Browsing by Author "Alves, C"
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- Can differences in the management of children with respiratory problems be explained by disease severity alone?Publication . Borensztajn, D; Zachariasse, J; Greber-Platzer, S; Alves, C; Freitas, PT; Smit, F; van der Lei, J; Steyerberg, E; Maconochie, I; Moll, H
- Cistadenoma multiquístico da próstata: caso clínicoPublication . Furtado, A; Féria, R; Silva, A; Kronenberg, P; Alves, C; Cardoso, POs cistadenomas prostáticos são tumores raros e como tal pouco reportados na literatura. Descreve-se o caso clínico de um indíviduo do sexo masculino, com 48 anos de idade, assintomático e sem antecedentes pessoais do foro urológico, referenciado à consulta por PSA elevado e achado ecográfico de volumosa massa pélvica. A cistoscopia apresentava, estritamente, um abaulamento extrínseco da parede vesical póstero-inferior. Levou-se a cabo a excisão cirúrgica da massa tumoral e a sua análise anátomo-patológica caracterizou-a como cistadenoma multiquístico da próstata.
- Improving the Manchester Triage System for pediatric emergency care: an international multicenter studyPublication . Seiger, N; van Veen, N; Almeida, HI; Steyerberg, E; van Meurs, A; Carneiro, R; Alves, C; Maconochie, I; van der Lei, J; Moll, HOBJECTIVE:To validate use of the Manchester triage system in paediatric emergency care. DESIGN: Prospective observational study. SETTING: Emergency departments of a university hospital and a teaching hospital in the Netherlands, 2006-7. PARTICIPANTS: 17,600 children (aged <16) visiting an emergency department over 13 months (university hospital) and seven months (teaching hospital). INTERVENTION: Nurses triaged 16,735/17,600 patients (95%) using a computerised Manchester triage system, which calculated urgency levels from the selection of discriminators embedded in flowcharts for presenting problems. Nurses over-ruled the urgency level in 1714 (10%) children, who were excluded from analysis. Complete data for the reference standard were unavailable in 1467 (9%) children leaving 13,554 patients for analysis. MAIN OUTCOME MEASURES: Urgency according to the Manchester triage system compared with a predefined and independently assessed reference standard for five urgency levels. This reference standard was based on a combination of vital signs at presentation, potentially life threatening conditions, diagnostic resources, therapeutic interventions, and follow-up. Sensitivity, specificity, and likelihood ratios for high urgency (immediate and very urgent) and 95% confidence intervals for subgroups based on age, use of flowcharts, and discriminators. RESULTS: The Manchester urgency level agreed with the reference standard in 4582 of 13,554 (34%) children; 7311 (54%) were over-triaged and 1661 (12%) under-triaged. The likelihood ratio was 3.0 (95% confidence interval 2.8 to 3.2) for high urgency and 0.5 (0.4 to 0.5) for low urgency; though the likelihood ratios were lower for those presenting with a medical problem (2.3 (2.2 to 2.5) v 12.0 (7.8 to 18.0) for trauma) and in younger children (2.4 (1.9 to 2.9) at 0-2 months [corrected] v 5.4 (4.5 to 6.5) at 8-16 years). CONCLUSIONS: The Manchester triage system has moderate validity in paediatric emergency care. It errs on the safe side, with much more over-triage than under-triage compared with an independent reference standard for urgency. Triage of patients with a medical problem or in younger children is particularly difficult.
- Lung Adenocarcinoma Presenting as a Multiple Cavitary DiseasePublication . Carreto, L; Alves, C; Eurico, J; Cavinho, P
- Methaemoglobinemia Induced by Poppers and Bupropion Intoxication in the Emergency Department.Publication . Batista, F; Alves, C; Trindade, M; Duarte, JA; Marques, RA 40-year-old man presented to the emergency department with dyspnoea and fatigue after bupropion and popper consumption. Clinical examination was remarkable for central cyanosis not responding to supplementary oxygen. Arterial blood gas analysis showed a methaemoglobin value of 30.3%. Methaemoglobinemia was diagnosed and the patient was treated with methylene blue. However, during methylene blue administration, the patient developed a generalized tonic-clonic seizure that was successfully managed with diazepam. Combined intoxications can be a critical problem in the emergency department. Early recognition and treatment of poisoning are key for good patient outcome. LEARNING POINTS: Distinguishing toxidromes is critical for adequate treatment of patients with drug intoxication; the most common side effect of bupropion consumption is dose-dependent seizures.The diagnosis of methaemoglobinemia requires a high index of suspicion, particularly in a patient presenting with central cyanosis not responding to supplementary oxygen.Treatment with methylene blue is recommended when the percentage of methaemoglobin is above 30% or when the patient has symptoms related to methaemoglobinemia.
