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Fracture management in emergency department

Jonathan Porter, Robert Porter, Kevin Joseph Chan
OBJECTIVES: The purpose of this study is to determine the predictive value of clinical suspicion for scaphoid fracture in children aged 4 to 11 years, to look at the efficiency and practicality of current management of children presenting to the emergency department, and to help quantify the burden of the treatment strategy of immobilization for 10 to 14 days on clinical grounds despite negative or equivocal x-rays on presentation. METHODS: We performed a retrospective chart review study of a consecutive sample of all children aged 4 to 11 years old who presented to a tertiary pediatric emergency department from January 1, 2009, to December 31, 2013, within 24 hours of a wrist injury, with a clinical suspicion sufficient to order a scaphoid x-ray...
March 12, 2018: Pediatric Emergency Care
Avijit Barai, Bruce Lambie, Conor Cosgrave, Joanne Baxter
OBJECTIVE: Distal radius fracture (DRF) is a common presentation to the ED. However, little is known about the long-term functional outcome of these patients following their initial management in the ED. METHODS: In order to evaluate the long-term functional outcome of DRF, we collected the Disabilities of Arm, Shoulder and Hand (DASH) scores from the patients who attended our ED with DRF between January 2014 and June 2015. We divided the patients into two groups based on their overall management: (i) conservative group who did not have any surgical interventions; and (ii) open reduction internal fixation (ORIF) group who needed surgical interventions in the theatre...
February 28, 2018: Emergency Medicine Australasia: EMA
Tsung-You Tsai, Li-Ang Lee, Wei-Chieh Chao, Yi-Chan Lee
Herein, the authors report a rare patient with a transnasal intracranial penetration injury caused by a chopstick that resulted in optic nerve transection as well as the removal of the chopstick using a bidirectional approach. A 25-year-old male presented to our emergency department with right blindness and bilateral epistaxis. Preoperative computed tomographic angiography demonstrated a transnasal stick-like foreign body causing a skull base fracture and suspected vascular injury. Due to the shape of the chopstick and the high risk of massive bleeding, an exclusively endoscopic or open craniotomy approach is not suitable for removal...
February 23, 2018: Journal of Craniofacial Surgery
Aaron Hanson, Amy L Drendel
Objective: Most children treated in the emergency department (ED) with painful conditions are discharged home to the care of their parents. There is growing evidence that at-home pain management is inadequate. No studies have evaluated the child's report of their at-home pain experience. Our objective was to explore the child's perspective on the pain experience at home after ED discharge. Methods: We performed semistructured interviews with children aged 4 to 14 years discharged from the ED with an arm fracture...
July 2017: Paediatrics & Child Health
Zachary J Grabel, Sheyan J Armaghani, Catphuong Vu, Amit Jain, S Tim Yoon
BACKGROUND: The optimal form of treatment for C2 spine fractures is controversial. This investigation analyzed the variations in treatment of C2 fractures over time, by age group, and by geographic location. METHODS: The Nationwide Emergency Department Sample (NEDS) database was queried to identify patients 18 years and older who sustained C2 fracture without neurological injury from 2006-2012. Subsequently patients were further filtered based on the intervention they received: collar, halo, and surgery...
February 21, 2018: World Neurosurgery
Joshua B Holt, Natalie A Glass, Apurva S Shah
BACKGROUND: Supracondylar humeral fractures (SCHF) are the most common elbow fractures in children. The epidemiology of these injuries in the United States is described. METHODS: The Nationwide Emergency Department Sample database was queried for all children (age, below 18 y) with SCHF treated in the emergency department (ED) from 2006 to 2011, and weighted estimates were extracted. RESULTS: A total of 63,348 ED visits for SCHF were identified...
February 16, 2018: Journal of Pediatric Orthopedics
Ghideon Ezaz, Susan L Murphy, Jessica Mellinger, Elliot B Tapper
BACKGROUND: Injuries are more morbid and complicated to manage in patients with cirrhosis. However, data are limited regarding the relative risk of injury and severity of injury from falls in patients with cirrhosis compared to those without cirrhosis. METHODS: We examined the nationally representative National Emergency Department Sample, an all-payer database including all patients presenting with falls 2009-2012. We determined the relative risks for and clinical associations with severe injuries...
