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Anne-Maree Kelly

Publications and source records attributed to Anne-Maree Kelly.

29 records · Page 2Linked to original sources
PubMed2004

Does potassium concentration measured on blood gas analysis agree with serum potassium in patients with diabetic ketoacidosis?

OBJECTIVE: The aims of this study were to define the maximum clinically acceptable difference between potassium concentrations on different samples and to determine the degree of agreement between potassium concentration measured on blood gas analysis and serum for patients with diabetic ketoacidosis (DKA). METHODS: This project comprised two sub studies. In the first, 15 emergency physicians, intensivists and endocrinologists were surveyed and asked to mark on a line with markings at 0.5 mmol/L intervals, the maximum clinically acceptable differences (both above and below the 'true' value) between potassium concentration measured on different samples. The maximum clinically acceptable difference was calculated as the median of responses. The second study was a retrospective agreement study. Patients with an ED diagnosis of DKA were identified from a computer database. They were eligible for inclusion if they had both blood gas analysis including potassium concentration and serum potassium concentration and pH was less than 7.3. Data collected included potassium concentration on serum and blood gas samples, pH, serum glucose concentration and time of sample collections. Data were analysed using bias plot and Spearman correlation analyses. RESULTS: The maximum clinically acceptable difference was defined as 0.5 mmol/L for both over and underestimation of potassium concentration. Fifty patients were studied with a median pH of 7.17 and median serum glucose of 29.5 mmol/L. Difference in potassium concentration between samples ranged from -0.9-2.9 mmol/L. 80% of sample pairs had a difference within the maximum clinically acceptable difference defined previously. The magnitude of difference between samples correlated with serum glucose (P = 0.0033, coefficient 0.41) but not with pH. CONCLUSION: This study suggests that potassium concentration derived from blood gas analysis may not be an acceptable substitute for serum potassium concentration in patients with diabetic ketoacidosis, particularly at higher serum glucose concentrations.

Adult↗
PubMed2003

Call-to-needle times for thrombolysis in acute myocardial infarction in Victoria.

OBJECTIVE: To determine the proportion of patients in Victoria treated within the British Heart Foundation 90-minute call-to-needle (CTN) time benchmark for thrombolysis of ST-elevation myocardial infarction (STEMI), and to validate the British Heart Foundation 90-minute benchmark with respect to mortality. DESIGN: Cohort study. SETTING: 20 hospitals and two ambulance services in the State of Victoria, Australia. PARTICIPANTS: 1147 patients with STEMI transported to hospital by ambulance and eligible for thrombolysis. MAIN OUTCOME MEASURES: CTN time, and in-hospital mortality. RESULTS: Median CTN time was 83 minutes (mean, 93.2 min; range, 29-894 min). Median door-to-needle (DTN) time was 37 minutes (mean, 46.5 min; range, 0-853 min). 61% of patients received thrombolysis within the 90-minute benchmark. Patients with CTN times > 90 minutes had an increased risk of dying (relative risk, 1.8; 95% CI, 1.3-2.7). Factors associated with CTN time < 90 minutes were lower DTN time, prior notification of the receiving hospital and transport time less than 20 minutes. CONCLUSION: The British Heart Foundation CTN time benchmark is being met for 61% of eligible STEMI patients in Victoria. Strategies to reduce CTN time should be region-specific, and should include attempts to reduce DTN and to enhance ambulance-hospital communication. Prehospital thrombolysis may be appropriate for some regions.

Adult↗
PubMed2003

Lack of agreement in classification of the severity of acute asthma between emergency physician assessment and classification using the National Asthma Council Australia guidelines (1998).

AIMS: To determine the level of agreement in classification of the severity of acute asthma at presentation to the emergency department, between emergency physician global assessment and severity classification according to the National Asthma Council Guidelines, Australia 1998 (NACG). METHODS: Prospective observational study in emergency departments throughout Australia, participating in the Asthma Snapshot 2000 project. Patients between the ages of one and 60 years presenting to participating emergency departments with acute asthma between 21 August and 3 September 2000 were included. Data collected were emergency physician global assessment of asthma severity and severity classification according to the National Asthma Council Guidelines and disposition. RESULTS: Five hundred and five subjects had completed data for emergency physician assessment of severity and for calculation of severity classification according to the National Asthma Council Guidelines. Weighted kappa for agreement in classification was 0.48 (95% confidence interval: 0.40, 0.56). Emergency physicians assess asthma as less severe compared to the National Asthma Council Guidelines assessment. CONCLUSIONS: Agreement between physician assessment of severity of acute asthma and severity classification according to National Asthma Council Guidelines is only moderate. This may have implications in treatment and disposition. This also suggests that emergency physicians may be using other methods to classify acute asthma than the National Asthma Council Guidelines classification.

Asthma↗
PubMed2003

Application of topical local anesthetic at triage reduces treatment time for children with lacerations: a randomized controlled trial.

