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INTRODUCTION For people living with human immunodeficiency virus (PLHIV) on antiretroviral therapy (ART), viral load (VL) testing is the gold standard approach to timely monitor treatment effectiveness, identify virological failure [...], : Introduction: Antiretroviral therapy (ART) monitoring using viral load (VL) testing is challenging in high‐burden, limited‐resources settings. Chemokine IP‐10 (interferon gamma‐induced protein 10) strongly correlates with human immunodeficiency virus (HIV) VL. Its determination could serve to predict virological failure (VF) and to triage patients requiring VL testing. We assessed the field performance of a semi‐quantitative IP‐10 lateral flow assay (LFA) for VF screening in South Africa, and the cost‐effectiveness of its implementation in Mozambique. Methods: A cross‐sectional study was conducted between June and December 2021 in three primary health clinics in the Western Cape. Finger prick capillary blood was collected from adults on ART for ≥1 year for direct application onto the IP‐10 LFA (index test) and compared with a plasma VL result ≤1 month prior (reference test). We estimated the area under the receiver operating characteristic curves (AUC), sensitivity and specificity, to evaluate IP‐10 LFA prediction of VF (VL>1000 copies/ml). A decision tree model was used to investigate the cost‐effectiveness of integrating IP‐10 LFA combined with VL testing into the current Mozambican ART monitoring strategy. Averted disability‐adjusted life years (DALYs) and HIV acquisitions, and incremental cost‐effectiveness ratios were estimated. Results: Among 209 participants (median age 38 years and 84% female), 18% had VF. Median IP‐10 LFA values were higher among individuals with VF compared to those without (24.0 vs. 14.6; p Conclusions: The IP‐10 LFA is an effective VF triage test for routine ART monitoring. Combining a highly sensitive, low‐cost IP‐10 LFA‐based screening with targeted VL confirmatory testing could result in significant healthcare quality improvements and cost savings in settings with limited access to VL testing.

ABBREVIATIONS. ED, emergency department; PEM, pediatric emergency medicine; GEM, general emergency medicine; CI, confidence interval. Because the priority of care often is based on triage categorization, consistent and appropriate triage [...], Objective. To compare triage categorization as a measure of perceived patient acuity on presentation to the emergency department by pediatric emergency medicine (PEM) attending physicians, nurses, and pediatric residents with their general emergency medicine (GEM) counterparts. Methods. A questionnaire that contained 12 pediatric triage scenarios was sent to all PEM attending physicians, triage-trained nurses, and pediatric residents and their GEM counterparts at a large urban hospital with separate pediatric and general emergency departments. Participants were asked to use a 3-tier triage system (emergent, urgent, nonurgent) to assign a triage level for each patient scenario. Results. The response rate was 99%. The κ level of agreement was highest (.39) among the PEM physicians. Significantly more GEM attending physicians triaged the following scenarios at a higher acuity level as compared with PEM attending physicians with a trend toward emergent triage: simple febrile seizure, 50% (95% confidence interval [CI]: 30%-70%) versus 7.7% (95% CI: 1%-34%); 18-month-old with fever and bumps on lips, 21% (95% CI: 9%-43%) versus 0% (95% CI: 0%-23%); and 15-month-old well-appearing child with high fever, 50% (95% CI: 30%-70%) versus 7.7% (95% CI: 1%-34%). Significant differences were found between GEM and PEM triage-trained nurses only in the 15-month-old high fever scenario and between GEM and pediatric residents in the 15-month-old high fever scenario, the 18-month-old with fever and bumps on lips scenario, and a fever/limp scenario. Conclusions. The level of agreement of triage assignment within each group was only fair. GEM participants and PEM participants agreed on most scenarios. However, GEM participants were more likely to triage children with certain febrile illnesses at higher acuity levels as compared with their PEM counterparts. Pediatrics 2004;114:356-360; emergency, triage, fever, child.

ABSTRACT. Objective. Despite intense interest in allocation of resources to neonatal intensive care, no description exists of resource use by the large numbers of newborns admitted for triage, the process [...]

