Emergency Medicine Journal最新文献

{"title":"Disposable female urinal bottle (the UniWee) improves patient experience for immobile women with lower limb fractures.","authors":"Sophy Booth, Peter Ellis, Mark D Lyttle, Savneet Lochab, James Pegrum, Siân Thomas","doi":"10.1136/emermed-2024-214181","DOIUrl":"https://doi.org/10.1136/emermed-2024-214181","url":null,"abstract":"<p><strong>Background: </strong>Female patients with lower limb fractures experience pain and loss of dignity when manoeuvered onto a bedpan. Poor bladder management, including urinary catheterisation for convenience, can lead to longer hospital stays and eventual loss of independence. Staff at Great Western Hospital Emergency Department modify disposable male urinal bottles to accommodate the female perineum without need to reposition the patient. These have not been used consistently and no formal evidence supported their use.</p><p><strong>Methods: </strong>This project was inspired by a patient who advocated widespread use of the 'female' urinal. We formalised the design of the urinal and spread use to other hospitals and an ambulance service in the South West of England over three improvement cycles. Feedback on utility and acceptability of this urinal was sought from the study group of female immobile patients (primarily hip fracture) and healthcare staff supporting them to use the urinal. Local feasibility studies were initiated in an emergency department and then extended to the emergency and trauma departments. The final cycle was a study in four hospital sites. Evaluation was conducted from January 2021 to February 2023.</p><p><strong>Results: </strong>The final study cohort included 103 immobile female patients and 118 healthcare professionals. 74% of patients (n=103) and 78% of healthcare professionals (n=118) in this trial would recommend the urinal. Patients felt they avoided pain because the urinal minimised movement and that it was a more dignified way to void their bladder. Healthcare professionals felt that the potential advantages were reducing the need for urinary catheters, and reducing lifting and log rolling patients.</p><p><strong>Conclusion: </strong>A disposable urinal that accommodates female anatomy and supplies the same advantage as the male urinal bottle in allowing the patient to void the bladder without repositioning, appears to be acceptable to patients and staff and would have value in many clinical settings.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In emergency settings, does the use of testicular pulse oximetry aid diagnosis of testicular torsions?","authors":"Lauren Grace Edwards, Joshua William Feldman, Craig Ferguson","doi":"10.1136/emermed-2025-214936","DOIUrl":"https://doi.org/10.1136/emermed-2025-214936","url":null,"abstract":"<p><p>Pulse oximetry is a non-invasive and inexpensive method of detecting oxygenation, which could help to reduce unnecessary scrotal exploration and expedite diagnosis if shown to be accurate in patients with suspected testicular torsion. A short systematic review was conducted to address the following three-part question: in emergency settings, can the use of testicular pulse oximetry aid the diagnosis of testicular torsion?The Medline, Embase and Cochrane databases were searched using the Ovid interface on 29 January 2025. The search included papers from 1946 on Medline, from 1974 on Embase and from 1998 on Cochrane. The search strategy yielded one study that directly answered the three-part question. Study information, participant group, relevant outcomes and study weaknesses were extracted.The only study identified was a case series including 16 participants. Results showed that oxygen saturation and pulse rate were undetectable in all torted testes but detectable in all unaffected testes. However, due to the small sample size, the results of this study cannot be reliably extrapolated to a wider population. This review excluded research articles where near-infrared spectroscopy was used rather than pulse oximetry to characterise testicular blood flow, though that technology may also show future promise.The clinical bottom line is that there is currently insufficient evidence for the use of pulse oximetry in this context. However, the evidence identified suggests that the technique shows promise, particularly for use in resource-poor environments.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of nasal clips as first aid for anterior epistaxis.","authors":"Bethany Foo, Ame Kumba Saidy","doi":"10.1136/emermed-2024-214829","DOIUrl":"https://doi.org/10.1136/emermed-2024-214829","url":null,"abstract":"<p><p>A short systematic review was undertaken to establish whether the use of a nasal clip is superior to manual compression as first aid in patients presenting to the ED with epistaxis. A systematic keyword search of EMBASE, MEDLINE, Cochrane and Google Scholar databases returned two relevant papers. The author, year, country of publication, patient group studied, study type, key findings and weaknesses are tabulated. Our results suggest that nasal clips are an effective intervention for first aid in epistaxis, although larger prospective studies are required to fully address this clinical question.