Emergency medicine journal : EMJ
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Observational Study
Need for pharmacological analgesia after cast immobilisation in children with bone fractures: an observational cross-sectional study.
Bone fractures are a common reason for children and adolescents to seek evaluation in the ED. Little is known about the pain experienced after cast immobilisation and discharge from the ED and its optimal management. We aimed to investigate the administration of pharmacological analgesia in the first days after cast immobilisation and to identify possible influencing variables. ⋯ Although some studies recommend scheduled analgesic treatment after discharge for bone fractures, this study would suggest analgesia on demand in children with non-displaced fractures, limiting scheduled analgesia to children with displaced fractures.
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Observational Study
Validity of the Taiwan Triage and Acuity Scale in mainland China: a retrospective observational study.
The Taiwan Triage and Acuity Scale (TTAS), developed for use in EDs, has been shown to be an excellent tool for triaging patients with high predictive performance, with an area under the receiver operating curve (AUROC) of 0.75. TTAS has been widely used in hospitals in Taiwan since 2010, but its utility has not been studied outside of Taiwan. Thus, the aim of this study was to evaluate the validity of using the TTAS in the ED of a tertiary hospital in mainland China to predict patient outcomes. ⋯ The TTAS had good validity in predicting patient outcomes and ED resource utilisation in a tertiary hospital in mainland China. Compared with the performance of the TTAS in Taiwan, our results suggest that the TTAS can usefully be applied outside of Taiwan.
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Observational Study
Prehospital benzodiazepine use and need for respiratory support in paediatric seizures.
Paramedics are frequently called to attend seizures in children. High-quality evidence on second-line treatment of benzodiazepine (BZD)-refractory convulsions with parenteral long-acting antiepileptic drugs in children has become available from the ED. In order to address the potential need for an alternative agent, we set out to determine the association of BZD use prehospital and the need for respiratory support. ⋯ Increasing administration of BZD doses was associated with higher use of respiratory support. Alternative prehospital antiepileptic drugs to minimise respiratory depression should be investigated in future research.
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Emergency physicians use diagnostic and prognostic tests on a daily basis to assess for life-threatening illness and to inform clinical decisions. Current and new tests must be scientifically evaluated for their diagnostic utility. We discuss the evaluation of diagnostic and prognostic tests using the Bayesian likelihood ratio (LR) and logistic regression diagnostic odds ratio (OR) frameworks. ⋯ The concepts of diagnostic multivariate testing also underlie the framework of clinical decision rules which have gained acceptance in emergency medicine. Clinical decision rules can be viewed as a subanalysis within the joint LR framework. Ultimately, a variety of approaches may be acceptable and even complementary to assess a diagnostic test, each with its own merits and limitations.