Carl Marincowitz, Benjamin Gravesteijn, Trevor Sheldon, Ewout Steyerberg, Fiona Lecky
BACKGROUND: There is international variation in hospital admission practices for patients with mild traumatic brain injury (TBI) and injuries on CT scan. Only a small proportion of patients require neurosurgical intervention, while many guidelines recommend routine admission of all patients. We aim to validate the Hull Salford Cambridge Decision Rule (HSC DR) and the Brain Injury Guidelines (BIG) criteria to select low-risk patients for discharge from the emergency department. METHOD: A cohort from 18 countries of Glasgow Coma Scale 13-15 patients with injuries on CT imaging was identified from the multicentre Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) Study (conducted from 2014 to 2017) for secondary analysis...
July 27, 2021: Emergency Medicine Journal: EMJ
Daniele Orso, Nicola Guglielmo, Francesco Cugini
No abstract text is available yet for this article.
July 21, 2021: Emergency Medicine Journal: EMJ
Anna Kaal, Lars Snel, Martijn Dane, Nathalie van Burgel, Thomas Ottens, Winifred Broekman, Lahssan El Bouazzaoui, Nikki Kolfschoten, Emile Schippers, Ewout Steyerberg, Soufian Meziyerh, Cees van Nieuwkoop
BACKGROUND: Guidelines recommend maximal efforts to obtain blood and sputum cultures in patients with COVID-19, as bacterial coinfection is associated with worse outcomes. The aim of this study was to evaluate the yield of bacteriological tests, including blood and sputum cultures, and the association of multiple biomarkers and the Pneumonia Severity Index (PSI) with clinical and microbiological outcomes in patients with COVID-19 presenting to the emergency department (ED). METHODS: This is a substudy of a large observational cohort study (PredictED study)...
July 21, 2021: Emergency Medicine Journal: EMJ
Patrick Aldridge, Rachel Parish, Heather Castle, Emma Russell, Raj Rout, Roohi Singh
BACKGROUND: Recent research suggests that between 20% and 50% of paediatric head injuries attending our emergency department (ED) could be safely discharged soon after triage, without the need for medical review, using a 'Head Injury Discharge At Triage' tool (HIDAT). We sought to implement this into clinical practice. METHODS: Paediatric ED triage staff underwent competency-based assessments for HIDAT with all head injury presentations 1 May to 31 October 2020 included in analysis...
July 21, 2021: Emergency Medicine Journal: EMJ
Keita Shibahashi, Kazuhiro Sugiyama, Yusuke Kuwahara, Takuto Ishida, Atsushi Sakurai, Nobuya Kitamura, Takashi Tagami, Taka-Aki Nakada, Munekazu Takeda, Yuichi Hamabe
BACKGROUND: The novel simplified out-of-hospital cardiac arrest (sOHCA) and simplified cardiac arrest hospital prognosis (sCAHP) scores used for prognostication of hospitalised patients have not been externally validated. Therefore, this study aimed to externally validate the sOHCA and sCAHP scores in a Japanese population. METHODS: We retrospectively analysed data from a prospectively maintained Japanese database (January 2012 to March 2013). We identified adult patients who had been resuscitated and hospitalised after intrinsic out-of-hospital cardiac arrest (OHCA) (n=2428, age ≥18 years)...
July 21, 2021: Emergency Medicine Journal: EMJ
Robin Pap, Craig Lockwood, Matthew Stephenson, Paul Simpson
BACKGROUND: Globally, the measurement of quality is an important process that supports the provision of high-quality and safe healthcare services. The requirement for valid quality measurement to gauge improvements and monitor performance is echoed in the Australian prehospital care setting. The aim of this study was to use an evidence-informed expert consensus process to identify valid quality indicators (QIs) for Australian prehospital care provided by ambulance services. METHODS: A modified RAND/UCLA appropriateness method was conducted with a panel of Australian prehospital care experts from February to May 2019...
