Emergency medicine journal : EMJ最新文献_第4页

Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales 复苏血管内球囊阻塞主动脉(REBOA):基于人口的差距分析创伤患者在英格兰和威尔士

Emergency medicine journal : EMJ Pub Date : 2015-11-23 DOI: 10.1136/emermed-2015-205217

E. Barnard, J. Morrison, R. Madureira, R. Lendrum, M. Fragoso-Iñiguez, A. Edwards, F. Lecky, O. Bouamra, T. Lawrence, J. Jansen

{"title":"Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales","authors":"E. Barnard, J. Morrison, R. Madureira, R. Lendrum, M. Fragoso-Iñiguez, A. Edwards, F. Lecky, O. Bouamra, T. Lawrence, J. Jansen","doi":"10.1136/emermed-2015-205217","DOIUrl":"https://doi.org/10.1136/emermed-2015-205217","url":null,"abstract":"Introduction Non-compressible torso haemorrhage (NCTH) carries a high mortality in trauma as many patients exsanguinate prior to definitive haemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct that has the potential to bridge patients to definitive haemostasis. However, the proportion of trauma patients in whom REBOA may be utilised is unknown. Methods We conducted a population based analysis of 2012–2013 Trauma Audit and Research Network (TARN) data. We identified the number of patients in whom REBOA may have been utilised, defined by an Abbreviated Injury Scale score ≥3 to abdominal solid organs, abdominal or pelvic vasculature, pelvic fracture with ring disruption or proximal traumatic lower limb amputation, together with a systolic blood pressure <90 mm Hg. Patients with non-compressible haemorrhage in the mediastinum, axilla, face or neck were excluded. Results During 2012–2013, 72 677 adult trauma patients admitted to hospitals in England and Wales were identified. 397 patients had an indication(s) and no contraindications for REBOA with evidence of haemorrhagic shock: 69% men, median age 43 years and median Injury Severity Score 32. Overall mortality was 32%. Major trauma centres (MTCs) received the highest concentration of potential REBOA patients, and would be anticipated to receive a patient in whom REBOA may be utilised every 95 days, increasing to every 46 days in the 10 MTCs with the highest attendance of this injury type. Conclusions This TARN database analysis has identified a small group of severely injured, resource intensive patients with a highly lethal injury that is theoretically amenable to REBOA. The highest density of these patients is seen at MTCs, and as such a planned evaluation of REBOA should be further considered in these hospitals.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131790347","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}

引用次数: 70

A profile of suspected child abuse as a subgroup of major trauma patients 疑似虐待儿童患者作为重大创伤患者亚群的概况

Emergency medicine journal : EMJ Pub Date : 2015-11-23 DOI: 10.1136/emermed-2015-205285

F. Davies, T. Coats, R. Fisher, T. Lawrence, F. Lecky

{"title":"A profile of suspected child abuse as a subgroup of major trauma patients","authors":"F. Davies, T. Coats, R. Fisher, T. Lawrence, F. Lecky","doi":"10.1136/emermed-2015-205285","DOIUrl":"https://doi.org/10.1136/emermed-2015-205285","url":null,"abstract":"Introduction Non-accidental injury (NAI) in children is an important cause of major injury. The Trauma Audit Research Network (TARN) recently analysed data on the demographics of paediatric trauma and highlighted NAI as a major cause of death and severe injury in children. This paper examined TARN data to characterise accidental versus abusive cases of major injury. Methods The national trauma registry of England and Wales (TARN) database was interrogated for the classification of mechanism of injury in children by intent, from January 2004 to December 2013. Contributing hospitals’ submissions were classified into accidental injury (AI), suspected child abuse (SCA) or alleged assault (AA) to enable demographic and injury comparisons. Results In the study population of 14 845 children, 13 708 (92.3%, CI 91.9% to 92.8%) were classified as accidental injury, 368 as alleged assault (2.5%, CI 2.2% to 2.7%) and 769 as SCA (5.2%, CI 4.8% to 5.5%). Nearly all cases of severely injured children suffering trauma because of SCA occurred in the age group of 0–5 years (751 of 769, 97.7%), with 76.3% occurring in infants under the age of 1 year. Compared with accidental injury, suspected victims of abuse have higher overall injury severity scores, have a higher proportion of head injury and a threefold higher mortality rate of 7.6% (CI 5.51% to 9.68%) vs 2.6% (CI 2.3% to 2.9%). Conclusions This study highlights that major injury occurring as a result of SCA has a typical demographic pattern. These children tend to be under 12 months of age, with more severe injury. Understanding these demographics could help receiving hospitals identify children with major injuries resulting from abuse and ensure swift transfer to specialist care.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127507275","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}

