The impact of a concurrent trauma alert evaluation on time to head computed tomography in patients with suspected stroke.
ABSTRACT Emergency department (ED) overcrowding threatens quality of care by delaying the time to diagnosis and treatment of patients with time-sensitive diseases, such as acute stroke.
The authors hypothesized that the presence of a trauma alert evaluation would impede the time to head computed tomography (hCT) in patients with stroke-like symptoms.
This was a secondary analysis of prospectively collected data on patients with potential stroke who received an hCT in an urban trauma center ED from January 1, 2004, to November 30, 2004. Structured data collection included historical and examination items, National Institutes of Health (NIH) stroke scale score, laboratory and radiographic results, and final diagnosis. Admitted patients were followed in hospital. Patients who presented within one hour following a trauma evaluation were compared with patients who presented without concurrent trauma for triage time until completion of hCT. Chi-square, t-tests, and 95% confidence intervals (95% CIs) were used for comparisons.
The 171 patients enrolled had a mean (+/- standard deviation) age of 60.7 (+/- 7) years; 60% were female; and 58% were African American. Of these, 72 patients had a significant cerebrovascular event (38 [22%] ischemic stroke, 25 [15%] transient ischemic attack, seven [4%] intracranial hemorrhage, one [0.6%] subarachnoid hemorrhage, and one [0.6%] subdural hematoma). The remaining diagnoses included 4.6% migraine, 2.3% seizure, 2.9% syncope, 2.3% Bell's palsy, and 2.9% vertigo. There was no significant difference in time to hCT in patients who presented during a trauma activation and those who did not (99 minutes [interquartile range (IQR) = 24-156] vs. 101 minutes [IQR = 43-151.5]; p = 0.537). In subgroup analysis of patients with a significant cerebrovascular event, times to hCT were also similar (24 minutes [IQR = 12-99] vs. 61 minutes [IQR = 15-126]; p = 0.26).
In the authors' institution, the presence of concurrent trauma evaluation does not delay CT imaging of patients with potential stroke.
Conference Paper: Sequential detection and estimation of soft failures in linear systems[Show abstract] [Hide abstract]
ABSTRACT: An algorithm is reported for soft failure detection and estimation which has very modest computational requirements. Soft failures manifest themselves as deviations from the expected statistical behaviour of system inputs. The detection scheme utilizes only one Kalman filter and requires the implementation of a Wald Sequential Detector (WSD). The algorithm consists of applying the Sequential Probability Ratio Test (SPRT) to the nonwhite Kalman filter innovations for rapid failure detection. The Average Sample Number (ASN) is used for estimating failed parameters. Some computer simulation results are presented.Decision and Control including the Symposium on Adaptive Processes, 1979 18th IEEE Conference on; 01/1980
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ABSTRACT: Emergency department (ED) crowding occurs when demands for ED care exceed the supply of available resources. Prior studies have shown that ED crowding is associated with a delay in provision of critical ED services, but the impact of ED crowding on acute stroke care has not been extensively studied. We conducted a retrospective study of patients who presented to the ED with acute stroke symptoms (ischemic stroke, transient ischemic attack, intracerebral hemorrhage) at 2 hospitals. All patients with active stroke symptoms who presented within 3 hours were included and a random sample of patients with symptoms >3 hours was used for comparison. The association between ED crowding measures (waiting room number, ED occupancy, number of admitted patients, and total patient hours) and time to head CT order, completion, and interpretation, and time to administration of thrombolysis was determined. Of 253 patients presenting with acute stroke symptoms ≤3 hours from symptom onset, 52 (21%) received thrombolysis. A random comparison group of 253 patients with symptoms >3 hours was identified. There was no significant association between ED crowding and delays in CT timing or thrombolysis in patients with symptoms ≤3 hours. Several measures of ED crowding were associated with prolonged times to CT order and completion in patients with symptoms >3 hours. ED crowding was not associated with care delays in thrombolysis-eligible patients with stroke. However, those with symptoms >3 hours do experience CT delays at higher levels of ED crowding.Stroke 02/2011; 42(4):1074-80. DOI:10.1161/STROKEAHA.110.586610 · 6.02 Impact Factor
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ABSTRACT: Traumatic brain injury (TBI) constitutes the leading cause of posttraumatic mortality. Practically, the major interventions required to treat TBI predicate expedited transfer to CT after excluding other immediately life-threatening conditions. At our center, trauma responses variably consist of either full trauma activation (FTA) including an attending trauma surgeon or a non-trauma team response (NTTR). We sought to explore whether FTAs expedited the time to CT head (TTCTH). Retrospective review augmented demographics of 88 serious head injuries identified from a Regional Trauma Registry within one year at a level I trauma center. The data were analyzed using STATA. There were 58 FTAs and 30 NTTRs; 86% of FTAs and 17% of NTTRs were intubated prehospital. Although FTAs were more seriously injured (median ISS 29, MAIS head 19, GCS score at scene 6.0), NTTRs were also severely injured (median ISS 25, MAIS head 21, GCS at scene 10) and older (median 54 vs. 26 years). Median TTCTH was double without dedicated FTA (median 50 vs. 26 minutes, p < 0.001), despite similar justifiable delays (53% NTTR, 52% FTA). Without FTA, most delays (69%) were for emergency intubation. TTCTH after securing the airway was longer for NTTR group (median 38 vs. 26 minutes, p =0.0013). Even with no requirements for ED interventions, TTCTH for FTA was less than half versus NTTR (25 vs. 61 minutes, p =0.0013). Multivariate regression analysis indicated age and FTA with an attending surgeon as significant predictors of TTCTH, although the majority of variability in TTCTH was not explained by these two variables (R^2=0.33). Full trauma activations involving attending trauma surgeons were quicker at transferring serious head injury patients to CT. Patients with FTA were younger and more seriously injured. Discerning the reasons for delays to CT should be used to refine protocols aimed at minimizing unnecessary delays and enhancing workforce efficiency and clinical outcome.World Journal of Emergency Surgery 11/2013; 8(1):48. DOI:10.1186/1749-7922-8-48 · 1.06 Impact Factor