Development of outcomes for evaluating emergency care triage: a Delphi approach.

BACKGROUND: Triage is used as standard of care for prioritization and identification of time-critical patients in the emergency department (ED) globally, but it is unclear what outcomes should be used to evaluate triage. Currently used outcomes do not include important time-critical diagnoses and conditions. METHOD: We used 18 Swedish triage experts to collect and assess outcomes for the evaluation of 5-level triage systems. The experts suggested 68 outcomes which were then tested through a modified Delphi approach in three rounds. The outcomes aimed to identify correctly prioritized red patients (in need of a resuscitation team), and orange patients (other time critical conditions). Consensus was pre-defined as 70% dichotomized (positive/negative) concordance. RESULTS: Diagnoses, interventions, mortality, level of care and lab results were included in the outcomes. Positive consensus was reached for 49 outcomes and negative consensus for 7 outcomes, with an 83% response rate. The five most approved outcomes were the interventions Percutaneous coronary intervention, Surgical airway and Massive transfusion together with the diagnoses Tension pneumothorax and Intracerebral hemorrhage that received specific interventions. The outcomes with the clearest disapproval included Admittance to a ward, Treatment with antihistamines and The ordering of a head computed tomography scan. The outcomes were considered valid only if occurring in or from the ED. CONCLUSION: This study proposes a standard of 49 outcomes divided into two sets tied to red and orange priority respectively, to be used when evaluating 5-level priority triage systems; Lund Outcome Set for Evaluation of Triage (LOSET). The proposed outcomes include diagnoses, interventions and laboratory results. Before widespread implementation of LOSET, prospective testing is needed, preferably at multiple sites.

Social Media Approval Reduces Emotional Arousal for People High in Narcissism: Electrophysiological Evidence.

We used event-related potentials (ERPs) to examine if posting a "selfie" and receiving validation from others in the form of "likes" on social media can help narcissists reduce psychological distress. After all participants completed the narcissistic personality inventory (NPI) and experienced social exclusion, participants completed an auditory startle task that elicits the P3 to white noise-an ERP component that reflects emotional arousal and is sensitive to psychological distress. Participants were then randomly assigned to either view a personal "selfie" that quickly received a significant number of ostensibly real "likes" (selfie with likes condition), view a "selfie" with no feedback (selfie only condition), or view a neutral picture before (neutral picture condition) completing the auditory startle task again. Results revealed that participants high on the Leadership/Authority subscale of the NPI in the "selfie" with "likes" condition demonstrated a pre-post manipulation decrease in P3 mean amplitude, relative to participants in the other two conditions. These results suggest that approval via social media can help certain kinds of narcissists alleviate distress from social exclusion.