Abstract T MP50: Appropriate Stroke Team Activations Through Use of Los Angeles Pre-hospital Stroke Scale (LAPSS)

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Martha Power ◽  
Frank Bittner ◽  
Patricia Horstman ◽  
Owen Lander ◽  
Thomas Marshall ◽  
...  
Keyword(s):  
Los Angeles ◽  
Chart Review ◽  
Medical Service ◽  
Eligible Patient ◽  
Retrospective Chart Review ◽  
Activation Time ◽  
Number Of Patients ◽  
Stroke Team ◽  
Triage Protocol ◽  
Mild Stroke

Background and Purpose: Target Stroke SM aims to reduce the Door to Needle (DTN) times to 60 minutes or less in eligible ischemic stroke patients. They advocate Emergency Medical Service (EMS) pre-notification, a rapid triage protocol,stroke team notification, and a single call activation system 1 . Prior to February 2013 the Stroke Team averaged 92.8 Stroke Team Activations monthly. This volume placed a burden on the Stroke Team and ancillary departments. DeLuca and colleagues noted a possible criticism of Stroke Code in that patients with symptoms mimicking a stroke may overload the stroke personnel 2. We set out to decrease unnecessary stroke team activations without missing an opportunity to treat an eligible patient. Methods: A retrospective chart review was performed on all Stroke Team Activations between February and July 2012. We identified the volume of cancelled activations, number of patients too late or symptoms too mild, stroke mimics and treatments provided. The Los Angeles Pre-hospital Stroke Scale (LAPSS) was chosen as a screening tool for Medical Command to use with EMS personnel. The Stroke Team Activation time was shortened from 8 to 6 hours from last known well. The Emergency Department physicians had override authority for Activations. The revised Stroke Team Activation Guideline was disseminated in early 2013. To assess the utility of LAPSS as a Stroke Team Activation tool we compared the pre-LAPSS to the post-LAPSS data. A report completed by Medical Command on all requested Stroke Team Activations was also reviewed. Outcomes: A total of 557 patients were reviewed pre-LAPSS and 426 post-LAPSS. In comparison, the updated Stroke Team Activation Guideline resulted in a decrease of stroke team activations by 23.5%. Average DTN times remained under 60 minutes. A higher percent of patients seen were treated with rtPA (8.6% pre vs. 9.9% post). We have not missed the opportunity to treat an eligible stroke patient. Conclusion: A higher percentage of patients can be treated with DTN times under 60 minutes without overburdening the Stroke Team when procedures are in place for optimum specificity to identify those patients who would benefit from rapid team activation and stroke intervention.

Retrospective Chart Review of Cryopreserved Amniotic Membrane for Knee Pain

2020 ◽  
Author(s):  
Ruben Berrocal Timmons
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Amniotic Membrane ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Mean Values ◽  
Number Of Patients ◽  
The Impact

Objective: Treatment of joint pain with an injection of the amniotic membrane has not been adequately studied. This study retrospectively reviewed Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analgesic usage data from patients treated with the injection of cryopreserved amniotic membrane (CAM) in their knees to determine the impact of treatment on patients’ pain, quality of life, and analgesic usage. Methods: Chart review was conducted on 40 patients. Institutional Review Board (IRB) approval was obtained prior to initiation of the project. The membrane was utilized as per the FDA guidance of 21CFR1271. Retrospective data, including demographics, medical history, pain score, quality of life score, analgesic usage and adverse events, were collected from their medical records for each consenting patient through 6 months after CAM injection. Results: A total of 40 patients were considered in the final analysis. Mean VAS for pain level improved from 7.0 to 2.6 (p<0.001). WOMAC daily activity function score improved from a mean score of 52 to 28 (p<0.001). Opioid and non-steroidal anti-inflammatory drug (NSAID) usage decreased from 97% to 25% (p<0.001). No adverse events were reported. Conclusion: Mean values for VAS and WOMAC scores significantly improved at all time points and the number of patients who used analgesics decreased as compared to baseline. CAM injection into painful knee joints decreases pain, improves physical function, and decreases the use of analgesics in the absence of adverse events.

