European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
Helicopter Emergency Medical Services save lives: outcome in a cohort of 1073 polytraumatized patients.
In many Western countries, Helicopter Emergency Medical Services (HEMS) have become standard in the prehospital care of severely injured patients. Several studies have shown that HEMS have a positive effect on patient's outcome, although it remains unclear which specific patients benefit most from its care. The aim of this study was to assess the effect of HEMS on the outcome of a large polytraumatized (Injury Severity Score≥16) population. ⋯ On-scene HEMS care has a positive effect on the survival of polytraumatized patients, saving 5.4 additional lives per 100 HEMS deployments. This positive effect is especially observed in patients with abnormal vital signs (respiratory and hemodynamically). Research and revision of dispatch criteria are important to reach patients that benefit most from HEMS care.
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Comparative Study
Malarial cases presenting to a European urban Emergency Department.
Malaria accounts for approximately 225 million infections and 781 000 deaths annually worldwide. Malaria should be considered in the Emergency Department as an important cause of illness in returning travellers. We were interested in evaluating the malarial caseload presenting to an urban inner city Emergency Department in terms of the nature and severity of clinical presentations. ⋯ Malarial cases occurred predominantly in immigrants who were returning to endemic areas to visit friends and relatives in their country of origin. The majority of patients did not undergo antimalarial prophylaxis. Severe malaria is a medical emergency requiring urgent recognition and appropriate antimicrobial and critical care therapy. Improving public awareness and healthcare promotion regarding risks of travel-related malaria may help to improve compliance with prophylaxis and preventative measures, and thereby reduce the prevalence of malarial infection in this group.
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Comparative Study
Identifying predictors of an abnormal computed tomographic scan among patients with a head injury and a Glasgow Coma Scale of 15.
The aim of this study was to determine the proportions of patients with a head injury and a Glasgow Coma Scale of 15 with an abnormal computed tomographic (CT) head scan and to explore its predictors. ⋯ Abnormal CT and NS interventions were infrequent in patients with a head injury and a Glasgow Coma Scale of 15. We identified three predictors of abnormal head CTs.
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Comparative Study
Operating characteristics of a qualitative troponin assay for the diagnosis of acute coronary syndrome.
The troponin I serum level is widely used in acute coronary syndrome patients for their classification. The qualitative assay is faster and more available than the quantitative assay. The objective was to determine the operating characteristics of a qualitative troponin I assay compared with a quantitative method. ⋯ The degree of agreement between the second rapid qualitative and quantitative troponin I was excellent (κ=0.946; 95% confidence interval, 0.903-0.989). The sensitivity, specificity, negative predictive value, and positive predictive value of the rapid qualitative troponin I test were 92.6, 100, 96.8, and 100%, respectively. In conclusion, this study reveals an excellent agreement between quantitative and qualitative bedside assays 6 h after admission in a sample of Iranian patients in the emergency department.
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To determine if ultrasound guided measurement of the optic nerve sheath diameter accurately predicted elevated intracranial pressure (ICP) as demonstrated by cranial computed tomography (CT) in at-risk emergency department patients. ⋯ This study shows that the ultrasound guided optic nerve sheath diameter is a sensitive and specific test for predicting elevated ICP. A prospective validation study across emergency departments would test applicability of this test. We propose an algorithm for incorporating ultrasound for the management of suspected intracranial hypertension in emergency departments.