The latest medical research on Emergency Medicine
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about emergency medicine gathered by our medical AI research bot.
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Safer coalmines, happier, healthier and more engaged canaries.EMA - Emergency Medicine Australasia
Addressing and limiting burnout and its significant impacts on emergency physicians is an important and ongoing challenge, requiring much more than...
Aeromedical retrievals in Queensland: A five-year review.EMA - Emergency Medicine Australasia
Aeromedical services are an essential part of the healthcare system. Centralised coordination of aeromedical retrieval tasking offers benefits for safety, timeliness and efficiency in service delivery. The aim of the present study is to review aeromedical retrievals in Queensland exploring patient demographics, temporal patterns and usage characteristics.
This is a retrospective cases series for the period 1 January 2010 to 31 December 2014 incorporating data from Retrieval Services Queensland and Queensland Newborn Emergency Transport Service. Ethics approval was obtained (JCU-HREC H6137 and Public Health Act #RD005673). Descriptive analysis of the de-identified data was undertaken included patient demographics, referral and receiving locations, retrieval platform and acuity of transport request.
There were 73 042 aeromedical retrievals undertaken during the period, with an average of 40 cases per day (range 16-89). The majority (95%) of retrievals were for Queensland residents. Overall 23.1% of cases were cardiology-related and 12.7% were injury-related. Older adults aged 75-84 years had the highest rate of retrievals relative to the population with a crude rate of 942.4 per 100 000 per annum. Overall 14.9% of cases were Priority 1, which represents the tasking with the highest acuity but majority were Priority 4 (41.6%). One third (37.6%) of all patients were from inner regional locations.
Potential investments in health service planning may alleviate the burden on aeromedical services, particularly related to cardiology services in inner and outer regional Queensland. Aeromedical services are pivotal in enabling all sick and injured residents' access to the highest quality of care regardless of the remoteness of their residence.
Understanding childhood injuries in rural areas: Using Rural Acute Hospital Data Register to address previous data deficiencies.EMA - Emergency Medicine Australasia
The state of childhood injury in rural areas of Victoria is poorly understood. Currently only data on those children transferred from smaller hospital settings to larger settings appear in existing government datasets, significantly underestimating the characteristics of injury.
Detailed emergency presentation data (Victorian Emergency Minimum Dataset [VEMD] and non-VEMD) that makes up the Rural Acute Hospital Data Register database was collected and compared among children (aged 0-14 years) who have a principal diagnosis of injury.
Of the 8647 episodes of care identified for injured children aged 0-14 years, 3257 children were managed initially at smaller hospitals that do not report episode data to existing datasets.
The Rural Acute Hospital Data Register database captures the presentations at low-resource sites and highlights as much as a 35% deficit in the data that is currently available to inform injury prevention and safety initiatives in Victoria.
Bringing Back the Human Connection with a Tablet.Academic Emergency Medicine
"Don't leave me alone," she said. "I'm scared," he said. "Please help me," they said. Their voices echo in my mind against the backdrop of chaos of...
Specialised vestibular physiotherapy in the emergency department: A pilot safety and feasibility study.EMA - Emergency Medicine Australasia
To evaluate the safety and feasibility of vestibular physiotherapy in the ED, and its impact on adherence to evidence-based clinical practice.
This prospective pre-post implementation study of adults presenting with dizziness symptoms of potential vestibular aetiology measured the proportion of participants safely completing vestibular physiotherapy assessment and treatment.
A total of 52 participants were recruited (20 usual care and 32 vestibular physiotherapy). Thirty (93.8%) of 32 completed all components of physiotherapy assessment, and there were no adverse events recorded.
The results of the present study support extending the role of physiotherapists to managing peripheral vestibular dysfunction in the ED.
The Son Also Rises.Academic Emergency Medicine
Being the child of an emergency medicine (EM) doctor means a lot of unappetizing dinner conversations. The nauseating remarks are usually casually ...
