Emergency medicine journal : EMJ
-
Many emergency medicine clinical trials have struggled to recruit to 'time and target' with investigators having to make a large additional effort or extend the time for recruitment. This study was performed to describe our experience in the use of a computer 'app' to facilitate the process of research subject identification and communication between the ED staff and the research team. Key questions were: 1) Does the introduction of an iPad 'app' result in a greater rate of patient notification to the research team? 2) Which type of notification method was most used? ⋯ There was a significant increase in the immediacy of communication after the introduction of the iPad app. This occurred without a large amount of input from the research team, and seemed to be due to the staff knowing a specific location for the system and the ease of use, with the whole process taking less than 20 seconds. ED staff seemed to prefer using the 'app', as after it was introduced there was very little use of the well publicised 'research hotline' phone number. Information and communications technology can aid in the timely identification of potential research subjects in emergency care.
-
Paracetamol poisoning is common worldwide. Standard intravenous N-acetylcysteine (NAC) therapy is complex, and commonly associated with concentration-related adverse effects and the potential for administration errors. We aimed to determine whether adverse effect incidence could be reduced by antiemetic pre-treatment and/or a simpler and shorter intravenous N-acetylcysteine regimen. ⋯ In patients with paracetamol poisoning requiring acetylcysteine, adverse effects were substantially reduced by ondansetron pre-treatment and by using a modified, shorter treatment regimen. Ondansetron, but not the modified regimen, increased the frequency of liver function abnormalities. If large effectiveness studies confirm the modified regimen is non-inferior to conventional then shorter and safer treatment would be possible for this common poisoning.
-
Pre-hospital triage is becoming increasingly important as Regional Trauma Networks for children are implemented in England. The low incidence of trauma in children makes pre-hospital assessment of injury severity and where to send an injured child challenging. Currently there are few validated pre-hospital triage tools for children's trauma and no consensus on which to use. We investigate performance characteristics of pre-hospital paediatric triage tools currently in use in England for identifying injured children. ⋯ From TARN data, two triage tools demonstrated acceptable under-triage rates (3% and 4%) for severe injuries but unacceptable over-triage of moderate injuries (83% and 72%). Two tools demonstrated acceptable over-triage (7% and 16%) with unacceptable under-triage (61% and 63%). Four tools demonstrated unacceptable under- and over-triage. For moderate and minor injuries, three tools demonstrated acceptable under- and over-triage rates (all 0%). The other five tools had unacceptable under-triage rates (25-100%). All eight tools had acceptable over-triage rates (1%-21%). (See tables 1 and 2) Abstract 004 Table 1Performance characteristics of pre-hospital paediatric trauma triage tools-TARN/severe injuries ToolnISS>15Undertriage rate (%)Overtriage rate (%)East Midlands701230383London472North West780Northern977South West London; Surrey1259Wessex3923Paediatric Trauma Score617Paediatric Triage Tape283946316 Abstract 004 Table 2Performance characteristics of pre-hospital paediatric trauma triage tools-Moderate/minor injuries ToolnISS>15Undertriage (%)Overtriage (%)East Midlands29344018London2511North West021Northern019South West London; Surrey509Wessex507Paediatric Trauma Score1001Paediatric Triage Tape18114753 CONCLUSION: For severe injuries, none of the pre-hospital triage tools for injured children currently used in England meet recommended criteria for over- and under-triage rates. For moderate to minor injuries, all tools achieved acceptable over-triage rates but tended to under-triage. There is an urgent need for development of triage tools to accurately risk-stratify injured children in the pre-hospital setting.
-
Most people enjoy sexual intercourse without complications, but a significant, if small, number need to seek emergency medical help for related health problems. The true incidence of these problems is not known. We therefore assessed all admissions to our emergency department (ED) in direct relation to sexual intercourse. ⋯ Sexual activity is mechanically dangerous, potentially infectious and stressful for the cardiovascular system. Because information on ED presentation related to sexual intercourse is scarce, more efforts should be undertaken to document all such complications to improve treatment and preventative strategies.
-
To describe the relationship between waiting time and patient satisfaction, and to determine predictors of overall care rating in an emergency department (ED) fast-track setting. ⋯ Waiting time was found to be highly predictive of patient satisfaction in an emergency fast-track unit with English language and NPs also associated with improved overall care rating. Future measures to improve patient satisfaction in fast-track units should focus on these factors.