ZA, Qureshi I, Azad A, Harris TR, Thomas SH. Q-DEPICT: Qatar Determining Emergency Physician Incidence of COVID-Positive Testing. Qatar Med J 2021; 2021:44. [PMID: 34660215 PMCID: PMC8501270 DOI: 10.5339/qmj.2021.44] [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] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/15/2021] [Indexed: 11/05/2022] Open
Abstract
Despite protective measures such as personal protective equipment (PPE) and a COVID airway management program (CAMP), some emergency physicians will inevitably test positive for COVID. We aim to develop a model predicting weekly numbers of emergency physician COVID converters to aid operations planning. The data were obtained from the electronic medical record (EMR) used throughout the national healthcare system. Hamad Medical Corporation's internal emergency medicine workforce data were used as a source of information on emergency physician COVID conversion and numbers of emergency physicians completing CAMP training. The study period included the spring and summer months of 2020 and started on March 7 and ran for 21 whole weeks through July 31. Data were extracted from the system's EMR database into a spreadsheet (Excel, Microsoft, Redmond, USA). The statistical software used for all analyses and plots was Stata (version 16.1 MP, StataCorp, College Station, USA). All data definitions were made a priori. A total of 35 of 250 emergency physicians (14.0%, 95% CI 9.9%–19.9%) converted to a positive real-time reverse transcriptase-polymerase chain reaction (PCR) during the study's 21-week period. Of these. only two were hospitalized for having respiratory-only disease, and none required respiratory support. Both were discharged within a week of admission. The weekly number of newly COVID-positive emergency physicians was zero and was seen in eight of 21 (38.1%) weeks. The peak weekly counts of six emergency physicians with new COVID-positive were seen in week 14. The mean weekly number of newly COVID-positive emergency physicians was 1.7 ± 1.9, and the median was 1 (IQR, 0 to 3). This study demonstrates that in the State of Qatar's Emergency Department (ED) system, knowing only four parameters allows the reliable prediction of the number of emergency physicians likely to convert COVID PCR tests within the next week. The results also suggest that attention to the details of minimizing endotracheal intubation (ETI) risk can eliminate the expected finding of the association between ETI numbers and emergency physician COVID numbers.
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Affiliation(s)
| | - Ashid Kodumayil
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Sarah A Thomas
- BSc Candidate in Medical Biosciences, Faculty of Medicine, Imperial College London, UK
| | | | | | - Isma Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Aftab Azad
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Tim R Harris
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail: .,Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail: .,Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
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21
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Pathan SA, Thomas CE, Bhutta ZA, Qureshi I, Thomas SA, Moinudheen J, Thomas SH. Qatar Prediction Rule Using ED Indicators of COVID-19 at Triage. Qatar Med J 2021; 2021:18. [PMID: 34422577 PMCID: PMC8359675 DOI: 10.5339/qmj.2021.18] [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] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/04/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The presence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and its associated disease, COVID-19 has had an enormous impact on the operations of the emergency department (ED), particularly the triage area. The aim of the study was to derive and validate a prediction rule that would be applicable to Qatar's adult ED population to predict COVID-19-positive patients. METHODS This is a retrospective study including adult patients. The data were obtained from the electronic medical records (EMR) of the Hamad Medical Corporation (HMC) for three EDs. Data from the Hamad General Hospital ED were used to derive and internally validate a prediction rule (Q-PREDICT). The Al Wakra Hospital ED and Al Khor Hospital ED data formed an external validation set consisting of the same time frame. The variables in the model included the weekly ED COVID-19-positivity rate and the following patient characteristics: region (nationality), age, acuity, cough, fever, tachypnea, hypoxemia, and hypotension. All statistical analyses were executed with Stata 16.1 (Stata Corp). The study team obtained appropriate institutional approval. RESULTS The study included 45,663 adult patients who were tested for COVID-19. Out of these, 47% (n = 21461) were COVID-19 positive. The derivation-set model had very good discrimination (c = 0.855, 95% Confidence intervals (CI) 0.847-0.861). Cross-validation of the model demonstrated that the validation-set model (c = 0.857, 95% CI 0.849-0.863) retained high discrimination. A high Q-PREDICT score ( ≥ 13) is associated with a nearly 6-fold increase in the likelihood of being COVID-19 positive (likelihood ratio 5.9, 95% CI 5.6-6.2), with a sensitivity of 84.7% (95% CI, 84.0%-85.4%). A low Q-PREDICT ( ≤ 6) is associated with a nearly 20-fold increase in the likelihood of being COVID-19 negative (likelihood ratio 19.3, 95% CI 16.7-22.1), with a specificity of 98.7% (95% CI 98.5%-98.9%). CONCLUSION The Q-PREDICT is a simple scoring system based on information readily collected from patients at the front desk of the ED and helps to predict COVID-19 status at triage. The scoring system performed well in the internal and external validation on datasets obtained from the state of Qatar.
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Affiliation(s)
| | | | | | | | - Sarah A Thomas
- Bachelor Candidate in Medical Biosciences, Faculty of Medicine, Imperial College London, UK
| | | | - Stephen H Thomas
- Hamad Medical Corporation, Doha, Qatar E-mail:
- Blizard Institute of Barts & The London School of Medicine, Queen Mary Univ. of London, UK
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22
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Irfan FB, Castren M, Bhutta ZA, George P, Qureshi I, Thomas SH, Pathan SA, Alinier G, Shaikh LA, Suwaidi JA, Singh R, Shuaib A, Tariq T, McKenna WJ, Cameron PA, Djarv T. Ethnic differences in out-of-hospital cardiac arrest among Middle Eastern Arabs and North African populations living in Qatar. Ethn Health 2021; 26:460-469. [PMID: 30303400 DOI: 10.1080/13557858.2018.1530736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Abstract
Aims: There are very few studies comparing epidemiology and outcomes of out-of-hospital cardiac arrest (OHCA) in different ethnic groups. Previous ethnicity studies have mostly determined OHCA differences between African American and Caucasian populations. The aim of this study was to compare epidemiology, clinical presentation, and outcomes of OHCA between the local Middle Eastern Gulf Cooperation Council (GCC) Arab and the migrant North African populations living in Qatar.Methods: This was a retrospective cohort study of Middle Eastern GCC Arabs and migrant North African patients with presumed cardiac origin OHCA resuscitated by Emergency Medical Services (EMS) in Qatar, between June 2012 and May 2015.Results: There were 285 Middle Eastern GCC Arabs and 112 North African OHCA patients enrolled during the study period. Compared with the local GCC Arabs, univariate analysis showed that the migrant North African OHCA patients were younger and had higher odds of initial shockable rhythm, pre-hospital interventions (defibrillation and amioderone), pre-hospital scene time, and decreased odds of risk factors (hypertension, respiratory disease, and diabetes) and pre-hospital response time. The survival to hospital discharge had greater odds for North African OHCA patients which did not persist after adjustment. Multivariable logistic regression showed that North Africans were associated with lower odds of diabetes (OR 0.48, 95% CI 0.25-0.91, p = 0.03), and higher odds of initial shockable rhythm (OR 2.86, 95% CI 1.30-6.33, p = 0.01) and greater scene time (OR 1.02 95% CI 1.0-1.04, p = 0.02).Conclusions: North African migrant OHCA patients were younger, had decreased risk factors and favourable OHCA rhythm and received greater ACLS interventions with shorter pre-hospital response times and longer scene times leading to better survival.
