Emergency Medicine

AimsThe outbreak of COVID-19, lockdown and self-isolation has created a lot of additional pressure on the society as a whole. We aim to audit the number of patients presenting to SVUH ED since March 27th 2020 (the date at which the government imposed a stay-at-home order) with an overdose.MethodsThe cohort of cases analysed was identified using ED MAXIMS under the subheading of ‘overdose and poisoning’ presentations. Data were collected using MAXIMS and clinical portal and stored on the SVUH system and analysed using Microsoft Excel and SPSS.ResultsThere were a total of 713 cases in both years (from 27th of March – 31st December), with 353 (49.5%) admitted in 2019 and 360 (50.5%) admitted in 2020. Out of those admitted, 423 patients were females (196 and 227 in 2019 and 2020 respectively). There was a significant increase in the number of female presentations in 2020, with a p value of 0.041.When stratifying patients based on age, the mean ages were 37.22 (SD 17.04) and 34.18 (SD17....

BACKGROUNDImpact of geriatric consultative services (GCS) on hospital readmission and mortality outcomes for cognitively impaired (CI) patients is not known.OBJECTIVEEvaluate impact of GCS on hospital readmission and mortality among CI inpatients.DESIGNSecondary data analysis of a prospective trial of a computerized decision support system between July 1, 2006 and May 30, 2008.SETTINGStudy conducted at Eskenazi hospital, Indianapolis, Indiana, a 340‐bed, public hospital with over 2300 yearly admissions of patients ages 65 years or older.PATIENTSThere were 415 inpatients aged 65 years and older with CI enrolled from July 2006 to March 2008.MEASUREMENTSThirty‐day and 1‐year mortality and hospital readmission following the index admission. Cox proportional hazard models were used to determine the association between receiving GCS, readmission, or mortality while adjusting for demographics, discharge destination, delirium, Charlson Comorbidity Index, and prior hospitalizations. The prop...

The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis...

To assess recent epidemiologic characteristics, temporal trends, and predictors of death and discharge disposition in patients with sepsis. This is a cross-sectional retrospective cohort study using the US National Inpatient Sample (NIS) data from 2009 to 2012. The study population included adults (18years and older) with sepsis-related International Classification of Diseases, Ninth Revision, Clinical Modification codes at the time of discharge. Factors associated with in-hospital mortality and patient discharge disposition were derived from multivariate analyses using multinomial logistic models by SAS PROC LOGISTIC with GLOGIT link. Of 1 303 640 patients admitted, 15% died, 30% were discharged to home without home care, 34% were transferred to a skilled outpatient facility, and 4% were transferred to another short-term hospital. In-hospital mortality decreased from 16.5% to 13.8% (P<.001) across time. Length of stay also decreased from 6.7 to 5.9days (P<.001). Reductions in...

RESUMEN Objetivo general Determinar la sensibilidad del Eco Doppler en las lesiones vasculares por trauma de miembros inferiores en pacientes ingresados con esta impresión diagnóstica en el Hospital Dr Domingo Luciani durante el período Abril 2008-Diciembre 2011. Objetivos específicos Determinar Grupo etario y sexo del paciente con lesión vascular. Definir el mecanismo de trauma de los pacientes sometidos a Eco Doppler por lesión vascular. Mencionar los hallazgos ecográficos de los pacientes ingresados con lesión vascular. Conocer la lesión vascular más frecuente. Precisar los hallazgos quirúrgicos de los pacientes sometidos a Eco doppler por lesión vascular. Correlacionar los hallazgos quirúrgicos con los ecográficos. Método de investigación Estudio retrospectivo, descriptivo. Basado en la base de datos de la Unidad de Politraumatizados y en los Servicios de Cirugía General del hospital ‘Dr Domingo Luciani’. Lapso 2008-2011. Criterios de inclusión Paciente mayor de 18 años con impr...

Sonography – similar to what happened almost two centuries ago with the introduction of stethoscopes – has completely changed patients’ clinical management in Internal Medicine. The availability of performant, sometimes even small-sized and cost-effective machines, has allowed doctors in Internal-Medicine units to perform bedside-ultrasound examinations alongside regular clinical ones. [...]

Background In order to reduce the incidence of in-hospital cardiac arrest (IHCA) at general wards, medical emergency teams (MET) were implemented in the Capital Region of Denmark in 2012 as the efferent part of a track and trigger system. The National Early Warning Score (NEWS) system became the afferent part. This study aims at investigating the incidence of IHCA at general wards before and after the implementation of the NEWS system. Material and methods We included patients at least 18 years old with IHCA at general wards in our hospital in the periods of 2006 to 2011 (pre-EWS group) and 2013 to 2018 (post-EWS group). Data was obtained from a local database and the National In-Hospital Cardiac Arrest Registry (DANARREST). We calculated incidence rate ratios (IRR) for IHCA at general wards with 95% confidence interval (95% CI). Odds ratios (OR) for return of spontaneous circulation (ROSC) and 30-day survival were also calculated with 95% CI. Results A total of 444 IHCA occurred be...