- Protocolo Triagem Manchester IIIPublication . Alves, C
- Recém-nascidos no serviço de urgência pediátrica: casuística de um anoPublication . Garcia, C; Mascarenhas, I; Teixeira, AT; Bento, V; Alves, C; Almeida, HIntrodução: Os serviços de urgência pediátrica são ambientes particularmente deletérios para os recém-nascidos. A identifica - ção precoce da doença neste grupo é fundamental, uma vez que o atraso diagnóstico pode estar associado a consequências graves. A maioria dos sistemas de triagem utilizados nos serviços de urgência pediátrica não possui algoritmos específicos para os recém-nascidos. Este estudo teve como objetivos caracterizar os recém-nascidos que recorreram ao serviço de urgência pediátrica, analisar a sua categorização pelo Sistema de Triagem de Manchester e identificar fatores de risco associados ao internamento. Métodos: Estudo retrospetivo efetuado pela análise dos dados de recém-nascidos admitidos no serviço de urgência pediátrica no ano de 2012. Resultados: Foram incluídos 779 recém-nascidos com idade média de 16,78 dias. Os principais diagnósticos de admissão foram as infeções respiratórias (21,9%) e a cólica do lactente (21%). Ficaram internados 22,2%, sendo os principais motivos as infe - ções respiratórias baixas (19,7%), os episódios de apparent life threatening event (15%) e as gastroenterites agudas (10,8%). A presença de hipoxemia e a realização de exames complementares no serviço de urgência pediátrica associaram-se a maior taxa de internamento (p = 0,001), assim como a atribuição de nível de prioridade “urgente”, “muito urgente” ou “emergente” pelo Sistema de Triagem de Manchester (p = 0,001). Discussão: O recurso dos recém-nascidos ao serviço de urgência pediátrica neste hospital ocorre maioritariamente por situa- ções de doença aguda. Os diagnósticos de admissão mais frequentes apresentam pouca gravidade clínica, já que contribuem pouco para o número de internamentos. Verifica-se uma correlação entre o nível de prioridade atribuído pelo Sistema de Triagem de Manchester e a necessidade de internamento neste grupo etário.
- Validity of the Manchester Triage System in emergency care: A prospective observational study.Publication . Zachariasse, J; Seiger, N; Rood, P; Alves, C; Freitas, PT; Smit, F; Roukema, G; Moll, HOBJECTIVES: To determine the validity of the Manchester Triage System (MTS) in emergency care for the general population of patients attending the emergency department, for children and elderly, and for commonly used MTS flowcharts and discriminators across three different emergency care settings. METHODS: This was a prospective observational study in three European emergency departments. All consecutive patients attending the emergency department during a 1-year study period (2010-2012) were included. Validity of the MTS was assessed by comparing MTS urgency as determined by triage nurses with patient urgency according to a predefined 3-category reference standard as proxy for true patient urgency. RESULTS: 288,663 patients were included in the analysis. Sensitivity of the MTS in the three hospitals ranged from 0.47 (95%CI 0.44-0.49) to 0.87 (95%CI 0.85-0.90), and specificity from 0.84 (95%CI 0.84-0.84) to 0.94 (95%CI 0.94-0.94) for the triage of adult patients. In children, sensitivity ranged from 0.65 (95%CI 0.61-0.70) to 0.83 (95%CI 0.79-0.87), and specificity from 0.83 (95%CI 0.82-0.83) to 0.89 (95%CI 0.88-0.90). The diagnostic odds ratio ranged from 13.5 (95%CI 12.1-15.0) to 35.3 (95%CI 28.4-43.9) in adults and from 9.8 (95%CI 6.7-14.5) to 23.8 (95%CI 17.7-32.0) in children, and was lowest in the youngest patients in 2 out of 3 settings and in the oldest patients in all settings. Performance varied considerably between the different emergency departments. CONCLUSIONS: Validity of the MTS in emergency care is moderate to good, with lowest performance in the young and elderly patients. Future studies on the validity of triage systems should be restricted to large, multicenter studies to define modifications and improve generalizability of the findings.