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Affiliation(s)
- Furqan B Irfan
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Maaret Castren
- Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Zain A Bhutta
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Pooja George
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Isma Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sameer A Pathan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, Qatar
- School of Health and Social Work, Paramedic Division, University of Hertfordshire, Hatfield, UK
| | - Loua A Shaikh
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, Qatar
| | - Jassim A Suwaidi
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Tooba Tariq
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | | | - Peter A Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Therese Djarv
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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23
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Elmoheen A, AlEssai G, Awad Salem W, Thomas SH. The establishment of a medical toxicology consulting service for advancing care of poisoning and overdose in Qatar. Qatar Med J 2021; 2020:44. [PMID: 33520686 PMCID: PMC7819277 DOI: 10.5339/qmj.2020.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/26/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives: The State of Qatar, in recent decades, underwent rapid, and substantial population growth. The country's emergency medicine (EM) needs are met by government-operated facilities of the Hamad Medical Corporation (HMC), which see virtually all acute-care cases in adults and children. In 2017, emergency departments (ED) established the Medical Toxicology Consulting Service (MTCS). This report aims to outline the MTCS's initial 100 cases’ experience and report salient findings that can help ongoing national strategies in meeting Qatar's medical toxicology needs. Methods: The study setting is Qatar, and the clinical base for the MTCS was the country's sole level I center, Hamad General Hospital. The MTCS group is composed of six physicians, all with advanced training in medical toxicology. The study group is composed of the first 100 consecutive cases of the MTCS registry. Registry entry was triggered by in-person consultation, telephone consultation, or identification of cases by daily MTCS rounder surveillance of the ED's electronic tracking board. Results: The MTCS institution identified a significant number of medical toxicology cases within the national hospital system. The trends of poisoning in this study showed a median age of 30 years (range 1–81 years, IQR 22–36 years). Fourteen patients were < 18 years old. The median interval between exposure and ED presentation was 2 hours, with a range of 15 minutes to 24 hours (IQR 1–3 hours). Most patients (71%, 95% CI, 51%–80%) were symptomatic because they were exposed. The MTCS recommended therapeutic intervention in over a third of cases (36%, 95% CI, 27%–46%). Decontamination procedures were ordered in 8% of cases (95% CI, 4%–15%) and specific therapies recommended in 13 cases (13%, 95% CI, 7%–21%). Conclusions: The study highlighted that the availability of experts in medical toxicology, such as with a poison center or toxicology consultation service, results in significant resource conservation in the management of poisoned patients.
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Affiliation(s)
- Amr Elmoheen
- Department of Emergency Medicine, Hamad Medical Corporation, Qatar E-mail:
| | - Galal AlEssai
- Department of Emergency Medicine, Hamad Medical Corporation, Qatar E-mail:
| | - Waleed Awad Salem
- Department of Emergency Medicine, Hamad Medical Corporation, Qatar E-mail:
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24
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Jenkins D, Thomas SA, Pathan SA, Thomas SH. Increasing consultant-level staffing as a proportion of overall physician coverage improves emergency department length of stay targets. BMC Emerg Med 2021; 21:5. [PMID: 33441082 PMCID: PMC7805094 DOI: 10.1186/s12873-020-00399-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives One goal of Emergency Department (ED) operations is achieving an overall length of stay (LOS) that is less than four hours. The goal of the current study was to assess for association between increasing number of on-duty EM Consultants and LOS, while adjusting for overall (all-grade) on-duty emergency doctors’ numbers and other operational factors. Methods This was a retrospective analysis of three years (2016–2019) of data, employing a unit of analysis of 3276 eight-hour ED shifts. The study was conducted using a prospectively populated ED database in a busy (annual census 420,000) Middle Eastern ED with staffing by Consultants and multiple non-Consultant grades (Specialists, fellows, and residents). Using logistic regression, the main predictor variable of “on-duty Consultant n” was assessed for association with the study’s primary (dichotomous) endpoint: whether a shift’s median LOS met the target of < 240 min. Linear regression was used to assess for association between on-duty Consultant n and the study’s secondary (continuous) endpoint: median LOS for the ED shift. Results Multivariate logistic regression adjusting for a number of operations factors (including total EP on-duty complement) identified an association between increasing n of on-duty Consultants and the likelihood of a shift’s meeting the 4-h ED LOS target (OR 1.27, 95% CI 1.20 to 1.34, p < .0001). Multiple linear regression, which also adjusted for total on-duty EP n and other operational factors, also indicated LOS benefit from more on-duty Consultants: each additional on-duty Consultant was associated with a shift’s median LOS improving by 5.4 min (95% CI 4.3 to 6.5, p < .0001). Conclusions At the study site, in models that adjusted for overall on-duty EP numbers as well as myriad other operational factors, increasing numbers of on-duty Consultants was associated with a statistically and operationally significant reduction in ED LOS. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-020-00399-8.
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Affiliation(s)
- Dominic Jenkins
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
| | | | - Sameer A Pathan
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar.,Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
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25
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Qureshi RS, Qureshi I, Abbasy M, Malik WA, Ponnapan B, Gauhar A, Chaudhry S, Pathan S, Jenkins D, Thomas SH. Unexpected return visits to emergency department: A healthcare quality management challenge. International Journal of Healthcare Management 2020. [DOI: 10.1080/20479700.2018.1500223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Omrani AS, Pathan SA, Thomas SA, Harris TR, Coyle PV, Thomas CE, Qureshi I, Bhutta ZA, Mawlawi NA, Kahlout RA, Elmalik A, Azad AM, Daghfal J, Mustafa M, Jeremijenko A, Soub HA, Khattab MA, Maslamani MA, Thomas SH. Randomized double-blinded placebo-controlled trial of hydroxychloroquine with or without azithromycin for virologic cure of non-severe Covid-19. EClinicalMedicine 2020; 29:100645. [PMID: 33251500 PMCID: PMC7678437 DOI: 10.1016/j.eclinm.2020.100645] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 09/05/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hydroxychloroquine (HC) ± azithromycin (AZ) is widely used for Covid-19. The Qatar Prospective RCT of Expediting Coronavirus Tapering (Q-PROTECT) aimed to assess virologic cure rates of HC±AZ in cases of low-acuity Covid-19. METHODS Q-PROTECT employed a prospective, placebo-controlled design with blinded randomization to three parallel arms: placebo, oral HC (600 mg daily for one week), or oral HC plus oral AZ (500 mg day one, 250 mg daily on days two through five). At enrollment, non-hospitalized participants had mild or no symptoms and were within a day of Covid-19 positivity by polymerase chain reaction (PCR). After six days, intent-to-treat (ITT) analysis of the primary endpoint of virologic cure was assessed using binomial exact 95% confidence intervals (CIs) and χ2 testing. (ClinicalTrials.gov NCT04349592, trial status closed to new participants.). FINDINGS The study enrolled 456 participants (152 in each of three groups: HC+AZ, HC, placebo) between 13 April and 1 August 2020. HC+AZ, HC, and placebo groups had 6 (3·9%), 7 (4·6%), and 9 (5·9%) participants go off study medications before completing the medication course (p = 0·716). Day six PCR results were available for all 152 HC+AZ participants, 149/152 (98·0%) HC participants, and 147/152 (96·7%) placebo participants. Day six ITT analysis found no difference (p = 0·821) in groups' proportions achieving virologic cure: HC+AZ 16/152 (10·5%), HC 19/149 (12·8%), placebo 18/147 (12·2%). Day 14 assessment also showed no association (p = 0·072) between study group and viral cure: HC+AZ 30/149 (20·1%,), HC 42/146 (28·8%), placebo 45/143 (31·5%). There were no serious adverse events. INTERPRETATION HC±AZ does not facilitate virologic cure in patients with mild or asymptomatic Covid-19. FUNDING The study was supported by internal institutional funds of the Hamad Medical Corporation (government health service of the State of Qatar).
