Emergency medicine journal : EMJ最新文献

{"title":"Evaluating the effect of driving distance to the nearest higher level trauma centre on undertriage: a cohort study.","authors":"Job F Waalwijk,&nbsp;Robin D Lokerman,&nbsp;Rogier van der Sluijs,&nbsp;Audrey A A Fiddelers,&nbsp;Luke P H Leenen,&nbsp;Martijn Poeze,&nbsp;Mark van Heijl","doi":"10.1136/emermed-2021-211635","DOIUrl":"https://doi.org/10.1136/emermed-2021-211635","url":null,"abstract":"<p><strong>Background: </strong>It is of great importance that emergency medical services professionals transport trauma patients in need of specialised care to higher level trauma centres to achieve optimal patient outcomes. Possibly, undertriage is more likely to occur in patients with a longer distance to the nearest higher level trauma centre. This study aims to determine the association between driving distance and undertriage.</p><p><strong>Method: </strong>This prospective cohort study was conducted from January 2015 to December 2017. All trauma patients in need of specialised care that were transported to a trauma centre by emergency medical services professionals from eight ambulance regions in the Netherlands were included. Patients with critical resource use or an Injury Severity Score ≥16 were defined as in need of specialised care. Driving distance was calculated between the scene of injury and the nearest higher level trauma centre. Undertriage was defined as transporting a patient in need of specialised care to a lower level trauma centre. Generalised linear models adjusting for confounders were constructed to determine the association between driving distance to the nearest higher level trauma centre per 1 and 10 km and undertriage. A sensitivity analysis was conducted with a generalised linear model including inverse probability weights.</p><p><strong>Results: </strong>6101 patients, of which 4404 patients with critical resource use and 3760 patients with an Injury Severity Score ≥16, were included. The adjusted generalised linear model demonstrated a significant association between a 1 km (OR 1.04; 95% CI 1.04 to 1.05) and 10 kilometre (OR 1.50; 95% CI 1.42 to 1.58) increase in driving distance and undertriage in patients with critical resource use. Also in patients with an Injury Severity Score ≥16, a significant association between driving distance (1 km (OR 1.06; 95% CI 1.06 to 1.07), 10 km (OR 1.83; 95% CI 1.71 to 1.95)) and undertriage was observed.</p><p><strong>Conclusion: </strong>Patients in need of specialised care are less likely to be transported to the appropriate trauma centre with increasing driving distance. Our results suggest that emergency medical services professionals incorporate driving distance into their decision making regarding transport destinations, although distance is not included in the triage protocol.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"457-462"},"PeriodicalIF":3.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39473605","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":"Temporal changes in blood pressure following prehospital rapid sequence intubation.","authors":"Pieter Francsois Fouche,&nbsp;Ben Meadley,&nbsp;Toby StClair,&nbsp;Alison Winnall,&nbsp;Christopher Stein,&nbsp;Paul Andrew Jennings,&nbsp;Stephen Bernard,&nbsp;Karen Smith","doi":"10.1136/emermed-2020-210887","DOIUrl":"https://doi.org/10.1136/emermed-2020-210887","url":null,"abstract":"<p><strong>Background: </strong>Rapid Sequence intubation (RSI) is an airway procedure that uses sedative and paralytic drugs to facilitate endotracheal intubation. It is known that RSI could impact blood pressure in the peri-intubation period. However, little is known about blood pressure changes in longer time frames. Therefore, this analysis aims to describe the changes in systolic blood pressure in a large cohort of paramedic-led RSI cases over the whole prehospital timespan.</p><p><strong>Methods: </strong>Intensive Care Paramedics in Victoria, Australia, are authorised to use RSI in medical or trauma patients with a Glasgow Coma Scale <10. This retrospective cohort study analysed data from patientcare records for patients aged 12 years and above that had received RSI, from 1 January 2008 to 31 December 2019. This study quantifies the systolic blood pressure changes using regression with fractional polynomial terms. The analysis is further stratified by high versus Low Shock Index (LSI). The shock index is calculated by dividing pulse rate by systolic blood pressure.</p><p><strong>Results: </strong>During the study period RSI was used in 8613 patients. The median number of blood pressure measurements was 5 (IQR 3-8). Systolic blood pressure rose significantly by 3.4 mm Hg (p<0.001) and then returned to baseline in the first 5 min after intubation for LSI cases. No initial rise in blood pressure is apparent in High Shock Index (HSI) cases. Across the whole cohort, systolic blood pressure decreased by 7.1 mm Hg (95% CI 7.9 to 6.3 mm Hg; p<0.001) from the first to the last blood pressure measured.