Triaje por enfermería en el ictus agudo

Autores/as

DOI: https://doi.org/10.6018/eglobal.465261
Palabras clave: Ictus, triaje, presentación cardinal, enfermería.

Resumen

En las ultimas décadas, el papel de la enfermería en el triaje y cribado de pacientes en los servicios de urgencias y emergencias, tanto en el entorno prehospitalario como sobre todo en los hospitales, es esencial e indiscutible. Con el objetivo de analizar el triaje realizado por enfermería para detectar los pacientes con ictus agudo, y llegado el caso mejorarlo, se ha realizado un estudio retrospectivo de las presentaciones cardinales del ictus, la escala del Instituto Nacional de la Salud de Estados Unidos, y la escala modificada de Rankin, aplicadas en el set del triaje por enfermería en el Hospital Universitario de Salamanca, durante el período comprendido entre los años 2016 y 2019, ambos inclusive. El total de historias clínicas analizadas ha sido de 1572. El análisis está centrado en la fiabilidad, evaluado por enfermería, de la presentación cardinal del ictus agudo, y de las dos escalas, frente a los algoritmos tradicionales rápidos de detección del ictus, en particular el método FAST, y la escala de Cincinnati. Nuestro estudio demuestra que son varias las presentaciones clínicas que escapan a las escalas rápidas, por lo que es esencial ampliar los métodos de triaje del ictus agudo realizados por enfermería, con el fin de evitar retardos en la detección y el tratamiento definitivo (enfermedad tiempo-dependiente). Así pues, la identificación ampliada de las presentaciónes cardinales, junto con el uso de escalas más detalladas aplicadas por enfermería entrenada, se muestran como herramientas muy útiles de detección del ictus agudo.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

Wolf LA, Delao AM, Perhats C, Moon MD, Zavotsky KE. Triaging the Emergency Department, Not the Patient: United States Emergency Nurses’ Experience of the Triage Process. J Emerg Nurs. 2018; 44(3): 258-66. DOI: 10.1016/j.jen.2017.06.010.

Bazyar J, Farrokhi M, Salari A, Khankeh HR. The principles of triage in emergencies and disasters: a systematic review. Prehosp Disaster Med. 2020; 35(3): 305-313. DOI: 10.1017/S1049023X20000291.

P. Funderburke, P. Exploring best practice for triage. J Emerg Nurs. 2008; 34(2): 180-182. DOI: 10.1016/j.jen.2007.11.013.

Haghigh S, Ashrafizadeh H, Mojaddami F, Kord B. A survey on knowledge level of the nurses about hospital Triage. J Nurs Educ. 2017; 5 (6): 46‑52. DOI: 10.21859/jne-05067.

Magnusson C, Herlitz J, Axelsson C. Affiliations expand Pre-hospital triage performance and emergency medical services nurse's field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study. Scand J Trauma Resusc Emerg Med. 2020; 28(1): 81. DOI: 10.1186/s13049-020-00766-1.

Reisi Z, Saberipour B, Adienh M, Hemmatipour A, Shahvali E.A. The level of awareness of the emergency department nurses of the triage principles in teaching hospitals. J of Nurs Mid Sci. 2018; 5 (1): 32-37. DOI: 10.4103/JNMS.JNMS_5_18

William J. Powers, Alejandro A. Rabinstein, Teri Ackerson, Opeolu M. Adeoye, Nicholas C. Bambakidis, Kyra Becker, José Biller, Michael Brown, Bart M. Demaerschalk, Brian Hoh, Edward C. Jauch, Chelsea S. Kidwell, Thabele M. Leslie-Mazwi, Bruce Ovbiagele, Phillip A. Scott, Kevin N. Sheth, Andrew M. Southerland, Deborah V. Summers, and David L. Tirschwell and on behalf of the American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018; 49: e46–e99. DOI: 10.1161/STR.0000000000000158.

Ekundayo OJ, Saver JL, Fonarow GC, Schwamm LH, Xian Y, Zhao X, Hernandez AF, Peterson ED, Cheng EM. Patterns of emergency medical services use and its association with timely stroke treatment: findings from Get With The Guidelines–Stroke. Circ Cardiovasc Qual Outcomes. 2013; 6: 262–269. DOI: 10.1161/CIRCOUTCOMES.113.000089.

BE-FAST (Balance, Eyes, Face, Arm, Speech, Time) Reducing the Proportion of Strokes Missed Using the FAST Mnemonic Aroor SS, Singh R, Goldstein LB, Stroke. 2017; 48: 479-481. DOI: 10.1161/STROKEAHA.116.015169.

Rudd M, Buck D, Ford GA, Price CI. A systematic review of stroke recognition instruments in hospital and prehospital settings. Emerg Med J, 2016; 33(11): 818-822. DOI: 10.1136/emermed-2015-205197.

Schlemm E, Ebinger M, Nolte CH, Endres M, Schlemm L. Optimal transport destination for ischemic stroke patients with unknown vessel status: use of prehospital triage scores. Stroke. 2017; 48: 2184–2191. DOI: 10.1161/STROKEAHA.117.017281.