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Affiliation(s)
- Ali S. Omrani
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Sameer A. Pathan
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
- Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sarah A. Thomas
- BSc Candidate in Medical Biosciences, Faculty of Medicine, Imperial College London, UK
| | - Tim R.E. Harris
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
- Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
| | - Peter V. Coyle
- Departments of Virology and Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha
| | - Caroline E. Thomas
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
| | - Isma Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
| | - Zain A. Bhutta
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
| | - Naema Al Mawlawi
- Departments of Virology and Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha
| | - Reham Al Kahlout
- Departments of Virology and Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha
| | - Ashraf Elmalik
- Department of Pharmacy, Hamad General Hospital, Doha, Qatar
| | - Aftab M. Azad
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
| | - Joanne Daghfal
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Mulham Mustafa
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Andrew Jeremijenko
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Hussam Al Soub
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Mohammed Abu Khattab
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Muna Al Maslamani
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Stephen H. Thomas
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
- Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
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27
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Levine M, Minns A, Ontiveros S, Thomas SH, Cantrell FL. Evaluating the impact of home quarantine during the coronavirus pandemic on pediatric exploratory ingestions. Clin Toxicol (Phila) 2020; 59:673-674. [PMID: 33191809 DOI: 10.1080/15563650.2020.1846743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Michael Levine
- Department of Emergency Medicine, University of California, Los Angeles, CA, USA
| | - Alicia Minns
- Department of Emergency Medicine, Division of Medical Toxicology, University of California, San Diego, CA, USA
| | - Sam Ontiveros
- Department of Emergency Medicine, Division of Medical Toxicology, University of California, San Diego, CA, USA
| | - Stephen H Thomas
- Barts and The London School of Medicine, Blizard Institute, London, UK.,Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
| | - F Lee Cantrell
- California Poison Control System, San Diego Division, San Diego, CA, USA
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28
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Elmoheen A, Salem WA, Al Essai G, Shukla D, Pathare A, Thomas SH. The Role of Point-of-Care Ultrasound (POCUS) in Envenomation by a Desert Viper. Am J Case Rep 2020; 21:e924306. [PMID: 32822334 PMCID: PMC7467632 DOI: 10.12659/ajcr.924306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Patient: Male, 53-year-old Final Diagnosis: Snakebite envenomation Symptoms: Pain • swelling Medication: — Clinical Procedure: Antivenom administration • Point of care ultrasound (POCUS) Specialty: Critical Care Medicine • Radiology • Toxicology
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Affiliation(s)
- Amr Elmoheen
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Waleed Awad Salem
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Galal Al Essai
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Dharmesh Shukla
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ankush Pathare
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H. Thomas
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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29
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Jenkins D, Sharfeen Qureshi R, Moinudheen J, Pathan SA, Thomas SH. Evaluation of Electronic Medical Record Downtime in a Busy Emergency Department. Qatar Med J 2020; 2020:20. [PMID: 32775247 PMCID: PMC7393182 DOI: 10.5339/qmj.2020.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/28/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives: This study aimed to investigate electronic medical record (EMR) implementation in a busy urban academic emergency department (ED) and to determine the frequency, duration, and predictors of EMR downtime episodes. Materials and Methods: This study retrospectively analyzed data collected real time by the EMR and by the operations group at the study ED from May 2016 to December 2017. The study center has used the First Net Millennium EMR (Cerner Corporation, Kansas City, Missouri, USA). The ED operations data have been downloaded weekly from the EMR and transferred to the analytics software Stata (version 15MP, StataCorp, College Station, Texas, USA). Results: During the study period, 12 episodes of EMRD occurred, with a total of 58 hours and a mean of 4.8 ± 2.7 hours. The occurrence of EMRD event has not been associated with on-duty physician coverage levels (p = 0.831), month (p = 0.850), or clinical shift (morning, evening, or night shift) (p = 0.423). However, EMRD occurrence has been statistically significantly associated with weekdays (p = 0.020). Discussion: In a real-world implementation of EMR in a busy ED, EMRD episodes averaging approximately 5 hours occurred at unpredictable intervals, with a frequency that remained unchanged over the first 20 months of the EMR deployment. Conclusion: The study could define downtime characteristics at the study center. The EMRD episodes have been associated with inaccuracies in hourly census reporting, with a rebound phenomenon of over-reporting in the first hour or two after restoration of EMR operations.
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30
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Bhutta ZA, Qureshi I, Shujauddin M, Thomas SA, Masood M, Dsouza LB, Iqbal N, Irfan FB, Pathan SA, Thomas SH. Characterizing Agreement in the Level of Interarm Blood Pressure Readings of Adults in the Emergency Department (CALIBRATE Study). Qatar Med J 2020; 2020:14. [PMID: 32391250 PMCID: PMC7198471 DOI: 10.5339/qmj.2020.14] [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] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/01/2019] [Indexed: 11/03/2022] Open
Abstract
Background: Increased interarm systolic blood pressure difference (IASBPD) is one of the major predictors of cardiovascular disease. An IASBPD of >10 mmHg is of clinical significance. However, studies have reported a high number of patients visiting the emergency department (ED) with high IASBPD and varying correlation of IASBPD to age, ethnic background, and comorbidities such as hypertension and diabetes. Objective: The CALIBRATE study aimed to measure the IABPDs in the multiethnic patient population presenting to the ED in Qatar and to assess the distribution of IASBPD in this population. Methods: In a sitting position, two consecutive blood pressure (BP) measurements were recorded from the right and left arms for each participant using a calibrated automated machine and appropriate cuff sizes. The data were recorded using predefined data fields, including patient demographics, past medical, and social and family history. The continuous variables were reported as mean or median based on the distribution of data. The data were analyzed using Stata MP 14.0. Results: A total of 1800 patients, with a mean age of 34 (10) years, were prospectively recruited from the ED. The median absolute systolic BP difference (ΔSBP) between the right and left arms was 6 (3-10) mmHg, and it was the same for the first (ΔSBP1) and the second readings (ΔSBP2). The absolute average of ΔSBP1 and ΔSBP2 was 7 (4-10) mmHg. The difference in systolic BP difference (SBP) of < 20 mmHg for interarm blood pressure was seen in the 95th percentile of the population. No meaningful association could be detected between the IABPD and the study variables such as age, demographics, regions of interest, and risk factors. Conclusion: In population presenting to the ED, the IASBPD of at least 20 mmHg reached at the 95th percentile, validating the known significant difference. The utility of SBP difference can be improved further by taking the average of two individual readings.
