The test characteristics of physician clinical gestalt for determining the presence and severity of anaemia in patients seen at the emergency department of a tertiary referral hospital in Tanzania

Sawe, Hendry R.; Mfinanga, Juma A.; Mwafongo, Victor; Reynolds, Teri; Runyon, Michael S.

doi:10.1136/emermed-2015-204908

Cited by 3 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding was in contrast to what was known in the past about physician gestalt. Although physicians in our ED have the ability to accurately diagnose anaemia based on clinical exam as reported by Sawe et al [ 29 ], anaemia was not documented in many of the children in our study. There is a clear need for physicians to take time to properly examine children and look for signs of anaemia even when the primary chief complaint or referral diagnosis is not obviously related to anaemia or the need for blood transfusion.…”

Section: Discussionmentioning

confidence: 68%

Emergency blood transfusion practices among anaemic children presenting to an urban emergency department of a tertiary hospital in Tanzania

et al. 2017

View full text Add to dashboard Cite

BackgroundSevere anaemia contributes significantly to mortality, especially in children under 5 years of age. Timely blood transfusion is known to improve outcomes. We investigated the magnitude of anaemia and emergency blood transfusion practices amongst children under 5 years presenting to the Emergency Department (ED) of Muhimbili National Hospital (MNH) in Tanzania.MethodsThis prospective observational study enrolled children under 5 years old with anaemia, over a 7-week period in August and September of 2015. Anaemia was defined as haemoglobin of <11 g/dL. Demographics, anaemia severity, indications for transfusion, receipt of blood, and door to transfusion time were abstracted from the charts using a standardized data entry form. Anaemia was categorized as severe (Hb <7 g/dL), moderate (Hb 7–9.9 g/dL) or mild (Hb 10–10.9 g/dL).ResultsWe screened 777 children, of whom 426 (55%) had haemoglobin testing. Test results were available for 388/426 (91%), 266 (69%) of whom had anaemia. Complete data were available for 257 anaemic children, including 42% (n = 108) with severe anaemia, 40% (n = 102) with moderate anaemia and 18% (n = 47) with mild anaemia. Forty-nine percent of children with anaemia (n = 125) had indications for blood transfusion, but only 23% (29/125) were transfused in the ED. Among the non-transfused, the provider did not identify anaemia in 42% (n = 40), blood was not ordered in 28% (n = 27), and blood was ordered, but not available in 30% (n = 29). The median time to transfusion was 7.8 (interquartile range: 1.9) hours. Mortality was higher for the children with severe anemia who were not transfused as compared with those with severe anaemia who were transfused (29% vs 10%, p = 0.03).ConclusionThe burden of anaemia is high among children under 5 presenting to EMD-MNH. Less than a quarter of children with indications for transfusion receive it in the EMD, the median time to transfusion is nearly 8 h, and those not transfused have nearly a 3-fold higher mortality. Future quality improvement and research efforts should focus on eliminating barriers to timely blood transfusion.Electronic supplementary materialThe online version of this article (10.1186/s12878-017-0091-y) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 68%

Emergency blood transfusion practices among anaemic children presenting to an urban emergency department of a tertiary hospital in Tanzania

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The 2016 global EM articles selected for full review are listed in Table 4. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Nineteen articles were selected for inclusion, of which 15 (79%) were categorized as emergency care, three (16%) were categorized as development, and one (5%) was categorized as disaster response articles. Eighteen (95%) articles were original research manuscripts and one (5%) was a review article.…”

Section: Resultsmentioning

confidence: 99%

“…In Nigeria, Burnham-Marusich et al 18 used a nested design to conduct two-step screening for sickle cell disease, which due to pain crises and acute infections poses a heavy burden on the emergency care system in sub-Saharan Africa. In another article studying anemia, Sawe et al 26 demonstrated that clinical gestalt was a fair alternative to laboratory testing in diagnosing anemia in resource-limited settings.…”

