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BMC Emergency Medicine

Femke Nawijn, Wietske H W Ham, Roderick M Houwert, Rolf H H Groenwold, Falco Hietbrink, Diederik P J Smeeing
BACKGROUND: Emergency department utilization has increased tremendously over the past years, which is accompanied by an increased necessity for emergency medicine research to support clinical practice. Important sources of evidence are systematic reviews (SRs) and meta-analyses (MAs), but these can only be informative provided their quality is sufficiently high, which can only be assessed if reporting is adequate. The purpose of this study was to assess the quality of reporting of SRs and MAs in emergency medicine using the PRISMA statement...
February 11, 2019: BMC Emergency Medicine
Sidi Driss El Jaouhari, Nawfal Doghmi, Hamza Najout, Massine El Hamouni, El Hassane Kabiri, Hicham Bekkali, Jaafar Salim Lalaoui, Mustapha Bensghir
BACKGROUND: Pregnancy constitutes a significant factor in thyroid hypertrophy and can rarely progress to respiratory distress. We describe case of pregnant woman with acute respiratory distress following a tracheal compression due to goiter, quickly resulting in respiratory arrest, requiring emergency orotracheal intubation and thyroidectomy. CASE PRESENTATION: A pregnant woman with a growing goiter was referred to the hospital with a respiratory difficulty. During the examination, we found a large homogeneous goiter...
January 29, 2019: BMC Emergency Medicine
Natalie Champagne, Leila Eadie, Luke Regan, Philip Wilson
BACKGROUND: The aim of the present review is to assess the effectiveness of ultrasound (US) in the detection of upper and lower limb bone fractures in adults compared to a diagnostic gold standard available in secondary and tertiary care centres (e.g. radiography, CT scan or MRI). METHODS: The review followed PRISMA guidelines and used a database-specific search strategy with Medline, EMBASE and The Cochrane Library plus secondary sources (see supplementary material for completed PRISMA checklist)...
January 28, 2019: BMC Emergency Medicine
Matthew Thomas, Sarah Voss, Jonathan Benger, Kim Kirby, Jerry P Nolan
BACKGROUND: Hyperoxia following out of hospital cardiac arrest (OHCA) is associated with a poor outcome. Animal data suggest the first hour post resuscitation may be the most important. In the UK the first hour usually occurs in the prehospital environment. METHODS: A prospective controlled trial, cluster randomised by paramedic, comparing titrated oxygen with 100% oxygen for the first hour after return of spontaneous circulation (ROSC) following OHCA. The trial was done in a single emergency medical services (EMS) system in the United Kingdom (UK) admitting patients to three emergency departments...
January 25, 2019: BMC Emergency Medicine
Magnus Andersson Hagiwara, Carl Magnusson, Johan Herlitz, Elin Seffel, Christer Axelsson, Monica Munters, Anneli Strömsöe, Lena Nilsson
BACKGROUND: Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care. METHODS: We used a retrospective study design where 30 randomly selected prehospital medical records were screened for AEs each month in three prehospital organizations in Sweden during a period of one year...
January 24, 2019: BMC Emergency Medicine
Müller M Mundenga, Hendry R Sawe, Michael S Runyon, Victor G Mwafongo, Juma A Mfinanga, Brittany L Murray
BACKGROUND: Alcohol and illicit drugs have been found to be major contributing factors leading to severe injuries in a variety of settings. In Tanzania, the use of these substances among injured patients has not been studied. We investigated the prevalence of positive tests for alcohol and illicit drug use among injured patients presenting to the emergency medicine department (ED) of Muhimbili National Hospital (MNH). METHODS: This was a prospective cohort study of a consecutive sample of patients > 18 years of age presenting to the ED-MNH with injury related complaints in October and November 2015...
January 24, 2019: BMC Emergency Medicine
Bjoern Hussmann, Carsten Schoeneberg, Pascal Jungbluth, Matthias Heuer, Rolf Lefering, Teresa Maek, Frank Hildebrand, Sven Lendemans, Hans-Christoph Pape
BACKGROUND: Whether enhanced prehospital volume therapy leads to outcome improvements in severely injured patients with severe traumatic brain injury (TBI) remains controversial. The aim of this study was to investigate the influence of prehospital volume therapy on the clinical course of severely injured patients with severe TBI. METHODS: Data for 122,672 patients from TraumaRegister DGU® (TR-DGU) was analyzed. Inclusion criteria were defined as follows: Injury Severety Score (ISS) ≥ 16, primary admission, age ≥ 16 years, Abbreviated Injury Scale (AIS) head ≥3, administration of at least one unit of packed red blood cells (pRBCs), and available volume and blood pressure data...
