Emergency medicine journal : EMJ最新文献

{"title":"Response to performance of the Hull Salford Cambridge Decision Rule: the start of the traumatic brain injury (TBI) assessment and recovery journey.","authors":"Carl Marincowitz, Benjamin Gravesteijn, Trevor Sheldon, Ewout Steyerberg, Fiona Lecky","doi":"10.1136/emermed-2022-212480","DOIUrl":"https://doi.org/10.1136/emermed-2022-212480","url":null,"abstract":"In the CENTER-TBI core cohort, 30% of patients with TBI managed and discharged from the ED had persistent disability and a Glasgow Outcome Scale score of less than eight months following injury.3 However, initial CT findings in mTBI are not necessarily predictive of longer term disability and functional impairment following injury.4 5 Therefore, our study cohort of patients with mTBI with injuries identified on CT imaging may not be at higher risk of longer term functional impairment and need for rehabilitation than other patients with mTBI. The primary purpose of the risk assessment and selection of patients for CT imaging who have sustained head trauma in the ED is to identify potentially life-threatening injuries which may require neurosurgical intervention and admission to hospital due to the risk of deterioration.6 The aim of our work is to help clarify which injuries identified by CT imaging are in this category based on both patient characteristics and CT findings. [...]new biomarkers are welcome for both ‘indications for admission to hospital’ and ‘assessment for risk of post head injury symptoms’, which also are currently being reviewed by the National Institute for Health and Care Excellence Head Injury Guideline Update Committee.7 Although it is important that patients at risk of long-term sequelae from their injuries are identified and receive appropriate rehabilitation, it is currently difficult to identify such patients in the acute phase of their injury.8 Inpatient hospital admission has associated costs and risks, which have been exacerbated by the COVID-19 pandemic and current large increase in demand for urgent and emergency care services.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"875-876"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40564815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency care for older people living with frailty: patient and carer perspectives","authors":"E. Regen, K. Phelps, J. V. van Oppen, Peter Riley, Jagruti Lalseta, Graham Martin, S. Mason, S. Conroy","doi":"10.1136/emermed-2022-212420","DOIUrl":"https://doi.org/10.1136/emermed-2022-212420","url":null,"abstract":"Background Little is known about how frailty impacts on older people’s experiences of emergency care, despite patient experience being essential to providing person-centred care. This qualitative study reports on the experiences of older people with frailty in the ED and their and their carers’ preferences for emergency care. Methods Older people (aged 75+ years) who were at least mildly frail and/or their carers, with current or recent experience of emergency care, were recruited from three EDs in England between January and June 2019. Data were collected via semi-structured in-depth interviews which explored participants’ views on their recent experience of emergency care and their priorities and preferred outcomes. Interviews were audio-recorded, transcribed verbatim and analysed following the principles of the Framework approach. Results Forty participants were interviewed: 24 patients and 16 carers who, between them, described ED attendances for 28 patients across the three sites. Often informed by previous negative experiences, there was a strong desire to avoid conveyance to EDs, and a sense of helplessness or acquiescence to attend. Although staff attitudes were on the whole seen as positive, the ED experience was dominated by negative experiences relating to very basic issues such as a lack of help with eating, drinking, toileting and discomfort from long waits on hard trolleys. Participants reported that communication and involvement in decision making could be improved, including involving next of kin, who were viewed as critical to supporting vulnerable older people during sometimes very protracted waits. Conclusion Frailty reflects a vulnerability and a need for support in basic activities of daily living, which EDs in this study, and perhaps more widely, are not set up to provide. Changes at the levels of clinical practice and service design are required to deliver even the most basic care for older people with frailty in the ED environment.