Judith Tintinalli - Academia.edu (original) (raw)
Papers by Judith Tintinalli
Academic Emergency Medicine, 2008
depicts the 10th anniversary of the international emergency medical services (EMS) competition, R... more depicts the 10th anniversary of the international emergency medical services (EMS) competition, Rallye-Rejviz, held in Zlate Hory, Czech Republic, in May 2006 (Figure 1). Francis Mencl provides the commentary. EMS squads from all around the world compete and are scored on their performance on resuscitation scenarios. The Rallye also includes demonstrations of a disaster simulation and a water rescue. This year's competitors included teams from the Czech Republic,
North Carolina medical journal
The purpose of this paper is to describe patient characteristics and clinical conditions seen in ... more The purpose of this paper is to describe patient characteristics and clinical conditions seen in North Carolina emergency departments (EDs) in 2007. Data were analyzed from a static database of all 2007 ED visits in the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). Data were captured from 80% of North Carolina EDs on January 1, 2007 and 93% as of December 31, 2007. ED visits were analyzed by age, sex, method of ED arrival, return and repeat ED visits, expected source of payment, and ED disposition. Data were also analyzed by selected disease and injury groups that were thought by the authors to be of epidemiologic or demographic importance to North Carolina. The first and second leading ED visit diagnosis groups in North Carolina were abdominal pain and chest pain. The top three disease groups resulting in ED visits were chest pain/ischemic heart disease (17.9% of all ED visits), substance and alcohol abuse or withdrawal (11.2%), and diabetes (...
Infectious Diseases in Clinical Practice, 2008
Objectives: To describe the incidence and etiology of meningitis among patients presenting to the... more Objectives: To describe the incidence and etiology of meningitis among patients presenting to the emergency department (ED) who undergo lumbar puncture (LP) and to describe clinical criteria to select which adult patients would not need an LP because the likelihood of meningitis is low. Materials and Methods: This was a retrospective chart review of the results of LPs performed in a tertiary care ED from March to October 2003 on patients aged 16 to 50 years suspected of having meningitis. Using the electronic record, we recorded presenting symptoms, comorbidities, results of (cerebrospinal fluid) analysis, ED length of stay, and complications. The association between specific physical examination or laboratory findings and meningitis was determined through the calculation of sensitivity, specificity, and negative/positive predictive values. Results: Data from the results of 164 LPs were analyzed. Eleven patients (6.7%) had meningitis confirmed by gram stain, culture, or DNA analysis. The causative agents included 55% viral (2 enterovirus, 2 herpes simplex virus, 1 varicella, and 1 coxsackie), 27% bacterial (1 coagulase-negative Staphylococcus aureus, 1 rickettsial, and 1 syphilis) and 18% parasitic/fungal (1 cysticercosis and 1 Cryptococcus neoformans). The most common presenting symptoms or comorbidities in patients receiving an LP were headache (75.6%), fever (47.6%), neck pain or stiffness (23.8%), HIV (11.6%), a history of migraine headaches (4.9%), or a history of cancer or chemotherapy (4.9%). No combination of clinical criteriaVincluding the absence of the classic triad of headache, neck stiffness, and altered mental statusVruled out meningitis. Cerebrospinal fluid findings such as pleocytosis and lymphocytic predominance were strongly associated with meningitis (P = 0.0003 and 0.0004, respectively). Patients receiving an LP stayed in the ED 48.6% longer than other ED patients, and 10 patients (6.1%) returned to the ED within 1 week complaining of headache. Conclusions: In this study, no clinical criteria were identified to select which adult patients would not need an LP because the likelihood of meningitis is low. The absence of fever, neck stiffness, and altered mental status did not rule out adult meningitis. More research may be needed to evaluate the need for adding antiviral agents to the standard regimen when treating presumptive meningi-tis on adults in the ED. More research is needed to risk stratify adult patients and improve the utilization of LPs in the ED.
New England Journal of Medicine, 1990
... 26. Hurd WW, Miodovnik M, Hertzberg V, Lavin JP. Selective management of abruptio placentae: ... more ... 26. Hurd WW, Miodovnik M, Hertzberg V, Lavin JP. Selective management of abruptio placentae: a prospective study . Obstet Gynecol 1983; 61:467–73. ... 22. Ita Litmanovitz, Tzipora Dolfin, Samuel Arnon, Clary Fleser, Valeria Rathouse, Moshe Feigin, Rivka H. Regev. ...
