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Carl H. Schultz - One of the best experts on this subject based on the ideXlab platform.
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comparative analysis of multiple casualty incident triage algorithms
Annals of Emergency Medicine, 2001Co-Authors: Alan Garner, Ken Harrison, Carl H. SchultzAbstract:STUDY OBJECTIVE: We sought to retrospectively measure the accuracy of multiple-casualty incident (MCI) triage algorithms and their component physiologic variables in predicting adult patients with critical injury. METHODS: We performed a retrospective review of 1,144 consecutive adult patients transported by ambulance and admitted to 2 trauma centers. Association between first-recorded out-of-hospital physiologic variables and a resource-based definition of severe injury appropriate to the MCI context was determined. The Association between severe injury and Triage Sieve, Simple Triage and Rapid Treatment, modified Simple Triage and Rapid Treatment, and CareFlight Triage was determined in the patient population. RESULTS: Of the physiologic variables, the Motor Component of the Glasgow Coma Scale had the Strongest Association with severe injury, followed by systolic blood pressure. The differences between CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment were not dramatic, with sensitivities of 82% (95% confidence interval [CI] 75% to 88%), 85% (95% CI 78% to 90%), and 84% (95% CI 76% to 89%), respectively, and specificities of 96% (95% CI 94% to 97%), 86% (95% CI 84% to 88%), and 91% (95% CI 89% to 93%), respectively. Both forms of Triage Sieve were significantly poorer predictors of severe injury. CONCLUSION: Of the physiologic variables used in the triage algorithms, the Motor Component of the Glasgow Coma Scale and systolic blood pressure had the Strongest Association with severe injury. CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment had similar sensitivities in predicting critical injury in designated trauma patients, but CareFlight Triage had better specificity. Because patients in a true mass casualty situation may not be completely comparable with designated trauma patients transported to emergency departments in routine circumstances, the best triage instrument in this study may not be the best in an actual MCI. These findings must be validated prospectively before their accuracy can be confirmed.
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comparative analysis of multiple casualty incident triage algorithms
Annals of Emergency Medicine, 2001Co-Authors: Alan Garner, Ken Harrison, Anna Lee, Carl H. SchultzAbstract:Abstract Study Objective: We sought to retrospectively measure the accuracy of multiple-casualty incident (MCI) triage algorithms and their component physiologic variables in predicting adult patients with critical injury. Methods: We performed a retrospective review of 1,144 consecutive adult patients transported by ambulance and admitted to 2 trauma centers. Association between first-recorded out-of-hospital physiologic variables and a resource-based definition of severe injury appropriate to the MCI context was determined. The Association between severe injury and Triage Sieve, Simple Triage and Rapid Treatment, modified Simple Triage and Rapid Treatment, and CareFlight Triage was determined in the patient population. Results: Of the physiologic variables, the Motor Component of the Glasgow Coma Scale had the Strongest Association with severe injury, followed by systolic blood pressure. The differences between CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment were not dramatic, with sensitivities of 82% (95% confidence interval [CI] 75% to 88%), 85% (95% CI 78% to 90%), and 84% (95% CI 76% to 89%), respectively, and specificities of 96% (95% CI 94% to 97%), 86% (95% CI 84% to 88%), and 91% (95% CI 89% to 93%), respectively. Both forms of Triage Sieve were significantly poorer predictors of severe injury. Conclusion: Of the physiologic variables used in the triage algorithms, the Motor Component of the Glasgow Coma Scale and systolic blood pressure had the Strongest Association with severe injury. CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment had similar sensitivities in predicting critical injury in designated trauma patients, but CareFlight Triage had better specificity. Because patients in a true mass casualty situation may not be completely comparable with designated trauma patients transported to emergency departments in routine circumstances, the best triage instrument in this study may not be the best in an actual MCI. These findings must be validated prospectively before their accuracy can be confirmed. [Garner A, Lee A, Harrison K, Schultz CH. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. November 2001;38:541-548.]
Daniel H Oleary - One of the best experts on this subject based on the ideXlab platform.