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"226 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132486904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A man with fever and rash.","authors":"Yuki Nakanishi, Hirokazu Toyoshima, Hiromu Takeda","doi":"10.1136/emermed-2021-212096","DOIUrl":"https://doi.org/10.1136/emermed-2021-212096","url":null,"abstract":"REFERENCES 1 Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Ann R Coll Surg Engl 2009;91:2–7. 2 Shah A, Judge A, Delmestri A, et al. Incidence of shoulder dislocations in the UK, 19952015: a populationbased cohort study. BMJ Open 2017;7:e016112. 3 et alMicheo W, Castillo B, Vives JR. Shoulder fractures, separationdislocation, and other soft tissue injuries, 2014. Available: https://now.aapmr.org/shoulder-fracturesseparation-dislocation-and-other-soft-tissue-injuries/ 4 Perron AD, Ingerski MS, Brady WJ, et al. Acute complications associated with shoulder dislocation at an academic emergency department. J Emerg Med 2003;24:141–5. 5 Emond M, Le Sage N, Lavoie A, et al. Clinical factors predicting fractures associated with an anterior shoulder dislocation. Acad Emerg Med 2004;11:853–8. 6 Shuster M, AbuLaban RB, Boyd J, et al. Prospective evaluation of a guideline for the selective elimination of prereduction radiographs in clinically obvious anterior shoulder dislocation. CJEM 2002;4:257–62. 7 Hendey GW. Necessity of radiographs in the emergency department management of shoulder dislocations. Ann Emerg Med 2000;36:108–13. 8 Shuster M, AbuLaban RB, Boyd J. Prereduction radiographs in clinically evident anterior shoulder dislocation. Am J Emerg Med 1999;17:653–8. 9 Hendey G, Kinlaw K. Clinically significant abnormalities in postreduction radiographs after anterior shoulder dislocation. Ann Emerg Med 1996;28:399–402. 10 Harvey RA, Trabulsy ME, Roe L. Are postreduction anteroposterior and scapular Y views useful in anterior shoulder dislocations? Am J Emerg Med 1992;10:149–51. 11 Hendey GW, Chally MK, Stewart VB. Selective radiography in 100 patients with suspected shoulder dislocation. J Emerg Med 2006;31:23–8. 12 Chong M, Karataglis D, Learmonth D. Survey of the management of acute traumatic firsttime anterior shoulder dislocation among trauma clinicians in the UK. Ann R Coll Surg Engl 2006;88:454–8. 13 Zhang AL, Montgomery SR, Ngo SS, et al. Arthroscopic versus open shoulder stabilization: current practice patterns in the United States. Arthroscopy 2014;30:436–43. 14 Secko MA, Reardon L, Gottlieb M, et al. Musculoskeletal ultrasonography to diagnose dislocated shoulders: a prospective cohort. Ann Emerg Med 2020;76:119–28. 15 Seyedhosseini J, Saiidian J, Hashemi Taheri A, et al. Accuracy of pointofcare ultrasound using low frequency curvilinear transducer in the diagnosis of shoulder dislocation and confirmation of appropriate reduction. Turk J Emerg Med 2017;17:132–5. 16 Akyol C, Gungor F, Akyol AJ, et al. Pointofcare ultrasonography for the management of shoulder dislocation in ED. Am J Emerg Med 2016;34:866–70. 17 Lahham S, Becker B, Chiem A, et al. Pilot study to determine accuracy of posterior approach ultrasound for shoulder dislocation by novice Sonographers. West J Emerg Med 2016;17:377–82. 18 Ahmadi K, Hashemian AM, SinehSepehr K, et al. Bedside ultrasonography for verification of shoulder reduction: a long way to go. Chin J Trauma","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"661-696"},"PeriodicalIF":3.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40720535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation into the predictive capability for mortality and the trigger points of the National Early Warning Score 2 (NEWS2) in emergency department patients.","authors":"Huw Masson,&nbsp;John Stephenson","doi":"10.1136/emermed-2020-210190","DOIUrl":"https://doi.org/10.1136/emermed-2020-210190","url":null,"abstract":"<p><strong>Introduction: </strong>National Early Warning Score 2 (NEWS2) is widely used to monitor and trigger assessment throughout a patient's hospital journey. Since the development and role out of NEWS2, its ability to predict mortality has been assessed in several settings, although to date not within an undifferentiated ED population.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of all adult ED attendees at two EDs in Northern England, between March and November 2019. Multilevel multiple logistic regression analyses were conducted on patient episode data to assess the relationship between mortality at 2, 7 and 30 days from attendances; and maximum NEWS2, adjusting for age, sex, arrival mode and triage priority.