February 14, 2018: American Journal of Medicine
Tara Rhine, Shari L Wade, Nanhua Zhang, Huaiyu Zang, Stephanie Kennebeck, Lynn Babcock
OBJECTIVES: Care decisions for young children presenting to the emergency department (ED) with head injury are often challenging (e.g. whether to obtain neuroimaging). We sought to identify factors associated with acute management of children at-risk for clinically important traumatic brain injury (ciTBI) and describe symptom management. METHODS: Observational evaluation of children, ages 0-4years, presenting to a pediatric ED following minor head injury. Children with ≥1 risk element per the Pediatric Emergency Care Academic Research Network's decision rule were deemed "at-risk" for ciTBI...
January 31, 2018: American Journal of Emergency Medicine
David Kugelman, Abdullah Qatu, Jack Haglin, Sanjit Konda, Kenneth Egol
OBJECTIVES: To assess the role self-reported treatment for a psychiatric diagnoses may play in long-term functional outcomes following operatively managed tibial plateau fractures. DESIGN: Prospective cohort study. SETTING: Academic medical center. PATIENTS: Over an 11 year period, patients were screened and identified on presentation to the emergency department or in the clinical office for inclusion in an IRB approved registry...
January 30, 2018: Journal of Orthopaedic Trauma
George Fotakopoulos, Demosthenes Makris, Eleni Tsianaka, Polikceni Kotlia, Paulos Karakitsios, Charalabos Gatos, Alkiviadis Tzannis, Kostas Fountas
OBJECT: To identify the risk factors for post-traumatic amnesia (PTA) and to document the incidence of PTA after mild traumatic brain injuries. METHODS: This was a prospective study, affecting mild TBI (mTBI) (Glasgow Coma Scale 14-15) cases attending to the Emergency Department between January 2009 and April 2012 (40 months duration). Patients were divided into two groups (Group A: without PTA, and Group B: with PTA, and they were assessed according to the risk factors...
February 5, 2018: Brain Injury: [BI]
M N Baig, Orna Ni Bhroin, Rajnita Auckloo, Cathal Mac Dhaibheid, Usman Baig, Fergus Byrne
Introduction The British Orthopaedic Association Standards for Trauma (BOAST) Guideline 7 informs the standard of care patients should expect when they come to orthopaedic fracture clinics in the United Kingdom (UK). Objectives We compared our fracture clinic's practice against the standards set by BOAST Guideline 7 to make changes for aligning with the standard of care. We aimed to then re-audit our practice for further evaluation against the guidelines. Material and methods We prospectively collected data from 100 patients presenting to the fracture clinics of different orthopaedic consultants working in our hospital, using the Royal College of Surgeons in Ireland's (RCSI's) satisfaction with outpatients services (SWOPS) questionnaire...
November 29, 2017: Curēus
Maria Carmen G Diaz, Lloyd N Werk, James H Crutchfield, Lori K Handy, James P Franciosi, Joanne Dent, Raymond Villanueva, Eileen Antico, Alex Taylor, Tim Wysocki
OBJECTIVE: Emergency department (ED) and urgent care (UC) physicians' accurate assessment of the neurovascular and musculoskeletal (NV/MSK) examination in pediatric patients with suspected elbow fracture is crucial to the early recognition of neurovascular compromise. Our objective was to determine the impact of computer-based simulation (CBS) and computerized clinical decision support systems (CCDSS) on ED and UC physicians' assessment of the NV/MSK examination of pediatric patients with elbow fracture as noted in their documentation...
January 23, 2018: Pediatric Emergency Care
Lane C Thaut, Andrew S Murtha, Anthony E Johnson, Jamie L Roper
BACKGROUND: The management of patients with impaled unexploded devices is rare in the civilian setting. However, as the lines of the traditional battlefield are blurred by modern warfare and terrorist activity, emergency providers should be familiar with facility protocols, plans, and contact information of their local resources for unexploded devices. CASE REPORT: A 44-year-old male sustained a close-proximity blast injury to his lower extremities while manipulating a mortar-type firework...
