Public Health Disasters

Afolabi, Michael

doi:10.1007/978-3-319-92765-7_1

Cited by 4 publications

(3 citation statements)

References 66 publications

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“…In a health disaster like this pandemic [30], conceptually, the healthcare provider's efforts should be directed to those with the better chance to survive [31], especially in low resource settings or countries where infrastructure is poor and access to respiratory equipment and supplies like HFNC and NIV was very difficult. As far as we have searched the literature there are few publications about the value of the RI to predict mortality or mechanical ventilation in COVID-19 patients [32,33].…”

Section: Discussionmentioning

confidence: 99%

Rox Index Variation as Predictor of Outcomes in COVID-19 Patients. Calderón Hospital Quito

Maldonado,

Endara,

Carrión

et al. 2024

Preprint

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Background: During the pandemic, Emergency departments were overcrowded with critically ill patients and confronted ethical dilemmas to assign respiratory support to them due to scarce resources. Quick tools to evaluate patients at admission were needed; many scores were used but inaccurate to predict outcomes. The Rox Index is an easy and fast score that reflects the respiratory status in acute respiratory failure patients, this score could predict the outcome of covid 19 patients. Hypothesis: The 24-hour difference in the Rox Index discriminate accurately the mortality and needs for mechanical ventilation of patients with covid-19. Methods: Study design: Prospective analytic study. Population: 204 Patients admitted to the emergency department from May to August 2020. Data were collected from the clinical records. The Rox Index was calculated at admission and 24h later, the difference was used to establish the outcome, a logistic regression model adjusting for age, sex, presence of comorbidities and disease severity to build and perform ROC analysis. Results: Difference in respiratory ROX Index between admission and 24h is a good predictor for death AUC 0.92 and for mechanic ventilation AUC: 0.75. Each decrease in one unit of the difference at 24h had an Odds Ratio for death risk: 1.48 (95%CI: 1.31-1.67) and for mechanic ventilation: 1.16 (95%IC: 1.1-1.23). Conclusion: The 24-hour variation of Rox Index has good predictive value and allows healthcare professionals to identify which patients will benefit from invasive treatment, especially in low resource settings where emergency physicians deal with survival.

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Section: Discussionmentioning

confidence: 99%

Rox Index Variation as Predictor of Outcomes in COVID-19 Patients. Calderón Hospital Quito

Maldonado,

Endara,

Carrión

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…In a health disaster like the COVID-19 pandemic [ 21 ], conceptually, the healthcare provider’s efforts should be directed to those with the better chance of survival [ 22 ], especially in low-resource settings or countries where infrastructure is poor and access to respiratory equipment and supplies like HFNC and non-invasive ventilation was limited. As far as we have searched the literature, there are some publications about the value of the RI in predicting mortality or mechanical ventilation in COVID-19 patients [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

ROX Index Variation as a Predictor of Outcomes in COVID-19 Patients

Maldonado,

Endara,

Abril

et al. 2024

JCM

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Background: During the COVID-19 pandemic, emergency departments were overcrowded with critically ill patients, and many providers were confronted with ethical dilemmas in assigning respiratory support to them due to scarce resources. Quick tools for evaluating patients upon admission were necessary, as many existing scores proved inaccurate in predicting outcomes. The ROX Index (RI), a rapid and straightforward scoring system reflecting respiratory status in acute respiratory failure patients, has shown promise in predicting outcomes for COVID-19 patients. The 24 h difference in the RI accurately gauges mortality and the need for invasive mechanical ventilation (IMV) among patients with COVID-19. Methods: Study design: Prospective cohort study. A total of 204 patients were admitted to the emergency department from May to August 2020. Data were collected from the clinical records. The RI was calculated at admission and 24 h later, and the difference was used to predict the association with mortality and the need for IMV, a logistic regression model was used to adjust for age, sex, presence of comorbidities, and disease severity. Finally, the data were analyzed using ROC. Results: The difference in respiratory RI between admission and 24 h is a good predictor for death (AUC 0.92) and for mechanic ventilation (AUC: 0.75). Each one-unit decrease in the RI difference at 24 h was associated with an odds ratio of 1.48 for the risk of death (95%CI: 1.31–1.67) and an odds ratio of 1.16 for IMV (95% IC: 1.1–1.23). Conclusions: The 24 h variation of RI is a good prediction tool to allow healthcare professionals to identify the patients who will benefit from invasive treatment, especially in low-resource settings.

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“…Ethical inquiries in prehospital triage include issues of human rights, vulnerability, limited resources and options, justice, insecurity, urgency, instability, and decision-making in limited time. Due to these complexities, ethical approaches to decision-making during triage have generally been speculative, tentative and lacking, and remain an ongoing area of research [29]. However, triage is difficult to justify in terms of ethics on a daily basis in medicine.…”

Section: Ethical Considerations In Prehospital Triagementioning

confidence: 99%

Herding cats: ethics in prehospital triage

2021

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Objective: Triage can create an ethical slippery slope when providing prehospital emergency health care. In triage decisions, emergency management is like the idiom of “herding cats”, which refers to managing or controlling the chaos and organizing people toward common goals. The purpose of this literature review is to explore the ethical framework of prehospital triage and to provide a critical view of the subject. Methods: Published materials related to “triage”, “ethics”, and “prehospital emergency medicine” were extracted from online databases and books from 1985 until February 2021. The papers were handled in seven themes including the historical basis, the importance of the triage, ethical considerations in prehospital triage, justice, assessment and decision-making, the variability of triage assessment criteria, and the reliability of triage decisions. Except for the historical basis and the importance of triage, the other five groups were discussed with an ethical critique of the content. The methodology in this article is based on a critical interpretation of discussions on triage through ethical approaches. Results: There are three basic ethical approaches to triage: utilitarianism, beneficence, and justice. Due to the historical military basis of triage, results-focused approaches have become more prominent. Ethical values in prehospital triage include the issues of human rights, moral rights, social justice, and beneficence. Ethical difficulties in triage decision-making involve vulnerability, limited resources, the concern of safety, the urgency of the situation, and instability. Triage decisions may be affected by subjective approaches such as the personal values and beliefs of the decision-makers. Conclusions: Three predominant ethical concepts in triage are utilitarianism, beneficence, and justice. The unique dynamics of the field influence triage decision-making in a variety of ways. The way triage is structured makes it more amenable to subjective influences. Considering the differences in prehospital triage models and approaches, there is an important need for an ethical framework that expresses clear values and principles that will guide prehospital emergency caregivers. In this paper, it is suggested that an ethical framework should include the following six headings: basic bioethical principles, distributing scarce resources, decision-making process, community support, assessment criteria, and promote the common good.

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Public Health Disasters

Cited by 4 publications

References 66 publications

Rox Index Variation as Predictor of Outcomes in COVID-19 Patients. Calderón Hospital Quito

Rox Index Variation as Predictor of Outcomes in COVID-19 Patients. Calderón Hospital Quito

ROX Index Variation as a Predictor of Outcomes in COVID-19 Patients

Herding cats: ethics in prehospital triage

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