Early warning scores serve as valuable tools for predicting adverse events in patients. This study aimed to compare the diagnostic performance of National Early Warning Score, Hamilton Early Warning Score, Standardized Early Warning Score, and Triage Early Warning Score in forecasting intubation and mortality among patients with coronavirus disease 2019.
Methods
This predictive correlation study included 370 patients admitted to the emergency department of 22 Bahman Hospital in Neyshabur, Iran, from December 2021 to March 2022. The aforementioned scores were assessed daily upon patient admission and throughout a 1-month hospitalization period, alongside intubation and mortality occurrences. Data analysis used SPSS 26 and MEDCALC 20.0.13 software. We adhered to the Standards for Reporting of Diagnostic Accuracy Studies guidelines to ensure the accurate reporting of our study.
Results
The patients’ mean age was 65.03 ± 18.47 years, with 209 (56.5%) being male. Both Standardized Early Warning Score and Hamilton Early Warning Score demonstrated high diagnostic performance, with area under the curve values of 0.92 and 0.95, respectively. For Standardized Early Warning Score, the positive likelihood ratio was 10.81 for intubation and 17.90 for mortality, whereas for Hamilton Early Warning Score, the positive likelihood ratio was 7.88 for intubation and 10.40 for mortality. The negative likelihood ratio values were 0.23 and 0.17 for Standardized Early Warning Score and 0.21 and 0.18 for Hamilton Early Warning Score, respectively, for the 24-hour period preceding intubation events and mortality.
Discussion
Findings suggest that Standardized Early Warning Score, followed by Hamilton Early Warning Score, has superior diagnostic performance in predicting intubation and mortality in patients with coronavirus disease 2019 within 24 hours before these outcomes. Therefore, serial assessments of Hamilton Early Warning Score or Standardized Early Warning Score may be valuable tools for health care providers in identifying high-risk patients with coronavirus disease 2019 who require intubation or are at increased risk of mortality.
{"title":"Comparison of Performance Characteristics in Early Warning Scoring Tools for Diagnosis of Intubation and Mortality Among COVID-19 Patients","authors":"Fatemeh Shamsabadi MSN, Abdolghader Assarroudi PhD, Mohammadreza Armat PhD, Zohreh Sarchahi MSN, Mohammad Sahebkar MSc","doi":"10.1016/j.jen.2024.06.002","DOIUrl":"10.1016/j.jen.2024.06.002","url":null,"abstract":"<div><h3>Introduction</h3><div><span><span>Early warning scores serve as valuable tools for predicting adverse events in patients. This study aimed to compare the </span>diagnostic<span> performance of National Early Warning Score, Hamilton Early Warning Score, Standardized Early Warning Score, and Triage Early Warning Score in forecasting intubation and mortality among patients with </span></span>coronavirus disease 2019.</div></div><div><h3>Methods</h3><div>This predictive correlation study included 370 patients admitted to the emergency department of 22 Bahman Hospital in Neyshabur, Iran, from December 2021 to March 2022. The aforementioned scores were assessed daily upon patient admission and throughout a 1-month hospitalization period, alongside intubation and mortality occurrences. Data analysis used SPSS 26 and MEDCALC 20.0.13 software. We adhered to the Standards for Reporting of Diagnostic Accuracy Studies guidelines to ensure the accurate reporting of our study.</div></div><div><h3>Results</h3><div>The patients’ mean age was 65.03 ± 18.47 years, with 209 (56.5%) being male. Both Standardized Early Warning Score and Hamilton Early Warning Score demonstrated high diagnostic performance<span>, with area under the curve values of 0.92 and 0.95, respectively. For Standardized Early Warning Score, the positive likelihood ratio was 10.81 for intubation and 17.90 for mortality, whereas for Hamilton Early Warning Score, the positive likelihood ratio was 7.88 for intubation and 10.40 for mortality. The negative likelihood ratio values were 0.23 and 0.17 for Standardized Early Warning Score and 0.21 and 0.18 for Hamilton Early Warning Score, respectively, for the 24-hour period preceding intubation events and mortality.</span></div></div><div><h3>Discussion</h3><div>Findings suggest that Standardized Early Warning Score, followed by Hamilton Early Warning Score, has superior diagnostic performance in predicting intubation and mortality in patients with coronavirus disease 2019 within 24 hours before these outcomes. Therefore, serial assessments of Hamilton Early Warning Score or Standardized Early Warning Score may be valuable tools for health care providers in identifying high-risk patients with coronavirus disease 2019 who require intubation or are at increased risk of mortality.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 6","pages":"Pages 786-800"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jen.2024.09.002
{"title":"Psychological Distress and the Needs of Family Members of Critically Ill Patients in Emergency Departments During the COVID-19 Pandemic: A Correspondence","authors":"","doi":"10.1016/j.jen.2024.09.002","DOIUrl":"10.1016/j.jen.2024.09.002","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 6","pages":"Pages 688-689"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jen.2024.05.003
Emre Kudu MD, Yasemin Özdamar MD, Faruk Danış MD, Mehmet C. Demir MD, Buğra İlhan MD, Nalan Metin Aksu MD
Introduction
Carotid blowout syndrome is a rare but fatal complication often witnessed secondary to treating patients with head and neck cancer. It occurs when damage and necrosis lead to the carotid artery wall rupture. The symptoms encountered in these patients range from asymptomatic to cardiac arrest. Here, we present 5 cases of carotid blowout syndrome in the emergency department.
