BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency...BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency department(ED).METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care.Primary endpoints included respiratory adverse events,with secondary endpoints of level of sedation,hypotension,other PSA-related adverse events and patient satisfaction.RESULTS:Of 986 patients,501 were randomized to usual care and 485 to additional ETC monitoring.In this series,48%of the patients were female,with a mean age of 46 years.Orthopedic manipulations(71%),cardioversion(12%)and abscess incision and drainage(12%)were the most common procedures,and propofol and fentanyl were the sedative/analgesic combination used for most patients.There was no difference in patients experiencing de-saturation(Sa O2<90%)between the two groups;however,patients in the ETC group were more likely to require airway repositioning(12.9%vs.9.3%,P=0.003).Hypotension(SBP<100 mm Hg or<85 mm Hg if baseline<100 mm Hg)was observed in 16(3.3%)patients in the ETC group and 7(1.4%)in the control group(P=0.048).CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes.We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used.We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.展开更多
Dear editor,Patients with supraventricular tachycardia(SVT)commonly present to the emergency department(ED).Current guidelines[1,2]do not recommend routine pathology testing and a report on the topic has questioned th...Dear editor,Patients with supraventricular tachycardia(SVT)commonly present to the emergency department(ED).Current guidelines[1,2]do not recommend routine pathology testing and a report on the topic has questioned their role.A systematic review concluded that troponin testing is commonly performed with a high proportion of positive fi ndings,but these results were not associated with major adverse cardiac events.[3]The conclusions of this review were limited by paucity of data and heterogeneity among studies.展开更多
BACKGROUND： Blood cultures （BC ） are commonly ordered during the initial assessment ofpatients with community-acquired pneumonia （CAP）, yet their yield remains low. Selective use of BCwould allow the opportunity ...BACKGROUND： Blood cultures （BC ） are commonly ordered during the initial assessment ofpatients with community-acquired pneumonia （CAP）, yet their yield remains low. Selective use of BCwould allow the opportunity to save healthcare resources and avoid patient discomfort. The studywas to determine what demographic and clinical factors predict a greater likelihood of a positiveblood culture result in patients diagnosed with CAP.METHODS： A structured retrospective systematic chart audit was performed to comparerelevant demographic and clinical details of patients admitted with CAP, in whom blood culture resultswere positive, with those of age, sex, and date-matched control patients in whom blood cultureresults were negative.RESULTS： On univariate analysis, eight variables were associated with a positive BC result.After logistic regression analysis, however, the only variables statistically significantly associatedwith a positive BC were WBC less than 4.5 x 109/L [likelihood ratio （LR）： 7.75, 95% CI=2.89-30.39], creatinine 〉106 !mol/L （LR： 3.15, 95%CI=1.71-5.80）, serum glucose〈6.1 mmol/L （LR： 2.46,95%CI=1.14-5.32）, and temperature 〉 38 °C （LR： 2.25, 95% CI =1.21-4.20）. A patient with all of thesevariables had a LR of having a positive BC of 135.53 （95% CI=25.28-726.8） compared to patientswith none of these variables.CONCLUSIONS： Certain clinical variables in patients with CAP admitted to hospitals doappear to be associated with a higher probability of a positive yield of BC, with combinations of thesevariables increasing this likelihood. We have identified a subgroup of CAP patients in whom bloodcultures are more likely to be useful.展开更多
Dear editor, Chest pain is a frequent complaint of patients presenting to the emergency department (ED), and many of them are referred to the cardiology service for further investigation. At the Charles V. Keating Eme...Dear editor, Chest pain is a frequent complaint of patients presenting to the emergency department (ED), and many of them are referred to the cardiology service for further investigation. At the Charles V. Keating Emergency and Trauma Centre in Halifax, Nova Scotia, Canada, 4,800 (6.6%) of the approximately 73,000 patients per year register with a complaint of “chest pain”, and 20% of patients are referred to cardiology. Coagulation studies, specifi cally international normalized ratio (INR) frequently part of the “routine” panel of blood tests, are ordered for patients in the ED being investigated or treated for chest pain suspected to be cardiac in nature. Recent calls to examine how much of our practice is likely to benefit patients in any way have led us to question the clinical utility of routine use of these tests.展开更多
Triage aims to identify and prioritize patients with time-sensitive health care needs.This process is particularly important when demand for emergency care exceeds the available resources.A small number of triage inst...Triage aims to identify and prioritize patients with time-sensitive health care needs.This process is particularly important when demand for emergency care exceeds the available resources.A small number of triage instruments have been purpose designed for low-and middle-income countries.Most recently,the World Health Organization,in collaboration with the International Committee of the Red Cross and Médecins Sans Frontières,has released the Interagency Integrated Triage Tool(IITT).Despite endorsement by leading global health agencies,little has been published regarding the IITT’s validity and reliability.Although triage is widely regarded as a critical tool for organizing emergency care services,many instruments have demonstrated suboptimal sensitivity for the detection of time-critical illness.There is a pressing need therefore to assess the performance of the IITT relative to other systems.Recent efforts to implement and evaluate the tool in the Western Pacific region will provide valuable insights into its validity,reliability and acceptability.展开更多