</p><p><strong>Conclusions: </strong>Our study shows that in RSI patients a small transient elevation in systolic blood pressure in the immediate postintubation period is found in LSI, but this elevation is not apparent in HSI. Blood pressure decreased over the prehospital phase in RSI patients with LSI, but increased for HSI cases.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"451-456"},"PeriodicalIF":3.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emermed-2020-210887","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39193261","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":"Multi-institutional intervention to improve patient perception of physician empathy in emergency care.","authors":"Katie Pettit,&nbsp;Anne Messman,&nbsp;Nathaniel Scott,&nbsp;Michael Puskarich,&nbsp;Hao Wang,&nbsp;Naomi Alanis,&nbsp;Erin Dehon,&nbsp;Sara Konrath,&nbsp;Robert D Welch,&nbsp;Jeffrey Kline","doi":"10.1136/emermed-2020-210757","DOIUrl":"https://doi.org/10.1136/emermed-2020-210757","url":null,"abstract":"<p><strong>Background: </strong>Physician empathy has been linked to increased patient satisfaction, improved patient outcomes and reduced provider burnout. Our objective was to test the effectiveness of an educational intervention to improve physician empathy and trust in the ED setting.</p><p><strong>Methods: </strong>Physician participants from six emergency medicine residencies in the US were studied from 2018 to 2019 using a pre-post, quasi-experimental non-equivalent control group design with randomisation at the site level. Intervention participants at three hospitals received an educational intervention, guided by acognitivemap (the 'empathy circle'). This intervention was further emphasised by the use of motivational texts delivered to participants throughout the course of the study. The primary outcome was change in E patient perception of resident empathy (Jefferson scale of patient perception of physician empathy (JSPPPE) and Trust in Physicians Scale (Tips)) before (T1) and 3-6 months later (T2).</p><p><strong>Results: </strong>Data were collected for 221 residents (postgraduate year 1-4.) In controls, the mean (SD) JSPPPE scores at T1 and T2 were 29 (3.8) and 29 (4.0), respectively (mean difference 0.8, 95% CI: -0.7 to 2.4, p=0.20, paired t-test). In the intervention group, the JSPPPE scores at T1 and T2 were 28 (4.4) and 30 (4.0), respectively (mean difference 1.4, 95% CI: 0.0 to 2.8, p=0.08). In controls, the TIPS at T1 was 65 (6.3) and T2 was 66 (5.8) (mean difference -0.1, 95% CI: -3.8 to 3.6, p=0.35). In the intervention group, the TIPS at T1 was 63 (6.9) and T2 was 66 (6.3) (mean difference 2.4, 95% CI: 0.2 to 4.5, p=0.007). Hierarchical regression revealed no effect of time×group interaction for JSPPPE (p=0.71) nor TIPS (p=0.16).</p><p><strong>Conclusion: </strong>An educational intervention with the addition of text reminders designed to increase empathic behaviour was not associated with a change in patient-perceived empathy, but was associated with a modest improvement in trust in physicians.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"420-426"},"PeriodicalIF":3.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39622865","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":"Development and implementation of a clinician report to reduce unnecessary urine drug screen testing in the ED: a quality improvement initiative.","authors":"Jason Robert Vanstone,&nbsp;Shivani Patel,&nbsp;Michelle L Degelman,&nbsp;Ibrahim W Abubakari,&nbsp;Shawn McCann,&nbsp;Robert Parker,&nbsp;Terry Ross","doi":"10.1136/emermed-2020-210009","DOIUrl":"https://doi.org/10.1136/emermed-2020-210009","url":null,"abstract":"<p><strong>Background: </strong>Unnecessary testing is a problem-facing healthcare systems around the world striving to achieve sustainable care. Despite knowing this problem exists, clinicians continue to order tests that do not contribute to patient care. Using behavioural and implementation science can help address this problem. Locally, audit and feedback are used to provide information to clinicians about their performance on relevant metrics. However, this is often done without evidence-based methods to optimise uptake. Our objective was to improve the appropriate use of laboratory tests in the ED using evidence-based audit and feedback and behaviour change techniques.