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Abstracts from international emergency medicine journals
  1. EMJ Production
  1. Production, BMJ Publishing Group, London, UK
  1. Correspondence to Dr EMJ Production, Production, BMJ Publishing Group, London, UK; production.emj{at}bmjgroup.com

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

Qualitative needs assessment for paediatric emergency care in Kampala, Uganda

Boyoung Ahn, Ezekiel Mupere, Belén Irarrázaval, Robert O. Opoka, … Nicolaus W. Glomb

Introduction Acute childhood illnesses, such as malaria, pneumonia, and diarrhoea, represent the leading causes of under-five mortality in Uganda. Given that most early child deaths are treatable with timely interventions, emergency units dedicated to paediatric populations have been established in the country. In light of recent developments, the department of paediatrics at Makerere University requested a needs assessment in the paediatric acute care unit (PACU) at Mulago National Referral Hospital, which could guide the development of a new training curriculum for medical providers.

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Methods We administered a survey for medical providers working in the PACU at Mulago Hospital, which assessed their self-rated comfort levels with paediatric assessment, treatment, and teamwork skills. We also conducted focus groups with a smaller subset of medical providers to understand barriers and facilitators to paediatric emergency and critical care.

Results Of 35 paediatric assessment, treatment, and teamwork skills, 29 (83%) questions had the median comfort rating of 6 or 7 on a 7-point Likert scale. The remaining 6 (17%) skills had a median comfort rating of 5 or lower. Focus groups identified a number of major barriers to caring for critically ill children, including limited resources and staffing, training gaps, and challenges with interprofessional teamwork. In terms of training development, focus group participants suggested continuous training for all medical providers working in the PACU led by local leaders.

Conclusion This study identified the need and desirability of continuous trainings in the PACU. Key components include objective skills assessment, simulation-based scenarios, and interprofessional teamwork. Training development should be augmented by increases in resources, staffing, and training opportunities in collaboration with the Uganda Ministry of Health.

Annals of emergency medicine

Official Journal of the American College of Emergency Physicians

Comparison of nebulized ketamine at three different dosing regimens for treating painful conditions in the emergency department: a prospective, randomized, double-blind clinical trial

Daniel Dove, MD; Catsim Fassassi, DO; Ashley Davis, MD; Jefferson Drapkin, MPH; Mahlaqa Butt, MPH; Rukhsana Hossain, MPH; Sarah Kabariti, MPH; Antonios Likourezos, MA, MPH; Ankit Gohel, PharmD; Patrizia Favale, PharmD; Michael Silver, MS; John Marshall, MD; Sergey Motov, MD

Study objective We aimed to assess and compare the analgesic efficacies and adverse effects of ketamine administered through a breath-actuated nebulizer at three different dosing regimens for emergency department patients presenting with acute and chronic painful conditions.

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Methods This was a prospective, randomised, double-blinded trial comparing 3 doses of nebulized ketamine (0.75 mg/kg, 1 mg/kg, and 1.5 mg/kg) administered through breath-actuated nebulizer in adult emergency department patients aged 18 years and older with moderate to severe acute and chronic pain. The primary outcome included the difference in pain scores on an 11-point numeric rating scale between all 3 groups at 30 min. Secondary outcomes included the need for rescue analgesia (additional doses of nebulized ketamine or intravenous morphine) and adverse events in each group at 30 and 60 min.

Results We enrolled 120 subjects (40 per group). The difference in mean pain scores at 30 min between the 0.75 mg/kg and 1 mg/kg groups was 0.25 (95% CI (CI) 1.28 to 1.78); between the 1 mg/kg and 1.5 mg/kg groups was −0.225 (95% CI −1.76 to 1.31); and between the 0.75 mg/kg and 1.5 mg/kg groups was 0.025 (95% CI −1.51 to 1.56). No clinically concerning changes in vital signs occurred. No serious adverse events occurred in any of the groups.

Conclusion We found no difference between all 3 doses of ketamine administered through breath-actuated nebulizer for short-term treatment of moderate to severe pain in the emergency department.

Canadian Journal of emergency medicine

CJEM is the official publication of the Canadian Association of Emergency Physicians (CAEP)

ED occupancy as a single measure has similar predictive accuracy to complex crowding scores and is easily generalizable to diverse emergency departments. Real-time tracking of this simple indicator could be used to prompt investigation and implementation of crowding interventions

Esli Osmanlliu, Matthew Slimovitch, Olivier Drouin, Nathalie Lucas, Jocelyn Gravel & Nathalie Gaucher

Background: The management of children with an asthma exacerbation includes timely systemic corticosteroids and frequent short-acting beta-agonist therapy. In selected patients, inhaled short-acting beta-agonist administration by parents may promote comfort, constitute an educational opportunity for the family, and safely reduce provider workload. Our objective was to evaluate parental satisfaction and perceived safety of this new approach.

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Methods: This was a cross-sectional study, conducted in a tertiary paediatric ED. We investigated patient and parent perspectives on a newly implemented parental short-acting beta-agonist administration programme. A convenience sample of families participating in this programme was approached for study enrolment. The primary outcome was the proportion of parents and children who were satisfied with the programme. We also evaluated the programme’s safety and impact on asthma education as reported by parents.

