Trauma and psychiatric disorders, a systematic review

Clous, E.A. et al. Journal of Trauma and Acute Care Surgery. Published online: 26 January 2017

Background: Suicide is currently a topic of high priority for policy-makers, researchers and clinicians. The World Health Organization estimated 804.000 suicide deaths worldwide in 2012. Some studies that focused on patients with self-inflicted injury revealed that mortality in this group is higher than for patients who sustain unintentional injury. However little is known about the impact of psychiatric disorders on health care resources including length of hospital stay.

Conclusion: Patients who have a psychiatric disorder or who have attempted suicide are at higher risk of increased in-hospital mortality and prolonged length of stay after sustaining injuries. These patients also tend to be at higher risk of complications after severe trauma, however future research is needed to confirm these potentially important implications.

Read the full abstract here

NHS ambulance services

The National Audit Office (NAO) has published NHS ambulance services.

This report provides an update to the NAO 2011 report and examines:

  • the challenges facing the ambulance service in England
  • the performance of the service
  • the extent to which the service is maximising its impact and supporting the challenges facing the wider health system.

It highlights that NHS ambulance services are finding it increasingly difficult to cope with rising demand for urgent and emergency services.

Full report: NHS Ambulance Services

NAO Podcast on Ambulance Service:

 

Additional links: BBC news report

ICT system to compensate for a sudden shortage of emergency department physicians

Tanaka, K. et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. Published online: 23 January 2017

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Background: A sudden shortage of physician resources due to overwhelming patient needs can affect the quality of care in the emergency department (ED). Developing effective response strategies remains a challenging research area. We created a novel system using information and communication technology (ICT) to respond to a sudden shortage, and tested the system to determine whether it would compensate for a shortage.

 

Discussion: After introducing the system, probability of multiple casualties increased. Thus the system may contribute to improvement in the ability to respond to sudden excessive patient needs in multiple causalities.

Conclusions: A novel system using ICT successfully secured immediate responses from needed physicians outside the hospital without increasing user workload, and increased the ability to respond to excessive patient needs. The system appears to be able to compensate for a shortage of physician in the ED due to excessive patient transfers, particularly during off-hours.

Read the full article here

The shock index and the probability of hospital admission and inpatient mortality

Balhara, K.S. et al. (2017) Emergency Medicine Journal. 34:89-94

Study objectives: The shock index (SI), defined as the ratio of HR to systolic BP, has been studied as an alternative prognostic tool to traditional vital signs in specific disease states and subgroups of patients. However, literature regarding its utility in the general ED population is lacking. Our main objective was to determine the probability of admission and inpatient mortality based on the first measured SI at initial presentation in the general adult ED population in our tertiary care centre.

Conclusions: In our single-centre study, the initial SI recorded in the ED shows promise as a clinical metric in the general adult ED population, increasing the probability of both hospital admission and inpatient mortality, specifically at a threshold of SI >1.2.

Read the full article here

Image-based teleconsultation using smartphones or tablets

Boissin, C. et al. (2017) Emergency Medicine Journal. 34:95-99

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Background: Mobile health has promising potential in improving healthcare delivery by facilitating access to expert advice. Enabling experts to review images on their smartphone or tablet may save valuable time. This study aims at assessing whether images viewed by medical specialists on handheld devices such as smartphones and tablets are perceived to be of comparable quality as when viewed on a computer screen.

 

Conclusion: This study suggests that handheld devices could be a substitute for computer screens for teleconsultation by physicians working in emergency settings.

Read the full article here

Pediatric ENT Complaints: An Update

Weller, M.A. et al. (2017) Emergency Medicine. 49(1) pp. 8-17

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This review highlights the diagnosis and management of the three most common causes of pediatric otolaryngologic complaints seen in the ED.

Among all of the causes of ear, nose, and throat (ENT) complaints, acute otitis media (AOM), bacterial sinusitis, and streptococcal pharyngitis (SP) are the most common infections prompting pediatric presentation to the ED. Through a series of case scenarios, along with key questions to help guide the clinician’s work-up, this review covers the proper evaluation and management of pediatric ENT complaints.

Read the full review here

AHEAD Study: an observational study of the management of anticoagulated patients who suffer head injury

Mason, S. et al. (2017) BMJ Open. 7:e014324.

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Objectives: Management of anticoagulated patients after head injury is unclear due to lack of robust evidence. This study aimed to determine the adverse outcome rate in these patients and identify risk factors associated with poor outcome.

 

Conclusions: In alert warfarinised patients following head injury, the presence of symptoms is associated with greater risk of adverse outcome. Those with GCS=15 and no symptoms are a substantial group and have a low risk of adverse outcome.

Read the full abstract and article here