Impact of point of care testing on length of stay of patients in the emergency department: a cluster randomized controlled study.Academic Emergency Medicine
Crowding is a frequent concern in the emergency department (ED). Laboratory point of care testing (POCT) has been proposed to decrease patients' length of stay (LOS). Our objective was to determine whether an extended panel of POCT solutions could reduce LOS.
This was a single-center, prospective, open-label, controlled cluster-randomized study. Blood test processing was randomized into one-week inclusion periods: interventional arm (laboratory analyses performed on POCT analyzers implemented in the ED) or control arm (central laboratory). The primary endpoint was LOS of patients in the ED. Secondary endpoints were time to result (TTR), ED crowding surrogates, and average total cost of an ED visit in each arm.
A total of 23,231 patients were included and 20,923 analyzed for the main outcome measure. Mean age was 46 ± 20 years, and 7,905 (36%) underwent blood sampling. Mean LOS was 203 ± 161 and 210 ± 168 minutes (min) in the POCT arm and control arm, respectively. LOS reduction for the entire ED population was -9 min (95% CI -22 to 5; p=0.22) compared to the control arm, and -17 min (95% CI -34.0 to 0.6; p=0.06) for patients undergoing blood sampling. The mean TTR was 28 ± 31 and 79 ± 34 minutes in the POCT and control arm, respectively (TTR reduction -51 min (95% CI -54 to -48; p<0.001).
The implementation of an extended panel of POCT solutions in an ED did not significantly reduce the LOS, but reduced the TTR.
My Family Didn't Sign Up for This.Academic Emergency Medicine
"Will buddies." That was an unfortunate phrase a friend of mine and I coined together during a shift early in the pandemic. He was a resident in ou...
The rate of short-term revisits after diagnosis of non-specific abdominal pain is similar for surgeons and emergency physicians - results from a single tertiary hospital emergency department.Scandinavian Journal of
Acute abdominal pain can be a diagnostic challenge even for experienced surgeons. Delayed diagnosis can lead to higher morbidity, mortality and increased costs. While readmission rate has been used to evaluate quality of surgical care, studies addressing the issue in emergency departments (ED) are rare. The role of emergency physicians in the care of patients with abdominal pain is increasing in many European countries, including Finland. It is not known whether this has an effect on the number of readmissions. Here we evaluate whether the increasing role of emergency physicians in examining patients presenting with abdominal pain has affected the rate of short-term revisits among patients with non-specific abdominal pain (NSAP).
We identified consecutive ED patients receiving a diagnosis of NSAP 1.1. 2015-31.12.2016 in the ED of Tampere University Hospital. Those revisiting the ED within 48 h were selected for further analysis. Data were obtained from electronic medical records. We compared the outcomes of those initially examined by surgeons and by emergency physicians.
During the study period, 173,630 patients visited our ED, of whom 6.1% (n = 10,609) were discharged with a diagnosis of NSAP. Only 3.0% of patients revisited the ED, 0.7% required hospitalization and 0.06% immediate surgery. The short-term revisit rates among those originally examined by surgeons and by emergency physicians were similar, 2.8 and 3.2% respectively (p = 0.193).
The rate of short-term revisits in patients with NSAP was altogether low. The increasing role of emergency physicians in the care of acute abdominal patients did not affect the revisit rate.
Resuscitative endovascular balloon occlusion of the aorta may contribute to improved survival.Scandinavian Journal of
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an increasingly used trauma resuscitation procedure, however, there are no reports of whether or not the survival of patients treated with REBOA increases over time.
This retrospective cohort study from a nationwide trauma registry in Japan was conducted between 2004 and 2015. Patients treated with REBOA were divided into three calendar year periods: early-period (2004-2007), mid-period (2008-2011), and late-period (2012-2015). The primary outcome of in-hospital survival was compared between the periods (early-period: reference) using mixed effects logistic regression analysis after adjustment for characteristics, trauma severity, and therapeutic choices.
