1455 A 10-year review of insulin-related enquiries to the UK National Poisons Information Service (NPIS)
Conclusion
We received 1195 enquiries involving insulin. Further analysis was limited to the 169 enquiries involving insulin only (90.5% via injection).
Most enquiries (88%) concerned adults ≥ 18 years. There were 34 non-diabetic and 98 diabetic patients: 32 Type 1, 10 Type 2, and 56 type undocumented. Exposures were intentional (n=114, 68%), from therapeutic error (n=28), accidental (n=16) or circumstances unknown (n=11).
Long-acting insulins were involved in 71 cases, and the highest dose was 20000 units (table 1). The lowest recorded blood glucose concentration (mmol/L) at the time of the enquiry was in the range 0&n...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Moyns, E., Ferner, R., Euan, S., Gray, L., Thanacoody, R., Bradberry, S. Tags: RCEM Moderated Papers Source Type: research
1718 Another CT aortogram request? A 1 year retrospective case note review of all ED-requested CT aortograms
Conclusion
201 CTA were requested by ED in a single year (2019).
5 (2.4%) scans diagnosed acute aortic syndrome (AAS), with an additional 3 scans that identified thoracic aortic aneurysm without AAS.
13 (6.5%) abdominal aortic aneurysms were identified of which 2 had ruptured.
In addition, 24 (11.9%) patients had non aortic pathologies identified from the scan (6 gallstones, 3 pneumonia, 3 renal colic, 2 metastatic disease, 2 pancreatitis, 2 pulmonary embolism, 6 ‘other’ diagnoses).
Of those with confirmed AAS, only one had an ADD-RS (aortic dissection detection risk score) of 2 (>2 recommend straight to CTA...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Manouchehri, S., Wilson, S., Ticehurst, F. Tags: RCEM Moderated Papers Source Type: research
1397 I dont have time: strategies for increasing research engagement in emergency department clinicians
Conclusion
Registry data show 41 distinct initiatives established in the time period led or delivered by the research group. These included face-to-face teaching, publication writing support, a research internship program and small grant funding. Research outputs (publications or conference abstracts) showed a 23-fold increase from two in 2018 to 47 in 2021.
The project to develop a research culture in ED has had a positive effect on both type and number of research-related activities across all clinical staff groups. This case study illustrates how research activities delivered close to clinical practice under visible, fo...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Jarman, H., Halter, M., Moss, P., Seel, C. Tags: RCEM Moderated Papers Source Type: research
1337 Evaluation of a trauma unit bypass tool in predicting major trauma
Conclusion
The sensitivity of the Wessex TUB is 51.3% and the specificity is 71.3% which makes the tool a poor predictor of major trauma. The tool could be improved by altering thresholds for vital signs (blood pressure and Glasgow Coma Scale) and by providing clarity around the injury findings.
This study provides the first full evaluation of this tool in clinical practice and makes some recommendations to improve performance. This could lead to more accurate identification of patients who have suffered major trauma and ensure they are transported to an appropriate specialist centre. However, it was identified that ISS>...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Freshwater, E. Tags: RCEM Moderated Papers Source Type: research
1704 Feasibility of implementing a 0-2 troponin algorithm in routine clinical practice
Conclusion
728 sets of serial samples where obtained on 711 patients, 40.1% female median age 61.8 years,(interquartile range 50.6–75). Comparison of classification is shown in table 1. Overall agreement was good but there were 6 cases where a positive 3 hour delta occurred with a 2 hour delta of 3 or less. 4 had values exceeding the 99th percentile on the admission sample so would have been retained for further investigation. The remaining 4 patients had co-existing clinical conditions that required further investigation.
Abstract 1704 Table 1 Classification Delta ≤3 at 2 h Delta >3 at 2 h Delta ≤7 at ...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Ford, S., Krishnanandan, S., Collinson, P. Tags: RCEM Moderated Papers Source Type: research
1527 Venous thromboprophylaxis in ambulatory emergency department patients managed with lower limb immobilization. A national survey
Conclusion
A total of 116 (69%) of Type 1 EDs submitted a response. Nearly all (>95%) would consider thromboprophylaxis when a rigid cast was applied, but this was less for removable semi-rigid splints of the ankle (53%) or knee (20%). Of responding EDs, 83% used a RAM; most often a locally developed tool or NICE guidance. Published RAMs designed specifically for use in these patients were used by only 16% of EDs. When indicated, the majority of departments reported using LMWH (70%) in accordance with NICE guidelines, but 29% used a DOAC. Duration of thromboprophylaxis prescription also varied widely (table 1).
