BACKGROUND

Pediatric Early Warning Scores (PEWS) help identify children at risk of clinical deterioration, but their accuracy across diverse settings, populations, interventions, and outcomes remains unexplored.

To determine the accuracy of PEWS in detecting clinical deterioration events (CDE) among pediatric patients seen at the emergency department (ED).

Retrospective cohort study.

Pediatric patients aged 1 month to 18 years seen at the ED.

Southern Philippines Medical Center Emergency Department, Davao City, Philippines from January 2021 to December 2022.

Area under the curve (AUC) of PEWS in detecting CDE; Brighton PEWS optimal cut-off and its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR).

Among the 345 patients, 56 experienced CDE and 289 did not. Patients with CDE had significantly lower median age (1.00 year vs 5.00 years; p < 0.001), oxygen saturation (93.00% vs 98.00%; p < 0.001), and pediatric Glasgow Coma Scale scores (8.00 vs 15.00; p < 0.0001) compared to those without CDE. Heart rate (135.00 vs 111.00 beats per minute; p < 0.001), and respiratory rate (32.50 vs 24.00 breaths per minute; p < 0.001) were significantly higher in patients with CDE. The two groups also differed significantly in terms of comorbidity distribution (p < 0.001) and diagnosis (p < 0.001). The AUC of Brighton PEWS was 0.9064 (95% CI 0.8716 to 0.9357), with an optimal cut-off score of ≥4.00. This threshold yielded 76.79% sensitivity, 88.58% specificity, 56.60% PPV, 95.20% NPV, 6.72 LR+, and 0.26 LR-.

The Brighton PEWS demonstrates strong diagnostic accuracy in predicting CDE among pediatric patients. A cut-off score of ≥4.00 offers a balanced combination of sensitivity, specificity, and likelihood ratios for ED application.

INTRODUCTION

The Philippines is considered a disaster-prone country, making basic pre-hospital trauma care essential in the disaster response. The Bureau of Fire Protection (BFP) is mandated by law as the lead agency in providing emergency medical services (EMS) in the country, which plays a critical role in disaster response. This study aimed to investigate the influence of the different factors (knowledge, training, experience, and logistics) on the disaster preparedness of the BFP EMS personnel and to identify the strongest predictor among the factors.

A correlational study was done among 125 EMS personnel in the Bureau of Fire ProtectionNational Capital Region (BFP-NCR) using stratified random sampling. A four-part questionnaire, which included a demographic form, a 20-item knowledge test, a logistics compliance checklist from the Department of Health licensing tool, and the Emergency Preparedness Information Questionnaire (EPIQ) was used. Statistical analysis done were Pearson correlation and logistic regression.

The findings showed that knowledge (OR = 0.299, 95% CI: 0.128–0.689), training (OR = 3.2, 95% CI: 1.8–5.6), and experience (OR = 1.9, 95% CI: 1.1–3.4) affected the level of disaster preparedness. Furthermore, logistics did not show a significant effect (p > 0.05).

The strongest predictor of disaster preparedness among the factors is knowledge. Even though logistics is an essential factor, its effectiveness still depends on the proper utilization by trained personnel. Recommendations include continuous training and retention of experienced personnel, which are essential to enhance BFP EMS readiness during disasters.