Background:Patients with burn injuries are considered to have an increased risk of venous thromboembolism(VTE).While untreated VTEs can be fatal,no studies have examined chemoprophylaxis effectiveness.This study aimed...Background:Patients with burn injuries are considered to have an increased risk of venous thromboembolism(VTE).While untreated VTEs can be fatal,no studies have examined chemoprophylaxis effectiveness.This study aimed to quantify the variation in prevalence of VTE prophylaxis use in patients in Australian and New Zealand burns units and whether prophylaxis use is associated with in-hospital outcomes following burn injury.Methods:Admission data for adult burns patients(aged≥16 years)admitted between 1 July 2016 and 31 December 2018 were extracted from the Burns Registry of Australia and New Zealand.Mixed effects logistic regression modelling investigated whether VTE prophylaxis usewas associated with the primary outcome of in-hospital mortality.Results:There were 5066 admissions over the study period.Of these patients,81%(n=3799)with a valid response to the VTE prophylaxis data field received some form of VTE prophylaxis.Use of VTE prophylaxis ranged from 48.6%to 94.8%of patients between units.In-hospital death was recorded in<1%of patients(n=33).After adjusting for confounders,receiving VTE prophylaxis was associated with a decrease in the adjusted odds of in-hospital mortality(adjusted odds ratio=0.21;95%CI,0.07–0.63;p=0.006).Conclusions:Variation in the use of VTE prophylaxis was observed between the units,and prophylaxis use was associated with a decrease in the odds of mortality.These findings provide an opportunity to engage with units to further explore differences in prophylaxis use and develop future best practice guidelines.展开更多
Purpose:To systematically review the risk of permanent disability related to road traffic injuries(RTIs)and to determine the implications for future research regarding permanent impairment following road traffic crash...Purpose:To systematically review the risk of permanent disability related to road traffic injuries(RTIs)and to determine the implications for future research regarding permanent impairment following road traffic crashes.Methods:We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement.An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020.Two teams include 2 reviewers each,screened independently the titles/abstracts,and after that,reviewed the full text of the included studies.The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology(STROBE)checklist.A third reviewer was assessed any discrepancy and all data of included studies were extracted.Finally,the data were systematically analyzed,and the related data were interpreted.Results:Five out of 16 studies were evaluated as high-quality according to the STROBE checklist.Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005.Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2%to 23%for car occupants and 2.8%to 46%for cyclists.Seven studies reported the risk of permanent medical impairment of the different body regions.Eleven studies stated the most common body region to develop permanent impairment,of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured.Conclusion:The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world.This would facilitate decisionmaking about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.展开更多
基金supported by a grant from the Capital Health Research FundHalifax+1 种基金Nova ScotiaCanada
文摘BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency department(ED).METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care.Primary endpoints included respiratory adverse events,with secondary endpoints of level of sedation,hypotension,other PSA-related adverse events and patient satisfaction.RESULTS:Of 986 patients,501 were randomized to usual care and 485 to additional ETC monitoring.In this series,48%of the patients were female,with a mean age of 46 years.Orthopedic manipulations(71%),cardioversion(12%)and abscess incision and drainage(12%)were the most common procedures,and propofol and fentanyl were the sedative/analgesic combination used for most patients.There was no difference in patients experiencing de-saturation(Sa O2<90%)between the two groups;however,patients in the ETC group were more likely to require airway repositioning(12.9%vs.9.3%,P=0.003).Hypotension(SBP<100 mm Hg or<85 mm Hg if baseline<100 mm Hg)was observed in 16(3.3%)patients in the ETC group and 7(1.4%)in the control group(P=0.048).CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes.We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used.We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.
文摘Dear editor,Patients with supraventricular tachycardia(SVT)commonly present to the emergency department(ED).Current guidelines[1,2]do not recommend routine pathology testing and a report on the topic has questioned their role.A systematic review concluded that troponin testing is commonly performed with a high proportion of positive fi ndings,but these results were not associated with major adverse cardiac events.[3]The conclusions of this review were limited by paucity of data and heterogeneity among studies.
