Emergency medicine journal : EMJ
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No specific early warning score universally validated for use in all children presenting to the Emergency Department (ED) exists. POPS is a novel aggregate scoring system, designed for ED use. ⋯ POPS is a useful tool to predict the admission likelihood from the ED. POPS≥2 correctly predicts 50% of children who should be admitted and 85% of children who should be discharged. Multi-centre validation would help to refine POPS, increasing its sensitivity and specificity to admission likelihood, to improve the safety of discharge decisions and healthcare resource utilisation.
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Anaphylaxis is under-reported in emergency settings and the potential for diagnostic confusion with acute asthma has been reported, especially in children who experience predominantly respiratory symptoms. However, no previous study has directly investigated the probability of unrecognised anaphylaxis in either adults or children presenting with acute asthma. ⋯ The results support the conclusion that some cases of anaphylaxis are unidentified and managed as acute asthma in children. The local frequency was estimated at 4.1% of children admitted to PICU but larger prospective multi-centre studies are required to better define the true prevalence nationally.
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Observational Study
Comparison of outcomes in patients with head trauma, taking preinjury antithrombotic agents.
This study compares clinical outcomes in patients with head trauma, taking preinjury antiplatelet drugs (aspirin, clopidogrel) and anticoagulants (warfarin). ⋯ A high proportion of patients taking warfarin underwent neuroimaging, but brain injury and admission rates were comparable between groups. There were no significant differences in short-term outcomes between the groups. The overall mortality is higher for patients on antiplatelet agents than warfarin.
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Randomized Controlled Trial
The effectiveness of a specially designed shoulder chair for closed reduction of acute shoulder dislocation in the emergency department: a randomised control trial.
The objective of this study was to demonstrate the effectiveness of a specially designed chair for closed reduction of acute shoulder dislocations. ⋯ The chair method had a 77% success rate in reducing acute shoulder dislocations without sedation. There was no difference in pain level experienced by patients between the chair method and the traditional method. Patient factors, including patients who have had previous shoulder surgery and patients who have fracture dislocations, contribute to the reduced efficacy of the chair method. It remains possible that the chair method may reduce patient length of stay in the ED in uncomplicated patients.
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Following a spate of high profile murders there is concern that injuries and deaths caused by knives is increasing in England and Wales, especially within the teenage population. Excluding police and Home Office statistics, there are few UK studies examining Emergency Department data. ⋯ Both from TARN and ONS data, the rate of death and serious injury from stab wounds rose in the middle of the last decade but since 2006 is falling. Stabbings account for a low proportion of overall injury deaths and hospitalised trauma patients. The vast majority are due to assault and affect young men in urban areas, particularly London, the North East and the North West. Accidental death from stabbing is rare although suicide using sharp implements, particularly amongst older men, is perhaps more common than previously thought.