Background: Burnout is a pressing concern among Emergency Ward (EW) nurses, stemming from the intense demands of their profession, including long hours, exposure to traumatic events, and the need for quick decision-making. This issue not only affects nurses' well-being but also has repercussions for patient care and the healthcare system. Objective: This study aimed to investigate the association between effort-reward and work-life imbalance on burnout among EW nurses in a public hospital. Methods: The study was a cross-sectional analytical study conducted from February to May 2022 involving 32 EW nurses employed at Public Hospital I.A. Moeis Hospital in Samarinda City, Indonesia. The research employed several instruments for data collection through stratified random sampling. Chi square and logistic regression analysis were performed to assess the factors contributing to burnout among EW nurses, including effort-reward imbalance, worklife balance, namely monotonous work, self-efficacy, communication among healthcare professionals, and workload. Result: There was positive correlation between effort-reward and work-life imbalance on burnout among EW nurses. The multivariate test results showed that workload, self-efficacy, communication, and monotonous work had higher risk of developing burnout in EW nurses. Conclusion In this study, we found that effort-reward and work-life imbalance were significantly associated with burnout in EW nurses in a public hospital. The development of comprehensive assessment of burnout among EW nurses and its early intervention should be warranted.
Burnout, Psychological ; Emergency Ward ; Emergency Service, Hospital ; Nurses ; Hospitals, Public

BACKGROUND

Palliative Care focuses on the needs of both the patient and their families, aiming to enhance their overall quality of life. It achieves this by anticipating, preventing, reducing, and treating suffering through comprehensive support across various aspects of life. This approach promotes patient autonomy, provides access to information, and encourages the freedom to make choices. Referring patients to Supportive and Palliative Care in a timely manner enhances their quality of life, improving symptom control, mood, and understanding of their illness. Additionally, it reduces distress for both the patient and their caregiver during the end-of-life period.

This study aimed to determine the proportion of late referrals among patients diagnosed with debilitating illnesses consulting at the Emergency Department of Batangas Medical Center from July to December 2022 and who needed Supportive and Palliative Care using the Palliative Care and Rapid Emergency Screening Tool, considering age, sex, and the specific diagnosis of the debilitating illness. Additionally, the timing of referrals for both discharged and admitted patients requiring Supportive and Palliative Care was described, with categories including those referred within one week, beyond one week, and those not referred at all.

This retrospective study was conducted via chart review of all patients with debilitating illnesses who visited the Emergency Department of Batangas Medical Center, admitted or discharged, from July 2022 to December 2022. Timing of referral to Supportive and Palliative Care was obtained from the admission charts and/or the SPC referral logbook. Frequency analysis specifically frequency tabulation was used to summarize data.

Between July and December 2022, 2,097 patients diagnosed with debilitating illnesses at the Emergency Department were identified. Only 2.52% of them received referrals to Supportive and Palliative Care, and among this group, more than half (38) were referred later than one week after diagnosis.

This study identified the need for comprehensive improvements in the referral process, emphasizing timely access to Supportive and Palliative Care for patients of all demographic facing debilitating illnesses. The call for systemic changes advocates for clear protocols and guidelines, reducing oversight and delays. The Palliative Care and Rapid Emergency Screening Tool can streamline referrals, while collaboration between healthcare providers and the palliative care team ensures a more efficient system. Strategies advocating for healthcare infrastructure improvement and awareness campaigns may be developed to facilitate timely referrals for patients across age and gender spectrums.

Chest pain is one of the most common complaints in the emergency department. Diseases of the heart, aorta, lungs, esophagus, stomach, mediastinum, pleura, and abdominal viscera can all cause chest discomfort (Gulati et al., 2021; Jiao et al., 2021; Lu et al., 2022). Clinicians in the emergency department are expected to immediately recognize life-threatening chest pain (Jiao et al., 2021). Delayed diagnosis further increases the risk of complications and mortality (Liu et al., 2021). In this case, we present an elderly Chinese female who had a history of myocardial infarction two years previously, with chest pain eventually found to be caused by ingestion of a duck bone.
Humans ; Female ; Aged ; Esophagus ; Foreign Bodies/diagnosis* ; Chest Pain/complications* ; Emergency Service, Hospital ; Heart

