Le sepsis, un syndrome d'infection générale grave, est une importante cause de décès dans le monde et a un impact considérable sur le taux de mortalité dans le département des soins intensifs des hôpitaux. Plusieurs médecins soutiennent que le diagnostic de sepsis est fréquemment omis, menant ainsi à de graves conséquences pour l'état de santé du patient. Considérant cette problématique, la présente étude a pour buts de déterminer les caractéristiques du processus décisionnel des médecins en situation de triage et de prise en charge du sepsis pédiatrique, d'évaluer la performance des médecins en contexte de détection du sepsis pédiatrique et enfin, de valider une méthode permettant de développer un modèle cognitif de prise de décision relié à cette condition médicale. Une tâche décisionnelle à l'aide d'un tableau d'information est administrée aux participants. Les résultats sont analysés selon une combinaison de méthodes : la théorie de détection de signal, l'identification de la règle décisionnelle et l'extraction du processus décisionnel. Le personnel médical a une capacité de discrimination moyenne. Leurs réponses tendent vers un biais libéral. La comparaison entre un arbre décisionnel normatif et les arbres décisionnels individuels a démontré une mésestimation de l'importance des critères diagnostics pertinents. Il y a présence d'hétérogénéité quant aux critères utilisés par les médecins pour poser le diagnostic. Ces résultats permettent de cibler davantage la problématique de détection du sepsis pédiatrique et démontre la pertinence de développer un outil d'aide à la détection afin de soutenir les médecins dans leurs décisions. Les résultats de la présente étude fournissent des lignes directrices quant au développement d'un tel outil. Les résultats montrent également que la combinaison de la théorie de détection de signal, de l'identification de la règle décisionnelle et de l'extraction du processus décisionnel fournie une méthode adaptée afin de développer des modèles de prise de décision.

Timely management in pre-hospital emergency care enhances the chances of patients' survival or clinical outcomes of an Acute Coronary Syndrome (ACS). In Botswana nurses serve in the frontline of pre-hospital emergency services as the initial recipients of the emergency reports and situations. Knowledge of the patient's characteristics will assist the nurses as well as the family/others to understand the patient's responses during an ACS situation and therefore enable prompt patient assessment and facilitation of early access to appropriate care. Patient and family involvement in care during cardiac emergencies also influences the patient outcomes. This is a non-experimental, quantitative, exploratory and descriptive study, designed to explore and describe the characteristics of patients with the experience of an ACS, and the available resources during the pre-hospital phase of emergency care, with the aim of improving patients' clinical outcomes. The results indicated that optimal care by nurses is essential in the chain of care influencing patients' chances of surviving ACS. / Health Studies / M.A. (Health Studies)

Introdução: Triagem para admissão em unidades de terapia intensiva (UTIs) é realizada rotineiramente e é comumente baseada somente no julgamento clínico, o que pode mascarar vieses e preconceitos. Neste estudo, foram avaliadas a reprodutibilidade e validade de um algoritmo de apoio a decisões de triagem em UTI. Também foi avaliado o efeito da implementação de um instrumento de auxílio à tomada de decisão para a priorização de vagas de UTI nas decisões de admissão em UTI. Foi avaliada, ainda, a acurácia da predição prognóstica dos médicos na população de pacientes em deterioração clínica aguda. Métodos: Para o primeiro objetivo do estudo, um algoritmo computadorizado para auxiliar as decisões de priorização de vagas em UTI foi desenvolvido para classificar pacientes nas categorias do sistema de priorização da \"Society of Critical Care Medicine (SCCM)\". Nove médicos experientes (experts) avaliaram quarenta vinhetas clínicas baseadas em pacientes reais. A referência foi definida como as prioridades