Editor’s note: The Hong Kong Journal of Emergency Medicine has partnered with a small group of selected journals of international emergency medicine societies to share from each a highlighted research study, as selected monthly by their editors. Our goals are to increase awareness of our readership to research developments in the international emergency medicine literature, promote collaboration among the selected international emergency medicine journals, and support the improvement of emergency medicine world-wide, as described in the WAME statement at http://www.wame.org/about/policy-statements#Promoting%20Global%20Health. Abstracts are reproduced as published in the respective participating journals and are not peer reviewed or edited by the Hong Kong Journal of Emergency Medicine.
Triage live lecture versus triage video podcast in pre-hospital students’ education
Aghababaeiana H, Araghi Ahvazi L, Moosavi A, Ahmadi Mazhin S, Tahery N, Nouri M, Kiarsi M, Kalani L
Afr J Emerg Med 2019; 9(2): 81–86
Introduction: Triage is the process of determining the priority of patients’ treatments based on the severity of their conditions. The aim of the present study was to survey the effect of triage video podcasting on the knowledge and performance of pre-hospital students.
Methods: Sixty pre-hospital students were randomly divided into two groups of a 30-subject control group and a 30-subject intervention group. A pre-test was administered among all students. Afterward, for the first group, triage education was offered through lectures using PowerPoint, while for the second group, audio and video podcasts tailored for this training program were employed. Right after the training as well as 1 month later, post-tests were run for both groups, and the results were analyzed using an independent t-test and covariance.
Results: No significant difference was observed between the effects of both types of education on knowledge and performance, either immediately or 1 month after training.
Discussion: We suggest that video podcasts are ready to replace traditional teaching methods in triage.
Racial and ethnic disparities in opioid prescribing for long bone fractures at discharge from the emergency department: a cross-sectional analysis of 22 centers from a health care delivery system in Northern California
Robert J Romanelli, Zijun Shen, Nina Szwerinski, Alexandra Scott, Stephen Lockhart, Alice R Pressman
Ann Emerg Med (2019)
https://doi.org/10.1016/j.annemergmed.2019.05.018
Study objective: We examine racial and ethnic differences in opioid prescribing and dosing for long bone fractures at emergency department (ED) discharge.
Methods: We conducted an electronic health records–based cross-sectional study of adults with long bone fractures who presented to the ED across 22 sites from a health care delivery system (2016–2017). We examined differences in opioid prescribing at ED discharge and, among patients with a prescription, differences in opioid dosing (measured as morphine milligram equivalents) by race/ethnicity, using regression modeling with statistical adjustment for patient, fracture, and prescriber characteristics.
Results: A total of 11,576 patients with long bone fractures were included in the study: 64.4% were non-Hispanic White; 16.4%, 7.3%, 5.8%, and 5.1%, respectively, were Hispanic, Asian, Black, and of other or unknown race; and 65.6% received an opioid at discharge. After adjusting for other factors, rates of opioid prescribing were not different by race/ethnicity; however, among patients with an opioid prescription, total morphine milligram equivalent units prescribed were 4.3%, 6.0%, and 8.1% less for Hispanics, Blacks, and Asians relative to non-Hispanic Whites.
Conclusion: Racial and ethnic minority groups with long bone fractures receive similar frequencies of opioid prescriptions at discharge, with a small potency difference. How this affects pain relief and why it happens is unclear.
Register to donate while you wait: assessing public opinions of the acceptability of utilizing the emergency department waiting room for organ and tissue donor registration
Brittany Ellis, MD, MSc, Michael Hartwick, MD, MEd, Jeffrey J Perry, MD, MSc
CJEM 2019: 1–4
doi:10.1017/cem.2019.347
Objective: Our objectives were to identify barriers to the organ donation registration process in Ontario and to determine the acceptability of using the emergency department (ED) waiting room to provide knowledge and offer opportunities for organ and tissue donor registration.
