Emergency medicine journal : EMJ
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Severe traumatic brain injury (TBI) in childhood causes long term neurodisability and death, though early neurosurgical intervention may improve outcome. Primary transfer to a neurosurgical centre reduces the time from initial Emergency Department arrival to performance of time critical procedures. Paediatric trauma and neurosurgery services in England have recently undergone reconfiguration. To assist pre-hospital clinicians in determining the most suitable destination for an injured child a number of trauma triage tools have been developed. We aimed to assess the performance of these tools in identifying children with severe TBI. ⋯ None of the existing paediatric pre-hospital trauma triage tools perform adequately in identifying severe TBI. Given the incidence of severe TBI in this population, and the benefits of appropriate disposition, any such tools subsequently derived should pay particular attention to their performance in regard to severe TBI with particular focus on optimising under triage rates.
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There is limited epidemiological data for allergy Emergency Department (ED) presentations. Following recent launch of NICE guidelines and World Allergy Organisation (WAO) severity descriptions we investigated the epidemiology, management and outcomes of allergy patients presenting to a single ED. ⋯ NICE guidelines were not consistently followed but this did not seem to result in measurable short terms complications. A significant number of patients had a known precipitant.
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Anaphylaxis is under-reported in emergency settings and the potential for diagnostic confusion with acute asthma has been reported, especially in children who experience predominantly respiratory symptoms. However, no previous study has directly investigated the probability of unrecognised anaphylaxis in either adults or children presenting with acute asthma. ⋯ The results support the conclusion that some cases of anaphylaxis are unidentified and managed as acute asthma in children. The local frequency was estimated at 4.1% of children admitted to PICU but larger prospective multi-centre studies are required to better define the true prevalence nationally.
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Appropriate activation of multi-disciplinary trauma teams improves outcome for severely injured patients, but can disrupt normal service in the rest of the hospital. Derriford Hospital uses a two-tiered trauma team activation system. The emergency department (ED) trauma team is activated in response to a significant traumatic mechanism; the hospital trauma team is activated when this mechanism co-exists with physiological abnormality or specific anatomical injury. The aim of this study was to compare characteristics, process measures and outcomes between patients treated by ED or hospital trauma teams to evaluate the approach in a UK setting and to estimate any cost savings involved. Figure 1 outlines the composition and activation criteria of the teams. Abstract 014 Figure 1(a) ED trauma team activation and (b) Hospital trauma team activation. ⋯ A two-tiered trauma team activation system is an efficient, safe and cost-effective way of dealing with trauma patients presenting to a Major Trauma Centre in the UK.
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The Redesigned Fracture Pathway has revolutionised fracture management, decreased orthopaedic workload and improved the patient journey. The Pathway consists of guideline driven treatment of patients with fractures. There is no follow up for many stable injuries, virtual review of other fractures and orthopaedic registrar referral for admission decisions. Many discharged patients never receive a clinic appointment necessitating the development of discharge information leaflets and a move from plaster casts to Velcro splints. Have orthopaedics simply passed their workload onto the Emergency Department? 1) Patients with fractures are discharged with no follow up, does this necessitate longer consultations in ED? 2) Without routine follow up do patients simply pitch back up to ED? 3) Has the admissions process actually improved? ⋯ Direct discharges from ED do not require longer consultations nor do they return to ED. Orthopaedic admission is increasingly efficient and breaches are down. Is Fracture Pathway Redesign good for the Emergency Department? Yes!