July 21, 2021: Emergency Medicine Journal: EMJ
Pieter Francsois Fouche, Ben Meadley, Toby StClair, Alison Winnall, Christopher Stein, Paul Andrew Jennings, Stephen Bernard, Karen Smith
BACKGROUND: Rapid Sequence intubation (RSI) is an airway procedure that uses sedative and paralytic drugs to facilitate endotracheal intubation. It is known that RSI could impact blood pressure in the peri-intubation period. However, little is known about blood pressure changes in longer time frames. Therefore, this analysis aims to describe the changes in systolic blood pressure in a large cohort of paramedic-led RSI cases over the whole prehospital timespan. METHODS: Intensive Care Paramedics in Victoria, Australia, are authorised to use RSI in medical or trauma patients with a Glasgow Coma Scale <10...
July 16, 2021: Emergency Medicine Journal: EMJ
Jiun-Hao Yu, Chien-Yu Liu, Wei-Kung Chen, Shao-Hua Yu, Fen-Wei Huang, Ming-Tzu Yang, Chih-Yu Chen, Hong-Mo Shih
BACKGROUND: Emergency medical service (EMS) personnel have high COVID-19 risk during resuscitation. The resuscitation protocol for patients with out-of-hospital cardiac arrest (OHCA) was modified in response to the COVID-19 pandemic. However, how the adjustments in the EMS system affected patients with OHCA remains unclear. METHODS: We analysed data from the Taichung OHCA registry system. We compared OHCA outcomes and rescue records for 622 cases during the COVID-19 outbreak period (1 February to 30 April 2020) with those recorded for 570 cases during the same period in 2019...
July 14, 2021: Emergency Medicine Journal: EMJ
Benjamin M Bloom, Thomas C Hughes
No abstract text is available yet for this article.
June 30, 2021: Emergency Medicine Journal: EMJ
Richard Hotham, Colin O'Keeffe, Tony Stone, Suzanne M Mason, Christopher Burton
BACKGROUND: EDs globally are under increasing pressure through rising demand. Frequent attenders are known to have complex health needs and use a disproportionate amount of resources. We hypothesised that heterogeneity of patients' reason for attendance would be associated with multimorbidity and increasing age, and predict future attendance. METHOD: We analysed an anonymised dataset of all ED visits over the course of 2014 in Yorkshire, UK. We identified 15 986 patients who had five or more ED encounters at any ED in the calendar year...
June 29, 2021: Emergency Medicine Journal: EMJ
Daniel J Lane, Lauren Roberts, Shawn Currie, Rachel Grimminck, Eddy Lang
BACKGROUND: Extended periods awaiting an inpatient bed in the emergency department (ED) may exacerbate the state of patients with acute psychiatric illness, increasing the time it takes to stabilise their acute problem in hospital. Therefore, we assessed the association between boarding time and hospital length of stay for psychiatric patients. METHODS: ED clinical records were linked to inpatient administrative records for all patients with a primary psychiatric diagnosis admitted to a Calgary, Alberta hospital between April 2014 and March 2018...
June 29, 2021: Emergency Medicine Journal: EMJ
Talib Dbouk, Silvia Aranda-García, Roberto Barcala-Furelos, Antonio Rodríguez-Núñez, Dimitris Drikakis
AIM: Cardiopulmonary resuscitation (CPR) is an emergency procedure where interpersonal distance cannot be maintained. There are and will always be outbreaks of infection from airborne diseases. Our objective was to assess the potential risk of airborne virus transmission during CPR in open-air conditions. METHODS: We performed advanced high-fidelity three-dimensional modelling and simulations to predict airborne transmission during out-of-hospital hands-only CPR...
June 29, 2021: Emergency Medicine Journal: EMJ
Hayden Richards, Karen Robins-Browne, Troy O'Brien, Greer Wilson, Jeremy Furyk
BACKGROUND: The COVID-19 pandemic has led to a surge in critically unwell patients with type 1 respiratory failure. In an attempt to reduce the number of patients requiring mechanical ventilation, prone positioning (PP) of non-intubated patients has been added to many hospital guidelines around the world. We set out to conduct a systematic review of the evidence relating to PP in the non-intubated patient with type 1 respiratory failure secondary to COVID-19 and other causes. METHODS: The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement...