classificadas por dois investigadores com acesso ao prontuário completo dos pacientes. As concordâncias entre as prioridades do algoritmo com as prioridades da referência e com as prioridades dos experts foram avaliadas. As correlações entre a prioridade do algoritmo e o julgamento clínico de adequação da admissão na UTI em contexto com e sem escassez de vagas também foram avaliadas. A validade foi ainda avaliada através da aplicação do algoritmo, retrospectivamente em uma coorte de 603 pacientes com solicitação de vagas de UTI, para correlação com desfechos clínicos. Para o segundo objetivo do estudo, um estudo prospectivo, quaseexperimental foi conduzido, antes (maio/2014 a novembro/2014, fase 1) e após (novembro/2014 a maio/2015, fase 2) a implementação de um instrumento de auxílio à tomada de decisão, que foi baseado no algoritmo descrito acima. Foi avaliado o impacto da implementação do instrumento de auxílio à tomada de decisão na ocorrência de admissões potencialmente inapropriadas na UTI em uma coorte de pacientes com solicitações urgentes de vaga de UTI. O desfecho primário foi a proporção de solicitações de vaga potencialmente inapropriadas que foram admitidas na UTI em até 48 horas após a solicitação. Solicitações de vaga potencialmente inapropriadas foram definidas como pacientes prioridade 4B, conforme diretrizes da SCCM de 1999, ou prioridade 5, conforme diretrizes da SCCM de 2016. Foram realizadas análises multivariadas com teste de interação entre fase e prioridades para avaliação dos efeitos diferenciados em cada estrato de prioridade. Para o terceiro objetivo do estudo, a predição prognóstica realizada pelo médico solicitante foi registrada no momento da solicitação de vaga de UTI. Resultados: No primeiro objetivo do estudo, a concordância entre as prioridades do algoritmo e as prioridades da referência foi substancial, com uma mediana de kappa de 0,72 (IQR 0,52-0,77). As prioridades do algoritmo evidenciaram uma maior reprodutibilidade entre os pares [kappa = 0,61 (IC95% 0,57-0,65) e mediana de percentagem de concordância = 0,64 (IQR 0,59-0,70)], quando comparada à reprodutibilidade entre os pares das prioridades dos experts [kappa = 0,51 (IC95% 0,47-0,55) e mediana de percentagem de concordância = 0,49 (IQR 0,44-0,56)], p=0,001. As prioridades do algoritmo também foram associadas ao julgamento clínico de adequação da admissão na UTI (vinhetas com prioridades 1, 2, 3 e 4 seriam admitidas no último leito de UTI em 83,7%, 61,2%, 45,2% e 16,8% dos cenários, respectivamente, p < 0,001) e com desfechos clínicos reais na coorte retrospectiva, como admissão na UTI, consultas com equipe de cuidados paliativos e mortalidade hospitalar. No segundo objetivo do estudo, 2374 solicitações urgentes de vaga de UTI foram avaliadas, das quais 1184 (53,8%) pacientes foram admitidos na UTI. A implementação do instrumento de auxílio à tomada de decisão foi associada com uma redução de admissões potencialmente inapropriadas na UTI, tanto utilizando a classificação de 1999 [adjOR (IC95%) = 0,36 (0,13-0,97), p = 0,043], quanto utilizando a classificação de 2016 [adjOR (IC95%) = 0,35 (0,13-0,96, p = 0,041)]. Não houve diferença em mortalidade entre as fases 1 e 2 do estudo. No terceiro objetivo do estudo, a predição prognóstica do médico solicitante foi associada com mortalidade. Ocorreram 593 (34,4%), 215 (66,4%) e 51 (94,4%) óbitos nos grupos com prognóstico de sobrevivência sem sequelas graves, sobrevivência com sequelas graves e nãosobrevivência, respectivamente (p < 0,001). Sensibilidade foi 31%, especificidade foi 91% e a área sob a curva ROC foi de 0,61 para predição de mortalidade hospitalar. Após análise multivariada, a gravidade da doença aguda, funcionalidade prévia e admissão na UTI foram associadas com uma maior chance de erro prognóstico, enquanto que uma predição de pior prognóstico foi associada a uma menor chance de erro prognóstico. O grau de expertise do médico solicitante não teve efeito na predição prognóstica. Discussão/Conclusão: Neste estudo, um algoritmo de apoio a decisões de triagem em UTI demonstrou boa reprodutibilidade e validade. Além disso, a implementação de um instrumento