scholarly journals A Retrospective Analysis of Patients with Short Stature in the South of China between 2007 and 2015

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Su Wu ◽  
Qian-qi Liu ◽  
Wei Gu ◽  
Shi-ning Ni ◽  
Xing Shi ◽  
...  
Keyword(s):  
Short Stature ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The South ◽  
Treatment Needs ◽  
Normal Height ◽  
Poor Growth ◽  
Number Of Patients ◽  
Medical University ◽  
Age Range

Objective. To describe the demographic features of children with short stature and poor growth in the south of China and provide better guidance on clinical strategy and decisions. Study Design. This retrospective, chart review study analyzed children with short stature and poor growth admitted to the Department of Endocrinology of Children’s Hospital of Nanjing Medical University from Jan 2007 to Dec 2015. Results. The chart review yielded 4142 patients, including 2546 boys and 1596 girls (P < 0.001); the number of patients gradually increased per year from 2007 to 2015. There was an upward trend in the average levels of height standard deviations (SDs) during the study period (P < 0.001), both in males (P < 0.001) and females (P < 0.001). Mean height SDs were smaller in females (-2.42±1.09) than males (-2.33±1.03; P = 0.01). The percentage of females admitted at normal height (33.83%) was lower than that of males (37.20%; P = 0.028). The peak age range of hospitalization in males was 10–12 years of age, while females were generally admitted earlier—8–10 years. Conclusions. There was an increasing tendency to focus on children’s height. Parents and pediatricians were recommended to pay more attention to the treatment needs of girls while avoiding excessive treatment of those who merely appear not to be tall enough without a clear medical issue related to growth, especially for boys.

scholarly journals Vancomycin and DRESS: A retrospective chart review of 32 cases in Los Angeles, California

2017 ◽  
Vol 77 (5) ◽  
pp. 973-975 ◽  
Author(s):  
Barbara D. Lam ◽  
Melanie M. Miller ◽  
Adam V. Sutton ◽  
David Peng ◽  
Ashley B. Crew
Keyword(s):  
Los Angeles ◽  
Chart Review ◽  
Retrospective Chart Review

scholarly journals Treatment of Advanced Oropharyngeal Cancers with Chemotherapy and Radiation

2003 ◽  
Vol 82 (5) ◽  
pp. 367-370 ◽  
Author(s):  
Maria M. LoTempio ◽  
Marilene B. Wang ◽  
Ahmad Sadeghi
Keyword(s):  
Los Angeles ◽  
Primary Tumor ◽  
Chart Review ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Concomitant Chemotherapy ◽  
Small Series ◽  
Lost To Follow Up ◽  
Base Of The Tongue

We conducted a retrospective chart review of treatment outcomes in 17 adults who had been selected to undergo concomitant chemotherapy and radiation (chemo/XRT) for late-stage oropharyngeal cancers. All patients had been treated at the West Los Angeles VA Medical Center between March 1, 1998, and Sept. 30, 2000. Nine patients had a primary tumor at the base of the tongue, five had a primary tumor in the tonsillar area, and three had a tumor that affected both sites. Of this group, 15 patients completed one to three cycles of chemo/XRT, and the remaining two died during therapy. At the most recent follow-up, 9 of the 17 patients (52.9%) were documented to still be alive; seven patients had earlier died as a result of their primary tumor or a distant metastasis, and one patient had been lost to follow-up after completing treatment. At study's end, the duration of post-treatment survival ranged from 2 to 36 months (mean: 12.5). Based on the results of our small series, we conclude that chemo/XRT is a valid alternative to surgery with postoperative radiation and to radiation alone. Chemo/XRT yields acceptable rates of local control and allows for organ preservation with tolerable side effects.

