Artificial Intelligence-Based Triage for Patients with Acute Abdominal Pain in emergency Department; a Diagnostic Accuracy Study

Introduction: Artificial intelligence (AI) is the development of computer systems which are capable of doing human intelligence tasks such as decision making and problem solving. AI-based tools have been used for predicting various factors in medicine including risk stratification, diagnosis and choice of treatment. AI can also be of considerable help in emergency departments, especially patients’ triage. Objective: This study was undertaken to evaluate the application of AI in patients presenting with acute abdominal pain to estimate emergency severity index version 4 (ESI-4) score without the estimate of the required resources. Methods: A mixed-model approach was used for predicting the ESI-4 score. Seventy percent of the patient cases were used for training the models and the remaining 30% for testing the accuracy of the models. During the training phase, patients were randomly selected and were given to systems for analysis. The output, which was the level of triage, was compared with the gold standard (emergency medicine physician). During the test phase of the study, another group of randomly selected patients were evaluated by the systems and the results were then compared with the gold standard. Results: Totally, 215 patients who were triaged by the emergency medicine specialist were enrolled in the study. Triage Levels 1 and 5 were omitted due to low number of cases. In triage Level 2, all systems showed fair level of prediction with Neural Network being the highest. In Level 3, all systems again showed fair level of prediction. However, in triage Level 4, decision tree was the only system with fair prediction. Conclusion: The application of AI in triage of patients with acute abdominal pain resulted in a model with acceptable level of accuracy. The model works with optimized number of input variables for quick assessment

Outcome-Based Validity and Reliability Assessment of Raters Regarding the Admission Triage Level in the Emergency Department: a Cross-Sectional Study

Introduction: Emergency department (ED) is usually the first line of healthcare supply to patients in non-urgent to critical situations and, if necessary, provides hospital admission. A dynamic system to evaluate patients and allocate priorities is necessary. Such a structure that facilitates patients’ flow in the ED is termed triage. Objective: This study was conducted to investigate the validity and reliability of implementation of Emergency Severity Index (ESI) system version 4 by triage nurses in an overcrowded referral hospital with more than 80000 patient admissions per year and an average emergency department occupancy rate of more than 80%. Method: This prospective cross-sectional study was conducted in a tertiary care teaching hospital and trauma center with an emergency medicine residency program. Seven participating expert nurses were asked to assess the ESI level of patients in 30 written scenarios twice within a three-week interval to evaluate the inter-rater and intra-rater reliability. Patients were randomly selected to participate in the study, and the triage level assigned by the nurses was compared with that by the emergency physicians. Finally, based on the patients’ charts, an expert panel evaluated the validity of the triage level. Results: During the study period, 527 patients with mean age of 54 ± 7 years, including 253 (48%) women and 274 (52%) men, were assessed by seven trained triage nurses. The degree of retrograde agreement between the collaborated expert panel’s evaluation and the actual triage scales by the nurses and physicians for all 5 levels was excellent, with the Cohen’s weighted kappa being 0.966 (CI 0.985–0.946, p < 0.001) and 0.813 (CI 0.856–0.769, p<0.001), respectively. The intra-rater reliability was 0.94 (p < 0.0001), and the inter-rater reliability for all the nurses was in perfect agreement with the test result (Cohen’s weighted kappa were as follows: 0.919, 0.956, 0.911, 0.955, 0.860, 0.956, and 0.868; p < 0.001). Conclusion: The study findings showed that there was perfect reliability and, overall, almost perfect validity for the triage performed by the studied nurses

Outcome-Based Validity and Reliability Assessment of Raters Regarding the Admission Triage Level in the Emergency Department: a Cross-Sectional Study

