CJEM最新文献

{"title":"Diversion of hospital admissions from the emergency department using an interprofessional team: a propensity score analysis.","authors":"Ivy Cheng, Alex Kiss, Natalie Coyle, Aikta Verma, Kaif Pardhan, Justin N Hall, Belinda Wagner, Will Thomas-Boaz, Steven Shadowitz, Clare Atzema","doi":"10.1007/s43678-024-00760-x","DOIUrl":"10.1007/s43678-024-00760-x","url":null,"abstract":"<p><strong>Purpose: </strong>To examine if an ED interprofessional team (\"ED1Team\") could safely decrease hospital admissions among older persons.</p><p><strong>Methods: </strong>This single-center, retrospective, propensity score matched study was performed at a single ED during a control (December 2/2018-March 31/2019) and intervention (December 2/2019-March 31/2020) period. The intervention was assessed by the ED1Team, which could include an occupational therapist, physiotherapist, and social worker. We compared admission rates between period in persons age ≥ 70 years. Next, we compared visits attended by the ED1Team to (a) control period visits, and (b) intervention period visits without ED1Team attendance.</p><p><strong>Secondary outcomes: </strong>ED length-of-stay, 7-day subsequent hospital admission and mortality in discharged patients.</p><p><strong>Results: </strong>There were 5496 and 4876 eligible ED visits during the control and intervention periods, respectively. In the latter group, 556 (11.4%) received ED1Team assessment. After matching, there was an absolute 2.3% (p = 0.07) reduction in the admission rate between control and intervention periods. After matching the 556 ED1Team attended visits to control period visits, and to intervention period visits without the intervention, admission rates decreased by 10.0% (p = 0.006) and 13.5% (p < 0.001), respectively. For discharged patients, median ED length-of-stay decreased by 1.0 h (p < 0.001) between control and intervention periods and increased by 2.3 h (p < 0.001) compared to intervention period without the intervention. For patients discharged by the ED1Team, subsequent readmissions after 7 days were slightly higher, but mortality was not significantly different.</p><p><strong>Conclusion: </strong>ED1Team consultation was associated with a decreased hospital admission rate in older ED patients. It was associated with a slightly longer ED length-of-stay and subsequent early hospitalizations. Given that even a small increase in freed hospital beds would release some of the pressure on an overextended healthcare system, these results suggest that upscaling of the intervention might procure systems-wide benefits.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"732-740"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057597","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":"ATV associated injuries: any changes after 20 years?","authors":"John M Tallon, Aaron Sibley","doi":"10.1007/s43678-024-00750-z","DOIUrl":"10.1007/s43678-024-00750-z","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"758-759"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057596","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":"Derivation of a clinical prediction score for the diagnosis of clinically significant symptomatic carotid artery disease.","authors":"Kasim E Abdulaziz, Monica Taljaard, Dar Dowlatshahi, Ian G Stiell, George A Wells, Marco L A Sivilotti, Marcel Émond, Mukul Sharma, Grant Stotts, Jacques Lee, Andrew Worster, Judy Morris, Ka Wai Cheung, Albert Y Jin, Demetrios J Sahlas, Heather E Murray, Ariane MacKey, Steve Verreault, Marie-Christine Camden, Samuel Yip, Philip Teal, David J Gladstone, Mark I Boulos, Nicolas Chagnon, Elizabeth Shouldice, Clare L Atzema, Tarik Slaoui, Jeanne Teitlebaum, Jeffrey J Perry","doi":"10.1007/s43678-024-00759-4","DOIUrl":"10.1007/s43678-024-00759-4","url":null,"abstract":"<p><strong>Objectives: </strong>Emergent vascular imaging identifies a subset of patients requiring immediate specialized care (i.e. carotid stenosis > 50%, dissection or free-floating thrombus). However, most TIA patients do not have these findings, so it is inefficient to image all TIA patients in crowded emergency departments (ED). Our objectives were to derive and internally validate a clinical prediction score for clinically significant carotid artery disease in TIA patients.</p><p><strong>Methods: </strong>This was a planned secondary analysis of a prospective cohort study from 14 Canadian EDs. Among 11555 consecutive adult ED patients with TIA/minor stroke symptoms over 12 years, 9882 had vascular imaging and were included in the analysis. Our main outcome was clinically significant carotid artery disease, defined as extracranial internal carotid stenosis ≥ 50%, dissection, or thrombus in the internal carotid artery, with contralateral symptoms.