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
1655 The 'CCHILDS screen: a practical guide to a consultation with refugee and asylum seeking children within the Paediatric Emergency Department (PED)
Conclusion
This opinion article summarises three main aspects in the assessment of a refugee or asylum-seeking child in the paediatric emergency department. Firstly, the key considerations regarding the child’s background prior to entering the UK and the barriers they may encounter to accessing healthcare. Secondly, the healthcare assessment upon arrival to the emergency department and a framework that could be used for clinical assessment. Finally, the consideration of their long-term healthcare needs and the importance of empowering these young individuals to lead a healthy lifestyle. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Chawla, J., Houbby, N., Davies, S., Stewart, C. Tags: APEM Lightning Papers Source Type: research
1456 Fatal propranolol overdoses reported to the UK National Poisons Information Service (NPIS) over 5 years 01/01/2017-31/12/2021
Conclusion
There were 46 fatalities (aged 14–70 years) with 57% (n=26) of them being less than 40 years of age, and the majority of these being female (77%; n=20). Thirteen cases involved propranolol only and in the 33 cases of mixed overdose the mean number of co-ingestants was two, with a maximum of 13. An antidepressant was co-ingested in 21 cases. The reported dose of propranolol ingested was documented in 23/46 cases, median 3,200 mg (IQR 1,920–4,480 mg) and in three patients exceeded 7,000 mg. Cardiac arrest prior to contact with the NPIS was recorded in 41/46 cases. Fourteen (34%) occurred in hospital an...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Williams, H., Jagpal, P., Sandilands, E., Gray, L., Thanacoody, R., Bradberry, S. Tags: RCEM Lightning Papers Source Type: research
1723 Diagnostic accuracy of a novel transcriptomic classifier for bacterial and viral infections - an individual patient data meta-analysis
Conclusion
360 patients (54.4%) were consensus adjudicated to have a bacterial infection (range: 37.9–81.2%) and 153 (23.1%) to have a viral infection (range: 15.3–44.1%). Pooled likelihood ratios of the interpretation bands for bacterial infections were (from ‘very unlikely bacterial’ to ‘very likely bacterial’) 0.082 (0.039–0.176)/0.333 (0.264–0.419)/2.244 (1.598–3.152)/9.459 (5.808–15.404), associated with a rule-in specificity of 0.947 (0.915–0.967) and a rule-out sensitivity of 0.981 (0.960–0.991) in the outer interpretation bands. Pooled likeliho...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Uhle, F., Pilot Study Investigator group, Evangelos Giamarellos-Bourboulis, Bauer, W., Sun, L., Chen, U.-I., Sweeney, T. E., Liesenfeld, O. Tags: RCEM Lightning Papers Source Type: research
1423 The positives, the challenges and the impact: an exploration of early careers nurses experiences in the Emergency Department
Conclusion
Four key themes emerged; (1) Drawn to ED Nursing’ ; (2) ‘Teamwork’; (3)‘Time to care’ and (4) ‘Psychological impact’’. Opportunities for learning and development and being able to provide good levels of patient care were identified important to participants. Challenging aspects of the job included high workloads, exposure to traumatic incidents, violence and aggression. The psychological impact included feelings of burnout, exhaustion, flashbacks, personal growth and perspective. Teamwork, a strong support network and opportunities for formal and informal debrief w...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Skene, I., Power, H., Murray, E. Tags: RCEM Lightning Papers Source Type: research
1491 Determinants of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia
Conclusion
During the study period, 6184 patients were identified. After predefined exclusions, 998 patients were included in the final analysis. 218 (21.8%) patients recorded one or more episodes of PIH, with a peak prevalence at 8 minutes. The variables significantly associated with PIH were: age >55 years, pre-PHEA tachycardia (>100/minute), fluid administration prior to HEMS arrival, and fentanyl omission at induction, table 1.
