Introduction: Under-triage increases patients' risks for morbidity and mortality, whereas over-triage limits the resources available to sicker patients. This study aimed to determine the rates as well as associated factors of under-triage and over-triage in emergency department (ED), based on Emergency Severity Index (ESI) triage system. Methods: In this retrospective cross-sectional study, triage level of ED patients based on the ESI version 4, was studied during a 9-month period in 2019. Patients' ESI level, which were examined by triage nurses were reevaluated by 3 emergency physicians and the rate of correct, under-, and over-triage as well as their associated factors were analyzed. Results: 1000 cases of triage were evaluated. Triage was correct in 69.1% of cases. The rate of under-triage was 4.9%, and that of overtriage was 26.0%. Over-triage was significantly more common among patients aged 18-30 years than for those aged =65 years (adjusted odds ratio [OR] = 1.73; 95% confidence interval [CI]: 1.07-2.81; p = 0.026); those with traumatic injuries (adjusted OR = 1.80; 95% CI: 1.29-2.52; p = 0.001); those arriving at the hospital during the evening shift (adjusted OR = 1.42; 95% CI: 1.01-2.0; p = 0.046); patients who were hospitalized (adjusted OR = 0.35; 95% CI: 0.22-0.54; p < 0.001); and those with severe pain (adjusted OR = 0.28; 95% CI: 0.10-0.84; p = 0.023). Younger age was also significantly associated with under-triage. Patients aged 18-30 years were under-triaged more often than those aged =65 years (adjusted OR = 3.05; 95% CI: 1.16-8.00; p = 0.023). Conclusion: Over-triage was substantially more common than under-triage in Vajira Hospital. Factors associated with over-triage were younger age, traumatic injury, arrival time, hospital admission, and severe pain. Younger age was the only factor related to under-triage.

Dove Press is a member of the Open Access Initiative, specializing in peer reviewed Medical Journals. View articlesor submit your research for publishing

Background: Hazardous areas are places emitting hazardous materials, terrorist- or war-related, which lead to public health risks in developed and developing countries globally. Hence, prehospital emergency medical personnel who work as frontliners should be trained. Patients and Methods: Data via pretest, posttest, and questionnaire surveys regarding the HART’s knowledge of and confidence in operational skills were collected using the 5-point Likert scale. The cohort included prehospital emergency medical personnel aged > 18 years. The training program comprised lectures, practicals, and examinations and included three subcourses: emergency medicine in the chemical, biological, radiation, and nuclear hazardous area (EM-CBRN) course; Thailand Tactical Emergency Medical Service (TTEMS) course; and cooperation and preparation for disaster (CPD) course. Results: The HART’s mean multiple choice question (MCQ) posttest knowledge score (12.80± 3.11) was significantly higher (p< 0.001) than the mean pretest knowledge score (7.74± 3.71) for the EM-CBRN course. The HART’s mean MCQ posttest knowledge score (24.04± 2.79) was significantly higher (p< 0.001) than the mean pretest knowledge score (14.34± 3.92) for the TTEMS course. Further, the HART’s mean MCQ posttest knowledge score (21.03± 3.49) was significantly higher (p< 0.001) than the mean pretest knowledge score (14.40± 5.08) for the CPD course. The HART’s mean confidence in operational skill score for the EM-CBRN course was significantly higher (p< 0.001) after training (4.45± 0.59) than before training (2.77± 0.90). The HART’s mean confidence in operational skill score for the TTEMS course was significantly higher (p< 0.001) after training (4.55± 0.59) than before training (2.78± 0.98). The HART’s mean confidence in operational skill score for the CPD course was significantly higher (p< 0.001) after training (4.70± 0.41) than before training (3.03± 0.90). Conclusion: The HART training program significantly affected the HART’s knowledge development and confidence in operational skills, particularly the frontline prehospital emergency medical personnel. Therefore, prehospital emergency medical personnel should undergo training, and learning activities must be developed to reinforce capacity and improve knowledge and confidence.

