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EMERGENCY AND INTENSIVE CRITICAL CARE (121 journals)                     

Showing 1 - 124 of 124 Journals sorted alphabetically
AACN Advanced Critical Care     Full-text available via subscription   (Followers: 36)
Academic Emergency Medicine     Hybrid Journal   (Followers: 90)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acute and Critical Care     Open Access   (Followers: 9)
Acute Cardiac Care     Hybrid Journal   (Followers: 11)
Acute Medicine     Full-text available via subscription   (Followers: 8)
Advances in Emergency Medicine     Open Access   (Followers: 16)
Advances in Neonatal Care     Hybrid Journal   (Followers: 43)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 7)
African Journal of Emergency Medicine     Open Access   (Followers: 7)
AINS - Anasthesiologie - Intensivmedizin - Notfallmedizin - Schmerztherapie     Hybrid Journal   (Followers: 5)
American Journal of Emergency Medicine     Hybrid Journal   (Followers: 54)
Annals of Emergency Medicine     Hybrid Journal   (Followers: 126)
Annals of Intensive Care     Open Access   (Followers: 37)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 15)
Archives of Academic Emergency Medicine     Open Access   (Followers: 6)
Archives of Trauma Research     Open Access   (Followers: 4)
ASAIO Journal     Hybrid Journal   (Followers: 2)
Australasian Journal of Paramedicine     Open Access   (Followers: 7)
Australian Critical Care     Full-text available via subscription   (Followers: 21)
Bangladesh Critical Care Journal     Open Access   (Followers: 1)
BMC Emergency Medicine     Open Access   (Followers: 25)
BMJ Quality & Safety     Hybrid Journal   (Followers: 65)
Burns Open     Open Access  
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 2)
Case Reports in Acute Medicine     Open Access   (Followers: 3)
Case Reports in Critical Care     Open Access   (Followers: 13)
Case Reports in Emergency Medicine     Open Access   (Followers: 19)
Chronic Wound Care Management and Research     Open Access   (Followers: 7)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32)
Clinical Intensive Care     Hybrid Journal   (Followers: 6)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 3)
Clinical Risk     Hybrid Journal   (Followers: 5)
Crisis: The Journal of Crisis Intervention and Suicide Prevention     Hybrid Journal   (Followers: 15)
Critical Care     Open Access   (Followers: 74)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 29)
Critical Care Clinics     Full-text available via subscription   (Followers: 34)
Critical Care Explorations     Open Access   (Followers: 3)
Critical Care Medicine     Hybrid Journal   (Followers: 279)
Critical Care Research and Practice     Open Access   (Followers: 13)
Current Emergency and Hospital Medicine Reports     Hybrid Journal   (Followers: 5)
Current Opinion in Critical Care     Hybrid Journal   (Followers: 73)
Disaster and Emergency Medicine Journal     Open Access   (Followers: 12)
Egyptian Journal of Critical Care Medicine     Open Access   (Followers: 2)
EMC - Urgenze     Full-text available via subscription  
Emergency Care Journal     Open Access   (Followers: 7)
Emergency Medicine (Medicina neotložnyh sostoânij)     Open Access  
Emergency Medicine Australasia     Hybrid Journal   (Followers: 17)
Emergency Medicine Clinics of North America     Full-text available via subscription   (Followers: 19)
Emergency Medicine International     Open Access   (Followers: 8)
Emergency Medicine Journal     Hybrid Journal   (Followers: 53)
Emergency Medicine News     Full-text available via subscription   (Followers: 7)
Emergency Nurse     Full-text available via subscription   (Followers: 17)
Enfermería Intensiva (English ed.)     Full-text available via subscription  
European Burn Journal     Open Access   (Followers: 10)
European Journal of Emergency Medicine     Hybrid Journal   (Followers: 23)
Frontiers in Emergency Medicine     Open Access   (Followers: 8)
Global Journal of Transfusion Medicine     Open Access   (Followers: 1)
Hong Kong Journal of Emergency Medicine     Full-text available via subscription   (Followers: 5)
Indian Journal of Burns     Open Access   (Followers: 2)
Injury     Hybrid Journal   (Followers: 20)
Intensive Care Medicine     Hybrid Journal   (Followers: 82)