de auxílio à tomada de decisões para priorização de vagas de UTI foi associada a uma redução de admissões potencialmente inapropriadas na UTI. Também foi encontrado que a predição prognóstica dos médicos solicitantes foi associada a mortalidade hospitalar, porém a acurácia foi pobre, principalmente devido a uma baixa sensibilidade para detectar risco de morte / Introduction: Intensive care unit (ICU) admission triage is performed routinely and is often based solely on clinical judgment, which could mask biases. In this study, we sought to evaluate the reliability and validity of an algorithm to aid ICU triage decisions. We also aimed to evaluate the effect of implementing a decision-aid tool for ICU triage on ICU admission decisions. We also evaluated the accuracy of physician\'s prediction of hospital mortality in in acutely deteriorating patients. Methods: For the first objective of the study, a computerized algorithm to aid ICU triage decisions was developed to classify patients into the Society of Critical Care Medicine\'s prioritization system. Nine senior physicians evaluated forty clinical vignettes based on real patients. Reference standard was defined as the priorities ascribed by two investigators with full access to patient\'s records. Agreement of algorithm-based priorities with the reference standard and with intuitive priorities provided by the physicians were evaluated. Correlations between algorithm prioritization and physician\'s judgment of appropriateness of ICU admission in scarcity and non-scarcity settings were also evaluated. Validity was further assessed by retrospectively applying this algorithm to 603 patients with requests for ICU admission for association with clinical outcomes. For the second objective of the study, a prospective, quasi-experimental study was conducted, before (May 2014 to November 2014, phase 1) and after (November 2014 to May 2015, phase 2) the implementation of a decision-aid tool for ICU admission triage, which was based on the aforementioned algorithm. We assessed the impact of the implementation of the decision-aid tool in potentially inappropriate ICU admissions in a cohort of patients referred for urgent ICU admission. Primary outcome was the proportion of potentially inappropriate ICU referrals that were admitted to the ICU in 48 hours following referral. Potentially inappropriate ICU referrals were defined as priority 4B patients, as described by the 1999 Society of Critical Care Medicine (SCCM) guidelines and as priority 5 patients, as described by the 2016 SCCM guidelines. We conducted multivariate analyses and evaluated the interaction between phase and triage priorities to assess for differential effects in each priority strata. For the third objective of the study, physicians\' prognosis and other variables were recorded at the moment of ICU referral. Results: On the first objective of the study, agreement between algorithm-based priorities and the reference standard was substantial, with a median kappa of 0.72 (IQR 0.52-0.77). Algorithm-based priorities demonstrated higher interrater reliability [overall kappa of 0.61 (95%CI 0.57-0.65) and median percent agreement of 0.64 (IQR 0.59-0.70)] than physician\'s intuitive prioritization [overall kappa of 0.51 (95%CI 0.47-0.55) and median percent agreement of 0.49 (IQR 0.44-0.56)], p=0.001. Algorithm-based priorities were also associated with physicians\' judgment of appropriateness of ICU admission (priorities 1, 2, 3 and 4 vignettes would be admitted to the last ICU bed in 83.7%, 61.2%, 45.2% and 16.8% of the scenarios, respectively, p < 0.001) and with actual ICU admission, palliative care consultation and hospital mortality in the retrospective cohort. On the second objective of the study, of 2374 urgent ICU referrals, 1184 (53.8%) patients were admitted to the ICU. Implementation of the decision-aid tool was associated with a reduction of potentially inappropriate ICU admissions using the 1999 [adjOR (95% CI) = 0.36 (0.13-0.97), p = 0.043] or 2016 [adjOR (95%CI) = 0.35 (0.13-0.96, p = 0.041)] definitions. There was no difference on mortality between phases 1 and 2. On the third objective