</p><p><strong>Methods: </strong>Using the behaviour change wheel, we implemented an audit and feedback tool that provided information to ED physicians about their use of laboratory tests; specifically, we focused on education and review of the appropriate use of urine drug screen tests. The report was designed in collaboration with end users to help maximise engagement. Following development of the report, audit and feedback sessions were delivered over an 18-month period.</p><p><strong>Results: </strong>Data on urine drug screen testing were collected continually throughout the intervention period and showed a sustained decrease among ED physicians. Test use dropped from a monthly departmental average of 26 urine drug screen tests per 1000 patient visits to only eight tests per 1000 patient visits following the initiation of the audit and feedback intervention.</p><p><strong>Conclusion: </strong>Audit and feedback reduced unnecessary urine drug screen testing in the ED. Regular feedback sessions continuously engaged physicians in the audit and feedback intervention and allowed the implementation team to react to changing priorities and feedback from the clinical group. It was important to include the end users in the design of audit and feedback tools to maximise physician engagement. Inclusion in this process can help ensure physicians adopt a sense of ownership regarding which metrics to review and provides a key component for the motivation aspect of behaviour change. Departmental leadership is also critical to the process of implementing a successful audit and feedback initiative and achieving sustained behaviour change.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"471-478"},"PeriodicalIF":3.1,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emermed-2020-210009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38905667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency medicine patient wait time multivariable prediction models: a multicentre derivation and validation study.","authors":"Katie Walker,&nbsp;Jirayus Jiarpakdee,&nbsp;Anne Loupis,&nbsp;Chakkrit Tantithamthavorn,&nbsp;Keith Joe,&nbsp;Michael Ben-Meir,&nbsp;Hamed Akhlaghi,&nbsp;Jennie Hutton,&nbsp;Wei Wang,&nbsp;Michael Stephenson,&nbsp;Gabriel Blecher,&nbsp;Buntine Paul,&nbsp;Amy Sweeny,&nbsp;Burak Turhan","doi":"10.1136/emermed-2020-211000","DOIUrl":"https://doi.org/10.1136/emermed-2020-211000","url":null,"abstract":"<p><strong>Objective: </strong>Patients, families and community members would like emergency department wait time visibility. This would improve patient journeys through emergency medicine. The study objective was to derive, internally and externally validate machine learning models to predict emergency patient wait times that are applicable to a wide variety of emergency departments.</p><p><strong>Methods: </strong>Twelve emergency departments provided 3 years of retrospective administrative data from Australia (2017-2019). Descriptive and exploratory analyses were undertaken on the datasets. Statistical and machine learning models were developed to predict wait times at each site and were internally and externally validated. Model performance was tested on COVID-19 period data (January to June 2020).</p><p><strong>Results: </strong>There were 1 930 609 patient episodes analysed and median site wait times varied from 24 to 54 min. Individual site model prediction median absolute errors varied from±22.6 min (95% CI 22.4 to 22.9) to ±44.0 min (95% CI 43.4 to 44.4). Global model prediction median absolute errors varied from ±33.9 min (95% CI 33.4 to 34.0) to ±43.8 min (95% CI 43.7 to 43.9). Random forest and linear regression models performed the best, rolling average models underestimated wait times. Important variables were triage category, last-k patient average wait time and arrival time. Wait time prediction models are not transferable across hospitals. Models performed well during the COVID-19 lockdown period.</p><p><strong>Conclusions: </strong>Electronic emergency demographic and flow information can be used to approximate emergency patient wait times. A general model is less accurate if applied without site-specific factors.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"386-393"},"PeriodicalIF":3.