June 23, 2021: Emergency Medicine Journal: EMJ
Seo Young Kim, Sun Young Lee, Tae Han Kim, Sang Do Shin, Kyoung Jun Song, Jeong Ho Park
AIMS: A short awareness time interval (ATI, time from witnessing the arrest to calling for help) and bystander cardiopulmonary resuscitation (CPR) are important factors affecting neurological recovery after out-of-hospital cardiac arrest (OHCA). This study investigated the association of the location of OHCA with the length of ATI and bystander CPR. METHODS: This population-based observational study used the nationwide Korea OHCA database and included all adults with layperson-witnessed OHCA with presumed cardiac aetiology between 2013 and 2017...
June 23, 2021: Emergency Medicine Journal: EMJ
Eric Tam, Sally Graglia
No abstract text is available yet for this article.
June 22, 2021: Emergency Medicine Journal: EMJ
Catherine Ashton, M Laffan, P J Hutchinson, Fiona Lecky, S Ralhan, Jason E Smith, Jonathan P Coles, Simon Stanworth, Nicola Curry
INTRODUCTION: Patients aged 60 or over account for over half of the severely injured trauma patients and a traumatic brain injury is the most common injury sustained. Many of these patients are taking antiplatelet medications but there is clinical equipoise about the role of platelet transfusion in patients with traumatic intracranial haemorrhage (ICH) taking prior antiplatelet medications. METHOD: A prepiloted survey was designed to explore a range of clinical issues in managing patients taking antiplatelet medications admitted with a traumatic brain injury...
June 22, 2021: Emergency Medicine Journal: EMJ
Kate Bradman, Katherine Stannage, Sharon O'Brien, Simon Green, Natasha Bear, Meredith Borland
BACKGROUND: Management of common childhood spiral tibial fractures, known as toddler's fractures, has not significantly changed in recent times despite the availability of immobilisation devices known as controlled ankle motion (CAM) boots. We compared standard therapy with these devices on quality-of-life measures. METHODS: A prospective randomised controlled trial, comparing immobilisation with an above-knee plaster of Paris cast (AK-POP) with a CAM boot in children aged 1-5 years with proven or suspected toddler's fractures presenting to a tertiary paediatric ED in Perth, Western Australia, between March 2018 and February 2020...
June 22, 2021: Emergency Medicine Journal: EMJ
Gijs Hesselink, Özcan Sir, Nadia Koster, Carolien Tolsma, Maartje Munsterman, Marcel Olde Rikkert, Yvonne Schoon
OBJECTIVES: With the 'teach-back' method, patients or carers repeat back what they understand, so that professionals can confirm comprehension and correct misunderstandings. The effectiveness of teach-back has been underexamined, particularly for older patients discharged from the emergency department (ED). We aimed to determine whether teach-back would reduce ED revisits and whether it would increase patients' retention of discharge instructions, improve self-management at home and increase satisfaction with the provision of instructions...
June 17, 2021: Emergency Medicine Journal: EMJ
Emily Neill, Nancy Anaya, Sally Graglia
No abstract text is available yet for this article.
June 17, 2021: Emergency Medicine Journal: EMJ
Claire Patry, Anne Perozziello, Clio Pardineille, Christiane Aubert, Pauline de Malglaive, Christophe Choquet, Agathe Raynaud-Simon, Manuel Sanchez
BACKGROUND: Medical patients are on occasion admitted transiently to surgical wards when more appropriate wards are at capacity, potentially leading to suboptimal care. The aim of this study was to compare 6-month outcomes in older adults diagnosed with medical conditions in the ED then admitted inappropriately to surgical wards (defined as outliers), with outcomes in comparable patients admitted to medical wards (controls). METHODS: In a matched cohort study, 100 consecutive medical outliers from the ED aged 75 years and over were matched according to age, sex and diagnosis to 200 controls...
June 17, 2021: Emergency Medicine Journal: EMJ
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