of the study, physician\'s prognosis was associated to hospital mortality. There were 593 (34.4%), 215 (66.4%) and 51 (94.4%) deaths in the groups ascribed a prognosis of survival without disabilities, survival with severe disabilities or no survival, respectively (p < 0.001). Sensitivity was 31%, specificity was 91% and the area under the ROC curve was 0.61 for prediction of mortality. After multivariable analysis, severity of illness, performance status and ICU admission were associated to an increased likelihood of incorrect classification, while worse predicted prognosis was associated to a lower chance of incorrect classification. Physician\'s level of expertise had no effect on predictive ability. Discussion/Conclusion: In this study, a ICU admission triage algorithm demonstrated good reliability and validity. Moreover, the implementation of a decision-aid tool for ICU triage was associated with a reduction of potentially inappropriate ICU admissions. It was also found that physician\'s prediction was associated to hospital mortality, but overall accuracy was poor, mainly due to low sensitivity to detect mortality risk

Les algies pelviennes aigues constituent le premier motif de consultation aux urgences gynécologiques. Les étiologies possibles de ces algies pelviennes aigues sont nombreuses et incluent à la fois des affections gynécologiques et non gynécologiques. Certaines de ces affections peuvent, en l’absence de diagnostic précoce et d’un traitement adapté, avoir des conséquences très graves. Dans ce travail, nous avons développé un autoquestionnaire standardisé de manière qualitative dédié aux urgences gynécologiques par des entretiens structurés. Nous avons ensuite construit des modèles de prédiction clinique dédiés (i) au diagnostic de rupture tubaire chez les patientes porteuses de grossesses extra-utérines et (ii) au diagnostic de torsion d’annexe à partir de cet autoquestionnaire. Après avoir défini le concept d’urgence potentiellement à risque en gynécologie, nous avons proposé (iii) un modèle de prédiction clinique de celles-ci basé sur notre autoquestionnaire standardisé. A l’issue du développement de ces modèles, nous avons sélectionné certains items de l’autoquestionnaire standardisé afin d’en proposer une version simplifiée. L’utilisation de nos modèles pour le tri et le diagnostic des patientes aux urgences gynécologiques pourrait permettre d’optimiser la prise en charge des patientes. Dans les groupes à haut risque de pathologie, les patientes pourraient bénéficier d’une prise en charge plus rapide avec une éventuelle diminution de la morbidité secondaire à la pathologie. Pour les patientes classées à bas risque, une désescalade des examens complémentaires et des chirurgies inutiles pourrait aussi permettre une diminution de la morbidité d’origine iatrogène. / Acute pelvic pain is the main reason for emergency gynecologic consultation. The possible etiologies of acute pelvic pain are numerous and include both gynecological and non gynecological diseases. Some of these conditions may, in the absence of early diagnosis and appropriate treatment, have very serious consequences. In this work, we developed qualitatively a standardized self-assessed questionnaire dedicated to gynecological emergencies by structured interviews. We then developed clinical prediction rules for (i) the diagnosis of tubal rupture in patients who have ectopic pregnancies and (ii) the diagnosis of adnexal torsion. After a definition of the concept of potentially at risk emergencies in gynecology, we have proposed (iii) a clinical prediction rule based on our questionnaire. Following the development of these models, we selected items from the self-assessed questionnaire in order to propose a simplified version. Using our models for triaging and diagnosis of patients with gynecologic emergencies may optimize the management of patients. In groups at high risk of disease, patients may benefit from faster medical management with a possible decrease in morbidity. For patients classified as low risk, decrease of complementary tests and unnecessary surgery could also allow a reduction of iatrogenic morbidity.

