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Emergency Medicine Journal: EMJ

Caitlin Wilson, Clare Harley, Stephanie Steels
INTRODUCTION: Paramedics are involved in examining, treating and diagnosing patients. The accuracy of these diagnoses is evaluated using diagnostic accuracy studies. We undertook a systematic review of published literature to provide an overview of how accurately paramedics diagnose patients compared with hospital doctors. A bivariate meta-analysis was incorporated to examine the range of diagnostic sensitivity and specificity. METHODS: We searched MEDLINE, CINAHL, Embase, AMED and the Cochrane Database from 1946 to 7 May 2016 for studies where patients had been given a diagnosis by paramedics and hospital doctors...
September 14, 2018: Emergency Medicine Journal: EMJ
William G P Niven, David Wilson, Steve Goodacre, Alexander Robertson, Samira Jane Green, Tim Harris
BACKGROUND: Patients presenting with chest pain represent a significant proportion of attendances to the ED. The History, ECG, Age, Risk Factors and Troponin (HEART) Score is validated for the risk stratification of suspected ischaemic chest pain within the ED. The goal of this research was to establish the interoperator reliability of the HEART Score as performed in the ED by different grades of doctor and nurse. METHODOLOGY: Patients with suspected ischaemic chest pain presenting to the ED of an inner city, London Hospital, were recruited prospectively between January and May 2016...
September 14, 2018: Emergency Medicine Journal: EMJ
Leigh Keen, Jenna Katherine Bulger, Nigel Rees, Helen Snooks, Greg Fegan, Simon Ford, Bridie Angela Evans, Mirella Longo
BACKGROUND: Rapid Analgesia for Prehospital Hip Disruption was a small study designed to determine the feasibility of undertaking a randomised controlled trial (RCT) to test the clinical and cost-effectiveness of paramedics administering Fascia Iliaca Compartment Block as early prehospital pain relief to patients with a fractured hip. The objective was to devise a simple and effective method of random allocation concealment suitable for use by paramedics while in the emergency prehospital setting...
September 12, 2018: Emergency Medicine Journal: EMJ
(no author information available yet)
No abstract text is available yet for this article.
September 7, 2018: Emergency Medicine Journal: EMJ
Maysam Ali Abdulwahid, Andrew Booth, Janette Turner, Suzanne M Mason
BACKGROUND: Optimising the efficiency and productivity of senior doctors is critical to ED function and delivery of safe patient care. Time and motion studies (TMS) can allow quantification of how these doctors spend their working time, identify inefficiencies in the current work processes and provide insights into improving working conditions, and enhancing productivity. Three questions were addressed: (1) How do senior emergency doctors spend their time in the ED? (2) How much of their time is spent on multitasking? (3) What is the number of tasks completed per hour? METHODS: The literature was systematically searched for TMS of senior emergency doctors...
September 5, 2018: Emergency Medicine Journal: EMJ
Margaret E Samuels-Kalow, Matthew Niedzwiecki, Ari B Friedman, Peter E Sokolove, Renee Y Hsia
OBJECTIVE: The majority of paediatric ED visits result in discharge but little is known about what ED resources are deployed for these visits. The goal of this study was to understand the utilisation of diagnostic testing, procedures and hospital admission for paediatric ED visits triaged as 'non-urgent'. STUDY DESIGN: We examined US ED visits for children aged 0-17 years from 1 January 2009 to 31 December 2011 in the National Hospital Ambulatory Medical Care Survey...
September 4, 2018: Emergency Medicine Journal: EMJ
Jonathan Graeme Bunn, Susan Jane Croft, Colin O'Keeffe, Richard M Jacques, Rebecca M Simpson, Tony Stone, Simon Paul Conroy, Suzanne M Mason
BACKGROUND: We explored the urgent care axis across EDs in Yorkshire and Humber (Y&H) for patients aged ≥75 years to identify where interventions could be targeted to prevent ED attendances and inpatient admissions. METHODS: Hospital Episode Statistics (HES) data for attendances across 18 EDs in Y&H from April 2011 to March 2014 were retrospectively analysed. HES A&E and Admitted Patient Care patient records data were linked to describe the entire patient pathway...
September 3, 2018: Emergency Medicine Journal: EMJ
Peter Paal, Simon Rauch
No abstract text is available yet for this article.
August 29, 2018: Emergency Medicine Journal: EMJ
Robert Scott, Brian Burns, Sandra Ware, Floris Oud, Matthew Miller
BACKGROUND: With the increasing role of point-of-care coagulation testing in trauma, we sought to test the reliability of the thromboelastography (TEG)6s machine in a simulated rotary wing environment. METHOD: A two-arm study was conducted, running TEG6s quality control cartridges in a helicopter flight simulator with realistic vibration and in stable ground conditions. The flight conditions during testing included take-offs, landings and inflight emergencies such as engine failures...
August 29, 2018: Emergency Medicine Journal: EMJ
James Alexander Keitley
No abstract text is available yet for this article.
August 29, 2018: Emergency Medicine Journal: EMJ
Ellen J Weber, Zhe Hui Hoo
Sample size estimates are critical to the planning and interpretation of clinical studies, whether they are descriptive or analytical. Too small a sample size will result in imprecise estimates in a descriptive study and failure to achieve 'statistical significance' in an analytic or comparative study. Here we discuss what both researchers and readers should understand about the reasons for sample size estimates, how they are done and how achieving or not achieving the desired sample size can affect the interpretation of the outcomes...
