High-Risk Chief Complaints III: Abdomen and Extremities

Tekwani, Karis L.; Sikka, Rishi

doi:10.1016/j.emc.2009.07.006

Cited by 7 publications

(7 citation statements)

References 59 publications

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“…For instance, certain CCs that are often considered high-risk in developed settings (e.g., chest pain, abdominal pain) were absent from this high-risk list. 15,24,25 At the same time, certain CCs that are typically, albeit not universally, considered low-risk in HICs (e.g., general weakness/malaise) were present in this high-risk list. 18 Moreover, a case-by-case review of the mortality associated with "abdominal distension" showed the most common diagnoses to be bowel obstruction, peritonitis, and liver disease.…”

Section: Discussionmentioning

confidence: 93%

“…However, care must be taken to build systems in LMICs that address local language and disease patterns. For instance, certain CCs that are often considered high‐risk in developed settings (e.g., chest pain, abdominal pain) were absent from this high‐risk list 15,24,25 . At the same time, certain CCs that are typically, albeit not universally, considered low‐risk in HICs (e.g., general weakness/malaise) were present in this high‐risk list 18 .…”

Section: Discussionmentioning

confidence: 97%

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Defining High‐risk Emergency Chief Complaints: Data‐driven Triage for Low‐ and Middle‐income Countries

Rice

Leanza

Mowafi

et al. 2020

Academic Emergency Medicine

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Objectives: Emergency medicine in low-and middle-income countries (LMICs) is hindered by lack of research into patient outcomes. Chief complaints (CCs) are fundamental to emergency care but have only recently been uniquely codified for an LMIC setting in Uganda. It is not known whether CCs independently predict emergency unit patient outcomes. Methods: Patient data collected in a Ugandan emergency unit between 2009 and 2018 were randomized into validation and derivation data sets. A recursive partitioning algorithm stratified CCs by 3-day mortality risk in each group. The process was repeated in 10,000 bootstrap samples to create an averaged risk ranking. Based on this ranking, CCs were categorized as "high-risk" (>29 baseline mortality), "medium-risk" (between 2 and 0.59 baseline mortality), and "low-risk" (<0.59 baseline mortality). Risk categories were then included in a logistic regression model to determine if CCs independently predicted 3-day mortality. Results: Overall, the derivation data set included 21,953 individuals with 7,313 in the validation data set. In total, 43 complaints were categorized, and 12 CCs were identified as high-risk. When controlled for triage data including age, sex, HIV status, vital signs, level of consciousness, and number of complaints, high-risk CCs significantly increased 3-day mortality odds ratio (OR = 2.39, 95% confidence interval [CI] = 1.95 to 2.93, p < 0.001) while low-risk CCs significantly decreased 3-day mortality odds (OR = 0.16, 95% CI = 0.09 to 0.29, p < 0.001). Conclusions: High-risk CCs were identified and found to predict increased 3-day mortality independent of vital signs and other data available at triage. This list can be used to expand local triage systems and inform emergency training programs. The methodology can be reproduced in other LMIC settings to reflect their local disease patterns.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 97%

Defining High‐risk Emergency Chief Complaints: Data‐driven Triage for Low‐ and Middle‐income Countries

Rice

Leanza

Mowafi

et al. 2020

Academic Emergency Medicine

View full text Add to dashboard Cite

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“…Risk of perforation in this group is also significantly higher than the general population, as much as 50%. 30 Difficulty in obtaining clinical symptoms, as well as equivocal laboratory results, can lead to an inability of the emergency physician to diagnose appendicitis in children or seniors accurately. This may increase the risk of perforation in those not surgically treated in time, as well as risk removal of a healthy appendix in those who are misdiagnosed with appendicitis.…”

Section: Discussionmentioning

confidence: 99%

“…34 CT testing on a pregnant woman involves radiation exposure to the mother and to the fetus, with the likelihood of development of childhood cancer doubling with 1 CT scan during the first trimester of pregnancy. 30,35 Magnetic resonance imaging (MRI) is an alternative that does not pose the same complications of radiation exposure; however, the time to obtain an MRI and the cost can be prohibitive. 30 The safety of the mother and the fetus is a top priority, and sonography plays a prominent role in maintaining safe and critical care for these patients.…”

Section: Discussionmentioning

confidence: 99%

“…30,35 Magnetic resonance imaging (MRI) is an alternative that does not pose the same complications of radiation exposure; however, the time to obtain an MRI and the cost can be prohibitive. 30 The safety of the mother and the fetus is a top priority, and sonography plays a prominent role in maintaining safe and critical care for these patients. [36][37][38][39]…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Imaging of Appendicitis With Supplementation by Transabdominal and Transvaginal Sonography

Hobbs

2015

Journal of Diagnostic Medical Sonography

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Acute appendicitis is a condition that can affect any member of the population. Without timely treatment there is a high likelihood of rupture leading to peritonitis, and early diagnosis is imperative to obtaining treatment. Sonography can be used without fear of radiation exposure to the patient and with relatively little discomfort, ideal for pediatric patients. It can also be used with little patient preparation, with the possibility of a more rapid diagnosis than other imaging modalities. For patients presenting with atypical symptoms, sonography may be used to increase diagnostic accuracy, which will lead to a drop in the surgical removal rate of a healthy appendix. When diagnostic criteria are met, sonography results can be correlated with the patient's blood test and clinical symptoms to make a positive diagnosis. The addition of the transvaginal approach for female patients has further increased the rate of success of diagnosing acute appendicitis, so that appropriate emergent surgery can be done.

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Vascular Abdominal Emergencies

Lewiss¹,

Egan²,

Shreves³

2011

Emergency Medicine Clinics of North America

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Patients with nonspecific abdominal pain can have any one of many disease processes. The physical examination may not reveal clear abnormalities, making the diagnosis more difficult. Vascular abdominal emergencies are not common but, when present, may be catastrophic, with significant morbidity and, frequently, mortality. Most of the conditions are time sensitive, leaving the integrity of organ blood flow at risk. Thromboembolic disease leads to ischemia and eventual infarction of the intra-abdominal organs. Aneurismal dilation of the aorta with rupture leads to rapid hypovolemic shock and death if not diagnosed. A high index of suspicion is critical to the successful diagnosis.

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High-Risk Chief Complaints III: Abdomen and Extremities

Cited by 7 publications

References 59 publications

Defining High‐risk Emergency Chief Complaints: Data‐driven Triage for Low‐ and Middle‐income Countries

Defining High‐risk Emergency Chief Complaints: Data‐driven Triage for Low‐ and Middle‐income Countries

Diagnostic Imaging of Appendicitis With Supplementation by Transabdominal and Transvaginal Sonography

Vascular Abdominal Emergencies

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