• Does the pandemic medical early warning score system correlate with disposition decisions made at patient contact by emergency care practitioners?

      Gray, J.T; Challen, K.; Oughton, L. (2010-12)
      Objective To assess the performance of the pandemic medical early warning score (PMEWS) in a cohort of adult patients seen in the community by emergency care practitioners (ECP) and its correlation with ECP decision-making to either ‘treat and leave’ or transfer for hospital assessment. Methods Cases attended by ECP in South Yorkshire in 2007 in which the final ECP working diagnosis was a respiratory condition were retrospectively identified from the Yorkshire Ambulance Service database. The patient report forms were reviewed for the PMEWS variables and scores calculated using the PMEWS system. The outcome measure was management in the community versus transport to hospital. Receiver operating characteristics (ROC) curves were calculated to assess the discrimination of PMEWS. Results A cohort of 300 patients was assessed. 217 (72%) were aged 65 years or over, and 272 (91%) had either comorbid disease or impaired functional status. 98 (33%) were deemed to need hospital assessment or admission. The ROC curves suggested that there is good correlation between the PMEWS score and the decision to discharge. Conclusions PMEWS correlates well with decisions to admit to hospital or leave at home made by extended role practitioners in the patient group studied; however, further prospective work is required to further validate early warning scoring systems in prehospital care. https://emj.bmj.com/content/emermed/27/12/943.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emj.2009.072959
    • National swine flu adult assessment guidelines: retrospective validation of objective criteria in three proxy datasets

      Challen, K.; Bentley, A.; Bright, J.; Gray, J.; Walter, D. (2011-04)
      OBJECTIVES: To validate the objective criteria in the Department of Health Adult Swine Flu Assessment Tool against proxy datasets for pandemic influenza. DESIGN: Comparative validation study with 3 datasets. SETTING: Urban Emergency Department (group 1) and prehospital care (groups 2 and 3). PARTICIPANTS: Adults with community-acquired pneumonia (group 1, n=281), shortness of breath (group 2, n=211) or any respiratory diagnosis (group 3, n=300). OUTCOME MEASURES: Hospital admission (group 1), hospital admission or intravenous therapy (group 2) and transfer to emergency department (group 3). RESULTS: Sensitivity and specificity of the tool were 0.73 (95% CI 0.67 to 0.8) and 0.83 (0.72 to 0.9) in group 1, 0.64 (0.55 to 0.71) and 0.63 (0.52 to 0.73) in group 2 and 0.84 (0.75 to 0.9) and 0.55 (0.48 to 0.62) in group 3. Analysis of individual components of the tool and a summative score is presented. CONCLUSIONS: The objective criteria of the proposed DH assessment tool do not perform particularly well in predicting relevant clinical outcomes in feasible proxy conditions for pandemic influenza. https://emj.bmj.com/content/emermed/28/4/287.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emj.2009.083683