Maria Carolina Barbosa Teixeira Lopes

Triage at the Emergency Department: association between triage levels and patient outcome

OBJETIVOIdentificar a associacao entre variaveis sociodemograficas, clinicas e categorias de triagem com desfechos do protocolo desenvolvido no Hospital Sao Paulo (HSP).METODOEstudo de coorte retrospectivo realizado com pacientes maiores de 18 anos submetidos ao protocolo de triagem em agosto de 2012. Utilizou-se regressao logistica para associar as categorias de risco aos desfechos (p-valor≤0,05).RESULTADOSHomens com idade mais avancada e atendidos pelas especialidades clinicas apresentaram maiores taxas de internacao e obito. Pacientes com alta prioridade apresentaram taxa de internacao e obitos cinco e 10,6 vezes maior, respectivamente (p<0,0001).CONCLUSAOO grupo de maior prioridade associou-se a maiores taxas de internacao e obitos. O protocolo foi capaz de detectar pacientes com condicoes mais urgentes e identificar fatores de risco para internacao hospitalar e obito.OBJECTIVE Identify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP). METHODS Retrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05). RESULTS Men with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001). CONCLUSION The high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.

Capacidade funcional e a gravidade do trauma em idosos

OBJECTIVE: Correlate functional capacity in elderly people with the severity of the trauma and compare it before and after the trauma. METHODS: Prospective observational study conducted in an emergency department, comprised of 55 elderly people, age 60 and over, of both sexes, who suffered trauma. The incapacity of patients with functional limitations of various origins was assessed. The research instruments applied at three different times were: the Functional Independence Measure and the Injury Severity Score to assess the severity of the trauma. RESULTS: Functional capacity within 48 hours of the trauma was significantly higher than functional capacity at discharge and after one month. The lower the severity of the trauma was the greater the functional capacity of the aged. CONCLUSION: The functional capacity of the elderly deteriorated during the time of hospital stay and one month after discharge.

Factors associated with functional impairment of elderly patients in the emergency departments

ABSTRACT Objective: To assess the functional capacity of elderly patients in the emergency department as to Basic and Instrumental Activities of Daily Living. Methods: A cross-sectional study of 200 elderly patients admitted to the emergency department of a teaching hospital in São Paulo (SP), Brazil. The functional capacity of the elderly was assessed by the Katz index and Lawton & Brody scale. Statistical analyses were performed using analysis of variance, Bonferroni correction, χ2 test, or the likelihood ratio test. Results: Most seniors were independent (65%), and the degree of dependence was related to age, female gender, being single and widowed, and presence of cerebrovascular disease and dementia. The more dependent elderly for Instrumental Activities of Daily Living had increased dependence for Basic Activities. Conclusion: We emphasize the importance of assessing the functional capacity of the elderly in the emergency department as it provides data for the nursing care in order to minimize or to avoid their functional impairment.

Measuring trauma severity using the 1998 and 2005 revisions of the Abbreviated Injury Scale

OBJECTIVES This study aims to compare injury and trauma severity as measured by the 1998 and 2005 revisions of the Abbreviated Injury Sca le and to determine the mortality in the Injury Severity Score and the New Injury Severity Score in both versions. METHOD This cross-sectional retrospective study analyzed injuries of trauma patients from three university hospitals in Sao Paulo, Brazil. Each injury was coded using the Abbreviated Injury Scale 1998 and 2005. The statistical tests applied were the Wilcoxon, McNemar-Bowker, Kappa, and Z tests. RESULTS Comparing the two versions resulted in significant disagreement regard ing the scores of certain body regions. With the 2005 version, injury and trauma severity levels were significantly decreased, and the mortality was higher at lower scores. CONCLUSION Injury and trauma severity were decreased and the percentage mortality was changed when the 2005 revision of the Abbreviated Injury Scale was used.Objetivo: Comparar a gravidade das lesoes e do trauma mensurada pelas versoes da Abbreviated Injury Scale 1998 e 2005 e verificar a mortalidade nos escores Injury Severity Score e New Injury Severity Score nas duas versoes. Metodo: Estudo transversal e retrospectivo analisou lesoes de pacientes de trauma, de tres hospitais universitarios do municipio de Sao Paulo, Brasil. Cada lesao foi codificada com Abbreviated Injury Scale 1998 e 2005. Os testes estatisticos aplicados foram Wilcoxon, McNemar-Bowker, Kappa e teste Z. Resultados: A comparacao das duas versoes resultou em discordância significante de escores em algumas regioes corporeas. Com a versao 2005 os niveis de gravidade da lesao e do trauma foram significantemente reduzidos e a mortalidade foi mais elevada em escores mais baixos. Conclusao: Houve reducao da gravidade da lesao e do trauma e alteracao no percentual de mortalidade com o uso da Abbreviated Injury Scale 2005.

Nursing staff sizing in the emergency room of a university hospital

OBJECTIVE To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. METHOD The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. RESULTS The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. CONCLUSION A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed.OBJECTIVE To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. METHOD The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. RESULTS The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. CONCLUSION A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed.

