2139 Major trauma services in space and time: a retrospective cohort study of geospatial and temporal factors in major trauma and its pre-hospital care in the North of England
Conclusion
2987 incidents were included, 22% attended by PHCC teams. Compared to conventional ambulance services, PHCC teams were more likely to respond major trauma in areas of greater geographic isolation (OR 2.10, 95% CI 1.22-3.48), p=0.005). There were significant differences in the mechanism of injury attended and no significant difference in likelihood of PHCC response by day or night period. PHCC team response and increasing geographic isolation was associated with longer on-scene times (p <0.005).
PHCC teams are more likely to respond in areas of greater geographic isolation and have the potential to mitigate ge...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: McHenry, R., Smith, C. Tags: RCEM Moderated Source Type: research
2136 The association of ABO and Rh blood groups with 30-day mortality following traumatic injury - a retrospective observational study
Conclusion
4188 patients were included. The median age was 59.3 [39.0-77.9] years, n=2634 (62.9%) were male, the median injury severity score was 19 [10-25], and 30-day mortality was 9.3%. Pairwise comparison demonstrated increased mortality in O Rh negative patients (Oneg) compared to three other groups, table 1. Compared to all other ABO Rh groups combined, Oneg patients had significantly greater 30-day mortality – 15.1% compared to 8.8%; RR 1.72 (95%CI 1.32-2.24), p=0.0002 (significance defined as p<0.0063 (eight comparisons)). There was no difference in admission PT or aPTT between Oneg and all other groups co...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Li, J., Bell, R., Barnard, E., Barrett, L., Basheer, B., Bowman, J., Boyle, A. Tags: RCEM Moderated Source Type: research
2315 Understanding seasonal demand for emergency care: aggregating routine data from regional emergency departments and acute hospital admissions
Conclusion
After controlling for key variables, results indicated that ED outcomes showed more seasonal and regional variation than APC outcomes (figure 1). However, there were no clear systematic effects of winter across all sites for any outcome.
Findings suggest that seasonal pressures on emergency care are complex and not due simply to increases in treatments or procedures, or to increased avoidable usage. Although seasonal virus diagnoses were controlled for, absolute numbers of these cases were too small to have fully accounted for seasonal pressure. Hospitals may already be accounting well for increased seasonal dem...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Lewis, J., Jacques, R., Simpson, R., Hasan, M., Croft, S., Croft, S., McMurray, R., Mason, S., HDRUK Regional Linked Data Consortium Tags: RCEM Moderated Source Type: research
2340 The role of NEWS in predicting short term morbidity and mortality in the ED
Conclusion
256,701 patients were included finally, consisting of 247,842 (96.55%), 5,847 (2.28%) and 3,012 (1.17%) in low, medium, and high NEWS categories. The primary outcome of mortality within 24-hours was comprised of 205 (0.08%) patients. The logistic regression model performance achieved AUROC curves between 0.65 - 0.95 (24-hour mortality 0.95, 48-hour mortality 0.94, ICU admission 0.82, inpatient admission 0.68, 7-day reattendance 0.65). Within this study of an undifferentiated population of emergency care attendances across East London, increasing NEWS was associated with increased mortality, admission and reatten...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Lai, J., Pott, J., Bloom, B. Tags: RCEM Moderated Source Type: research
2161 What happened to my patient? A novel automated patient follow up system for emergency medicine clinicians reflections
Conclusion
48 EM clinicians (59%) of all grades responded. Most read these emails (93.8%) and 27.1% read every email in detail. 91.7% agreed with the statement ‘I have found the automated follow-up emails useful’ (61.1% strongly agreed).
Clinicians used the information for workplace-based assessments, supervisor meetings, discussion with peers and to facilitate collection of patient feedback. The qualitative feedback was also positive ‘It’s brilliant, informative and helpful for me as an established consultant to reflect on the cases I see and advise on.’