</p><p><strong>Results: </strong>Data were collected from 91 871 valid patient episodes associated with 64 760 patients. NEWS2 was a significant predictor of mortality at 2 days (OR 1.75; 95% CI 1.58 to 1.93); at 7 days (OR 1.69; 95% CI 1.59 to 1.80); at 30 days (OR 1.58; 95% CI 1.52 to 1.64). For the analyses of categorised NEWS2, NEWS2 of 2-20 was significantly associated with mortality at 2, 7 and 30 days compared with none assigned: OR 3.54 (95% CI 2.15 to 5.85) at 2 days; OR 6.05 (95% CI 3.92 to 9.34) at 7 days; OR 12.4 (95% CI 7.91 to 19.3) at 30 days. Increasing age, male sex, arrival by ambulance and higher triage categories were also associated with significantly increased mortality. Area under the receiver operating characteristic curve values of 0.963, 0.946 and 0.915, respectively, were recorded for mortality outcomes, with optimum likelihood ratios associated with a trigger of 4 NEWS2 points.</p><p><strong>Conclusions: </strong>NEWS2 is an effective predictor of mortality for patients presenting to the ED. Findings suggest that maximum NEWS2 of 4 and over may be the best trigger point for escalation of treatment. Findings also suggest a NEWS2 of 0-1 can identify a very low-risk group within the ED.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"685-690"},"PeriodicalIF":3.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39079355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of point-of-care ultrasound (PoCUS) for shoulder dislocations and reductions in the emergency department: a diagnostic randomised control trial (RCT).","authors":"Mark Anthony Attard Biancardi,&nbsp;Robert David Jarman,&nbsp;Tania Cardona","doi":"10.1136/emermed-2020-210947","DOIUrl":"https://doi.org/10.1136/emermed-2020-210947","url":null,"abstract":"<p><strong>Background: </strong>Following blunt trauma, diagnosis of shoulder dislocation based on physical examination alone is difficult due to possible concurrent proximal humeral fractures. X-rays are therefore used to confirm diagnosis. Results from recent observational studies comparing diagnostic accuracy of point-of-care ultrasound (PoCUS) with X-rays for shoulder dislocation have been encouraging. The aim of this study was to determine whether PoCUS improves diagnostic accuracy when used with physical examination for the diagnosis of shoulder dislocation, proximal humeral fracture and ascertaining successful reduction in the ED.</p><p><strong>Methods: </strong>A prospective, single-centre, open, parallel randomised control study over a 6-month period was used to answer the research question and test the null hypothesis. Consecutive eligible adult patients attending the ED of Mater Dei Hospital in Malta were randomised to either the control (C) (physical examination only) or experimental group (E) (physical examination and a two-point PoCUS scan). The study objectives were to measure diagnostic accuracy for both examinations for detecting shoulder dislocation, any associated proximal humeral fractures and confirming reduction. X-rays were used as reference standard for both groups.</p><p><strong>Results: </strong>1206 patients were enrolled in this study (C n=600, E n=606). 290 dislocations (C n=132 and E n=158), 332 proximal humeral fractures (C n=154 and E n=178) and 278 reductions (C n=130 and E n=148) were analysed. A statistically significant difference (p<0.001) was found between the two groups for diagnostic accuracy in shoulder dislocation (C=65%, likelihood ratio (LR)+=2.03 and LR-=0.35 and E=100%, LR+=∞ and LR-=0), proximal humeral fractures (C=45.7%, LR+=1.23 and LR-=0.52 and E=98.3%, LR+=103.9 and LR-=0.03) and reduction (C=68.7%, E=100%). The null hypothesis for this study was thus rejected.</p><p><strong>Conclusions: </strong>The addition of PoCUS to a physical examination significantly improves diagnostic accuracy for dislocations, proximal humeral fractures and reduction confirmation.</p><p><strong>Trial registration number: </strong>International Standard Randomised Controlled Trials Number Registry (ISRCTN17048126).</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"655-661"},"PeriodicalIF":3.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39433539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular complications of prehospital emergency anaesthesia in patients with return of spontaneous circulation following medical cardiac arrest: a retrospective comparison of ketamine-based and midazolam-based induction protocols.","authors":"Christopher King,&nbsp;Asher Lewinsohn,&nbsp;Chris Keeliher,&nbsp;Sarah McLachlan,&nbsp;James Sherrin,&nbsp;Hafsah Khan-Cheema,&nbsp;Peter Sherren","doi":"10.1136/emermed-2020-210531","DOIUrl":"https://doi.org/10.1136/emermed-2020-210531","url":null,"abstract":"<p><strong>Background: </strong>Hypotension following intubation and return of spontaneous circulation (ROSC) after cardiac arrest is associated with poorer patient outcomes. In patients with a sustained ROSC requiring emergency anaesthesia, there is limited evidence to guide anaesthetic practice. At the Essex & Herts Air Ambulance Trust, a UK-based helicopter emergency medical service, we assessed the relative haemodynamic stability of two different induction agents for post-cardiac arrest medical patients requiring prehospital emergency anaesthesia (PHEA).