引用次数: 44

The changing face of major trauma in the UK 英国重大创伤的变化

Emergency medicine journal : EMJ Pub Date : 2015-11-23 DOI: 10.1136/emermed-2015-205265

A. Kehoe, A. Kehoe, Jason E. Smith, Jason B. Smith, A. Edwards, D. Yates, F. Lecky, F. Lecky

{"title":"The changing face of major trauma in the UK","authors":"A. Kehoe, A. Kehoe, Jason E. Smith, Jason B. Smith, A. Edwards, D. Yates, F. Lecky, F. Lecky","doi":"10.1136/emermed-2015-205265","DOIUrl":"https://doi.org/10.1136/emermed-2015-205265","url":null,"abstract":"Aim Major trauma (MT) has traditionally been viewed as a disease of young men caused by high-energy transfer mechanisms of injury, which has been reflected in the configuration of MT services. With ageing populations in Western societies, it is anticipated that the elderly will comprise an increasing proportion of the MT workload. The aim of this study was to describe changes in the demographics of MT in a developed Western health system over the last 20 years. Methods The Trauma Audit Research Network (TARN) database was interrogated to identify all cases of MT (injury severity score >15) between 1990 and the end of 2013. Age at presentation, gender, mechanism of injury and use of CT were recorded. For convenience, cases were categorised by age groups of 25 years and by common mechanisms of injury. Longitudinal changes each year were recorded. Results Profound changes in the demographics of recorded MT were observed. In 1990, the mean age of MT patients within the TARN database was 36.1, the largest age group suffering MT was 0–24 years (39.3%), the most common causative mechanism was road traffic collision (59.1%), 72.7% were male and 33.6% underwent CT. By 2013, mean age had increased to 53.8 years, the single largest age group was 25–50 years (27.1%), closely followed by those >75 years (26.9%), the most common mechanism was low falls (39.1%), 68.3% were male and 86.8% underwent CT. Conclusions This study suggests that the MT population identified in the UK is becoming more elderly, and the predominant mechanism that precipitates MT is a fall from <2 m. Significant improvements in outcomes from MT may be expected if services targeting the specific needs of the elderly are developed within MT centres.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"30 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123856470","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}

引用次数: 245

Prevalence of alcohol related attendance at an inner city emergency department and its impact: a dual prospective and retrospective cohort study 内城急诊科酒精相关的患病率及其影响:一项双前瞻性和回顾性队列研究

Emergency medicine journal : EMJ Pub Date : 2015-03-23 DOI: 10.1136/emermed-2014-204581