Intensive Care Medicine Experimental     Open Access   (Followers: 2)
Intensivmedizin up2date     Hybrid Journal   (Followers: 4)
International Journal of Critical Illness and Injury Science     Open Access   (Followers: 1)
International Journal of Emergency Medicine     Open Access   (Followers: 9)
International Journal of Emergency Mental Health and Human Resilience     Open Access   (Followers: 2)
International Paramedic Practice     Full-text available via subscription   (Followers: 14)
Iranian Journal of Emergency Medicine     Open Access  
Irish Journal of Paramedicine     Open Access   (Followers: 2)
Journal Européen des Urgences et de Réanimation     Hybrid Journal   (Followers: 1)
Journal of Acute Care Physical Therapy     Hybrid Journal   (Followers: 3)
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal Of Cardiovascular Emergencies     Open Access  
Journal of Concussion     Open Access  
Journal of Critical Care     Hybrid Journal   (Followers: 48)
Journal of Critical Care Medicine     Open Access   (Followers: 18)
Journal of Education and Teaching in Emergency Medicine     Open Access   (Followers: 1)
Journal of Emergencies, Trauma and Shock     Open Access   (Followers: 13)
Journal of Emergency Medical Services     Full-text available via subscription   (Followers: 12)
Journal of Emergency Medicine     Hybrid Journal   (Followers: 53)
Journal of Emergency Medicine, Trauma and Acute Care     Open Access   (Followers: 25)
Journal of Emergency Practice and Trauma     Open Access   (Followers: 6)
Journal of Intensive Care     Open Access   (Followers: 9)
Journal of Intensive Care Medicine     Hybrid Journal   (Followers: 22)
Journal of Intensive Medicine     Open Access  
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 3)
Journal of Stroke Medicine     Hybrid Journal  
Journal of the American College of Emergency Physicians Open     Open Access   (Followers: 1)
Journal of the Intensive Care Society     Hybrid Journal   (Followers: 4)
Journal of the Royal Army Medical Corps     Hybrid Journal   (Followers: 6)
Journal of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 81)
Journal of Translational Critical Care Medicine     Open Access   (Followers: 5)
Journal of Trauma and Acute Care Surgery, The     Hybrid Journal   (Followers: 34)
La Presse Médicale Open     Open Access  
Médecine de Catastrophe - Urgences Collectives     Hybrid Journal  
Medicina Intensiva     Open Access   (Followers: 3)
Medicina Intensiva (English Edition)     Hybrid Journal   (Followers: 1)
Mediterranean Journal of Emergency Medicine & Acute Care : MedJEM     Open Access  
Notfall + Rettungsmedizin     Hybrid Journal   (Followers: 3)
OA Critical Care     Open Access   (Followers: 3)
OA Emergency Medicine     Open Access   (Followers: 2)
Open Access Emergency Medicine     Open Access   (Followers: 6)
Open Journal of Emergency Medicine     Open Access   (Followers: 2)
Palliative Care : Research and Treatment     Open Access   (Followers: 19)
Palliative Medicine     Hybrid Journal   (Followers: 54)
Prehospital Emergency Care     Hybrid Journal   (Followers: 19)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 41)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
Resuscitation     Hybrid Journal   (Followers: 54)
Resuscitation Plus     Open Access   (Followers: 2)
Saudi Critical Care Journal     Open Access   (Followers: 2)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine     Open Access   (Followers: 11)
Seminars in Thrombosis and Hemostasis     Hybrid Journal   (Followers: 46)
Shock : Injury, Inflammation, and Sepsis : Laboratory and Clinical Approaches     Hybrid Journal   (Followers: 10)
Sklifosovsky Journal Emergency Medical Care     Open Access  
The Journal of Trauma Injury Infection and Critical Care     Full-text available via subscription   (Followers: 24)
Therapeutics and Clinical Risk Management     Open Access   (Followers: 2)
Transplant Research and Risk Management     Open Access  
Trauma Case Reports     Open Access   (Followers: 1)
Trauma Monthly     Open Access   (Followers: 3)
Visual Journal of Emergency Medicine     Full-text available via subscription   (Followers: 1)
Western Journal of Emergency Medicine     Open Access   (Followers: 11)
 AEM Education and Training : A Global Journal of Emergency Care     Open Access   (Followers: 1)

