Archives of emergency medicine
-
Randomized Controlled Trial Comparative Study Clinical Trial
Dog-bite lacerations: a controlled trial of primary wound closure.
Dog-bite wounds are often left open because of their reputation for infection if primarily closed. A prospective randomized trial comparing primary closure with leaving the wound open was performed to assess infection and cosmesis. Ninety-six patients with 169 lacerations had thorough surgical debridement and irrigation of their wounds. ⋯ Significantly (P less than 0.01), more wound infections occurred in the hand in both groups compared to the rest of the body, indicating that particular attention should be paid to management of such wounds. It was concluded that dog-bite wounds should receive thorough surgical treatment and can be safely sutured at presentation. Special care should be given to hand wounds.
-
Comparative Study
Accuracy of detection of radiographic abnormalities by junior doctors.
This study assessed the ability of junior doctors in accident and emergency to detect radiographic abnormalities. Their assessments of 505 radiographs taken at nights and weekends over a period of 8 months and showing abnormalities were examined. Each assessment by a senior house officer (SHO) was compared with the subsequent diagnosis of a radiologist of senior registrar or consultant status. ⋯ It is considered that the proportion of missed abnormalities gives a truer index of SHOs' abilities. No improvement in performance was evident over the 6-month period of the SHOs tenure of post. It is argued that it is unrealistic to expect accident and emergency SHOs to acquire this complex skill simply through experience and that more formal training and guidance is needed.
-
The various guidelines for the administration of tetanus toxoid and antitetanus immunoglobulin are not only complicated, but also have never been supported by any scientific experimental studies. This study has measured the antibody levels in a random sample of 157 patients presenting to an accident and emergency department. Levels were measured before and after boosting doses. ⋯ In fact, no patient in the study had a level below the 'protective level'. Bearing in mind the small number of patients in the study, it could be argued that the level of immunity against tetanus in the United Kingdom is likely to be higher than assumed. If this is proven to be correct, then the length of time between booster injections of toxoid can be extended and the use of Human Antitetanus Immunoglobulin can be further restricted.