2300 Door-to-antibiotic time on mortality of admitted sepsis patients: systematic review and meta-analysis
Conclusion
We included 43 articles (190,974 patients). Pooled OR for mortality for patients who received antibiotics ≤1h was 0.85 (95%CI:0.68-1.07) comparing with patients who received antibiotics >1h. Reductions in the risk of death in patients with earlier antibiotic administration were observed in patients at 3h (OR:0.80, 95%CI:0.68-0.95) and 6h (OR:0.58, 95%CI:0.39-0.86). In subgroup analysis of sepsis patients with shock, pooled ORs for mortality at the time points of 1, 3 and 6h h for antibiotic administration were 0.95(0.73-1.22), 0.80(0.64-1.01) and 0.77(0.84-1.11) respectively. Among sepsis patients without ...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Graham, C., Leung, L. Y., Huang, H.-L., Leung, C. Y., Lam, C., Lo, R., Yeung, C. Y., Tsoi, P., Brabrand, M., Walline, J., Hung, K. Tags: RCEM Free Papers Source Type: research
2028 Is language a barrier to inclusion in research in paediatric emergency medicine? A rapid review of PEM research in the UK
Conclusion
1687 articles were found initially; 18 met the inclusion criteria. Eight studies (44.4%) reported exclusion of people requiring translation services. Nine studies (50%) made no mention of whether people requiring translation services were included or excluded in the study. 11 out of 18 survey responses were received. The key themes to exclusionary practice identified were oversight, access to adequate translation services (including cost implications), and lack of guidance.
English language proficiency was reported to be a reason for exclusion from participation in PEM research. Various challenges to inclusive p...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Walsh, H., Dliso, S., Ahmed, A., Moxon, M., Roper, L., Messahel, S. Tags: APEM Elizabeth Molyneux Prize Papers Source Type: research
2321 Accuracy of and patient compliance with NHS111 advice given by clinically vs non-clinically trained call-handlers regarding paediatric patients
Conclusion
Clinically Trained Call-handlers (CTCs) were much more likely than NCTCs to recommend self-care (OR=10.75*) and less likely to recommend ambulance conveyance (OR=0.43*), ED attendance (OR=0.76*) or primary care (OR=0.18*). Patients were less likely to attend ED following self-care advice from a CTC vs NCTC (OR=0.06*).
Patients attending ED following consultation with a CTC vs NCTC were more likely to receive a low-urgency ED classification if they received NHS111 advice to self-care (OR=1.25*) or seek primary care (OR=1.09*), but less likely to receive a low-urgency classification if advised to attend ED (OR=0.9...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Lewis, J., Simpson, R., Stone, T., Okeeffe, C., Ennis, N., Jay, N., Croft, S., Mason, S. Tags: APEM Elizabeth Molyneux Prize Papers Source Type: research
2113 Preferences of 16-17 year olds in the emergency setting as to their preferred ward area (adults or children) on admission
Conclusion
The findings indicated that 54.7% (52/95) of participants preferred to be seen in the Paediatric Emergency Department (PED), with 16-year olds showing a higher preference (62.2%) compared to 17-year olds (48.0%). Additionally, 58.9% (56/95) desired a choice in treatment location, and 67.4% (64/95) expressed a preference for age-specific wards during admissions. Notably, participants with learning disabilities (12/95) exhibited a significantly higher preference for PED (83.3%).
On average, 10 patients between the ages 16-17 attend ED per day with 8 discharged. At the very most, enabling patient choice will result...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Ha, H., Jones, S., Roland, D. Tags: APEM Elizabeth Molyneux Prize Papers Source Type: research
2135 Cooking on GAS: implementing guidelines for suspected Group A streptococcus in the emergency department at royal Aberdeen childrens hospital
Conclusion
21 BTS were sent in the 2 months pre-guideline (October – December 2022), and 137 BTS were sent in the 6 months post-guideline (December 2022 – June 2023). GAS positivity was 38.1% versus 33.6% respectively. Rates of GAS-positive patients receiving antibiotics on discharge decreased from 100.0% to 69.6% (p=0.077); all GAS-positive patients not given antibiotics on discharge were prescribed antibiotics after swab result. GAS-negative patients receiving antibiotics fell from 69.2% to 57.1% (p=0.543). FeverPAIN ≥4 had a PPV of 50% pre-guideline, whilst the post-guideline revised treatment threshold F...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Addinall, A., Bowbeer, C., Stephen, F. Tags: APEM Elizabeth Molyneux Prize Papers Source Type: research
2176 Measuring what matters: validation of the patient-reported outcome measure for older people living with frailty receiving Acute Care (PROM-OPAC)
Conclusion
66 participants completed the final draft PROM-OPAC. 98% responses were complete and median completion time was 11 (IQR: 12) minutes. Responses were adequately distributed without end-effects and internal consistency was acceptable (Cronbach’s alpha: 0.71). Eight items had acceptable fit on two factors for self-determination and security (RMSEA: 0.065; TLI: 0.917; CFI: 0.944) and as hypothesised these responses were lower when respondents had longer waiting times or required hospital admission.