Case Presentations
Patients demonstrated symptoms ranging from subtle bleeding to hemodynamic instability, highlighting the diverse nature of carotid blowout syndrome in this population. Notably, while all patients had a history of radiotherapy, some had additional risk factors for carotid blowout syndrome, including prior surgery (n = 2), malnutrition (n = 3), and tracheostomies (n = 2). Definitive diagnoses were established through clinical evaluation and computed tomography angiography. Immediate interventions included bleeding control, resuscitation, and consultations with relevant specialties. Four patients underwent interventional radiology procedures, and 1 patient received otolaryngology care. While 2 patients recovered completely, 1 died in the emergency department, and 1 in the intensive care unit. One patient’s clinical course was complicated by a stroke.
Conclusion
The approach to the carotid blowout syndrome patient includes complex steps that proceed in a multidisciplinary manner, starting from triage until discharge. Emergency nurses play crucial roles at every stage. They should be aware of carotid blowout syndrome when evaluating patients with head and neck cancer presenting with bleeding. When treating these patients, emergency nurses should be ready for airway interventions, bleeding control, and massive transfusion protocol. In this context, the multifaceted approaches made by nurses contribute significantly to carotid blowout syndrome management in the emergency department.
{"title":"Emergency Management and Nursing Considerations of Carotid Blowout Syndrome","authors":"Emre Kudu MD, Yasemin Özdamar MD, Faruk Danış MD, Mehmet C. Demir MD, Buğra İlhan MD, Nalan Metin Aksu MD","doi":"10.1016/j.jen.2024.05.003","DOIUrl":"10.1016/j.jen.2024.05.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Carotid blowout syndrome<span> is a rare but fatal complication often witnessed secondary to treating patients with head and neck cancer. It occurs when damage and necrosis lead to the carotid artery<span> wall rupture. The symptoms encountered in these patients range from asymptomatic to cardiac arrest. Here, we present 5 cases of carotid blowout syndrome in the emergency department.</span></span></div></div><div><h3>Case Presentations</h3><div><span>Patients demonstrated symptoms ranging from subtle bleeding to hemodynamic instability, highlighting the diverse nature of carotid blowout syndrome in this population. Notably, while all patients had a history of radiotherapy, some had additional risk factors for carotid blowout syndrome, including prior surgery (</span><em>n</em> = 2), malnutrition (<em>n</em><span> = 3), and tracheostomies (</span><em>n</em><span><span><span><span> = 2). Definitive diagnoses were established through clinical evaluation and </span>computed tomography angiography. Immediate interventions included bleeding control, resuscitation, and consultations with relevant specialties. Four patients underwent </span>interventional radiology procedures<span>, and 1 patient received otolaryngology care. While 2 patients recovered completely, 1 died in the emergency department, and 1 in the </span></span>intensive care unit. One patient’s clinical course was complicated by a stroke.</span></div></div><div><h3>Conclusion</h3><div>The approach to the carotid blowout syndrome patient includes complex steps that proceed in a multidisciplinary manner, starting from triage until discharge. Emergency nurses play crucial roles at every stage. They should be aware of carotid blowout syndrome when evaluating patients with head and neck cancer presenting with bleeding. When treating these patients, emergency nurses should be ready for airway interventions, bleeding control, and massive transfusion protocol. In this context, the multifaceted approaches made by nurses contribute significantly to carotid blowout syndrome management in the emergency department.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 6","pages":"Pages 736-746"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jen.2024.06.003
Amanda Criswell MSN, RN, CEN, Angela Allen Duck PhD, RN, CNE, Katie C. Hall PhD, RN, CNE
Introduction
Opioid-related events continue to claim lives in the United States at alarming rates. Naloxone-dispensing rates fall dramatically short of national expectations. Emergency registered nurses are uniquely poised to connect at-risk patients with naloxone resources. This study sought to (1) describe the emergency registered nurses’ willingness to provide naloxone resources and (2) explore variables that may influence the nurse’s willingness to provide resources.
Methods
A cross-sectional, survey-based design was deployed using an online branch logic approach to include a national sample of emergency registered nurses. The Willingness to Provide, a validated questionnaire, measured the registered nurse’s willingness to provide naloxone resources for patients at risk of opioid overdose. Eight variables were assessed for potential influence on willingness.
Results
A total of 159 nurses from 32 states and the District of Columbia completed the online survey via the Research Electronic Data Capture platform. The results revealed a mean Willingness to Provide score of 38.64 indicating a willingness to provide naloxone resources. A statistically significant relationship was identified between the nurse’s willingness and years of nursing experience (P = .001), knowledge (P = .015), desire (P = .001), and responsibility (P < .001).