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Affiliation(s)
- Z A Bhutta
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - I Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - M Shujauddin
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - S A Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - M Masood
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - L B Dsouza
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - N Iqbal
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weil Cornell Medical College in Qatar, Doha, Qatar
| | - F B Irfan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - S A Pathan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
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Offerman S, Gosen J, Thomas SH, Padilla-Jones A, Ruha AM, Levine M. Bupropion associated seizures following acute overdose: who develops late seizures. Clin Toxicol (Phila) 2020; 58:1306-1312. [DOI: 10.1080/15563650.2020.1742919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Steve Offerman
- Medical Toxicology Consultation Service, Kaiser Permanente Northern California, Sacramento, CA, USA
| | - Jasmin Gosen
- College of Medicine, California North State University, Elk Grove, CA, USA
| | - Stephen H. Thomas
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
- Weill Cornell Medical College, Doha, Qatar
| | - Angie Padilla-Jones
- Department of Medical Toxicology, Banner-University Medical Center, Phoenix, AZ, USA
| | - Anne-Michelle Ruha
- Department of Medical Toxicology, Banner-University Medical Center, Phoenix, AZ, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Michael Levine
- Department of Emergency Medicine, University of California, Los Angeles, CA, USA
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Ali Bhuta Z, Pathan S, Tuukka P, Alinier G, Akhter N, Thomas SH, Cameron PA, Castren M. Evaluation of the impact of ‘Act FAST’ stroke awareness campaign on calls to Emergency Medical Services and ambulance dispatches in Qatar. Journal of Emergency Medicine, Trauma and Acute Care 2020. [DOI: 10.5339/jemtac.2020.qhc.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Zain Ali Bhuta
- Department of Emergency Medicine and Service, Helsinki University Hospital, Helsinki, Finland
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Sameer Pathan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Puolakka Tuukka
- Department of Emergency Medicine and Service, Helsinki University Hospital, Helsinki, Finland
| | - Guillaume Alinier
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- Weill Cornell Medicine Qatar, Doha, Qatar
- Hamad Medical Corporation Ambulance Service, Doha, Qatar
| | | | - Stephen H. Thomas
- Queen Mary University of London, London, United Kingdom
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Peter A. Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Maaret Castren
- Department of Emergency Medicine and Service, Helsinki University Hospital, Helsinki, Finland
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Pathan SA, Baroudi OA, Rahman ZH, Saleh WAH, Thomas SW, Jenkins D, Thomas SH. Electronic medical record error in reported time of discharge: A prospective analysis at a tertiary care hospital. International Journal of Healthcare Management 2020. [DOI: 10.1080/20479700.2019.1709008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sameer A. Pathan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- The Interim Translational Research Institute (iTRI), Hamad Medical Corporation, Doha, Qatar
| | - Omar Al Baroudi
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zahra H. Rahman
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Warda Ali H. Saleh
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Stephen W. Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dominic Jenkins
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H. Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- The Interim Translational Research Institute (iTRI), Hamad Medical Corporation, Doha, Qatar
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Eisenback JD, Holland LA, Schroeder J, Thomas SH, Beacham JM, Hanson SF, Paes-Takahashi VS, Vieira P. Meloidogyne aegracyperi n. sp. (Nematoda: Meloidogynidae), a root-knot nematode parasitizing yellow and purple nutsedge in New Mexico. J Nematol 2019; 51:e2019-71. [PMID: 34179811 PMCID: PMC6909390 DOI: 10.21307/jofnem-2019-071] [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] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Indexed: 11/15/2022] Open
Abstract
Meloidogyne aegracyperi n. sp. is described from roots of purple nutsedge in southern New Mexico, USA. Mature females are small (310–460 µm), pearly white, with their egg masses completely contained inside root galls. The neck is often at a 90 to 130° angle to the protruding posterior end with the perineal pattern. The distance of the dorsal esophageal gland orifice (DGO) to the base of the stylet is relatively long (4.0–6.1 µm), and the excretory pore is level with the base of the stylet. The anterior portion of the rounded lumen lining of the metacorpus contains 3 to 10 small vesicles. The perineal pattern has a rounded dorsal arch with a tail terminal area that is smooth or marked with rope-like striae. Only two males were found. The body twists 90° throughout its length. The DGO to the base of the stylet is long (3.0–3.3) µm. The cephalic framework of the second-stage juvenile is weak, and the stylet is short (10.1–11.8 µm). The DGO to the base of the stylet is long (3–5 µm). The tail is very long (64–89 µm) and the hyaline portion of the tail is very narrow, making the tail finely pointed. Eggs are typical for the genus and vary in length (85.2–99.8 µm) and width (37.1–48.1 µm), having a L/W ratio of (2.1–2.6). Maximum likelihood phylogenetic analyses of the different molecular loci (partial 18S rRNA, D2-D3 of 28S rRNA, internal transcribed spacer (ITS) rRNA, cytochrome oxidase subunit II (COII)-16S rRNA of mitochondrial DNA gene fragments and partial Hsp90 gene) placed this nematode on an independent branch in between M. graminicola and M. naasi and a cluster of species containing M. chitwoodi. M. fallax, and M. minor. Greenhouse tests showed that yellow and purple nutsedge were the best hosts, but perennial ryegrass, wheat, bentgrass, and barley were also hosts.
