Helisamara Mota Guedes

Efficacy of the Manchester Triage System: a systematic review

INTRODUCTION The growing number of patients in emergency departments can lead to overcrowding, often adding to organisational problems. Triage aims to predict the severity of disease, with the aim of organising patient flow. The aim of this study was to analyse the efficacy of the Manchester Triage System (MTS) for risk classification of patients. METHODS A systematic review of the literature in Ebscohost, Pubmed and Scielo (2002-2013) was undertaken. Articles were selected independently by two researchers using selection criteria. Twenty-two articles were selected for inclusion in this review. RESULTS The results support the applicability of the MTS, which has proven validity for use in children, adults, patients with coronary syndrome and patients with acute pulmonary embolism. The MTS was found to be inclusive, and to predict emergency department admission and death in the short term. CONCLUSION The majority of studies found that the MTS was useful in triage of patients in emergency departments, but sub-triage and super-triage (i.e. under and over classification of severity, respectively) still occur.

Valor de predição do Sistema de Triagem de Manchester: avaliação dos desfechos clínicos de pacientes

OBJECTIVE To analyze the predictive value of the Manchester Triage System in relation to clinical outcome of patients. METHODS Prospective observational study of 577 patients admitted to the ER and subjected to risk classification. The Therapeutic Intervention Scoring System-28 (TISS-28) was used to measure the severity of patients (primary outcome) and secondary outcomes: high / transfer, death, and length of hospital stay. Descriptive and univariate analyzes were conducted. RESULTS Patients classified as red are 10.7 times more likely to have scores above 14 in TISS-28 in relation to others. Patients classified as red have 5.9 times more chance of progression to death compared to others. Patients of high priority service are 1.5 times more likely to be hospitalized over five days than low priority. CONCLUSIONS STM proved a good predictor of clinical outcomes.

Predictive value of the Manchester Triage System: evaluation of patients' clinical outcomes.

OBJECTIVE To analyze the predictive value of the Manchester Triage System in relation to clinical outcome of patients. METHODS Prospective observational study of 577 patients admitted to the ER and subjected to risk classification. The Therapeutic Intervention Scoring System-28 (TISS-28) was used to measure the severity of patients (primary outcome) and secondary outcomes: high / transfer, death, and length of hospital stay. Descriptive and univariate analyzes were conducted. RESULTS Patients classified as red are 10.7 times more likely to have scores above 14 in TISS-28 in relation to others. Patients classified as red have 5.9 times more chance of progression to death compared to others. Patients of high priority service are 1.5 times more likely to be hospitalized over five days than low priority. CONCLUSIONS STM proved a good predictor of clinical outcomes.

Risk behavior for the Human Immunodeficiency Virus among motel clients

This study aimed to verify risk behavior for infection with the Human Immunodeficiency Virus in people who attended motels. This is a cross-sectional study conducted in two motels in two municipalities in the state of Minas Gerais, Brazil, with a sample of 308 randomly selected individuals, aged between 18 and 60 years. Bivariate (chi-square and t test for independent samples) and multivariate (logistic regression) statistical tests were performed. A total of 45.8% of the participants reported not having used a condom during the last vaginal sexual intercourse, 48.4% did not use a condom during the last oral sex, while 26.3% reported not having used a condom in the last anal intercourse. Having a steady partner was the strongest predictor of not using condoms. Probable beliefs regarding loyalty involved in a stable relationship may be contributing to the failure to use condoms during intercourse, increasing the risk of HIV infection.This study aimed to verify risk behavior for infection with the Human Immunodeficiency Virus in people who attended motels. This is a cross-sectional study conducted in two motels in two municipalities in the state of Minas Gerais, Brazil, with a sample of 308 randomly selected individuals, aged between 18 and 60 years. Bivariate (chi-square and t test for independent samples) and multivariate (logistic regression) statistical tests were performed. A total of 45.8% of the participants reported not having used a condom during the last vaginal sexual intercourse, 48.4% did not use a condom during the last oral sex, while 26.3% reported not having used a condom in the last anal intercourse. Having a steady partner was the strongest predictor of not using condoms. Probable beliefs regarding loyalty involved in a stable relationship may be contributing to the failure to use condoms during intercourse, increasing the risk of HIV infection.Este estudio tuvo como objetivo determinar las conductas de riesgo al virus de inmunodeficiencia humana en personas que asistieron moteles. Estudio transversal realizado en dos moteles en dos municipios de Minas Gerais con una muestra de 308 personas. Bivariado se realizaron pruebas estadísticas (Jue-cuadrado y t para muestras independientes) y multivariado (regresión logística). La mayoría (42,5%) tenían entre 18 y 25 años y el 45,8% no había utilizado preservativo en sus últimas relaciones sexuales vaginales, 48,4% no usó condón para sexo oral, mientras que 26,3 % reportó no haber utilizado el su última relación anal. Tener una pareja estable fue el mejor predictor para no usarse condones. Llegamos a la conclusión de que la lealtad tiende a estar involucrada en una relación estable puede estar contribuyendo a la no utilización de preservativos en las relaciones, aumentando la vulnerabilidad.

