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 worldwide, 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 Abstracts are reproduced as published in the respective participating journals and are not peer reviewed or edited by the Hong Kong Journal of Emergency Medicine.
African Journal of Emergency Medicine
The official journal of the African Federation for Emergency Medicine, the Emergency Medicine Association of Tanzania, the Emergency Medicine Society of South Africa, the Egyptian Society of Emergency Medicine, the Libyan Emergency Medicine Association, the Ethiopian Society of Emergency Medicine Professionals, the Sudanese Emergency Medicine Society, the Society of Emergency Medicine Practitioners of Nigeria and the Rwanda Emergency Care Association.
Predicting mortality in trauma patients – a retrospective comparison of the performance of six scoring systems applied to polytrauma patients from the emergency centre of a South African central hospital
Milton M, Engelbrecht A, Geyser M
Afr J Emerg Med. 2021; 11(4): 453–458.
doi:10.1016/j.afjem.2021.09.001.
Introduction: Over 90% of trauma-related deaths worldwide ensue in low- and middle-income countries. Multiple useful trauma scoring systems have been devised. Although validated in high-income countries, they cannot always be replicated in resource-limited countries. This study compares six trauma scores to identify the best-suited system to use for polytrauma patients in a hospital in Pretoria, South Africa.
Methods: This is an observational retrospective analysis of polytrauma admissions from 1 July 2016 to 31 December 2016. Data collected from patients’ records from the EC of Steve Biko Academic Hospital were analysed using Stata Release 14. Outcomes were recorded as 30-day survival, intensive care unit (ICU) and overall length of hospital stay (LOS). Scores pertaining to patient mortality were compared in terms of sensitivity, specificity and cut-off points based on receiver operating characteristic (ROC) curve. Finally, for LOS, Pearson correlation analysis was used.
Results: At the best calculated mortality prediction cut-points for the scores, the sensitivities and specificities were, respectively, 87% and 68% for TRISS, 81% and 61% for ISS, 81% and 60% for RTS and 61% and 69% for REMS. The SI and RSI (cut-points used in agreement with the literature) produced sensitivities 58% and 48%, and specificities of 73% and 83%, respectively. Forty-five (41.7%) patients required ICU admission. Although the ICU LOS best correlated with ISS (r = 0.2710), the ICU LOS correlation coefficient was weak for all trauma scores. None of the scores had a significant p value for hospital LOS.
Discussion: Among the scores compared, TRISS had the highest sensitivity and NPV for mortality prediction in this South African polytrauma population. ISS correlated best with ICU LOS. However, compared to developed countries, ROC analyses and predictability of these scores fare relatively worse, and no correlation was found with hospital LOS. Therefore, we conclude that further studies are needed to ascertain a more suitable system for resource-limited settings.
Reproduced with permission
Paediatric emergency care at an academic referral hospital in Mozambique
Ismail H, Chowdhary H, Taira BR, Moiane S, Faruk L, Alface B, Mohole J, Gonçalves O, Hartford EA, Buck WC
Afr J Emerg Med. 2021; 11(4): 410–415.
doi:10.1016/j.afjem.2021.07.003.
Background: Improved emergency care of children with acute illness or injuries is needed for countries in Africa to continue to reduce childhood mortality rates. Quality improvement efforts will depend on robust baseline data, but little has been published on the breadth and severity of paediatric illness seen in Mozambique.
Methods: This was a retrospective review of routinely collected provider shift summary data from the Paediatric Emergency Department (PED) at Hospital Central de Maputo (HCM), the principal academic and referral hospital in the country. All children 0 to 14 years of age seen in the 12-month period from August 2018 to July 2019 were included. Descriptive statistical analyses were performed.
Results: Data from 346 days and 64,966 patient encounters were analysed. The large majority of patients (96.4%) presented directly to the PED without referral from a lower level facility. An average of 188 patients was seen per day, with significant seasonal variation peaking in March (292 patients/day). The most common diagnoses were upper respiratory infections (URIs), gastroenteritis, asthma and dermatologic problems. The highest acuity diagnoses were neurologic problems (59%), asthma (57%) and neonatal diagnoses (50%). Diagnoses with the largest proportion of admissions included neurologic problems, malaria and neonatal diagnoses. Rapid malaria antigen tests were the most commonly ordered laboratory test across all diagnostic categories; full blood count (FBC) and chemistries were also commonly ordered. Urinalysis and HIV testing were rarely done in the PED.
Conclusion: This epidemiologic profile of illness seen in the HCM PED will allow for improved resource utilization. We identified opportunities for evidence-based care algorithms for common diagnoses such as respiratory illness to improve patient care and flow. The PED may also be able to optimize laboratory and radiology evaluation for patients and develop standardized admission criteria by diagnosis.
Reproduced with permission
Annals of Emergency Medicine
(The print version of this article has been scheduled for May 2022.)