STUDY OBJECTIVES: We determine whether application of topical local anesthetic at triage reduces total treatment time for children with simple lacerations. METHODS: This prospective, randomized, double-blind, controlled trial was conducted in an urban pediatric emergency department (ED). Participants were children who were aged 1 to 10 years and had simple lacerations. Exclusions were wounds to digits, ears, penis, nose, or mucous membranes; wounds close to the eye; deep wounds involving bone, cartilage, tendon, or vessels; wounds older than 6 hours; allergy or previous reaction to local anesthetics; trivial wounds unlikely to require any intervention; previous anesthesia to area before presentation; and failure to obtain consent. Participants were randomized to application of adrenaline 1:1,000, lignocaine (lidocaine) 4%, and amethocaine 0.5% (ALA) or placebo (adrenaline 1:1,000 solution) at triage. The primary outcome measure was total treatment time (triage time to discharge time). Secondary outcomes were the proportion of children from each group who required sedation and subgroup analysis by mode of wound closure. Analysis was by Mann-Whitney U test comparing times and chi(2) test comparing sedation rate. RESULTS: One hundred sixty-one patients were eligible for analysis (84 ALA, 77 control). Sixty-five patients were sutured, 84 were treated with glue, 6 were treated with Steristrips, and 6 were not provided with formal closure. The median treatment time for the ALA group was 77 minutes compared with 108 minutes for the control group (effect size 31 minutes; 95% confidence interval 15 to 47 minutes; P =.0019). There was no difference in requirement for sedation between the groups. CONCLUSION: The application of ALA at triage significantly reduces total treatment time for children with simple lacerations.

Anesthesia, Local↗
PubMed2002

Venous pCO(2) and pH can be used to screen for significant hypercarbia in emergency patients with acute respiratory disease.

This prospective study of patients with acute respiratory illness or potential ventilatory compromise compared pCO(2) and pH on an arterial and a venous blood sample with the aims of determining whether venous pH and pCO(2) can replace arterial values in the management of patients with acute respiratory disease and to determine whether there is a cut-off level of venous pCO(2) that can accurately screen for significant hypercarbia (pCO(2) > 50 mm Hg). Data were analyzed using bias plot and receiver operator characteristic (ROC) curve methods. There were 196 sample-pairs analyzed; 56 (29%) had significant hypercarbia. For pH, there was very good agreement with venous samples being an average of 0.034 pH units lower than arterial samples. With respect to pCO(2), there was only fair agreement, with the pCO(2) on average 5.8 mm Hg higher in venous samples and 95% limits of agreement -8.8 to +20.5 mm Hg. The ROC curve analysis showed that a venous pCO(2) level of 45 mm Hg was a potential screening cutoff (sensitivity for the detection of hypercarbia of 100%, specificity 57%). This study shows that venous pH is an acceptable substitute for arterial measurement but there is not sufficient agreement for venous pCO(2) to be able to replace arterial pCO(2) in the clinical evaluation of ventilatory function. Venous pCO(2) may be able to be used as a screening test for hypercarbia using a screening cut-off of 45 mm Hg.

Asthma↗
PubMed2002

Patients with a longer duration of symptoms of acute asthma are more likely to require admission to hospital.

OBJECTIVE: To determine whether, for patients with moderate or severe asthma presenting to emergency departments, there is a difference in need for hospitalization between those with a duration of symptoms less than 6 h and those with a longer duration of symptoms. METHODS: This prospective, observational study investigated a sample of patients presenting with acute asthma between 21 August and the 3 September 2000, attending study emergency departments and classified as having moderate or severe asthma according to the National Asthma Guidelines. Data collected included duration of symptoms (less than 6 h or greater than 6 h) and disposition following emergency department treatment (home, ward, intensive care unit, high dependency unit, transfer). Data analysis was by Chi square analysis. RESULTS: Of 381 eligible patients, 348 had sufficient data for entry into this study (33 had missing data). Patients with duration of symptoms more than 6 h were more likely to require hospital admission (P < 0.0001). The relative risk for hospital admission or transfer as opposed to discharge from the emergency department for the group with a duration of symptoms of more than 6 h was 2.2. CONCLUSION: Patients presenting with moderate or severe asthma and a duration of symptoms of more than 6 h are more likely to require hospital admission or transfer for further treatment than patients with a shorter duration of symptoms. This has implications for decision making regarding asthma management and disposition in the emergency department.

Acute Disease↗
PubMed2002

Determining the most effective level of TRISS-derived probability of survival for use as an audit filter.