Background/Objectives: Accurate telephone triage of emergency medical cases plays a crucial role in improving outcomes for critically ill patients. Effective triage enables emergency medical dispatchers to provide appropriate pre-arrival instructions and to deploy operational units according to the patient’s severity level. This study aimed to develop and assess the content validity of the Emergency Medical Triage Protocol and Criteria-Based Dispatch Code (EMTP-CBDC) for Thailand. The objective was to ensure the tool’s content accuracy and applicability in prioritizing emergency responses in line with medical urgency, considering global changes and universal standards. Methods: A cross-sectional descriptive study was conducted from 15–30 April 2024. The content validity of the newly developed EMTP-CBDC, comprising 30 symptom groups, was evaluated by five emergency physician experts with at least 1 year of experience in emergency medical oversight. The assessment focused on four aspects: relevance, clarity, simplicity, and ambiguity. The Content Validity Index (CVI) was calculated at both the item level (I-CVI) and the scale level using the average index (S-CVI/Ave). To adjust for chance agreement, the probability of chance agreement (Pc) and the modified kappa coefficient (k*) were calculated for each item. Results: The content validation revealed I-CVI values ranging from 0.80 to 1.00 across all items. The S-CVI/Ave scores were 0.97 for relevance, 0.93 for clarity, 0.98 for simplicity, and 0.94 for ambiguity. These values surpassed the accepted thresholds for content validity. Conclusions: The EMTP-CBDC developed for Thailand demonstrated good content validity across relevance, clarity, simplicity, and ambiguity. Further studies are needed to establish its reliability and field performance before routine implementation.

Purpose: This study aimed to determine the percentage of missed opportunities (MOs) to identify and treat older adults presenting with palliative care (PC) needs at one emergency department (ED). The secondary objective was to determine the rate of treatment interventions regardless of whether the patients received a PC plan as well as the direct cost of treatment. Patients and Methods: In this retrospective study, PC need was determined using broad and narrow criteria. The subjects comprised patients aged 65 or older who had out-of-hospital cardiac arrest and/or died in the ED (Group 1) or within 72 hours after ED disposition (Group 2) over a 3-year period (2016– 2018). Overall, 17,414 older adults visited the ED, 60 died in the ED, and 400 died within 72 hours after ED disposition and admitted to in-hospital ward. In total, 200 patients were randomly selected; of these, 15 were excluded. Results: Of the remaining 185 patients enrolled, 161/185 (87%) met the PC criteria and 60/161 (37.3%) were missed opportunities for PC planning. Group 1, had thirty patients, and 8 of those 30 (27%) were missed opportunities for PC planning. Group 2, 131/161 (81.4%), died within 72 hours, and there were 52 missed opportunities (39.7%) of ED PC planning. By comorbidity (Group 2), providers considered PC planning most often for cancer patients (PC: 41.8%; missed opportunities: 15.4%; p = 0.001) and there were more missed opportunities for PC planning among those with ischemic heart disease (PC: 19.0%; missed opportunities: 36.5%; p = 0.025). Conclusion: Of the older adults who visited the ED, 87% merited palliative care; further, 37% of opportunities for PC planning were missed. Providers considered PC planning most often for cancer patients. Recognizing PC needs and initiating care in the ED can improve end-of-life quality for dying patients.

Hypoglycemia is a reversible cause of cardiac arrest that can be identified during cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the effect of prehospital intravenous (IV) dextrose administration during CPR on the outcomes of patients with OHCA with hypoglycemia compared with those without hypoglycemia who did not receive dextrose. This was a retrospective single-center cohort study including adult patients with nontraumatic OHCA aged ≥ 18 years who were assisted by Vajira Emergency Medical Service and delivered to the emergency department of the Faculty of Medicine Vajira Hospital, Navamindradhiraj University, between January 1, 2019, and June 30, 2023. Patients were divided into dextrose and nondextrose groups. The primary outcome was sustained return of spontaneous circulation (ROSC) at the scene, and the secondary outcome was survival to hospital discharge. Subgroup analyses were conducted by stratification according to diabetes status. Inverse probability of treatment weighting (IPTW) based on propensity scores and multiple logistic regression analysis were performed for statistical evaluation. Among 246 eligible patients, sustained return of spontaneous circulation (ROSC) at the scene occurred in 45.5% of the dextrose group and 44.0% of the nondextrose group, while 30-day survival was 25.6% and 12.8%, respectively. After inverse probability of treatment weighting, dextrose administration was not significantly associated with sustained ROSC at the scene (adjusted risk ratio 1.13, 95% confidence interval 0.80–1.59; p = 0.484) but was associated with a higher likelihood of 30-day survival (adjusted risk ratio 2.38, 95% confidence interval 1.18–4.80; p = 0.015). In subgroup analyses, patients with diabetes who received dextrose had markedly higher 30-day survival compared with those who did not (36.4% vs. 6.5%; adjusted risk ratio 18.86, 95% confidence interval 3.82–93.10; p < 0.001), whereas no significant benefit was observed among patients without diabetes (23.2% vs. 14.9%; adjusted risk ratio 1.81, 95% confidence interval 0.92–3.53; p = 0.084). Dextrose administration during CPR in OHCA patients with hypoglycemia was not associated with improved sustained ROSC at the scene but was linked to better survival to hospital discharge, possibly due to benefits on post-resuscitation physiology rather than immediate resuscitation success.