RESUMO
Introduction Deterioration of clinical condition of in-hospital patients further leads to intensive care unit (ICU) transfer or death which can be reduced by the use of prediction tools. The early warning scoring (EWS) system is a prediction tool used in monitoring medical patients in hospitals, hospital staying length, and inpatient mortality. The present study evaluated four different EWS systems for the prediction of patient survival. Method The present prospective observational study has analyzed 217 patients visiting the emergency department from November 2016 to November 2018, followed by demographic and clinical data collection. Modified Early Warning Score (MEWS), Triage Early Warning Score (TEWS), Leed's Early Warning Score (LEWS), and patient-at-risk scores (PARS) were assigned based upon body temperature, consciousness level, heart rate, blood pressure, respiratory rate, mobility, etc. Data was analyzed with the help of R 4.0.4 (R Foundation, Vienna, Austria) and Microsoft Excel (Microsoft, Redmond, Washington). Results Out of these 217 patients, 205 got shifted to a ward, and 12 died, amongst which the majority belonged to the 31-40 age group. Among patients admitted to ICU had a MEWS greater than 3, TEWS within the range 0 to 2 and 3 to 5, LEWS greater than 7, and PARS greater than 5 on the initial days of admission. The patients who died and those who were shifted to the ward showed significant differences in EWS. A significant association was observed between all the EWS and patient outcomes (p<0.001). Conclusion MEWS, TEWS, LEWS, and PARS were effective in the prediction of inpatient mortality as well as admission to the ICU. With the increase in the EWS, there was an increase in the duration of ICU stay and a decrease in chances of survival.
RESUMO
Background and Aims: Out-of-hospital cardiac arrest is one of the leading causes of death in India. Only 1.3% of these arrests receive bystander cardiopulmonary resuscitation (CPR). Bystander CPR increases a victim's chances of survival; training school children in Hands-Only CPR (HOCPR) is a proven method of increasing bystander CPR rates. Heart Rescue India is an international project working to improve care for cardiovascular diseases, and as a part of it, a ten module Cardiovascular disease (CVD) educational programme, including HOCPR training, was conducted in ten schools in 2017-18. The objective of our study was to assess the effectiveness of HOCPR training for 8th-grade high school students. Methods: Four hundred fourteen of the 530 enroled students from ten schools of Bengaluru participated in the study. The participants attended a one-hour didactic session about the recognition of cardiac arrest and HOCPR in three simple steps. Subsequently, students received hands-on training for HOCPR. The sessions included pre- and post-assessment of knowledge and skills. The results were statistically analysed using paired t-test and the McNemar test. Results: The mean overall pre-assessment score for knowledge was 62.07 ± 28.38%, and the post-assessment score was 72.42 ± 26.58% (P < 0.001). In addition, there was a statistically significant improvement in the post-training scores for HOCPR in all three parameters, namely compressions per minute, depth and chest recoil. Conclusion: The study demonstrated a simple yet effective HOCPR programme for high school children.
RESUMO
BACKGROUND: In India, the mortality due to polytrauma after road traffic injuries is high and there is a need to train medical and paramedical personnel. The AIIMS Trauma Assessment and Management (ATAM) course was developed at the Apex Trauma Centre of All India Institute of Medical Sciences, New Delhi to sensitize medical personnel with initial assessment and management of polytrauma victims. The aim of this study was to evaluate the impact on knowledge and skills and also evaluate the feedback and the perception of the participants of the ATAM course. METHODS: The course was conducted for doctors, nurses and other paramedical/allied professionals in five tertiary level centres associated to medical colleges from geographically diverse locations (Anand, Bengaluru, Delhi, Lucknow and Thrissur). Cognitive knowledge was assessed using pre-training and post-training multiple choice question (MCQ) tests. The participants also self-rated their level of knowledge, skill, confidence and capability (Numerical rating scale of 1-10). Post-training feedback was obtained from the participants using a five-point Likert scale response. RESULTS: 26 ATAM courses were conducted by 68 course instructors and attended by 780 participants. These participants include 40.4% doctors, 44.2% nurses, 4.7% paramedical technicians, 4.2% medical students and 6.4% paramedical and allied health professionals. There was significant improvement (p < 0.0001) in the cognitive knowledge, skill, confidence and capability of the participants. 85%-86% of the participants strongly agreed or agreed that the course content was effective and 85% of participants perceived that the course was excellent or very good. CONCLUSION: The ATAM course had a positive impact on the knowledge, skills, confidence and capability of health caregivers attending the course. The ATAM course is an effective, practical and favourable option that is tailored to the polytrauma training needs of India. We recommend widespread dissemination of this course.
RESUMO
In a mass casualty situation due to chemical, biological, radiological, or nuclear (CBRN) event, triage is absolutely required for categorizing the casualties in accordance with medical care priorities. Dealing with a CBRN event always starts at the local level. Even before the detection and analysis of agents can be undertaken, zoning, triage, decontamination, and treatment should be initiated promptly. While applying the triage system, the available medical resources and maximal utilization of medical assets should be taken into consideration by experienced triage officers who are most familiar with the natural course of the injury presented and have detailed information on medical assets. There are several triage systems that can be applied to CBRN casualties. With no one standardized system globally or nationally available, it is important for deploying a triage and decontamination system which is easy to follow and flexible to the available medical resources, casualty number, and severity of injury.