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Biomedical subjects

S Carley

Publications and source records attributed to S Carley.

At least 19 recordsLinked to original sources
PubMed2006

Validation of the Paediatric Triage Tape.

INTRODUCTION: The Paediatric Triage Tape (PTT) is an easy to use major incident primary triage tool, based upon a modification of the Triage Sieve. The purpose of this study was to prospectively validate the PTT for use in paediatric major incidents. METHODS: A database of children presenting the Trauma Unit of the Red Cross Children's Hospital, Cape Town, was developed over a nine month period. Each child was triaged using the PTT, and had an Injury Severity Score (ISS) calculated. Additionally, the New Injury Severity Score (NISS) was calculated, and the presence of interventions that may occur to the children ("Garner criteria") was documented. The sensitivity, specificity, overtriage, and undertriage rates were calculated. RESULTS: 3461 children were entered into the database. For identifying children with an ISS of over 15, the PTT had a sensitivity of 37.8%, specificity of 98.6%, overtriage rate of 38.8%, and an undertriage rate of 3.5%. Against the NISS and Garner criteria, the results were comparable. CONCLUSION: The PTT has poor sensitivity at identifying immediate priority children by these criteria. Specificity (the ability to identify non-T1 patients) is excellent, and the overtriage and undertriage rates are within the range deemed unavoidable by the American College of Surgeons.

Algorithms↗
PubMed2006

A procedure based alternative to the injury severity score for major incident triage of children: results of a Delphi consensus process.

BACKGROUND: Triage at the site of a major incident is key to effective scene management. A number of triage algorithms have been suggested to assist the triage officer to determine triage priorities. However, many advocated scores were not specifically developed for use in major incidents, nor are they designed for multiple age groups. Many of these algorithms have not been validated: those that have were validated against the Injury Severity Score, which is of little relevance in a major incident--it is the urgency of medical intervention that is of importance in this setting. OBJECTIVES: To develop a set of criteria against which major incident triage algorithms can be tested. METHODS: Sixteen experts from the UK and South Africa took part in a three round Delphi consensus method in order to develop clinical criteria against which major incident triage algorithms may be tested. RESULTS: Thirty nine statements were initially identified as possible determinants of triage priority: 29 statements reached consensus. These associate specific clinical interventions with triage priority. CONCLUSION: Delphi may be used to identify which clinical criteria define triage priority in a major incident setting. These criteria and the associated triage categories may be used as for the validation of specific major incident triage algorithms. This method may be used to develop specific criteria for other triage algorithms.

Algorithms↗
PubMed2006

Diagnosis of pulmonary embolism with CT pulmonary angiography: a systematic review.

OBJECTIVE: To appraise the evidence on the diagnostic accuracy of CT pulmonary angiography and the prognostic value of a negative CT pulmonary angiogram in the diagnosis of pulmonary embolism. METHODS: Medline, EMBASE, and grey literature were systematically searched by two researchers. Any study which compared CT pulmonary angiography to an acceptable reference standard or prospectively followed up a cohort of patients with a normal CT pulmonary angiogram was included. Study methods were appraised independently by two researchers, and data were extracted independently by three researchers. RESULTS: Thirteen diagnostic and 11 follow up studies were identified. Studies varied in prevalence of pulmonary embolism (19-79%), patient groups, and method quality. Few studies recruited unselected emergency department patients. There was heterogeneity in the analysis of sensitivity (53 to 100%), specificity (79 to 100%), and false negative rate (1.0 to 10.7%). The pooled false negative rate of combined negative CT pulmonary angiography and negative deep vein thrombosis testing was 1.5% (95% CI 1.0 to 1.9%). CONCLUSION: Diagnostic studies give conflicting results for the diagnostic accuracy of CT pulmonary angiography. Follow up studies show that CT pulmonary angiography can be used in combination with investigation for deep vein thrombosis to exclude pulmonary embolism.

Angiography↗
PubMed2006

Who's who at a major incident: standardising role titles for emergency planners.

OBJECTIVE: To standardise the names for key roles in a major incident. METHODS: A Delphi study using experts in major incident planning. RESULTS: There is clear consensus regarding the need for standard nomenclature. The expert group identified 28 roles, and 184 different names were initially given by group members for the 28 roles. Agreement on a common nomenclature was achieved in only 12/28 roles. CONCLUSION: There is agreement for a standardised nomenclature for major incident roles. However, consensus may be difficult to achieve from within an expert group.