           

Similar Journals
Journal Cover
Emergency Medicine Journal
Journal Prestige (SJR): 0.912
Citation Impact (citeScore): 1
Number of Followers: 53  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1472-0205 - ISSN (Online) 1472-0213
Published by BMJ Publishing Group Homepage  [62 journals]
  • Highlights from this issue

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      Authors: Leech; C.
      Pages: 567 - 567
      Abstract: The COVID-19 oximetry at home programme This months Editors Choice is an analysis of the CO@h programme. In November 2020, NHS England recommended that patients with symptomatic confirmed COVID-19 who were over 65 years or clinically vulnerable be provided with a pulse oximeter and to call emergency services if the reading was ≤92% or primary care if the reading was 93%–94%. During the study period of October 2020 to May 2021, 217K patients were within the inclusion criteria but only 2.5% of these were enrolled into the programme and there was considerable variation between the definition/inclusion of clinically vulnerable, start dates and take up in each region. Analysing data pre and post implementation, there was no significant difference in 28 day mortality. There was a small increase in both ED attendances and a similar increase in emergency hospital admissions, which may reflect that pulse oximetry was effective at detecting...
      Keywords: EMJ Primary survey
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2022-212705
      Issue No: Vol. 39, No. 8 (2022)
       
  • Community emergency medicine throughout the UK and Ireland: a comparison
           of current national activity

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      Authors: Hanks, A; Ramage, L, Leech, C, PreHOspital Trainee Operated research Network (PHOTON) Research group collaborators, Cookson, Knapp, Moore, Patton, Rao, Masud, Bowker
      Pages: 568 - 574
      Abstract: BackgroundCommunity emergency medicine (CEM) aims to bring highly skilled, expert medical care to the patient outside of the traditional ED setting. Currently, there are several different CEM models in existence within the UK and Ireland which confer multiple benefits including provision of a senior clinical decision-maker early in the patient’s journey, frontloading of time-critical interventions, easing pressure on busy EDs and reducing inpatient bed days. This is achieved through increased community-based management supplemented by utilisation of alternative care pathways. This study aimed to undertake a national comparison of CEM services currently in operation.MethodA data collection tool was distributed to CEM services by the Pre-Hospital trainee Operated Research Network in October 2020 which aimed to establish current practice among services in the UK and Ireland. It focused on six key sections: service aims; staffing and training; job tasking and patient selection; funding and vehicles used; equipment and medication; data collection, governance and research activity.ResultsSeven services responded from across England, Wales and Ireland. Similarities were found with the aims of each service, staffing structures and operational times. There were large differences in equipment carried, categories of patient targeted and with governance and research activity.ConclusionWhile some national variations in services are explained by funding and geographical location, this review process revealed several differences in practice under the umbrella term of CEM. A national definition of CEM and its aim, with guidance on scope of practice and measurable outcomes, should be generated to ensure high standard and cost-effective emergency care is delivered in the community.
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2021-211695
      Issue No: Vol. 39, No. 8 (2022)
       
  • A man with blurred vision and headache

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      Authors: Lee, Y.-C; Liu, Y.-C, Lee, W.-J.
      Pages: 574 - 616
      Abstract: Clinical Introduction A 51-year-old man with a medical history of hypertension presented to the ED with a 2-week headache and blurred vision, in addition to a visual defect for over 1 month. Under ophthalmic examination, visual acuity was 0.8/0.4 (1.0) and visual field test showed right 3/4 quadrantanopsia. Ocular point-of-care ultrasound was performed (figure 1). Question What is the most likely diagnosis'
      Retrobulbar mass
      Retinal detachment
      Papilloedema with increased intracranial pressure
      Vitreous haemorrhage Answer C. Papilloedema with increased intracranial pressure. Ultrasonographic optic nerve sheath diameter (ONSD) and optic disc height measurement can serve as a rapid, non-invasive method for bedside assessment of intracranial pressure (ICP). Optic disc protrusion and disc height greater than 0.6 mm are strongly associated with papilloedema.1 An estimated ONSD greater than 5 mm is consistent with ICP>20 cm H2O.2 In this case, ocular...
      Keywords: EMJ Image Challenge
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2021-211995
      Issue No: Vol. 39, No. 8 (2022)
       
