Implementation of a Community-Based Triage for Patients with Suspected Transient Ischemic Attack or Minor Stroke Study: A Prospective Multicenter Observational Study
Hiroki TaguchiYasuhiro HasegawaKuniaki BandohHideki KoyasuYuukou WatanabeKohei YamashitaKenji ShimazakiHiroshi ShimaMasaaki MiyakawaYoshikazu Niwa
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Keywords:
Triage
Stroke
Minor stroke
Neuroradiology
Background and Aims Decision-making is the major component in triaging EDs patients. EDs Triage systems have applied different approaches to triaging intoxicated patients. Pros & Cons for these approaches need to be identified. Aim is to analysis management of intoxicated patients during various triage process. Methods Critical review includes five triage systems, Emergency Severity Index, Australasian Triage Scale, Canadian triage and Acuity Scale, Manchester Triage System and 5-tier Triage protocol. These systems have been analyzed via meta-synthesis in terms of evidence-based criteria, inclusiveness, specific application and practicability. Results General physiologic signs & symptoms were the gold standard for determining acuity in patients that have been applied by all triage systems. Conscious level, air way, respiratory status and circulation assessment were identified as major criteria in decision-making. 5-tier Triage protocol showed the most comprehensiveness characteristics to prioritizing intoxicated patients. Discussion Resources necessary for evidence-based performance to support nursing decisions in triaging intoxicated patients needs fundamentally to be developed. It`s necessary to develop National Triage Scale to approach intoxicated patients effectively.
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Triage is the process of ordering
patients according to medical
priority. The overall objective is to do the
most good for the most people. Hospital triage involves identifying
and preferentially treating
life-threatening conditions. Ambulance triage systems
include colour-coded and 'priority-
based' systems. There is lack of uniformity and
continuity in triage processes in
South Africa. No definitive triage physiological
or algorithmic scoring system
is currently in use. A uniform national ambulance
and hospital-based system would
facilitate triage and treatment.
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This chapter on mass casualty triage outlines the fundamentals of providing care in humanitarian settings, including overall guidance to clinical care, key aspects of patient triage, including the rationing of care based on priority for treatment, and approaches for paediatrics. It clarifies the differences between medical triage and mass casualty triage, describes the process of balancing needs with the resources available, recognizing situations where large numbers of patients overwhelm resources, and discusses triage models and organization, triage teams, and triage algorithms.
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Mass Casualty
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Eighty-six patients with transient ischemic attacks (TIA) or minor stroke from the carotid artery territory, examined in the extracranial carotid arteries by duplex ultrasound, were prospectively followed for 3 years to find out whether a higher degree of carotid stenosis in these patients might predict mortality and morbidity in myocardial infarction (MI). Thirty-three of these (38%) had carotid stenosis greater than or equal to 50% on one or both sides. In these patients, 36% (12/33) suffered MI during follow-up compared to 7% (4/53) in the patients with lesser degree of stenosis. 75% (12/16) of the MI's were fatal. The total mortality in MI was 30% (10/33) in patients having a stenosis greater than or equal to 50%, in TIA-patients it was 24% (12/51) and in patients with TIA + greater than or equal to 50% stenosis it was 36% (10/28). It is suggested that the presence of high degree stenosis in the carotid arteries might predict mortality and morbidity in MI among TIA and minor stroke subjects.
Stroke
Minor stroke
Carotid artery disease
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To triage, to triage to buy an apt gig; Home again, home again, diagnosed thingamajig. To triage, to triage to buy an apt doc; Home again, home again, diagnosed thingamabob. To triage, to triage a gallop a trot; To buy some granite to put in the plot. One million, three million coverage supplied, If he hadn’t been killed, he must have died.
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Emergency nursing
Identification
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The triage system currently recommended by the Association of Emergency Physicians (ACEP) and Emergency Nurses Association (ENA) is a five levels triage, Emergency Severity Index (ESI) due to more structured, concise, and clear. Cibabat Hospital used a relatively new triage of four modified levels of the Australian Triage Scale (ATS) which accuracy and time triage have not been evaluated. The purpose of this study was to compare the four level triage of modification of ATS and five levels of ESI triage based on accuracy and time triage. The researcher used a quantitative quasi-experimental design with samples of triage activities totaling 38 in the control group and 38 intervention groups, using accidental sampling techniques. Univariate analysis consisted of frequency distribution for nurse characteristics, time triage and accuracy, bivariate analysis used the Mann-Whitney test. The results showed there were no differences, triage modification of ATS with ESI triage in accuracy (p-0.488), and length of triage (p-0.488) ESI triage accuracy was in the expected triage category (76.3%), under triage (13.2%), and over triage (10.5%). Triage modified ATS, expected triage (73.7%), under triage (18.4%), and over triage (7.9%). ESI triage has more expected and less under triage than ATS modification triage. Under triage caused prolong waiting times, unexpected risks, increases morbidity and mortality. Based on the length of time, ESI triage averaged 167 seconds, triage modification of ATS an average of 183 seconds. ESI flowchrat is easier to understand because is simple, has slight indicators in each category. Conclusion of this study is there is no significant difference in the level of accuracy and duration of triage. However, based on data distribution, ESI triage gives more expected triage decisions, less under triage and 16 seconds faster. Suggestions given to the Cibabat Hospital, can use ESI triage as an alternative triage assessment option because easy to use, structured, simple, and clear.
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