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing time delays and enhancing reperfusion eligibility related to stroke suspicion by the Emergency Medical Dispatch Centre: a registry-based observational study.","authors":"Nedim Leto, Elisabeth Farbu, Paul Barach, Michael Busch, Helene Lund, Conrad Arnfinn Bjørshol, Martin Kurz, Annette Fromm, Øyvind Østerås, Linn Therese Hagen, Thomas Werner Lindner","doi":"10.1136/emermed-2024-214294","DOIUrl":"https://doi.org/10.1136/emermed-2024-214294","url":null,"abstract":"<p><strong>Background and aims: </strong>Research on the importance of the Emergency Medical Dispatch Centre (EMDC) role in reducing the time delays for patients with acute ischaemic stroke (AIS) is limited. This study aimed to analyse how Norwegian EMDCs' accurate suspicions can impact the clinical care times in this patient group.</p><p><strong>Methods: </strong>We collected clinical care time metrics and acute reperfusion treatment data from the Norwegian Stroke Registry on patients with AIS in Western Norway who were evaluated by the EMDC and had an ambulance dispatched in 2021. In case a stroke was suspected by the EMDC, the dispatcher communicated their diagnosis suspicions to the ambulance personnel. Outcomes of interest were reperfusion treatment for AIS, prehospital and in-hospital time-to-treatment delays, and patient outcomes.</p><p><strong>Results: </strong>Of the 1106 patients with AIS in our region, 771 (70 %) fulfilled the inclusion criteria. The EMDC suspected a stroke in 481 cases (62 %). Patients with suspected stroke experienced lower ambulance on-scene times (11 min vs 15 min; p=0.001), Emergency Medical Service prehospital times (40 min vs 49 min; p=0.021) and door-to-needle times (23 min vs 31 min; p=0.023). The EMDC stroke suspicion was associated with increased thrombolysis rates (OR 2.42 (95% CI 1.72 to 3.40)) after adjusting for age, sex, risk factors and functional status prior to the stroke event. The door-to-groin puncture times were lower for patients with a stroke suspicion who received endovascular treatment (65 min vs 85 min; p=0.004). No differences in the National Institutes of Health Stroke Scale score at the initial hospital arrival (4 vs 4; p=0.42) or in 90-day functional independence outcomes (rate of modified Rankin Scale score 0-2; 240 (61%) vs 160 (66%); p=0.24) were observed.</p><p><strong>Conclusions: </strong>Accurate EMDC recognition of stroke suspicion alerts to ambulances were associated with a reduction in time until treatment and increased intravenous thrombolysis rates. A significant proportion of patients who had a stroke were not identified by the dispatcher. Improving dispatcher stroke assessment training, tools and knowledge may reduce time delays, thus improving patient outcomes.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproducibility of the Manchester Triage System: a multicentre vignette study.","authors":"Arian Zaboli, Francesco Brigo, Gabriele Magnarelli, Hugh Gorick, Tiziano Garbin, Patrick Clauser, Serena Sibilio, Gloria Brigiari, Magdalena Massar, Michael Mian, Norbert Pfeifer, Gianni Turcato","doi":"10.1136/emermed-2024-214213","DOIUrl":"https://doi.org/10.1136/emermed-2024-214213","url":null,"abstract":"<p><strong>Background: </strong>While several studies have evaluated the performance of the Manchester Triage System (MTS), none have specifically examined its accurate application by triage nurses and its association with clinical outcomes. This study focuses on the agreement between nurse-assigned MTS codes and those assigned by an expert group, as well as their ability to predict clinical outcomes.</p><p><strong>Methods: </strong>This multicentre simulation study was conducted from January to March 2024 across four EDs in Italy employing MTS in clinical practice. Two emergency physicians developed 30 vignettes derived from real clinical cases to encompass diverse triage scenarios and priority codes. An expert MTS group, composed of three experienced nurses, assigned MTS priority codes following the guidelines outlined in the official MTS textbook. Subsequently, the vignettes were presented to triage nurses, who independently assigned MTS codes. Error rate, agreement between nurse-assigned and expert MTS group codes, and the predictive ability for secondary clinical outcomes (mortality within 72 hours, hospitalisation, life-saving intervention, severe condition in the ED and time-dependent pathology) were compared between the MTS priority assigned by the expert MTS group codes and nurse-assigned triage codes.</p><p><strong>Results: </strong>77 nurses from four EDs participated. The triage code assignment error rate was 28.6% (660/2310). The overall agreement between the triage and expert nurses yielded a Cohen's kappa of 0.59 (95% CI 0.58 to 0.59). Expert MTS group applications performed better compared with nurse-assigned codes in predicting clinical outcomes. The mean error rate per nurse was 30% (9/30). Nurses with more ED experience and triage expertise had higher error rates.</p><p><strong>Conclusion: </strong>The application of MTS using case vignettes was suboptimal in our setting, with more senior nurses having higher error rates. Correct application of MTS better predicted clinical outcomes. It is important to conduct future studies to understand how to best support nursing clinical decision-making in triage.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of nasogastric tube location using point-of-care ultrasonography in paediatric patients.","authors":"Ayla Akca Caglar, Oksan Derinoz Guleryuz, Songül Tomar Güneysu, Özlem Çolak","doi":"10.1136/emermed-2024-214126","DOIUrl":"https://doi.org/10.1136/emermed-2024-214126","url":null,"abstract":"<p><strong>Background: </strong>Nasogastric tubes (NGTs) are used in children emergency departments (EDs) for gastric decompression, as well as for enteral nutrition and drug administration in hospitalised patients. Radiography is considered the gold standard for determining NGT location and may require repeat films until the tube is appropriately positioned. Point-of-care ultrasonography (POCUS) could potentially be useful in avoiding radiation in these children.