To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Triage criteria rely on physiologic, anatomic, and mechanistic indicators of injury to minimize over-triage and under-triage, which remain persistendy high (35%—65%). The Visensia Index Score (VIS) is a proprietary algorithm in a bedside monitor (OBS Medical, IN) mat integrates five vital signs: (1) heart rate; (2) respiratory rate; (3) blood pressure; (4) pulse oximetry; and (5) temperature. It calculates a score ranging from 1 (no abnormality) to 5 (severe abnormalities). The aim of this study was to explore the utility of VIS in identifying trauma patients likely to have a poor prognosis on arrival to the emergency departments.
After Institutional Review Board approval, the trauma registry was used to review 117 patients admitted to a Level-1 Trauma Center over a six month period. The first set of vital signs was obtained upon arrival to the emergency department. An initial VIS and a mean VIS (based on multiple VS) was calculated. The analysis included a multivariate mathematical technique and k-means cluster analysis. Clusters of populations with different Visensia scores were compared and differences in their outcomes were analyzed.
Two major clusters were identified: VIS Scores >3 increased the risk of mortality as compared to those with scores <3; odds ratio 3.3 [1.04–10.3; p <0.001). There was no association with length of intensive care unit stay, hospital days; or Injury Severity Scale (ISS) scores.
Cluster analysis, a novel multidimensional approach, shows association of a higher VIS (>3) as a useful point-of-care parameter to identify trauma patients likely to have a poorer prognosis, much more than retrospectively computed ISS and Trauma and Injury Severity Scores (TRISS).
Vital signs (VS) data collected in prehospital care and recorded in trauma registries are often missing or unreliable as it is difficult to record dynamic changes while performing resuscitation and stabilization. The purpose of this study was to test the hypothesis that analysis of continuous vital signs improves data quality, and predicts life-saving interventions (LSI) better than use of retrospectively compiled Trauma Registry (TR) data.
After Institutional Review Board approval, six emergency medical services helicopters were equipped with a Vital Signs Data Recorder (VSDR) to capture continuous VS from the patient onto a handheld personal digital assistant (PDA). Prehospital LSIs (fluid bolus, cardiopul-monary resuscitation, drugs, intubation, etc.) and those performed within two hours after arrival in the trauma resuscitation unit were considered outcome variables. The VSDR and TR data were compared using Bland-Altman method. A multivariate analysis was performed to determine which VS variable best predicted LSIs using the values in the TR and the VSDR.
Prehospital VSDR data were collected from 177 patients. There was a significant difference between the highest and lowest heart rate, systolic blood pressure (SBP), and oxygen saturation between the VSDR and the TR data (p <0.001).The VSDR highest heart rate and lowest oxygen saturation recorded predicted LSIs while none of the TR vital signs did so in a multivariate model. The SBP was not an independent predictor of LSI.
The VSDR data increased the odds of predicting LSIs compared to the TR data. Using continuous vital signs in prehospital care may lead to the development of better trauma prognostic models.
The potential for disasters exists in all communities. To mitigate the potential catastrophes that confront humanity in the new millennium, an evidence-based approach to disaster management is required urgently. This study moves toward such an evidence-based approach by identifying peer-reviewed publications following a range of disasters and events over the past three decades.
Peer-reviewed, event-specific literature was identified using a comprehensive search of the electronically indexed database, MEDLINE (1956–January 2009). An extended comprehensive search was conducted for one event to compare the event-specific literature indexed in MEDLINE to other electronic databases (EMBASE, CINAHL, AMED, CENTRAL, Psych Info, Maternity and Infant Care, EBM Reviews).
Following 25 individual disasters or overwhelming crises, a total of 2,098 peer-reviewed, event-specific publications were published in 789 journals (652 publications following disasters/events caused by natural hazards, 966 following human-made/technological disasters/events, and 480 following conflict/complex humanitarian events).The event with the greatest number of peer-reviewed, event-specific publications was the 11 September 2001 terrorist attacks (686 publications). Prehospital and Disaster Medicine published the greatest number of peer-reviewed, event-specific publications (54), followed by Journal of Traumatic Stress (42), Military Medicine (40), and Psychiatric Services (40). The primary topics of event-specific publications were mental health, medical health, and response. When an extended, comprehensive search was conducted for one event, 75% of all peer-reviewed, event-specific publications were indexed in MEDLINE.
A broad range of multi-disciplinary journals publish peer-reviewed, event-specific publications. While the majority of peer-reviewed, event-specific literature is indexed in MEDLINE, comprehensive search strategies should include EMBASE to increase yield.
Email your librarian or administrator to recommend adding this to your organisation's collection.