Discussion
In this representative sample, emergency nurses are willing to provide naloxone resources; furthermore, results indicate that higher knowledge, desire, and responsibility scores increase the nurse’s willingness to provide naloxone resources; with education and clear expectations, emergency nurses may be able to improve the connection of patients at risk of opioid overdose with naloxone, a potentially lifesaving connection.
{"title":"Willingness to Provide Naloxone Resources for Patients at Risk of Opioid Overdose: A National Survey of Emergency Registered Nurses","authors":"Amanda Criswell MSN, RN, CEN, Angela Allen Duck PhD, RN, CNE, Katie C. Hall PhD, RN, CNE","doi":"10.1016/j.jen.2024.06.003","DOIUrl":"10.1016/j.jen.2024.06.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Opioid-related events continue to claim lives in the United States at alarming rates. Naloxone-dispensing rates fall dramatically short of national expectations. Emergency registered nurses are uniquely poised to connect at-risk patients with naloxone resources. This study sought to (1) describe the emergency registered nurses’ willingness to provide naloxone resources and (2) explore variables that may influence the nurse’s willingness to provide resources.</div></div><div><h3>Methods</h3><div>A cross-sectional, survey-based design was deployed using an online branch logic approach to include a national sample of emergency registered nurses. The Willingness to Provide, a validated questionnaire, measured the registered nurse’s willingness to provide naloxone resources for patients at risk of opioid overdose. Eight variables were assessed for potential influence on willingness.</div></div><div><h3>Results</h3><div>A total of 159 nurses from 32 states and the District of Columbia completed the online survey via the Research Electronic Data Capture platform. The results revealed a mean Willingness to Provide score of 38.64 indicating a willingness to provide naloxone resources. A statistically significant relationship was identified between the nurse’s willingness and years of nursing experience (<em>P</em> = .001), knowledge (<em>P</em> = .015), desire (<em>P</em> = .001), and responsibility (<em>P</em> < .001).</div></div><div><h3>Discussion</h3><div>In this representative sample, emergency nurses are willing to provide naloxone resources; furthermore, results indicate that higher knowledge, desire, and responsibility scores increase the nurse’s willingness to provide naloxone resources; with education and clear expectations, emergency nurses may be able to improve the connection of patients at risk of opioid overdose with naloxone, a potentially lifesaving connection.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 6","pages":"Pages 762-772"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emergency nursing in Gaza’s war zone presents innumerable challenges when caring for female patients in a depleted health care system. Negative health outcomes specifically impact women of all ages due to lack of access to menstrual products, prenatal and primary care, private bathrooms, medication, essential nutrition, and clean water. The massive destruction of infrastructure and consequent internal displacement of millions has led to a rise in infectious diseases. The few remaining functional hospitals depend heavily on foreign medical delegations for supplies, which results in a lack of standardized treatment for women’s health complaints. Emergency departments must also navigate overcrowding, lack of basic supplies and specialists, and prioritization of daily mass casualty incidents from nearby explosions. These obstacles make treatment, discharge teaching, and follow-up care for women’s health difficult to implement. Despite these arduous circumstances, Gazan health care professionals find innovative solutions to improve outcomes and reduce harm while honoring the cultural and religious preferences of their female patients.
{"title":"Caring for Women in an Active War Zone","authors":"Abeerah Muhammad MSN, RN, CEN, Jamla Rizek MBA, MSN, RN, CEN, CPEN, NHDP-BC, NRP","doi":"10.1016/j.jen.2024.08.002","DOIUrl":"10.1016/j.jen.2024.08.002","url":null,"abstract":"<div><div>Emergency nursing in Gaza’s war zone presents innumerable challenges when caring for female patients in a depleted health care system. Negative health outcomes specifically impact women of all ages due to lack of access to menstrual products, prenatal and primary care, private bathrooms, medication, essential nutrition, and clean water. The massive destruction of infrastructure and consequent internal displacement of millions has led to a rise in infectious diseases. The few remaining functional hospitals depend heavily on foreign medical delegations for supplies, which results in a lack of standardized treatment for women’s health complaints. Emergency departments must also navigate overcrowding, lack of basic supplies and specialists, and prioritization of daily mass casualty incidents from nearby explosions. These obstacles make treatment, discharge teaching, and follow-up care for women’s health difficult to implement. Despite these arduous circumstances, Gazan health care professionals find innovative solutions to improve outcomes and reduce harm while honoring the cultural and religious preferences of their female patients.</div></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 6","pages":"Pages 722-726"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jen.2024.09.001
Gabrielle L. Allman BSN Student, Fabrice I. Mowbray PhD, RN
{"title":"A Nursing Student’s Perspective on the Value of Prelicensure Clinical Experience in the Emergency Department","authors":"Gabrielle L. Allman BSN Student, Fabrice I. Mowbray PhD, RN","doi":"10.1016/j.jen.2024.09.001","DOIUrl":"10.1016/j.jen.2024.09.001","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 6","pages":"Pages 713-715"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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