  • Population-level impact of a pulse oximetry remote monitoring programme on
           mortality and healthcare utilisation in the people with COVID-19 in
           England: a national analysis using a stepped wedge design

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      Authors: Beaney, T; Clarke, J, Alboksmaty, A, Flott, K, Fowler, A, Benger, J, Aylin, P. P, Elkin, S, Neves, A. L, Darzi, A.
      Pages: 575 - 582
      Abstract: BackgroundTo identify the population-level impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home (CO@h)) in England on mortality and health service use.MethodsWe conducted a retrospective cohort study using a stepped wedge pre-implementation and post-implementation design, including all 106 Clinical Commissioning Groups (CCGs) in England implementing a local CO@h programme. All symptomatic people with a positive COVID-19 PCR test result from 1 October 2020 to 3 May 2021, and who were aged ≥65 years or identified as clinically extremely vulnerable were included. Care home residents were excluded. A pre-intervention period before implementation of the CO@h programme in each CCG was compared with a post-intervention period after implementation. Five outcome measures within 28 days of a positive COVID-19 test: (i) death from any cause; (ii) any ED attendance; (iii) any emergency hospital admission; (iv) critical care admission and (v) total length of hospital stay.Results217 650 people were eligible and included in the analysis. Total enrolment onto the programme was low, with enrolment data received for only 5527 (2.5%) of the eligible population. The period of implementation of the programme was not associated with mortality or length of hospital stay. The period of implementation was associated with increased health service utilisation with a 12% increase in the odds of ED attendance (95% CI: 6% to 18%) and emergency hospital admission (95% CI: 5% to 20%) and a 24% increase in the odds of critical care admission in those admitted (95% CI: 5% to 47%). In a secondary analysis of CO@h sites with at least 10% or 20% of eligible people enrolled, there was no significant association with any outcome measure.ConclusionAt a population level, there was no association with mortality before and after the implementation period of the CO@h programme, and small increases in health service utilisation were observed. However, lower than expected enrolment is likely to have diluted the effects of the programme at a population level.
      Keywords: Open access, Editor's choice, COVID-19
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2022-212378
      Issue No: Vol. 39, No. 8 (2022)
       
  • Association of the COVID-19 pandemic with bystander cardiopulmonary
           resuscitation for out-of-hospital cardiac arrest: a population-based
           analysis in Tokyo, Japan

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      Authors: Shibahashi, K; Kawabata, H, Sugiyama, K, Hamabe, Y.
      Pages: 583 - 588
      Abstract: BackgroundThe impact of the COVID-19 pandemic on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is unclear. This study aimed to investigate whether rates of bystander CPR and patient outcomes changed during the initial state of emergency declared in Tokyo for the COVID-19 pandemic.MethodsThis retrospective study used data from a population-based database of OHCA maintained by the Tokyo Fire Department. By comparing data from the periods before (18 February to 6 April 2020) and during the declaration of a state of emergency (7 April 2020 to 25 May 2020), we estimated the change in bystander CPR rate, prehospital return of spontaneous circulation, and survival and neurological outcomes 1 month after OHCA, accounting for outcome trends in 2019. We performed a multivariate regression analysis to evaluate the potential mechanisms for associations between the state of emergency and these outcomes.ResultsThe witnessed arrest rates before and after the declaration periods in 2020 were 42.5% and 45.1%, respectively, compared with 44.1% and 44.7% in the respective corresponding periods in 2019. The difference between the two periods in 2020 was not statistically significant when the trend in 2019 was considered. The bystander CPR rates before and after the declaration periods significantly increased from 34.4% to 43.9% in 2020, an 8.3% increase after adjusting for the trend in 2019. This finding was significant even after adjusting for patient and bystander characteristics and the emergency medical service response. There were no significant differences between the two periods in the other study outcomes.ConclusionThe COVID-19 pandemic was associated with an improvement in the bystander CPR rate in Tokyo, while patient outcomes were maintained. Pandemic-related changes in patient and bystander characteristics do not fully explain the underlying mechanism; there may be other mechanisms through which the community response to public emergency increased during the pandemic.
      Keywords: COVID-19
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2021-212212
      Issue No: Vol. 39, No. 8 (2022)
       