Background: Due to the COVID-19 pandemic, health care for patients who experienced out-of-hospital cardiac arrest (OHCA) has been suboptimal. Objective: To describe the demographic, clinical, and logistical characteristics of patients who experienced OHCA during the peak of the COVID-19 pandemic. Design: Descriptive study. Participants: 136 males and 58 females, aged 8 days to 89 years old, who experienced OHCA and were subsequently sent to the emergency department of Southern Philippines Medical Center (SPMC). Setting: Southern Philippines Medical Center, Davao City, March 15 to December 31, 2020. Main outcome measures: Demographic, clinical, and logistical characteristics of patients. Main results: Of the 194 patients, 149 (76.80%) experienced OHCA at home. Among them, 42 (21.65%) received initial CPR at the scene, with 36 (85.71%) of these procedures performed by ambulance crews. Only one (0.52%) patient received automated extracorporeal defibrillation performed by a bystander. There were 147 (75.77%) patients who were transported by private vehicles. The average times for dispatch, response and turnaround of the emergency medical services (EMS) were 8 minutes, 19 minutes, and 56 minutes, respectively. Of the 194 patients, 176 (90.72%) were transported without ongoing resuscitation. Upon arrival at the emergency department, 184 (94.84%) patients had unknown arrest rhythm. Only one (0.52%) patient had a return of spontaneous circulation and was admitted to the ICU. All the other patients expired within 10 to 15 minutes upon arriving at the emergency department. Conclusion In this study, most OHCAs happened at home, with few receiving CPR at the scene, primarily from ambulance crews. The average EMS response time was 19 minutes. Most patients were transported from the scene without ongoing resuscitation, and had an unknown arrest rhythm upon arrival at the emergency department. All patients expired shortly after arriving at the emergency department.
Resuscitation ; Ambulances

OBJECTIVE: To investigate humanistic practice ability of nurses in a general hospital in Hunan Province and analyze the factors affecting their practices to provide evidence for interventions to improve humanistic practice ability of the nurses. METHODS: A total of 1196 nurses were surveyed using a self-designed questionnaire and a nurse humanistic practice ability assessment scale questionnaire for assessment of their abilities for humanistic care practice, psychological adjustment, interpersonal communication, self-management, ethics and legal practice. Univariate and multivariate analyses were performed for analysis of the factors affecting the practice abilities of the nurses. RESULTS: The total score of humanistic practice ability of the 1196 nurses was 105.69±16.45 (the full score of the scale was 130), and the scores of humanistic care practice ability, psychological adjustment ability, interpersonal communication ability, self-management ability, ethics and legal practice ability were 40.95±6.46, 16.41±2.66, 16.41±2.66, 11.32±2.05 and 12.43±2.00, respectively. Univariate analysis and multiple linear regression analysis showed that gender (P=0.033), age (P < 0.001), department (P=0.015), working years (P < 0.001), professional title (P < 0.001), first academic degree (P < 0.001), highest academic degree (P < 0.001), family location (P=0.010), marital status (P=0.023), number of patients to care for (P=0.022), number of children (P=0.001), previous humanities related training (P < 0.001), training times (P < 0.001), and care received from family members (P < 0.001) and colleagues (P < 0.001) were all the factors affecting humanistic practice ability of the nurses. Among these factors, age, working in department of obstetrics and gynecology and emergency department, professional title, humanities training, and care from family and colleagues explained 20.7% of the variance. CONCLUSION The humanistic practice ability of nurses in this general hospital is above the average level, but their self-management ability needs to be improved. Intervention measures should be implemented to improve the nurses' humanistic practice ability including more attentions to the key groups and departments, strengthening the training of humanistic practice ability, and improving the promotion assessment system.
Child ; Female ; Pregnancy ; Humans ; Hospitals, General ; Emergency Service, Hospital ; Multivariate Analysis ; Research Design

Humans ; COVID-19/epidemiology* ; Contact Tracing ; Pandemics ; SARS-CoV-2 ; Emergency Service, Hospital

Child ; Humans ; Nitrous Oxide ; Emergency Service, Hospital

Adult ; Humans ; Heart Arrest/therapy* ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Out-of-Hospital Cardiac Arrest/therapy* ; Treatment Outcome