Emergency medicine journal : EMJ
-
Frequent use of emergency medical services (EMS) is recognised to be a global phenomenon, although paediatric frequent use is poorly understood. This systematic review aimed to understand how paediatric frequent use of EMS is currently defined, identify factors associated with paediatric frequent use of EMS and determine effectiveness of interventions for paediatric patients who frequently use EMS. ⋯ The broad range of reasons for frequent use suggests that a single intervention is unlikely to be effective at addressing the causes of frequent use. There is a need for further research to better identify the underlying reasons for frequent EMS use among paediatric patients and to develop interventions in this population.
-
Identification of trauma patients at significant risk of death in the prehospital setting is challenging. The prediction probability of basic indices like vital signs, Shock Index (SI), SI multiplied by age (SIA) or the GCS is limited and more complex scores are not feasible on-scene. The Reverse SI multiplied by GCS score (rSIG) has been proposed as a triage tool to identify trauma patients with an increased risk of dying at EDs. Age adjustment (rSIG/A) displayed no advantage.We aim to (1) validate the accuracy of the rSIG in predicting death or early transfusion in a large trauma registry population, and (2) determine if the rSIG is valid for evaluation of trauma patients in the prehospital setting. ⋯ The prehospital rSIG/A can be a useful adjunct for the prehospital evaluation of trauma patients and their allocation to trauma centres or trauma team activation. However, we could not confirm that the rSIG at hospital admission is a reliable tool for risk stratification.
-
Patients with lower limb injuries are commonly discharged from the ED with the affected area immobilised. Rigid casting of the lower limb is known to be a risk factor for the development of venous thromboembolism (VTE), making thromboprophylaxis in this population an important consideration for clinicians in the ED. The use of structured risk assessment methods (RAMs) to evaluate VTE risk and recommend thromboprophylaxis to those at higher risk is widespread in the UK. However, the evidence informing this practice is nearly exclusively based on studies of patients with rigid lower limb casts but many patients with knee injuries, including some with significant thrombotic risk factors, are managed in semi-rigid ('cricket') knee splints. These are both removable and allow free movement of the ankle, but the baseline risk of VTE and the performance of different RAMs in this population are not known. ⋯ In our cohort of patients managed in semi-rigid removable knee splints, the risk of symptomatic VTE was low, about 1 in 250, and current methods of VTE risk assessment did not prove clinically useful.