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Abstract
Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.
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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
A systematic review of burn injuries in low- and middle-income countries: Epidemiology in the who-defined African region
Rybarczyk MM, Schafer JM, Elm CM, Sarvepalli S, Vaswani PA, Balhara KS, Carlson LC, Jacquet GA
Introduction According to the WHO, burns result in the loss of approximately 18 million disability adjusted life years (DALYs) and more than 250 000 deaths each year, more than 90% of which are in low- and middle-income countries (LMICs). The epidemiology of these injuries, especially in the WHO-defined African Region, has yet to be adequately defined.
Methods We performed a systematic review of the literature regarding the epidemiology of thermal, chemical, and electrical burns in the WHO-defined African Region. All articles indexed in PubMed, EMBASE, Web of Science, Global Health, and the Cochrane Library databases as of October 2015 were included.
Results The search resulted in 12 568 potential abstracts. Through multiple rounds of screening using criteria determined a priori, 81 manuscripts with hospital-based epidemiology as well as eleven manuscripts that included population-based epidemiology were identified. Although the studies varied in methodology, several trends were noted: young children appear to be at most risk; most individuals were burned at home; and hot liquids and flame are the most common aetiologies.
Discussion While more population-based research is essential to identifying specific risk factors for targeted prevention strategies, our review identifies consistent trends for initial efforts at eliminating these often devastating and avoidable injuries.
Annals of Emergency Medicine
Official Journal of the American College of Emergency Physicians
Structured clinical decision aids are seldom compared with subjective physician judgement, and are seldom superior
David L Schriger, Joshua W Elder, Richelle J Cooper
Study objective We determine how often studies that evaluate the performance of an aid for decisionmaking, be it a simple laboratory or imaging test or a complex multielement decision instrument, compare the aid’s performance to independent, unaided physician judgement.
Methods This was a cross-sectional survey of all Original Research and Brief Research Report articles in Annals of Emergency Medicine from 1998 to 2015. We included all articles that evaluated the performance of an aid for decisionmaking in assisting a physician with a decision about testing, treatment, diagnosis, or disposition. Two authors independently characterised the intent and purpose of each aid for decisionmaking, determined whether each study had a comparison to unaided physician judgement within the article or in a separate article, and recorded the result of that comparison.
Results One hundred seventy-one (8.3%) of 2060 research articles studied the performance characteristics of an aid for decisionmaking, 48 of which were formal clinical decision instruments. Forty of the 171 studies retrospectively analysed existing databases and therefore could not assess physician judgement. Investigators compared the aid for decisionmaking to physician judgement in 11% (15/131) of the prospective studies, including 15% (6/41) of studies that evaluated a formal clinical decision instrument. For nine articles that had no comparison to physician judgement, we found six unique external publications that compared that aid to physician clinical judgement. The decision aid was superior to clinical judgement in 2 of the 21 studies that contained a comparison.
Conclusion Physician judgement is infrequently assessed when the performance of an aid for decisionmaking is evaluated, and, when reported, the decision aid seldom outperformed physician judgement.
Emergencias
Official Journal of the Spanish Society of Emergency Medicine
Ethyl chloride aerosol spray for local anaesthesia before arterial puncture: randomised placebo-controlled trial
Sendoa Ballesteros-Peña, Irrintzi Fernández-Aedo, Gorka Vallejo-De la Hoz, en representación del grupo de trabajo DIASURE
Objective To compare the efficacy of an ethyl chloride aerosol spray to a placebo spray applied in the emergency department to the skin to reduce pain from arterial puncture for blood gas analysis.
Material and methods Single-blind, randomised placebo-controlled trial in an emergency department of Hospital de Basurto in Bilbao, Spain. We included 126 patients for whom arterial blood gas analysis had been ordered. They were randomly assigned to receive application of the experimental ethyl chloride spray (n=66) or a placebo aerosol spray of a solution of alcohol in water (n=60). The assigned spray was applied just before arterial puncture. The main outcome variable was pain intensity reported on an 11-point numeric rating scale.
Results The median (IQR) pain level was 2 (1–5) in the experimental arm and 2 (1–4.5) in the placebo arm (p=0.72).
Conclusion Topical application of an ethyl chloride spray did not reduce pain caused by arterial puncture.