文摘BACKGROUND： Blood cultures （BC ） are commonly ordered during the initial assessment ofpatients with community-acquired pneumonia （CAP）, yet their yield remains low. Selective use of BCwould allow the opportunity to save healthcare resources and avoid patient discomfort. The studywas to determine what demographic and clinical factors predict a greater likelihood of a positiveblood culture result in patients diagnosed with CAP.METHODS： A structured retrospective systematic chart audit was performed to comparerelevant demographic and clinical details of patients admitted with CAP, in whom blood culture resultswere positive, with those of age, sex, and date-matched control patients in whom blood cultureresults were negative.RESULTS： On univariate analysis, eight variables were associated with a positive BC result.After logistic regression analysis, however, the only variables statistically significantly associatedwith a positive BC were WBC less than 4.5 x 109/L [likelihood ratio （LR）： 7.75, 95% CI=2.89-30.39], creatinine 〉106 !mol/L （LR： 3.15, 95%CI=1.71-5.80）, serum glucose〈6.1 mmol/L （LR： 2.46,95%CI=1.14-5.32）, and temperature 〉 38 °C （LR： 2.25, 95% CI =1.21-4.20）. A patient with all of thesevariables had a LR of having a positive BC of 135.53 （95% CI=25.28-726.8） compared to patientswith none of these variables.CONCLUSIONS： Certain clinical variables in patients with CAP admitted to hospitals doappear to be associated with a higher probability of a positive yield of BC, with combinations of thesevariables increasing this likelihood. We have identified a subgroup of CAP patients in whom bloodcultures are more likely to be useful.
文摘Dear editor, Chest pain is a frequent complaint of patients presenting to the emergency department (ED), and many of them are referred to the cardiology service for further investigation. At the Charles V. Keating Emergency and Trauma Centre in Halifax, Nova Scotia, Canada, 4,800 (6.6%) of the approximately 73,000 patients per year register with a complaint of “chest pain”, and 20% of patients are referred to cardiology. Coagulation studies, specifi cally international normalized ratio (INR) frequently part of the “routine” panel of blood tests, are ordered for patients in the ED being investigated or treated for chest pain suspected to be cardiac in nature. Recent calls to examine how much of our practice is likely to benefit patients in any way have led us to question the clinical utility of routine use of these tests.
文摘Triage aims to identify and prioritize patients with time-sensitive health care needs.This process is particularly important when demand for emergency care exceeds the available resources.A small number of triage instruments have been purpose designed for low-and middle-income countries.Most recently,the World Health Organization,in collaboration with the International Committee of the Red Cross and Médecins Sans Frontières,has released the Interagency Integrated Triage Tool(IITT).Despite endorsement by leading global health agencies,little has been published regarding the IITT’s validity and reliability.Although triage is widely regarded as a critical tool for organizing emergency care services,many instruments have demonstrated suboptimal sensitivity for the detection of time-critical illness.There is a pressing need therefore to assess the performance of the IITT relative to other systems.Recent efforts to implement and evaluate the tool in the Western Pacific region will provide valuable insights into its validity,reliability and acceptability.
文摘Background:Patients with burn injuries are considered to have an increased risk of venous thromboembolism(VTE).While untreated VTEs can be fatal,no studies have examined chemoprophylaxis effectiveness.This study aimed to quantify the variation in prevalence of VTE prophylaxis use in patients in Australian and New Zealand burns units and whether prophylaxis use is associated with in-hospital outcomes following burn injury.Methods:Admission data for adult burns patients(aged≥16 years)admitted between 1 July 2016 and 31 December 2018 were extracted from the Burns Registry of Australia and New Zealand.Mixed effects logistic regression modelling investigated whether VTE prophylaxis usewas associated with the primary outcome of in-hospital mortality.Results:There were 5066 admissions over the study period.Of these patients,81%(n=3799)with a valid response to the VTE prophylaxis data field received some form of VTE prophylaxis.Use of VTE prophylaxis ranged from 48.6%to 94.8%of patients between units.In-hospital death was recorded in<1%of patients(n=33).After adjusting for confounders,receiving VTE prophylaxis was associated with a decrease in the adjusted odds of in-hospital mortality(adjusted odds ratio=0.21;95%CI,0.07–0.63;p=0.006).Conclusions:Variation in the use of VTE prophylaxis was observed between the units,and prophylaxis use was associated with a decrease in the odds of mortality.These findings provide an opportunity to engage with units to further explore differences in prophylaxis use and develop future best practice guidelines.
基金funded by Sina Trauma and Surgery Research Center,Tehran University of Medical Sciences(grant number is 98-01-38-41758).
文摘Purpose:To systematically review the risk of permanent disability related to road traffic injuries(RTIs)and to determine the implications for future research regarding permanent impairment following road traffic crashes.Methods:We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement.An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020.Two teams include 2 reviewers each,screened independently the titles/abstracts,and after that,reviewed the full text of the included studies.The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology(STROBE)checklist.A third reviewer was assessed any discrepancy and all data of included studies were extracted.Finally,the data were systematically analyzed,and the related data were interpreted.Results:Five out of 16 studies were evaluated as high-quality according to the STROBE checklist.Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005.Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2%to 23%for car occupants and 2.8%to 46%for cyclists.Seven studies reported the risk of permanent medical impairment of the different body regions.Eleven studies stated the most common body region to develop permanent impairment,of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured.Conclusion:The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world.This would facilitate decisionmaking about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.