Introduccion: La mitomicina C es un agente quimioterapeutico en virtud a su actividad antiproliferativa y antibiotica. Se evalua el resultado de la cervicotomia radial endoscopica combinada con la inyeccion intralesional de mitomicina C para el tratamiento de las estenosis severas de cuello vesical luego del fracaso del tratamiento tradicional. Materiales y metodo: Revision retrospectiva de los pacientes con estenosis severa de cuello vesical intervenidos entre julio de 2013 y agosto de 2015 con la utilizacion de mitomicina C. El 54.5% de los pacientes habia fracasado al menos una vez con la realizacion de cervicotomia interna y/o reseccion endoscopica de cuello vesical. En nuestra intervencion se realizaron tres o cuatro incisiones endoscopicas con corte frio en el cuello de la vejiga, seguido por la inyeccion intralesional de 0.3 a 0.4 mg/ml de mitomicina C en cada sitio de incision. Resultados: Un total de 11 pacientes fueron tratados con incision endoscopica con corte frio en el...

An Emergency Department (ED), or the Emergency Room (ER), is a specialized patient care facility in tertiary and quaternary health care centers dedicated to Emergency Medicine. The main function of which, is to take care of patients with immediate and emergent health issues. In view of limited literature on Emergency Medicine in India, a comparative study of the admission and discharge diagnoses was performed, as a baseline for future reference in continuous quality improvement. A scientific endeavor dedicated to undertake a comparative study between the emergency department provisional diagnosis and the final inpatient discharge diagnosis, thus determining the diagnostic accuracy of the emergency medicine department in large health care centers of India. A total of 3000 patients visiting the emergency department were considered and a comparative study was performed between the emergency department diagnoses and the final discharge diagnoses of these patients after admission to resp...

Background. The growing geriatric population in the United States (US) has prompted better understanding of treatment of the elderly in the hospital and emergency room (ER) settings. This study examines factors influencing the disposition of psychogeriatric patients after their initial presentation in the ER. Methods. Data was collected on patients 65 years of age or older arriving at the ER of a large urban hospital in the USA (January 2009–December 2010). Results. Of the total subjects (n=95) included in the study, majority were females (66.3%) with an average age of 75.5 years. The chief complaint for psychogeriatric patients coming to the ER was delirium (61.6%). Caucasians were significantly more likely than African-American patients to get a psychiatric consult (33% versus 9%). Patients with delirium were less likely than patients with other psychiatric complaints to get a psychiatric consult in the ER (1.2% versus 47.2%) and less likely to be referred to a psychiatric inpatie...

© Der/die Autor(en) 2021 Michael Bauer · Heinrich Volker Groesdonk · Franziska Preissing · Petra Dickmann · Tobias Vogelmann · Herwig Gerlach 1 Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland 2 Klinik für Interdisziplinäre Intensivmedizin und Intermediate Care, Helios Klinikum Erfurt, Erfurt, Deutschland 3 CytoSorbents Europe GmbH, Berlin, Deutschland 4 LinkCare GmbH, Stuttgart, Deutschland 5 Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes KlinikumNeukölln, Berlin, Deutschland

Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related...

Background Hospitalizations attributable to urinary tract infections (UTI) have increased in recent years. One possible reason for the increase in admissions is a lack of effective oral agents, due to increasing rates of antimicrobial resistance, necessitating treatment with IV antibiotics. Our objective was to compare the rates of inpatient vs. outpatient treatment for UTIs. Methods We used the MarketScan database to identify UTI inpatient and outpatient visits from January 2001 through September 2015. Incidence rates for inpatient and outpatient visits were determined as a function of people at risk for UTIs. A difference-in-difference model with a change point in 2007 was used. Results During our study period, we identified 32,521,146 outpatient visits for UTI and 297,470 inpatient UTI visits. Rates for inpatient and outpatient visits were rising at similar rates before 2007. After 2007, the slopes differed, and the incidence of outpatient visits increased statistically (P = 0.02...

