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10.1186/s13049-016-0250-3 http://scihub22266oqcxt.onion/10.1186/s13049-016-0250-3 C4848793!4848793 !27121376     free     free     free Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=27121376 &cmd=llinks): Failed to open stream: HTTP request failed! 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Coma of unknown origin in the emergency department: implementation of an in-house management routine |pdf=|usr=}}{{27121376 }} gab.com Text Coma of unknown origin in the emergency department: implementation of an in-house management routine JO: Scand J Trauma Resusc Emerg Med http://www.kidney.de/pget.php?&tw=1&pmid=27121376 #FOAvip BACKGROUND: Coma of unknown origin is an emergency caused by a variety of possibly life-threatening pathologies. Although lethality is high, there are currently no generally accepted management guidelines. METHODS: We implemented a new interdisciplinary standard operating procedure (SOP) for patients presenting with non-traumatic coma of unknown origin. It includes a new in-house triage process, a new alert call, a new composition of the clinical response team and a new management algorithm (altogether termed "coma alarm"). It is triggered by two simple criteria to be checked with out-of-hospital emergency response teams before the patient arrives. A neurologist in collaboration with an internal specialist leads the in-hospital team. Collaboration with anaesthesiology, trauma surgery and neurosurgery is organised along structured pathways that include standardised laboratory tests and imaging. Patients were prospectively enrolled. We calculated response times as well as sensitivity and false positive rates, thus proportions of over- and undertriaged patients, as quality measures for the implementation in the SOP. RESULTS: During 24 months after implementation, we identified 325 eligible patients. Sensitivity was 60 % initially (months 1-4), then fluctuated between 84 and 94 % (months 5-24). Overtriage never exceeded 15 % and undertriage could be kept low at a maximum of 11 % after a learning period. We achieved a median door-to-CT time of 20 minutes. 85 % of patients needed subsequent ICU treatment, 40 % of which required specialised neuro-ICUs. DISCUSSION: Our results indicate that our new simple in-house triage criteria may be sufficient to identify eligible patients before arrival. We aimed at ensuring the fastest possible proceedings given high portions of underlying time-sensitive neurological and medical pathologies while using all available resources as purposefully as possible. CONCLUSIONS: Our SOP may provide an appropriate tool for efficient management of patients with non-traumatic coma. Our results justify the assignment of the initial diagnostic workup to neurologists and internal specialists in collaboration with anaesthesiologists. Twit Text FOAVip Coma of unknown origin in the emergency department: implementation of an in-house management routine ????Scand J Trauma Resusc Emerg Med http://www.kidney.de/pget.php?&tw=1&pmid=27121376 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=27121376 #FOAvip English Wikipedia <ref>{{Cite pmid|27121376 }}</ref> Coma of unknown origin in the emergency department: implementation of an in-house management routine #MMPMID27121376 Braun M ; Schmidt WU ; Möckel M ; Römer M ; Ploner CJ ; Lindner T Scand J Trauma Resusc Emerg Med 2016[Apr]; 24 (ä): 61 PMID27121376 show ga BACKGROUND: Coma of unknown origin is an emergency caused by a variety of possibly life-threatening pathologies. Although lethality is high, there are currently no generally accepted management guidelines. METHODS: We implemented a new interdisciplinary standard operating procedure (SOP) for patients presenting with non-traumatic coma of unknown origin. It includes a new in-house triage process, a new alert call, a new composition of the clinical response team and a new management algorithm (altogether termed "coma alarm"). It is triggered by two simple criteria to be checked with out-of-hospital emergency response teams before the patient arrives. A neurologist in collaboration with an internal specialist leads the in-hospital team. Collaboration with anaesthesiology, trauma surgery and neurosurgery is organised along structured pathways that include standardised laboratory tests and imaging. Patients were prospectively enrolled. We calculated response times as well as sensitivity and false positive rates, thus proportions of over- and undertriaged patients, as quality measures for the implementation in the SOP. RESULTS: During 24 months after implementation, we identified 325 eligible patients. Sensitivity was 60 % initially (months 1-4), then fluctuated between 84 and 94 % (months 5-24). Overtriage never exceeded 15 % and undertriage could be kept low at a maximum of 11 % after a learning period. We achieved a median door-to-CT time of 20 minutes. 85 % of patients needed subsequent ICU treatment, 40 % of which required specialised neuro-ICUs. DISCUSSION: Our results indicate that our new simple in-house triage criteria may be sufficient to identify eligible patients before arrival. We aimed at ensuring the fastest possible proceedings given high portions of underlying time-sensitive neurological and medical pathologies while using all available resources as purposefully as possible. CONCLUSIONS: Our SOP may provide an appropriate tool for efficient management of patients with non-traumatic coma. Our results justify the assignment of the initial diagnostic workup to neurologists and internal specialists in collaboration with anaesthesiologists. |*Algorithms [MESH] |Adolescent [MESH] |Adult [MESH] |Aged [MESH] |Aged, 80 and over [MESH] |Coma/*diagnosis/mortality/therapy [MESH] |Emergency Medical Services/*organization & administration [MESH] |Female [MESH] |Follow-Up Studies [MESH] |Germany/epidemiology [MESH] |Humans [MESH] |Male [MESH] |Middle Aged [MESH] |Reproducibility of Results [MESH] |Retrospective Studies [MESH] |Survival Rate/trends [MESH] |Transportation of Patients [MESH] |Triage/*methods [MESH] |Wounds and Injuries/*diagnosis [MESH]Coma of unknown origin in the emergency department: implementation of (epmc).pdf DeepDyve Pubget Overpricing