Emergency Medicine Journal: EMJ

Helena Pfeiffer, Laura Elizabeth Cowley, Alison Mary Kemp, Stuart R Dalziel, Anne Smith, John Alexander Cheek, Meredith L Borland, Sharon O'Brien, Megan Bonisch, Jocelyn Neutze, Ed Oakley, Louise M Crowe, Stephen Hearps, Mark D Lyttle, Silvia Bressan, Franz E Babl
OBJECTIVE: The validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool calculates the probability of abusive head trauma (AHT) in children <3 years of age who have sustained intracranial injuries (ICIs) identified on neuroimaging, based on combinations of six clinical features: head/neck bruising, seizures, apnoea, rib fracture, long bone fracture and retinal haemorrhages. PredAHT version 2 enables a probability calculation when information regarding any of the six features is absent...
January 13, 2020: Emergency Medicine Journal: EMJ
Ffion Davies
No abstract text is available yet for this article.
January 13, 2020: Emergency Medicine Journal: EMJ
Merel van Loon, Roos C Van der Mast, M Christien van der Linden, Floris A van Gaalen
BACKGROUND: Routine screening programmes for hazardous alcohol use in the ED miss large numbers of patients. We investigated whether patient-related or staff-related factors cause screening failures and whether unscreened patients are at increased risk of hazardous alcohol use. METHODS: This is a secondary analysis of a prospective study. From November 2012 to November 2013, all adult patients visiting a Dutch inner city ED were screened for hazardous alcohol consumption using the Alcohol Use Disorders Identification Test-Consumption...
January 13, 2020: Emergency Medicine Journal: EMJ
Sarah Hui Wen Yao, Shu-Ling Chong, Gene Yong-Kwang Ong
No abstract text is available yet for this article.
January 9, 2020: Emergency Medicine Journal: EMJ
Samuel Finnikin, Gail Hayward, Fay Wilson, Daniel Lasserson
BACKGROUND: The National Early Warning Scores (NEWS) is used in various healthcare settings to augment clinical decision making, and there is growing interest in its application in primary care. This research aimed to determine the distribution of NEWS among patients in UK out-of-hours (OOH) general practice and explore the relationship between NEWS and referral of patients to hospital. METHODS: A historical cohort study using routinely collected data from the Birmingham Out-of-hours general practice Research Database...
January 9, 2020: Emergency Medicine Journal: EMJ
Mehdi Naderi, Siamak Sabour
No abstract text is available yet for this article.
January 9, 2020: Emergency Medicine Journal: EMJ
Zhenghong Liu, Yi Ting Lim, Kwok Fai Mark Leong
OBJECTIVE: The use of tissue adhesives has become a popular option for closure of wounds in the ED. There have been a growing number of reports of inadvertent tissue adhesive injuries including closure of the eyelids. We aim to identify and compare various removal methods of tissue adhesives described in the literature in an exploratory trial. METHODS: A review was first conducted to establish all published methods for the removal of medical-grade tissue adhesives as well as commercial cyanoacrylates...
January 9, 2020: Emergency Medicine Journal: EMJ
Suzanne Ablard, Maxine Kuczawski, Fiona C Sampson, Suzanne M Mason
BACKGROUND: Policies aimed at diverting care from EDs to alternative services have not been successful in reducing ED attendances and have contributed to confusion for service users when making care-seeking decisions. It is important that service users are at the heart of decision making to ensure new services meet the needs of those who will be accessing them. In this study, service users were encouraged to think freely about the desirable qualities of an ideal urgent and emergency care (UEC) system...
January 9, 2020: Emergency Medicine Journal: EMJ
Michael Abernethy
No abstract text is available yet for this article.
January 8, 2020: Emergency Medicine Journal: EMJ
Kenneth W McKinley, John Babineau, Cindy G Roskind, Meridith Sonnett, Quynh Doan
OBJECTIVE: We developed a discrete event simulation model to evaluate the impact on system flow of a quality improvement (QI) initiative that included a time-specific protocol to decrease the time to antibiotic delivery for children with cancer and central venous catheters who present to a paediatric ED with fever. METHODS: The model was based on prospective observations and retrospective review of ED processes during the maintenance phase of the QI initiative between January 2016 and June 2017 in a large, urban, academic children's hospital in New York City, USA...
January 8, 2020: Emergency Medicine Journal: EMJ
Anisa Jabeen Nasir Jafar, Jamie C Sergeant, Fiona Lecky
BACKGROUND: In 2017, the WHO produced its first minimum data set (MDS) for emergency medical team (EMT) daily reporting during the sudden-onset disasters (SODs), following expert consensus. The MDS was deliberately designed to be simple in order to improve the rate of data capture; however, it is new and untested. This study assesses the inter-rater agreement between practitioners when performing the injury aspect of coding within the WHO EMT MDS. METHODS: 25 clinical case vignettes were developed, reflecting potential injuries encountered in an SOD...
January 7, 2020: Emergency Medicine Journal: EMJ
Clifford Mann
No abstract text is available yet for this article.
