Articles: emergency-services.
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A short systematic review was undertaken to assess whether adult patients presenting to the ED with a first seizure require a CT head scan to rule out emergent intracranial pathology. MEDLINE, EMBASE, Cochrane and Google Scholar databases were searched. ⋯ Our results indicate that adults presenting with a first seizure are a high-yield group for CT with a number needed to scan (NNS) between 10 and 19 for findings that would change management in ED, such as haemorrhage, infarction and tumours. We believe that this NNS is sufficiently low to justify the routine use of neuroimaging for these patients in emergency care.
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Multicenter Study Observational Study
Frailty is associated with 30-day mortality: a multicentre study of Swedish emergency departments.
Older patients living with frailty have an increased risk for adverse events. The Clinical Frailty Scale (CFS) is a 9-point frailty assessment instrument that has shown promise to identify frail emergency department (ED) patients at increased risk of adverse outcomes. The aim of this study was to investigate the association between CFS scores and 30-day mortality in an ED setting when assessments are made by regular ED staff. ⋯ Patients living with frailty, had significantly higher mortality and admission rates as well as longer ED and in-hospital LOS compared with robust patients. The results confirm the capability of the CFS to risk stratify short-term mortality in older ED patients.
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Junior doctors joining EDs are required to rapidly acquire new knowledge and skills, but there is little research describing how this process can be facilitated. We aimed to understand what would make ED formal induction and early socialisation more effective. ⋯ Effective socialisation, consistent with previous literature, was identified as critical. Junior doctors see consultant behaviours and interactions as key to creating a safe learning space.
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Observational Study
Can We Improve Mortality Prediction in Patients with Sepsis in the Emergency Department?
Background and Objectives: Sepsis represents a global health challenge and requires advanced diagnostic and prognostic approaches due to its elevated rate of morbidity and fatality. Our study aimed to assess the value of a novel set of six biomarkers combined with severity scores in predicting 28 day mortality among patients presenting with sepsis in the Emergency Department (ED). Materials and Methods: This single-center, observational, prospective cohort included sixty-seven consecutive patients with septic shock and sepsis enrolled from November 2020 to December 2022, categorized into survival and non-survival groups based on outcomes. ⋯ The GCS, SOFA, APACHEII, and SAPS II/III showed superior predictive ability. Combining IL-6 with suPAR, AZU1, and clinical scores SOFA, APACHE II, and SAPS II enhanced prediction accuracy compared with individual biomarkers. Conclusion: In our study, IL-6 and SAPS II/III were the most accurate predictors of 28 day mortality for sepsis patients in the ED.