European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Multicenter Study
Trend analysis of emergency department malpractice claims in the Netherlands: a retrospective cohort analysis.
Over the past two decades, several quality improvement projects have been implemented in emergency departments (EDs) in the Netherlands, one of these being the training and deployment of emergency physicians. In this study we aim to perform a trend analysis of ED quality of care in Dutch hospitals, as measured by the incidence of medical malpractice claims. ⋯ Even though the number of ED visits increased significantly over the past two decades, the number of malpractice claims filed after an ED visit decreased. Various quality improvement initiatives, including the training and employment of emergency physicians, may have contributed to the observed decrease in claims.
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Multicenter Study Comparative Study
Drowning in fresh or salt water: respective influence on respiratory function in a matched cohort study.
For the most severe drowned patients, hypoxemia represents one of the major symptoms. As the influence of the type of water (fresh or salt water) on respiratory function is still unclear, the primary endpoint of this multicenter study was to compare hypoxemia according to the type of water. ⋯ Drowning in fresh water was associated with deeper hypoxemia in the initial assessment. Despite this initial difference, latter respiratory and biological parameters or outcome were similar in both groups.
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Several decision aids can 'rule in' and 'rule out' acute coronary syndromes (ACS) in the Emergency Department (ED) but all require measurement of blood biomarkers. A decision aid that does not require biomarker measurement could enhance risk stratification at triage and could be used in the prehospital environment. We aimed to derive and validate the History and ECG-only Manchester ACS (HE-MACS) decision aid using only the history, physical examination and ECG. ⋯ Using only the patient's history and ECG, HE-MACS could 'rule out' ACS in 9.4% of patients while effectively risk stratifying remaining patients. This is a very promising tool for triage in both the prehospital environment and ED. Its impact should be prospectively evaluated in those settings.
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Comparative Study Observational Study
Quick Sepsis-related Organ Failure Assessment predicts 72-h mortality in patients with suspected infection.
The aim of this study was to compare quick Sepsis-related Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS) scores for predicting mortality. ⋯ The qSOFA scores are more accurate than SIRS scores for predicting 72-h mortality and are better at predicting 72-h mortality than 28-day mortality.
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Observational Study
Feasibility of continuous noninvasive arterial pressure monitoring in a prehospital setting, measurements during emergency transfer.
In severely injured or acutely ill patients close monitoring of blood pressure (BP) can be crucial. At the prehospital scene and during transfer to hospital, the BP is usually monitored using intermittent oscillometric measurements with an upper arm cuff every 3-5 min. The BP can be monitored noninvasively and continuously using the continuous noninvasive arterial pressure (CNAP) device. In this study, we investigated the feasibility of a CNAP device in a prehospital setting. ⋯ Continuous measurement of the BP obtained by the CNAP device is feasible and safe in a prehospital setting under potentially difficult conditions.