Emergency medicine journal : EMJ
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In the past nine years, the number of patients attending the A&E department of the Royal Victoria Hospital Belfast, with neurological complaints has more than doubled.The number of A&E attendees with neurological complaints is similar to cardiology and higher than gastroenterological complaints. Approximately half of attendees were referred for further investigations or specialist opinion via their primary care physician. Of all attendees only a small number (29%) were referred to or discussed with the neurology department.More than half of A&E attendees presenting with neurological complaints are admitted, mostly under medical team (95%). The number of patients admitted with neurological complaints is higher than for gastroenterology or cardiology. ⋯ The results of the pilot study suggest that provision of a RANC can reduce unnecessary hospital admissions for patients with neurological complaints. The pilot study received very positive feedback from A&E colleagues and patients. Regular provision of the service may lead to considerable cost savings.emermed;31/9/779-b/SA32EMERMED2014204221TB1T1sa32-EMERMED2014204221TB1Compare time period with and without RANC01/08/13-31/08/13RANC not in place25/09/13-23/10/13RANC in placeA+E attendees71496849Neurology patients479436Admitted269211% admitted56.2%48.4%Referred to RANC048Admission avoided028If no RANC availableAdmission rate56.2%54.8%emermed;31/9/779-b/SA32EMERMED2014204221TB2T2sa32-EMERMED2014204221TB2A and E attendances in last 9 years in RVH by medical specialityYearCardGastroNeuroResp200527211747237124652006235917692292248020072831182225202908200825982247254031502009295920102836328820103103220930503362201133142629363635842012488234014419550420134966383950635714emermed;31/9/779-b/EMERMED2014204221F15F1EMERMED2014204221F15RVH A&E attendances by speciality since 2005emermed;31/9/779-b/EMERMED2014204221F16F2EMERMED2014204221F16Neurological symptoms seen in the RANC.
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Facial injuries are a common presentation to the ED with data suggesting that this may be as high as 4%. There is little data on the epidemiology of paediatric facial injuries and how these are managed by the ED team. The exposure of structures such as the eyes, brain and thyroid to ionising radiation may be potentially harmful and at present there are no nationally agreed guidelines on which patients require imaging in the ED. The aim of this study was to look at the patterns of imaging in a cohort of paediatric facial injuries presenting to an ED in the West Midlands.emermed;31/9/782-b/SA13EMERMED2014204221TB1T1sa13-EMERMED2014204221TB1 A comparison of the imaging requests for the paediatric and adult facial injuriesCT HeadCT FacePA MandibleOPGTMJOMOrbitChild8117404864Adult100241714022669411 METHODS: A retrospective note review of all facial injuries presenting to any one of the three sites that make up the Heart of England NHS Foundation Trust in 2012 was conducted. Electronic records were examined to look for the mechanism of injury, disposal as well if any imaging had been performed during the initial presentation. Where imaging was performed the actual imaging as well as formal radiology reports were accessed to ascertain for the presence or absence of a facial fracture. ⋯ The study highlights that paediatric facial injuries are less common than adult facial injuries and that facial fractures make up only 1.5% of all paediatric facial injuries. Clinicians should consider this when requesting facial X-rays given the potential harm of ionising radiation to the head and neck region. Further studies are in progress to develop evidence based guidelines for imaging children with facial injuries within the ED.The table refers to the total number of different imaging requests and not the number of patients imaged. Some patients had more than one type of imaging requested.
