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Immediate Care Dmg Download
UCLA Health is among the most comprehensive and advanced health care systems in the world. Our mission is to provide state-of-the-art patient care, generate research discoveries leading to new treatments and diagnoses, and train future generations of health care professionals. Together, the UCLA Hospital System and the David Geffen School of Medicine at UCLA strive every day to be a leader in setting the standards of excellence.
UCLA Health hospitals consistently rank among the best, including top 5 in the most recent annual assessment by U.S. News & World Report. For 33 consecutive years, we have earned a spot on the national honor roll of 20 hospitals providing the highest-quality care across multiple areas.
Mortality in paediatric emergency care units in Africa often occurs within the first 24 h of admission and remains high. Alongside effective triage systems, a practical clinical bedside risk score to identify those at greatest risk could contribute to reducing mortality.
Eight clinical prognostic factors that could be rapidly assessed by healthcare staff for triage were combined to create the FEAST Paediatric Emergency Triage (PET) score and externally validated. The score discriminated those at highest risk of fatal outcome at the point of hospital admission and compared well to other published risk scores. Further laboratory tests were also identified as prognostic factors which could be added if resources were available or as indices of severity for comparison between centres in future research studies.
We identified prognostic factors for mortality in febrile children with signs of shock admitted to emergency care wards in East Africa and enrolled into the FEAST (Fluid Expansion as Supportive Therapy) trial, and used them to develop a bedside risk score for mortality. This score was then validated using data on children admitted to a rural district hospital in Kilifi, Kenya, and its performance compared to other published risk scores.
The FEAST PET score was applied to the two validation datasets using the non-parametric area under the receiver operating curve (AUROC) to measure discriminative ability. Mortality was defined as death within 2 days of admission as time of death was not available in the two validation datasets. The FEAST data and two validation datasets were also used to validate other previously published scores. To validate the PEDIA score, immediate death (death within 4 h after admission, and calculated exactly in FEAST) was interpreted as death on the same day as admission, early death (death between 4 and 48 h) was interpreted as death within 2 calendar days of admission but not the same day, and late death (>48 h) as death occurring more than 2 days after admission. Calibration was measured by Hosmer-Lemeshow goodness-of-fit χ2 tests evaluated on groups defined by quintiles . PRISM III, Bedside PEWS, AQUAMAT, and PEDIA scores were calculated using the available admission variables and unavailable variables in the scores were set to 0 (as recommended). Assessments at later time points were not available to use for PRISM III, although this score recommends using the worst clinical measurement in the first 24 h [13, 27].
Herein, we have developed and externally validated a bedside clinical risk score for severely ill children presenting to emergency care wards in resource-limited settings in Africa that identifies those at greatest risk of mortality within 48 h of admission. The FEAST PET score is straightforward to use, includes only clinical variables that are measured at the bedside, does not rely on laboratory tests, and is not limited to children with specific diagnoses, but rather covers different presentation syndromes reflecting the population of children presenting to hospital in these settings.
Advantages of using the FEAST dataset to develop a clinical bedside score are its large size, multi-centred and multi-disease nature with substantial subgroups with severe malaria and sepsis, and its high quality as it was collected during a randomised controlled trial [50, 51] with few missing data for bedside measures. The pragmatic nature of the trial design enabled it to be carried out in centres without a history of research and without many interventions at a site level. The standard-of-care for trial participants was thus very similar to the standard-of-care on the wards, but with increased monitoring by nurses over the first 48 h of admission. One important limitation is that, despite it being a useful prognostic factor in other studies , we were not able to consider mid-upper arm circumference in any analysis due to differences in data completeness between survivors and non-survivors (violating the missing at random assumption needed for multiple imputation), probably due to mid-upper arm circumference being of low priority to complete immediately upon admission.
Although it would benefit from external validation in a multi-centre African population outside of the FEAST trial centres before implementation, there are several ways that the FEAST PET score could be used. One would be as an inclusion criterion for clinical trials, or to stratify children into groups or perform risk-adjusted comparisons of emergency care. For research studies recording laboratory data, the FEAST PETaL score could be used for inter-site or inter-centre comparisons. However, potentially the most valuable use of this standardised, validated score is to support the implementation of triage in resource-limited routine care settings, thereby facilitating rapid prioritisation of care, or closer monitoring, for the sickest children and hence improved outcomes. Improved triage has been shown to reduce mortality in these settings  and the FEAST PET score would work across specific syndromes and specific diseases to identify those that need prioritisation of any supportive therapies available. It would also help ensure consistent comparisons between patients by clinicians, compared to simple clinical opinion, and encourage better examination of clinical signs by all staff. Having a score that is simple to implement and uses commonly measured clinical signs could increase the number of hospitals in resource-limited settings that successfully implement the triage process.
The FEAST trial was supported by a grant (G0801439) from the Medical Research Council, United Kingdom provided through the (MRC) DFID concordat. Baxter Healthcare donated the resuscitation fluids. The funders (Medical Research Council) and Baxter Healthcare Sciences had no role in the design of this study, data collection and analysis, decision to publish, or preparation of the manuscript. We thank the FEAST trial management group, the investigators at all sites, and all members of the trial steering, monitoring and review committees. Particular thanks are due to the children and families who participated in the FEAST trial.
Nationally, we are seeing urgent care patients wait an average of 15-30 minutes before being seen by a healthcare provider, which would likely be the case at DMH Express Care North. As part of the DMH Express Care group, they have a sister facility in Decatur 2.3 miles away that you may want to consider if the wait gets too long.
The vaccine will not cause you to test positive on viral tests for COVID-19, such as PCR tests or antigen tests. If you receive a positive viral test for COVID-19 after receiving the shot, follow your health care provider's guidance for isolating and additional testing.
Side effects may include injection site pain similar to a tetanus shot. Some recipients have reported one or two days of fatigue, muscle pain and flu-like symptoms. Most people can manage side effects with ibuprofen or acetaminophen. If you cannot manage the side effects with these medications, or you want to speak with a health care provider, we suggest that you contact your primary care physician. You can also schedule a virtual urgent care visit to speak with a doctor from the comfort of home.
Adverse reactions to the vaccine have been very rare. If you received the vaccine within the last 3 to 4 weeks and develop any of the following symptoms, you should contact your health care provider and seek immediate medical treatment.
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