Enrolment of adolescents and young adults with cancer (AYAWC) to clinical trials at the Children’s Hospital of Eastern Ontario (CHEO).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18043-e18043
Author(s):  
Sarah Lum ◽  
Isabelle Laforest ◽  
Kenneth Tang ◽  
Lesleigh S. Abbott
Keyword(s):  
Clinical Trials ◽  
Chart Review ◽  
Tertiary Care ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Pediatric Hospital ◽  
Best Interest ◽  
Younger Patients ◽  
Time Period ◽  
Number Of Patients

e18043 Background: Five-year survival among AYAWC has seen less improvement than in other age groups. One hypothesized reason is low accrual to clinical trials, for which the reasons need further determination. Our objectives were to determine the enrolment of AYAWC on treatment clinical trials at CHEO, a tertiary care pediatric hospital in Ottawa, Canada and to determine barriers to enrolment of AYAWC compared to younger patients. Methods: A retrospective chart review of patients diagnosed at CHEO over 10 years from January 1, 2006 to December 31, 2015 was performed. AYAWC included 15-18 year olds, and younger patients included 0-14 year olds. Patients 18 years and older are treated at adult centers. The number of patients enrolled on an upfront treatment clinical trial was collected while those not enrolled were reviewed for documented non-enrolment reasons. Clinical trials available at CHEO during this time period were also recorded. Results: A total of 733 patients were diagnosed with 96 AYAWC and 637 younger patients. The proportion of patients enrolled on clinical trials was 19.8% (19) AYAWC and 27.3% (174) younger patients (p = 0.12). Trials were not available for 57.3% (55) of AYAWC and 53.7% (342) of younger patients for their disease type (p = 0.51). For the remaining 41 AYAWC, 46.3% were enrolled. For AYAWC not enrolled, 40.9% had a reason documented: for 22.2% a physician felt it was not in the patient’s best interest, 44.4% did not meet eligibility, 33.3% of families/patients declined. For the remaining 295 of younger patients that had trials available, 59% enrolled on a trial. For younger patients not enrolled, 25.6% had another reason documented: for 25.8% a physician felt it was not in the patient’s best interest, 45.2% did not meet trial eligibility, 25.8% of families/patients declined, 3.2% other reason. Conclusions: There were fewer AYAWC enrolled on trials compared to younger children. There were not fewer trials available for AYAWC patients than younger children. For patients not enrolled, the majority did not have an open trial available and otherwise, reasons for non-enrolment did not differ significantly between groups. Next steps could include data from local adult centers.

scholarly journals Risk Factor Management with Guideline-Based Medications for Prevention of Recurrent Ischemic Stroke: A Retrospective Chart Review

2017 ◽  
Vol 8 (4) ◽  
pp. 5
Author(s):  
Jessica S. Rose ◽  
Jeffrey A. Kyle ◽  
Jessica W. Skellley
Keyword(s):  
Transient Ischemic Attack ◽  
Stroke Prevention ◽  
Chart Review ◽  
Recurrent Stroke ◽  
Retrospective Chart Review ◽  
Cardioembolic Stroke ◽  
Secondary Stroke Prevention ◽  
Number Of Patients ◽  
Appropriate Prescribing ◽  
Ischemic Attack

Background: Implementation of new practice guidelines for stroke prevention has decreased the number of patients experiencing recurrent stroke. Clinical trials show antihypertensives, high-intensity statins, and antithrombotics to be beneficial after stroke. Objective: The objective of this study was to determine if recurrent stroke patients were discharged on guideline-based medications for secondary stroke prevention, and to identify potential errors in appropriate prescribing of medications. Methods: A retrospective chart review was conducted at a community hospital and included patients 19 years and older diagnosed with their second, third, or fourth stroke (transient ischemic attack or cerebrovascular accident). Descriptive statistics were used to describe collected information. Collected data included relevant patient demographics, diagnosis, past medical history, medications, and readmission rates. The primary objective was the percentage of patients appropriately discharged on guideline-based secondary stroke prevention medications. Appropriate treatment was based upon the 2010 and 2014 American Heart Association/American Stroke Association Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. Results: A total of 124 charts were reviewed, 106 charts met the inclusion criteria. Guideline-based and appropriate medication-use was initiated in 9% and 4% of patients with noncardioembolic and cardioembolic stroke, respectively. Therapy deemed not guideline-based, but appropriate was initiated in 20% and 9% of patients with noncardioembolic and cardioembolic stroke, respectively. Errors in appropriate prescribing of secondary prevention medications were related to statins and antihypertensives. Conclusion: Better adherence to preventative recurrent stroke measures is needed at the time of patient discharge.   Type: Student Project