Classificação de risco: retrato de população atendida num serviço de urgência brasileiro

Theoretical framework:Urgent and emergency services haverepresented the main gateway into the health system, leadingto unit overcrowding. Rearranging ...

Comportamentos de risco frente ao vírus da imunodeficiência humana entre frequentadores de motéis

This study aimed to verify risk behavior for infection with the Human Immunodeficiency Virus in people who attended motels. This is a cross-sectional study conducted in two motels in two municipalities in the state of Minas Gerais, Brazil, with a sample of 308 randomly selected individuals, aged between 18 and 60 years. Bivariate (chi-square and t test for independent samples) and multivariate (logistic regression) statistical tests were performed. A total of 45.8% of the participants reported not having used a condom during the last vaginal sexual intercourse, 48.4% did not use a condom during the last oral sex, while 26.3% reported not having used a condom in the last anal intercourse. Having a steady partner was the strongest predictor of not using condoms. Probable beliefs regarding loyalty involved in a stable relationship may be contributing to the failure to use condoms during intercourse, increasing the risk of HIV infection.This study aimed to verify risk behavior for infection with the Human Immunodeficiency Virus in people who attended motels. This is a cross-sectional study conducted in two motels in two municipalities in the state of Minas Gerais, Brazil, with a sample of 308 randomly selected individuals, aged between 18 and 60 years. Bivariate (chi-square and t test for independent samples) and multivariate (logistic regression) statistical tests were performed. A total of 45.8% of the participants reported not having used a condom during the last vaginal sexual intercourse, 48.4% did not use a condom during the last oral sex, while 26.3% reported not having used a condom in the last anal intercourse. Having a steady partner was the strongest predictor of not using condoms. Probable beliefs regarding loyalty involved in a stable relationship may be contributing to the failure to use condoms during intercourse, increasing the risk of HIV infection.Este estudio tuvo como objetivo determinar las conductas de riesgo al virus de inmunodeficiencia humana en personas que asistieron moteles. Estudio transversal realizado en dos moteles en dos municipios de Minas Gerais con una muestra de 308 personas. Bivariado se realizaron pruebas estadísticas (Jue-cuadrado y t para muestras independientes) y multivariado (regresión logística). La mayoría (42,5%) tenían entre 18 y 25 años y el 45,8% no había utilizado preservativo en sus últimas relaciones sexuales vaginales, 48,4% no usó condón para sexo oral, mientras que 26,3 % reportó no haber utilizado el su última relación anal. Tener una pareja estable fue el mejor predictor para no usarse condones. Llegamos a la conclusión de que la lealtad tiende a estar involucrada en una relación estable puede estar contribuyendo a la no utilización de preservativos en las relaciones, aumentando la vulnerabilidad.

Relationship between complaints presented by emergency patients and the final outcome

Objetivo:relacionar queixas apresentadas pelos pacientes classificados pelo Sistema de Triagem de Manchester em um pronto-socorro com o desfecho final (alta/obito/transferencia).Metodos:estudo de coorte prospectivo, realizado com 509 pacientes que deram entrada no pronto-socorro e que nele permaneceram por mais de 24 horas apos a admissao, sendo acompanhados ate o desfecho final. Os dados foram digitados e analisados com estatistica descritiva e analitica em um pacote estatistico.Resultados:entre os pacientes, 59,3% eram do sexo masculino, com idade media de 59,1 anos. As queixas principais eram de mal-estar no adulto (130-22,5%), dispneia em adulto (81-14,0%), dor abdominal em adulto (58-10,0%), alteracoes de comportamento (34-5,9%), sendo que, desses, 87% recebeu alta. Foram encontrados mais obitos nos pacientes classificados nas cores mais graves, sendo 42,8% classificados como vermelho, 17,0% laranja e 8,9% como amarelo. Entre os pacientes classificados como verde, 9,6% evoluiu para obito.Conclusao:nas diversas cores do Sistema de Triagem Manchester, o obito prevaleceu nos pacientes que apresentaram a queixa de mal-estar no adulto, dispneia, sofreram trauma craniano, trauma maior, diarreia e vomito. Quanto maior a prioridade clinica maior a prevalencia de obito.Abstract Objective: to relate complaints presented by emergency room patients, classified using the Manchester Triage System, with the final outcome (discharge/death/transfer). Methods: prospective cohort study, involving 509 patients who were admitted to the emergency room and remained there for more than 24 hours after admission, being monitored to the final outcome. Data were analyzed with a statistical program using descriptive and analytical statistics. Results: the mean age of the patients was 59.1 years and 59.3% were male. The main complaints were unwell adult (130 - 22.5%), shortness of breath in adults (81 - 14.0%), abdominal pain in adults (58 - 10.0%) and behaving strangely (34 - 5.9%), with 87% of the patients being discharged. More deaths were found in the patients classified in the severe colors, with 42.8% classified as red, 17.0% as orange and 8.9% as yellow. Among the patients classified as green, 9.6% died. Conclusion: in the various colors of the Manchester Triage System, death prevailed in patients that presented the complaints of unwell adult, shortness of breath, head injury, major trauma, diarrhea and vomiting. The higher the clinical priority the greater the prevalence of death.