Opioid prescription reduction after implementation of a feedback program in a national subset of emergency departments
Jonathan J Oskvarek, Amer Aldeen, Jason Shawbell, Arvind Venkat, Mark S Zocchi, Jesse M Pines
Study objective: Reducing excessive opioid prescribing in emergency departments (EDs) may prevent opioid addiction. We evaluated the largest personalized feedback and peer comparison intervention to date on emergency clinician opioid prescription rates in a national emergency clinician group.
Methods: This interrupted time-series analysis of a quality improvement intervention included data from adults discharged from 102 EDs in 17 states from 1 January 2019 to 31 July 2021. From 16 June 2020 to 30 November 2020, site-level ED directors received emails on local opioid prescription rates. From 1 December 2020 to 31 July 2021, all clinicians were granted electronic dashboard access, which showed prescription rates compared with peers, and national ED leaders sent emails to high-prescribing clinicians and engaged in one-on-one conversations. The primary outcome was opioid prescriptions per 100 discharges.
Results: The study included 5,328,288 ED discharges from 924 physicians and 472 advanced practice providers. Opioid prescription rates did not change meaningfully in the site-level director feedback period (mean difference = –0.3, 95% confidence interval (CI) = –0.6 to –0.1). During the direct clinician feedback period, opioid prescription rates declined from 10.4 per 100 discharges to 8.4 per 100 discharges (mean difference = –2.0, 95% CI = –2.4 to –1.5), a 19% relative reduction. Among prescribers in the highest initial quintile, opioid prescribing reduced by 35% among physicians and 41% among advanced practice providers in the direct feedback period.
Conclusion: We demonstrated a large, sustained reduction in opioid prescribing by emergency clinicians using direct, personalized feedback to clinicians and an electronic dashboard for peer comparison.
How to cite this article:
Oskvarek, JJ, Aldeen, A, Shawbell, J, et al. Opioid prescription reduction after implementation of a feedback program in a national subset of emergency departments. Ann Emerg Med 2022. DOI: 10.1016/j.annemergmed.2021.12.009.
Emergency department visits during the postpartum period: a Canadian cohort study
Brittany A Matenchuk, Rhonda J Rosychuk, Brian H Rowe, Amy Metcalfe, Radha Chari, Susan Crawford, Susan Jelinski, Jesus Serrano-Lomelin, Maria B Ospina
Study objective: Challenges in transitioning from obstetric to primary care in the postpartum period may increase emergency department (ED) visits. This study described the frequency, characteristics and predictors of maternal ED visits in the postpartum period.
Methods: Retrospective cohort study of all live-birth pregnancies occurs in Alberta (Canada) between 2011 and 2017. Individual-level health and ED utilization data were linked across five population health databases. We calculated age-standardized ED visit rates in the postpartum period and used negative binomial regression models to assess the outcome of any ED visit in the postpartum period associated with relevant sociodemographic and clinical factors. Results were reported using rate ratios (RRs) and 95% confidence intervals (95% CIs).
Results: Data on 255,929 pregnancies from 193,965 individuals were analysed. During the study period, 44.7% of pregnancies had one or more ED visits; 29.7% of visits occurred within 6 weeks after delivery. Increased postpartum ED visits were associated with living in remote (RR = 2.8, 95% CI = 2.6 to 2.9) or rural areas (RR = 2.3, 95% CI = 2.3 to 2.4), age less than 20 years (RR = 2.5, 95% CI = 2.4 to 2.6), mental (RR = 1.6, 95% CI = 1.6 to 1.7) and major/moderate health conditions (RR = 1.5, 95% CI = 1.5 to 1.6), multiparity 4 or more (RR = 2.0, 95% CI = 1.9 to 2.1), caesarean delivery (RR = 1.4, 95% CI = 1.4 to 1.4) and intensive prenatal care (RR = 1.4, 95% CI = 1.4 to 1.5).
Conclusion: Almost one-third of ED visits in the postpartum occurred within 6 weeks immediately after delivery. Potential gaps in equitable access and quality of prenatal care should be bridged by appropriate transitions to primary care in the postpartum period.
How to cite this article:
Matenchuk BA, Rosychuk RJ, Rowe BH, et al. Emergency department visits during the postpartum period: a Canadian cohort study. Ann Emerg Med 2022. DOI: 10.1016/j.annemergmed.2021.09.419.