Abstrac...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Crainie, C., Cooper, J. Tags: RCEM Moderated Papers Source Type: research
1695 Which clinical features best predict occult scaphoid fracture? A systematic review and meta-analysis
Conclusion
Eight studies reported data on 1,685 wrist injuries. The prevalence of scaphoid fracture despite normal radiographs was 7.3%. The most accurate predictors of occult scaphoid fracture were pain with supination against resistance (sensitivity 100%, specificity 97.9%, LR 45.0 [95% CI 6.5–312.5], supination strength <10% of contralateral side (sensitivity 84.6%, specificity 76.9%, LR 3.7 [95% CI 2.2–6.1]), pain on ulnar deviation (sensitivity 55.2%, specificity 76.4%, LR 2.3 [95% CI 1.8–3.0]), and pronation strength <10% of contralateral side (sensitivity 69.2%, specificity 64.6%, LR 2.0 [95%...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Coventry, L., Oldrini, I., Novak, A., Dean, B., Metcalfe, D. Tags: RCEM Moderated Papers Source Type: research
1559 Background noise in an Emergency Department: an observational study from staff and patient perspectives
Conclusion
In a large urban teaching hospitalEmergency Department noise was greater than 45dB for staff between 76% and 96% of the time (30% to 100% for patients). There was little difference across the 24hr cycle. A door decreased the noise experienced by patients, but only if left closed. In the resuscitation rooms monitor alarms were much louder for patients than for staff.
Noise levels likely to impair communication are present in the ED for most of the time. Staff awareness and improved design of both buildings and equipment might mitigate this negative acoustic environment. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Coats, T., Emar, M., Smith, E. Tags: RCEM Moderated Papers Source Type: research
1683 Clinical impact of a novel ambulatory computed tomography coronary angiography pathway for patients at a moderate risk of suspected acute coronary syndromes
Conclusion
We identified 1,341 patients eligible for ambulatory CTCA (524 pre-implementation of pathway; 817 post-implementation; 820 [61%] male; mean age 57 [SD 14]). Pre-implementation, 46.6% (n=244) of these patients were admitted to the Ambulatory Care Unit (ACU). Post-implementation, 32% (n=258) were admitted to the ACU; only 7 (1.3%) eligible patients received ambulatory CTCA after implementation of the service. A further 25 ‘moderate risk’ patients received an inpatient CTCA. The median time to ambulatory CTCA from admission was 1 (IQR 0.75–3) day. Five (71.4%) ambulatory CTCAs were abnormal, ident...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Buglass, V. Tags: RCEM Moderated Papers Source Type: research
1754 A thematic analysis of Twitter posts pre and post-publication of CRASH-3 trial results using Blooms Digital Taxonomy. Examining how social media theories impact knowledge translation
Conclusion
Eight overarching themes emerging from the pre-publication phase: emotion and feeling (90.21%), hashtagging (40.21%), tagging (26.09%), education-related information (10.87%), research-related information (9.78%), conference (7.61%), statement (3.26%) and poll (2.17%). 16 overarching themes emerged from the post-publication phase: hashtagging (56.06%), tagging (36.79%), article posting (23.05%), emotion and feeling (21.83%), education-related information (19.54%), summarising (14.42%), notification of results (9.57%), media outlook (7.01%), conference (6.74%), commenting (6.06%), open questions (5.26%), judging ...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Bhullar, S. S., Ahmed, K. Tags: RCEM Moderated Papers Source Type: research
1790 Longitudinal coagulation profiles in patients presenting with acute severe traumatic brain injury (TBI): A prospective observational study
Conclusion
25 patients with severe TBI (GCS <12) were recruited. Patients were stratified by their admission INR. 18 patients had an admission INR <1.2 (62% n= 18), and 7 had INR >1.2 (38% n=7). 7 patients who did not have INR >1.2 on their first admission blood test later developed coagulopathy (with an INR >1.2).
