Research Interests: Epidemiology, Death, Injury Prevention, Health, Disability, and 15 moreHumans, Injury, Female, Disease, Burden of Disease, Health Status, Determinants, Adult, Major Trauma, Disabled Persons, Injury Severity Score, Disability Evaluation, health status indicators, European Countries, and Accidents Traffic
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Providing optimal care to patients with ST-segment elevated myocardial infarction is challenging. If a patient experiences chest pain and calls the emergency number, a cascade of actions is initiated that should lead to a diagnosis, start... more
Providing optimal care to patients with ST-segment elevated myocardial infarction is challenging. If a patient experiences chest pain and calls the emergency number, a cascade of actions is initiated that should lead to a diagnosis, start of treatment and reperfusion of the infarcted myocardium. This should all happen within 90 min after first medical contact, irrespective of the location of the patient or the time of day. The complex organization that is needed to achieve this goal in every ST-segment elevated myocardial infarction patient accounts for a fascinating interplay between prehospital and in-hospital care, in a situation when every minute counts. State-of-the-art care should be provided according to the latest insights and guidelines.
Research Interests: Survival Analysis, Treatment Outcome, Medicine, Electrocardiography, Emergency Medical Services, and 10 moreHumans, Registries, Percutaneous Coronary Intervention, Myocardial Infarction, Time Factors, Recombinant Proteins, Chest Pain, Thrombolytic Therapy, Platelet Aggregation Inhibitors, and Cardiovascular medicine and haematology
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Research Interests: Nursing, Emergency Medicine, Medicine, Humans, Injury, and 15 moreFemale, Male, Netherlands, Clinical Sciences, Public health systems and services research, Retrospective Studies, Reproducibility of Results, Elsevier, Sensitivity and Specificity, Clinical Protocols, Predictive value of tests, Confidence Interval, Injury Severity Score, Guideline Adherence, and Patient selection
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conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation
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Research Interests: Death, Quality of life, Public Health, Population, Humans, and 14 moreFemale, Male, Netherlands, Registries, Health Status, Middle Aged, Adult, Wounds and Injuries, Disabled Persons, Injury Severity Score, Disability Evaluation, health status indicators, Medical and Health Sciences, and Accidents Traffic
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Prehospital trauma triage ensures proper transport of patients at risk of severe injury to hospitals with an appropriate corresponding level of trauma care. Incorrect triage results in undertriage and overtriage. The American College of... more
Prehospital trauma triage ensures proper transport of patients at risk of severe injury to hospitals with an appropriate corresponding level of trauma care. Incorrect triage results in undertriage and overtriage. The American College of Surgeons Committee on Trauma recommends an undertriage rate below 5% and an overtriage rate below 50% for prehospital trauma triage protocols. In order to find the most accurate prehospital trauma triage protocol, a clear overview of all currently available protocols and corresponding outcomes is necessary. The aim of this systematic review was to evaluate the current literature on all available prehospital trauma triage protocols and determine accuracy of protocol-based triage quality in terms of sensitivity and specificity. A search of Pubmed, Embase, and Cochrane Library databases was performed to identify all studies describing prehospital trauma triage protocols before November 2016. The search terms included 'trauma,' 'trauma center...
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To assess among seriously injured accident victims whether change of the Triage Revised Trauma Score (T-RTS) between first assessment and arrival at the hospital independently predicts mortality. Prospective cohort study. The study... more
To assess among seriously injured accident victims whether change of the Triage Revised Trauma Score (T-RTS) between first assessment and arrival at the hospital independently predicts mortality. Prospective cohort study. The study analysed data on 507 trauma patients with multiple injuries and with a Hospital Trauma Index-Injury Severity Score (HTI-ISS) of 16 or higher, who were presented directly by ambulance services to the Accident & Emergency Department of the University Medical Centre Utrecht (the Netherlands) in 1999 and 2000. Compared to non-intubated patients whose T-RTS remained unchanged (reference category), the mortality risk was 3.1 times higher [95% confidence interval (CI): 1.5-6.3, p = 0.001] for patients with deteriorating T-RTS, 2.9 times higher (95% CI: 1.3-6.5, p < 0.001) for patients who had an initially good T-RTS but were nevertheless intubated and 5.7 times higher (95% CI: 3.6-9.0, p < 0.001) for patients who had an initially poor T-RTS and were intuba...
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To determine the background and consequences of failing to diagnose injuries in prehospital care. Prospective cohort study. Data were collected from 507 trauma patients with multiple injuries, and a Hospital trauma index-injury severity... more
To determine the background and consequences of failing to diagnose injuries in prehospital care. Prospective cohort study. Data were collected from 507 trauma patients with multiple injuries, and a Hospital trauma index-injury severity score of 16 or higher, who were delivered by the emergency ambulance service to the emergency department of the University Medical Centre Utrecht, the Netherlands, in 1999-2000. The percentage of missed injuries varied from 9-55. For every additional year of age the risk of missing thoracic injuries was 2% higher. The risk of missing head injuries was 84% lower in people with a Triage revised trauma score (T-RTS) < 11. Initially missing an injury had no consequences for duration of stay in the ICU except in those patients with injuries to the lower extremities. A difference in quality of life was only reported for patients in whom injuries ofthe ribs, shoulder or clavicle had been missed. For every year of age, there was a 2% greater risk of dying...
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For chest pain patients without ST-segment elevation in the pre-hospital setting, current clinical guidelines merely offer in-hospital risk stratification and management, as opposed to chest pain patients with ST-segment elevation for... more
For chest pain patients without ST-segment elevation in the pre-hospital setting, current clinical guidelines merely offer in-hospital risk stratification and management, as opposed to chest pain patients with ST-segment elevation for whom there is a straightforward pre-hospital strategy for diagnosis, medication regimen and logistics. The FAMOUS TRIAGE study will assess the effects of introducing a pre-hospital triage system that reliably stratifies chest pain patients without ST-segment elevation into 1) patients at high risk for NSTEMI requiring a direct transfer to a PCI-hospital; 2) patients at intermediate risk for a major adverse cardiac event (MACE) who could be evaluated at the nearest non-PCI hospital; and 3) patients at low risk for MACE (benign non-cardiac chest pain) who could have further evaluation at home or in a primary care setting. The FAMOUS TRIAGE study will be performed in three phases. In the first phase an appropriate pre-hospital risk stratification tool wil...