</p><p><strong>Results: </strong>Of 9882 patients, 888 (9.0%) had clinically significant carotid artery disease. Logistic regression was used to derive a 13-variable reduced model. We simplified the model into a score (Symcard [Symptomatic carotid artery disease] Score), with suggested cut-points for high, medium, and low-risk stratification. A substantial portion (38%) of patients were classified as low-risk, 33.8% as medium risk, and 28.2% as high risk. At the low-risk cut-point, sensitivity was 92.9%, specificity 41.1%, and diagnostic yield 1.7%.</p><p><strong>Conclusions: </strong>This simple score can predict carotid artery disease in TIA patients using readily available information. It identifies low-risk patients who can defer vascular imaging to an outpatient or specialty clinic setting. Medium-risk patients may undergo imaging immediately or with slight delay, depending on local resources. High-risk patients should undergo urgent vascular imaging.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"741-750"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074807","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":"Which adults aged 65 and older are at low-risk for cervical spine injuries after low-level falls?","authors":"Jessica McCallum, Debra Eagles, Ian Stiell, Monica Taljaard, Christian Vaillancourt, Mathew Mercuri, Natasha Clayton, Éric Mercier, Judy Morris, Rebecca Jeanmonod, Catherine Varner, David Barbic, Ian M Buchanan, Mariyam Ali, Yoan K Kagoma, Ashkan Shoamanesh, Paul Engels, Sunjay Sharma, Andrew Worster, Shelley L McLeod, Marcel Émond, Alexandra Papaioannou, Sameer Parpia, Kerstin de Wit","doi":"10.1007/s43678-024-00752-x","DOIUrl":"10.1007/s43678-024-00752-x","url":null,"abstract":"<p><strong>Objectives: </strong>The population is aging and falls are a common reason for emergency department visits. Appropriate imaging in this population is important. The objectives of this study were to estimate the prevalence of cervical spine injury and identify factors associated with cervical spine injuries in adults ≥ 65 years after low-level falls.</p><p><strong>Methods: </strong>This was a pre-specified sub-study of a prospective observational cohort study of intracranial bleeding in emergency patients ≥ 65 years presenting after low-level falls. The primary outcome was cervical spine injury. The risk factors of interest were Glasgow coma scale (GCS) < 15, head injury, neck pain, age, and frailty defined as Clinical Frailty Scale ≥ 5. Multivariable logistic regression was used to measure the strength of association between risk factors and cervical spine injury. A descriptive analysis of absence of significant risk factors was performed to determine patients who may not require imaging.</p><p><strong>Results: </strong>There were 4308 adults ≥ 65 who sustained low-level falls with mean age of 82.0 (standard deviation ± 8.8) years and 1538 (35.7%) were male; 23 [0.5% (95% confidence interval (CI) 0.3-0.8%)] were diagnosed with cervical spine injuries. The adjusted odds ratios and 95% CIs were 1.3 (0.5-3.2) for GCS < 15, 5.3 (1.7-26.7) for head injury, 13.0 (5.7-31.2) for new neck pain, 1.4 (1.0-1.8) for 5-year increase in age, and 1.1 (0.4-2.9) for frailty. Head injury or neck pain identified all 23 cervical spine injuries. Management was a rigid collar in 19/23 (82.6%) patients and none had surgery.</p><p><strong>Conclusions: </strong>In emergency patients ≥ 65 years presenting after a low-level fall, head injury, neck pain, and older age were associated with the diagnosis of cervical spine injury. There were no cervical spine injuries in those without head injury or neck pain. Patients with no head injury or neck pain may not require cervical spine imaging.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"721-726"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115983","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":"Can we leverage technology to enhance discharge communication in pediatric emergency departments?","authors":"Janet A Curran, Emma Tavender, Simonne Collins","doi":"10.1007/s43678-024-00789-y","DOIUrl":"https://doi.org/10.1007/s43678-024-00789-y","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"26 10","pages":"689-690"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483181","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":"Global Research Highlights.","authors":"","doi":"10.1007/s43678-024-00774-5","DOIUrl":"https://doi.org/10.1007/s43678-024-00774-5","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"26 10","pages":"751-755"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483182","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":"Just the facts: recognizing and managing delirium in older adults in the ED.","authors":"Priyank