K. Parkinson, D. Newbury-Birch, A. Phillipson, P. Hindmarch, E. Kaner, E. Stamp, L. Vale, John Wright, J. Connolly

{"title":"Prevalence of alcohol related attendance at an inner city emergency department and its impact: a dual prospective and retrospective cohort study","authors":"K. Parkinson, D. Newbury-Birch, A. Phillipson, P. Hindmarch, E. Kaner, E. Stamp, L. Vale, John Wright, J. Connolly","doi":"10.1136/emermed-2014-204581","DOIUrl":"https://doi.org/10.1136/emermed-2014-204581","url":null,"abstract":"Background Alcohol related hospital attendances are a potentially avoidable burden on emergency departments (EDs). Understanding the number and type of patients attending EDs with alcohol intoxication is important in estimating the workload and cost implications. We used best practice from previous studies to establish the prevalence of adult alcohol related ED attendances and estimate the costs of clinical management and subsequent health service use. Methods The setting was a large inner city ED in northeast England, UK. Data were collected via (i) retrospective review of hospital records for all ED attendances for four pre-specified weeks in 2010/2011 to identify alcohol related cases along with 12 months of follow-up of the care episode and (ii) prospective 24/7 assessment via breath alcohol concentration testing of patients presenting to the ED in the corresponding weeks in 2012/2013. Results The prevalence rates of alcohol related attendances were 12% and 15% for the retrospective and prospective cohorts, respectively. Prospectively, the rates ranged widely from 4% to 60% across week days, rising to over 70% at weekends. Younger males attending in the early morning hours at weekends made up the largest proportion of alcohol related attendances. The mean cost per attendance was £249 (SD £1064); the mean total cost for those admitted was £851 (SD £2549). The most common reasons for attending were trauma related injuries followed by psychiatric problems. Conclusions Alcohol related attendances are a major and avoidable burden on emergency care. However, targeted interventions at weekends and early morning hours could capture the majority of cases and help prevent future re-attendance.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"223 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132116386","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}

引用次数: 53

Highlights from this issue 本期重点报道

Emergency medicine journal : EMJ Pub Date : 2007-09-01 DOI: 10.1136/emermed-2020-210174

Simon Smith

{"title":"Highlights from this issue","authors":"Simon Smith","doi":"10.1136/emermed-2020-210174","DOIUrl":"https://doi.org/10.1136/emermed-2020-210174","url":null,"abstract":"Quality and safety in emergency departments Two articles in this issue focus on Quality and Safety of clinical care within Emergency Departments (EDs). The International Federation of Emergency Medicine (IFEM) have produced a Quality Framework, and in the article by Hansen et al, the authors provide a summary of this document. This article provides an excellent introduction into the particular issues within Emergency Care when it comes to ensuring high quality and safe care at a strategic level. The patients expectations and the consequent obligations of the system (and clinicians) are described. The article neatly describes the ‘enablers’ and ‘barriers’ to quality of care, and provides suggestions regarding measurement and activities to support delivery of highquality care. For me, the takehome message is that prioritisation, coordination, and integration of emergency care is vital. Further work on measurement and demonstration of quality of care is needed. While the focus of the Hansen et al article is strategic elements of quality of emergency care, Lim et al have written an article focusing on more operational and tactical elements of this subject. This paper describes how the results of a successful quality improvement initiative can be sustained, in this case over 4 1⁄2 years later. There was an initial multimodal intervention to reduce unnecessary cannulation in the Emergency Department and the successful outcome was maintained. The discussion highlights interesting considerations for quality improvement activities; that is, how do you change departmental behaviours and culture, and what makes the improvements ‘stick’?","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127220393","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}

引用次数: 0

Diagnostic decision support in the ED: practical considerations. 急诊科的诊断决策支持:实际考虑。

Emergency medicine journal : EMJ Pub Date : 2005-06-01 DOI: 10.1136/EMJ.2005.22780CORR1

P. Ramnarayan, A. Tomlinson, J. Britto, G. Kulkarni

引用次数: 2

BestBETs reply from the BestBETs group. BestBETs来自BestBETs组的回复。

Emergency medicine journal : EMJ Pub Date : 2004-07-01 DOI: 10.1136/EMJ.2004.016519

K. Mackway-Jones

引用次数: 2

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Outpatient treatment of pulmonary embolism. 以证据为基础的急诊医学:曼彻斯特皇家医院的最佳赌注。肺栓塞的门诊治疗。

Emergency medicine journal : EMJ Pub Date : 2003-07-01 DOI: 10.1136/EMJ.20.4.370

K. Hogg, D. Dawson

引用次数: 1

British Thoracic Society guidelines on non-invasive ventilation. 英国胸科学会无创通气指南。

Emergency medicine journal : EMJ Pub Date : 2002-09-01 DOI: 10.1136/EMJ.19.5.435

J. Wyatt, F. Bellis

引用次数: 8

Pattern of injuries in helmeted motorcyclists in Singapore. 新加坡戴头盔摩托车手的受伤模式。

Emergency medicine journal : EMJ Pub Date : 1999-10-01 DOI: 10.1016/S0196-0644(99)80202-9

K. Tham, E. Seow, G. Lau

引用次数: 41