Beginning thrombolytic therapy for heart attacks before hospital admission did not significantly improve patients' chances for survival or reduce complications. However, treatment begun within 70 minutes of the onset of symptoms reduced the number of complications and lessened the impact of the attack. Thrombolytic therapy is used to dissolve blood clots or prevent them from forming. A total of 360 patients who called paramedics and were suspected of having a heart attack were randomly assigned to one of two groups. One group received aspirin and thrombolytic therapy before arriving at the hospital; the other group did not. Patients who received treatment before arriving at the hospital began treatment 33 minutes earlier than the other patients. Measurements of the outcome of the two treatment strategies did not differ between the two groups., Objective.--To determine the effect of prehospital-initiated vs hospital-initiated treatment of myocardial infarction on clinical outcome. Design.--Randomized, controlled clinical trial. Setting.--Multicenter study involving 19 hospitals and all paramedic systems in the Seattle, Wash, metropolitan area. Patients.--A total of 360 patients with symptoms for 6 hours or less, no risk factors for serious bleeding, and ST-segment elevation were selected by paramedics and a remote physician for inclusion into the trial. They represented 4% of patients with chest pain who were screened and 21% of those with acute infarction. Interventions.--Patients were allocated to have aspirin and alteplase treatment initiated before or after hospital arrival. Intravenous sodium heparin was administered to both groups in the hospital. Main Outcome Measure.--The primary endpoint was a ranked composite score (combining death, stroke, serious bleeding, and infarct size). The relation between time to treatment and outcome (composite score, infarct size, ejection fraction, and mortality) was also assessed. Results.--Initiating treatment before hospital arrival decreased the interval from symptom onset to treatment from 110 to 77 minutes (P

Trauma is a leading cause of death in children and, compared with adult trauma, has different aspects that must be considered. The Pediatric Trauma Score (PTS), a new method of assessing the level of trauma in children is presented. Although there is no established comprehensive method for evaluating the PTS, it was compared against other established diagnostic systems for triaging pediatric trauma victims. This study retrospectively evaluates the cases of 376 children who ranged in age from newborn to 14 years. The Pediatric Trauma Score was found to have no particular advantage when compared to other methods, was found to be less accurate, and required learning a separate scoring system. Its use can not be recommended over other systems of grading trauma and triaging pediatric patients, such as the Revised Trauma Score.

This review discusses the emerging trend in the management of abdominal trauma and the choice treatment options. Recent and upcoming advances in research and technology development indicate that there is a shift from operative to selective nonoperative mode of treatment and management of blunt or penetrating abdominal trauma. It is safe and cost-effective.

ABBREVIATIONS. SP, suburban practice; FTE, full-time equivalents; UP, urban practice; RA, research assistant. Telephone triage is an important component of pediatric practice and has traditionally been divided into daytime and [...], Objective. To compare daytime nurse telephone triage calls received by a suburban practice with those received by a hospital-based, inner-city pediatric practice. Methods. A research assistant, listening simultaneously with triage personnel, prospectively coded all calls received by the nurse triage telephone offices in 2 pediatric practices. Calls were coded the first full, non-holiday week of 3 consecutive summer and 3 consecutive winter months, alternating morning and afternoon sessions. One practice was suburban and had almost all commercially insured patients; the other was hospital-based, in an inner-city, and consisted mostly of patients with Medicaid coverage or no health insurance. Results. A total of 901 calls were triaged in the suburban practice (SP) and 768 in the urban practice (UP). The chief complaints of calls regarding medical problems were similar at both sites. Difficulties with language were noted less often in SP compared with UP (1% vs 17%). The reason for the calls differed by site: medical problem relating to illness or injury (SP 55% vs UP 40%); social issue (SP 1% vs UP 9%); documentation request (SP 2% vs UP 7%); request for laboratory work (SP .3% vs UP 4%); and well child advice (SP 9% vs UP 5%). The disposition of calls also differed by site: telephone advice was offered significantly more in SP than in UP (32% vs 20%); fewer calls required the need for the medical record in SP than in UP (2% vs 12%). Conclusions. Calls received by a daytime nurse telephone triage office in an affluent SP and a UP are similar in regard to medical problems. Training programs can feasibly prepare physicians and nurses for both kinds of practice settings. The urban site received more calls affected by language and social issues. This could have administrative implications for staffing ratios, language skills of staff and knowledge of available support services. Pediatrics 2000;106:231-233; telephone, telephone triage.