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Affiliation(s)
- J D Eisenback
- School of Plant and Environmental Science, Virginia Tech, Blacksburg, VA, 24061
| | - L A Holland
- Department of Plant Pathology, University of California-Davis, Davis, CA, 95616
| | - J Schroeder
- Department of Entomology, Plant Pathology and Weed Science, New Mexico State University, Las Cruces, NM, 88003
| | - S H Thomas
- Department of Entomology, Plant Pathology and Weed Science, New Mexico State University, Las Cruces, NM, 88003
| | - J M Beacham
- Department of Entomology, Plant Pathology and Weed Science, New Mexico State University, Las Cruces, NM, 88003
| | - S F Hanson
- Department of Entomology, Plant Pathology and Weed Science, New Mexico State University, Las Cruces, NM, 88003
| | - V S Paes-Takahashi
- Department of Plant Protection, Universidade Estadual Paulista "Julio Mesquita Filho" (UNESP/FCAV), Jaboticabal, SP, 14884900
| | - P Vieira
- School of Plant and Environmental Science, Virginia Tech, Blacksburg, VA, 24061
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35
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Dsouza LB, Pathan SA, Bhutta ZA, Thomas SA, Momin U, Mirza S, Elanani R, Qureshi R, Khalaf W, Thomas SH. ABC/2 estimation in intracerebral hemorrhage: A comparison study between emergency radiologists and emergency physicians. Am J Emerg Med 2019; 37:1818-1822. [DOI: 10.1016/j.ajem.2018.12.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 11/16/2022] Open
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Bashir K, Farook KS, Thomas SH. The learning preferences of millennial emergency medicine residents in Qatar. Int J Med Educ 2019; 10:136-137. [PMID: 31353323 PMCID: PMC6773367 DOI: 10.5116/ijme.5d1b.ae92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/02/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Khalid Bashir
- Department of Emergency medicine, Hamad General Hospital, Doha, Qatar
| | | | - Stephen H. Thomas
- Department of Emergency medicine, Hamad General Hospital, Doha, Qatar
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37
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Qureshi I, Pathan SA, Qureshi RS, Thomas SH. Intramuscular versus oral diclofenac for acute pain in adults with acute musculoskeletal injuries presenting to the ED setting: a prospective, double-blind, double-dummy, randomised controlled trial. Emerg Med J 2019; 36:401-406. [PMID: 31217178 DOI: 10.1136/emermed-2018-208214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The current study aimed to ascertain differences in early postmedication pain reduction in participants presenting with acute musculoskeletal injuries (MSI) to the ED receiving intramuscular (IM) versus per oral (PO) diclofenac. METHODS This was a prospective, double-blinded, randomised controlled trial conducted between January and June 2018 at the ED of Hamad General Hospital in Doha, Qatar. Adults (18-65 years of age) presenting to the ED within 24 hours of an acute MSI, who had a triage pain score measured using numerical rating scale of at least five or above were enrolled in this trial. Participants randomised to either IM (75 mg) with oral placebo, or oral (100 mg) diclofenac group with IM placebo using a computer-generated randomised concealed list in blocks of six and eight. The primary objective was to compare the proportion of IM versus PO participants attaining a 50% reduction in pain score at 30 min from t0. RESULTS 300 participants were enrolled (150 in the IM diclofenac group and 150 in the PO diclofenac group) in the trial. The primary outcome was achieved in 99.3 (95% CI 96.3 to 100) in the IM group and 86.7 (95% CI 80.2 to 91.7) in PO group. There was an absolute risk difference of 12.7%. This corresponds to a number needed to treat of 8 cases (95% CI 6 to 14) receiving IM rather than the PO diclofenac in order to achieve one additional case of 50% pain reduction within 30 min of drug administration. There were no adverse events experienced in any treatment groups. CONCLUSION IM diclofenac injection provides rapid analgesia over PO administration of diclofenac. However, given the preparation needed for an IM injection, oral administration may be preferable when and if clinical circumstances allow a choice in non-steroidal anti-inflammatory drug administration route.
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Affiliation(s)
- Isma Qureshi
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sameer A Pathan
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar.,Monash University, Clayton, Victoria, Australia
| | | | - Stephen H Thomas
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medical College in Qatar, Doha, Qatar.,Queen Mary University of London, London, United Kingdom
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38
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Thomas SH, Thomas SW, Thomas SA, Pathan S. Helicopter Emergency Medical Services Literature 1972-2017: Characteristics and Trends. Air Med J 2019; 38:115-124. [PMID: 30898282 DOI: 10.1016/j.amj.2018.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022]
Abstract
Since its inception in the latter part of the 20th century, the rapid expansion of helicopter emergency medical services (HEMS) has been accompanied by remarkable growth in the relevant evidence base. There are many review articles describing lessons contained within the various arenas of HEMS literature, but there is little or no characterization of the numbers and types of publications comprising the HEMS-related evidence base. This study analyzed all indexed publications mentioning HEMS (with abstract included) in the United States National Library of Medicine's PubMed collection. The aims of the analysis were to provide quantitative, qualitative, and longitudinal trend information regarding the 1972 to 2017 evidence base relevant to HEMS.
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Affiliation(s)
- Stephen H Thomas
- Weill Cornell Medical College, Doha, Qatar; University of London, London, United Kingdom; Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar.
| | | | | | - Sameer Pathan
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
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39
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Pathan SA, Mitra B, Mirza S, Momin U, Ahmed Z, Andraous LG, Shukla D, Shariff MY, Makki MM, George TT, Khan SS, Thomas SH, Cameron PA. Emergency Physician Interpretation of Point-of-care Ultrasound for Identifying and Grading of Hydronephrosis in Renal Colic Compared With Consensus Interpretation by Emergency Radiologists. Acad Emerg Med 2018; 25:1129-1137. [PMID: 29663580 DOI: 10.1111/acem.13432] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 03/06/2018] [Accepted: 04/09/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The ability of emergency physicians (EPs) to identify hydronephrosis using point-of-care ultrasound (POCUS) has been assessed in the past using computed tomography (CT) scans as the reference standard. We aimed to determine the ability of EPs to identify and grade hydronephrosis on POCUS using the consensus interpretation of POCUS by emergency radiologists as the reference standard. METHODS The study was conducted at an urban academic emergency department (ED) as a secondary analysis of previously collected ultrasound data from the EP-performed POCUS databank. Patients were eligible for inclusion if they had both POCUS and CT scanning performed during the index ED visit. Two board-certified emergency radiologists and six EPs interpreted each POCUS study independently. The interpretations were compared with the consensus interpretation by emergency radiologists. Additionally, the POCUS interpretations were also compared with the corresponding CT findings. Institutional approval was obtained for conducting this study. All the analyses were performed using Stata MP 14.0 (StataCorp). RESULTS A total of 651 patient image-data sets were eligible for inclusion in this study. Hydronephrosis was reported in 69.6% of POCUS examinations by radiologists and 72.7% of CT scans (p = 0.22). Using the consensus radiology interpretation of POCUS as the reference standard, EPs had an overall sensitivity of 85.7% (95% confidence interval [CI] = 84.3%-87.0%), specificity of 65.9% (95% CI = 63.1%-68.7%), positive likelihood ratio of 2.5 (95% CI = 2.3-2.7), and negative likelihood ratio of 0.22 (95% CI = 0.19-0.24) for hydronephrosis. When using CT scan as the reference standard, the EPs had an overall sensitivity of 81.1% (95% CI = 79.6% to 82.5%), specificity of 59.4% (95% CI = 56.4%-62.5%), positive likelihood ratio of 2.0 (95% CI = 1.8-2.2), and negative likelihood ratio of 0.32 (95% CI = 0.29-0.35) for hydronephrosis. The specificity of EPs was improved to 94.6% (95% CI = 93.7%-95.4%) for categorizing the degree of hydronephrosis as "moderate or severe" versus "none or mild," with positive likelihood ratio of 6.33 (95% CI = 5.3-7.5) and negative likelihood ratio of 0.69 (95% CI = 0.66-0.73). CONCLUSIONS Emergency physicians were found to have moderate to high sensitivity for identifying hydronephrosis on POCUS when compared with the consensus interpretation of the same studies by emergency radiologists. These POCUS findings by EPs produced more definitive results when at least moderate degree of hydronephrosis was present.