  • Prognostic value of National Early Warning Scores (NEWS2) and component
           physiology in hospitalised patients with COVID-19: a multicentre study

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      Authors: Scott, L. J; Tavare, A, Hill, E. M, Jordan, L, Juniper, M, Srivastava, S, Redfern, E, Little, H, Pullyblank, A.
      Pages: 589 - 594
      Abstract: BackgroundNational Early Warning Scores (NEWS2) are used to detect all-cause deterioration. While studies have looked at NEWS2, the use of virtual consultation and remote monitoring of patients with COVID-19 mean there is a need to know which physiological observations are important.AimTo investigate the relationship between outcome and NEWS2, change in NEWS2 and component physiology in COVID-19 inpatients.MethodsA multi-centre retrospective study of electronically recorded, routinely collected physiological measurements between March and June 2020. First and maximum NEWS2, component scores and outcomes were recorded. Areas under the curve (AUCs) for 2-day, 7-day and 30-day mortality were calculated.ResultsOf 1263 patients, 26% died, 7% were admitted to intensive care units (ICUs) before discharge and 67% were discharged without ICU. Of 1071 patients with initial NEWS2, most values were low: 50% NEWS2=0–2, 27% NEWS2=3–4, 14% NEWS2=5–6 and 9% NEWS2=7+. Maximum scores were: 14% NEWS2=0–2, 22% NEWS2=3–4, 17% NEWS2=5–6 and 47% NEWS2=7+. Higher first and maximum scores were predictive of mortality, ICU admission and longer length of stay. AUCs based on 2-day, 7-day, 30-day and any hospital mortality were 0.77 (95% CI 0.70 to 0.84), 0.70 (0.65 to 0.74), 0.65 (0.61 to 0.68) and 0.65 (0.61 to 0.68), respectively. The AUCs for 2-day mortality were 0.71 (0.65 to 0.77) for supplemental oxygen, 0.65 (0.56 to 0.73) oxygen saturation and 0.64 (0.56 to 0.73) respiratory rate.ConclusionWhile respiratory parameters were most predictive, no individual parameter was as good as a full NEWS2, which is an acceptable predictor of short-term mortality in patients with COVID-19. This supports recommendation to use NEWS2 alongside clinical judgement to assess patients with COVID-19.
      Keywords: Open access, COVID-19
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2020-210624
      Issue No: Vol. 39, No. 8 (2022)
       
  • Need for pharmacological analgesia after cast immobilisation in children
           with bone fractures: an observational cross-sectional study

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      Authors: Cozzi, G; Cortellazzo Wiel, L, Bassi, A, Giangreco, M, Dibello, D, Rozzo, M, Di Carlo, V, Genovese, M. R. L, Barbi, E.
      Pages: 595 - 600
      Abstract: BackgroundBone 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.MethodsA prospective observational cross-sectional study was conducted at the ED of the children’s hospital, Institute for Maternal and Child Health of Trieste, Italy, from October 2019 to June 2020. Patients aged 0–17 years with bone fractures were included. The primary outcome was the administration of analgesia during the 10 days following discharge, while secondary outcomes were the associated variables, including age, gender, fracture type and location, the mean limitation in usual activities and the frequency of re-evaluation at the ED for pain. Data were recorded through a questionnaire, completed by caregivers and collected by the researchers mainly through a telephone interview. The primary endpoint was evaluated as the ratio between the number of children who took at least one analgesic dose and the total enrolled children, while X2 or Fisher’s exact tests were used to assess secondary outcomes.ResultsDuring the study period, 213 patients, mean age 10 years (IQR: 8–13), were enrolled. Among them, 137 (64.3%) did not take any analgesic during follow-up. Among children who were administered analgesia, 22 (28.9%) received it only on the first day, and 47 (61.8%) for less than 5 days. One hundred and sixty one patients (75.6%) did not report any limitation in usual activities because of pain. The administration of analgesia was not related to the child’s age, gender or fracture site. Displaced fractures were associated with significantly more frequent analgesia being taken (OR 5.5, 95% CI 1.4 to 21.0).ConclusionAlthough 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.
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2020-210989
      Issue No: Vol. 39, No. 8 (2022)
       