January 20, 2018: Journal of Emergency Medicine
Tiago Rua, Sanjay Vijayanathan, David Parkin, Vicky Goh, Paul McCrone, Sam Gidwani
Background Wrist injury is a common presentation to the Emergency Department in the United Kingdom. Among these injuries, the scaphoid is the most common fractured carpal bone. However, given the limited ability of conventional radiography to accurately diagnose a suspected scaphoid fracture on presentation, its diagnosis and management remain challenging. Despite the vast clinical evidence supporting the superior accuracy of magnetic resonance imaging, there is little to no evidence around the real-world clinical and economic impact of immediate magnetic resonance imaging in the management of suspected scaphoid fractures...
December 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
Jeanette Schultz Johansen, Kjerstin Havnes, Kjell H Halvorsen, Stine Haustreis, Lillann Wilsgård Skaue, Elena Kamycheva, Liv Mathiesen, Kirsten K Viktil, Anne Gerd Granås, Beate H Garcia
INTRODUCTION: Drug-related problems (DRPs) are common in the elderly, leading to suboptimal therapy, hospitalisations and increased mortality. The integrated medicines management (IMM) model is a multifactorial interdisciplinary methodology aiming to optimise individual medication therapy throughout the hospital stay. IMM has been shown to reduce readmissions and drug-related hospital readmissions. Using the IMM model as a template, we have designed an intervention aiming both to improve medication safety in hospitals, and communication across the secondary and primary care interface...
January 23, 2018: BMJ Open
Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin-Khan, Trevor Russell
Shoulder injuries are a commonly presenting complaint to the ED. In the absence of an obvious deformity, they can be difficult to assess and definitively diagnose because of the multiple structures that cause shoulder pain, the acuity and severity of pain and the lack of range of motion in the ED setting. The quality of ED care provided to patients with musculoskeletal shoulder pain is crucial to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common shoulder injuries and conditions in the ED...
January 18, 2018: Emergency Medicine Australasia: EMA
M N Baig, C Egan
Introduction Paediatric patient bone fractures are the source of a large number of orthopaedic outpatient visits, especially for fracture clinics. The National Institute for Health and Care Excellence (NICE) guideline NG38 provides guidance on assessing and managing non-complex fractures, such as buckle (i.e., torus) fractures in paediatric patients. Objective We retrospectively audited outpatient records of children younger than 12 years presenting with distal radius buckle fractures for May and June 2017...
November 8, 2017: Curēus
Taylor J Jackson, Todd J Blumberg, Apurva S Shah, Wudbhav N Sankar
BACKGROUND: Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system...
January 10, 2018: Journal of Pediatric Orthopedics
Sarah Kuhn-Régnier, Michael Stickel, Björn-Christian Link, Henning Fischer, Reto Babst, Frank J P Beeres
PURPOSE: Traditionally, in the German-speaking countries, trauma patients are treated by general surgeons specialized in trauma surgery known as the Unfallchirurg. Over the last decade, a trend towards a lower influence of surgeons and a higher influence of subspecialties in the emergency department has been noted. With additional transformations in the health care system towards highly specialized medicine and the arising of new (sub-) specialties, diversification in the management of the trauma patient appears to occur...
January 6, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Kasim Turgut, Mehmet Ediz Sarihan, Cemil Colak, Taner Güven, Ali Gür, Sükrü Gürbüz
BACKGROUND: Emergency services manage trauma patients frequently and falls from height comprise the main cause of emergency service admissions. In this study, we aimed to analyse the demographic characteristics of falls from height and their relationship to the mortality. METHODS: A total of 460 patients, who admitted to the Emergency Department of Inonu University between November 2011 and November 2014 with a history of fall from height, were examined retrospectively...
2018: World Journal of Emergency Medicine
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