European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
Unplanned return visit to emergency department: a descriptive study from a tertiary care hospital in a low-income country.
The objective of this study was to determine the incidence, causes, and factors associated with unplanned return visits to emergency department of a tertiary care centre in a low-income country. We conducted a retrospective chart review of all patients who had unplanned returned visit to our emergency department within 48 h of their initial visit during a 1-year study period. The incidence of unplanned revisits is 2%. ⋯ During return visits 55% of patients required admission. On multivariable logistic regression model; fever, triage categories 1 and 2, and patients leaving against medical advice were the independent risk factors for revisits requiring admission. Infectious diseases are the leading cause of return visits in our setting.
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Randomized Controlled Trial
Antibiotic prophylaxis at triage for simple traumatic wounds: a pilot study.
Antibiotic administration at the time of wound manipulation has not been shown to decrease infection rates for simple traumatic wounds. Antibiotic administration at the time of initial emergency department (ED) presentation, however, has not been explored. Patients presenting to the ED with simple traumatic wounds received 1 g of oral flucloxacillin, or identical placebo, at triage. ⋯ Time from drug administration to wound manipulation was 64.3 min [95% confidence interval (CI) 36.6-91.9] placebo versus 75.0 min (95% CI: 51.7-98.3) flucloxacillin, P=0.657. Six of 36 patients (17%) reported wound infection in the placebo group, and four of 34 (12%) in the flucloxacillin group, P=0.736. Administration of oral flucloxacillin at triage failed to reduce the rate of wound infection for simple traumatic wounds closed in the ED.
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We aim to describe the characteristics and the management of the paediatric poisonings registered in the Toxicology Surveillance System created by the Intoxications Working Group of the Spanish Society of Paediatric Emergencies. We reviewed 130 episodes registered during 1 year. The main involved substances were drugs (73, 56.2%), household products (24,18.5%) and ethanol (16, 12.3%). ⋯ Approximately 10% received prehospital treatment and 56.9% received treatment in the paediatric emergency department (PED), which mainly activated charcoal. Approximately 50% were managed as outpatients, and all did well. Although intoxications are infrequent in PED and the short-term prognosis is good, the consumption of healthcare resources is high.
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In this study we aimed to determine whether isosorbide dinitrate (ISDN) bolus is associated with hypotension in patients aged at least 75 years presenting to an emergency department (ED) with acute heart failure (AHF) syndrome. This is a retrospective study, and all patients with AHF presenting in our ED during 2007 were included. We included 136 patients: 25 (18%) of them received ISDN in bolus (group B) among other treatments, and 111 (82%) did not (group O). ⋯ The mean lower systolic blood pressure after treatment was similar: 116±18 mmHg in group O compared with 116±19 mmHg in group B+, and was less than 90 mmHg in 0% cases in group B+ versus 3% in group O (P=0.5). Secondary endpoints were not significant, with mortality in group B of 4% versus 10% in group O (P=0.32). ISDN is not associated with more hypotension when used in bolus for elderly patients treated in the ED for AHF.