Saraburi Hospital Medical Journal

Comparison of accuracy between Regional 4 Triage System and Emergency severity index and Canadian Triage and Acuity Scale in the emergency department of Saraburi Hospital

2024-05-09T07:05:06+07:00

Saraburi Hospital has been using a triage system called the "Regional 4 Triage System" (R4TS) since 2013. R4TS was adapted from two standard triage systems, the Emergency Severity Index (ESI) and the Canadian Triage and Acuity Scale (CTAS).

The purpose of this study was to investigate the accuracy and prediction of life-saving intervention in level 1 triage of the R4TS compared with the ESI, and the CTAS.

This diagnostic accuracy study took place at Saraburi Hospital, collecting data from patients who visited the Emergency Department in August and September 2021. Index cases (R4TS, CTAS, and ESI) were triaged at the unit and compared to reference triage assessed by two highly experienced emergency physicians. Life-saving interventions at level 1 triage were also collected and analyzed.

The study enrolled 200 participants. R4TS exhibited the highest overall validity at 69.00%, followed by ESI at 65.00%, and CTAS at 63.00%. In level 1, R4TS, ESI and CTAS had good validity above 70%. R4TS had the highest validity in levels 2-4, while CTAS was highest at level 1. The diagnostic odds ratio for R4TS was 408.50 (95% CI: 48.44-3,444.95) at level 1 and 31.96 (95% CI: 13.81-73.96) at level 2. R4TS showed the highest sensitivity, specificity, positive predictive value, and positive likelihood ratio at level 1 (70.37%, 99.42%, 95.00%, and 121.74%, respectively). Life-saving intervention prediction was consistent across all three systems (AUC = 0.7962; 95% CI 0.7324-0.8487).

R4TS demonstrates validity and accuracy similar to standard triage systems (ESI and CTAS). It excels, particularly in level 1-2 triage, and exhibits a strong predictive capability for life-saving interventions.

ศึกษาความสัมพันธ์ระหว่างดัชนีการสร้างเรติคิวโลไซต์กับภาวะพร่องเอนไซม์ G-6- PD ในทารกแรกเกิด โรงพยาบาลสระบุรี

2024-07-08T10:01:36+07:00

Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is a common hereditary enzymatic disorder in red blood cells, characterized by a significantly high prevalence in Thailand. This condition often leads to a pronounced increase in enzyme deficiency and is a contributing factor to neonatal jaundice. In severe cases, it can result in neonatal jaundice-associated brain damage and acute hemolysis due to rapid red blood cell breakdown. The main objective of this study was to investigate the correlation between the reticulocyte production index (RPI) and G-6-PD deficiency. Additionally, the study aimed to assess the occurrence of G-6-PD deficiency among newborns at Saraburi Hospital.The study involved analyzing G-6-PD enzyme levels using the careSTART G6PD Biosensor Analyzer on blood samples from 295 newborns. These samples were collected for analysis at the hospital's hematology and clinical chemistry laboratories. The results indicated that there was no statistically significant difference in RPI between the G-6-PD deficient group and the G-6-PD normal group (p-value < 0.05). Similarly, the study found significant differences in Hemoglobin (Hb) and Hematocrit (Hct) levels (p-value < 0.05).The prevalence of G-6-PD deficiency was found to be 15.25% in males, 77.78% in females among the deficient group, while the normal group exhibited 84.75% in males and 47.60% in females. The analysis of Hemoglobin, Hematocrit, and RPI values (expressed as Mean, Standard Deviation, and Min-Max) for both groups showed that RPI values greater than 3% in the G-6-PD deficient group indicated compensatory reticulocyte production to replace lost red blood cells. Furthermore, the male-to-female ratio within the G-6-PD deficient group was found to be 3.5 to 1.

The Relationship Between High Blood Pressure and the Occurrence of Aortic Aneurysm Rupture; Case control study in Saraburi hospital.

2024-05-08T14:26:29+07:00

Introduction Aortic dissection is a medical emergency condition with a high mortality rate if left untreated. Among patients with aortic dissection, a major risk factor is high blood pressure, which can be managed. By controlling high blood pressure, the incidence of aortic dissection can be reduced.
Objectives The research conducted at Saraburi Hospital aims to study the correlation between high blood pressure levels and the occurrence of aortic dissection when compared to individuals with hypertension possessing similar baseline characteristics.
Method A matched case-control study was conducted to investigate patients admitted to Saraburi Hospital’s emergency room due to aortic dissection between January 2011 and December 2020. The research compared blood pressure data among hypertensive patients in Saraburi Hospital’s hypertension clinic during the same period. These patients were paired with a control group based on baseline characteristics, such as gender, age range, blood pressure records from 5 years before aortic dissection diagnosis, smoking habit, diabetes, hyperlipidemia, stroke, coronary heart disease, and regular medications.
Result In total, 175 patients participated in the study, divided into two groups: 35 patients with aortic dissection and 140 individuals in the control group. The findings revealed that the blood pressure levels of the aortic dissection group on the day of diagnosis were significantly higher than those of the control group [Adjusted odds ratio (AOR): 1.04, 95% CI: 1.01-1.08, p-value < 0.010]. When comparing blood pressure levels on the day of diagnosis between the case group and the control group, it was statistically significant that the case group had a significantly higher diagnosis of hypertensive emergencies than the control group. [Odd ratio (OR): 49.16, 95%CI: 6.95-347.18, p-value < 0.010])
Conclusion Management of elevated blood pressure levels and hypertensive emergencies, particularly the reduction of systolic blood pressure, can help reduce the occurrence of aortic dissection at the Saraburi hospital.
Keywords Aortic dissection, Hypertension, Controlling high blood pressure, Blood pressure category, Hypertensive crisis

A study of entrance surface dose and radiation dose from digital chest x-ray, Saraburi Hospital

2024-06-11T15:02:43+07:00

Despite the relatively low exposure of patients to chest radiography, cumulative radiation doses directly affect bodily changes. In the Radiology Unit of Saraburi Hospital, there has been no previous assessment of the entrance surface dose (ESD) from radiography. This study aims to optimize patient care by raising staff awareness of proper radiation usage and reducing radiation risk in clinical diagnosis through an examination of ESD, exposure index (EI), and their association with various parameters of chest radiography. Data collected from chest radiography include sex, age, and chest thickness. Analysis was conducted on the ESD and EI of 200 patients who received services in X-ray Room 1 on business days from March 1 to June 30, 2024. The results indicate that the ESD of PA upright chest X-ray examinations meets standard criteria, with an average of 0.10 mGy (S.D. = 0.04) and a third quartile of 0.22 mGy. Most radiographs (99%) fall within an EI range of 200 < EI < 400, demonstrating an acceptable patient dose. The primary parameters correlated with and regressed on ESD are mAs (milliampere-seconds), chest thickness, and body weight (r = 0.965, 0.847, and 0.799 respectively, p-value < 0.001). ESD increases when mAs, chest thickness, and body weight also increase. The following prediction equation was derived: Y’ = -0.029 + 0.045x + 0.002t.