Of 236,698 trauma patients, 633 patients treated with REBOA were analyzed. Distribution of the patients across periods was as follows: early-period (91), mid-period (276), and late-period (266). In-hospital survival was 39, 49, and 60% in the early-period, mid-period, and late-period, respectively. In regression modeling, the late-period (OR = 2.976, 95% CI = 1.615-5.482) was associated with improved in-hospital survival compared to the early-period, however, the mid-period (OR = 1.614, 95% CI = 0.898-2.904) was not associated with improved survival.
Survival of patients treated with REBOA during the late-period improved compared with survival during the early-period, after adjustment for characteristics, trauma severity, and therapeutic choices. REBOA may be one of the important factors related to progression of modern trauma treatment.
Association of Emergency Department Opioid Administration with Ongoing Opioid Use: A Retrospective Cohort Study of Patients with Back Pain.Academic Emergency Medicine
Opioids are commonly administered in the emergency department (ED) and prescribed for the treatment of back pain. It is important to understand the unintended consequences of this approach to inform treatment decisions and the consideration of alternative treatments. Recent evidence has shown that ED opioid prescriptions are associated with future opioid use. The objective of this study was to measure the association of opioid administration in the ED to patients treated for back pain with future opioid use.
This is a retrospective study of opioid naïve adults discharged from the ED with a diagnosis of back pain. Patients were stratified by opioid therapy (none, ED administration only, prescription only, or ED administration + prescription). Relative risks of ongoing opioid use (filling >90-day supply in 180 days following ED visit as documented in the prescription drug monitoring program) were calculated for each opioid therapy group and compared to no the no opioid group.
We identified 24,487 opioid naïve back pain patients.. The median age was 38 years, 55% were female and 56% were non-Hispanic white. 41% received no opioid, 10% were only administered an ED opioid, 18% only received a prescription, and 31% received an ED opioid + prescription. The adjusted relative risks of ongoing use compared to the no opioid group were: ED only 1.9, prescription only 2.1, ED+ prescription 2.3. The increased risk persisted for other definitions of ongoing use and after adjustment for baseline pain scores.
For opioid naïve patients with back pain, both ED opioid administration and opioid prescriptions are associated with a doubling of the risk of ongoing opioid use compared to patients not treated with opioids. This supports the consideration of minimizing exposure to opioids while treating back pain in the ED.
Automated retrospective calculation of the EDACS and HEART scores in a multicenter prospective cohort of emergency department chest pain patients.Academic Emergency Medicine
Coronary risk scores are commonly applied to emergency department (ED) patients with undifferentiated chest pain. Two prominent risk score-based protocols are the Emergency Department Assessment of Chest pain Score Accelerated Diagnostic Protocol (EDACS-ADP) and the History, ECG, Age, Risk factors and Troponin (HEART) pathway. Since prospective documentation of these risk determinations can be challenging to obtain, quality improvement projects could benefit from automated retrospective risk score classification methodologies.
EDACS-ADP and HEART pathway data elements were prospectively collected using a web-based electronic clinical decision support (eCDS) tool over a 24-month period (2018-2019) among patients presenting with chest pain to 13 EDs within an integrated health system. Data elements were also extracted and processed electronically (retrospectively) from the electronic health record (EHR) for the same patients. The primary outcome was agreement between the prospective/eCDS and retrospective/EHR datasets on dichotomous risk protocol classification, as assessed by kappa statistics (ĸ).
There were 12,110 eligible eCDS uses during the study period, of which 66% and 47% were low risk encounters by EDACS-ADP and HEART pathway, respectively. Agreement on low risk status was acceptable for EDACS-ADP (ĸ = 0.73, 95% CI 0.72-0.75) and HEART pathway (ĸ = 0.69, 95% CI 0.68-0.70), and for the continuous scores (interclass correlation coefficients of 0.87 and 0.84 for EDACS and HEART, respectively).
Automated retrospective determination of low risk status by either the EDACS-ADP or HEART pathway provides acceptable agreement compared to prospective score calculations, providing a feasible risk adjustment option for use in large dataset analyses.