  • Girl with genital bleeding and dysuria

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      Authors: Caruso, M; Lembo, M. A, Cozzi, G.
      Pages: 600 - 633
      Abstract: Clinical introduction A 10-year-old girl presented with genital bleeding and dysuria for 4 days. In the last 2 days, she needed to change pads four times a day. No trauma or fever was reported. She was taking fosfomycin for presumed urinary tract infection, without improvement of her symptoms. At physical examination, a red-soft doughnut-shaped mass at vaginal introitus was noted (figure 1). No signs of pubertal growth spurt were present. Question What is the diagnosis'
      Vaginal tumour
      Urethral prolapse
      Polyps
      Sexual abuse Answer B The physical examination was suggestive of urethral prolapse, an eversion of distal urethral mucosa through the external meatus. Urethral prolapse is a rare condition in prepubertal Caucasian girls. The pathogenesis is unknown, but seems related to an oestrogen deficiency associated with predisposing factors that increase abdominal pressure such as constipation, cough or straining.
      Keywords: EMJ Image Challenge
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2020-210848
      Issue No: Vol. 39, No. 8 (2022)
       
  • Association between the number of endotracheal intubation attempts and
           rates of adverse events in a paediatric emergency department

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      Authors: Abid, E. S; Miller, K. A, Monuteaux, M. C, Nagler, J.
      Pages: 601 - 607
      Abstract: BackgroundChallenges in emergent airway management in children can affect intubation success. It is unknown if number of endotracheal intubation attempts is associated with rates of adverse events in the paediatric ED setting.ObjectiveWe sought to (1) Identify rates of intubation-related adverse events, (2) Evaluate the association between the number of intubation attempts and adverse events in a paediatric ED, and (3) Determine the effect of videolaryngoscopy on these associations.Design and methodsWe performed a retrospective observational study of patients who underwent endotracheal intubation in a paediatric ED in the USA between January 2004 and December 2018. Data on patient-related, provider-related and procedure-related characteristics were obtained from a quality assurance database and the health record. Our primary outcome was frequency of intubation-related adverse events, categorised as major and minor. The number of intubation attempts was trichotomised to 1, 2, and 3 or greater. Multivariable logistic regression models were used to determine the relationship between the number of intubation attempts and odds of adverse events, adjusting for demographic and clinical factors.ResultsDuring the study period, 628 patients were intubated in the ED. The overall rate of adverse events was 39%. Hypoxia (19%) was the most common major event and mainstem intubation (15%) the most common minor event. 72% patients were successfully intubated on the first attempt. With two intubation attempts, the adjusted odds of any adverse event were 3.26 (95% CI 2.11 to 5.03) and with ≥3 attempts the odds were 4.59 (95% CI 2.23 to 9.46). Odds similarly increased in analyses of both major and minor adverse events. This association was consistent for both traditional and videolaryngoscopy.ConclusionIncreasing number of endotracheal intubation attempts was associated with higher odds of adverse events. Efforts to optimise first attempt success in children undergoing intubation may mitigate this risk and improve clinical outcomes.
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2021-211570
      Issue No: Vol. 39, No. 8 (2022)
       
  • Recurrent abdominal pain in a 7-year-old girl

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      Authors: Trombetta, A; Barbi, E, Pederiva, F.
      Pages: 607 - 634
      Abstract: Clinical introduction A 7-year-old girl was admitted to the emergency department for a 2-month history of recurrent abdominal pain, accompanied by nocturnal awakening, vomiting and interruption of daily activities. Her medical history was unremarkable, her family had recently moved from a low-income country. At admission, the girl was afebrile, with mild abdominal tenderness without guarding. Blood tests showed neutrophilic leucocytosis (white blood cells 21 740/mL, N 18 620/mL), with haemoglobin 14 g/dL and thrombocytosis (platelets 685 000/mL) with C-reactive protein (CRP) level (0.5 mg/dL, normal range 0–0.5 mg/dL). An abdominal ultrasound scan failed to show abnormalities. Twelve hours after admission, the abdominal pain worsened, the temperature spiked to 39°C, the abdominal examination showed increased tenderness and diffuse guarding, while the CRP rose to 5.9 mg/dL. A supine X-ray was performed (figure 1). What is the diagnosis'
      Appendicitis
      Bowel perforation
      Choledocholithiasis with cholangitis
      Kidney stones with urinary...
      Keywords: EMJ Image Challenge
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2020-211046
      Issue No: Vol. 39, No. 8 (2022)
       
