Nicola Parenti

Reliability and validity of an Italian four-level emergency triage system

Objectives To measure the reliability and predictive validity of a four-level triage system (I-4L). Methods This observational study was conducted in an urban hospital. Five nurses were randomly selected to assign a triage level to 246 paper scenarios, using the I-4L model. The I-4L model is a four-level triage system: urgency category (UC) 1 requires immediate response; UCs 2, 3 and 4 require assessment within 20, 60 and 120 min, respectively. Weighted κ statistics were used to measure the inter-rater and intrarater reliability of the triage tool and the validity of the model was assessed based on the accuracy in predicting admission and in predicting a reference standards triage code. Results The I-4L models inter-rater reliability was κ=0.73 (95% CI 0.67 to 0.79), and the intrarater reliability was κ=0.82 (95% CI 0.67 to 0.96). Its accuracy of triage rating for admission and for prediction of a reference standards triage code was good: 79% (95% CI 73% to 86%) and 93% (95% CI 89% to 96%), respectively. The percentages of patients admitted per triage level using the I-4L model was: 100% UC 1; 42% UC 2; 6% UC 3; and 2% UC 4. Conclusions The I-4L triage model shows a good inter-rater and intrarater reliability for rating triage acuity and for accuracy in patient admission and prediction of a reference standards triage code.

A cross-sectional study on the comparison of five ultrasound measurements to estimate central venous pressure in spontaneously breathing and ventilated patients

The correlation of the inferior vena cava (IVC) diameter and the internal jugular vein (IJV) diameter with Central Venous Pressure (CVP) was already tested. Few reports compared IVC and IJV ultrasound measures in the same population. No data there are on the correlation of the internal jugular vein diameter and CVP in ventilated patients.

Syncope in Prinzmetal’s variant angina

Syncope is a very common disease in Emergency Department. Prinzmetal’s variant angina has an high prevalence in Italy. It could begin as a syncope. Early diagnosis of both is important because their prognosis is sometimes unfavourable. During initial evaluation, physical and instrumental exams aren’t often diagnostic. On the contrary, the history is often useful. If there is a diagnostic hypothesis of cardiac syncope, ECG monitoring, also for 48-72 hours, is fundamental.