Journal of Emergency Nursing, 2002
The study objectives were to compare reliability and validity of a 3-level (3L) triage system wit... more The study objectives were to compare reliability and validity of a 3-level (3L) triage system with a new 5-level (5L) triage system and determine the effect of nursing experience on triage reliability.
Burns, 2009
Approximately 600,000 burns present to Emergency Departments each year in the United States, yet ... more Approximately 600,000 burns present to Emergency Departments each year in the United States, yet there is little systematic or evidence-based training of Emergency Physicians in acute burn management. We retrospectively accessed the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) database to identify all thermal burns and electrical injuries with associated thermal burns presenting to 92% of North Carolina Emergency Departments over a 1-year period. 10,501 patients met inclusion criteria, 0.3% of all state-wide reported ED visits. Ninety-two percent of burn visits were managed exclusively by Emergency Physicians without acute intervention by burn specialists, including 87% of first degree, 82% of second degree, and 53% of third degree injuries. Only 4.3% were admitted; 4.3% were transferred to another institution. Fifty-five percent were male; 33% were aged 25-44 and 33% presented on weekends. This is the first state-wide study of burn injury and identifies Emergency Physicians as the major providers of acute burn care. Ninety-two percent of 10,501 burn visits, including the majority of severe injuries, were managed exclusively by Emergency Physicians. This supports a need for improved, evidence-based training of Emergency Physicians in the acute management of burns of all types.
Annals of Emergency Medicine, 1998
Namibia is a sparsely populated nation in southwest Africa. A state-run health service provides c... more Namibia is a sparsely populated nation in southwest Africa. A state-run health service provides care to most of the population. The geography and population distribution dictate the delivery systems for prehospital and emergency care. A state-run ambulance service provides basic patient transportation to the state-run hospitals. There is no 911 system. Two private aeromedical companies in Namibia provide the full range of ground and aeromedical treatment, diver rescue, and helicopter and fixed-wing transport services. The scope of care includes cricothyrotomies, chest tubes, and rapid-sequence intubation. Equipment is modern and virtually identical to what is used in the United States. There are no emergency physicians in Namibia. General medical officers are the backbone of the state-run health service. General medical officers assigned to cover the ED are called casualty officers. No specialized training beyond internship is required, and assignments to casualty are viewed as temporary until better positions become available. Only the largest state hospital in the capital has a dedicated, 24-hour emergency staff. The private prehospital care/transport systems are well organized and sophisticated. Formal efforts should be undertaken to develop ties with our colleagues in Namibia. Potential areas for collaboration include injury surveillance and prevention, field trauma resuscitation, and prehospital care.
Annals of Emergency Medicine, 1994
« PreviousNext »Annals of Emergency Medicine Volume 24, Issue 5 , Pages 849-856, November 1994. E... more « PreviousNext »Annals of Emergency Medicine Volume 24, Issue 5 , Pages 849-856, November 1994. Emergency department surveillance: An examination of issues and a proposal for a national strategy****. MD, MPH Herbert G. Garrison: Affiliations. ...
Academic Emergency Medicine, 2008
The chief complaint (CC) is the data element that documents the patient's reason for visiting the... more The chief complaint (CC) is the data element that documents the patient's reason for visiting the emergency department (ED). The need for a CC vocabulary has been acknowledged at national meetings and in multiple publications, but to our knowledge no groups have specifically focused on the requirements and development plans for a CC vocabulary.The national consensus meeting ''Towards Vocabulary Control for Chief Complaint'' was convened to identify the potential uses for ED CC and to develop the framework for CC vocabulary control. The 10-point consensus recommendations for action were 1) begin to develop a controlled vocabulary for CC, 2) obtain funding, 3) establish an infrastructure, 4) work with standards organizations, 5) address CC vocabulary characteristics for all user communities, 6) create a collection of CC for research, 7) identify the best candidate vocabulary for ED CCs, 8) conduct vocabulary validation studies, 9) establish beta test sites, and 10) plan publicity and marketing for the vocabulary.