This novel system provides EM clinici...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Croft, S., Harding, J., Hartshorn, R., Bircher, T., Singleton, P. Tags: RCEM Moderated Source Type: research
2109 Prehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort study
Conclusion
We linked 12870/24955 (51.6%) cases and identified 348/12870 (2.7%) with a positive reference standard. None of the strategies provided high sensitivity (>0.80) with acceptable positive predictive value (>0.15). The National Early Warning Score, version 2 (NEWS2) provided combinations of sensitivity and specificity that were similar or superior to all other early warning scores. The area under the receiver operating characteristic curve for NEWS2 applied to patients with a diagnostic impression of sepsis or infection was 0.756 (95% confidence interval [CI] 0.729 to 0.783). NEWS2 thresholds of >4, >6 ...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Goodacre, S., Sutton, L., Hawksworth, O., Iftikhar, K., Croft, S., Fuller, G., Millins, M., Waterhouse, S. Tags: RCEM Moderated Source Type: research
2238 When a doctor and a nurse share their view in a simulated emergency care interaction: developing an automatic gaze annotation method for multiple eye-tracking data analysis
Conclusion
Three forms of joint gaze behaviours were recognised: joint attention (two people look at the same part of an object), narrow joint field view (two people look at different parts of an object, see figure 1), and broad joint field view (two people share a view field but look at different objects). Although it is still preliminary, the technology enables researchers to analyse shared field view, in addition to joint attention, between team members. This has great potential for further research on health team interactions and its application to medical education.
Abstract 2238 Figure 1Still image: annotated images...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Coffey, F., Reilly, J.-J., Mackenzie, A., Bise, K., Saitoh, T., Meredith, M., Ryan, L., Timmons, S., Tsuchiya, K. Tags: RCEM Moderated Source Type: research
2268 Thoracic wall regional blocks: safe and effective approach to analgesia for rib fractures in ED
Conclusion
We conducted 131 blocks, with 80% being single-shot injections and 20% involving catheter insertions. The average BATTLE score in this group was 28.2 (80% probability of complications). Remarkably, no major complications requiring intervention occurred during the study. We did observe nine minor complications, but none of them necessitated any intervention (<1% for single-shot blocks). ED Physicians are already well-versed in the use of ultrasound. Our study demonstrates that ED Physicians can safely administer early SAPB and ESP to patients with multiple rib fractures within the Emergency Department.
Abstra...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Bailur, G. S., Hudson, A., Jones, G., Tucker, H. Tags: RCEM Moderated Source Type: research
2173 Developing an integrated care programme for acute paediatric settings
Conclusion
Key considerations include the importance of dual-trained staff handling acute and mental health needs. Staff should possess an awareness of the various components of the programme and clear communication strategies to ensure seamless care transitions. Barriers included unanticipated cost changes, and difficulties in securing a physical space within an emergency care setting, which is appropriate, safe, and able to meet young people’s needs. This study highlights challenges in developing a complex mental health programme in the NHS emergency setting. Our findings emphasise the need for shared awareness of ...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Rajabzadeh, V., Chantziara, S., Otis, M., Barber, S., Hofer, S. G., Straus, J., Kay, M., Hayhoe, B., Nicholls, D. Tags: APEM Lightning Papers Source Type: research
2134 Evidence based medicine - a FORCE for environmental sustainability
Conclusion
The carbon count of a wrist splint (Promedics wrist splint) was found to be 0.967 kgCO2e whilst that of a bandage was 0.038 kgCO2e, meaning a carbon reduction of 0.929613 kgCO2e per patient. As it is estimated that there are approximately 60,000 annual presentations to UK Emergency Departments with buckle fractures of the wrist this would equate to a potential reduction of 55,777 kgCO2e (56 tonnes CO2e). To put this into context on average a tree absorbs in the region of 25 kgCO2e a year, therefore to offset the use of splints instead of a bandage more than two thousand trees would need to be planted.
The FORCE...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Hewitson, R. Tags: APEM Lightning Papers Source Type: research
2023 In paediatric trauma patients presenting to a paediatric major trauma centre, does the choosing wisely criteria safely reduce the rate of abdominal CT scanning?