Further exploration of the trends seen in conventional coagulation tests and TEG’s over time is required and to understand how these changes correlate to the clinical and imaging findings. The utility of viscoelastic studies such as TEG’s in the assessment of TBI associated coagulopath...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Barrett, L., Manktelow, A., Thomas, W., Disegna, A., Needham, E., OLeary, R., Boyle, A., Curry, N., Stanworth, S., Newcombe, V. Tags: RCEM Moderated Papers Source Type: research
1767 A survey to define the pre-hospital blood resuscitation practices of UK Air Ambulances
Conclusion
Nineteen (95.0%) AAs responded, and transported a total of 12,170 patients to hospital during 2019. The mean pre-hospital time (999-call to hospital arrival) was 92.2 (±18.6) minutes. 18 (94.7%) AAs routinely carried blood products, including combinations of red cells, thawed plasma, freeze-dried plasma, and fibrinogen concentrate, table 1. The mean units of red cells and plasma carried were 2.6 (±0.9) and 3.0 (±1.1) respectively.
709 (5.8%) adult patients received a prehospital transfusion, of which n=669 (94.4%) had a traumatic aetiology; n=384 (57.4%) and n=183 (27.4%) were transfused &ge...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Barnard, E., Green, L., Woolley, T., Stanworth, S., Cardigan, R., Smith, J. Tags: RCEM Moderated Papers Source Type: research
1690 Can triage based interventions reduce length of stay in a paediatric emergency department? A literature review
Conclusion
Nine studies (two randomised controlled trials, seven non randomised) were found. Interventions included; reallocated staff for triage, a paediatrician in triage and a series of triage nurse initiated treatments, investigations and protocols. Average reductions in emergency department length of stay ranged from four to forty four minutes per patient.
The common principle identified was early decision making. Statistical significance was demonstrated with few exceptions. Estimates of bias were low. The quality of evidence was high.
Limitations included; uneven benefit (e.g. whilst overall length of stay was reduc...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Heyningen, C. L. v. Tags: APEM Lightning Papers Source Type: research
1804 Survey of discharge practice and review of safety-netting instructions for children attending Emergency Departments in the UK & Ireland with acute wheeze or asthma: a PERUKI study
Conclusion
This two-phase study was conducted across PERUKI registered sites between June 2020 – September 2021. Phase 1 consisted of single site survey responses regarding departmental discharge practices for acute wheezy presentations. During phase 2, discharge instructions provided for caregivers underwent formal review. Data abstraction tools were developed based upon existing literature regarding written wheeze safety-netting information, BTS/SIGN 2019 asthma guidelines, NICE safety-netting recommendations and the BTS Asthma Discharge Bundle.
National comparison of discharge practices and written safety-netting ...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Hannah, R., Chavasses, R., Paton, J., Walton, E., Roland, D., Foster, S., Lyttle, M. Tags: APEM Lightning Papers Source Type: research
1657 Trauma imaging appropriateness in paediatric patients conveyed to a trauma unit compared to a major trauma centre - a retrospective observational study
Conclusion
In the study period n=315 patients were identified. 229 (72.7%) underwent CT <12hrs and were included in the analysis: n=93 MTC, n=136 TU, table 1. CT imaging was judged as appropriate in n=77/93 (82.8%) MTC and n=104/136 (76.5%) TU scans, p=0.32. The median time to first CT was 35.0 [26.0–75.0] minutes MTC, and 76.0 [48.0–109.0] minutes TU, p<0.0001.
Abstract 1657 Table 1CT appropriateness and timing associated with transfer status at a single MTC
Primary Attendance to MTC Secondary Transfer to MTC CT <12 hours of hospital arrival/n(%) 93 (41%) 136 (59%) Age in years/median [IQR ] 9....
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Hibberd, O., Price, J., Laurent, A., Agrawal, S., Barnard, E. Tags: APEM Lightning Papers Source Type: research
