European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Previous studies have identified that there is a cohort of frequent attenders to the emergency department (ED). Recent initiatives aim to provide care closer to home and alternatives to ED attendance. This study aims to identify what impact frequent attenders still have on the ED. ⋯ There remains a cohort of frequent attenders that use the ED for their healthcare needs. A significant proportion of these attendances are associated with alcohol use, chronic disease or mental health problems. Reduction of attendances may be achieved by case management strategies and improving access to primary care and drug and alcohol services.
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Comparative Study
Utilization of a UK emergency department by care home residents: a retrospective observational study.
There is little information available on the impact of care home residents upon emergency departments (EDs) in the UK. Our objective was to determine utilization of a UK ED by local care home residents. This study took place in a busy district general ED in an urban setting. ⋯ Most common presentation categories were trauma (38%), respiratory disorders (11.2%), cardiovascular disorders (10.8%), gastrointestinal disorders (9.3%) and genitourinary disorders (6.4%). Although accounting only for 1.5% of daily attendances, care home residents have a high admission and inpatient mortality rate. This study provides important information on presentation patterns for this subgroup of the population and identifies areas for further study.
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We aim to define the characteristics of patients with hand injuries in the emergency department (ED), their management and operative findings. Decision on admission was also analyzed between the ED and the hand and reconstructive microsurgical team. We reviewed 504 patients seen at the ED over a 3-month period with isolated hand injuries and found more males (88%) who were between 20 and 30 years of age (51%). ⋯ About 62% of the patients were discharged after treatment at the ED while 38% were admitted. A high level of concurrence in the decisions made by the ED and hand and reconstructive microsurgery signifies good quality assessment performed by the ED. The operative findings of fractures, tendon, nerve and vessel injuries for those who were admitted to the wards are higher than those admitted to 'day surgery'.
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Review Case Reports
A meta-analysis on the utility of peripheral venous blood gas analyses in exacerbations of chronic obstructive pulmonary disease in the emergency department.
The objective of this case-based review is to identify and summarize the relevant evidence for the clinical utility of peripheral venous blood gas (pVBG) analyses in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in the emergency department. Relevant studies were identified using the Cochrane Library, Medline, Embase, and CINAHL databases and by hand searching of references of published articles. Included studies were prospective trials comparing arterial and pVBG results in patients with COPD or respiratory distress that reported at least average differences and/or limits of agreement between the two results in English. ⋯ No studies investigated the role of pVBG analysis in treatment alteration or clinical outcomes. Available evidence suggests that there is good agreement for pH and HCO3 values between arterial and pVBG results in patients with COPD, but not for pO2 or pCO2. Widespread clinical use is limited because of the lack of validation studies on clinical outcomes.