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Associations of coronary heart disease with common carotid artery near and far wall intima media thickness the multi ethnic study of atherosclerosis
Journal of The American Society of Echocardiography, 2015Co-Authors: Joseph F Polak, Moyses Szklo, Daniel H OlearyAbstract:Background Intima-media thickness (IMT) measured on ultrasound images of the common carotid artery (CCA) is associated with cardiovascular risk factors and events. Given the physics of ultrasound, CCA far wall IMT measurements are favored over near wall measurements, but this theoretical advantage is not well studied. Methods A total of 6,606 members of the Multi-Ethnic Study of Atherosclerosis, a longitudinal cohort study (mean age, 62.1 years; 52.7% women) who had near wall and far wall CCA IMT measurements. Multivariate linear regression models were used to estimate model goodness of fit of Framingham risk factors with near wall IMT, far wall IMT, and combined mean IMT. Multivariate Cox proportional hazards models were used to estimate hazard ratios for incident coronary heart disease events for each IMT variable. Change in Harrell's C statistic was used to compare the incremental value of each IMT variable when added to Framingham risk factors. Results Mean IMT had the Strongest Association with risk factors ( R 2 = 0.31), followed by near wall ( R 2 = 0.26) and far wall ( R 2 = 0.22) IMT. Far wall IMT improved the prediction of coronary artery disease events over the Framingham risk factors (change in C statistic, 0.012; 95% CI, 0.006–0.017; P P = .004), but near wall IMT did not. Conclusions Far wall CCA IMT showed the Strongest Association with incident coronary heart disease, whereas mean IMT had the Strongest Associations with risk factors. This difference might affect the selection of appropriate IMT variables in different studies.
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abstract p331 Associations of coronary heart disease with common carotid artery near and far wall intima media thickness imt the multi ethnic study of atherosclerosis
Circulation, 2014Co-Authors: Joseph F Polak, Moyses Szklo, Daniel H OlearyAbstract:Background: Intima-media thickness (IMT) as measured on ultrasound images of the common carotid artery (CCA) is associated with cardiovascular events and used to measure the effects of lipid lowering interventions. Far wall CCA IMT is favored over near wall IMT based on the physics of ultrasound. Materials and Methods: We studied 6606 members of the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort study (mean age 62.1 years; 52.7% female) who had near wall and far wall CCA IMT measurements. Multivariable linear regression models were used to estimate model goodness-of-fit of near wall IMT, far wall IMT, and mean IMT with Framingham risk factors (FRF). Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident coronary heart disease (CHD) events for each IMT variable. Change in Harrell’s C-statistic was used to compare the incremental value of each IMT variable when added to FRF. Results: Mean IMT had the Strongest Association with risk factors (R2 = 0.31), followed by the near wall (R2 = 0.26) and far wall IMT (R2 = 0.22). Far wall IMT improved the prediction of coronary artery disease events (change in C statistic: 0.009; 95% Confidence Intervals: 0.004, 0.015; p= 0.001) as did mean IMT (p=0.033) but near wall IMT did not. Conclusion: Far wall CCA IMT had the Strongest Association with incident CHD whereas combined near wall and far wall IMT had the Strongest Association with risk factors. Selected IMT variables may give different results in intervention trials than in outcome studies.
Alan Garner - One of the best experts on this subject based on the ideXlab platform.
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comparative analysis of multiple casualty incident triage algorithms
Annals of Emergency Medicine, 2001Co-Authors: Alan Garner, Ken Harrison, Carl H. SchultzAbstract:STUDY OBJECTIVE: We sought to retrospectively measure the accuracy of multiple-casualty incident (MCI) triage algorithms and their component physiologic variables in predicting adult patients with critical injury. METHODS: We performed a retrospective review of 1,144 consecutive adult patients transported by ambulance and admitted to 2 trauma centers. Association between first-recorded out-of-hospital physiologic variables and a resource-based definition of severe injury appropriate to the MCI context was determined. The Association between severe injury and Triage Sieve, Simple Triage and Rapid Treatment, modified Simple Triage and Rapid Treatment, and CareFlight Triage was determined in the patient population. RESULTS: Of the physiologic variables, the Motor Component of the Glasgow Coma Scale had the Strongest Association with severe injury, followed by systolic blood pressure. The differences between CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment were not dramatic, with sensitivities of 82% (95% confidence interval [CI] 75% to 88%), 85% (95% CI 78% to 90%), and 84% (95% CI 76% to 89%), respectively, and specificities of 96% (95% CI 94% to 97%), 86% (95% CI 84% to 88%), and 91% (95% CI 89% to 93%), respectively. Both forms of Triage Sieve were significantly poorer predictors of severe injury. CONCLUSION: Of the physiologic variables used in the triage algorithms, the Motor Component of the Glasgow Coma Scale and systolic blood pressure had the Strongest Association with severe injury. CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment had similar sensitivities in predicting critical injury in designated trauma patients, but CareFlight Triage had better specificity. Because patients in a true mass casualty situation may not be completely comparable with designated trauma patients transported to emergency departments in routine circumstances, the best triage instrument in this study may not be the best in an actual MCI. These findings must be validated prospectively before their accuracy can be confirmed.