  • Prehospital benzodiazepine use and need for respiratory support in
           paediatric seizures

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      Authors: Pfeiffer, C. K; Smith, K, Bernard, S, Dalziel, S. R, Hearps, S, Geis, T, Kabesch, M, Babl, F. E, On behalf of the PREDICT Network
      Pages: 608 - 615
      Abstract: BackgroundParamedics 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.MethodsWe conducted a retrospective observational study of state-wide ambulance service data (Ambulance Victoria in Victoria, Australia, population: 6.5 million). Children aged 0–17 years assessed for seizures by paramedics were analysed for demographics, process factors, treatment and airway management. We calculated adjusted ORs (AOR) of the requirement for respiratory support in relation to the number of BZD doses administered.ResultsParamedics attended 5112 children with suspected seizures over 1 year (1 July 2018 to 30 June 2019). Overall, need for respiratory support was low (n=166; 3.2%). Before ambulance arrival, 509 (10.0%) had already received a BZD and 420 (8.2%) were treated with midazolam by paramedics. Of the 846 (16.5%) patients treated with BZD, 597 (70.6%) received 1 BZD dose, 156 (18.4%) 2 doses and 93 (11.0%)>2 doses of BZD. Patients who were administered 1, 2 and>2 doses of BZD received respiratory support in 8.9%, 32.1% (AOR 4.6 vs 1 dose, 95% CI 2.9 to 7.4) and 49.5% (AOR 10.3 vs 1 dose, 95% CI 6.0 to 17.9), respectively.ConclusionsIncreasing 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.
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2021-211735
      Issue No: Vol. 39, No. 8 (2022)
       
  • Validity of the Taiwan Triage and Acuity Scale in mainland China: a
           retrospective observational study

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      Authors: Chen, Q.-Q; Chiu, S. Y.-H, Tsai, L.-Y, Hu, R.-F.
      Pages: 617 - 622
      Abstract: ObjectivesThe 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.MethodsA retrospective observational study was performed on patients 14 years of age or older attending the ED of a tertiary hospital in mainland China between 1 January 2016 and 31 March 2016. The validity of the TTAS in predicting hospital admission, intensive care unit (ICU) admission, death, ED length of stay (LOS) and ED resource utilisation was evaluated by determining the correlation of these outcomes with the TTAS, AUROC and test characteristics.ResultsA total of 7843 patients were included in this study. There were significant differences between the TTAS categories in disposition, ED LOS and ED resource utilisation (p
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2019-208732
      Issue No: Vol. 39, No. 8 (2022)
       
  • Reliability and validity of the Netherlands Triage Standard in emergency
           care settings: a case scenario study

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      Authors: Smits, M; Plat, E, Alink, E, de Vries, M, Apotheker, M, van Overdijk, S, Giesen, P.
      Pages: 623 - 627
      Abstract: BackgroundThe Netherlands Triage Standard (NTS) is a triage system that can be used by different types of emergency care organisations. Our objective was to determine the interrater reliability and construct validity of the NTS when applied to self-presenting patients.MethodsWe performed a cross-sectional case scenario study consisting of two parts: (1) paediatric triage in January-February 2019 and (2) adult triage in October-November 2020. In each part, we invited nurse triagists from three general practitioner cooperatives, three ambulance dispatching centres and three hospital emergency departments in the Netherlands to participate. We used 40 case scenarios involving paediatric patients and 41 involving adult patients who could self-present to any emergency care organisation. In advance, an expert panel determined the urgency (six levels) of the case scenarios (reference standard). The main outcome for reliability was the intraclass correlation coefficient (ICC) for urgency level. The main outcomes for validity were degree of agreement with the reference standard, for urgency level, and sensitivity and specificity for high versus low urgency. We used descriptive statistics and logistic multilevel modelling with both case and triagist as random effects.Results218 out of 240 invited triagists participated. The ICC among all triagists was 0.73 for paediatric cases and 0.88 for adult cases and was highest in general practitioner cooperatives. For paediatric cases, there was 62.3% agreement with the reference standard about urgency, 17.4% underestimation and 20.2% overestimation. The sensitivity of the NTS for identifying highly urgent paediatric cases was 85.2%; the specificity was 89.7%. For adult cases, there was 68.3% agreement, 13.7% underestimation and 18.0% overestimation. The sensitivity of triage for high urgency in adults was 94.5% and the specificity 83.3%.ConclusionNTS appears to have good reliability and construct validity for estimating the urgency of health complaints of non-referred patients presenting themselves in emergency care.
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2021-211359
      Issue No: Vol. 39, No. 8 (2022)
       
