AIM: To compare the reported injuries on initial assessment of the chest X-ray (CXR) in thoracic trauma patients to a second read performed by a dedicated trauma radiologist. METHODS: By retrospective analysis of a pr...AIM: To compare the reported injuries on initial assessment of the chest X-ray (CXR) in thoracic trauma patients to a second read performed by a dedicated trauma radiologist. METHODS: By retrospective analysis of a prospective database, 712 patients with an injury to the chest admitted to the University Medical Center Utrecht were studied. All patients with a CXR were included in the study. Every CXR was re-evaluated by a trauma radiologist, who was blinded for the initial results. The findings of the trauma radiologist regarding rib fractures, pneumothoraces, hemothoraces and lung contusions were compared with the initial reports from the trauma team, derived from the original patient files. RESULTS: A total of 516 patients with both thorax trauma and an initial CXR were included in the study. After re-evaluation of the initial CXR significantly more lung contusions (53.3% vs 34.1%, P < 0.001), hemothoraces (17.8% vs 11.0%, P < 0.001) and pneumothoraces (34.4% vs 26.4%, P < 0.001) were detected.During initial assessment significantly more rib fractures were reported (69.8% vs 62.3%, P < 0.001). CONCLUSION: During the initial assessment of a CXR from trauma patients in the emergency department, a significant number of treatment-dictating injuries are missed. More awareness for these specific injuries is needed.展开更多
Intensive care faces economic challenges. Therefore, evidence proving both effectiveness and efficiency, i.e., cost-effectiveness, of delivered care is needed. Today, the quality of care is an important issue in the h...Intensive care faces economic challenges. Therefore, evidence proving both effectiveness and efficiency, i.e., cost-effectiveness, of delivered care is needed. Today, the quality of care is an important issue in the health care debate. How do we measure quality of care and how accurate and representative is this measurement? In the following report, several topics which are used for the evaluation of intensive care unit(ICU) performance are discussed:(1) The use of general outcome prediction models to determine the risk of patients who are admitted to ICUs in an increasing variety of case mix for the different intensive care units, together with three major limitations;(2) As critical care outcomes research becomes a more established entity, mortality is now only one of many endpoints that are relevant. Mortality is a limited outcome when assessing critical care performance, while patient interest in quality of life outcomes is relevant; and(3) The Quality Indicators Committee of the Society of Critical Care Medicine recommended that short-term readmission is a major performance indicator of the quality of intensive care medicine.展开更多
In the last two decennia, the mixed population general intensive care unit(ICU) with a "closed format" setting has gained in favour compared to the specialized critical care units with an "open format&q...In the last two decennia, the mixed population general intensive care unit(ICU) with a "closed format" setting has gained in favour compared to the specialized critical care units with an "open format" setting. However, there are still questions whether surgical patients benefit from a general mixed ICU. Trauma is a significant cause of morbidity and mortality throughout the world. Major or severe trauma requiring immediate surgical intervention and/or intensive care treatment. The role and type of the ICU has received very little attention in the literature when analyzing outcomes from critical injuries. Severely injured patients require the years of experience in complex trauma care that only a surgery/trauma ICU can provide. Should a trauma center have the capability of a separate specialized ICU for trauma patients("closed format") next to its standard general mixed ICU?展开更多
AIM To assess the performance and clinical relevance of the Early Warning Scoring(EWS)system at the Intermediate Care Unit(IMCU).METHODS This cohort study used all the Vital PAC EWS(Vi EWS)scores collected during each...AIM To assess the performance and clinical relevance of the Early Warning Scoring(EWS)system at the Intermediate Care Unit(IMCU).METHODS This cohort study used all the Vital PAC EWS(Vi EWS)scores collected during each nursing shift from 2014through 2016 at the mixed surgical IMCU of an academic teaching hospital.Clinical deterioration defined as transfer to the Intensive Care Unit(ICU)or mortality within 24 h was the primary outcome of interest.RESULTS A total of 9113 aggregated Vi EWS scores were obtained from 2113 admissions.The incidence of the combined outcome was 272(3.0%).The area under the curve of the Vi EWS was 0.72(CI:0.69-0.75).Using a threshold value of six,the sensitivity was 68%with a positive predictive value of 5%and a number needed to trigger(e.g.,false alarms)of 19%.CONCLUSION The Vi EWS at the IMCU has a discriminative performance that is considerably lower than at the hospital ward.The number of false alarms is high,which may result in alarm fatigue.Therefore,use of the Vi EWS in its current form at the IMCU should be reconsidered.展开更多