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To explore the increasing numbers of Emergency Medicine registrars that obtained their primary medical degree from United Kingdom (UK) or Irish universities, who work in Emergency Departments (ED) throughout Australia and New Zealand. emermed;31/9/777-a/SA4EMERMED2014204221TB1T1sa4-EMERMED2014204221TB1 Table 1 Trends in Australasian Emergency Medicine registrar numbers 2008-2013 (courtesy of ACEM Policy & Research Department) Year Total registrars Total IMGs UK/Ire IMGs % UK/Ire of total IMGs % UK/Ire of total registrars 2008 1420 787 285 36.2 20.1 2009 1654 958 329 34.3 19.9 2010 1952 1137 413 36.3 21.2 2011 1973 1144 437 38.2 22.1 2012 2078 1185 481 40.6 23.1 2013 2258 1252 566 45.2 25.1 METHODS: The VERS-2013 (Victoria Emergency Registrar Study) was published at the Australasian College for Emergency Medicine (ACEM) annual scientific meeting in Adelaide in November 2013.(1) As a follow on, ACEM provided the authors with data regarding country of primary degree for international medical graduates (IMG) working in Australasian EDs. ⋯ Many IMGs (in particular from UK and Ireland) leave their country of origin to work overseas in Australia and New Zealand. Highly trained, skilled independent practitioners have, in the past, returned to the UK to work at consultant level. However, evidence from ACEM (table 1) and the VERS-20131 study show clearly that these doctors are now migrating to Australia for the long-term, leaving EDs the length and breath of the British Isles bereft of talented senior EM decision-making personnel. Meanwhile in Australia, continued IMG influx is at odds with a stated Health Workforce Australia taskforce aim to achieve self-sufficiency by 2025.2 The challenge is set for the College of Emergency Medicine, in conjunction with the UK and Irish governments, to enhance the attractiveness of Emergency Medicine as a credible and sustainable career option. emermed;31/9/777-a/EMERMED2014204221F4F1EMERMED2014204221F4.
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Pulmonary Embolism (PE) in pregnancy remains one of the leading causes of maternal morbidity and mortality in the developed world. However, there is a paucity of high quality evidence resulting in a lack of consensus in managing this group of patients. The aim of the study was to address the diagnostic utility of D dimer for suspected PE in pregnant and postpartum patients, and to identify any clinical presentation variables that are predictors of PE in this group of patients. ⋯ According to our study, there is supportive evidence that a negative D-dimer result is useful as a means of ruling out PE in pregnant and post-partum patients. However, we need a larger prospective observational study to collaborate the findings.
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The relationship between age and presenting Glasgow Coma Scale (GCS) in adults with traumatic brain injury (TBI) has not so far been explored in detail. We have previously reported a trend for higher GCS in elderly patients presenting to our major trauma centre with isolated TBI compared with younger adults. The aim of this study was to confirm and define this relationship using a national trauma registry and to evaluate potential contributory factors. emermed;31/9/775-c/SA2EMERMED2014204221TB1T1sa2-EMERMED2014204221TB1 Table 1 Isolated Head AIS 3+ patients 1988-2014 N(total 13547) Adults*mean (95% CI), **median (IQR) N(total 2485) Elderly*mean (95% CI), **median (IQR) Male 10410 76.8% (76.1%-77.6%) 1368 55.1% (53.1%-57.0%) Age* *26.1 (15.9-42.0) *77.6 (71.0-84.0) ISS** **16 (13-25) **17 (16-25) AIS head** **4 (3-5) **4 (4-5) Presenting GCS** **14 (9-15) Underwentprocedure* 1681 12.4% (11.9%-13.0%) 200 8.0% (7.0%-9.1%) 30 day mortality* 1072 7.9% (7.5%-8.4%) 732 29.5% (27.7%-31.2%) Injury mechanism Blast 4 0.0% (0%-0.1%) 0 Blow 1862 13.7% (13.2%-14.3%) 53 2.1% (1.6%-2.7%) Other 1664 12.3% (11.7%-12.8%) 96 3.9% (3.1%-4.6%) Fall <2 m 2073 15.3% (14.7%-15.9%) 1244 50.1% (48.1%-52.0%) Fall >2 m 2382 17.6% (16.9%-18.2%) 524 21.1% (19.5%-22.7%) RTC 5553 41.0% (40.2%-41.8%) 567 22.8% (21.2%-24.5%) Stabbing/shooting 9 0.1% (0%-0.1%) 1 0.0% (0%-0.1%) ⋯ We believe that this is the first study to demonstrate that elderly patients present with a higher GCS than younger adults for a given anatomical severity of TBI. This difference is not confined to any particular mechanism of injury nor any type of intracranial injury. These findings may have profound implications for prehospital trauma triage tools, outcome prediction methodologies and neurosurgical decision-making.