862 e-Letters

  • Advancing Trauma Care Beyond Mortality: A Call for Comprehensive Evaluation

    Dear Editor,
    I am writing to delve deeper into the findings, clinical implications, and limitations of the systematic review titled "Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review" by Dr. Bath et al., recently published in the Emergency Medicine Journal [1]. This discussion aims to provide a nuanced understanding of the implications of the study's findings in the realm of trauma care and healthcare policy.
    The systematic review uncovers a critical knowledge gap regarding the impact of trauma system implementation on morbidity, quality of life, and economic outcomes, beyond the traditionally studied metric of mortality. The findings suggest that while trauma systems have demonstrated efficacy in reducing mortality rates, their effects on morbidity and economic burden remain poorly understood. This highlights the need for a more comprehensive approach to evaluating the effectiveness of trauma care systems, one that considers a broader spectrum of patient outcomes.
    From a clinical standpoint, the implications of these findings are profound. Trauma care extends far beyond the immediate management of injuries; it encompasses the long-term physical, psychological, and socioeconomic consequences experienced by patients. By elucidating the limited evidence regarding the impact of trauma systems on morbidity and economic outcomes, this study underscores the importance of adopting...

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  • Nail polish and pulse oximetry

    To the Editor!
    We have read the original contribution by Sutcu Cicek et al. [1] with high interest regarding the effect of nail polish and henna on pulse oximetry readings. In their study, these authors report on the influence of both factors in 33 normoxic healthy females. Although the study is interesting, it has significant limitations, which must be addressed.

    To our surprise, the authors state, it is not proven that nail polish effects the accuracy of pulse oximeters [1]. However, several randomized, controlled trials with both healthy persons and critically ill patients report on the effect of nail polish on oxygen saturation measured by pulse oximetry [2, 3, 4]. Interestingly, some of these studies have been cited by the authors themselves.

    Sample size calculation prior to beginning of a trial is obligate to determine the significance of results. Unfortunately, in this trial an adequate mathematical sample size calculation was obviously waived. Therefore, results of the present study cannot be interpreted regarding both the statistical significance and the clinical relevance.

    To determine pulse oximetry accuracy, intermittent arterial blood gas analyses (ABGA) are essential [3]. However, accuracy in the present study was only determined by consecutive pulse oximeter measurements over a specific duration, which may alter pulse oximetry readings. A major limitation of the present study is that accuracy is not analyzed in the present study al...

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  • Emergency Department overcrowding
    Richard M Makower

    Dear Editor

    The articles on the problems of Emergency Department (ED) overcrowding make interesting reading, as the problems outlined are familiar to us in the UK, and I am sure that we would all identify similar causes and both short and long term solutions.[1]

    The list of stopgap measures, in the article by Fatovich and Hirsch [1] is also familiar to us all. Ambulance diversion is difficult outside larg...

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  • Vasopressin or adrenaline in cardiac resuscitation
    Thomas E Locker

    Dear Editor

    The best evidence topic report (BET) by Hogg and Mahu [1] raises a number of concerns, both with the article itself and the BETs process as a whole. The relative efficacy of adrenaline and vasopressin in the management of cardiac arrest is an important subject of relevance to all who work in Emergency Medicine. For this BET to only include those papers directly comparing vasopressin and adrenaline is to...

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  • Steering wheel spin?
    Michael D Simmons

    Dear Editor

    Nigam and Cutter totally fail to present evidence to justify the claim that “Welsh emergency vehicles examined exhibited an unacceptable level of bacterial contamination”.[1] What is more, a press release from the editorial team to local newspapers led Madeline Brindley of The Western Mail to write, “Dirty ambulances infested with huge amounts of harmful bacteria are carrying seriously ill patients to hos...

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  • Diagnostic decision support in the ED: practical considerations
    Padmanabhan Ramnarayan

    Dear Editor

    Graber's article raises several valid points about the provision of diagnostic decision support in the ED.[1] The Emergency Depertment (ED) is one setting where reaching the correct diagnosis - for simple clinical problems and unusual ones - may reduce the burden of diagnostic error and its costly adverse consequences.[2]

    In Graber's study, QMR and ILIAD were tested for their diagnostic accu...

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  • What is "relative analgesia?"
    Marten C Howes

    Dear Editor

    I welcome the paper by Frampton et al.[1] describing their experiences of nurse-administered nitrous oxide, which adds further evidence to the literature [2] supporting this technique as a useful and safe method of easing the suffering of children during their attendance at an Emergency Department.

    I feel that the use of the term “relative analgesia” is somewhat confusing; this is not...

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  • Emergency Department overcrowding - a universal problem
    Ian A Sammy

    Dear EDitor

    I read with interest the article by Schull.[1] Having recently moved back to Trinidad from the UK, I had thought that the problems encountered by Emergency Departments in developing countries were different from those in the developed world. Unfortunately, they are all too familiar: overcrowding, long waiting times, lack of inpatient facilities, and lack of trained staff. Each of these problems differ in d...

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  • Vasopressin and adrenaline in cardiac resuscitation - the BET.
    Kerstin Hogg

    Dear Editor

    We read with interest the comments on our best evidence topic review on Vasopressin or adrenaline in cardiac resuscitation and are happy to explain the process involved in producing the BET.

    This literature search was first conducted in March 2002. Our initial and specific question was:
    Is vasopressin more effective than adrenaline in achieving return of circulation and longte...

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  • Authors' Reply
    Yamni Nigam

    Dear Editor

    With reference to the comments made by Dr Simmons [1] concerning 'A preliminary investigation into bacterial contamination of Welsh emergency ambulances'.[2] We fully accept that the methods used were not rigorous enough to accurately quantify numbers of bacteria for any given measured area. However, our work was simply described as a preliminary investigation and this pilot study did identify short...

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