文摘AIM: To compare the reported injuries on initial assessment of the chest X-ray (CXR) in thoracic trauma patients to a second read performed by a dedicated trauma radiologist. METHODS: By retrospective analysis of a prospective database, 712 patients with an injury to the chest admitted to the University Medical Center Utrecht were studied. All patients with a CXR were included in the study. Every CXR was re-evaluated by a trauma radiologist, who was blinded for the initial results. The findings of the trauma radiologist regarding rib fractures, pneumothoraces, hemothoraces and lung contusions were compared with the initial reports from the trauma team, derived from the original patient files. RESULTS: A total of 516 patients with both thorax trauma and an initial CXR were included in the study. After re-evaluation of the initial CXR significantly more lung contusions (53.3% vs 34.1%, P < 0.001), hemothoraces (17.8% vs 11.0%, P < 0.001) and pneumothoraces (34.4% vs 26.4%, P < 0.001) were detected.During initial assessment significantly more rib fractures were reported (69.8% vs 62.3%, P < 0.001). CONCLUSION: During the initial assessment of a CXR from trauma patients in the emergency department, a significant number of treatment-dictating injuries are missed. More awareness for these specific injuries is needed.
文摘Intensive care faces economic challenges. Therefore, evidence proving both effectiveness and efficiency, i.e., cost-effectiveness, of delivered care is needed. Today, the quality of care is an important issue in the health care debate. How do we measure quality of care and how accurate and representative is this measurement? In the following report, several topics which are used for the evaluation of intensive care unit(ICU) performance are discussed:(1) The use of general outcome prediction models to determine the risk of patients who are admitted to ICUs in an increasing variety of case mix for the different intensive care units, together with three major limitations;(2) As critical care outcomes research becomes a more established entity, mortality is now only one of many endpoints that are relevant. Mortality is a limited outcome when assessing critical care performance, while patient interest in quality of life outcomes is relevant; and(3) The Quality Indicators Committee of the Society of Critical Care Medicine recommended that short-term readmission is a major performance indicator of the quality of intensive care medicine.
文摘In the last two decennia, the mixed population general intensive care unit(ICU) with a "closed format" setting has gained in favour compared to the specialized critical care units with an "open format" setting. However, there are still questions whether surgical patients benefit from a general mixed ICU. Trauma is a significant cause of morbidity and mortality throughout the world. Major or severe trauma requiring immediate surgical intervention and/or intensive care treatment. The role and type of the ICU has received very little attention in the literature when analyzing outcomes from critical injuries. Severely injured patients require the years of experience in complex trauma care that only a surgery/trauma ICU can provide. Should a trauma center have the capability of a separate specialized ICU for trauma patients("closed format") next to its standard general mixed ICU?
文摘AIM To assess the performance and clinical relevance of the Early Warning Scoring(EWS)system at the Intermediate Care Unit(IMCU).METHODS This cohort study used all the Vital PAC EWS(Vi EWS)scores collected during each nursing shift from 2014through 2016 at the mixed surgical IMCU of an academic teaching hospital.Clinical deterioration defined as transfer to the Intensive Care Unit(ICU)or mortality within 24 h was the primary outcome of interest.RESULTS A total of 9113 aggregated Vi EWS scores were obtained from 2113 admissions.The incidence of the combined outcome was 272(3.0%).The area under the curve of the Vi EWS was 0.72(CI:0.69-0.75).Using a threshold value of six,the sensitivity was 68%with a positive predictive value of 5%and a number needed to trigger(e.g.,false alarms)of 19%.CONCLUSION The Vi EWS at the IMCU has a discriminative performance that is considerably lower than at the hospital ward.The number of false alarms is high,which may result in alarm fatigue.Therefore,use of the Vi EWS in its current form at the IMCU should be reconsidered.
