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This is a randomized clinical trial that evaluates the impact of using an internet-based checklist for systematic assessment of patients reporting respiratory complaints with the conventional assessment, without using the checklist.
This is a randomized clinical trial that evaluates the impact of using an internet-based checklist for systematic assessment of patients reporting respiratory complaints with the conventional assessment, without using the checklist.
Study setting: emergency department related acute evaluation outpatient clinic
Inclusion criteria: 18 years of age or older; patients presenting to the ED reporting cough or dyspnea;
Exclusion criteria: acute respiratory failure; SpO2 < 92%; any signs of hemodynamic or respiratory instability; possible concurrent diagnosis requiring immediate assessment (e.g..: acute coronary syndrome or stroke; )
Primary outcome: need of reassessment in the ED or hospitalization within 1 month of index evaluation (intervention).
Secondary outcomes: number of complete blood counts ordered in the index evaluation; number of other diagnostic tests ordered in the index evaluation;
Randomization: block 1:1; stratified by gender and age (>50 years old).
Masking will be appllied to: patients; outcome assessors; data analysts;
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Checklist | Experimental | 2 checklists available for consultation by the attending physician: (1) dyspnea evaluation checklist and (2) cough evaluation checklist. The checklists are available on computers and mobile devices (smartphone, PDA or tablet computer). |
|
| Conventional assessment | Active Comparator | Evaluation of patients reporting dyspnea or cough made by the attending physician, without the use of the checklists for dyspnea or cough evaluation. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Checklist | Other | 3 page checklist with suggestions of possible diagnosis according to clinical presentation of patients presenting with dyspnea or cough; also suggests diagnostic tests that are likely to be useful in each situation. |
| Measure | Description | Time Frame |
|---|---|---|
| Need to visit the emergency department or acute evaluation outpatient clinic | 1 month | |
| Complete blood count ordered in the index evaluation | 1 month |
| Measure | Description | Time Frame |
|---|---|---|
| Number of diagnostic tests ordered in the index evaluation | 1 month | |
| Hospital admission | 1 month | |
| Antibiotics prescription |
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18 years of age or older; patients presenting to the ED reporting cough or dyspnea; legally capable.
Exclusion criteria: acute respiratory failure; SpO2 < 92%; any signs of hemodynamic or respiratory instability; possible concurrent diagnosis requiring immediate assessment (e.g..: acute coronary syndrome or stroke; )
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital de Clinicas de Porto Alegre | Porto Alegre | Rio Grande do Sul | 90035-903 | Brazil |
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| ID | Term |
|---|---|
| D004417 | Dyspnea |
| D003371 | Cough |
| ID | Term |
|---|---|
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
| D012818 | Signs and Symptoms, Respiratory |
| D012816 | Signs and Symptoms |
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| ID | Term |
|---|---|
| D057189 | Checklist |
| D002985 | Clinical Protocols |
| ID | Term |
|---|---|
| D003625 | Data Collection |
| D017531 | Health Care Evaluation Mechanisms |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
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|
| Conventional evaluation | Other | Physician evaluation without the use of checklists |
|
|
Frequency and type of antibiotic prescribed in each study arm |
| 1 month |
| Major events | Composite endpoint: revisit to emergency department OR hospital admission OR death | 1 month |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D013812 | Therapeutics |
| D016020 | Epidemiologic Study Characteristics |