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Affiliation(s)
- Sameer A. Pathan
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
- Department of Epidemiology & Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Australia
- National Trauma Research Institute The Alfred Hospital MelbourneAustralia
| | - Biswadev Mitra
- Department of Epidemiology & Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Australia
- National Trauma Research Institute The Alfred Hospital MelbourneAustralia
- Emergency & Trauma Centre The Alfred Hospital Melbourne Australia
| | - Salman Mirza
- Emergency Radiology Section Radiology Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Umais Momin
- Emergency Radiology Section Radiology Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Zahoor Ahmed
- Emergency Radiology Section Radiology Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Lubna G. Andraous
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Dharmesh Shukla
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Mohammed Y. Shariff
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Magid M. Makki
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Tinsy T. George
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Saad S. Khan
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Stephen H. Thomas
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
- Weill Cornell Medical College in Qatar Education City Doha Qatar
| | - Peter A. Cameron
- Department of Epidemiology & Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Australia
- National Trauma Research Institute The Alfred Hospital MelbourneAustralia
- Emergency & Trauma Centre The Alfred Hospital Melbourne Australia
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Levine M, Offerman S, Vohra R, Wolk B, LaPoint J, Quan D, Spyres M, LoVecchio F, Thomas SH. Assessing the Effect of a Medical Toxicologist in the Care of Rattlesnake-envenomated Patients. Acad Emerg Med 2018; 25:921-926. [PMID: 29498136 DOI: 10.1111/acem.13401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/14/2018] [Accepted: 02/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rattlesnake envenomation is an important problem in the United States, and the management of these envenomations can be complex. Despite these complexities, however, the majority of such cases are managed without the involvement of a medical toxicologist. The primary objective of this study was to evaluate the impact of a medical toxicology service (MTS) on the length of stay (LOS) of such patients. METHODS The authors conducted a retrospective study at six centers in California. Patients were included if they were admitted in the 2 years before the establishment of a MTS (pre-MTS) or in the 2 years after the creation of a MTS (post-MTS). RESULTS A total of 300 subjects were included (169 pre-MTS, 131 post MTS). Baseline characteristics between the pre-MTS and post-MTS groups were very similar. The creation of a MTS was associated with a significant reduction in the mean (95% confidence interval) LOS (69.5 [59.1-79.9] hours vs. 48.1 [41.4-54.8] hours). This reduced LOS was not associated with any statistically significant change in readmission rates. CONCLUSION Rattlesnake bite patients treated by a medical toxicologist have a significantly reduced LOS compared to those without direct involvement of a medical toxicologist.
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Affiliation(s)
- Michael Levine
- Department of Emergency Medicine Division of Medical Toxicology University of Southern California Los AngelesCA
| | - Steve Offerman
- Department of Emergency Medicine Division of Medical Toxicology Kaiser South Sacramento Sacramento CA
| | - Rais Vohra
- Department of Emergency Medicine UCSF Fresno Medical Center Fresno CA
| | - Brian Wolk
- Department of Emergency Medicine Loma Linda Medical Center Loma Linda CA
| | - Jeff LaPoint
- Department of Emergency Medicine Kaiser San Diego San Diego CA
| | - Dan Quan
- Scottsdale Healthcare Scottsdale AZ
| | - Meghan Spyres
- Department of Emergency Medicine Division of Medical Toxicology University of Southern California Los AngelesCA
| | - Frank LoVecchio
- Department of Emergency Medicine Maricopa Medical Center Phoenix AZ
| | - Stephen H. Thomas
- Department of Emergency Medicine Weill Cornell College of Medicine in Qatar and Hamad Medical Corporation Doha Qatar
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Thomas SH, Blumen I. Helicopter Emergency Medical Services Literature 2014 to 2016: Lessons and Perspectives, Part 2-Nontrauma Transports and General Issues. Air Med J 2018; 37:126-130. [PMID: 29478578 DOI: 10.1016/j.amj.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/30/2017] [Indexed: 06/08/2023]
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42
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Levine M, Stellpflug SJ, Pizon AF, Peak DA, Villano J, Wiegand T, Dib C, Thomas SH. Hypoglycemia and lactic acidosis outperform King’s College criteria for predicting death or transplant in acetaminophen toxic patients. Clin Toxicol (Phila) 2018; 56:622-625. [DOI: 10.1080/15563650.2017.1420193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Michael Levine
- Department of Emergency Medicine, Division of Medical Toxicology, University of Southern California, Los Angeles, CA, USA
| | - Samuel J. Stellpflug
- Department of Emergency Medicine, Division of Medical Toxicology, Regions Hospital, St. Paul, MN, USA
| | - Anthony F. Pizon
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Janna Villano
- Department of Emergency Medicine, Division of Medical Toxicology, University of California, San Diego, CA, USA
| | - Timothy Wiegand
- Department of Emergency Medicine, Division of Medical Toxicology, University of Rochester, Rochester, NY, USA
| | - Christian Dib
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephen H. Thomas
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Emergency Medicine, Weill Cornell Medical College in Qatar, Doha, Qatar
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43
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Thomas SH, Blumen I. Helicopter Emergency Medical Services Literature 2014 to 2016: Lessons and Perspectives, Part 1-Helicopter Transport for Trauma. Air Med J 2018; 37:54-63. [PMID: 29332779 DOI: 10.1016/j.amj.2017.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022]
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44
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George T, Elgharbawy MA, Fathi AA, Bhutta ZA, Pathan SA, Jenkins D, Thomas SH. Inaccuracy in electronic medical record-reported wait times to initial emergency physician evaluation. International Journal of Healthcare Management 2017. [DOI: 10.1080/20479700.2017.1418277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bhutta ZA, Qureshi I, Shujauddin M, Thomas S, Masood M, Dsouza LB, Iqbal N, Irfan FB, Pathan SA, Thomas SH. Abstract P491: Characterizing Agreement in Level of Inter-extremity Blood-Pressure Readings of Adults in the Emergency Department (CALIBRATE Study). Hypertension 2017. [DOI: 10.1161/hyp.70.suppl_1.p491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Inter-arm blood-pressure difference (IBPD) has been studied previously in multiple settings, but few reports are available from the Emergency department (ED) setting, where BP varies significantly due to acute medical conditions or stress from various factors. CALIBRATE aims to study the inter-arm blood pressure differences in the patients presenting to the ED in Qatar and to assess the IBPD distribution in this population.