Emergencias
MAY 2022:
Factors associated with in-hospital mortality and readmission in a cohort of patients treated with noninvasive ventilation during emergency department or out-of-hospital emergency care: the VentilaMadrid study
Marina Gómez-Morán Quintana, Cristina Horrillo García, Alicia Gutiérrez Misis, Víctor Quesada-Cubo, Ana Torres Poza, Ana Cintora Sanz, óscar Carrillo Fernández, Joaquín Antonio Rendo Murillo, Ana María Pérez Alonso, Laura Pastor Cabanillas, Natasha Leco Gil, Carolina Chaya Romero, Leticia Parejo García, Ana Belén Rubio Riballo, Isabel Canales Corcho, óscar Rodríguez Rodríguez, Soledad Gómez de la Oliva, Eva García Benavent, Armando Antiqueira Pérez, Manuel González Viñolis, Yolanda Aranda García, Alberto Albiñana Pérez, Marta Rincón Francés, María Luisa Martín Jiménez, Camino Fernández del Blanco, Raquel Barros González
Cited: Gómez-Morán Quintana M, Horrillo García C, Gutiérrez Misis A, et al. Factors associated with in-hospital mortality and readmission in a cohort of patients treated with noninvasive ventilation during emergency department or out-of-hospital emergency care: the VentilaMadrid study. Emergencias. 2022; 34: 7–14.
http://emergencias.portalsemes.org/descargar/factores-asociados-a-la-mortalidad-intrahospitalaria-y-reingreso-en-una-cohorte-tratada-con-ventilacin-no-invasiva-en-urgencias-extrahospitalarias-y-hospitalarias-estudio-ventilamadrid/
Objective: The aim of this study is to describe clinical, outcome and risk factors in a cohort of patients treated with noninvasive ventilation (NIV) in a hospital emergency department (ED) or by out-of-hospital emergency medical services (OHEMSs).
Methods: Multicenter, prospective cohort study enrolled consecutive patients with acute pulmonary oedema and/or exacerbated chronic obstructive pulmonary disease who were treated with NIV between November 2018 and November 2020 in a hospital ED or OHEMS setting in Madrid. We recorded baseline data, variables related to the acute episode and outcome variables, including in-hospital mortality and 30-day readmission.
Results: A total of 317 patients were included: 132 (41.6%) were treated in an OHEMS setting and 185 (58.4%) in a hospital ED. Forty-seven (16.3%) in-hospital deaths occurred, and 78 patients (28.8%) were readmitted within 30 days. Mortality in the hospital ED and OHEMS subsamples did not differ, but the patients who received NIV in an OHEMS setting had a lower 30-day readmission rate. On multivariate analysis, in-hospital mortality was associated with prior dependence in activities of daily living in the multivariate analysis (odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.11 to 5.27) and a low–moderate score on the Simplified Acute Physiology Score II (SAPS II) versus a high–very high one (OR = 2.69, 95% CI = 1.26 to 5.77). Mortality after OHEMS ventilation was associated with discontinuance of NIV during transfer (OR = 8.57, 95% CI = 2.19 to 33.60). Readmission within 30 days was associated with group (in-hospital ED application of NIV; OR = 3.24, 95% CI = 2.62 to 6.45) and prior dependence (OR = 2.08, 95% CI = 1.02 to 4.22).
Conclusion: Patients treated in the hospital ED and OHEMS setting have similar baseline characteristics, although acute episodes were more serious in the OHEMS group. No significant differences were found related to in-hospital mortality. Higher mortality was associated with dependence, a SAPS II score greater than 52 and discontinuance of NIV. Readmission was associated with dependence and NIV treatment in the hospital ED setting.
Keywords: Noninvasive ventilation, respiratory insufficiency, emergency health services, mortality, chronic obstructive pulmonary disease (COPD), pulmonary oedema, out-of-hospital emergency care
Emergency Medicine Journal
E-scooter incidents in Berlin: an evaluation of risk factors and injury patterns
Uluk D, Lindner T, Dahne M, Bickelmayer JW, Beyer K, Slagman A, Jahn F, Willy C, Moeckel M, Gerlach U
Background: E-scooters have emerged as a frequently used vehicle in German cities due to their high availability and easy access. However, investigations about the causes and mechanisms of E-scooter incidents and their trauma-specific consequences are rare.
Methods: We analysed all patients involved in E-scooter incidents from June to December 2019 who presented to four inner-city EDs in Berlin. The prospective data included patient-related and incident-related data, information on injury patterns and therapy, responses in a voluntary questionnaire concerning E-scooter use and general traffic experience.
Results: In total, 248 patients (129 males; median age 29 years (5–81)) were included: 41% were tourists and 4% were children. Most incidents (71%) occurred between July and September 2019, the majority occurring at weekends (58%). The injury pattern was mostly multifocal, affecting the lower (42%) and upper limbs (37%), and the head (40%). Traumatic brain injury was associated with alcohol consumption. Inpatient admission was recorded in 25% and surgery in 23%.
Conclusion: This study has defined the incidence of injury related to E-scooter use in a major European city. Stricter laws governing the use of E-scooters, the wearing of helmets and technical modifications to the E-scooter platforms might decrease E-scooter-associated incidents and resulting injuries in the future.
Trial registration number: German Clinical Trials Registry (DRKS00018061).
Uluk D, Lindner T, Dahne M, et al. E-scooter incidents in Berlin: an evaluation of risk factors and injury patterns. Emerg Med J. 26 May 2021.
