CJEM
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Non-fatal strangulation is a dangerous mechanism of injury among survivors of intimate partner violence and sexual assault, with inadequate evidence to guide investigation in the emergency department (ED). The primary objective is to identify the proportion of intimate partner violence and sexual assault where non-fatal strangulation occurs, and to describe the sequelae of injuries. ⋯ We found over 10% prevalence of non-fatal strangulation in survivors of intimate partner violence and sexual assault. There was a low rate of clinically important injury on the index ED visit secondary to non-fatal strangulation. Severe injury was primarily secondary to concomitant trauma, and utilization of CTA in this cohort was low. Increased awareness is needed among ED physicians regarding the need to consider CTA head and neck.
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Severely injured patients benefit from early identification and trauma centre treatment. Ontario has provincial prehospital trauma triage guidelines identifying patients who require direct trauma centre transport. Trauma patients not identified as meeting this provincial trauma triage standard are brought to the closest non-trauma hospital and may later be transferred to a trauma centre by a secondary interfacility transfer. Secondary interfacility transfers cause significant delays in receiving definitive care which have been associated with worse outcomes. The objective of this study was to determine the frequency that patients who underwent emergent secondary interfacility trauma transfer initially met prehospital trauma triage guidelines, as well as to assess the approximate delay to trauma centre care. ⋯ Patients who meet trauma triage criteria that end up undergoing secondary interfacility transfer experience significant delays. We recommend adding recreational vehicle collisions as a triage criterion. Emergency physicians should work with their local paramedic services to ensure severely injured patients are identified early to expedite transport.
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Trauma resuscitations are sporadic, high-acuity situations and conducting observation in the trauma bay for the purpose of quality improvement is challenging. We aim to review contemporary uses of trauma video review. ⋯ This study highlights common uses of trauma video review. The greatest benefit for this new technology is in quality improvement and education. The majority of studies focussed on critical procedures and QI initiatives, such as checklists, protocols and continued education. We recommend adoption of video review systems for ongoing improvement of team dynamics and overall trauma and emergency resuscitation.
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Neurovascular imaging for patients with high-risk transient ischemic attack (TIA) or minor stroke in the emergency department (ED) with computed tomography angiography (CTA) of the head and neck is the guideline-recommended standard of care, but it is underutilized in routine practice. We conducted a quality initiative to improve adherence to guidelines. ⋯ We provide a detailed framework that improved adherence to acute imaging guidelines for patients with TIA or minor stroke and anticipate that our approach could improve acute imaging for such patients in most EDs.