Administration of PROMs for research in emergency care settings was feasible with older people living with frailt...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Oppen, J. v., Coats, T., Conroy, S., Mackintosh, N., Valderas, J. M. Tags: RCEM Rod Little Prize Papers Source Type: research
2178 Relative hypotension: the mortality effect of below-baseline systolic pressure in older people receiving emergency care
Conclusion
5136 (16%) of 32548 ED attendances were linkable with recent discharge vital signs. Relative hypotension exceeding 7mmHg was associated with increased 30-day mortality (HR: 1.98; 95%CI: 1.66-2.35). The adjusted risk tool (AUC: 0.69; sensitivity: 0.61; specificity: 0.68) estimated each 1mmHg relative hypotension to increase 30-day mortality by 2% (OR: 1.02; 95%CI: 1.02-1.02). 30-day mortality prediction was marginally better with NEWS2 alone (AUC: 0.73; sensitivity: 0.59; specificity: 0.78) and NEWS2 + relative systolic (AUC: 0.74; sensitivity: 0.62; specificity: 0.75).
Comparing ED vital signs with recent discha...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Oppen, J. v., Owen, R., Jones, W., Beishon, L., Coats, T. Tags: RCEM Rod Little Prize Papers Source Type: research
2296 Predicting recovery in patients with mild traumatic brain injury and a normal CT using diffusion tensor imaging
Conclusion
The study included 153 patients, aged 20-70 (mean 44) years, 108 (71%) male, 70 (46%) with an incomplete recovery. The best model without DTI (UPFRONT-PLUS) explained 10% (-6-26) of the variation in outcome (ViO) with an area under the curve (AUC) of 0.57 (0.47-0.68). Adding DTI raised the ViO to 74% (66-82) and the AUC to 0.79 (0.77-0.81), p <0.001.
NFL could have avoided 36% of DTI with a sensitivity of 0.81 (0.67-0.89) if sampled at initial presentation, or 24% with a sensitivity of 0.95 (0.81-0.98) if sampled at the time of DTI.
This suggests that NFL and DTI could help select mild TBI patients at risk of...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Richter, S., Winzeck, S., Czeiter, E., Kornaropoulos, E., Whitehouse, D., Wang, K., Buki, A., Maas, A., Correia, M., Menon, D., Newcombe, V. Tags: RCEM Rod Little Prize Papers Source Type: research
2168 Are acute care clinicians delivering optimal end of life care and recognising the dying patient?
Conclusion
44 patients met selection criteria. 10/44 patients had recognition of possible active dying on admission. 32/44 had anticipatory medications prescribed. 6/44 were considered for referral to palliative care. 36/44 remained on active treatment prior to death.
This study suggests that there is a slowness in the recognition of the dying patient and prioritising patient-focused symptom management. Recognition of dying is an essential first step in improving care for dying patients, perhaps a criterion score would be helpful in practice such as the "traffic lights" model or the "palliative performance score." Educatio...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: McKernan, T., Ingley, S. Tags: RCEM Rod Little Prize Papers Source Type: research
2218 Patterns of emergency service use among migrants: a systematic review
Conclusion
The review to date has identified 20 studies for inclusion. Data show emergency service use among migrants were comparable to non-migrants. Migrant emergency service attendees were less likely to be registered with a general practitioner than non-migrant patients, suggesting migrants may face additional barriers to accessing primary care services. Migrants were also more likely to report self-referral to emergency services rather than referral through primary care services.
These findings raise concerns about health inequities amongst migrant populations who self-refer to emergency care (bypassing preventative c...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Matthews, N., Nellums, L., Jarman, H., Hargreaves, S. Tags: RCEM Rod Little Prize Papers Source Type: research
2175 The views of emergency care providers on providing emergency healthcare for asylum seekers and refugees
Conclusion
12 semi-structured interviews were carried out – 6 Doctors and 6 Nurses. 6 themes were developed across a spectrum of themes related to the individual and those related to the health system as a whole, namely: Behaviour and Culture; Presentation Patterns; Health System Literacy; ED Structure and Capacity; and Beyond the ED. Quotations outlined in the table attached demonstrates aspects of the themes identified. Portions of the data reflect previous findings - for example language barrier - highlighting their generalisability. New themes are also brought to light including particular issues around ED triage...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Doherty, C. Tags: RCEM Rod Little Prize Papers 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 - November 28, 2023 Category: Emergency Medicine Authors: Production, E. Tags: Global emergency highlights Source Type: research
Journal update monthly top five
This month’s update is by the St James’ Hospital, Dublin team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlighted 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—this paper could/should change practice. Venous thromboembolism with use of hormonal contraception and non-steroidal a...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Hamza, M., Kelly, O., O'Gara, C., Cuddihy, P., Bourke, M., Garcia Cadena, M. A., McMahon, G., Darbyshire, D. Tags: Journal update Source Type: research
Compass for antibiotic stewardship: using a digital tool to improve guideline adherence and drive clinician behaviour for appendicitis treatment in the emergency department
Conclusion
Antibiotic stewardship can be improved by ensuring clinicians have access to convenient and up-to-date guidelines through clinical decision support systems. The FITT model can help guide projects by identifying individual, task and technology barriers. Sustained adherence to clinical guidelines through simplification of guideline content is a potentially powerful tool to influence clinician behaviour in the ED. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Vu, M. T., Schwartz, H., Straube, S., Pondicherry, N., Emanuels, D., Dhanoa, J., Bains, J., Singh, M., Stark, N., Peabody, C. Tags: Original research Source Type: research
Developing an implementation intervention for managing acute vertigo in the emergency department
Conclusion
This study found several barriers to managing acute vertigo such as memory constraints, and inadequate supporting materials and training, although a robust desire for change. The implementation strategy’s initial phase is described, which must now be tested. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Herdman, D., Ahmad, H., Antoniades, G., Bailur, G., Pajaniappane, A., Moss, P. Tags: Original research Source Type: research