Purpose: The purpose of this study was to evaluate the effectiveness of triaging patients with motion-provoked dizziness into a benign paroxysmal positional vertigo (BPPV) clinic. Method: A retrospective chart review was performed of veterans who were tested and treated for BPPV in a triaged BPPV clinic and veterans who were tested and treated for BPPV in a traditional vestibular clinic. Results: The BPPV triage clinic had a hit rate of 39%. On average, the triaged BPPV clinic reduced patient wait times by 23 days relative to the wait times for the traditional vestibular clinic while also reducing patient costs. Conclusion: Triaging patients with BPPV is one method to improve access to evaluation and treatment and a mechanism for the effective use of clinic time and resources.

Dans cette thèse, nous proposons et évaluons la mise en place de la chaine complète de traitement de l'information pour la détermination de l'état de santé d'un blessé polytraumatisé. Nous faisons l'hypothèse que l'état de santé du blessé est observable dans un espace généré à partir de caractéristiques extraites sur des mesures provenant de capteurs portables. Au cours du polytraumatisme, son état se déplace dans des régions propres à chaque classe de choc hémorragique rencontrée, indépendante de l'individu. Le but de cette étude est de trouver ces régions par apprentissage supervisé pour un espace de dimension le plus faible possible (minimisation du nombre de capteurs). Pour cela, nous avons mis au point un modèle animal de choc hémorragique sur de jeunes porcs subissant une perte de sang continue à débit contrôlé. Dans un premier temps l'apprentissage a été réalisé en observant l'état instantané, l'évolution dynamique étant vue comme contextuelle. Dans un second temps nous avons évalué l'apport de l'information dynamique.

The detonation of a radiological dispersion device (RDD) may result in a situation where many individuals are exposed to contamination due to the inhalation of radioactive materials. Assessments of contamination may need to be performed by emergency response personnel in order to triage the potentially exposed public. The feasibility of using readily available standard 2x2-inch sodium-iodide detectors to determine the committed effective dose to a patient following the inhalation of a radionuclide has been investigated. The 2x2-NaI(Tl) detector was modeled using the Monte Carlo simulation code, MCNP-5, and was validated via a series of experimental benchmark measurements using a polymethyl methacrylate (PMMA) slab phantom. Such validation was essential in reproducing an accurate detector response. Upon verification of the detector model, six anthropomorphic phantoms, based on the MIRD-V phantoms, were modeled with nuclides distributed to simulate inhaled contamination. The nuclides assessed included Am-241, Co-60, Cs-137, I-131, and Ir-192. Detectors were placed at four positions on the phantoms: anterior right torso, posterior right torso, anterior neck, and lateral left thigh. The detected count-rate varied with respect to detector position, and the optimal detector location was determined on the body. The triage threshold for contamination was set at an action level of 250-mSv of intake. Time dependent biokinetic modeling was employed to determine the source distribution and activity in the body as a function of post-inhalation time. The detector response was determined as a function of count-rate per becquerel of activity at initial intake. This was converted to count-rate per 250-mSv intake for triage use by first responders operating the detector to facilitate triage decisions of contamination level. A set of procedure sheets for use by first responders was compiled for each of the phantoms and nuclides investigated.

