Emergency medicine journal : EMJ
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Multicenter Study Observational Study
Subarachnoid haemorrhage in the emergency department (SHED): a prospective, observational, multicentre cohort study.
People presenting to the ED with acute severe headache often undergo investigation to exclude subarachnoid haemorrhage (SAH). International guidelines propose that brain imaging within 6 hours of headache onset can exclude SAH, in isolation. The safety of this approach is debated. We sought to externally validate this strategy and evaluate the test characteristics of CT-brain beyond 6 hours. ⋯ Our data suggest a very low likelihood of SAH after a negative CT-brain scan performed early after headache onset. These results can inform shared decision-making on the risks and benefits of further investigation to exclude SAH in ED patients with acute headache.
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The WHO recognises patient safety as a serious public health problem. The COVID-19 pandemic affected adult EDs (AEDs) and paediatric EDs (PEDs) differently. We compared the culture of safety in the adult AED and PED before and after the COVID-19 pandemic. ⋯ The baseline perception of the culture of safety was higher in the PED but improved in both services during the COVID-19 pandemic. Adverse situations can provide an opportunity to improve patient safety culture.
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A short-cut systematic review was conducted using a described protocol. The three-part question addressed was: In adult patients presenting to the ED with diabetes-related visual symptoms, how effective is using a portable handheld fundus camera in diagnosing diabetic retinopathy?MEDLINE, Embase and Cochrane databases were searched for relevant evidence. Altogether, 237 papers were found using the search strategy developed. 12 provided the best evidence to answer the three-part question. ⋯ Jin et al (2017) demonstrated high-quality images with 63% rated as excellent, showing a comparable efficacy to a traditional tabletop camera. Das et al (2022) found that Remidio and Pictor handheld cameras had high success rates and image quality, with sensitivities of 77.5% (95% CI: 65.9% to 89.0%) and 78.1% (95% CI: 66.6% to 89.5%), respectively, comparable to the Zeiss tabletop camera's sensitivity of 84.9% (95% CI: 78.2% to 91.5%). The clinical bottom line is that the best available evidence supports the effectiveness of portable handheld fundus cameras for diagnosing diabetic retinopathy in emergency settings.