Emergency medicine journal : EMJ
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Observational Study
Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study.
To understand the effect of COVID-19 lockdown measures on severity of illness and mortality in non-COVID-19 acute medical admissions. ⋯ These data demonstrate a significant reduction in non-COVID-19 acute medical admissions during the early weeks of lockdown. Patients admitted during this period were of higher clinical acuity with a higher incidence of early inpatient mortality.
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A gender gap in faculty rank at academic institutions exists; however, data among graduate medical education (GME) programmes are limited. There is a need to assess gender disparities in GME leadership, as a lack of female leadership may affect recruitment, role modelling and mentorship of female trainees. This cross-sectional study aimed to describe the current state of gender in programme leadership (department chair, programme director (PD), associate/assistant PD (APD) and clerkship director (CD)) at accredited Emergency Medicine (EM) programmes in the USA to determine whether a gender gap exists. ⋯ While the representation of women in educational roles is encouraging, the number of women holding the rank of chairperson remains disproportionately low. Further studies are needed to evaluate reasons for this and strategies to increase gender equality in leadership roles.
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The recommended front of neck access procedure in can't intubate, can't oxygenate scenarios relies on palpation of the cricothyroid membrane (CTM), or dissection of the neck down to the larynx if CTM is impalpable. CTM palpation is particularly challenging in obese patients, most likely due to an increased distance between the skin and the CTM (CTM depth). The aims of this study were to measure the CTM depth in a representative clinical sample, and to quantify the relationship between body mass index (BMI) and CTM depth. ⋯ CTM depth was strongly associated with BMI in a retrospective analysis of patients having clinical CT scans.
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Observational Study
Projected paediatric cervical spine imaging rates with application of NEXUS, Canadian C-Spine and PECARN clinical decision rules in a prospective Australian cohort.
Clinical decision rules (CDRs) are commonly used to guide imaging decisions in cervical spine injury (CSI) assessment despite limited evidence for their use in paediatric populations. We set out to determine CSI incidence, imaging rates and the frequency of previously identified CSI risk factors, and thus assess the projected impact on imaging rates if CDRs were strictly applied as a rule in our population. ⋯ CSIs were rare (0.5% of our cohort), however, 40% of children received imaging. CDRs have been designed to guide imaging decisions; if strictly applied as a rule for imaging, the CDRs assessed in this study would increase imaging rates. Projected rates differ considerably depending on the CDR applied. These findings highlight the need for a validated paediatric-specific cervical spine imaging CDR.