January 23, 2019: BMC Emergency Medicine
Patrick Schober, Tessa Biesheuvel, Marcel A de Leeuw, Stephan A Loer, Lothar A Schwarte
BACKGROUND: Creating a patent airway by cricothyrotomy is the ultimate maneuver to allow oxygenation (and ventilation) of the patient. Given the rarity of airway management catastrophes necessitating cricothyrotomy, sufficiently sized prospective randomized trials are difficult to perform. Our Helicopter Emergency Medical Service (HEMS) documents all cases electronically, allowing a retrospective analysis of a larger database for all cases of prehospital cricothyrotomy. METHODS: We analyzed all 19,382 dispatches of our HEMS 'Lifeliner 1', since set-up of a searchable digital database...
January 23, 2019: BMC Emergency Medicine
Erasto Sylvanus, Hendry R Sawe, Biita Muhanuzi, Elly Mulesi, Juma A Mfinanga, Ellen J Weber, Said Kilindimo
BACKGROUND: Renal failure carries high mortality even in high-resource countries. Little attention has been paid to renal failure patients presenting acutely in emergency care settings in low-to-middle income countries (LMIC). Our aim was to describe the profile, management strategies and outcome of renal failure patients presenting with indications for emergent dialysis to an urban Emergency Department (ED) in a tertiary public hospital in Tanzania. METHODS: This was a prospective cohort study of consecutive patients (age ≥ 15 yrs) presenting to the Emergency Medicine Department of Muhimbili National Hospital from September 2017 to February 2018...
January 22, 2019: BMC Emergency Medicine
Alexandra Platon, Chloe Frund, Laura Meijers, Thomas Perneger, Elisabeth Andereggen, Minerva Becker, Alice Halfon Poletti, Olivier T Rutschmann, Pierre-Alexandre Poletti
BACKGROUND: Acute abdominal pain accounts for about 10% of emergency department visits and has progressively become the primary indication for CT scanning in most centers. The goal of our study is to identify biological or clinical variables able to predict or rule out significant pathology (conditions requiring urgent medical or surgical treatment) on abdominal CT in patients presenting to an emergency department with acute abdominal pain. METHODS: This was a retrospective cohort study performed in the emergency department of an academic center with an annual census of 60'000 patients...
January 18, 2019: BMC Emergency Medicine
Nathan Walzl, Jessica Jameson, John Kinsella, David J Lowe
BACKGROUND: Decision-making concerning the limitation of potentially life-prolonging treatments is often challenging, particularly in the Emergency Department (ED). Current literature in this area of Emergency Medicine is limited and heterogeneous. We seek to determine the factors that influence ceiling of treatment institution in the ED. METHODS: We conducted a phenomenological qualitative study employing semi-structured interviews. Emergency Medicine Consultants were recruited via a sample of convenience from 5 hospitals in the West of Scotland...
January 17, 2019: BMC Emergency Medicine
Marie-Josée Fleury, Marilyn Fortin, Louis Rochette, Guy Grenier, Christophe Huỳnh, Éric Pelletier, Helen-Maria Vasiliadis
BACKGROUND: This descriptive study compared 2014-15 to 2005-06 data on the quality of mental health services (MHS) in relation to emergency room (ER) use to assess the impact of the 2005 Quebec MH reform regarding access, continuity and appropriateness of care for patients with mental illnesses (PMI). METHODS: Data emanated from the Quebec Integrated Chronic Disease Surveillance System (Quebec/Canada). Participants (865,255 for 2014-15; 817,395 for 2005-06) were age 12 or over, with at least one MI, including substance use disorders (SUD), diagnosed during an ER visit, outpatient treatment or hospitalization...
January 15, 2019: BMC Emergency Medicine
Marie E Ward, Abel Wakai, Ronald McDowell, Fiona Boland, Eoin Coughlan, Moayed Hamza, John Browne, Ronan O'Sullivan, Una Geary, Fiona McDaid, Éidín Ní Shé, Frances J Drummond, Conor Deasy, Eilish McAuliffe
BACKGROUND: Early warning score systems have been widely recommended for use to detect clinical deterioration in patients. The Irish National Emergency Medicine Programme has developed and piloted an emergency department specific early warning score system. The objective of this study was to develop a consensus among frontline healthcare staff, quality and safety staff and health systems researchers regarding evaluation measures for an early warning score system in the Emergency Department...
