European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Multicenter Study
Agreement between ambulance and hospital records for information promoting urgent stroke treatment decisions.
Rapid decision-making during acute stroke care can improve outcomes. We wished to assess whether crucial information to facilitate decisions is routinely collected by emergency practitioners before hospital admission. ⋯ In a retrospective cohort of stroke patients admitted by emergency ambulance, standard practice did not consistently result in prehospital documentation of information that could promote rapid treatment decisions. Training emergency practitioners and/or providing clinical protocols could facilitate early stroke treatment decisions, but prehospital information availability is likely to be a limiting factor.
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Multicenter Study
Fascia iliaca compartment block for hip fractures: experience of integrating a new protocol across two hospital sites.
Fascia iliaca compartment block (FICB) administered through the loss of resistance technique effectively reduces pain and opiate requirement in elderly patients with hip fractures. FICB is a simple technique and is easily taught. This paper plots the implementation of FICB in two hospitals. ⋯ Organizational learning of this simple procedure can be achieved through a multidisciplinary approach, and committed departmental education and feedback. The impact on length of stay and mortality were striking; however, there may be other confounding factors. Only two cases of true anaesthetic toxicity occurred in 1586 patients. The authors conclude that FICB is a safe procedure and a useful adjunct for preoperative pain control in patients with hip fractures.
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Needlestick and 'sharps' injuries among those working with animals are a significant, under-reported and often ill-understood problem. Many patients present initially to Emergency Departments, where their potential to cause local and systemic infections and injury, zoonoses, allergic or anaphylactic reactions and death may be unrecognized. Increased awareness of the possibility of adverse effects and the consequences of these specific injuries is essential.
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Observational Study
The predictive validity of RETTS-HEV as an acuity triage tool in the emergency department of a Danish Regional Hospital.
The Rapid Emergency Triage and Treatment System - Hospital Unit West (RETTS-HEV) is a triage system used in the emergency department (ED) in Herning, Denmark, since 2010. It categorizes patients according to priority and defines a time limit on how long patients can wait before being seen by a doctor depending on the severity of their condition. The purpose of this study was to determine the predictive validity of RETTS-HEV by measuring the association between triage scores and outcomes such as the admission rate, the length of stay (LOS), and mortality. ⋯ RETTS-HEV was found to be closely related to all examined outcomes, and therefore useful in the risk stratification of ED patients.
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Diversion of suspected traumatic brain injury (TBI) patients to trauma centres may improve outcomes by expediting access to specialist neurosurgical care. This study aimed to determine the accuracy of the Head Injury Straight to Neurosurgery (HITSNS) triage rule for identifying patients with significant TBI. A diagnostic cohort study was performed using data from the HITSNS trial, the Trauma Audit and Research Network registry and the North East Ambulance service database. ⋯ A total of 3628 patients were included in the complete case analyses. The HITSNS triage tool demonstrated a sensitivity of 28.3% (95% confidence interval 21.8-35.4) and a specificity of 94.4% (95% confidence interval 93.6-95.2). The low sensitivity of the HITSNS triage rule suggests that a considerable proportion of patients with significant TBI may not be triaged directly to trauma centres, and further research is needed to improve the accuracy of bypass protocols.