Psychiatric emergencies occur frequently in the community setting, e.g. the patient’s home or public places. Little is known about the characteristics and outcome of these situations. This study describes psychiatric emergencies in the canton of Zurich, Switzerland, and examines determinants of their outcome. We retrospectively analyzed 620 medical records of consultations classified as psychiatric emergencies of a 24/7 service of community-based emergency physicians. Information on sociodemographic, clinical and situational factors was extracted. The observation period was 6 months in 2017. Binary logistic regression was used to examine predictors for involuntary admissions. Most emergency consultations (64.5%) took place at the patient’s home, followed by police stations (31.0%), public places (3.2%), and somatic hospitals (1.3%). Patient characteristics and reasons for consultation varied considerably between the locations. The first involved person was commonly a relative. Of al...

How does a collective succeed in practicing the same kind of attention together? This is an essential question for organizations that need to develop a common focus of attention, but it is difficult to address because the objects are multiple and in competition with one another. The attention-based view (ABV) highlights the central role of organizational structures (roles, working spaces, social representation, etc.) in the formation of collective attention, whilst simultaneously acknowledging their limitations. Attention-based view thus encourages scholars to explore the complementary role of social interactions. The objective of this paper is to study precisely how interactions relate to structures in the formation of collective attention. To achieve this, we interviewed and observed professionals at a French university hospital over the course of 18 months. Using hypnosis techniques, the professionals sought to pay closer attention to patients’ psychological states. We conducted ...

Introduction: Injuries are a major public health problem which can lead to disability or death. However, little is known about the incidence, presentation, management and outcomes of emergency care for patients with injuries among people from ethnic minorities in the UK. The aim of this study is to investigate what may differ for people from ethnic minorities compared with white British people when presenting with injury to ambulance and Emergency Departments (EDs).
Methods and analysis: This mixed methods study covers eight services, four ambulance services (three in England and one in Scotland) and four hospital EDs, located within each ambulance service. The study has five Work Packages (WP): (WP1) scoping review comparing mortality by ethnicity of people presenting with injury to emergency services; (WP2) retrospective analysis of linked NHS routine data from patients who present to ambulances or EDs with injury over 5 years (2016-2021); (WP3) postal questionnaire survey of 2000 patients (1000 patients from ethnic minorities and 1000 white British patients) who present with injury to ambulances or EDs including self-reported outcomes (measured by Quality of Care Monitor and Health Related Quality of Life measured by SF-12); (WP4) qualitative interviews with patients from ethnic minorities (n=40) and focus groups-four with asylum seekers and refugees and four with care providers and (WP5) a synthesis of quantitative and qualitative findings.
Ethics and dissemination: This study received a favourable opinion by the Wales Research Ethics Committee (305391). The Health Research Authority has approved the study and, on advice from the Confidentiality Advisory Group, has supported the use of confidential patient information without consent for anonymised data. Results will be shared with ambulance and ED services, government bodies and third-sector organisations through direct communications summarising scientific conference proceedings and publications.

Background:Transferred emergency general surgery (EGS) patients constitute a highly vulnerable, acutely ill population. Guidelines to facilitate timely, appropriate EGS transfers are lacking. We determined patient- and hospital-level factors associated with interhospital EGS transfers, a critical first step to identifying which patients may require transfer.Materials and methods:Adult EGS patients (defined by American Association for the Surgery of Trauma ICD-9 diagnosis codes) were identified within the 2008–2013 Nationwide Inpatient Sample (NIS) (n=17,175,450). Patient- and hospital-level factors were examined as predictors of transfer to another acute care hospital with a multivariate proportional cause-specific hazards model with a competing risks analysis to assess the effect of risk factors for transfer.Results:1.8% of encounters resulted in a transfer (n=318,286). Transferred patients were on average 62 years old and most commonly had Medicare (52.9% [n=168,363]), private (26.7% [n=84,991]), or Medicaid insurance (10.7% [n=34,279]). 67.7% were white. The most common EGS diagnoses among transferred patients were related to hepatopancreatobiliary (n=90,989 [28.6%]) and upper gastrointestinal tract (n=60,088 [18.9%]) conditions. Most transferred patients (n=269,976 [84.8%]) did not have a procedure prior to transfer. Transfer was more likely if patients were in small (Hazard ratio [HR] 2.52, 95% Confidence Interval [CI] 2.28–2.78) or medium (1.32, 1.21–1.44) versus large facilities, government (1.19, 1.11–1.28) versus private facilities, and rural (4.58, 3.98–5.27) or urban non-teaching (1.89, 1.70–2.10) versus urban teaching facilities. Patient-level factors were not strong predictors of transfer.Discussion:We identified that hospital-level characteristics more strongly predicted the need for transfer than patient-related factors. Consideration of these factors by providers as care is delivered in the context of the resources and capabilities of local institutions may facilitate transfer decision-making.