Methods:
In sitting position, two consecutive BP measurements were obtained from the right and left arm for each participant using calibrated automated machines and appropriate cuff sizes. Considering the demographic mix of the population presenting to the ED, a 1:1 of male to female and 2:1 for GCC (Gulf Cooperation Council) to non-GCC recruitment strategy was predefined. The data were recorded using predefined data fields including patient demographics, past medical, social and family history. The continuous variables were reported as mean (SD) or median (IQR) based on the distribution of data. The data was analyzed using Stata MP 14.0 (College Station, Texas).
Results:
A total of 1800 patients were prospectively recruited from the ED. The mean age was 34 (10) years. The absolute systolic blood pressure (ΔSBP) difference between the right and left arm was same for the first (ΔSBP1) and the second reading (ΔSBP2), as 6 mmHg (3-10). The absolute average of ΔSBP1 and ΔSBP2
was 7 mmHg (4-10). The difference in SBP of less than 20 mmHg for IBP was seen in 95
th
percentile of the population with single reading, whereas, with the average of two individual readings it was observed in 97
th
percentile. No meaningful association could be detected between the significant IBPD
and the study variables such as age, demographics, regions of interest and risk factors. Although, patients with diagnosed hypertension met the pre-defined criterion for significance, this difference was not clinically significant. There was no significant difference between IBPD noted for the Asia-pacific or Arab population.
Conclusion:
In population presenting to the ED, the IBPD of at least 20 mmHg reached at 95
th
percentile validating the known significant difference. The utility of SBP difference can be improved further by taking the average of two individual readings.
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Pathan SA, Soulek J, Qureshi I, Werman H, Reimer A, Brunko MW, Alinier G, Irfan FB, Thomas SH. Helicopter EMS and rapid transport for ST-elevation myocardial infarction: The HEARTS study. Journal of Emergency Medicine, Trauma and Acute Care 2017. [DOI: 10.5339/jemtac.2017.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Helicopter emergency medical services (HEMS) and ground EMS (GEMS) are both integral parts of out-of-hospital transport systems for patients with ST-elevation myocardial infarction (STEMI) undergoing emergency transport for primary percutaneous coronary intervention (PPCI). There are firm data linking time savings for PPCI transports with improved outcome. A previous pilot analysis generated preliminary estimates for potential HEMS-associated time savings for PPCI transports. Methods: This non-interventional multicenter study conducted over the period 2012–2014 at six centers in the USA and in the State of Qatar assessed a consecutive series of HEMS transports for PPCI; at one center consecutive GEMS transports of at least 15 miles were also assessed if they came from sites that also used HEMS (dual-mode referring hospitals). The study assessed time from ground or air EMS dispatch to transport a patient to a cardiac center, through to the time of patient arrival at the receiving cardiac unit, to determine proportions of patients arriving within accepted 90- and 120-minute time windows for PPCI. Actual times were compared to “route-mapping” GEMS times generated using geographical information software. HEMS' potential time savings were calculated using program-specific aircraft characteristics, and the potential time savings for HEMS was translated into estimated mortality benefit. Results: The study included 257 HEMS and 27 GEMS cases. HEMS cases had a high rate of overall transport time (from dispatch to receiving cardiac unit arrival) that fell within the predefined windows of 90 minutes (67.7% of HEMS cases) and 120 minutes (91.1% of HEMS cases). As compared to the calculated GEMS times, HEMS was estimated to accrue a median time saving of 32 minutes (interquartile range, 17–46). The number needed to transport for HEMS to get one additional case to PPCI within 90 minutes was 3. In the varied contexts of this multicenter study, the number of lives saved by HEMS, solely through time savings, was calculated as 1.34 per 100 HEMS PPCI transports. Conclusions: In this multicenter study, HEMS PPCI transport was found to be appropriate as defined by meeting predefined time windows. The overall estimate for lives saved through time savings alone was consistent with previous pilot data and was also generally consistent with favorable cost-effectiveness. Further research is necessary to confirm these findings, but judicious HEMS deployment for PPCI transports is justified by these data.
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Affiliation(s)
- Sameer A. Pathan
- 1Department of Emergency Medicine, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar
| | - Jason Soulek
- 2Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma, USA
| | - Isma Qureshi
- 1Department of Emergency Medicine, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar
| | - Howard Werman
- 3Department of Emergency Medicine and MedFlight of Ohio, Ohio State University, Columbus, Ohio, USA
| | - Andrew Reimer
- 4Cleveland Clinic Critical Care Transport and Francis Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Guillaume Alinier
- 6Hamad Medical Corporation Ambulance Service, Doha, Qatar
- 7School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
- 8Department of Public Health and Wellbeing, Northumbria University, Newcastle upon Tyne, NE7 7XA, UK
| | - Furqan B. Irfan
- 1Department of Emergency Medicine, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar
| | - Stephen H. Thomas
- 1Department of Emergency Medicine, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar
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Pathan SA, Bhutta ZA, Moinudheen J, Jenkins D, Farook S, Qureshi I, George P, Irfan FB, Al Khal AL, Thomas SH. Partial replacement of board-certified specialist-grade physicians with emergency medicine trainees in a busy emergency department: Lack of adverse effect on time to physician. Journal of Emergency Medicine, Trauma and Acute Care 2017. [DOI: 10.5339/jemtac.2017.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: Standard emergency department (ED) operation goals include minimization of the time interval between patients' initial ED presentation and initial emergency physician (EP) evaluation. Following up on previous work defining factors influencing the “time to physician” (tMD) in a busy ED, the current study was undertaken to evaluate whether tMD was adversely impacted by the ED's partial replacement of specialist-grade EPs with emergency medicine (EM) trainees (at the resident and fellow level). Methods: This retrospective study was conducted for four months (September–December 2015) using an ED administrative database (EDAD) in an urban academic tertiary ED with an annual census of approximately 500,000; during the four study months, the ED census was 165,969. To minimize confounding by time of day and related factors, data analysis focused solely on the “day shift” (0600–1400) of each of the study period's 122 days. EDAD data were combined with EP rostering data to generate a multivariate linear regression model that assessed the dependent variable tMD, for significant changes associated with increasing proportion – not necessarily always the same as increasing the absolute number of trainees (i.e., summed residents and fellows as a total percent of all on-duty EPs). There were trainees in the study ED throughout the study, but the trainee numbers as a proportion of the overall physician staffing fluctuated, thus providing a basis for analysis. The model adjusted for covariates previously demonstrated to impact tMD at the study center. Analyses were conducted with Stata 14MP, with statistical significance defined at p < 0.05 and confidence intervals (CIs) reported at the 95% level. Results: In an acceptable regression model that adjusted for multiple parameters influencing tMD, the introduction of a covariate representing the proportion of on-duty trainee physicians was very small in magnitude (β estimate 0.07, 95% CI − 0.16 to 0.30) and not statistically significant (p = 0.53). Conclusions: A multivariate analysis adjusting for variables contributing to tMD showed no indication of adverse tMD impact from partial replacement of board-certified specialist-grade EPs with EM trainees given adequate supervision by properly trained faculty.