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39344075","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":"Shockingly simple? Should you use manual or automated defibrillation in out of hospital cardiac arrest?","authors":"Caroline Leech,&nbsp;Gavin D Perkins","doi":"10.1136/emermed-2021-211999","DOIUrl":"https://doi.org/10.1136/emermed-2021-211999","url":null,"abstract":"In their EMJ paper, Derkenne and colleagues present an interesting study on the accuracy and speed of Emergency Physicians in assessing whether a defibrillator trace is shockable or nonshockable. The study used a webbased application (https://simul-shock.firebaseapp.com) to present 60 ECG rhythms from reallife outofhospital cardiac arrest (OHCA) cases to prehospital emergency physicians and compared their responses with a gold standard interpretation defined by three experts. In total, 190 complete responses were included in the analysis which identified a median sensitivity of 0.91 [IQR 0.81–1.00] to deliver a shock for shockable rhythms and specificity of 0.91 [0.80–0.96] to withhold a shock for a nonshockable rhythm. Sensitivity was highest where the shockable rhythm was ventricular tachycardia or coarse ventricular fibrillation (VF) (1.0 [1.0–1.0]) but significantly lower for fine VF (0.6 [0.2– 1.0]). We would recommend that you test yourself on the simulator app to see how you would have scored! This study raises a valuable question: whether prehospital practitioners should use an automated external defibrillator (AED) or use manual mode for the interpretation of rhythm and need for shock delivery in patients with OHCA. Emergency Physicians (EPs) manage patients conveyed to the Emergency Department in cardiac arrest on a daily–weekly basis and defibrillators are used in manual mode— the same skills are likely to be transferrable to the prehospital setting with a smaller team. However, in many settings. the majority of OHCA management is provided by paramedics and some Emergency Medical Services (EMS) insist that the AED mode is used for all OHCA cases. This aims to reduce the cognitive burden for a small resuscitation team, ensures 2 minute cycle timings are maintained and eliminates human performance variability in rhythm interpretation. The latter is particularly important when attendance at cardiac arrests or opportunities for training may be infrequent for an individual paramedic. The major disadvantage is that most AEDs require chest compressions to pause for 5–20 seconds to allow the machine to provide rhythm analysis: in comparison, EPs in this study took a median of 2.0–2.8 seconds to identify each cardiac rhythm. Pauses in chest compressions (CPR) are associated with a reduced likelihood of return of spontaneous circulation and are a particular concern in the majority of cardiac arrests where the underlying rhythm will not benefit from defibrillation. The present study showed that EPs exceeded the performance goals set for artefactfree ECG analysis by AEDs for coarse VF (performance standard &gt;90% sensitivity) and those observed when an AED is applied in reallife practice (sensitivity for coarse VF 99% [95% CI 98 to 99]). By contrast, performance for fine VF was lower than that observed for reallife performance for AEDs (sensitivity 88% [95% CI 81 to 97]) and for nonshockable rhythms (specificity performance standard &gt;95% specificity","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"344-345"},"PeriodicalIF":3.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39805431","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":"Assessment of emergency physicians' performance in identifying shockable rhythm in out-of-hospital cardiac arrest: an observational simulation study.","authors":"Clément Derkenne,&nbsp;Daniel Jost,&nbsp;Florian Roquet,&nbsp;Pascal Corpet,&nbsp;Benoit Frattini,&nbsp;Romain Kedzierewicz,&nbsp;Guillaume Bellec,&nbsp;Benjamin Rajon,&nbsp;Marianne Fernandez,&nbsp;Thomas Loeb,&nbsp;Emmanuel Pierantoni,&nbsp;Antoine Lamblin,&nbsp;Bertrand Prunet","doi":"10.1136/emermed-2021-211417","DOIUrl":"https://doi.org/10.1136/emermed-2021-211417","url":null,"abstract":"<p><strong>Background: </strong>Emergency physicians can use a manual or an automated defibrillator to provide defibrillation of patients who had out-of-hospital cardiac arrest (OHCA). Performance of emergency physicians in identifying shockable rhythm with a manual defibrillator has been poorly explored whereas that of automated defibrillators is well known (sensitivity 0.91-1.00, specificity 0.96-0.99). We conducted this study to estimate the sensitivity/specificity and speed of shock/no-shock decision-making by prehospital emergency physicians for shockable or non-shockable rhythm, and their preference for manual versus automated defibrillation.</p><p><strong>Methods: </strong>We developed a web application that simulates a manual defibrillator (https://simul-shock.firebaseapp.com/). In 2019, all (262) emergency physicians of six French emergency medical services were invited to participate in a study in which 60 ECG rhythms from real OHCA recordings were successively presented to the physicians for determination of whether they would or would not administer a shock. Time to decision was recorded. Answers were compared with a gold standard (concordant answers of three experts). We report sensitivity for shockable rhythms (decision to shock) and specificity for non-shockable rhythms (decision not to shock). Physicians were also asked whether they preferred manual or automated defibrillation.