European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Many studies illustrate variation in pain management protocols in emergency medicine. This study examines analgesia frameworks in emergency departments (EDs) in multiple countries, compares them with the recent literature, and illuminates the variability in protocols and treatment. A survey was conducted assessing the pain management framework and practices in a convenience sample of 40 hospitals distributed over 22 countries. ⋯ All (100%) reported analgesia administration in the trauma room. Oral paracetamol (67.5%) and intravenous morphine (92.5%) were the most commonly used analgesics. The variability in the pain management framework is high among EDs worldwide, highlighting the need for more international uniformity in analgesia practices in the ED.
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Identifying patients at risk of transfer to the ICU upon arrival to the Emergency Department (ED) might direct early therapy and optimize transfers. However, among the many ED patients, it is difficult to pinpoint the few who insidiously deteriorate to an ICU-requiring level. The aim of this study was to identify predictors in background information, vital values and blood-gas analysis for transfer to ICU 3-36 h after arrival among nontrauma ED patients. ⋯ The predictors identified could be used as part of ED triage to identify high-risk patients for ICU. These findings should be examined in a well-designed prospective cohort study.
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Reverse triage is a way to rapidly create inpatient surge capacity by identifying hospitalized patients who do not require major medical assistance for at least 96 h and who only have a small risk for serious complications resulting from early discharge. Electronic searches were conducted in the MEDLINE, TRIP, Cochrane Library, CINAHL, EMBASE, Web of Science, and SCOPUS databases to identify relevant publications published from 2004 to 2014. The reference lists of all relevant articles were screened for additional relevant studies that might have been missed in the primary searches. ⋯ When time to a medical referral or bed is less than 4-6 h, 100 additional lives per annum are predicted to be potentially saved. The results of our systematic review identified only a small number of publications addressing reverse triage, indicating that reverse triage and surge capacity are relatively new subjects of research within the medical field. Not all research questions could be fully answered.
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Comparative Study Observational Study
A comparison of a formal triage scoring system and a quick-look triage approach.
Emergency Department (ED) triage systems have become increasingly comprehensive over time, requiring ever more resources such as nursing time and computer support. There are very few studies that have looked at whether this increased complexity results in improved performance. ⋯ TNs assigning triage scores to ED patients on arrival, using only chief complaint and observation, were statistically comparable to scores assigned utilizing a resource-intense, comprehensive triage system, but clinically significant discrepancies were identified.