January 7, 2020: Emergency Medicine Journal: EMJ
Abena Obenewaa Akomeah, Hendry Robert Sawe, Juma A Mfinanga, Michael S Runyon, Erin Elizabeth Noste
BACKGROUND: The specialty of emergency medicine (EM) is new in most African countries, where emergency medicine registrar (residency) programmes (EMRPs) are at different stages of evolution and little is known about the programmes. Identifying and describing these EMRPs will facilitate planning for sustainability, collaborative efforts and curriculum development for existing and future programmes. Our objective was to identify and provide an overview of existing EMRPs in Africa and their applicant requirements, faculty characteristics and plans for sustainability...
January 7, 2020: Emergency Medicine Journal: EMJ
Christopher Price, Stephen McCarthy, Angela Bate, Peter McMeekin
OBJECTIVE: Evidence favours centralisation of emergency care for specific conditions, but it remains unclear whether broader implementation improves outcomes and efficiency. Routine healthcare data examined consolidation of three district general hospitals with mixed medical admission units (MAU) into a single high-volume site directing patients from the ED to specialty wards with consultant presence from 08:00 to 20:00. METHODS: Consecutive unscheduled adult index admissions from matching postcode areas were identified retrospectively in Hospital Episode Statistics over a 3-year period: precentralisation baseline (from 16 June 2014 to 15 June 2015; n=18 586), year 1 postcentralisation (from 16 June 2015 to 15 June 2016; n=16 126) and year 2 postcentralisation (from 16 June 2016 to 15 June 2017; n=17 727)...
January 7, 2020: Emergency Medicine Journal: EMJ
Alan Howard, Vinaithan Krishnan, Gerard Lane, John Caird
The practice of trepanning (referred to today as a craniotomy) dates back to the Neolithic period. Reasons for drilling a hole through the skull evolved from releasing evil spirits and curing insanity to practical management of head injuries in ancient Greece and Rome. Today, craniotomy or drilling a burr hole through the skull is very much the purview of the neurosurgeon. Yet one could argue that the procedure itself is more 'bone surgery' than 'brain surgery'. Nevertheless, despite the fact that head injury is a common presentation at district general hospitals and traumatic extra-axial haemorrhages are encountered often, the straightforward skillset required to drill a burr hole as a pretransfer, temporising, life-saving measure is seldom taught and has never gained traction...
December 30, 2019: Emergency Medicine Journal: EMJ
Alberto Milan, Pietrantonio Maldari, Andrea Iannaccone, Dario Leone, Eleonora Avenatti, Paola Molino, Sergio Livigni, Franco Veglio, Franco Aprà
BACKGROUND: Fluid therapy has a pivotal role in the management of acutely ill patients. However, whether or not a patient can tolerate additional intravascular volume is controversial and optimal strategy is unknown. Carotid femoral pulse wave velocity (cfPWV) evaluates arterial stiffness. OBJECTIVE: To determine whether cfPWV can predict the ability of patients to tolerate clinically indicated acute fluid expansion. METHODS: 50 consecutive patients requiring intravascular volume expansion were prospectively recruited in intensive care units...
December 24, 2019: Emergency Medicine Journal: EMJ
Maia Dorsett, Richelle J Cooper, Breena R Taira, Erin Wilkes, Jerome R Hoffman
No abstract text is available yet for this article.
December 24, 2019: Emergency Medicine Journal: EMJ
Tony Joy, Lisa Ramage, Sophie Mitchinson, Oliver Kirby, Rob Greenhalgh, Danë Goodsman, Gareth Davies
BACKGROUND AND OBJECTIVES: International and national health policies advocate greater integration of emergency and community care. The Physician Response Unit (PRU) responds to 999 calls 'taking the Emergency Department to the patient'. Operational since 2001, the service was reconfigured in September 2017. This article presents service activity data and implications for the local health economy from the first year since remodelling. METHODS: A retrospective descriptive analysis of a prospectively maintained database was undertaken...
December 19, 2019: Emergency Medicine Journal: EMJ
Gensheng Zhang, Kai Zhang, Xie Zheng, Wei Cui, Yucai Hong, Zhongheng Zhang
OBJECTIVES: To carry out a meta-analysis to examine the prognostic performance of the Mortality in Emergency Department Sepsis (MEDS) score in predicting mortality among emergency department patients with a suspected infection. METHODS: Electronic databases-PubMed, Embase, Scopus, EBSCO and the Cochrane Library-were searched for eligible articles from their respective inception through February 2019. Sensitivity, specificity, likelihood ratios and receiver operator characteristic area under the curve were calculated...
December 13, 2019: Emergency Medicine Journal: EMJ
John A Staples, Ketki Merchant, Shannon Erdelyi, Adam Lund, Jeffrey R Brubacher
BACKGROUND: Annual '4/20' cannabis festivals occur around the world on April 20 and often feature synchronised consumption of cannabis at 4:20 pm. The relationship between these events and demand for emergency medical services has not been systematically studied. METHODS: We conducted a population-based retrospective cohort study in Vancouver, Canada, using 10 consecutive years of data (2009-2018) from six regional hospitals. The number of emergency department (ED) visits between 4:20 pm and 11:59 pm on April 20 were compared with the number of visits during identical time intervals on control days 1 week earlier and 1 week later (ie, April 13 and April 27) using negative binomial regression...
December 12, 2019: Emergency Medicine Journal: EMJ
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