Academic Emergency Medicine, 2000
Objective: To assess whether advanced age is an independent predictor of survival to hospital dis... more Objective: To assess whether advanced age is an independent predictor of survival to hospital discharge in community-dwelling adult patients who sustained an out-of-hospital cardiac arrest in a suburban county. Methods: A prospective cohort study was conducted in a suburban county emergency medical services system of community-dwelling adults who had an arrest from a presumed cardiac cause and who received out-of-hospital resuscitative efforts from July 1989 to December 1993. The cohorts were defined by grouping ages by decade: 19-39, 40-49, 50-59, 60-69, 70-79, and 80 or more. The variables measured included age, gender, witnessed arrest, response intervals, location of arrest, documented bystander cardiopulmonary resuscitation, and initial rhythms. The primary outcome was survival to hospital discharge. Results are reported using analysis of variance, chi square, and adjusted odds ratios from a logistic regression model. Age group 50-59 served as the reference group for the regression model. Results: Of the 2,608 total presumed cardiac arrests, the overall survival rate to hospital discharge was 7.25%. Patients in age groups 40-49 and 50-59 experienced the best rate of successful resuscitation (10%). Each subsequent decade had a steady decline in successful outcome: 8.1% for ages 60-69; 7.1% for ages 70-79; and 3.3% for age 80ϩ. In a post-hoc analysis, further separation of the older age group revealed a successful outcome in 3.9% of patients ages 80-89 and 1% in patients 90 and older. Patients aged 80 years or more were more likely to arrest at home, were more likely to have an initial bradyasystolic rhythm, yet had a similar rate of resuscitation to hospital admission. In the regression model, age 80 or older was associated with a significantly worse survival to hospital discharge (OR = 0.4, 95% CI = 0.20 to 0.82). Conclusions: There was a twofold decrease in survival following out-of-hospital cardiac arrest to discharge in patients aged 80 or more when compared with the reference group in this suburban county setting. However, resuscitation for community-dwelling elders aged 65-89 is not futile. These data support that out-of-hospital resuscitation of elders up to age 90 years is not associated with a universal dismal outcome.
Emergencias, 2009
El crecimiento exponencial de los servicios de urgencias y emergencias hospitalarios (SUH) y los ... more El crecimiento exponencial de los servicios de urgencias y emergencias hospitalarios (SUH) y los sistemas de información prehospitalarios durante la última década han transformado la práctica clínica de la Medicina de Urgencias y Emergencias (MUE). La informática en MUE (IMUE) -la recogi-da, gestión, procesamiento de datos y su aplicación en la atención de los pacientes del SUH-es una de nuestras herramientas más importantes para mejorar la atención urgente y que repercuten más positivamente en la salud de la población.
Emergencias, 2009
Prehospital care is often defined as the connection between public safety, healthcare and public ... more Prehospital care is often defined as the connection between public safety, healthcare and public REVIEW ARTICLE Emergency Medicine Informatics (EMI) is the collection, management, processing, and application of emergency patient care and operational data. EMI is transforming and improving our prehospital care systems and emergency department (ED) operations, is critical for public health surveillance, and will enable us to expand clinical research in our institutions, regions, and nations. EMI is one of our most important tools for improving emergency care and positively impacting the health of the public. For prehospital care, EMI systems provide information to analyze the cost-effectiveness of clinical interventions, to organize EMS operations, to coordinate communication for service requests, to monitor quality control and educational needs, and to track patient outcomes. The practice of emergency medicine in the ED requires the capture of many data and time elements so that ED care is efficient. EMI modules support triage acuity and tracking, patient tracking, nurse and physician charting, clinical decision support, order entry, and discharge instructions and prescription generation. There must be coordination of the EMI with hospital, laboratory, and radiology reporting