Venema E, Lingsma HF, Chalos V, Mulder M, Lahr MMH, van der Lugt A, van Es A, Steyerberg EW, Hunink MGM, Dippel DWJ, Rozemberg B. Personalized prehospital triage in acute ischemic stroke. Stroke. 2019; 50: 313–320. DOI: 10.1161/STROKEAHA.118.022562.

Williams LS, Yilmaz EY, Lopez-Yunez AM. Retrospective Assessment of Initial Stroke Severity with the NIH Stroke Scale Stroke. 2000; 31: 858–862. DOI: 10.1161/01.STR.31.4.858

Banks JL, and Marotta CA. Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials A Literature Review and Synthesis. Stroke. 2007; 38: 1091–1096. DOI/10.1161/01.STR.0000258355.23810.c6.

Stanfield LM. Clinical decision making in triage: an integrative review. J Emerg Nurs. 2015; 41(5): 396–403. DOI: 10.1016/j.jen.2015.02.003.

Delmas, P, Fiorentino A, Antonini M, Vuilleumier S, Stotzer G, Kollbrunner A, Jaccard D, Hulas J, Rutschmann O, Simon J, Hugli O, Keranflec’h CG, Pasquier J. Effects of environmental distractors on nurse emergency triage accuracy: a pilot study protocol. Pilot Feasibility Stud. 2020 6: 171. DOI: 10.1186/s40814-020-00717-8

Chen SS, Chen JC, Ng CJ, Chen PL, Lee PH, Chang WY. Factors that influence the accuracy of triage nurses' judgement in emergency departments. Emerg Med J. 2010; 27(6): 451–455. DOI: 10.1136/emj.2008.059311.

Mistry B, Stewart De Ramirez S, Kelen G, PSK S, Balhara KS, Levin S, et al. Accuracy and Reliability of Emergency Department Triage Using the Emergency Severity Index: An International Multicenter Assessment. Ann Emerg Med. 2018; 71(5): 581–7.e3. DOI: 10.1016/j.annemergmed.2017.09.036.

Martin A, Davidson CL, Panik A, Buckenmyer C, Delpais P, Ortiz M. An examination of ESI triage scoring accuracy in relationship to ED nursing attitudes and experience. J Emerg Nurs. 2014; 40(5): 461–468. DOI: 10.1016/j.jen.2013.09.009.

Smith EE, Kent DM, Bulsara KR, Leung LY, Lichtman JH, Reeves MJ, Towfighi A, Whiteley WN, Zahuranec D. Accuracy of prediction instruments for diagnosing large vessel occlusion in individuals with suspected stroke: a systematic review for the 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018; 49: e111–e122. DOI: 10.1161/STR. 0000000000000160.

Berglund A, Svensson L, Wahlgren N, von Euler M; HASTA Collaborators. Face Arm Speech Time Test use in the prehospital setting, better in the ambulance than in the emergency medical communication center. Cerebrovasc Dis. 2014; 37: 212–216. DOI: 10.1159/000358116.

Sánchez F, Ballesteros, JC, Kraiem MS, Sánchez M, Moreno MN. “Predictive Modeling of ICU Healthcare-Associated Infections from Imbalanced Data. Using Ensembles and a Clustering-Based Undersampling Approach”, Appl. Sci. 2019; 9: 5287. DOI: 10.3390/app9245287

González, J., Martín, F., Sánchez, M., Sánchez, F. and Moreno M.N. “Multiclassifier systems for predicting neurological outcome of patients with severe trauma and polytrauma in intensive care units”. J Med Syst. 2017; 41:136, DOI: 10.1007/s10916-017-0789-1.

Reay G, MacDonald LS, Then KL, Hall M, Rankin JA. Triage emergency nurse decision-making: Incidental findings from a focus group study. Int Emerg. 2020; 48: 100791. DOI: 10.1016/j.ienj.2019.100791.

Levin S, Toerper M, Hamrock E, Hinson JS, Barnes S, Gardner H, et al. Machine-Learning-Based Electronic triage more accurately differentiates patients with respect to clinical outcomes compared with the emergency severity index. An Emerg Med. 2018; 71(5): 565–74.e2. DOI: 10.1016/j.annemergmed.2017.08.005.

Brosinski CM, Riddell AJ, Valdez S. Improving triage accuracy: a staff development approach. Clin Nurse Spec. 2017; 31(3): 145–148. DOI: 10.1097/NUR.0000000000000291.

Martin A, Davidson CL, Panik A, Buckenmyer C, Delpais P, Ortiz M. An examination of ESI triage scoring accuracy in relationship to ED nursing attitudes and experience. J Emerg Nurs. 2014; 40(5): 461–468. DOI: 10.1016/j.jen.2013.09.009.

Publicado
08-10-2021
Cómo citar
[1]
Rodríguez Vico, A. y Sánchez Hernández, F. 2021. Triaje por enfermería en el ictus agudo . Enfermería Global. 20, 4 (oct. 2021), 108–130. DOI:https://doi.org/10.6018/eglobal.465261.
Número
Sección
Originales