January 14, 2019: BMC Emergency Medicine
Odd Martin Vallersnes, Dag Jacobsen, Øivind Ekeberg, Mette Brekke
BACKGROUND: Though substance use is a known risk factor for self-discharge, patients self-discharging during treatment for acute poisoning have not previously been described. We charted characteristics of patients self-discharging during treatment for acute poisoning by substances of abuse looking for associations between self-discharge, repeated poisoning, and death. METHODS: All patients 12 years and older treated for acute poisoning by substances of abuse at an emergency outpatient clinic in Oslo, Norway, were included consecutively from October 2011 through September 2012...
January 11, 2019: BMC Emergency Medicine
Ilse van Beusekom, Ferishta Bakhshi-Raiez, Nicolette F de Keizer, Dylan W de Lange
BACKGROUND: The aim of this study was to describe the healthcare costs of intoxicated ICU patients in the year before and the year after ICU admission, and to compare their healthcare costs with non-intoxicated ICU patients and a population based control group. METHODS: We conducted a retrospective cohort study, combining a national health insurance claims database and a national quality registry database for ICUs. Claims data in the timeframe 2012 until 2014 were combined with the clinical data of patients who had been admitted to an ICU during 2013...
January 11, 2019: BMC Emergency Medicine
S Kepka, J C Dalphin, J B Pretalli, A L Parmentier, D Lauque, G Trebes, F Mauny, T Desmettre
BACKGROUND: Management of spontaneous pneumothorax (SP) is still subject to debate. Although encouraging results of recent studies about outpatient management with chest drains fitted with a one-way valve, no data exist concerning application of this strategy in real life conditions. We assessed how SP are managed in Emergency departments (EDs), in particular the role of outpatient management, the types of interventions and the specialty of the physicians who perform these interventions...
January 11, 2019: BMC Emergency Medicine
Steffie H A Brouns, Lisette Mignot-Evers, Floor Derkx, Suze L Lambooij, Jeanne P Dieleman, Harm R Haak
BACKGROUND: Studies on the reliability of the MTS and its predictive power for hospitalisation and mortality in the older population have demonstrated mixed results. The objective is to evaluate the performance of the Manchester Triage System (MTS) in older patients (≥65 years) by assessing the predictive ability of the MTS for emergency department resource utilisation, emergency department length of stay (ED-LOS), hospitalisation, and in-hospital mortality rate. The secondary goal was to evaluate the performance of the MTS in older surgical versus medical patients...
January 7, 2019: BMC Emergency Medicine
Anna Schneider, Markus Wehler, Matthias Weigl
BACKGROUND: Emergency departments (EDs) are highly dynamic and stressful care environments that affect provider and patient outcomes. Yet, effective interventions are missing. This study evaluated prospective effects of a multi-professional organizational-level intervention on changes in ED providers' work conditions and well-being (primary outcomes) and patient-perceived quality of ED care (secondary outcome). METHODS: A before and after study including an interrupted time-series (ITS) design over 1 year was established in the multidisciplinary ED of a tertiary referral hospital in Southern Germany...
January 3, 2019: BMC Emergency Medicine
Ararso Baru, Aklilu Azazh, Lemlem Beza
BACKGROUND: Globally, about 1.25 million people die annually from road trafficcollisions. Evidence from global safety report shows a decreasing trend of road traffic injury indeveloped countries while there is an increasing trend in many developing countriesincluding Ethiopia. This study is aimed at assessing factors affecting injury severity levels of road traffic collision victims referred to selected public hospitals in Addis Ababa based on the Haddon Matrix. METHODS: Ahospital-based cross-sectional study designwas implemented to randomly select a total of 363 road traffic collision victims...
January 3, 2019: BMC Emergency Medicine
Nicholas M Mohr, Ryan Dick-Perez, Azeemuddin Ahmed, Karisa K Harland, Dan Shane, Daniel Miller, Christine Miyake, Levi Kannedy, Brian M Fuller, James C Torner
BACKGROUND: Sepsis severity of illness is challenging to measure using claims, which makes sepsis difficult to study using administrative data. We hypothesized that emergency department (ED) charges may be associated with hospital mortality, and could be a surrogate marker of severity of illness for research purposes. The objective of this study was to measure concordance between ED charges and mortality in admitted patients with severe sepsis or septic shock. METHODS: Cohort study of all adult patients presenting to a 60,000-visit Midwestern academic ED with severe sepsis or septic shock (by ICD-9 codes) between July 1, 2008 and June 30, 2010...
December 29, 2018: BMC Emergency Medicine
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