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comparative analysis of multiple casualty incident triage algorithms
Annals of Emergency Medicine, 2001Co-Authors: Alan Garner, Ken Harrison, Anna Lee, Carl H. SchultzAbstract:Abstract Study Objective: We sought to retrospectively measure the accuracy of multiple-casualty incident (MCI) triage algorithms and their component physiologic variables in predicting adult patients with critical injury. Methods: We performed a retrospective review of 1,144 consecutive adult patients transported by ambulance and admitted to 2 trauma centers. Association between first-recorded out-of-hospital physiologic variables and a resource-based definition of severe injury appropriate to the MCI context was determined. The Association between severe injury and Triage Sieve, Simple Triage and Rapid Treatment, modified Simple Triage and Rapid Treatment, and CareFlight Triage was determined in the patient population. Results: Of the physiologic variables, the Motor Component of the Glasgow Coma Scale had the Strongest Association with severe injury, followed by systolic blood pressure. The differences between CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment were not dramatic, with sensitivities of 82% (95% confidence interval [CI] 75% to 88%), 85% (95% CI 78% to 90%), and 84% (95% CI 76% to 89%), respectively, and specificities of 96% (95% CI 94% to 97%), 86% (95% CI 84% to 88%), and 91% (95% CI 89% to 93%), respectively. Both forms of Triage Sieve were significantly poorer predictors of severe injury. Conclusion: Of the physiologic variables used in the triage algorithms, the Motor Component of the Glasgow Coma Scale and systolic blood pressure had the Strongest Association with severe injury. CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment had similar sensitivities in predicting critical injury in designated trauma patients, but CareFlight Triage had better specificity. Because patients in a true mass casualty situation may not be completely comparable with designated trauma patients transported to emergency departments in routine circumstances, the best triage instrument in this study may not be the best in an actual MCI. These findings must be validated prospectively before their accuracy can be confirmed. [Garner A, Lee A, Harrison K, Schultz CH. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. November 2001;38:541-548.]
Joseph F Polak - One of the best experts on this subject based on the ideXlab platform.
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Associations of coronary heart disease with common carotid artery near and far wall intima media thickness the multi ethnic study of atherosclerosis
Journal of The American Society of Echocardiography, 2015Co-Authors: Joseph F Polak, Moyses Szklo, Daniel H OlearyAbstract:Background Intima-media thickness (IMT) measured on ultrasound images of the common carotid artery (CCA) is associated with cardiovascular risk factors and events. Given the physics of ultrasound, CCA far wall IMT measurements are favored over near wall measurements, but this theoretical advantage is not well studied. Methods A total of 6,606 members of the Multi-Ethnic Study of Atherosclerosis, a longitudinal cohort study (mean age, 62.1 years; 52.7% women) who had near wall and far wall CCA IMT measurements. Multivariate linear regression models were used to estimate model goodness of fit of Framingham risk factors with near wall IMT, far wall IMT, and combined mean IMT. Multivariate Cox proportional hazards models were used to estimate hazard ratios for incident coronary heart disease events for each IMT variable. Change in Harrell's C statistic was used to compare the incremental value of each IMT variable when added to Framingham risk factors. Results Mean IMT had the Strongest Association with risk factors ( R 2 = 0.31), followed by near wall ( R 2 = 0.26) and far wall ( R 2 = 0.22) IMT. Far wall IMT improved the prediction of coronary artery disease events over the Framingham risk factors (change in C statistic, 0.012; 95% CI, 0.006–0.017; P P = .004), but near wall IMT did not. Conclusions Far wall CCA IMT showed the Strongest Association with incident coronary heart disease, whereas mean IMT had the Strongest Associations with risk factors. This difference might affect the selection of appropriate IMT variables in different studies.