scholarly journals Evaluation of a clinical protocol using intranasal fentanyl for treatment of vaso-occlusive crisis in sickle cell patients in the emergency department

2019 ◽  
Vol 25 (5) ◽  
pp. 293-299
Author(s):  
Hugo Paquin ◽  
Evelyne D Trottier ◽  
Yves Pastore ◽  
Nancy Robitaille ◽  
Marie-Joelle Dore Bergeron ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sickle Cell ◽  
Chart Review ◽  
Primary Outcome ◽  
Retrospective Chart Review ◽  
Hospitalization Rates ◽  
Number Of Patients ◽  
Implementation Period ◽  
Administration Time ◽  
Opiate Administration

Abstract Background Vaso-occlusive crisis (VOC) is one of the most frequent causes of emergency visits and admission in children with sickle cell disease (SCD). Objectives This study aims to evaluate whether the use of a new pain management pathway using intranasal (IN) fentanyl from triage leads to improved care, translated by a decrease in time to first opiate dose. Methods We performed a retrospective chart review of patients with SCD who presented to the emergency department (ED) with VOC, in the period pre- (52 patients) and post- (44 patients) implementation period of the protocol. Time to first opiate was the primary outcome and was evaluated pre- and postimplementation. Patients received a first opiate dose within 52.3 minutes of registration (interquantile range [IQR] 30.6, 74.6), corresponding to a 41.4-minute reduction in the opiate administration time (95% confidence interval [CI] −56.1, −27.9). There was also a 43% increase in the number of patients treated with a nonintravenous (IV) opiate as first opiate dose (95% CI 26, 57). In patients who were discharged from the ED, there was a 49% decrease in the number of IV line insertions (95% CI −67, −22). There was no difference in the hospitalization rates (difference of 6 [95% CI −13, 25]). Conclusions This study validates the use of our protocol using IN fentanyl as first treatment of VOC in the ED by significantly reducing the time to first opiate dose and the number of IVs.

Improving Adherence to the HIV Testing Algorithm With Resident Physician Intervention

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S149-S150
Author(s):  
Kimberly Johnson ◽  
Blake Buchan ◽  
Jessica Colon-Franco
Keyword(s):  
Hiv Testing ◽  
Preliminary Data ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Resident Physician ◽  
Interventional Study ◽  
Physician Intervention ◽  
Number Of Patients ◽  
Testing Algorithm ◽  
Hiv 1

Abstract Introduction The CDC recommends the following algorithm for HIV testing: (1) a screening HIV-1/HIV-2 Ag/Ab immunoassay, (2) HIV-1/HIV-2 antibody differentiation immunoassay, and, if these results are discordant, (3) HIV-1 nucleic acid test (NAT). Final interpretation of this algorithm depends on its completion. To assess the adherence of this algorithm, a retrospective chart review was performed to reveal that 31% of discordant results were not followed up by NAT. A prospective interventional study was devised to improve adherence to the algorithm. Methods A retrospective chart review was performed on all HIV testing performed from January 2017 to June 2018. The patients with discordant results without NAT were identified. These results then prompted a prospective interventional study. Starting in November 2018, a daily automated report was created to identify patients with discordant results and no NAT ordered after 48 hours. This report prompted the client services department to either call the provider if they were an outside client and tell them to contact the pathology resident, or call the resident directly if the provider was an internal client. The resident then provided guidance to order NAT. The total number of patients with discordant results with the intervention was monitored for adherence to the algorithm indicated by clinicians ordering the NAT. Preliminary data from November 2018 to March 2019 were analyzed and compared to the original data. Results The retrospective data revealed a total of 71 patients with discordant results and 22 (31%) did not have NAT testing. The preliminary prospective data revealed a total of 27 patients with discordant results and 3 (11%) did not have NAT testing. These data were found to be statistically significant with P = .04 with a chi-square test. Conclusion Resident physician intervention has significantly improved the adherence to the HIV testing algorithm based on preliminary data.

