ABSTRACT
ABSTRACT Objective: The aim of this study was to perform a narrative review of the leading pediatric triage systems in emergency departments (EDs). Data source: Articles published between 1999 and 2019 were identified by searching the MEDLINE, EMBASE, and PubMed databases using the keywords "pediatric triage", "pediatric assessment tools", and "emergency department triage" with an emphasis on studies that evaluated the validation and reliability of triage systems. Data synthesis: A total of 105 articles on pediatric emergency triage systems in 12 countries were evaluated. Triage systems were divided into two groups: color-stratified triage systems and alert systems. The color-stratified triage systems included in this review were the Canadian Triage and Acuity Scale (CTAS), Manchester Triage System (MTS), Emergency Severity Index (ESI), and Australasian Triage Scale (ATS), and the alert systems included were the Paediatric Observation Priority Score (POPS), Pediatric Early Warning Score (PEWS), and Pediatric Approach Triangle (PAT). Evidence corroborates the validity and reliability of MTS, PaedCTAS, ESI version 4, PEWS, POPS, and PAT in pediatric emergency services. Conclusions: These are fundamental tools for risk classification of patients seeking treatment in EDs. Not all triage systems have been assessed for validity and reliability; nor are they well suited for all regions of the world. Employing triage systems in Brazil requires cultural adaptation and rigorous training of the local health staff, in addition to validation and reliability studies in our country, since the social and cultural context of this country differs from those where these tools were developed.
RESUMO Objetivo: Realizar uma revisão narrativa dos principais sistemas de triagem pediátrica nos serviços de emergência. Fontes de dados: Artigos publicados entre 1999 e 2019, obtidos por meio de busca nos bancos de dados Medical Literature Analysis and Retrieval System Online (Medline), Embase e PubMed usando as palavras-chave "pediatric triage", "pediatric assessment tools" e "emergency department triage", com ênfase em estudos que avaliaram a validação e a confiabilidade desses sistemas. Síntese dos dados: Foram avaliados 105 artigos sobre sistemas de triagem na emergência pediátrica de 12 países. Os sistemas de triagem foram divididos em dois grupos: estratificados por cores e de alerta. Os sistemas de triagem com estratificação por cores incluídos nesta revisão foram: Canadian Triage and Acuity Scale (CTAS), Manchester Triage System (MTS), Emergency Severity Index (ESI) e Australian Triage Scale (ATS). Os sistemas de alerta incluídos foram: Paediatric Observation Priority Score (POPS), Pediatric Early Warning Score (PEWS) e Pediatric Approach Triangle (PAT). Há evidências que corroboram a validade e a confiabilidade do MTS, PedCTAS, ESI v.4, PEWS, POPS e PAT em serviços de emergência de pediátricos. Conclusões: Os sistemas de triagem são ferramentas fundamentais para o atendimento de pacientes que procuram serviços de emergência. Nem todos os sistemas de triagem foram avaliados para validação e confiabilidade nem se aplicam a todas as regiões do mundo. Para a aplicação de sistemas de triagem no Brasil, devem ser feitos adaptação cultural e treinamento do estafe de saúde local, bem como estudos de validação e confiabilidade em nosso país, dado o seu contexto social e cultural diferente daquele dos países onde essas ferramentas foram desenvolvidas.
ABSTRACT
CONTEXT: Surgical treatment of carotid body paragangliomas is a challenge to the surgeon because of the large vascularization of the tumor, involvement of the carotid vessels and the close anatomical relationship with the cranial nerves. CASE REPORT: A 63-year-old patient was submitted to resection of two carotid body paraganglioma tumors found in the right-side and left-side carotid bodies at the bifurcation of the common carotid arteries. Two surgeries were performed at different times and neither of them presented any morbidity. Arteriography was fundamental for diagnosis of the small, asymptomatic tumor on the right side. DESIGN: Case Report
Subject(s)
Humans , Male , Middle Aged , Carotid Body/surgery , Carotid Body Tumor/surgery , Carotid Arteries , Carotid Body , Carotid Body Tumor/diagnosis , Intraoperative ComplicationsABSTRACT
Os paragangliomas do corpo carotideo, embora raros, despertam grande interesse na clinica cirurgica devido as caracteristicas peculiares desta afeccao. O corpo carotideo atua como quimiorreceptor (formado por celulas paraganglionares), respondendo as variacoes do teor sanguineo de O2 e CO2. Embriologicamente o corpo carotideo desenvolve-se do mesenquima do terceiro e quarto arcos branquiais e elementos neurais originados da crista ectodermica. A malignidade destes tumores e definida pela presenca de metastases para linfonodos ou orgaos a distancia