</p><p><strong>Results: </strong>Among 215 respondents, we were able to analyse results for 190 physicians. 57% of emergency physicians preferred manual defibrillation. Median (IQR) sensitivity for a shock delivery for shockable rhythm was 0.91 (0.81-1.00); median specificity for no-shock delivery for non-shockable rhythms was 0.91 (0.80-0.96). More precisely, sensitivities for shock delivery for ventricular tachycardia (VT) and coarse ventricular fibrillation (VF) were both 1.0 (1.0-1.0); sensitivity for fine VF was 0.6 (0.2-1). Specificity for not shocking a pulseless electrical activity (PEA) was 0.83 (0.72-0.86), and for asystole, specificity was 0.93 (0.86-1). Median speed of decision-making (in seconds) were: VT 2.0 (1.6-2.7), coarse VF 2.1 (1.7-2.9), asystole 2.4 (1.8-3.5), PEA 2.8 (2.0-4.2) and fine VF 2.8 (2.1-4.3).</p><p><strong>Conclusions: </strong>Global sensitivity and specificity were comparable with published automated external defibrillator studies. Shockable rhythms with the best clinical prognoses (VT and coarse VF) were very rapidly recognised with very good sensitivity. The decision-making for fine VF or asystole and PEA was less accurate.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"347-352"},"PeriodicalIF":3.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39805432","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":"Predicting need for hospital admission in patients with traumatic brain injury or skull fractures identified on CT imaging: a machine learning approach.","authors":"Carl Marincowitz,&nbsp;Lewis Paton,&nbsp;Fiona Lecky,&nbsp;Paul Tiffin","doi":"10.1136/emermed-2020-210776","DOIUrl":"https://doi.org/10.1136/emermed-2020-210776","url":null,"abstract":"<p><strong>Background: </strong>Patients with mild traumatic brain injury on CT scan are routinely admitted for inpatient observation. Only a small proportion of patients require clinical intervention. We recently developed a decision rule using traditional statistical techniques that found neurologically intact patients with isolated simple skull fractures or single bleeds <5 mm with no preinjury antiplatelet or anticoagulant use may be safely discharged from the emergency department. The decision rule achieved a sensitivity of 99.5% (95% CI 98.1% to 99.9%) and specificity of 7.4% (95% CI 6.0% to 9.1%) to clinical deterioration. We aimed to transparently report a machine learning approach to assess if predictive accuracy could be improved.</p><p><strong>Methods: </strong>We used data from the same retrospective cohort of 1699 initial Glasgow Coma Scale (GCS) 13-15 patients with injuries identified by CT who presented to three English Major Trauma Centres between 2010 and 2017 as in our original study. We assessed the ability of machine learning to predict the same composite outcome measure of deterioration (indicating need for hospital admission). Predictive models were built using gradient boosted decision trees which consisted of an ensemble of decision trees to optimise model performance.</p><p><strong>Results: </strong>The final algorithm reported a mean positive predictive value of 29%, mean negative predictive value of 94%, mean area under the curve (C-statistic) of 0.75, mean sensitivity of 99% and mean specificity of 7%. As with logistic regression, GCS, severity and number of brain injuries were found to be important predictors of deterioration.</p><p><strong>Conclusion: </strong>We found no clear advantages over the traditional prediction methods, although the models were, effectively, developed using a smaller data set, due to the need to divide it into training, calibration and validation sets. Future research should focus on developing models that provide clear advantages over existing classical techniques in predicting outcomes in this population.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"394-401"},"PeriodicalIF":3.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emermed-2020-210776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25583023","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":"Impact of puberty as threshold to differentiate outcome of out-of-hospital cardiac arrest care groups: a nationwide observational study in France.","authors":"Elodie Privat,&nbsp;Valentine Baert,&nbsp;Joséphine Escutnaire,&nbsp;Cyrielle Dumont,&nbsp;Morgan Recher,&nbsp;Michael Genin,&nbsp;Francis Leclerc,&nbsp;Hervé Hubert,&nbsp;Stephane Leteurtre","doi":"10.1136/emermed-2020-210447","DOIUrl":"https://doi.org/10.1136/emermed-2020-210447","url":null,"abstract":"<p><strong>Background: </strong>Since 2005, the international guidelines for out-of-hospital cardiac arrest (OHCA) use puberty to differentiate paediatric and adult care. This threshold is mainly relied on the more frequent respiratory aetiologies in children. Hitherto, to the best of our knowledge, no study has compared the characteristics and outcomes of non-pubescent children, adolescents and adult patients with OHCA. In this study, we intended to describe the characteristics, outcome and factors associated with survival of patients who experienced OHCA in the three groups: children, adolescents (pubescent<18 years) and adults (<65 years), to assess the pertinence of the guidelines.