Conclusion
Intra-abdominal injury was found in 20.9% of all scans. 96.4% of CT abdomen requisitions adhered to NWCMTN guidelines. NWCMTN guidelines identified 3.6% of patients with no indications for a CT abdomen. The Choosing Wisely criteria identified 5.2% of patients at very low risk of intra-abdominal injury with no indications for a CT abdomen.
Almost all decisions to perform a CT abdomen in paediatric major trauma in the ED at Alder Hey are consistent with the NWCMTN guidelines. CT abdomen scans could be safely reduced by adopting the Choosing Wisely criteria. This audit highlights the importance of maximising guidel...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Reece, N., Messahel, S. Tags: APEM Lightning Papers Source Type: research
2064 Going green and on screen: digitalising patient information resources in a paediatric emergency department
Conclusion
Since go–live (August 2022) electronic resources have become the standard first offer for families
44 core electronic ED resources cover safety net advice for common conditions, health promotion and signposting links to support health inequalities
Sharing options: scanned via QR code (see figure 1), sent via text/SMS or printed to avoid impacts related to digital poverty
All resources can be translated via a Google translate function (132 languages)
The entire trust library of 1358 resources are accessible to any clinician and any patient user
On average, ED resources are accessed 4675 times/month.
To...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Gibbs, S., Sabir, L. Tags: APEM Lightning Papers Source Type: research
2086 The value of emergency care data set (ECDS) presentation codes for predicting mortality and inpatient admission
Conclusion
Data was collected from 84,999 patients, of which 1,159 people died within 30 days of attendance.
The mortality rate was the highest in Cardiac arrest (78.05%), Cardiac arrest due to Trauma (50%) and Respiratory arrest (50%). Drowsy (11.97%), Hypothermia (13.04%) and Cyanosis (10%) were also high risk categories. Chest pain was not a high risk presenting complaint. (table 1)
The initial presenting complaint in ECDS shows a useful ability to identify people at high and lower risk of death. This information may be useful for building automated triage models.
Abstract 2086 Table 1 Presentations Total first prese...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Teresa, B., Boyle, A., Subhi, M. Tags: RCEM Lightning Papers Source Type: research
2245 Mixed methods study exploring factors influencing ambulance clinician decisions to pre-alert emergency departments (EDs) of a patients arrival
Conclusion
Variation in pre-alert practice was not fully explained by casemix. Overall 142,795/1,363,274 conveyances were pre-alerted. Highest overall odds ratios (ORs) for pre-alert were associated with patient factors (working diagnosis OR:4.16,CI:4.05-4.26, NEWS2 OR:1.4,CI:1.39-1.4) but thresholds for pre-alerting varied between ambulance clinicians. Pre-alerts were more likely when there were longer turnaround times at EDs (OR:1.83,CI:1.69-1.98), potentially due to ambulance clinicians’ concerns about their ability to effectively manage deteriorating patients where long handovers were anticipated. There was a sig...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Sampson, F., Pilbery, R., Herbert, E., Long, J., Coster, J., OHara, R., Bell, F., Goodacre, S., Rosser, A., Spaight, R., Millins, M. Tags: RCEM Lightning Papers Source Type: research
2037 Multimorbidity and adverse outcomes in the emergency department: a cohort study
Conclusion
There were 1,273,937 attendances to EDs in the region during the study period, corresponding to 451,291 patients. The prevalence of multimorbidity was 9.6% (n=43504). After adjusting for confounding, multimorbidity was associated with higher 30-day mortality (8.2% vs 1.2%, OR 1.81 (1.72-1.91),p<0.001), longer time spent in department (mean difference 16 minutes (16-17 minutes), p<0.001), higher rate of hospital admission (60.1% vs 20.5%, OR 1.81 (1.76-1.86),p<0.001) and higher 7-day ED reattendance in those discharged from ED (7.8% vs 3.5%, OR 1.41 (1.32-1.50),p<0.001) . Magnitude of associations bet...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Reed, M. J., Blayney, M., Masterson, J., Lone, N. Tags: RCEM Lightning Papers Source Type: research