systems, and access to hospital and ambulatory clinic records. Clinical information should be aggregated into an ED Database which can then be used for clinical investigation. The cooperation and support of the hospital information services department, hospital administration, emergency medicine physicians, and emergency medicine researchers, is necessary so that the ED database will be well constructed, and most importantly, well used to improve patient care. Because the information from aggregated ED databases provides population-based information about acute illness and injury, ED databases are now one of the key elements of public health surveillance. An effective syndromic surveillance system based upon ED Chief Complaint (CC), nursing triage note, and ICD-9 or-10 CM codes requires the cooperation of hospital information systems professionals, hospital administrators, ED directors, and public health professionals. [Emergencias 2009;21:354-361]
Injury, 2005
Context: In 2002, an ice storm interrupted power to 1.3 million households in North Carolina, USA... more Context: In 2002, an ice storm interrupted power to 1.3 million households in North Carolina, USA. Previous reports described storm injuries in regions with frequent winter weather. [Blindauer KM, Rubin C, Morse DL, McGeehin M. The 1996 New York blizzard: impact on noninjury visits. Am J Emerg Med 1999;17(1):23-7; Centers for Disease Control and Prevention. Community needs assessment and morbidity surveillance following an ice storm--Maine, January 1998. MMRW 1998;47(17):351-5; Daley WR, Smith A, Paz-Argandona E, Malilay J, McGeehin M. An outbreak of carbon monoxide poisoning after a major ice storm in Maine. J Emerg Med 2000;18(1):87-93; Hamilton J. Quebec's ice storm'98: ''all cards wild, all rules broken'' in Quebec's shell-shocked hospitals. Can Med Assoc J 1998;158(4):520-4; Hartling L, Brison RJ, Pickett W. Cluster of unintentional carbon monoxide poisonings presenting to the emergency departments in Kingston, Ontario during 'Ice Storm 98'. Can J Public Health 1998;89(6):388-90; Hartling L, Pickett W, Brison RJ. The injury experience observed in two emergency departments in Kingston, Ontario during 'ice storm 98'. Can J Public Health 1999;90(2):95-8; Houck, PM, Hampson NB. Epidemic carbon monoxide poisoning following a winter storm. J Emerg Med 1997;15(4):469-73; Lewis LM, Lasater LC. Frequency, distribution, and management of injuries due to an ice storm in a large metropolitan area. South Med J 1994;87(2):174-8; Smith RW, Nelson DR. Fractures and other injuries from falls after an ice storm. Am J Emerg Med 1998;16(1):52-5]. We postulated that injuries might differ in a region where ice storms are less common. Objective: Identify storm-related injuries.
Academic Emergency Medicine, 2008
depicts the 10th anniversary of the international emergency medical services (EMS) competition, R... more depicts the 10th anniversary of the international emergency medical services (EMS) competition, Rallye-Rejviz, held in Zlate Hory, Czech Republic, in May 2006 (Figure 1). Francis Mencl provides the commentary. EMS squads from all around the world compete and are scored on their performance on resuscitation scenarios. The Rallye also includes demonstrations of a disaster simulation and a water rescue. This year's competitors included teams from the Czech Republic,
North Carolina medical journal
The purpose of this paper is to describe patient characteristics and clinical conditions seen in ... more The purpose of this paper is to describe patient characteristics and clinical conditions seen in North Carolina emergency departments (EDs) in 2007. Data were analyzed from a static database of all 2007 ED visits in the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). Data were captured from 80% of North Carolina EDs on January 1, 2007 and 93% as of December 31, 2007. ED visits were analyzed by age, sex, method of ED arrival, return and repeat ED visits, expected source of payment, and ED disposition. Data were also analyzed by selected disease and injury groups that were thought by the authors to be of epidemiologic or demographic importance to North Carolina. The first and second leading ED visit diagnosis groups in North Carolina were abdominal pain and chest pain. The top three disease groups resulting in ED visits were chest pain/ischemic heart disease (17.9% of all ED visits), substance and alcohol abuse or withdrawal (11.2%), and diabetes (...