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abstract p331 Associations of coronary heart disease with common carotid artery near and far wall intima media thickness imt the multi ethnic study of atherosclerosis
Circulation, 2014Co-Authors: Joseph F Polak, Moyses Szklo, Daniel H OlearyAbstract:Background: Intima-media thickness (IMT) as measured on ultrasound images of the common carotid artery (CCA) is associated with cardiovascular events and used to measure the effects of lipid lowering interventions. Far wall CCA IMT is favored over near wall IMT based on the physics of ultrasound. Materials and Methods: We studied 6606 members of the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort study (mean age 62.1 years; 52.7% female) who had near wall and far wall CCA IMT measurements. Multivariable linear regression models were used to estimate model goodness-of-fit of near wall IMT, far wall IMT, and mean IMT with Framingham risk factors (FRF). Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident coronary heart disease (CHD) events for each IMT variable. Change in Harrell’s C-statistic was used to compare the incremental value of each IMT variable when added to FRF. Results: Mean IMT had the Strongest Association with risk factors (R2 = 0.31), followed by the near wall (R2 = 0.26) and far wall IMT (R2 = 0.22). Far wall IMT improved the prediction of coronary artery disease events (change in C statistic: 0.009; 95% Confidence Intervals: 0.004, 0.015; p= 0.001) as did mean IMT (p=0.033) but near wall IMT did not. Conclusion: Far wall CCA IMT had the Strongest Association with incident CHD whereas combined near wall and far wall IMT had the Strongest Association with risk factors. Selected IMT variables may give different results in intervention trials than in outcome studies.
Anna Lee - One of the best experts on this subject based on the ideXlab platform.
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comparative analysis of multiple casualty incident triage algorithms
Annals of Emergency Medicine, 2001Co-Authors: Alan Garner, Ken Harrison, Anna Lee, Carl H. SchultzAbstract:Abstract Study Objective: We sought to retrospectively measure the accuracy of multiple-casualty incident (MCI) triage algorithms and their component physiologic variables in predicting adult patients with critical injury. Methods: We performed a retrospective review of 1,144 consecutive adult patients transported by ambulance and admitted to 2 trauma centers. Association between first-recorded out-of-hospital physiologic variables and a resource-based definition of severe injury appropriate to the MCI context was determined. The Association between severe injury and Triage Sieve, Simple Triage and Rapid Treatment, modified Simple Triage and Rapid Treatment, and CareFlight Triage was determined in the patient population. Results: Of the physiologic variables, the Motor Component of the Glasgow Coma Scale had the Strongest Association with severe injury, followed by systolic blood pressure. The differences between CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment were not dramatic, with sensitivities of 82% (95% confidence interval [CI] 75% to 88%), 85% (95% CI 78% to 90%), and 84% (95% CI 76% to 89%), respectively, and specificities of 96% (95% CI 94% to 97%), 86% (95% CI 84% to 88%), and 91% (95% CI 89% to 93%), respectively. Both forms of Triage Sieve were significantly poorer predictors of severe injury. Conclusion: Of the physiologic variables used in the triage algorithms, the Motor Component of the Glasgow Coma Scale and systolic blood pressure had the Strongest Association with severe injury. CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment had similar sensitivities in predicting critical injury in designated trauma patients, but CareFlight Triage had better specificity. Because patients in a true mass casualty situation may not be completely comparable with designated trauma patients transported to emergency departments in routine circumstances, the best triage instrument in this study may not be the best in an actual MCI. These findings must be validated prospectively before their accuracy can be confirmed. [Garner A, Lee A, Harrison K, Schultz CH. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. November 2001;38:541-548.]