</p><p><strong>Methods: </strong>We performed a retrospective database review over a 5-year period between December 2014 and December 2019 comparing ketamine-based and midazolam-based anaesthesia in this patient cohort. Our primary outcome was clinically significant hypotension within 30 min of PHEA, defined as a new systolic BP less than 90 mm Hg, or a 10% drop if less than 90 mm Hg before induction.</p><p><strong>Results: </strong>One hundred ninety-eight patients met inclusion criteria. Forty-eight patients received a ketamine-based induction, median dose (IQR) 1.00 (1.00-1.55) mg/kg, and a 150 midazolam-based regime, median dose 0.03 (0.02-0.04) mg/kg. Hypotension occurred in 54.2% of the ketamine group and 50.7% of the midazolam group (p=0.673). Mean maximal HRs within 30 min of PHEA were 119 beats/min and 122 beats/min, respectively (p=0.523). A shock index greater than 1.0 beats/min/mm Hg and age greater than 70 years were both associated with post-PHEA hypotension with ORs 1.96 (CI 1.02 to 3.71) and 1.99 (CI 1.01 to 3.90), respectively. Adverse event rates did not significantly differ between groups.</p><p><strong>Conclusion: </strong>PHEA following a medical cardiac arrest is associated with potentially significant cardiovascular derangements when measured up to 30 min after induction of anaesthesia. There was no demonstrable difference in post-induction hypotension between ketamine-based and midazolam-based PHEA. Choice of induction agent alone is insufficient to mitigate haemodynamic disturbance, and alternative strategies should be used to address this.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"672-678"},"PeriodicalIF":3.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39469442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sterile versus non-sterile gloves for traumatic wounds in the ED.","authors":"David Metcalfe,&nbsp;Nick R Parsons,&nbsp;Matthew L Costa","doi":"10.1136/emermed-2022-212517","DOIUrl":"https://doi.org/10.1136/emermed-2022-212517","url":null,"abstract":"the of non-","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"648-649"},"PeriodicalIF":3.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40541240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-critical telephone conversations in the emergency department: lessons learnt from a pilot educational project to improve communication skills over the telephone in response to the COVID-19 global pandemic.","authors":"Sarah Edwards,&nbsp;Lisa Keillor,&nbsp;Lorna Sandison,&nbsp;Abigail Millett,&nbsp;Ffion Davies","doi":"10.1136/emermed-2020-210481","DOIUrl":"https://doi.org/10.1136/emermed-2020-210481","url":null,"abstract":"<p><p>In many countries, the COVID-19 pandemic resulted in restricted hospital visiting by relatives.Staff have been forced to deliver unwelcome and bad news over the telephone. There are few training resources around how to do this. We created a bespoke training package consisting of a 15 min eLearning session and a 1-hour facilitated role-play session. Two simulated telephone calls to a professional actor posing as the relative were undertaken on a speakerphone. Following each simulated call, the actor gave feedback to the caller, focusing on the likely experience of a relative during these conversations. Elements specific to telephone conversations included ensuring the safety of the recipient to take the call (eg, not driving a car), ensuring they had adequate local support, and allowing a deliberate silence after delivering the bad news. Silence has a powerful impact, despite being uncomfortable. The opportunity to have written notes before calling and to offer a return call was seen as an opportunity for improving communication. We collated these experiences into a series of phrases found most useful and empathic by the actor and participants. A practical aide- mémoir was created from this learning that could be used to help deliver bad news quickly in the emergency department.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"712-715"},"PeriodicalIF":3.