Section: Plos Onementioning

confidence: 99%

Global Emergency Medicine: A Review of the Literature From 2016

Becker

Hansoti

Bartels

et al. 2017

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peerreviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners.Methods: This year 13,890 articles written in four languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles.Results: A total of 716 articles met our inclusion criteria and underwent full review. Fifty-nine percent were categorized as emergency care in resource-limited settings, 17% as EM development, and 24% as disaster and humanitarian response. Nineteen articles received scores of 18.5 or higher out of a maximum score of 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed Cohen's kappa of 0.441. Conclusions:In 2016, the total number of articles identified by our search continued to increase. The proportion of articles in each of the three categories remained stable. Studies and reviews with a focus on infectious diseases, pediatrics, and the use of ultrasound in resource-limited settings represented the majority of articles selected for final review. identify and consolidate the relevant global EM literature into a format that is readily available to academics and practitioners. [1][2][3][4][5][6][7][8][9][10][11] This year, our panel of reviewers and editors included physicians from Canada, Ethiopia, Ghana, Singapore, and the United States. T he Global EmergencyOur group strives to identify the most relevant practice changing articles, by scouring both the peerreviewed and gray literature via a comprehensive search strategy. Gray literature has been defined as any material produced by an organization whose primary function is not peer-reviewed academic publication. 12Our goal in performing a gray literature search is to identify new global EM research conducted by government agencies, local or international nongovernmental organizations, or other entities that may not have published in peer-reviewed journals.The primary goals of the review are to illustrate best practices, stimulate research, and promote further professionalization in the field of global EM through the identification of important new publications that focus on emergency care in the global context, including care provision in limited-resource settings, disaster and humanitarian response, and the development of EM as a clinical discipline throughout the world. At the same time, it is important to note that this review is not a formal systematic review or meta-analysis, as it does not aim to synthesize th...

show abstract

Modified systemic inflammatory response syndrome and provider gestalt predicting adverse outcomes in children under 5 years presenting to an urban emergency department of a tertiary hospital in Tanzania

et al. 2019

Self Cite

View full text Add to dashboard Cite

BackgroundModified systemic inflammatory response syndrome (mSIRS) criteria for the pediatric population together with the provider gestalt have the potential to predict clinical outcomes. However, this has not been studied in low-income countries. We investigated the ability of mSIRS and provider gestalt to predict mortality and morbidity among children presenting to the ED of a tertiary level hospital in Tanzania.MethodsThis prospective observational study enrolled a convenience sample of children under 5 years old, presenting to the Emergency Medicine Department of Muhimbili National Hospital from September 2015 to April 2016. Trained researchers used a structured case report form to record patient demographics, clinical presentation, initial provider gestalt of severity of illness, and the mSIRS criteria. Primary outcomes were 24-h mortality and overall in-hospital mortality. Data was analyzed using simple descriptive statistics, Kruskal-Wallis, Mann-Whitney U, and chi-squared tests.ResultsWe enrolled 1350 patients, median age 17 months (interquartile range 8–32 months), and 58% were male. Provider gestalt estimates of illness severity were recorded for all patients and 1030 (76.3%) had complete data for mSIRS categorization. Provider gestalt classified 97 (7.2%) patients as healthy, 546 (40.4%) as mildly ill, 457 (33.9%) as moderately ill, and 250 (18.5%) as severely ill. Of the patients, classifiable by mSIRS, 411/1030 (39.9%) had ≥ 2 mSIRS criteria. In predicting 24-h mortality, the ≥ 2 mSIRS and gestalt “severely ill” had sensitivities of 82% and 81%, respectively, and specificity of 61% and 84%, respectively. In predicting overall in-hospital mortality, the ≥ 2 mSIRS and gestalt “severely ill” had sensitivities of 66% and 70% with a specificity of 62% and 86% respectively.ConclusionBoth the mSIRS and provider gestalt were highly specific for predicting 24-h and overall in-hospital mortality in our patient population. The clinical utility of these assessment methods is limited by the low positive predictive value.Electronic supplementary materialThe online version of this article (10.1186/s41182-019-0136-y) contains supplementary material, which is available to authorized users.

show abstract

The test characteristics of physician clinical gestalt for determining the presence and severity of anaemia in patients seen at the emergency department of a tertiary referral hospital in Tanzania

Abstract: Physicians' estimates of the severity of anaemia were significantly concordant with laboratory haemoglobin measurements. Sensitivity of the gestalt estimate for severe anaemia was moderate. Interobserver agreement was 'almost perfect'.

Cited by 3 publications

References 22 publications

Emergency blood transfusion practices among anaemic children presenting to an urban emergency department of a tertiary hospital in Tanzania

Emergency blood transfusion practices among anaemic children presenting to an urban emergency department of a tertiary hospital in Tanzania

Global Emergency Medicine: A Review of the Literature From 2016

Modified systemic inflammatory response syndrome and provider gestalt predicting adverse outcomes in children under 5 years presenting to an urban emergency department of a tertiary hospital in Tanzania

Contact Info

Product

Resources

About