Submitted by Aelson Maciera (aelsoncm@terra.com.br) on 2017-08-25T18:10:30Z No. of bitstreams: 1 DissGA.pdf: 3509452 bytes, checksum: 61c3447f02d00b7e5dfca8f34747f8de (MD5) / Approved for entry into archive by Ronildo Prado (bco.producao.intelectual@gmail.com) on 2018-01-25T16:48:55Z (GMT) No. of bitstreams: 1 DissGA.pdf: 3509452 bytes, checksum: 61c3447f02d00b7e5dfca8f34747f8de (MD5) / Approved for entry into archive by Ronildo Prado (bco.producao.intelectual@gmail.com) on 2018-01-25T16:49:08Z (GMT) No. of bitstreams: 1 DissGA.pdf: 3509452 bytes, checksum: 61c3447f02d00b7e5dfca8f34747f8de (MD5) / Made available in DSpace on 2018-01-25T16:53:52Z (GMT). No. of bitstreams: 1 DissGA.pdf: 3509452 bytes, checksum: 61c3447f02d00b7e5dfca8f34747f8de (MD5) Previous issue date: 2017-02-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Down’s syndrome is defined by its genetic component. There is a set of anatomophysiological commitments that interfere in these children development, especially in language development. To evaluate this instruments and tests were developed, and they may auxiliate in the early detection of possible risks, identifying their potential and making interventional procedures easier. The main goal of this research was to characterize global language development repertoire in children younger than 48 months with Down’s syndrome, with the specific goal of comparing the contributions of Denver’s II Test of Triage Development, Portage’s Operationalized Inventory and Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) for the assessment and characterization of children’s younger than 48 months with Down’s syndrome linguistic repertoire. Participated on this research one boy and three girls with Down’s syndrome between the ages of 14 and 46 months old, whom frequented a public daycare and/or a specialized school in a city in São Paulo’s countryside. The evaluations were made through direct observation and interaction with participants. The evaluation sessions happened in the institutions frequented by the children and had the duration of 1 (one) hour. The number of meetings with each child variated. The sessions were composed of activities required by Denver’s II Test of Triage Development, Portage’s Operationalized Inventory and Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). With the legal responsible were made presential interviews for the filling of both Brasil’s Criteria Questionnaire and Anamnese Record. Regarding global development, although the children in this study had different ages, they presented similar repertoire and bellow the expected for their age range. The development bellow their age range was also verified regarding the language area. Regarding the instruments used, concludes that they complement each other, and make it possible to verify required abilities in a more specific way. The assessed evaluations matched the literature, pointing that children with Down’s syndrome tend to present a different development from the one seen in children without deficiency in all evaluated areas. The findings obtained with the instruments used allowed to verify the installed development and the potential of the participating children, favoring the elaboration of interventional programs considering the specificities of each children with Down’s syndrome. However, for the deeper comprehension of these children’s development, it is necessary new studies and the use of other instruments. / A síndrome de Down é definida pelo seu componente genético. Há um conjunto de comprometimentos anatomofisiológicos que interferem no desenvolvimento dessas crianças, em especial no desenvolvimento da linguagem e da fala. Para avaliação do desenvolvimento existem instrumentos e testes que podem auxiliar na detecção precoce de possíveis riscos, identificando o seu potencial e facilitando procedimentos de intervenção. O objetivo geral dessa pesquisa foi o de caracterizar o repertório de desenvolvimento da linguagem de crianças com síndrome de Down, menores de 48 meses, em relação ao seu repertorio global e o objetivo específico foi o de cotejar as contribuições do Teste de Triagem de Desenvolvimento de Denver II, do Inventário Portage Operacionalizado e do Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) para o levantamento e caracterização do repertório de linguagem de crianças com síndrome de Down menores de 48 meses. Participaram da pesquisa um menino e três meninas com síndrome de Down, com idade entre 14 a 46 meses, que frequentavam uma creche pública e/ou uma escola especializada de uma cidade do interior de São Paulo. As avaliações foram realizadas por meio de observação direta e interação com os participantes. As sessões de avaliação tinham duração de 1 hora e ocorreram nas instituições que as crianças frequentavam. O número de encontros com cada criança foi variável. As sessões eram compostas de atividades requeridas pelo Teste de Triagem de Desenvolvimento de Denver II, Inventário Portage Operacionalizado e VB-MAPP. As entrevistas presenciais foram realizadas com os responsáveis para preenchimento do Questionário Critério Brasil e da Ficha de Anamnese. As crianças participantes desse estudo apresentaram o repertório de desenvolvimento global e da linguagem semelhante e aquém do que esperado para a faixa etária, embora tivessem idades diferentes. Em relação aos instrumentos utilizados, conclui-se que esses se complementam, pois apresentam tarefas diversificadas mas que avaliam uma mesma área do desenvolvimento. Os três instrumentos empregados em conjunto possibilitam verificar as habilidades requeridas para a aquisição da linguagem e da fala de modo mais específico. As avaliações levantadas foram ao encontro aos dados da literatura, indicando que crianças com síndrome de Down tendem a apresentar um desenvolvimento diferente daquele visto em crianças sem deficiência em todas as áreas avaliadas. Os achados obtidos com os instrumentos empregados permitiram verificar o repertório atual da criança, favorecendo a elaboração de programas de intervenção e considerando as especificidades de cada criança com síndrome de Down. Entretanto, para uma compreensão aprofundada do desenvolvimento dessas crianças são necessários novos estudos e uso de outros instrumentos.

