Articles: outcome.
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The last decade has witnessed a rapidly growing public and academic interest in medical error, an interest that has culminated in the emergence of the science of error prevention in health care. The impact of this new science will be felt in all areas of medicine but perhaps especially in emergency medicine (EM). The emergency department's unique operating characteristics make it a natural laboratory for the study of error. ⋯ Changes in societal attitudes will be an important component of the new culture of patient safety. A nationwide reporting system is proposed to disseminate error information expediently. Canadian EM providers are in a pivotal position to provide leadership to the Canadian health care system in this important area.
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Cauda equina syndrome (CES) is a feared complication of lumbar disc herniation. It is generally accepted that CES requires decompression within 6 hours of symptom onset, but this time goal is rarely met, and the relative benefit of delayed decompression on functional status and quality of life (QOL) remains unknown. The study objective was to describe the functional status and quality of life outcomes for patients who undergo delayed surgical decompression for CES. ⋯ Patients who undergo delayed decompression for CES have increased pain and impaired social and physical function. Longer delays correlate with worse functional outcomes. Beyond 24 hours, decompression delay may be associated with a poorer quality of life but, because of the rarity of CES, the sample size in this study was too small to provide definitive conclusions. Since no patients underwent surgery within 38.4 hours of symptoms, it is not possible to comment on the importance of emergent decompression in early presenters.
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Pediatr Crit Care Me · Oct 2001
Respiratory syncytial virus infections in the pediatric intensive care unit: clinical characteristics and risk factors for adverse outcomes.
To describe the clinical characteristics of infants admitted to a pediatric intensive care unit (PICU) with respiratory syncytial virus (RSV) infection, including the prevalence of indications for RSV passive antibody prophylaxis (as currently recommended by the American Academy of Pediatrics), and to identify risk factors that predict adverse outcomes among this population. ⋯ A minority of infants admitted to our PICU for severe RSV disease meet currently recommended indications for RSV passive antibody prophylaxis. Risk factors that predict prolonged durations of ventilation, PICU stay, or hospital stay among this population include congenital heart disease, chronic lung disease, upper airway abnormalities, and noncardiac congenital malformations.
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Canadian hospitals gather few emergency department (ED) data, and most cannot track their case mix, care processes, utilization or outcomes. A standard national ED data set would enhance clinical care, quality improvement and research at a local, regional and national level. The Canadian Association of Emergency Physicians, the National Emergency Nurses Affiliation and l'Association des médecins d'urgence du Québec established a joint working group whose objective was to develop a standard national ED data set that meets the information needs of Canadian EDs. ⋯ The working group identified 69 mandatory elements, 5 preferred elements and 29 optional elements representing demographic, process, clinical and utilization measures. The Canadian Emergency Department Information System data set is a feasible, relevant ED data set developed by emergency physicians and nurses and tailored to the needs of Canadian EDs. If widely adopted, it represents an important step toward a national ED information system that will enable regional, provincial and national comparisons and enhance clinical care, quality improvement and research applications in both rural and urban settings.
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Patients with traumatic brain injury (TBI) have a high mortality and morbidity. This pilot study was undertaken to identify contributors to outcome in the early management of patients with TBI and to investigate the feasibility of a larger study. ⋯ Both initial GCS and severity of brain injury should be used to match TBI patients for injury severity in future studies. Lower initial GCS in deceased patients was likely due to greater severity of brain injury, although it is also possible that the lower GCS was due to decreased brain perfusion (perhaps reflecting inadequate resuscitation) in these patients. Volume of early fluid resuscitation, time to definitive therapy, and time of presentation to hospital may also be important determinants of patient outcome. A large case control outcome study is required to extend these observations.