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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A short cut review was carried out to establish whether local anaesthetic lubrication is necessary for urethral catheterisation in men. Two studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that the use of local anaesthetic is effective in this population and should form part of the procedure.
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Comparative Study
Emergency medical services versus private transport of trauma patients in the Sultanate of Oman: a retrospective audit at the Sultan Qaboos University Hospital.
This study aims to assess the differences in the outcome of road traffic trauma patients between those transported by emergency medical services (EMS) and those privately transported to the Sultan Qaboos University Hospital in the Sultanate of Oman in 2011. ⋯ EMS transported trauma patients had a statistically non-significant 36% reduction in mortality compared with privately transported patients admitted to the Sultan Qaboos University Hospital in 2011. Further, research that incorporates prehospital factors such as crash to arrival of EMS services and transport time to definitive healthcare facility should be conducted to evaluate the effectiveness of such a system in trauma care. Since non-EMS transport is likely to continue, public first aid training is critical to reduce mortality and morbidity of road traffic trauma in Oman.