ABBREVIATIONS. PTAS, Pediatric Triage and Advice System; AHR, after-hours referral; SLP, second-level physician. In recent years there has been dramatic growth in centralized call centers to manage after-hours calls from [...], Objectives. One-third of practices signing-out to The Children's Hospital Call Center in Denver, Colorado, choose to do second-level physician (SLP) triage for calls judged by the Center to require after-hours referral (AHR). We examined: 1) the effect of SLP triage on the rate of AHRs and 2) reasons for physicians' decisions. Design. From January 1998 to August 1998 all calls from patients using a 5-member suburban pediatric practice judged by the Call Center to require AHR were referred to the practice's on-call physician who did SLP triage and completed a questionnaire. Results. There were 955 eligible calls, 22% (N = 216) of which were initially given an urgent disposition by Call Center nurses. Physician questionnaires were completed for 97% (N = 209). Of patients initially triaged for AHR, 49% (N = 103) were subsequently given an AHR, 17% (N = 35) a next day office referral, and 34% (N = 71) home care and advice. Reasons for not urgently referring included the following: 1) medical problem didn't require urgent evaluation (95%, N = 99); 2) change in the patient's condition; (40% N = 43); 3) prior knowledge of family's ability to evaluate and care for the patient (40%, N = 43); and 4) knowledge of the patient's medical history (18%, N = 19). After SLP triage the overall urgent referral rate was 11%. Conclusions. Signing out to a Call Center decreased physicians' after-hours calls by 77% and SLP triage halved the number of urgent after-hours referrals. Pediatrics 2000;106:226-230; telephone triage, telephone medicine, call centers

Background. Despite the rapid growth of centralized call centers to provide after-hours triage to patients of multiple providers, little is known about the perceptions of parents regarding this type of care and their compliance with triage disposition recommendations. Design/Methods. From August through September 1999, randomized samples of after-hours calls were selected each day from computerized records at 4 pediatric call centers at 1) Children's Hospital, Denver, Colorado; 2) Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 3) Rainbow Babies and Children's Hospital, Cleveland, Ohio; and 4) All Children's Hospital, St Petersburg, Florida. All participating call centers use the same triage software. Calls were randomly selected to yield at least 250 callers with nonurgent dispositions and 100 with urgent dispositions from each site. Telephone surveys to callers were conducted by an external survey unit 3 to 7 days after the call to the call center. Results. Surveys were completed for 70.5% of those sampled (N = 1561). Parents indicated they were very satisfied or satisfied with aspects of care received from 92.6% (waiting time) to 99.4% (nurse courteousness) of the time. Satisfaction did not differ by site or by recommended disposition of the index call. Most parents (65.2%) reported no preference about speaking with a physician or nonphysician for after-hours care, whereas 27.7% preferred to speak with a physician. Usually speaking with a physician during office hours (odds ratio [OR]: 1.48), feeling it was important that provider knows child's medical history (OR: 3.47), and respondent having an educational level of college graduate or higher (OR: 1.30) were significant predictors of preferring to speak with a physician. Of the 37.0% (N = 723) of parents who reported any change in their relationship with their primary provider as a result of the after-hours call center, 95.7% (N = 691) assessed the change to be positive. Reported compliance with the call center disposition recommendation was 83.3% for urgent referral, 41.0% for next day, 4.5% for visit at a later time, and 78.2% for home care. The major reason given by parents for noncompliance was reporting that they heard a different disposition (76.9% for urgent to 100% for visit at a later time). Conclusions. Parental satisfaction with pediatric call centers was uniformly high in 4 different geographic locations, and almost all parents who reported any effect on their relationship with their primary provider assessed it as positive. Compliance with recommendations for urgent evaluation or home care was relatively high but for intermediary dispositions was low. In most cases in which noncompliance occurred, parents reported hearing a different disposition. Additional study is needed to clarify whether noncompliance, especially in cases in which an urgent recommendations was made, is attributable to poor nurse communication of the recommended disposition, parental misinterpretation, or parental difference of opinion. Pediatrics 2001;108(6). URL: http:// www.pediatrics.org/cgi/content/full/108/6/e111; telephone medicine, telephone triage, call center, health care delivery.

The staff of hospital emergency departments (EDs) needs to develop effective triage criteria to determine which of the 96 million people who go to EDs in the US each year need to be hospitalized or can be released with minimal treatment. Triage is a way of determining who needs immediate treatment, who can wait and who needs minimal treatment. A 1996 study found that 5% of ED patients assessed as having nonurgent problems were eventually admitted to the hospital. Other researchers have found it hard to properly classify patients using some triage criteria.