Consensus↗
PubMed2006

Comparison of paediatric major incident primary triage tools.

OBJECTIVES: To determine the sensitivity and specificity of paediatric major incident triage scores. The Paediatric Triage Tape (PTT), Careflight, Simple Triage and Rapid Treatment (START), and JumpSTART systems were tested. METHODS: In total, 3461 children presenting to a South African emergency department with trauma were scored using the four different methods. The sensitivity and specificity of the four scores was calculated against the Injury Severity Score (ISS), New ISS (NISS), and a modification of the Garner criteria (a measure of need for urgent clinical intervention). We also performed a Bayesian analysis of the scores against three different types of major incident. RESULTS: None of the tools showed high sensitivity and specificity. Overall, the Careflight score had the best performance in terms of sensitivity and specificity. The performance of the PTT was very similar. In contrast, the JumpSTART and START scores had very low sensitivities, which meant that they failed to identify patients with serious injury, and would have missed the majority of seriously injured casualties in the models of major incidents. CONCLUSION: The Careflight or PTT methods of triage should be used in paediatric major incidents in preference to the jumpSTART or START methods.

Algorithms↗
PubMed2006

Exposure or expert? Setting standards for postgraduate education through a Delphi technique.

OBJECTIVES: The aim of this study was to determine if a syllabus of upper limb anatomy for emergency clinicians composed by an expert panel reflected clinical practice as experienced by those at whom the syllabus would be directed. METHODS: A three round Delphi study was performed using an expert group. We compared this with a measure of the exposure to anatomical concepts in the day to day practice of trainees in emergency medicine. RESULTS: In total, 404 separate anatomical facts relating to the upper limb were reviewed by both groups. There was poor agreement (kappa = 0.348) between the expert group and the trainees. CONCLUSION: We have shown disparity between what an expert group believes trainees should know and what trainees are actually exposed to in clinical practice. We believe this demonstrates that curriculum development must strike a balance between important (expert) and common (exposure) information. We have shown how an expert:exposure matrix may be used to inform curriculum development.

Curriculum↗
PubMed2005

Simple nomograms to calculate sample size in diagnostic studies.

OBJECTIVES: To produce an easily understood and accessible tool for use by researchers in diagnostic studies. Diagnostic studies should have sample size calculations performed, but in practice, they are performed infrequently. This may be due to a reluctance on the part of researchers to use mathematical formulae. METHODS: Using a spreadsheet, we derived nomograms for calculating the number of patients required to determine the precision of a test's sensitivity or specificity. RESULTS: The nomograms could be easily used to determine the sensitivity and specificity of a test. CONCLUSIONS: In addition to being easy to use, the nomogram allows deduction of a missing parameter (number of patients, confidence intervals, prevalence, or sensitivity/specificity) if the other three are known. The nomogram can also be used retrospectively by the reader of published research as a rough estimating tool for sample size calculations.

Diagnostic Techniques and Procedures↗
PubMed2004

Best evidence topic reports. Does nimodipine reduce mortality and secondary ischaemic events after subarachnoid haemorrhage?

A short cut review was carried out to establish whether nimodipine is better than placebo at reducing mortality and neurological sequelae in patients with subarachnoid haemorrhage. Altogether 465 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

Adult↗
PubMed2001

Trauma education.

OBJECTIVE: Trauma is a diverse disease in which time critical decisions and skills affect patient outcome. This review article examines the methods and assessment of education for the management of the trauma patient. METHOD: Literature review. RESULTS: Education is a planned experience that leads to a change in behaviour. Adult education methods can be used to improve the knowledge, skills, attitudes and relationships of health care workers. Adult learners need careful consideration of lecture style, small group work, role play and skills stations in order to achieve these aims. These techniques are typically used in short intensive courses such as Advanced Trauma Life Support (ATLS) aimed at the initial care of the trauma patient. There is a relative lack of education directed at definitive care. It is important to assess the impact of trauma education in terms of clinical process, retention of skills/knowledge and the outcome of patients. A generic approach (the ABC approach) is applicable to the care of all critically ill or injured patients. This approach should be taught at junior level. CONCLUSION: The care of trauma patients can be improved by educating health care workers using adult educational strategies.

Adult↗