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Is the “beach position” of value during the “eyeball” assessment of patients?

Published:March 04, 2021DOI:https://doi.org/10.1016/j.ejim.2021.02.014
      The rapid identification at low cost of patients at risk is particularly important in emergency departments in low- and middle-income countries, which may lack experienced emergency healthcare providers and cannot afford to waste scarce resources [
      • Wuerz RC
      • Milne LW
      • Eitel DR
      • Travers D
      • Gilboy N.
      Reliability and validity of a new five-level triage instrument.
      ]. Within seconds some clinicians use fast System 1 thinking to determine if a patient is sick or not [
      • Sibbald M
      • Sherbino J
      • Preyra I
      • Coffin-Simpson T
      • Norman G
      • Monteiro S.
      Eyeballing: the use of visual appearance to diagnose ‘sick’.
      ], a judgement often based on the patient's facial expression and their behaviour [
      • Kline JA
      • Neumann D
      • Haug MA
      • Kammer DJ
      • Krabill VA.
      Decreased facial expression variability in patients with serious cardiopulmonary disease in the emergency care setting.
      ]. Supine emergency room patients with crossed ankles, crossed hands behind the neck, or folded hands over the upper abdomen, as if they were relaxing on a beach, have been reported to be highly unlikely to have any acute critical condition [
      • Rapoport MJ
      • Leonov Y
      • Leibovitz A.
      Body language in the emergency room.
      ]. This letter reports the prevalence of this “beach position” [
      • Schneider UC
      • Vajkoczy P.
      The beach position”: crossed legs as a marker for a favourable clinical course in neurological intensive care unit patients.
      ] in acutely ill patients during their admission to a low-resource hospital in Uganda, its association with in-hospital mortality and potential value as a predictor of outcome.
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