Results: From February 2019 to March 2020, 72 of 74 (97%) families approached for enrolment participated in the survey. A vast majority (95%) of parents appreciated the programme and 93% would participate again. Among children > 7 years, 86% preferred receiving inhaled short-acting beta-agonist by their parents rather than by a healthcare provider. Nearly all parents (96%) found the programme to be ‘safe’ or ‘very safe’. Some participants reported improvements in their inhaler administration technique (25%) and ability to recognise their child’s respiratory distress (25%).

Conclusion: A novel parental short-acting beta-agonist administration programme in the paediatric ED was widely appreciated by participating families. Parents perceived it as being safe, educational, and contributing to their child’s comfort.

Emergencias

Official Journal of the Spanish Society of Emergency Medicine (SEMES)

Mortality in patients treated for COVID-19 in the emergency department of a tertiary care hospital during the first phase of the pandemic: Derivation of a risk model for emergency departments

García-Martínez A, López-Barbeito B, Coll-Vinent B, Placer A, Font C, Vargas CR, Sánchez C, Piñango D, Gómez Angelats E, Gómez-Angelats E, Curtelin D, Salgado E, Aya F, Martínez-Nadal G, Alonso JR, García-Gozalbes J, Fresco L, Galicia M, Perea M, Carbó M, Iniesta N, Escoda O, Perelló R, Cuerpo S, Flores V, Alemany X, Miró O, Ortega Romero M

Objective. To develop a risk model to predict 30-day mortality after emergency department treatment for COVID-19.

Methods. Observational retrospective cohort study including 2511 patients with COVID-19 who came to our emergency department between March 1 and April 30, 2020. We analyzed variables with Kaplan Meier survival and Cox regression analyses.

Results. All-cause mortality was 8% at 30 days. Independent variables associated with higher risk of mortality were age over 50 years, a Barthel index score less than 90, altered mental status, the ratio of arterial oxygen saturation to the fraction of inspired oxygen (SaO2/FIO2), abnormal lung sounds, platelet concentration less than 100000/mm3, a C-reactive protein concentration of 5 mg/dL or higher, and a glomerular filtration rate less than 45 mL/min. Each independent predictor was assigned 1 point in the score except age, which was assigned 2 points. Risk was distributed in 3 levels: low risk (score of 4 points or less), intermediate risk (5 to 6 points), and high risk (7 points or above). Thirty-day risk of mortality was 1.7% for patients who scored in the low-risk category, 28.2% for patients with an intermediate risk score, and 67.3% for those with a high risk score.

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Conclusion. This mortality risk stratification tool for patients with COVID-19 could be useful for managing the course of disease and assigning health care resources in the emergency department.

Hong Kong Journal of emergency medicine

This journal is published on behalf of the Hong Kong College of Emergency Medicine andThe Hong Kong Society for Emergency Medicine and Surgery.

Oxygen therapy versus conservative therapy in suspected uncomplicated myocardial infarction without hypoxemia: a meta-analysis of randomized controlled studies

Zhang R, Zhu Y, Zhang M, Yin H, Wei J

Background: The effect of oxygen therapy in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline was uncertain.

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Objectives: We aimed to perform a rigorous and comprehensive meta-analysis to robustly quantify the efficacy of oxygen therapy in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline.

Methods: We searched EMBASE, MEDLINE, Web of Science, and the Cochrane Library from inception to August 2018. Two researchers screened studies and collected the data independently. Randomized controlled trials were included. The main outcome was mortality at the longest duration of follow-up.

Results: Seven studies involving 7732 patients (median = 157 patients; range = 72–6629 patients; interquartile range = 136–441 patients; oxygen therapy group = 3856 patients; conservative group = 3876 patients) were included. Compared with conservative therapy, oxygen therapy did not significantly reduce mortality at the longest follow-up (risk ratio = 0.97; 95% confidence interval = 0.68 to 1.40; z = 0.15; p = 0.88), at discharge (risk ratio = 1.04; 95% confidence interval = 0.48 to 2.26; z = 0.11; p = 0.91), 30 days (risk ratio = 1.08; 95% confidence interval = 0.78 to 1.49; z = 0.44; p = 0.66), and 6 months (risk ratio = 0.93; 95% confidence interval = 0.73 to 1.17; z = 0.66; p = 0.51) in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline. Furthermore, there was no significant difference between two groups with regard to infarct size (standard mean difference = 0.15, confidence interval = –0.13 to 0.44; z = 1.07, p = 0.28), cardiac troponin levels (standard mean difference = 0.30, confidence interval = –0.09 to 0.69; z = 1.51, p = 0.13), in hospital reinfarction (risk ratio = 1.49, confidence interval = 0.80 to 2.78; z = 1.25, p = 0.21), and new-onset atrial fibrillation (risk ratio = 0.91, confidence interval = 0.69 to 1.18; z = 0.72, p = 0.47). Multiple subgroup analysis, sensitivity analysis, and trial sequential analysis were consistent with overall findings.

Conclusion: Compared with conservative therapy, oxygen therapy did not decrease the mortality at the longest duration of follow-up, discharge, 30 days, and 6 months in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline. Furthermore, large-scale, multicenter studies are needed to confirm our results.

Registration: PROSPERO, number CRD42017078807.

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.