OBJECTIVE: To determine the most effective cut-off of TRISS-derived probability of survival (TRISS-PS) for the selection of trauma deaths for audit, using a large sample of trauma deaths from the United Kingdom (UK). METHODS: TRISS-PS and avoidability of death (as judged by an independent peer review panel) were compared for a sample of 222 trauma deaths. Sensitivity, specificity and predictive values were calculated for the 0.5 screening cut-off. ROC curves were derived to assess the ability of different levels of TRISS-PS to identify avoidable deaths. Calculations were made for both the raw sample and the sample adjusted for the sampling method used. RESULTS: For the weight-adjusted sample, the sensitivity of TRISS-PS greater than 0.5 for the detection of avoidable death is 80% (95% CI 61-91%), the specificity is 86% (95% CI 80-90%), PPV 42% (95% CI 29-56%) and NPV 97% (95% CI 93-99%). Twenty percent of avoidable deaths would have been 'missed' if the 0.5 level of audit filter had been used. Based on the same sample, the best cut-off is at TRISS-PS 0.33, with a sensitivity of 90% and specificity of 80%. It is estimated that this cut-off would have selected 62 deaths for audit and failed to identify 2 out of 25 avoidable deaths. CONCLUSION: The previously accepted audit filter of TRISS-PS of greater than 0.5 fails to identify a significant proportion of avoidable deaths. This study suggests that the most effective level of audit filter cut-off of TRISS-PS for the trauma system studied is 0.33. This level would identify 90% of avoidable deaths with 80% specificity. Similar ROC curve analysis could be used to determine appropriate TRISS-PS cut-offs for institutions or other trauma systems.

Aged↗
PubMed2002

Validation of a tool to safely triage selected patients with chest pain to unmonitored beds.

OBJECTIVE: To externally validate a chest pain protocol that triages low risk patients with chest pain to an unmonitored bed. METHODS: Retrospective study of all patients admitted from the emergency department of a tertiary referral public teaching hospital with an admission diagnosis of 'unstable angina' or suspected ischemic chest pain. Data was collected on adverse outcomes and analysed on the basis of intention-to-treat according to the chest pain protocol. RESULTS: There were no life-threatening arrhythmias, cardiac arrests or deaths within the first 72 h of admission in the group assigned to an unmonitored bed by the chest pain protocol ([0/244]; 0.0%: 95% confidence interval 0.0-1.5%). Four patients had an uncomplicated myocardial infarction, two patients had recurrent ischemic chest pain and one patient developed acute pulmonary oedema ([7/244]; 2.9%: 95% confidence interval 1.2-5.8%). CONCLUSION: This retrospective study externally validated the chest pain protocol. Care in a monitored bed would not have altered outcomes for patients triaged to an unmonitored bed by the chest pain protocol. Compared to current guidelines, application of the chest pain protocol could increase the availability of monitored beds.

Aged↗
PubMed2002

Parent visual analogue scale ratings of children's pain do not reliably reflect pain reported by child.

OBJECTIVES: To determine whether parent and child visual analogue scale (VAS) scores for the pain associated with acute conditions in the child agree sufficiently for these methods of measurement to be considered interchangeable in pain and analgesia research. DESIGN: This was a prospective, two-group, repeated measures, blinded study in an urban pediatric emergency department. Children aged 8 to 15 years seeking treatment for painful conditions and the parents of these children were asked to rate the child's pain independently using a VAS on as many as four occasions at 20-minute intervals. Both participants were blinded to their previous rating and the rating of the other participant. The main outcome measure was the correlation of child and parent VAS pain scores by Pearson correlation and bias plot (Bland-Altman) analysis of agreement between tests. RESULTS: Seventy-eight child-parent sets participated, yielding 289 VAS pain score comparison pairs for evaluation. The correlation between child and parent VAS pain scores was 0.63 (95% CI, 0.56-0.70). Bias plot analysis revealed a bias of 5% and 95% limits of agreement from -38 to +47 mm. The degree of difference between child and parent scores was variable, but there was an increasing tendency for parents to underestimate the child's pain when the child recorded VAS pain scores at the higher end of the scale. CONCLUSIONS: Parents' VAS score ratings of their children's pain correlate only moderately with the children's VAS pain scores and show poor levels of agreement. The difference between the measures is variable and appears to be more marked when the child reports a higher VAS score. This research raises doubt about whether parental rating of a child's pain is an appropriate surrogate marker in pediatric pain and analgesia research.

Acute Disease↗
PubMedDate not supplied

Agreement between bicarbonate measured on arterial and venous blood gases.

OBJECTIVE: This study aims to determine the extent of agreement between venous and arterial bicarbonate for a group of emergency department patients with respiratory or metabolic illness requiring blood gas analysis as part of their evaluation. METHODS: This prospective study of patients who were deemed by their treating doctor to require an arterial blood gas analysis to determine their ventilatory or acid-base status, compared bicarbonate on an arterial and a venous sample taken as close to simultaneously as possible. Data were analysed using bias (Bland-Altman) methods. Subgroup analyses were performed for the metabolic, respiratory, chronic obstructive airways disease and acidotic subgroups. RESULTS: Two hundred and forty-six patients were entered into the study; 195 with acute respiratory disease and 51 with suspected metabolic derangement. The values of bicarbonate on arterial and venous samples showed close agreement with an average difference between the samples of 1.20 mmol/L (95% limits of agreement being -2.73 to +5.13 mmol/L). Similar agreement was found for all subgroups. CONCLUSION: Venous bicarbonate estimation shows a high level of agreement with the arterial value, with acceptably narrow 95% limits of agreement. These results suggest that venous bicarbonate estimation may be an acceptable substitute for arterial measurement.

Adult↗