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Affiliation(s)
- Sameer A. Pathan
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Zain A. Bhutta
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Jibin Moinudheen
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Dominic Jenkins
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Saleem Farook
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Isma Qureshi
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Pooja George
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Furqan B. Irfan
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Abdul Latif Al Khal
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
- 2Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Stephen H. Thomas
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
- 2Weill Cornell Medical College in Qatar, Doha, Qatar
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Pathan SA, Bhutta ZA, Moinudheen J, Jenkins D, Silva AD, Sharma Y, Saleh WA, Khudabakhsh Z, Irfan FB, Thomas SH. Marginal analysis in assessing factors contributing time to physician in the Emergency Department using operations data. Qatar Med J 2017; 2016:18. [PMID: 28293539 PMCID: PMC5339449 DOI: 10.5339/qmj.2016.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/27/2016] [Indexed: 11/03/2022] Open
Abstract
Background: Standard Emergency Department (ED) operations goals include minimization of the time interval (tMD) between patients' initial ED presentation and initial physician evaluation. This study assessed factors known (or suspected) to influence tMD with a two-step goal. The first step was generation of a multivariate model identifying parameters associated with prolongation of tMD at a single study center. The second step was the use of a study center-specific multivariate tMD model as a basis for predictive marginal probability analysis; the marginal model allowed for prediction of the degree of ED operations benefit that would be affected with specific ED operations improvements. Methods: The study was conducted using one month (May 2015) of data obtained from an ED administrative database (EDAD) in an urban academic tertiary ED with an annual census of approximately 500,000; during the study month, the ED saw 39,593 cases. The EDAD data were used to generate a multivariate linear regression model assessing the various demographic and operational covariates' effects on the dependent variable tMD. Predictive marginal probability analysis was used to calculate the relative contributions of key covariates as well as demonstrate the likely tMD impact on modifying those covariates with operational improvements. Analyses were conducted with Stata 14MP, with significance defined at p < 0.05 and confidence intervals (CIs) reported at the 95% level. Results: In an acceptable linear regression model that accounted for just over half of the overall variance in tMD (adjusted r2 0.51), important contributors to tMD included shift census (p = 0.008), shift time of day (p = 0.002), and physician coverage n (p = 0.004). These strong associations remained even after adjusting for each other and other covariates. Marginal predictive probability analysis was used to predict the overall tMD impact (improvement from 50 to 43 minutes, p < 0.001) of consistent staffing with 22 physicians. Conclusions: The analysis identified expected variables contributing to tMD with regression demonstrating significance and effect magnitude of alterations in covariates including patient census, shift time of day, and number of physicians. Marginal analysis provided operationally useful demonstration of the need to adjust physician coverage numbers, prompting changes at the study ED. The methods used in this analysis may prove useful in other EDs wishing to analyze operations information with the goal of predicting which interventions may have the most benefit.
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Affiliation(s)
- Sameer A Pathan
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Zain A Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Jibin Moinudheen
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Dominic Jenkins
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Ashwin D Silva
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Yogdutt Sharma
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Warda A Saleh
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Zeenat Khudabakhsh
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Furqan B Irfan
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
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Tainter CR, Gentges JA, Thomas SH, Burns BD. Can Emergency Medicine Residents Predict Cost of Diagnostic Testing? West J Emerg Med 2016; 18:159-162. [PMID: 28116030 PMCID: PMC5226753 DOI: 10.5811/westjem.2016.10.31234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/12/2016] [Accepted: 10/24/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction Diagnostic testing represents a significant portion of healthcare spending, and cost should be considered when ordering such tests. Needless and excessive spending may occur without an appreciation of the impact on the larger healthcare system. Knowledge regarding the cost of diagnostic testing among emergency medicine (EM) residents has not previously been studied. Methods A survey was administered to 20 EM residents from a single ACGME-accredited three-year EM residency program, asking for an estimation of patient charges for 20 commonly ordered laboratory tests and seven radiological exams. We compared responses between residency classes to evaluate whether there was a difference based on level of training. Results The survey completion rate was 100% (20/20 residents). We noted significant discrepancies between the median resident estimates and actual charge to patient for both laboratory and radiological exams. Nearly all responses were an underestimate of the actual cost. The group median underestimation for laboratory testing was $114, for radiographs $57, and for computed tomography exams was $1,058. There was improvement in accuracy with increasing level of training. Conclusion This pilot study demonstrates that EM residents have a poor understanding of the charges burdening patients and health insurance providers. In order to make balanced decisions with regard to diagnostic testing, providers must appreciate these factors. Education regarding the cost of providing emergency care is a potential area for improvement of EM residency curricula, and warrants further attention and investigation.
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Affiliation(s)
- Christopher R Tainter
- University of California, San Diego, Department of Emergency Medicine and Department of Anesthesiology, Division of Critical Care, San Diego, California
| | - Joshua A Gentges
- The University of Oklahoma, Tulsa, Department of Emergency Medicine, Tulsa, Oklahoma
| | - Stephen H Thomas
- Weill Cornell College of Medicine in Qatar and Hamad Medical Corporation, Department of Emergency Medicine, Doha, Qatar
| | - Boyd D Burns
- The University of Oklahoma, Tulsa, Department of Emergency Medicine, Tulsa, Oklahoma
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50
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Moinudheen J, Pathan SA, Bhutta ZA, Jenkins DW, Silva AD, Sharma Y, Saleh WA, Khudabakhsh Z, Irfan FB, Thomas SH. Marginal analysis in assessing factors contributing time to physician in Emergency Department using operations data. Journal of Emergency Medicine, Trauma and Acute Care 2016. [DOI: 10.5339/jemtac.2016.icepq.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Standard Emergency Department (ED) operations goals include minimization of the time interval (hereafter tMD) between patients' initial ED presentation and initial physician evaluation.
Methods: The study was conducted using one month (May 2015) of an ED administrative database (EDAD), in HGH-ED, during the study month the ED saw 39,593 cases. The first step was generation of a multivariate model identifying the parameters associated with delay in tMD. In the second step, predictive marginal probability analysis was used to calculate the relative contributions of key covariates as well as demonstrate the likely tMD impact on modifying those covariates with operational improvements. Analyses were conducted with STATA 14 MP, with significance defined at p < .05 and confidence intervals (CIs) reported at the 95% level.
Results: In an acceptable linear regression model that accounted for just over half of the overall variance in tMD (adjusted r2 .51), important contributors to tMD included shift census (p = .008), shift time of day (p = .002), and physician coverage n (p = .004). Marginal predictive probability analysis was used to predict the overall tMD impact (improvement from 50 to 43 minutes, p < .001) of consistent staffing with 22 physicians.
Conclusions: The analysis identified expected variables contributing to tMD with regression demonstrating significance and effect magnitude of alterations in covariates including patient census, shift time of day, and physician n. Marginal analysis provided operationally useful demonstration of the need to adjust physician coverage numbers, prompting changes at the study ED.
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Affiliation(s)
| | | | - Zain A. Bhutta
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Yogdutt Sharma
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Warda A. Saleh
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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