Bhatnagar, Don Melady","doi":"10.1007/s43678-024-00742-z","DOIUrl":"10.1007/s43678-024-00742-z","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"703-705"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545719","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":"Understanding caregiver preferences and technology access to plan improvement of pediatric emergency department discharge instructions.","authors":"Michelle Fric, Jennifer Thull-Freedman","doi":"10.1007/s43678-024-00749-6","DOIUrl":"10.1007/s43678-024-00749-6","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 95% of children treated in emergency departments (EDs) in Alberta, Canada, are discharged home. Discharge teaching is an opportunity to provide caregivers with the information that they need to manage their child's condition at home and ensure appropriate follow-up. Our ED lacked a standard discharge instruction process. In preparation for local quality improvement, we sought to understand caregiver preferences regarding discharge instructions by assessing the preferred format, need for translated resources, and ability to effectively access electronic information using a Quick Response (QR) code.</p><p><strong>Methods: </strong>This project was completed at a tertiary pediatric ED in Calgary, Alberta in July and August 2021. Caregivers of pediatric patients were invited to complete a survey. Families requiring an interpreter were not eligible; however, this was recorded to estimate translation needs. Survey questions addressed preference of discharge instruction modality (verbal, printed, electronic), primary language spoken at home, ability to use English resources, and ability to use QR codes. Descriptive analyses were performed, and preferences were compared.</p><p><strong>Results: </strong>Of 117 caregivers approached, 104 completed the survey (89%). Caregivers had a strong preference for receiving written discharge instructions, with 98% desiring either electronic or printed resources in addition to verbal instructions. There was a similar likelihood of using printed (75%) versus electronic (79%) resources (p = 0.5). Three percent of families were unable to complete the survey due to a language barrier. Of the 104 participants, 19% noted that their primary language at home was not English but that they would still use English discharge instructions. Eighty percent of participants were able to successfully use the QR code.</p><p><strong>Conclusions: </strong>Caregivers had a strong preference for receiving written discharge instructions, with electronic or paper formats preferred equally. Translated resources will be important for some families. QR codes may be an effective tool for distributing electronic resources to most but not all families.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"727-731"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857397","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":"Social determinants of health in the emergency department.","authors":"Kate Palmer, Julie Atkinson, Jen Woodland, Pam McDougall, Kavish Chandra, Paul Atkinson","doi":"10.1007/s43678-024-00758-5","DOIUrl":"10.1007/s43678-024-00758-5","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"756-757"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977503","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":"Simulation tools in ultrasound-guided regional anesthesia: developing a simple, inexpensive erector spinae plane (ESP) block teaching model.","authors":"Omar Idrissi, Jake Rose, Joel P Turner","doi":"10.1007/s43678-024-00762-9","DOIUrl":"10.1007/s43678-024-00762-9","url":null,"abstract":"<p><p>The erector spinae plane (ESP) block is an increasingly utilized regional block in the emergency department, representing one effective alternative or adjunct to opioid analgesia in patients presenting with rib fractures. While there is growing interest, its widespread adoption faces hurdles, such as a lack of appropriate training resources. Gelatin-based phantoms to simulate human anatomy have been widely used to facilitate ultrasound-guided procedures, although no such model for the ESP block has yet been defined in the literature. To address this gap, we sought to design and assemble an inexpensive, simple to build, reusable phantom to simulate the sonographic anatomy of the posterior thoracic wall and serve as a task trainer for an ultrasound-guided ESP block. This novel phantom model reproduces an ultrasonographic fascial plane using a gelatin medium and 3D-printed thoracic spine with ribs allowing for needle guidance and hydrodissection.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"710-712"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121327","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}