Characterization of cardiac arrest in the emergency department of a Brazilian University Reference Hospital: A prospective study

Background & objectives: Sudden cardiac arrest (CA) represents one of the greatest challenges for medicine due to the vast number of cases and its social and economic impact. Despite advances in cardiopulmonary resuscitation (CPR) techniques, mortality rates have not significantly decreased over decades. This study was undertaken to characterize patients that have suffered CA and to identify factors related to mortality. Methods: This prospective study was conducted at Emergency Department of São Paulo Hospital, Brazil. Two hundred and eighty five patients were followed for one year after treatment for CA. The mean age was 66.3±17.2 yr, and they were predominantly male (55.8%) and Caucasian (71.9%). Mortality rate and factors associated with mortality were the primary and secondary outcome measures. Data were collected using an in-hospital Utstein-style report. A logistic regression analysis was used to determine which variables were related to mortality. Results: Regarding the characteristics of CPR, 76.5 per cent occurred in hospital, respiratory failure was the most common presumed immediate cause of CA (30.8%) and pulseless electrical activity was the most frequent initial rhythm (58.7%). All attempts at CPR utilized chest compressions and ventilation and the most utilized interventions were epinephrine (97.2%) and intubation (68.5%). Of all patients treated, 95.4 per cent died. Patients with pulseless electrical activity had a higher risk of death than those patients with ventricular fibrillation. Interpretation & conclusions: The findings of the study highlighted that the mortality rate among CA patients was high. The variable that best explained mortality was the initial CA rhythm.

Assessment of nurse’s knowledge about Glasgow coma scale at a university hospital

ABSTRACT Objective To assess knowledge of nurses of emergency services and intensive care units about Glasgow Coma Scale. Methods This cross-sectional analytical study included 127 nurses of critical units of an university hospital. We used structured interview with 12 questions to evaluate their knowledge about the scale. Association of Knowledge with professionals’ sociodemographic variables were verified by the Fisher-test, χ2 and likelihood ratio. Results Most of participants were women mean aged 31.1 years, they had graduated more than 5 years previously, and had 1 to 3 years of work experience. In the assessment of best score possible for Glasgow scale (question 3) nurses who had graduate more than 5 years ago presented a lower percentage success rate (p=0.0476). However, in the question 7, which evaluated what interval of the scale indicated moderate severity of brain trauma injury, those with more years of experience had higher percentage of correct answers (p=0.0251). In addition, nurses from emergency service had more correct answers than nurses from intensive care unit (p=0.0143) in the same question. Nurses graduated for more than 5 years ago had a lower percentage of correct answers in question 7 (p=0.0161). Nurses with more work experience had a better score (p=0.0119) to identify how assessment of motor response should be started. Conclusion Number of year since graduation, experience, and work at critical care units interfered in nurses’ knowledge about the scale, which indicates the need of training.

Triagem no Serviço de Emergência: associação entre as suas categorias e os desfechos do paciente

OBJETIVOIdentificar a associacao entre variaveis sociodemograficas, clinicas e categorias de triagem com desfechos do protocolo desenvolvido no Hospital Sao Paulo (HSP).METODOEstudo de coorte retrospectivo realizado com pacientes maiores de 18 anos submetidos ao protocolo de triagem em agosto de 2012. Utilizou-se regressao logistica para associar as categorias de risco aos desfechos (p-valor≤0,05).RESULTADOSHomens com idade mais avancada e atendidos pelas especialidades clinicas apresentaram maiores taxas de internacao e obito. Pacientes com alta prioridade apresentaram taxa de internacao e obitos cinco e 10,6 vezes maior, respectivamente (p<0,0001).CONCLUSAOO grupo de maior prioridade associou-se a maiores taxas de internacao e obitos. O protocolo foi capaz de detectar pacientes com condicoes mais urgentes e identificar fatores de risco para internacao hospitalar e obito.OBJECTIVE Identify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP). METHODS Retrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05). RESULTS Men with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001). CONCLUSION The high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.

Knowledge of healthcare professionals about rights of patient’s images

Objective To assess knowledge of healthcare professionals about capture and reproduction of images of patients in a hospital setting. Methods A cross-sectional and observational study among 360 healthcare professionals (nursing staff, physical therapists, and physicians), working at a teaching hospital in the city of São Paulo (SP). A questionnaire with sociodemographic information was distributed and data were correlated to capture and reproduction of images at hospitals. Results Of the 360 respondents, 142 had captured images of patients in the last year, and 312 reported seeing other professionals taking photographs of patients. Of the participants who captured images, 61 said they used them for studies and presentation of clinical cases, and 168 professionals reported not knowing of any legislation in the Brazilian Penal Code regarding collection and use of images. Conclusion There is a gap in the training of healthcare professionals regarding the use of patient´s images. It is necessary to include subjects that address this theme in the syllabus of undergraduate courses, and the healthcare organizations should regulate this issue.

One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital

ABSTRACT Objective: To describe neurological status and associated factors of survivors after cardiac arrest, upon discharge, and at 6 and 12 month follow-up. Methods: A cohort, prospective, descriptive study conducted in an emergency room. Patients who suffered cardiac arrest and survived were included. A one-year consecutive sample, comprising 285 patients and survivors (n=16) followed up for one year after discharge. Neurological status was assessed by the Cerebral Performance Category before the cardiac arrest, upon discharge, and at 6 and 12 months after discharge. The following factors were investigated: comorbidities, presence of consciousness upon admission, previous cardiac arrest, witnessed cardiac arrest, location, cause and initial rhythm of cardiac arrest, number of cardiac arrests, interval between collapse and start of cardiopulmonary resuscitation, and between collapse and end of cardiopulmonary resuscitation, and duration of cardiopulmonary resuscitation. Results: Of the patients treated, 4.5% (n=13) survived after 6 and 12 months follow-up. Upon discharge, 50% of patients remained with previous Cerebral Performance Category of the cardiac arrest and 50% had worsening of Cerebral Performance Category. After 6 months, 53.8% remained in the same Cerebral Performance Category and 46.2% improved as compared to discharge. After 12 months, all patients remained in the same Cerebral Performance Category of the previous 6 months. There was no statistically significant association between neurological outcome during follow-up and the variables assessed. Conclusion: There was neurological worsening at discharge but improvement or stabilization in the course of a year. There was no association between Cerebral Performance Category and the variables assessed.