Canadian Journal of Emergency Medicine最新文献

{"title":"Trends in emergency department visits during cold weather seasons among patients experiencing homelessness in Ontario, Canada: a retrospective population-based cohort study","authors":"Lucie Richard, Haley Golding, Refik Saskin, Salimah Z. Shariff, Jesse I. R. Jenkinson, Katherine Francombe Pridham, Carolyn Snider, Andrew Boozary, Stephen W. Hwang","doi":"10.1007/s43678-024-00675-7","DOIUrl":"https://doi.org/10.1007/s43678-024-00675-7","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Recent anecdotal reports suggest increasing numbers of people experiencing homelessness are visiting emergency departments (EDs) during cold weather seasons due to inadequate shelter availability. We examined monthly ED visits among patients experiencing homelessness to determine whether there has been a significant increase in such visits in 2022/2023 compared to prior years.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We used linked health administrative data to identify cohorts experiencing homelessness in Ontario between October and March of the 2018/2019 to 2022/2023 years. We analyzed the monthly rate of non-urgent ED visits as a proxy measure of visits plausibly attributable to avoidance of cold exposure, examining rates among patients experiencing homelessness compared to housed patients. We excluded visits for overdose or COVID-19. We assessed level and significance of change in the 2022/2023 year as compared to previous cold weather seasons using Poisson regression.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We identified a total of 21,588 non-urgent ED visits across the observation period among patients experiencing homelessness in Ontario. Non-urgent ED visits increased 27% (RR 1.24 [95% CI 1.14–1.34]) in 2022/2023 compared to previous cold weather seasons. In Toronto, such visits increased by 70% (RR 1.68 [95% CI 1.57–1.80]). Among housed patients, non-urgent ED visits did not change significantly during this time period.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Rates of ED visits plausibly attributable to avoidance of cold exposure by individuals experiencing homelessness increased significantly in Ontario in 2022/2023, most notably in Toronto. This increase in ED visits may be related to inadequate access to emergency shelter beds and warming services in the community.</p>","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-suicidal self-injury at a Canadian paediatric emergency department","authors":"","doi":"10.1007/s43678-024-00657-9","DOIUrl":"https://doi.org/10.1007/s43678-024-00657-9","url":null,"abstract":"<h3>Abstract</h3> <span> <h3>Objective</h3> <p>Our primary objective was to determine agreement between non-suicidal self-injury recorded at triage and during subsequent mental health assessment. The secondary objective was to describe patients who reported non-suicidal self-injury.</p> </span> <span> <h3>Methods</h3> <p>This is a health records review of patients aged 12–18 years who had an Emergency Mental Health Triage form on their health record from an ED visit June 1, 2017–May 31, 2018. We excluded patients with diagnoses of autism spectrum disorder or schizophrenia. We abstracted data from the Mental Health Triage form, Emergency Mental Health and Addictions Service Assessment forms and Assessment of Suicide and Risk Inventory. We calculated Cohen’s Kappa coefficient, sensitivity, and negative predictive value to describe the extent to which the forms agreed and the performance of triage for identifying non-suicidal self-injury. We compared the cohort who reported non-suicidal self-injury with those who did not, using t-tests, Wilcoxon rank-sum tests, and chi-square tests.</p> </span> <span> <h3>Results</h3> <p>We screened 955 ED visits and included 914 ED visits where 558 (58.4%) reported a history of non-suicidal self-injury. There were significantly more females in the group reporting non-suicidal self-injury (82.1%, <em>n</em> = 458) compared to the group not reporting non-suicidal self-injury (45.8%, <em>n</em> = 163). Patients reporting non-suicidal self-injury did so in triage and detailed Mental Health Assessment 64.7% of the time (Cohen’s Kappa Coefficient 0.6); triage had sensitivity of 71.5% (95% CI 67.3–75.4) and negative predictive value of 71.2% (95% CI 68.2–74.0). Cutting was the most common method of non-suicidal self-injury (80.3%).</p> </span> <span> <h3>Conclusion</h3> <p>Screening at triage was moderately effective in identifying non-suicidal self-injury compared to a detailed assessment by a specialised mental health team. More than half of children and adolescents with a mental health-related concern in our ED reported a history of non-suicidal self-injury, most of which were female. This symptom is important for delineating patients’ coping strategies.</p> </span>","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":"207 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid HIV testing in emergency departments: a paradigm shift.","authors":"Mazen El-Baba, Jessica Kent, Isaac I Bogoch, Kyle Vose, Jennifer Hulme, Megan Landes","doi":"10.1007/s43678-023-00589-w","DOIUrl":"10.1007/s43678-023-00589-w","url":null,"abstract":"","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":" ","pages":"7-9"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10242805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of hand-held metal detectors in the detection and localization of ingested metallic foreign bodies in children.","authors":"Jayanand Mekwan, Kavish Chandra, Paul Atkinson","doi":"10.1007/s43678-023-00593-0","DOIUrl":"10.1007/s43678-023-00593-0","url":null,"abstract":"","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":" ","pages":"69"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10233029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Just the facts: transgender and gender diverse identities in emergency medicine.","authors":"Murdoch Leeies, Ellie Caslake, Carys Massarella","doi":"10.1007/s43678-023-00583-2","DOIUrl":"10.1007/s43678-023-00583-2","url":null,"abstract":"","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":" ","pages":"10-14"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10280938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates of pediatric emergency department visits vary according to neighborhood marginalization in Ottawa, Canada","authors":"Habeeb AlSaeed, Ewa Sucha, Maala Bhatt, Nicholas Mitsakakis, Natalie Bresee, Melanie Bechard","doi":"10.1007/s43678-023-00625-9","DOIUrl":"https://doi.org/10.1007/s43678-023-00625-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Objectives</h3><p>To determine the association between neighborhood marginalization and rates of pediatric ED visits in Ottawa, Ontario. Secondary objectives investigated if the association between neighborhood marginalization and rates varied by year, acuity, and distance to hospital.