</p><p><strong>Methods: </strong>Data from the French national cardiac arrest registry (2012-2017) were used in this nationwide observational study. Victims of OHCA who were <65 years old were included. The characteristics and outcomes of children and adolescents, and adolescents and adults were compared. Logistic regression was performed in each group to identify factors associated with survival at day 30.</p><p><strong>Results: </strong>We included 934 children, 433 adolescents and 26 952 adults. Respiratory aetiology was more frequent and shockable rhythm less frequent in children compared with adolescents (25.5% vs 17.2%, p=0.025 and 2.4% vs 6.8%, p<0.001, respectively). However, these differences were not observed between adolescents and adults (17.2% vs 14.1%, p=0.266 and 6.8% vs 10%, p=0.055, respectively). Between children and adolescents, and adolescents and adults, there was no significant difference in survival at day 30 (8.6%vs 9.8% and 9.8% vs 8.5%, respectively). For all groups, shockable initial rhythm was a factor of survival.</p><p><strong>Conclusion: </strong>Frequency of respiratory aetiologies and shockable rhythm were common in adolescents and adults and different between children and adolescents. These results indicate that puberty as a threshold in international guidelines seems to be relevant.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"363-369"},"PeriodicalIF":3.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39296494","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":"Evaluation of initial shockable rhythm as an indicator of short no-flow time in cardiac arrest: a national registry study.","authors":"Keita Shibahashi,&nbsp;Kazuhiro Sugiyama,&nbsp;Takuto Ishida,&nbsp;Yuichi Hamabe","doi":"10.1136/emermed-2021-211823","DOIUrl":"https://doi.org/10.1136/emermed-2021-211823","url":null,"abstract":"<p><strong>Background: </strong>The duration from collapse to initiation of cardiopulmonary resuscitation (no-flow time) is one of the most important determinants of outcomes after out-of-hospital cardiac arrest (OHCA). Initial shockable cardiac rhythm (ventricular fibrillation or ventricular tachycardia) is reported to be a marker of short no-flow time; however, there is conflicting evidence regarding the impact of initial shockable cardiac rhythm on treatment decisions. We investigated the association between initial shockable cardiac rhythm and the no-flow time and evaluated whether initial shockable cardiac rhythm can be a marker of short no-flow time in patients with OHCA.</p><p><strong>Methods: </strong>Patients aged 18 years and older experiencing OHCA between 2010 and 2016 were selected from a nationwide population-based Japanese database. The association between the no-flow time duration and initial shockable cardiac rhythm was evaluated. Diagnostic accuracy was evaluated using the sensitivity, specificity and positive predictive value.</p><p><strong>Results: </strong>A total of 177 634 patients were eligible for the analysis. The median age was 77 years (58.3%, men). Initial shockable cardiac rhythm was recorded in 11.8% of the patients. No-flow time duration was significantly associated with lower probability of initial shockable cardiac rhythm, with an adjusted OR of 0.97 (95% CI 0.96 to 0.97) per additional minute. The sensitivity, specificity and positive predictive value of initial shockable cardiac rhythm to identify a no-flow time of <5 min were 0.12 (95% CI 0.12 to 0.12), 0.88 (95% CI 0.88 to 0.89) and 0.35 (95% CI 0.34 to 0.35), respectively. The positive predictive values were 0.90, 0.95 and 0.99 with no-flow times of 15, 18 and 28 min, respectively.</p><p><strong>Conclusions: </strong>Although there was a significant association between initial shockable cardiac rhythm and no-flow time duration, initial shockable cardiac rhythm was not reliable when solely used as a surrogate of a short no-flow time duration after OHCA.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"370-375"},"PeriodicalIF":3.1,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39816791","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}