Response to: The rSIG for trauma: one size fits all?
We thank Shi and Mao for their interest1 in our recently published article on The age-adjusted Reverse Shock Index multiplied by the Glasgow Coma Scale (rSIG/A) in prehospital assessment of trauma patients and their allocation to trauma centres or trauma team activation.2 The authors point out some shortcomings in our manuscript. We would like to take the opportunity to address them. While we agree with Shi and Mao that considering site of trauma in general is an important contributor in advanced prediction model, we feel the need to emphasise that the aim was not to determine the best possible prediction model, but to fin...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Frieler, S., Lefering, R., Gerstmeyer, J., Drotleff, N., Schildhauer, T. A., Waydhas, C., Hamsen, U., the TraumaRegister DGU Tags: PostScript Source Type: research
The rSIG for trauma: one size fits all？
We read with great interest the article by Frieler et al.1 The authors validated the accuracy of the rSIG (SBP/HRxGCS) in predicting the risk of mortality in trauma patients. The results of this study are positive. However, we have some concerns before rSIG is commonly used in the prehospital setting. First, the site of the trauma is a significant contributor to the large degree of heterogeneity in trauma; hence, anatomical variables should be considered in clinical prediction models.2 For example, there was a U-shaped relationship between SI values and mortality in patients with head injuries, which means that hypertensio...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Shi, Q., Mao, Z. Tags: PostScript Source Type: research
Top research priorities in prehospital critical care
We thank Mark Hodkinson1 for his encouraging comments regarding our recently published modified Delphi study and we agree that the output will help to expand the evidence base underlying prehospital critical care delivery.2 We would like to respond to the points raised within the letter. The author rightly notes that a considerably lower proportion of paramedics participated than doctors. We stipulated a minimum of 6 months in a prehospital critical care role for clinicians to be eligible to participate but other than this, participation was open to all for rounds 1 and 2. The study was advertised through social media, cir...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Ramage, L., McLachlan, S. Tags: PostScript Source Type: research
Top research priorities in prehospital critical care
It is pleasing to see that the long-awaited update to the top research priorities for prehospital critical care has been published,1 and the authors should be commended on their study and its valuable contribution to the literature and developing prehospital critical care. The Delphi process,1 as described by the authors, was not without its limitations. It is unfortunate that there were not more paramedics involved in the later stages of the study: 24% of subject matter experts were paramedics, compared with 76% doctors.1 The paramedic profession, particularly growth within prehospital critical care and research, has a we...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Hodkinson, M. E., Thames Valley Air Ambulance Tags: PostScript Source Type: research
Abstracts from international emergency medicine journals
Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Production, E. Tags: Global emergency highlights Source Type: research
Journal update monthly top five
Introduction This month’s update is from the emergency department and critical care unit at Salford Care Organisation, within the Northern Care Alliance NHS Foundation Trust. We used a multimodal search strategy, drawing on free open-access medical education resources and focused literature searches. We identified the five most interesting and relevant papers (decided by consensus, with editorial oversight) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as Worth a peek: interesting, but not yet ready for prime time Head turner: new concepts Game changer...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Horner, D., Ambrose, C., Mills, L., Blevings, R., Raza, S., Ibrahim, E., Kilgour, P. M., Prager, G. Tags: Journal update Source Type: research
Point-of-care ultrasound in the assessment of appendicitis
Case presentation A 15-year-old boy presents to the ED with 1 day of periumbilical non-radiating abdominal pain. The pain, described as a stinging sensation, started gradually 1 day prior to presentation after eating lunch and increased to an intensity of 8 out of 10 at its worst over the day. The patient reports that the pain has since improved to 4 out of 10. He does not have fevers, chills, anorexia, nausea, emesis, urinary symptoms, stool changes, testicular pain or swelling, and prior abdominal surgery. The patient has no significant medical or surgical history, takes no medications and has no allergies. He is afebril...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Boyle, M. J., Lin-Martore, M., Graglia, S. Tags: Sono case series Source Type: research
Engaging, empowering and educating the waiting patient
