European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
Camera-based measurement of respiratory rates is reliable.
Respiratory rate (RR) is one of the most important vital signs used to detect whether a patient is in critical condition. It is part of many risk scores and its measurement is essential for triage of patients in emergency departments. It is often not recorded as measurement is cumbersome and time-consuming. We intended to evaluate the accuracy of camera-based measurements as an alternative measurement to the current practice of manual counting. ⋯ In our pilot study, we found that camera-based measurements delivered accurate and reliable results. Future studies need to show that camera-based measurements are a secure alternative for measuring RRs in clinical settings as well.
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Rigid cervical collars are known to increase intracranial pressure (ICP) in severe traumatic brain injury (TBI). Cerebral blood flow might decrease according to the Kellie Monroe doctrine. For this reason, the use of the collar in patients with severe TBI has been abandoned from several trauma protocols in the Netherlands. There is no evidence on the effect of a rigid collar on ICP in patients with mild or moderate TBI or indeed patients with no TBI. As a first step we tested the effect in healthy volunteers with normal ICPs and intact autoregulation of the brain. ⋯ We included 22 male and 23 female volunteers. In total 360 ONSD measurements were performed in these 45 volunteers. Application of a collar resulted in a significant increase in ONSD in both the left (β=0.06, 95% confidence interval: 0.05-0.07, P<0.001) and the right eye (β=0.01, 95% confidence interval: 0.00-0.02, P=0.027) CONCLUSION: Application of a rigid cervical collar significantly increases the ONSD in healthy volunteers with intact cerebral autoregulation. This suggests that ICP may increase after application of a collar. In healthy volunteers, this seems to be of minor importance. On the basis of our findings the effect of a collar on ONSD and ICP in patients with mild and moderate TBI needs to be determined.
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The majority of uncomplicated toddler fractures of the tibia (toddler's fractures) do not need an orthopaedic surgeon's intervention or follow-up. However, inexperienced emergency room physicians, general practitioners and orthopaedic trainees and surgeons understandably defer to a cautious approach of referral and subsequent frequent clinical and radiographic follow-up. An evidence-based pathway can help prevent this overtreatment, reduce unnecessary radiation exposure and decrease the financial burden on families and the healthcare system. ⋯ Toddler's fractures do not require routine orthopaedic surgeon assessment, intervention or follow-up. If diagnosed and managed correctly at initial presentation, patients with toddler's fractures may be discharged safely without the need for further clinician contact. We developed a toddler's fracture clinical care pathway to reduce unnecessary orthopaedic surgeon referral and clinical and radiographic follow-up, thereby decreasing radiation exposure and costs to families and the healthcare system without risking patient outcomes.
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Comparative Study
The positive predictive value of an ambulance prealert for stroke and transient ischaemic attack.
Therapeutic options for ischaemic stroke, such as thrombolysis or thrombectomy, are time sensitive. Multiple innovations have been established to reduce the symptom-to-needle time. One such innovation is the prealerting of emergency department (ED) or stroke unit staff by prehospital personnel of suspected stroke patients. The diagnosis of stroke can sometimes be difficult, with stroke mimics being a recognized issue. The prealert mobilizes ED, stroke and imaging personnel, which, for a true-positive, improves door-to-needle times. However, there are a proportion of false-positive prealerts (nonstrokes) that have a significant resource activation implication. The aim of this study was to evaluate the positive predictive value of a prealert for stroke and transient ischaemic attack (TIA). ⋯ The diagnosis of true-positive stroke can be difficult in the prehospital environment. Although prealert has been shown to improve the patient's journey in terms of door-to-thrombolysis times, we have identified that the prealert has a significant false-positive rate that has important resource allocation and activation consequences. Further analysis of this may inform paramedic training and improve protocols for information handover.
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Comparative Study Observational Study
Management of chest pain in the French emergency healthcare system: the prospective observational EPIDOULTHO study.
The aim of this paper was to describe the epidemiology, and diagnostic and therapeutic strategies that emergency physicians use to manage patients presenting with chest pain at all three levels of the French emergency medical system - that is, dispatch centres (SAMUs: the medical emergency system), which operate the mobile intensive care units (MICUs), and hospitals' emergency departments (EDs), with a focus on acute coronary syndrome (ACS). ⋯ Management of chest pain at the three levels of the French medical emergency system is mainly oriented towards ruling out ACS. The strategy of diagnostic management is based on minimizing missed diagnoses of ACS.