August 28, 2018: Emergency Medicine Journal: EMJ
Maxwell Osei-Ampofo, Matthew J Tafoya, Chelsea A Tafoya, Rockefeller A Oteng, Hassan Ali, Torben K Becker
OBJECTIVE: Brief training courses in bedside ultrasound are commonly done by visiting faculty in low-income and middle-income countries, and positive short-term effects have been reported. Long-term outcomes are poorly understood. We held a training course on a cardiopulmonary ultrasound (CPUS) protocol over two separate 10-day periods in 2016. In 2017, 9-11 months after the initial training, we assessed skill and knowledge retention as well as perceived impact on local practice. METHODS: A written test using six clinical vignettes and an observed structured clinical examination were used to assess theoretical knowledge and practical skills...
August 28, 2018: Emergency Medicine Journal: EMJ
James Vassallo, Tim Nutbeam, Annette C Rickard, Mark D Lyttle, Barney Scholefield, Ian K Maconochie, Jason E Smith
INTRODUCTION: Paediatric traumatic cardiac arrest (TCA) is a high acuity, low frequency event. Traditionally, survival from TCA has been reported as low, with some believing resuscitation is futile. Within the adult population, there is growing evidence to suggest that with early and aggressive correction of reversible causes, survival from TCA may be comparable with that seen from medical out-of-hospital cardiac arrests. Key to this survival has been the adoption of a standardised approach to resuscitation...
August 28, 2018: Emergency Medicine Journal: EMJ
Laura Howard, Christopher Wibberley, Liz Crowe, Richard Body
BACKGROUND: Emergency medicine is a high-pressured specialty with exposure to disturbing events and risk. We conducted a qualitative study to identify which clinical events resulted in emotional disruption and the impact of these events on the well-being of physicians working in an ED. METHODS: We used the principles of naturalistic inquiry to conduct narrative interviews with physicians working in the ED at Central Manchester University Hospitals NHS Foundation Trust, between September and October 2016...
August 21, 2018: Emergency Medicine Journal: EMJ
Talea Cornelius, Nathalie Moise, Jeffrey L Birk, Donald Edmondson, Bernard P Chang
OBJECTIVES: Research in outpatient setting suggests that the presence of companions during a medical encounter can improve clinician-patient communication. It is not known if the presence of companions has a similar effect in the acutely stressful context of the ED. This study tested whether the presence of companions in the ED relate to stronger clinician-patient communication. We further explored effect modification by demographic factors (race/ethnicity, education and language) thought to compromise communication...
August 21, 2018: Emergency Medicine Journal: EMJ
Franz E Babl, Ed Oakley, Stuart R Dalziel, Meredith L Borland, Natalie Phillips, Amit Kochar, Sarah Dalton, John Alexander Cheek, Yuri Gilhotra, Jeremy Furyk, Jocelyn Neutze, Susan Donath, Stephen Hearps, Louise M Crowe, Marta Arpone, Silvia Bressan, Mark D Lyttle
OBJECTIVE: The National Emergency X-Radiography Utilisation Study II (NEXUS II) clinical decision rule (CDR) can be used to optimise the use of CT in children with head trauma. We set out to externally validate this CDR in a large cohort. METHODS: We performed a prospective observational study of patients aged <18 years presenting with head trauma of any severity to 10 Australian/New Zealand EDs. In a planned secondary analysis, we assessed the accuracy of the NEXUS II CDR (with 95% CI) to detect clinically important intracranial injury (ICI)...
August 20, 2018: Emergency Medicine Journal: EMJ
Eric D Adler, Quan M Bui
No abstract text is available yet for this article.
August 20, 2018: Emergency Medicine Journal: EMJ
Hanni Stoklosa, Nawal M Nour
No abstract text is available yet for this article.
August 17, 2018: Emergency Medicine Journal: EMJ
Patrick Nee, Elaine Weir, Madhur Vardhan, Ankita Vaidya
Whooping cough is a notifiable bacterial respiratory infection caused by Bordetella pertussis It may produce serious disease, especially in immunocompromised individuals and very young children. The number of reported cases increases in the winter months and the incidence peaks every 4-5 years. However, this periodicity is variable and is inconsistent between different geographical regions. Bordetella pertussis infection (BPI) may be underdiagnosed because of its seasonality and the fact that clinical features may be indistinguishable from other respiratory disorders in the paediatric ED setting...
August 10, 2018: Emergency Medicine Journal: EMJ
Ayobami T Akenroye, Abayomi Ajala, Elham Azimi-Nekoo, Gabriele S de Vos
BACKGROUND: In asthmatics, making a diagnosis of anaphylaxis could be challenging as respiratory symptoms are a common feature of both conditions. Identifying anaphylaxis is important to providing appropriate care. A prior study showed that anaphylaxis is sometimes misdiagnosed as acute asthma in children. We sought to identify the percentage of adults admitted to the intensive care unit (ICU) with asthma exacerbations who met criteria for anaphylaxis. METHODS: Retrospective chart review of adults admitted with acute asthma to the ICU at Jacobi Medical Center, a Level 1 trauma centre in Bronx, New York...
August 9, 2018: Emergency Medicine Journal: EMJ
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