Methods: We conducted a paper based on in-person survey over 9 days in March and April 2017. The survey instrument was created in English using existing literature and expert opinion, pilot tested and then translated into French. Data were collected from patients and visitors in an urban academic Canadian tertiary care ED waiting room. All adults in the waiting room were approached to participate during study periods. We excluded patients who were too ill and required immediate treatment.
Results: The number of attempted surveys was 324; 67 individuals (20.7%) declined participation. A total of 257 surveys were distributed and five were returned blank. This gave us a response rate of 77.8% with 252 completed surveys. The median age group was 51–60 years with 55.9% female. Forty-six percent reported their religion as Christian and 34.1% did not declare a religious affiliation; 44.1% were already registered donors. Most participants agreed or were neutral that the ED waiting room was an acceptable place to provide information on donation, and for registration as an organ and tissue donor (83.3% and 82.1%, respectively).
Conclusion: Individuals waiting in the ED are generally supportive of using the waiting room for distributing information regarding organ and tissue donation, and to allow donor registration.
Analysis of organ procurement from non-heart-beating donors over a 10-year period in Madrid
César Cardenete-Reyes, Ana María Cintora-Sanz, Alonso Mateos-Rodríguez, Carmen Cardós-Alonso, Ana María Pérez-Alonso
Emergencias 2019; 31: 252–256
Background and objective: The Autonomous Community of Madrid procures the largest number of organs from uncontrolled non-heart-beating donors (NHBD) after circulatory death in Spain. The aim of this study was to analyze the yield of these donations in terms of viable organs procured (category IIa) according to information extracted from the CORE registry of the Spanish National Transplant Organization (ONT) for the Madrid area.
Methods: Retrospective observational study of NHBD data registered between 2007 and 2017, including age, height, weight, body mass index (BMI), emergency care times, method of chest compressions applied (mechanical cardiopump vs manual compressions), and viable organs extracted.
Results: A total of 679 circulatory death donors were registered; 458 (67.6%) of them were utilized donors. The median BMI correlated negatively (–0.161) with the number of viable organs extracted (p < .001). The method of applying chest compressions significantly influenced liver viability: only those extracted after mechanical cardiopump compressions were viable for transplantation. Type of compressions did not affect kidney or lung viability.
Conclusion: Variables to bear in mind as predictors of success in NHBD donation are BMI and type of chest compressions applied.
Adapting the Canadian CT head rule age criteria for mild traumatic brain injury
Fournier N, Gariepy C, Prevost J-F, et al.
Emerg Med J 2019
doi:10.1136/emermed-2018-208153
Objective: With the aging population, the prevalence of mild traumatic brain injury (mTBI) among older patients is increasing, and the age criteria of the Canadian CT head rule (CCHR) is challenged by many emergency physicians. We modified the age criteria of the CCHR to evaluate its predictive capacity.
Methods: We conducted a retrospective cohort study at a level 1 trauma center ED of all mTBI patients 65 years old and over with an mTBI between 2010 and 2014. Main outcome was a clinically important brain injury (CIBI) reported on CT. The clinical and radiological data collection was standardized. Univariate analyses were performed to measure the predictive capacities of different age cut-offs at 70, 75, and 80 years.
Results: A total of 104 confirmed mTBI were included; CT scan identified 32 (30.8%) CIBI. Sensitivity and specificity (95% confidence interval (CI)) of the CCHR were 100% (89.1–100) and 4.2% (0.9–11.7) for a modified criteria of 70 years old; 100% (89.1–100) and 13.9% (6.9–24.1) for 75 years old; and 90.6% (75.0–98.0) and 23.6% (14.4–35.1) for 80 years old. Furthermore, modifying the age criteria to 75 years old showed a reduction of CT up to 25% (n = 10/41) among the individuals aged 65–74 years without missing CIBI.
Conclusion: Adjusting the age criteria of the Canadian CT head rule to 75 years could be safe while reducing radiation and ED resources. A future prospective study is suggested to confirm the proposed modification.
