Emergency medicine journal : EMJ
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Computed tomography (CT) is becoming increasingly popular as a primary imaging modality in adult trauma patients. This study aims to examine the added value of thoracic CT (TCT) in the context of paediatric trauma. ⋯ This study indicates a need for a comprehensive guideline for imaging in paediatric trauma, where the use of TCT is limited to specific patients, especially in view of the health implications that CT poses and source of financial burden for the NHS.
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To establish the efficacy of 2% viscous lignocaine in increasing oral intake in children with painful infectious mouth conditions compared with placebo. ⋯ Viscous lignocaine is no better than a flavoured gel placebo in improving oral intake in children with painful infectious mouth ulcers.
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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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How much does alcohol contribute to the demands on the Emergency Department (ED)? York is a popular tourist destination, particularly amongst hen and stag parties. But a quarter of the resident population have previously been identified as higher risk drinkers. So therefore, how much does alcohol contribute to the pressures on York ED? Additionally, clinical coding of alcohol within the ED is anecdotally unreliable. How true is this? We therefore undertook an alcohol needs assessment within York ED looking at general demographics, reasons for attendance and evidence of alcohol linked to the attendance. We also looked at the discrepancy between how much the ED was paid for these patients by commissioners and the actual cost to the acute trust. ⋯ The 4 randomly selected weeks amounted to a 5,704 patient sample, 7.2% of the total number of attendances in 2011. 9.8% of attendances were alcohol-related (553 patients) Between 21:00 and 09:00, this rose to 19.7% Alcohol was involved in 45% of mental health attendances The alcohol group was heavily over-represented in the patients removed by police (100%), refusing treatment (55%) and leaving prior to their treatment (41%) 10.3% of alcohol-related attendees remained in the ED for >4hours compared with 5.9% of non-alcohol-related attendees 62.8% of alcohol-related attendees were living within the City of York 18% of all ambulance journeys were due to alcohol Although 553 patients had evidence of alcohol in their attendance, it was only coded as such in 46 computer records If these figures are extrapolated to cover the annual patient population, the discrepancy between what the commissioners pay and the true cost of these patients is £552,431 CONCLUSION: Alcohol poses a disproportionate burden on York Emergency Department and Yorkshire Ambulance Service. With pressures on staffing, the 4 hour standard and ambulance turnaround times at an all-time high, how different would the ED be if the alcohol burden were reduced? This needs assessment fuels the argument for an 'invest to save' attitude to reduce alcohol-related attendance.
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WHO ETAT training courses provide comprehensive training in paediatric emergency care over 3.5-5 days and have been shown to improve outcome in resource-limited settings. However, the logistics, cost and impact on local service delivery of a five-day course may limit training opportunities in some settings. In this context, we aimed to determine whether a shorter, more focused course would be feasible. ⋯ 'Essential ETAT' was well received by participants and improvements in post-course test scores compared well to results from standard ETAT courses. Further evaluation is required to indicate whether knowledge is retained and changes clinical practice. Focused, short duration resuscitation training may offer a pragmatic and potentially cost-effective alternative to standard courses.