Emergency medicine journal : EMJ
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Multicenter Study
Validation of the Taiwan triage and acuity scale: a new computerised five-level triage system.
An ideal emergency department (ED) triage system accurately prioritises patients on the basis of the urgency of interventions required to avoid under- or over-triage. The objective of this study was to develop and validate a five-level Taiwan triage and acuity scale (TTAS) with an electronic decision support tool. ⋯ The TTAS was found to be a reliable triage system that accurately prioritises the treatment needed to avoid overtriage, more efficiently deploying the appropriate resources to ED patients.
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A short cut review was carried out to establish whether intranasal fentanyl is better than parenteral morphine for managing acute severe pain in children. 51 papers were found using the reported searches, of which 4 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that intranasal fentanyl is an effective and safe alternative to IV or IM morphine for managing acute pain in children presenting to the Emergency Department.
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Review
Outcome measures in major trauma care: a review of current international trauma registry practice.
Multiple reports over the past 20 years have criticised the care delivered to major trauma patients in England. The setting up of regional trauma networks is well underway to address these deficiencies. Outcomes currently collected in major trauma are restricted to mortality rates and process measures; however, many patients are left with long-term disabilities and reduced quality of life (QoL), which are not measured at present. ⋯ There is a considerable amount of disability and reduced QoL in survivors of major trauma that lasts for years following the injury. At present only the Victorian State Trauma Registry collects outcome measures that evaluate the extent of this. English regional trauma networks and the Trauma Audit and Research Network have the opportunity to learn from this experience and routinely start to collect measures of outcome that can drive service improvement and reduce patient morbidity.
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A short cut review was carried out to establish whether prophylactic antibiotics should be given to prevent Weil's disease after a fall into standing water. 30 papers were found using the reported searches, of which 4 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that if there is immersion in an endemic area for leptospirosis, or if there is higher risk of water contamination such as standing water, known rat infestation, drainage channels then doxycycline would have to be recommended. Other scenarios are not as clear.
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A short cut review was carried out to establish whether wrist splints require a thumb extension when immobilising suspected scaphoid fractures. 63 papers were found using the reported searches, of which 2 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that while there is no direct evidence to answer the clinical question, the research available strongly suggests that it is reasonable to continue using standard wrist splints to immobilise patients with suspected scaphoid fractures.