37 Identifying Vulnerable Children: Burn Pediatric Warning Scores and ICU Designation

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S25-S26
Author(s):  
Andrew Greenway ◽  
Jamie Heffernan ◽  
Kevin Xuereb ◽  
Abraham Houng ◽  
Carolyn Sun
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Care Delivery ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Hospital Length Of Stay ◽  
Level Of Care ◽  
Injured Child ◽  
Number Of Patients ◽  
Significant Difference

Abstract Introduction Pediatric Early Warning Scores (PEWS) facilitate the identification of non-ICU pediatric patients at risk for deterioration. Limited studies exist to describe the utility of Burn specific PEWS (bPEWS) in the early identification of clinical vulnerability. The purpose of this retrospective chart review was to associate a bPEWS assessment value with a need for elevation to an ICU level of care for the burn-injured child. Methods A retrospective chart review of all non-mechanically ventilated (nMV) pediatric patients admitted to the burn service from July 2013 to May 2016 (n=709). Data included bPEWS scores, age, total body surface area (TBSA) burn and hospital length of stay (LOS). A pediatric level of care (PLC) designation, instituted as a model of care delivery following this study, utilizes bPEWS to categorize patients by acuity. Patients are grouped by their highest bPEWS: a) unstable (bPEWS &gt; 8; b) watchers (bPEWS 5–7); and c) stable (bPEWS &lt; 5). This study retroactively utilizes this framework. Results 709 patient charts yielded 12,642 bPEWS data points. 37 patients (0.53%) scored &gt; 8 during their hospital stay. Patient age was not statistically significant, a=2.4 years, b=3.25, and c=2.3(F=0.64, p = 0.53). More secondary diagnoses were present in the a) unstable cohort (59%) than either the b) (26. 6%) or c) (20%); (c2 = 6.3, p = 0.02 and p &lt; 0.01). There was a statistically significant difference in the number of patients in the unstable cohort versus the watcher and stable cohorts combined (c2 = 13.21, p &lt; 0.01). Patient transfer to the pediatric ICU (PICU) occurred in 10.8% of the a) unstable group and none of the watcher or the stable cohorts (b, c), (p=0.02). Pediatric critical intensivist consults occurred in 19% of the a) unstable patients but not in either the watcher or the stable patients (p &lt; 0.01). The average LOS was 18.1 days in the a) unstable group, 9.41 days in the b) watcher group, and 6.06 days for the c) stable group, (F=19.20, p &lt; 0.01). TBSA burn was larger for the unstable group (12.5%), versus 5.74% for watcher patients, and 2.5 % for stable patients, (F=9.70, p &lt; 0.01). On average, the peak bPEWS scores occurred hospital day 3.27 in the unstable group, 2.58 in the watcher group, and day 1.88 in the stable status group, (NS) (F=0.88, p = 0.42). There were no mortalities. Conclusions This retrospective review captures the infrequent experience of significant clinical deterioration in the nMV pediatric burn population reflected through the bPEWS lens. There appears to be a relationship between high bPEWS scores, burn size, presence of a secondary diagnosis, and increasing LOS. This study supports the designation of these patients to higher levels of care. This bPEWS driven paradigm presently results in adjusted nursing staffing ratios, frequency of assessment, and mandated collaborative medical practice patterns. Applicability of Research to Practice Directly Applicable.

Sign in / Sign up

Export Citation Format

Share Document