Infectious Diseases in Clinical Practice, 2008
Objectives: To describe the incidence and etiology of meningitis among patients presenting to the... more Objectives: To describe the incidence and etiology of meningitis among patients presenting to the emergency department (ED) who undergo lumbar puncture (LP) and to describe clinical criteria to select which adult patients would not need an LP because the likelihood of meningitis is low. Materials and Methods: This was a retrospective chart review of the results of LPs performed in a tertiary care ED from March to October 2003 on patients aged 16 to 50 years suspected of having meningitis. Using the electronic record, we recorded presenting symptoms, comorbidities, results of (cerebrospinal fluid) analysis, ED length of stay, and complications. The association between specific physical examination or laboratory findings and meningitis was determined through the calculation of sensitivity, specificity, and negative/positive predictive values. Results: Data from the results of 164 LPs were analyzed. Eleven patients (6.7%) had meningitis confirmed by gram stain, culture, or DNA analysis. The causative agents included 55% viral (2 enterovirus, 2 herpes simplex virus, 1 varicella, and 1 coxsackie), 27% bacterial (1 coagulase-negative Staphylococcus aureus, 1 rickettsial, and 1 syphilis) and 18% parasitic/fungal (1 cysticercosis and 1 Cryptococcus neoformans). The most common presenting symptoms or comorbidities in patients receiving an LP were headache (75.6%), fever (47.6%), neck pain or stiffness (23.8%), HIV (11.6%), a history of migraine headaches (4.9%), or a history of cancer or chemotherapy (4.9%). No combination of clinical criteriaVincluding the absence of the classic triad of headache, neck stiffness, and altered mental statusVruled out meningitis. Cerebrospinal fluid findings such as pleocytosis and lymphocytic predominance were strongly associated with meningitis (P = 0.0003 and 0.0004, respectively). Patients receiving an LP stayed in the ED 48.6% longer than other ED patients, and 10 patients (6.1%) returned to the ED within 1 week complaining of headache. Conclusions: In this study, no clinical criteria were identified to select which adult patients would not need an LP because the likelihood of meningitis is low. The absence of fever, neck stiffness, and altered mental status did not rule out adult meningitis. More research may be needed to evaluate the need for adding antiviral agents to the standard regimen when treating presumptive meningi-tis on adults in the ED. More research is needed to risk stratify adult patients and improve the utilization of LPs in the ED.
New England Journal of Medicine, 1990
... 26. Hurd WW, Miodovnik M, Hertzberg V, Lavin JP. Selective management of abruptio placentae: ... more ... 26. Hurd WW, Miodovnik M, Hertzberg V, Lavin JP. Selective management of abruptio placentae: a prospective study . Obstet Gynecol 1983; 61:467–73. ... 22. Ita Litmanovitz, Tzipora Dolfin, Samuel Arnon, Clary Fleser, Valeria Rathouse, Moshe Feigin, Rivka H. Regev. ...
Journal of Emergency Nursing, 2002
The study objectives were to compare reliability and validity of a 3-level (3L) triage system wit... more The study objectives were to compare reliability and validity of a 3-level (3L) triage system with a new 5-level (5L) triage system and determine the effect of nursing experience on triage reliability.
Burns, 2009
Approximately 600,000 burns present to Emergency Departments each year in the United States, yet ... more Approximately 600,000 burns present to Emergency Departments each year in the United States, yet there is little systematic or evidence-based training of Emergency Physicians in acute burn management. We retrospectively accessed the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) database to identify all thermal burns and electrical injuries with associated thermal burns presenting to 92% of North Carolina Emergency Departments over a 1-year period. 10,501 patients met inclusion criteria, 0.3% of all state-wide reported ED visits. Ninety-two percent of burn visits were managed exclusively by Emergency Physicians without acute intervention by burn specialists, including 87% of first degree, 82% of second degree, and 53% of third degree injuries. Only 4.3% were admitted; 4.3% were transferred to another institution. Fifty-five percent were male; 33% were aged 25-44 and 33% presented on weekends. This is the first state-wide study of burn injury and identifies Emergency Physicians as the major providers of acute burn care. Ninety-two percent of 10,501 burn visits, including the majority of severe injuries, were managed exclusively by Emergency Physicians. This supports a need for improved, evidence-based training of Emergency Physicians in the acute management of burns of all types.
