Emergency medicine journal : EMJ
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The relationship between age and presenting Glasgow Coma Scale (GCS) in adults with traumatic brain injury (TBI) has not so far been explored in detail. We have previously reported a trend for higher GCS in elderly patients presenting to our major trauma centre with isolated TBI compared with younger adults. The aim of this study was to confirm and define this relationship using a national trauma registry and to evaluate potential contributory factors. emermed;31/9/775-c/SA2EMERMED2014204221TB1T1sa2-EMERMED2014204221TB1 Table 1 Isolated Head AIS 3+ patients 1988-2014 N(total 13547) Adults*mean (95% CI), **median (IQR) N(total 2485) Elderly*mean (95% CI), **median (IQR) Male 10410 76.8% (76.1%-77.6%) 1368 55.1% (53.1%-57.0%) Age* *26.1 (15.9-42.0) *77.6 (71.0-84.0) ISS** **16 (13-25) **17 (16-25) AIS head** **4 (3-5) **4 (4-5) Presenting GCS** **14 (9-15) Underwentprocedure* 1681 12.4% (11.9%-13.0%) 200 8.0% (7.0%-9.1%) 30 day mortality* 1072 7.9% (7.5%-8.4%) 732 29.5% (27.7%-31.2%) Injury mechanism Blast 4 0.0% (0%-0.1%) 0 Blow 1862 13.7% (13.2%-14.3%) 53 2.1% (1.6%-2.7%) Other 1664 12.3% (11.7%-12.8%) 96 3.9% (3.1%-4.6%) Fall <2 m 2073 15.3% (14.7%-15.9%) 1244 50.1% (48.1%-52.0%) Fall >2 m 2382 17.6% (16.9%-18.2%) 524 21.1% (19.5%-22.7%) RTC 5553 41.0% (40.2%-41.8%) 567 22.8% (21.2%-24.5%) Stabbing/shooting 9 0.1% (0%-0.1%) 1 0.0% (0%-0.1%) ⋯ We believe that this is the first study to demonstrate that elderly patients present with a higher GCS than younger adults for a given anatomical severity of TBI. This difference is not confined to any particular mechanism of injury nor any type of intracranial injury. These findings may have profound implications for prehospital trauma triage tools, outcome prediction methodologies and neurosurgical decision-making.
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Randomized Controlled Trial Multicenter Study
Clinical effects and safety of different strategies for administering intravenous diuretics in acutely decompensated heart failure: a randomised clinical trial.
The mainstay of treatment for acutely decompensated heart failure (ADHF) is intravenous diuretic therapy either as a bolus or via continuous infusion. ⋯ In patients with ADHF attending the ED, boluses of furosemide have a smaller diuretic effect but provide similar clinical relief, similar preservation of renal function, and a lower incidence of hypokalaemia than continuous infusion.
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Relatively little is currently known about the effectiveness of first-aid training for children and laypeople. We have undertaken a systematic review to synthesise the evidence and inform policy and practice in this area. ⋯ There is some evidence to support provision of first-aid training, particularly for children or young people, but many studies were judged to be at risk of bias. Conclusions cannot be drawn about which first-aid training courses or programmes are most effective or the age at which training can be most effectively provided. Few studies evaluated training in adult laypeople. High-quality studies are required assessing effectiveness and cost-effectiveness of standardised first-aid training to inform policy development and provision of first-aid training.