Validation of physiological scoring systems in the accident and emergency department

Subbe, Christian P; Slater, Anthony; Menon, Dilip; Gemmell, Les

doi:10.1136/emj.2006.035816

Cited by 141 publications

(124 citation statements)

References 12 publications

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“…deterioration risk by identifying abnormalities. [12] The ISS and the TRISS are widely accepted TSSs, and their calculation requires that all examinations and workups are performed and that injuries in anatomic locations are noted in a detailed manner. The accurate determination of the seriousness of the condition on the part of patient is only possible through accurate identification of the injury.…”

Section: Discussionmentioning

confidence: 99%

Value of the Glasgow Coma Scale, Age, and Arterial Blood Pressure (GAP) Score for Predicting the Mortality of Major Trauma Patients Presenting to the Emergency Department

Ahun¹,

Köksal²,

Sığırlı³

et al. 2014

Ulus Travma Acil Cerrahi Derg

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Section: Discussionmentioning

confidence: 99%

Value of the Glasgow Coma Scale, Age, and Arterial Blood Pressure (GAP) Score for Predicting the Mortality of Major Trauma Patients Presenting to the Emergency Department

Ahun¹,

Köksal²,

Sığırlı³

et al. 2014

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…[2] EWSs are known for their ability to detect physiological changes relating to vital signs. [3] Combining various standardised physiological parameters into an EWS has recently been recognised as a powerful tool in initiating appropriate responses from the initial contact at triage. [4,5] The benefits of an EWS include its objectivity and the fact that an aggregated score is a stronger predictor than individual vital signs and reliance on routinely recorded vital signs.…”

mentioning

confidence: 99%

Vital signs for children at triage: A multicentre validation of the revised South African Triage Scale (SATS) for children

et al. 2013

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Objective. To validate a revised version of the paediatric South African Triage Scale (SATS) against admission as a reference standard and compare the sensitivity of triage using: (i) clinical discriminators; (ii) an age-appropriate physiological composite score; and (iii) a combination of both. Methods. A prospective cohort study was undertaken validating the revised paediatric SATS against outcome markers of children at six emergency centres during a 2-month period in 2011. The primary outcome marker was the proportion of children admitted. Validity indicators including sensitivity (Se), specificity, positive predictive value and negative predictive value (NPV) were used to estimate the validity. Associated percentages for over-/under-triage were used to further assess practical application of the paediatric SATS. Results. A total of 2 014 children were included. The percentage of hospital admissions increased with an increase in the level of urgency from 5% in the non-urgent patients to 73% in the emergency patients. The data demonstrated that sensitivity increased substantially when using the SATS, which is a combination of clinical discriminators and the Triage Early Warning Score (TEWS) (Se 91.0%, NPV 95.3%), compared with use of clinical discriminators in isolation (Se 57.1%, NPV 86.3%) or the TEWS in isolation (Se 75.6%, NPV 89.1%). Conclusion. The results of this study illustrate that the revised paediatric SATS is a safe and robust triage tool.

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“…However, in the monitoring of early disease states, when some latency is acceptable, e.g., early hemorrhage detection, 12 sepsis detection, 25,34 or other early warning functionality, 23,24 we suggest that the SPRT may provide a means to improve classifier stability and to reduce false alarms, without any necessary loss in decision accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…In many reports, continual classifiers are evaluated without explicit consideration of their performance and consistency through time, such as reports by our group 12 and by others. [23][24][25] It is likely that, at least for a subset of continual monitoring applications, standard diagnostic test characteristics are insufficient and it would be valuable to consider consistency to quantify clinically relevant properties of the diagnostic test.…”

Section: Discussionmentioning

confidence: 99%

Are Standard Diagnostic Test Characteristics Sufficient for the Assessment of Continual Patient Monitoring?

et al. 2012

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Background. For diagnostic processes involving continual measurements from a single patient, conventional test characteristics, such as sensitivity and specificity, do not consider decision consistency, which might be a distinct, clinically relevant test characteristic. Objective. The authors investigated the performance of a decision-support classifier for the diagnosis of traumatic injury with blood loss, implemented with three different data-processing methods. For each method, they computed standard diagnostic test characteristics and novel metrics related to decision consistency and latency. Setting. Prehospital air ambulance transport. Patients. A total of 557 trauma patients. Design. Continually monitored vital-sign data from 279 patients (50%) were randomly selected for classifier development, and the remaining were used for testing. Three data-processing methods were evaluated over 16 min of patient monitoring: a 2-min moving window, time averaging, and postprocessing with the sequential probability ratio test (SPRT). Measurements. Sensitivity and specificity were computed. Consistency was quantified through cumulative counts of decision changes over time and the fraction of patients affected by false alarms. Latency was evaluated by the fraction of patients without a decision. Results. All 3 methods showed very similar final sensitivities and specificities. Yet, there were significant differences in terms of the fraction of patients affected by false alarms, decision changes through time, and latency. For instance, use of the SPRT led to a 75% reduction in the number of decision changes and a 36% reduction in the number of patients affected by false alarms, at the expense of 3% unresolved final decisions. Conclusion. The proposed metrics of decision consistency and decision latency provided additional information beyond what could be obtained from test sensitivity and specificity and are likely to be clinically relevant in some applications involving temporal decision making.

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Validation of physiological scoring systems in the accident and emergency department

Abstract: Introduction of a physiological scoring system would have identified only a small number of additional patients as critically ill and added little to the triage system currently in use.

Cited by 141 publications

References 12 publications

Value of the Glasgow Coma Scale, Age, and Arterial Blood Pressure (GAP) Score for Predicting the Mortality of Major Trauma Patients Presenting to the Emergency Department

Value of the Glasgow Coma Scale, Age, and Arterial Blood Pressure (GAP) Score for Predicting the Mortality of Major Trauma Patients Presenting to the Emergency Department

Vital signs for children at triage: A multicentre validation of the revised South African Triage Scale (SATS) for children

Are Standard Diagnostic Test Characteristics Sufficient for the Assessment of Continual Patient Monitoring?

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