Articles: emergency-services.
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Multicenter Study Observational Study
Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study.
In the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out. Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting. ⋯ Copeptin was independently associated with serious secondary headache as compared to benign headaches forms. Copeptin may be a promising novel blood biomarker that should be further validated to rule out serious secondary headache in the emergency department.
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Multicenter Study
17 Exploring ambulance conveyances to the emergency department: a descriptive analysis of non-urgent transports.
An NHS England report highlighted key issues in how patients were initially navigating access to healthcare. This has manifested in increased pressure on ambulance services and emergency departments (EDs) to provide high quality, safe and efficient services to manage this demand. This study aims to identify non-urgent conveyances by ambulance services to the ED that would be suitable for care at scene or an alternative response. ⋯ 16% of ambulance conveyances to ED in 2014 were non-urgent with around 1 in 3 patients under the age of 34 conveyed with non-urgent complaints. 1 in 5 patients had a non-urgent conveyance out of hours. AMPDS analysis identified target areas for intervention including referrals from other healthcare providers. Final ED diagnosis identified specific patient target areas including minor illness and alcohol intoxication.emermed;34/12/A872-a/F2F2F2Figure 2emermed;34/12/A872-a/F3F3F3Figure 3Age of patients taken to ED by ambulance (avoidable).
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Multicenter Study
How do patients with chest pain access Emergency Department care?
It is important that patients with symptoms of acute coronary syndrome receive appropriate medical care as soon as possible. Little is known about the preadmission actions that patients with chest pain take before arrival at the Emergency Department (ED). ⋯ In Belgium, the GP is still the first professional to be contacted for most patients. Other patients initially rely on their partner, family or friends when symptoms emerge. Too often, patients with chest pain rely on other transport to get to the ED instead of calling the Emergency Medical Services. This study included only patients who ultimately attended the ED.
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Multicenter Study
Practice Variation in Acute Bronchiolitis: A Pediatric Emergency Research Networks Study.
Studies characterizing hospitalizations in bronchiolitis did not identify patients receiving evidence-based supportive therapies (EBSTs). We aimed to evaluate intersite and internetwork variation in receipt of ≥1 EBSTs during the hospital management of infants diagnosed with bronchiolitis in 38 emergency departments of pediatric emergency research networks in Canada, the United States, Australia, New Zealand, the United Kingdom, Ireland, Spain, and Portugal. We hypothesized that there would be significant variation, adjusted for patient characteristics. ⋯ More than 30% of infants hospitalized with bronchiolitis received no EBST. The hospital site was a source of variation in all study outcomes, and the network also predicted the use of pharmacotherapy and radiography.
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Multicenter Study
50 How can informal support impact child PTSD symptoms following a psychological trauma?
An estimated 20% of children who present to hospital emergency departments following potentially traumatic events (e.g., serious injuries, road traffic accidents, assaults) will develop post-traumatic stress disorder as a consequence. The development of PTSD can have a substantial impact on a child's developmental trajectory, including their emotional, social and educational wellbeing. Despite this, only a small proportion will access mental health services, with the majority relying on informal sources of support. Parents, in particular, are often the primary source of support. However, it remains unclear what types of parental responses may be effective, and parents themselves report experiencing uncertainty about the best approach. To address this gap in knowledge, we examined the capacity for specific aspects of parental responding in the aftermath of child trauma to facilitate or hinder children's psychological recovery. ⋯ Findings indicate that children's social support can influence their post-trauma psychological outcomes. That parenting was associated with 6 month PTSD, even after controlling for the child's initial symptoms, suggests that parenting responses in the posttrauma period actively influence the child's poorer longer-term adjustment, rather than simply being a response to the child's initial distress. The results suggest that helping parents to provide fewer negative appraisals about the trauma/their child's response, and to encourage more adaptive coping styles, could be effective in improving child psychological outcomes. As emergency departments provide primary care and support for families affected by trauma, they could play an important role in making this advice available to parents.