While emergency departments are open to anyone without appointment, the need for prioritisation results in periods of waiting that are both wasteful and frustrating. However, value can be added to patient care by (1) engaging the waiting patient, (2) empowering the waiting patient and (3) educating the waiting patient. If these principles are implemented, they will benefit both the patient and the healthcare system. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Mohammed, A., Lockey, A. S. Tags: Concepts Source Type: research
How did the use of ED change during the first wave of the SARS-CoV-2 pandemic in the UK? An observational study
Conclusions
The study suggests that the decision to use the ED has a discretionary component. This could potentially contribute to unnecessary visits, and raises concerns that some patients who should present at the ED do not go. More effective communication about who should visit EDs during a pandemic, and the safety of doing so, is needed. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Calastri, C., Hess, S., Wilson, B. Tags: COVID-19 Original research Source Type: research
External validation of triage tools for adults with suspected COVID-19 in a middle-income setting: an observational cohort study
Conclusion
No risk score outperformed existing clinical decision-making in determining the need for inpatient admission based on prediction of the primary outcome in this setting. Use of the PRIEST score at a threshold of one point higher than the previously recommended best approximated existing clinical accuracy. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Marincowitz, C., Sbaffi, L., Hasan, M., Hodkinson, P., McAlpine, D., Fuller, G., Goodacre, S., Bath, P. A., Omer, Y., Wallis, L. A. Tags: Open access, COVID-19 Original research Source Type: research
Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis
Conclusion
In patients presenting to the ED with a diverse range of pain conditions, IVP provides similar levels of pain relief compared with opiates/opioids or NSAIDs at T30 post administration. Patients treated with NSAIDs had lower risk of rescue analgesia, and opioids cause more AEs, suggesting NSAIDs as the first-choice analgesia and IVP as a suitable alternative.
PROSPERO registration number
CRD42021240099. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Qureshi, I., Abdulrashid, K., Thomas, S. H., Abdel-Rahman, M. E., Pathan, S. A., Harris, T. Tags: Systematic review Source Type: research
A man with right flank pain
Clinical introduction A healthy, obese 38-year-old man had acute flank pain for 2 days. He also complained of a fever for 1 day. He denied haematuria, nausea, vomiting or constipation. A point-of-care abdominal ultrasound was obtained (figure 1). Question What is the diagnosis? Diverticulitis Appendicitis Epiploic appendagitis Urolithiasis Answer: C Epiploic appendagitis (EA) is an inflammation in the epiploic appendages, which is caused by spontaneous torsion or thrombosis of the central draining vein.1 EA is a rare occurrence but a benign and self-limited condition. However, the mimics of EA include appendicitis and dive...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Lee, H.-Y., Lien, W.-C., Wang, H.-P. Tags: EMJ Image Challenge Source Type: research
Methocarbamol versus diazepam in acute low back pain in the emergency department: a randomised double-blind clinical trial
Conclusions
In patients with LBP, the pain was relieved in the methocarbamol and diazepam groups after 60 min. Although diazepam was more effective, its use was associated with a slightly higher risk of drowsiness.
Trial registration number
The protocol of this clinical trial was prospectively registered in the irct.ir (IRCTID: IRCT20151113025025N4; https://irct.ir/trial/50148) . (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Sharifi, M., Abdorazzaghnejad, A., Yazdchi, M., Bahreini, M. Tags: Original research Source Type: research
Management of low back pain in Australian emergency departments for culturally and linguistically diverse populations from 2016 to 2021
Conclusion
Patients with low back pain from a CALD background, especially those lacking English proficiency, are significantly more likely to be imaged and admitted in Australian EDs. Future interventions improving the quality of ED care for low back pain should give special consideration to CALD patients. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Chen, Q., Maher, C. G., Rogan, E., Machado, G. Tags: Original research Source Type: research
Can you assess the Clinical Frailty Scale in the HEMS setting? A Feasibility Study
Patients living with frailty are at risk of worse outcomes.1 The Clinical Frailty Scale (CFS) is a tool that has been developed to assess a patient’s level of frailty.2 It is determined by a patient’s baseline health (status two weeks prior to hospital admission), with a score of 1 being very fit and 9 being terminally ill.2 Prior to the COVID-19 pandemic, frailty screening was part of the National Health Service England commissioning tariff, although there is no current agreement on when this should be assessed in the patient’s journey, and this has ceased since the pandemic.3 Helicopter emergency medica...
Source: Emergency Medicine Journal - June 22, 2023 Category: Emergency Medicine Authors: Morton, S., Gough, C. Tags: Research letter Source Type: research