  • Association between triage level and outcomes at Medecins Sans Frontieres
           trauma hospital in Kunduz, Afghanistan, 2015

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      Authors: Daebes, H. L; Tounsi, L. L, Nerlander, M, Gerdin Wärnberg, M, Jaweed, M, Mamozai, B. A, Nasim, M, Trelles, M, von Schreeb, J.
      Pages: 628 - 633
      Abstract: BackgroundFive million people die annually due to injuries; an increasing part is due to armed conflict in low-income and middle-income countries, demanding resolute emergency trauma care. In Afghanistan, a low-income country that has experienced conflict for over 35 years, conflict related trauma is a significant public health problem. To address this, the non-governmental organisation Médecins Sans Frontières (MSF) set up a trauma centre in Kunduz (Kunduz Trauma Centre (KTC)). MSF’s standardised emergency operating procedures include the South African Triage Scale (SATS). To date, there are few studies that assess how triage levels correspond with outcome in low-resource conflict settingsAimThis study aims to assess to what extent SATS triage levels correlated to outcomes in terms of hospital admission, intensive care unit (ICU) admission and mortality for patients treated at KTC.Method and materialsThis retrospective study used routinely collected data from KTC registries. A total of 17 970 patients were included. The outcomes were hospital admission, ICU admission and mortality. The explanatory variable was triage level. Covariates including age, gender and delay to arrival were used. Logistic regression was used to study the correlation between triage level and outcomes.ResultsOut of all patients seeking care, 28.7% were triaged as red or orange. The overall mortality was 0.6%. In total, 90% of those that died and 79% of ICU-admitted patients were triaged as red.ConclusionThe risk of positive and negative outcomes correlated with triage level. None of the patients triaged as green died or were admitted to the ICU whereas 90% of patients who died were triaged as red.
      Keywords: Open access
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2020-209470
      Issue No: Vol. 39, No. 8 (2022)
       
  • Diagnostic and prognostic test assessment in emergency medicine:
           likelihood and diagnostic odds ratios

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      Authors: Marill; K. A.
      Pages: 635 - 642
      Abstract: 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. These approaches can be applied to a single test in isolation using univariate techniques, or to a group of tests as commonly applied in clinical practice using multivariate methods. We compare and contrast the relative benefits and challenges of the LR and OR approaches, and assess their interchangeability. 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.
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2020-210506
      Issue No: Vol. 39, No. 8 (2022)
       
  • Journal update monthly top five

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      Authors: Shanahan, T. A. G; Cottey, L, Darbyshire, D, Hirst, R, Naquib, M, Oliver, G, Prager, G.
      Pages: 643 - 644
      Abstract: This month’s update is by the EMJ journal update monthly top five core team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as: Worth a peek—interesting, but not yet ready for prime time. Head turner—new concepts. Game changer—this paper could/should change practice. Extracorporeal life support for out-of-hospital cardiac arrest: a nationwide multicentre study by Jeong et alTopic: out-of-hospital cardiac arrestRating: worth a peek This paper sought to determine the benefit of extracorporeal life support (ECLS) in out-of-hospital cardiac arrest.1 The authors conducted a retrospective observational study using South Korean national registry data. As such, the methodology was primarily hypothesis generating. The authors chose a patient-orientated primary...
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2022-212672
      Issue No: Vol. 39, No. 8 (2022)
       
  • Abstracts from international Emergency Medicine journals

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      Authors: Production; E.
      Pages: 645 - 646
      Abstract: Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.
      PubDate: 2022-07-20T02:34:09-07:00
      DOI: 10.1136/emermed-2022-212675
      Issue No: Vol. 39, No. 8 (2022)
       
 
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