Annals of Emergency Medicine, 1998
Namibia is a sparsely populated nation in southwest Africa. A state-run health service provides c... more Namibia is a sparsely populated nation in southwest Africa. A state-run health service provides care to most of the population. The geography and population distribution dictate the delivery systems for prehospital and emergency care. A state-run ambulance service provides basic patient transportation to the state-run hospitals. There is no 911 system. Two private aeromedical companies in Namibia provide the full range of ground and aeromedical treatment, diver rescue, and helicopter and fixed-wing transport services. The scope of care includes cricothyrotomies, chest tubes, and rapid-sequence intubation. Equipment is modern and virtually identical to what is used in the United States. There are no emergency physicians in Namibia. General medical officers are the backbone of the state-run health service. General medical officers assigned to cover the ED are called casualty officers. No specialized training beyond internship is required, and assignments to casualty are viewed as temporary until better positions become available. Only the largest state hospital in the capital has a dedicated, 24-hour emergency staff. The private prehospital care/transport systems are well organized and sophisticated. Formal efforts should be undertaken to develop ties with our colleagues in Namibia. Potential areas for collaboration include injury surveillance and prevention, field trauma resuscitation, and prehospital care.
Annals of Emergency Medicine, 1994
« PreviousNext »Annals of Emergency Medicine Volume 24, Issue 5 , Pages 849-856, November 1994. E... more « PreviousNext »Annals of Emergency Medicine Volume 24, Issue 5 , Pages 849-856, November 1994. Emergency department surveillance: An examination of issues and a proposal for a national strategy****. MD, MPH Herbert G. Garrison: Affiliations. ...
Academic Emergency Medicine, 2008
The chief complaint (CC) is the data element that documents the patient's reason for visiting the... more The chief complaint (CC) is the data element that documents the patient's reason for visiting the emergency department (ED). The need for a CC vocabulary has been acknowledged at national meetings and in multiple publications, but to our knowledge no groups have specifically focused on the requirements and development plans for a CC vocabulary.The national consensus meeting ''Towards Vocabulary Control for Chief Complaint'' was convened to identify the potential uses for ED CC and to develop the framework for CC vocabulary control. The 10-point consensus recommendations for action were 1) begin to develop a controlled vocabulary for CC, 2) obtain funding, 3) establish an infrastructure, 4) work with standards organizations, 5) address CC vocabulary characteristics for all user communities, 6) create a collection of CC for research, 7) identify the best candidate vocabulary for ED CCs, 8) conduct vocabulary validation studies, 9) establish beta test sites, and 10) plan publicity and marketing for the vocabulary.
Academic Emergency Medicine, 2000
Objective: To assess whether advanced age is an independent predictor of survival to hospital dis... more Objective: To assess whether advanced age is an independent predictor of survival to hospital discharge in community-dwelling adult patients who sustained an out-of-hospital cardiac arrest in a suburban county. Methods: A prospective cohort study was conducted in a suburban county emergency medical services system of community-dwelling adults who had an arrest from a presumed cardiac cause and who received out-of-hospital resuscitative efforts from July 1989 to December 1993. The cohorts were defined by grouping ages by decade: 19-39, 40-49, 50-59, 60-69, 70-79, and 80 or more. The variables measured included age, gender, witnessed arrest, response intervals, location of arrest, documented bystander cardiopulmonary resuscitation, and initial rhythms. The primary outcome was survival to hospital discharge. Results are reported using analysis of variance, chi square, and adjusted odds ratios from a logistic regression model. Age group 50-59 served as the reference group for the regression model. Results: Of the 2,608 total presumed cardiac arrests, the overall survival rate to hospital discharge was 7.25%. Patients in age groups 40-49 and 50-59 experienced the best rate of successful resuscitation (10%). Each subsequent decade had a steady decline in successful outcome: 8.1% for ages 60-69; 7.1% for ages 70-79; and 3.3% for age 80ϩ. In a post-hoc analysis, further separation of the older age group revealed a successful outcome in 3.9% of patients ages 80-89 and 1% in patients 90 and older. Patients aged 80 years or more were more likely to arrest at home, were more likely to have an initial bradyasystolic rhythm, yet had a similar rate of resuscitation to hospital admission. In the regression model, age 80 or older was associated with a significantly worse survival to hospital discharge (OR = 0.4, 95% CI = 0.20 to 0.82). Conclusions: There was a twofold decrease in survival following out-of-hospital cardiac arrest to discharge in patients aged 80 or more when compared with the reference group in this suburban county setting. However, resuscitation for community-dwelling elders aged 65-89 is not futile. These data support that out-of-hospital resuscitation of elders up to age 90 years is not associated with a universal dismal outcome.