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40527941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound for diagnosis of purulent flexor tenosynovitis.","authors":"Emily Neill,&nbsp;Nancy Anaya,&nbsp;Sally Graglia","doi":"10.1136/emermed-2020-211113","DOIUrl":"https://doi.org/10.1136/emermed-2020-211113","url":null,"abstract":"CASE PRESENTATION A 49yearold right handdominant man with no significant medical history presented to the emergency department (ED) with severe right thumb pain. The patient sustained a laceration to the palmar surface of his right thumb 2 days prior to presentation; he did not seek care at that time because the laceration appeared superficial, bleeding was easily controlled and pain was minimal. The patient subsequently developed worsening pain and swelling of his thumb with pain radiating to his right forearm. His pain was exacerbated by any passive or active range of motion of the digit. He took naproxen at home with minimal pain relief, and at the time of presentation to the ED was unable to continue working due to pain. He endorsed subjective fevers and chills but denied any associated neurovascular symptoms, nausea or vomiting. On examination, the patient held the right thumb in slight flexion, with significant swelling of the entire digit extending to the right thenar eminence. There was minimal associated erythema and no proximal lymphangitic spread. There was a wellhealed linear laceration on the medial aspect of the right thumb without any associated discharge, bleeding or dehiscence. There was no palpable crepitus. The range of motion was significantly limited by pain, and the patient had marked tenderness to palpation diffusely, including over his flexor tendon sheath. Xray of the right hand showed mild soft tissue swelling around the right thumb but was otherwise unremarkable. Laboratory workup was notable for leucocytosis, with a white blood cell count of 14.4×10/L, and elevated inflammatory markers, with an erythrocyte sedimentation rate of 26 mm/hour (reference range, 0–10 mm/hour) and C reactive protein of 109.5 mg/L (reference range, <7.5 mg/L). ED pointofcare ultrasound (POCUS) performed by the ED resident and attending physicians showed oedema surrounding the flexor pollicis longus (FPL) tendon, demonstrated by a hypoechoic fluid collection around the tendon sheath (see figure 1), concerning for purulent flexor tenosynovitis (FTS). Based on this ultrasound, intravenous antibiotics were administered and the hand surgery service was consulted for operative management and admission.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"716-718"},"PeriodicalIF":3.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39241561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelling STEMI service delivery: a proof of concept study.","authors":"Justin Cole,&nbsp;Richard Beare,&nbsp;Thanh Phan,&nbsp;Velandai Srikanth,&nbsp;Dion Stub,&nbsp;Karen Smith,&nbsp;Karen Murdoch,&nbsp;Jamie Layland","doi":"10.1136/emermed-2020-210334","DOIUrl":"https://doi.org/10.1136/emermed-2020-210334","url":null,"abstract":"<p><strong>Background: </strong>Access to individual percutaneous coronary intervention (PCI) centres has traditionally been determined by historical referral patterns along arbitrarily defined geographic boundaries. We set out to produce predictive models of ST-elevation myocardial infarction (STEMI) demand and time-efficient access to PCI centres.</p><p><strong>Methods: </strong>Travel times from random addresses to PCI centres in Melbourne, Australia, were estimated using Google map application programming interface (API). Departures at 08:15 and 17:15 were compared with 23:00 to determine the effect of peak hour traffic congestion. Real-world ambulance travel times were compared with estimated travel times using Google map developer software. STEMI incidence per postcode was estimated by merging STEMI incidence per age group data with age group per postcode census data. PCI centre network configuration changes were assessed for their effect on hospital STEMI loading, catchment size, travel times and the number of STEMI cases within 30 min of a PCI centre.</p><p><strong>Results: </strong>Nearly 10% of STEMI cases travelled more than 30 min to a PCI centre, increasing to 20% by modelling the removal of large outer metropolitan PCI centres (p<0.05). A model of 7 PCI centres compared favourably to the current existing network of 11 PCI centres (p=0.18 (afternoon), p=0.5 (morning and night)). The intraclass correlation between estimated travel times and ambulance travel times was 0.82, p<0.001.</p><p><strong>Conclusion: </strong>This paper provides a framework to integrate prehospital environmental variables, existing or altered healthcare resources and health statistics to objectively model STEMI demand and consequent access to PCI. Our methodology can be modified to incorporate other inputs to compute optimum healthcare efficiencies.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"701-707"},"PeriodicalIF":3.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39748723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}