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We calculated rates of pediatric ED visits per 1000 person-years for census dissemination areas within 100 km of the Children’s Hospital of Eastern Ontario for patients &lt; 18 years old from January 2018 through December 2020. The 2016 Ontario Marginalization Index categorized neighborhoods along quintiles of residential instability, material deprivation, ethnic concentration, and dependency. Generalized mixed-effects models determined the incidence rate ratios of pediatric ED visits for each quintile of marginalization; multivariate models were used to control for year of presentation and distance to hospital. Analysis was repeated for low versus high acuity ED visits.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>There were 154,146 ED visits from patients in 2055 census dissemination areas within 100 km of CHEO from 2018 to 2020. After controlling for year and distance from hospital in multivariate analyses, there were higher rates of pediatric ED visits for dissemination areas with high residential instability, high material deprivation, and low ethnic concentration. These findings did not change according to visit acuity.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Neighborhood residential instability and material deprivation should be considered when locating alternatives to emergency care.</p>","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138818936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pickup for a case of hiccups: point-of-care ultrasonography detects a liver abscess in a 74-year-old gentleman","authors":"Lynette Yan Ee Chung, Yun Ying Ho, Sze Joo Juan","doi":"10.1007/s43678-023-00623-x","DOIUrl":"https://doi.org/10.1007/s43678-023-00623-x","url":null,"abstract":"","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":"71 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138690313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Completeness and accuracy of digital charting vs paper charting in simulated pediatric cardiac arrest: a randomized controlled trial","authors":"Alexandra St-Onge-St-Hilaire, Adam Cheng, Jennifer Davidson, Brandi Wan, Yiqun Lin","doi":"10.1007/s43678-023-00624-w","DOIUrl":"https://doi.org/10.1007/s43678-023-00624-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Objectives</h3><p>To determine if data collected through digital charting are more complete and more accurate compared to traditional paper-based charting during simulated pediatric cardiac arrest.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We performed a single-center simulation-based randomized controlled trial. Participants were randomized to a novel handheld digital charting device (intervention group) or to the standard resuscitation paper chart (control group). Participants documented two 15-min simulated pediatric cardiac arrest scenarios. We compared the charting completeness between the two groups. Completeness score (primary outcome) was established by calculating a completeness score for each group based on a list of pre-determined critical tasks. Charting accuracy (secondary outcome) was compared between the two groups, defined as the time interval between the real-time task performance and charted time.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Charting data from 34 simulated cardiac arrest events were included in the analysis (<i>n</i> = 18 intervention; <i>n</i> = 16 control). The paper charting group had a higher completeness score (median (IQR) paper vs digital: 72.0% (66.4–76.9%) vs 65.0% (58.5–66.4%), <i>p</i> = 0.015). For accuracy, the digital charting group was superior to the paper charting group for all pre-established critical tasks.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Compared to paper-based charting, digital charting group captured more critical tasks during pediatric simulated resuscitation and was more accurate in the time intervals between real-time tasks performance and charted time. For tasks charted, paper-based charting was significantly more complete and more detailed during simulated pediatric cardiac arrest.</p>","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":"197 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138690399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dream one, do one, teach one: a mental practice script for bougie assisted cricothyrotomy","authors":"Jamie Riggs, Melissa McGowan, Christopher Hicks","doi":"10.1007/s43678-023-00630-y","DOIUrl":"https://doi.org/10.1007/s43678-023-00630-y","url":null,"abstract":"<p>Mental practice is an effective method for skill acquisition in medicine. We describe the integration of interview-derived sensory cues with a list of procedural steps into a cohesive script to facilitate mental practice for a High Acuity, Low-Occurrence procedure, the bougie-assisted cricothyrotomy. Data collection occurred through interviews with emergency physicians. Interview transcripts were analyzed on a coding framework based on a previously published list of procedural steps. These cues were integrated with procedural steps to create a narrative script. Eight interview transcripts were analyzed. A total of 328 cues were identified. On average, each participant identified 13.7 cues per procedure. This represents the first attempt to combine cues identified by practitioners along with procedural steps with the aim of supporting rich mental representations of a procedure. We expect that this script will be useful to physicians seeking to improve their skills in this rare procedure.</p>","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":"48 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138560316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Just the facts: seizure prophylaxis post-traumatic brain injury (TBI).","authors":"James Nunn, Kristin Kaupp, Robert S Green","doi":"10.1007/s43678-023-00554-7","DOIUrl":"10.1007/s43678-023-00554-7","url":null,"abstract":"","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":" ","pages":"943-945"},"PeriodicalIF":2.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9776751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}