</p><p><strong>Methods: </strong>Between September 2022 and February 2023, patients aged 0-18 years who presented to the Gazi University Faculty of Medicine Paediatric ED in Turkey and received NGTs were eligible for the study and included when our paediatric emergency physician certified in POCUS was present. The operation used a convex probe in B-mode to visualise the NGT tip as a hyperechoic line in the stomach. If not visualised, the air was injected through the tube to look for an air artefact on ultrasound. Radiographs were subsequently performed and interpreted by the treating ED physician, blinded to POCUS findings. The accuracy of POCUS was determined using radiography as a reference standard.</p><p><strong>Results: </strong>Twenty (13 boys) children were included in the study. The median age of the patients was 20 (IQR 9-108) months. 16 patients had underlying chronic neurological and metabolic diseases or congenital anomalies. Of the 20 NGTs, radiography detected 18 in the stomach. POCUS confirmed the NGT in the stomach for 15 of these patients by visualising the tip or air artefact. When radiography located the NGT in the oesophagus in two patients, POCUS was negative. The resulting test characteristics were as follows: sensitivity was 83% (95% CI 59% to 96%), specificity 100% (95% CI 16% to 100%), negative predictive value 40% (95% CI 19% to 65%), positive predictive value 100% (95% CI 78% to 100%) and accuracy 85% (95% CI 62% to 97%).</p><p><strong>Conclusion: </strong>POCUS may be an alternative method to radiography to confirm the location of the NGT in children. However, studies with a broader patient population are needed.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the refusal of first-aid instructions during emergency calls: an exploratory analysis of dispatchers' feedback.","authors":"Guglielmo Imbriaco, Donatella Del Giudice, Nicola Ramacciati","doi":"10.1136/emermed-2024-214436","DOIUrl":"https://doi.org/10.1136/emermed-2024-214436","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drivers of low-value diagnostic tests in emergency medicine practice: a qualitative descriptive study.","authors":"Vinay Gangathimmaiah, Rebecca Evans, Nishila Moodley, Tarun Sen Gupta, Karen Carlisle","doi":"10.1136/emermed-2024-214241","DOIUrl":"https://doi.org/10.1136/emermed-2024-214241","url":null,"abstract":"<p><strong>Introduction: </strong>Low-value diagnostic tests harm patients and healthcare systems. Elucidation of determinants of low-value tests is essential for their de-implementation. The aim of this study was to understand the drivers of low-value tests in emergency medicine (EM) practice.</p><p><strong>Methods: </strong>A qualitative descriptive study was conducted at an Australian academic ED. Purposive sampling was used to recruit participants. Semistructured interviews were used to collect data between February 2023 and May 2023. Interviews were audio-recorded, transcribed verbatim and uploaded to NVivo. Data were thematically analysed through line-by-line and axial coding. Codes were assigned to categories, subthemes and themes. Themes were further analysed using the behavioural domains of the Theoretical Domains Framework. Trustworthiness was ensured through reflexivity, data triangulation, thick description, audit trail and member checking.</p><p><strong>Results: </strong>Twenty-four interviews were conducted with participants who had a breadth of EM experience: 19 senior EM doctors and 5 doctors in EM training. Low-value tests were inherently understood and unanimously acknowledged by participants. Six drivers of low-value tests emerged: efficiency, culture, resources, complexity, consequences and abilities. Drivers exerted influence at systemic and individual levels by hindering (barriers) or facilitating (enablers) de-implementation of low-value tests. Drivers mapped to the following behavioural domains of the Theoretical Domains Framework: environmental resources and context (resources, complexity, efficiency), social influences (culture), belief about consequences (consequences), and beliefs about capabilities (abilities).</p><p><strong>Conclusion: </strong>An interconnected web of systemic and individual drivers is influencing emergency doctors' behaviour to perform low-value tests. De-implementation of low-value tests will require behavioural change through contemporaneous navigation of multilevel drivers. Behavioural change theories like the Theoretical Domains Framework provide a robust framework to navigate change in collaboration with multidisciplinary clinicians and community. Evidence-based, theory-informed, co-designed interventions are needed to address the drivers of low-value tests.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical guidelines: what drives local adoption?","authors":"Christopher Humphries","doi":"10.1136/emermed-2025-214889","DOIUrl":"https://doi.org/10.1136/emermed-2025-214889","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness and management of cannabinoid hyperemesis syndrome among staff in emergency departments in Wales.","authors":"James Ellis, Suresh Kumar Gopala Pillai","doi":"10.1136/emermed-2024-214519","DOIUrl":"https://doi.org/10.1136/emermed-2024-214519","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}