The pseudo-R2 for the final model suggests there is significant variation in the outcome not explained by the captured variables alone. Clinician gestalt appears to successfully identify p...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Price, J., Lachowycz, K., Major, R., Moncur, L., McLachlan, S., Keeliher, C., Steel, A., Barnard, E. Tags: RCEM Lightning Papers Source Type: research
1482 Prognostic accuracy of triage tools for adults with suspected COVID-19 in a middle-income setting
Conclusion
Of the 446,084 patients, 15,397 patients (3.45%, 95% CI:34% to 35.1%) experienced the primary outcome. Figure 1 presents the ROC curves for the triage tools for the total study period and figure 2 for the period of the Omicron wave. NEWS2, PMEWS, PRIEST tool and WHO algorithm identified patients at risk of adverse outcomes at recommended cut-offs with moderate sensitivity (>0.8) and specificity ranging from 0.47 (NEWS2) to 0.65 (PRIEST tool). The low prevalence of the primary outcome, especially in the Omicron period, meant use of these tools would have more than doubled admissions with only a small reduction...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Marincowitz, C., Sbaffi, L., Hodkinson, P., Mcalpine, D., Hasan, M., Fuller, G., Goodacre, S., Omer, Y., Bath, P. Tags: RCEM Lightning Papers Source Type: research
1428 What influences decisions and predicts transfer of older care-home residents to the emergency department? A synthesis of qualitative reviews and systematic review
Conclusion
In the qualitative component, six previous reviews met the inclusion criteria. Three syntheses were formed : (i) Transfer decisions involve negotiation with unequal power dynamics between residents, family members, care home staff and clinical practitioners (ii) Some transfers occur with the expectation that treatment in hospital will improve outcomes (iii) Some transfers occur due to factors external to the resident with no expectation that hospitalisation will be beneficial.
Twenty-six primary studies met the inclusion criteria for the quantitative component. Seven common domains of factors associated with ED ...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Marincowitz, C., Preston, L., Cantrell, A., Tonkins, M., Sabir, L., Mason, S. Tags: RCEM Lightning Papers Source Type: research
1755 The differential determinants of delivering prehospital emergency anaesthesia within 45-minutes of the 999-call - a multi-centre, retrospective observational study
Conclusion
1,155 adult trauma patients were included in the analysis. The primary outcome, PHEA ≤45-minute of 999-call, was achieved in n=196 (17.0%) of cases. The data model is under construction. However, there is signal that non-immediate dispatch type, older age, and night-time operations are all associated with a reduced likelihood of delivering PHEA ≤45-minutes of the 999-call.
Less than one in five trauma patients receive PHEA ≤45-minutes of the 999-call in the East of England. Results from this project may positively influence dispatch systems in order to increase the timely delivery of prehospital anaesth...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Kratz, M., Price, J., Lachowycz, K., Major, R., Moncur, L., McLachlan, S., Keeliher, C., Steele, A., Barnard, E. Tags: RCEM Lightning Papers Source Type: research
1404 Patients attending the emergency department for blunt thoracic trauma: a validation study of the STUMBL score
Conclusion
745 patients were enrolled (median age 64 [50;78], male/female ratio 1:4, median Charlson comorbidity index 2 [1;4], median STUMBL score 11 [6;17]). 65.2% of patients were discharged home after ED evaluation. 203 patients (27.2%) developed the primary outcome. The STUMBL score was significantly different in patients with complications compared to those without complications (9 [5;13] vs 21 [17;25], p<0.001). The C index of the score for the primary outcome was 0.9 (95% CI 0.88 – 0.93) (figure 1), and the result of the Hosmer-Lemeshow test was 9.01 (p=0.34). STUMBL score = 16 had a negative predictive va...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Giamello, J. D., Martini, G., Santoro, M., Prato, D., Arese, Y., Battle, C. E., Driscoll, T., Artana, N., Barutta, L., Sciolla, A., Lauria, G. Tags: RCEM Lightning Papers Source Type: research
1583 Impact of digital technology in care homes on Emergency Department attendances
Conclusion
We identified 8,702 care home residents through linkage between the secondary care and HealthCall datasets. Preliminary results suggest the use of HealthCall reduces expected monthly ED attendances for care home residents by 16% (95%CI 5 to 25, p-value<0.001). No significant change was observed in the impact of HealthCall during the post-intervention period.
This study finds that the implementation of the HealthCall technology reduces the expected number of monthly emergency department attendances for residents. The technology allows for ongoing monitoring of resident health alongside providing more convenien...
Source: Emergency Medicine Journal - November 22, 2022 Category: Emergency Medicine Authors: Garner, A., Knight, J., Preston, N., Dixon, S., Watchorn, S., Caiado, C., McShane, C., King, G., Mason, S. Tags: RCEM Lightning Papers Source Type: research