Introduction: Emergency department (ED) is usually the first line of healthcare supply to patients in non-urgent to critical situations and, if necessary, provides hospital admission. A dynamic system to evaluate patients and allocate priorities is necessary. Such a structure that facilitates patients’ flow in the ED is termed triage. Objective: This study was conducted to investigate the validity and reliability of implementation of Emergency Severity Index (ESI) system version 4 by triage nurses in an overcrowded referral hospital with more than 80000 patient admissions per year and an average emergency department occupancy rate of more than 80%. Method: This prospective cross-sectional study was conducted in a tertiary care teaching hospital and trauma center with an emergency medicine residency program. Seven participating expert nurses were asked to assess the ESI level of patients in 30 written scenarios twice within a three-week interval to evaluate the inter-rater and intra-rater reliability. Patients were randomly selected to participate in the study, and the triage level assigned by the nurses was compared with that by the emergency physicians. Finally, based on the patients’ charts, an expert panel evaluated the validity of the triage level. Results: During the study period, 527 patients with mean age of 54 ± 7 years, including 253 (48%) women and 274 (52%) men, were assessed by seven trained triage nurses. The degree of retrograde agreement between the collaborated expert panel’s evaluation and the actual triage scales by the nurses and physicians for all 5 levels was excellent, with the Cohen’s weighted kappa being 0.966 (CI 0.985–0.946, p < 0.001) and 0.813 (CI 0.856–0.769, p<0.001), respectively. The intra-rater reliability was 0.94 (p < 0.0001), and the inter-rater reliability for all the nurses was in perfect agreement with the test result (Cohen’s weighted kappa were as follows: 0.919, 0.956, 0.911, 0.955, 0.860, 0.956, and 0.868; p < 0.001). Conclusion: The study findings showed that there was perfect reliability and, overall, almost perfect validity for the triage performed by the studied nurses

Supramolecular Structure and Mechanical Properties of Wet-Spun Polyacrylonitrile/Carbon Nanotube Composite Fibers Influenced by Stretching Forces

The effect of different elongation conditions on the crystalline structure and physical and mechanical properties of polyacrylonitrile/carbon nanotube (PAN/CNT) microfibers during the wet spinning process was studied. It turns out that the response of polymer chains in PAN/CNT and in PAN fibers to the stretching forces from jet stretching and steam drawing is different. The X-ray diffraction (XRD) results showed that the crystalline domain size in steam-drawn PAN/CNT fibers is 1.5 times larger than in PAN fibers. CNTs alter the optimum stretching conditions, as they improve the crystalline structure of the PAN/CNT fibers at lower steam drawing ratios than PAN fibers, through nucleation of crystals on their surface. Synchrotron-radiation XRD studies revealed that the presence of CNTs improves the crystal orientation of PAN/CNT fibers significantly. In addition, steam drawing is more effective in improving the crystal orientation than jet stretching. The mechanical properties of PAN/CNT fibers have also been affected by steam drawing more than jet stretching. Multiwalled CNTs have the biggest impact on Young's modulus. The Young's modulus of PAN/CNT fibers could increase up to 19% higher than PAN fibers at specific stretching conditions, i.e., steam drawing ratio of 2.5. Better orientation of polymers and crystals in the fiber direction is the reason for the enhancement of Young's modulus. To our knowledge, the differences between the response of PAN/CNT and PAN fibers to stretching forces inside coagulation bath and after fiber coagulation as well as the difference in evolution of crystalline structure at different stretching stages has not been reported elsewhere

Extremity Fracture Diagnosis Using Bedside Ultrasound in Pediatric Trauma Patients Referring to Emergency Department; A Diagnostic Study

Background This study performed to assess the efficacy of ultrasound in screening upper and lower extremities fractures in comparison with standard X-ray in pediatric trauma patients. Materials and Methods This was a prospective diagnostic study conducted at the emergency department of Imam Khomeini Complex Hospital, Tehran, Iran. All patients with the age under 18-year-old admitted with limb trauma were first evaluated by attending emergency medicine physician using ultrasound and then underwent necessary X-rays. Thereafter, the ultrasound reports were compared with X-ray reports regarding measurement of its accuracy. Results Forty patients with the mean age of 9.47 ± 5.26 years (minimum of 2 and a maximum of 17 years) entered the study (75% were male). The average time of performing ultrasound in pediatric population is 3.99± 0.83 minutes which is statistically significant compared to X-ray, 16.12 ± 4.15 minutes (

The Impact of Shear and Elongational Forces on Structural Formation of Polyacrylonitrile/Carbon Nanotubes Composite Fibers during Wet Spinning Process

Wet spinning of polyacrylonitrile/carbon nanotubes (PAN/CNT) composite fibers was studied and the effect of spinning conditions on structure and properties of as-spun fibers influenced by the presence of CNTs investigated. Unlike PAN fibers, shear force had a larger effect on crystalline structure and physical and mechanical properties of PAN/CNT composite fibers compared to the elongational force inside a coagulation bath. Under shear force CNTs induced nucleation of new crystals, whereas under elongational force nucleation of new crystals were hindered but the already formed crystals grew bigger. To our knowledge, this key effect has not been reported elsewhere. At different shear rates, strength, Young’s modulus and strain at break of PAN/CNT as-spun fibers were improved up to 20% compared to PAN fibers. Application of jet stretch had less influence on physical and mechanical properties of PAN/CNT fibers compared to PAN fibers. However, the improvement of interphase between polymer chains and CNTs as a result of chain orientation may have contributed to enhancement of Young’s modulus of jet stretched composite fibers