Emergencias, 2009
El crecimiento exponencial de los servicios de urgencias y emergencias hospitalarios (SUH) y los ... more El crecimiento exponencial de los servicios de urgencias y emergencias hospitalarios (SUH) y los sistemas de información prehospitalarios durante la última década han transformado la práctica clínica de la Medicina de Urgencias y Emergencias (MUE). La informática en MUE (IMUE) -la recogi-da, gestión, procesamiento de datos y su aplicación en la atención de los pacientes del SUH-es una de nuestras herramientas más importantes para mejorar la atención urgente y que repercuten más positivamente en la salud de la población.
Emergencias, 2009
Prehospital care is often defined as the connection between public safety, healthcare and public ... more Prehospital care is often defined as the connection between public safety, healthcare and public REVIEW ARTICLE Emergency Medicine Informatics (EMI) is the collection, management, processing, and application of emergency patient care and operational data. EMI is transforming and improving our prehospital care systems and emergency department (ED) operations, is critical for public health surveillance, and will enable us to expand clinical research in our institutions, regions, and nations. EMI is one of our most important tools for improving emergency care and positively impacting the health of the public. For prehospital care, EMI systems provide information to analyze the cost-effectiveness of clinical interventions, to organize EMS operations, to coordinate communication for service requests, to monitor quality control and educational needs, and to track patient outcomes. The practice of emergency medicine in the ED requires the capture of many data and time elements so that ED care is efficient. EMI modules support triage acuity and tracking, patient tracking, nurse and physician charting, clinical decision support, order entry, and discharge instructions and prescription generation. There must be coordination of the EMI with hospital, laboratory, and radiology reporting systems, and access to hospital and ambulatory clinic records. Clinical information should be aggregated into an ED Database which can then be used for clinical investigation. The cooperation and support of the hospital information services department, hospital administration, emergency medicine physicians, and emergency medicine researchers, is necessary so that the ED database will be well constructed, and most importantly, well used to improve patient care. Because the information from aggregated ED databases provides population-based information about acute illness and injury, ED databases are now one of the key elements of public health surveillance. An effective syndromic surveillance system based upon ED Chief Complaint (CC), nursing triage note, and ICD-9 or-10 CM codes requires the cooperation of hospital information systems professionals, hospital administrators, ED directors, and public health professionals. [Emergencias 2009;21:354-361]
Injury, 2005
Context: In 2002, an ice storm interrupted power to 1.3 million households in North Carolina, USA... more Context: In 2002, an ice storm interrupted power to 1.3 million households in North Carolina, USA. Previous reports described storm injuries in regions with frequent winter weather. [Blindauer KM, Rubin C, Morse DL, McGeehin M. The 1996 New York blizzard: impact on noninjury visits. Am J Emerg Med 1999;17(1):23-7; Centers for Disease Control and Prevention. Community needs assessment and morbidity surveillance following an ice storm--Maine, January 1998. MMRW 1998;47(17):351-5; Daley WR, Smith A, Paz-Argandona E, Malilay J, McGeehin M. An outbreak of carbon monoxide poisoning after a major ice storm in Maine. J Emerg Med 2000;18(1):87-93; Hamilton J. Quebec's ice storm'98: ''all cards wild, all rules broken'' in Quebec's shell-shocked hospitals. Can Med Assoc J 1998;158(4):520-4; Hartling L, Brison RJ, Pickett W. Cluster of unintentional carbon monoxide poisonings presenting to the emergency departments in Kingston, Ontario during 'Ice Storm 98'. Can J Public Health 1998;89(6):388-90; Hartling L, Pickett W, Brison RJ. The injury experience observed in two emergency departments in Kingston, Ontario during 'ice storm 98'. Can J Public Health 1999;90(2):95-8; Houck, PM, Hampson NB. Epidemic carbon monoxide poisoning following a winter storm. J Emerg Med 1997;15(4):469-73; Lewis LM, Lasater LC. Frequency, distribution, and management of injuries due to an ice storm in a large metropolitan area. South Med J 1994;87(2):174-8; Smith RW, Nelson DR. Fractures and other injuries from falls after an ice storm. Am J Emerg Med 1998;16(1):52-5]. We postulated that injuries might differ in a region where ice storms are less common. Objective: Identify storm-related injuries.