Background Major incidents are characterized by a lack of resources compared to an overwhelming number of casualties, requiring a prioritization of medical treatment. Triage algorithms are an essential tool for prioritizing the urgency of treatment for patients, but the evidence to support one over another is very limited. We determined the influence of blood pressure limits on the diagnostic value of triage algorithms, considering if pulse should be palpated centrally or peripherally. Methods We used a database representing 500 consecutive HEMS patients. Each patient was allocated a triage category (T1/red, T2/yellow, T3/green) by a group of experienced doctors in disaster medicine, independent of any algorithm. mSTaRT, ASAV, Field Triage Score (FTS), Care Flight (CF), “Model Bavaria” and two Norwegian algorithms (Nor and TAS), all containing the question “Pulse palpable?”, were translated into Excel commands, calculating the triage category for each patient automatically. We used 5 blood pressure limits ranging from 130 to 60 mmHg to determine palpable pulse. The resulting triage categories were analyzed with respect to sensitivity, specificity and Youden Index (J) separately for trauma and non-trauma patients, and for all patients combined. Results For the entire population of patients within all triage algorithms the Youden Index (J) was highest for T1 (J between 0,14 and 0,62). Combining trauma and non-trauma patients, the highest J was obtained by ASAV (J = 0,62 at 60 mmHg). ASAV scored the highest within trauma patients (J = 0,87 at 60 mmHg), whereas Model Bavaria (J = 0,54 at 80 mmHg) reached highest amongst non-trauma patients. FTS performed worst for all patients (J = 0,14 at 60 mmHg), showing a lower score for trauma patients (J = 0,0 at 60 mmHg). Change of blood pressure limits resulted in different diagnostic values of all algorithms. Discussion We demonstrate that differing blood pressure limits have a remarkable impact on diagnostic values of triage algorithms. Further research is needed to determine the lowest blood pressure value that is possible to palpate at a peripheral artery compared to a central artery. Conclusion As a consequence, it might be important in which location pulses are palpated according to the algorithm at hand during triage of patients.

Timely management in pre-hospital emergency care enhances the chances of patients' survival or clinical outcomes of an Acute Coronary Syndrome (ACS). In Botswana nurses serve in the frontline of pre-hospital emergency services as the initial recipients of the emergency reports and situations. Knowledge of the patient's characteristics will assist the nurses as well as the family/others to understand the patient's responses during an ACS situation and therefore enable prompt patient assessment and facilitation of early access to appropriate care. Patient and family involvement in care during cardiac emergencies also influences the patient outcomes. This is a non-experimental, quantitative, exploratory and descriptive study, designed to explore and describe the characteristics of patients with the experience of an ACS, and the available resources during the pre-hospital phase of emergency care, with the aim of improving patients' clinical outcomes. The results indicated that optimal care by nurses is essential in the chain of care influencing patients' chances of surviving ACS. / Health Studies / M.A. (Health Studies)