Outcome-Based Validity and Reliability Assessment of Raters Regarding the Admission Triage Level in the Emergency Department: a Cross-Sectional Study

Introduction: Emergency department (ED) is usually the first line of healthcare supply to patients in non-urgent to critical situations and, if necessary, provides hospital admission. A dynamic system to evaluate patients and allocate priorities is necessary. Such a structure that facilitates patients’ flow in the ED is termed triage. Objective: This study was conducted to investigate the validity and reliability of implementation of Emergency Severity Index (ESI) system version 4 by triage nurses in an overcrowded referral hospital with more than 80000 patient admissions per year and an average emergency department occupancy rate of more than 80%. Method: This prospective cross-sectional study was conducted in a tertiary care teaching hospital and trauma center with an emergency medicine residency program. Seven participating expert nurses were asked to assess the ESI level of patients in 30 written scenarios twice within a three-week interval to evaluate the inter-rater and intra-rater reliability. Patients were randomly selected to participate in the study, and the triage level assigned by the nurses was compared with that by the emergency physicians. Finally, based on the patients’ charts, an expert panel evaluated the validity of the triage level. Results: During the study period, 527 patients with mean age of 54 ± 7 years, including 253 (48%) women and 274 (52%) men, were assessed by seven trained triage nurses. The degree of retrograde agreement between the collaborated expert panel’s evaluation and the actual triage scales by the nurses and physicians for all 5 levels was excellent, with the Cohen’s weighted kappa being 0.966 (CI 0.985–0.946, p < 0.001) and 0.813 (CI 0.856–0.769, p<0.001), respectively. The intra-rater reliability was 0.94 (p < 0.0001), and the inter-rater reliability for all the nurses was in perfect agreement with the test result (Cohen’s weighted kappa were as follows: 0.919, 0.956, 0.911, 0.955, 0.860, 0.956, and 0.868; p < 0.001). Conclusion: The study findings showed that there was perfect reliability and, overall, almost perfect validity for the triage performed by the studied nurses

Development of Porous Polyacrylonitrile Composite Fibers: New Precursor Fibers with High Thermal Stability

Polyacrylonitrile (PAN) fibers with unique properties are becoming increasingly important as precursors for the fabrication of carbon fibers. Here, we suggest the preparation of porous PAN composite fibers to increase the homogeneity and thermal stability of the fibers. Based on the thermodynamics of polymer solutions, the ternary phase diagram of the PAN/H2O/Dimethylformamide (DMF) system has been modeled to introduce porosity in the fibers. Adding a conscious amount of water (4.1 wt.%) as a non-solvent to the PAN solution containing 1 wt.% of graphene oxide (GO), followed by wet spinning, has led to the preparation of porous composite fibers with high thermal stability and unique physicochemical properties. Differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA) results elucidate that PAN/GO/H2O porous composite fibers have a higher thermal decomposition temperature, increased residual weight, reduced heat release rate, and higher crystallinity in comparison with the pristine PAN fibers, being a promising precursor for the development of high-performance carbon fibers. The results show a promising application window of the synthesized PAN fibers in electronic and electrochemical devices

Development of Porous Polyacrylonitrile Composite Fibers: New Precursor Fibers with High Thermal Stability

Polyacrylonitrile (PAN) fibers with unique properties are becoming increasingly important as precursors for the fabrication of carbon fibers. Here, we suggest the preparation of porous PAN composite fibers to increase the homogeneity and thermal stability of the fibers. Based on the thermodynamics of polymer solutions, the ternary phase diagram of the PAN/H2O/Dimethylformamide (DMF) system has been modeled to introduce porosity in the fibers. Adding a conscious amount of water (4.1 wt.%) as a non-solvent to the PAN solution containing 1 wt.% of graphene oxide (GO), followed by wet spinning, has led to the preparation of porous composite fibers with high thermal stability and unique physicochemical properties. Differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA) results elucidate that PAN/GO/H2O porous composite fibers have a higher thermal decomposition temperature, increased residual weight, reduced heat release rate, and higher crystallinity in comparison with the pristine PAN fibers, being a promising precursor for the development of high-performance carbon fibers. The results show a promising application window of the synthesized PAN fibers in electronic and electrochemical devices