AVALIAÇÃO DA GRAVIDADE DE PACIENTES INTERNADOS EM CLÍNICAS DE UM HOSPITAL

Introduccion: Los datos acerca de la gravedad clinica de los pacientes atendidos en una institucion hospitalaria permiten orientar la asistencia de enfermeria de manera de ofrecer un cuidado de mayor calidad. Objetivo: Evaluar la gravedad de pacientes internados en un hospital en relacion a su alta/transferencia o muerte. Metodo: Se considero una cohorte concurrente con 577 pacientes de un hospital grande del Vale do Jequitinhonha, Minas Gerais, Brasil. En la admision el paciente era evaluado y se le aplicaba el TISS-28 entre 24 y 48 h para la determinacion de la gravedad de los pacientes por medio de la cuantificacion de las intervenciones de enfermeria. Se procedio al analisis aplicando tests de Chi-cuadrado, Kruskal-Wallis y Mann-Whitney. Resultados: Se encontro una diferencia significativa para las siguientes variables: edad, tiempo de permanencia de los pacientes y puntuacion obtenida en el TISS-28 en relacion con el resultado alta/transferencia y muerte. El TISS-28 mostro una precision de 77,9%, tanto en la Unidad de Terapia Intensiva (UTI) como en la Sala de Emergencia (ER), para medir la gravedad clinica de los pacientes. En las unidades clinicas medica y quirurgica la precision fue de 65%. Conclusion: El TISS-28 mostro ser el mejor instrumento para medir la gravedad de los pacientes en la UTI y ER en comparacion con aquellos internados en las clinicas.

Associação entre sinais vitais e Sistema Manchester de Triagem: estudo observacional retrospectivo

Objetivo: avaliar a associacao entre os sinais vitais coletados na entrada do paciente ao departamento de emergencia e os niveis de risco do Sistema de Triagem de Manchester (STM). Metodo: estudo observacional retrospectivo cuja amostra foi de 154.714 pacientes. O fator de exposicao foi os dados dos sinais vitais, e o desfecho primario o nivel de risco do STM. Analises descritiva e inferencial foram conduzidas. Resultados: O dado vital mais avaliado foi a intensidade da dor, e a pressao arterial o menos avaliado. Alteracoes na frequencia cardiaca para mais ou menos dos padroes fisiologicos aumentaram a prioridade clinica dos pacientes. Discussao: Quanto maior o nivel de gravidade do STM, maior a variabilidade em torno da media dos sinais vitais avaliados. Conclusao: Pacientes mais graves tendem a apresentar maior variacao nos sinais vitais na admissao ao departamento de emergencia.

Implementação de Estratégias para a Redução da Mortalidade Materna no Vale do Jequitinhonha

Visando contribuir com a reducao da mortalidade materna no Vale do Jequitinhonha foi desenvolvido acoes com o objetivo de atualizar e uniformizar as condutas clinicas dos profissionais de saude para a assistencia as emergencias obstetricas. A acao contemplou os municipios da Microrregiao de Saude de Diamantina em quatro etapas: I – atualizacao do protocolo; II – apresentacao dos resultados para a equipe e ajuste; III – criacao de parcerias com a Comissao Intergestora Regional, e apresentacao da proposta de um curso de atualizacao e divulgacao do protocolo; IV – realizacao do Curso de Emergencias Obstetricas. Foram coletados dados sobre as caracteristicas do atendimento a parturiente antes e apos a realizacao do curso. Analise descritiva foi procedida. Compareceram ao evento 108 profissionais de saude. Foram distribuidos 16 cartazes coloridos de seis diferentes fluxogramas de atendimento aos hospitais de cada municipio. Dos questionarios entregues no inicio e final do curso obteve-se os seguintes resultados: na maioria dos municipios e garantido as parturientes o direito a presenca de acompanhante; houve diferenca em pacientes atendidos pelo convenio e SUS; o partograma nao e utilizado em sete cidades; os metodos nao farmacologicos de alivio da dor mais descritos foram a bola, deambulacao e massagem. Observou-se falta de algumas medicacoes necessarias para intercorrencias. A proposta apresentou repercussao positiva, houve uma boa adesao e participacao dos profissionais. Espera-se que grandes atores estrategicos tenham sido sensibilizados e que mudanca da pratica obstetrica aconteca. Torna-se necessario incentivar outros eventos desta natureza para que a mortalidade materna na regiao diminua cada vez mais.