Emergency Medicine Journal

SEPTEMBER 25, 2024

Being a trauma team leader, emergency physician in charge or clinical lead all look very different and require a range of skills, but are all certainly forms of leadership that have a significant impact on the running of an emergency department, patient outcomes and, as is increasingly being recognised, staff well-being.

Leadership 52

Leadership Emergency Department Outcomes Wellness 52

The Trauma Pro

OCTOBER 25, 2024

Here are the factoids: The original data were derived from a 17-center study conducted from 2018-2020; this study only included 1,387 patients who had pelvic fractures (as well as other injuries). The primary outcome was the development of VTE during the hospitalization.

Fractures 147

Fractures Head Injuries Operations Ultrasounds 147

Emergency Medicine Journal

OCTOBER 26, 2023

Methods We investigated four 18-month periods between 2005 and 2018. Primary outcome was survival at hospital discharge with a good neurological outcome. Results Of 21 781 patients under consideration, 3476 (16%) met the inclusion criteria.

Resuscitation 75

Resuscitation Basic Life Support Hospitals CPR 75

Dr. Smith's ECG Blog

JUNE 5, 2024

This combination is often extremely effective for maintaining good longterm outcome ( Lanza and Shimokawa — Eur Cardiol 18: e38, 2023 ). As a result — an ICD may need to be considered in selected cases.

EKG/ECG 106

EKG/ECG Outcomes 106

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Three outcomes were evaluated, with none being deemed the primary outcome. Background: Sepsis remains one of the leading causes of morbidity and mortality. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

Pediatric EM Morsels

SEPTEMBER 22, 2023

2018 Oct;14(2):47-54. Epub 2018 Oct 31. Orenstein JB, Klein BL, Gotschall CS, Ochsenschlager DW, Klatzko MD, Eichelberger MR. Age and outcome in pediatric cervical spine injury: 11-year experience. Korean J Neurotrauma. doi: 10.13004/kjnt.2018.14.2.47. 2018.14.2.47. PMID: 30402418; PMCID: PMC6218357. J Pediatr Surg.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

Pediatric EM Morsels

JUNE 9, 2023

Carneiro de Moura, 2018 ] Seen in 57% of cohort. Banc-Husu, 2023 ; Luoto, 2020; Carneiro de Moura, 2018 ] Basics are best (always)! Banc-Husu, 2023 ; Luoto, 2020; Carneiro de Moura, 2018 ] Basics are best (always)! Long-term Outcomes and Health Perceptions in Pediatric-onset Portal Hypertension Complicated by Varices.

Pediatrics 152

Pediatrics Head Injuries Airway Management Administration 152

Emergency Medicine Journal

FEBRUARY 20, 2024

Background Andexanet alfa was approved in 2018 for reversal of direct oral anticoagulants but due to issues of cost and access, four-factor prothrombin complex concentrate (4F-PCC) continues to be used for this indication. Primary outcome includes rate of mortality/hospice at hospital discharge.

Hospice 74

Hospice Outcomes Hospitals 74

RebelEM

NOVEMBER 6, 2024

2018 Jun;54(6):849-854. Epub 2018 Apr 19. 2018 Apr 4;100(7):e46. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30521261 Gottlieb M, Schiebout J. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. doi: 10.1016/j.jemermed.2018.02.011. 2018.02.011. J Am Acad Orthop Surg.

Dislocations 59

Dislocations Fractures Soft Tissue Injuries Outcomes 59

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). 2018 Mar;28(3):210-217. That sounds reasonable, so what has changed?

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

EMDocs

JUNE 1, 2023

Several secondary outcomes suggest a signal toward harm with hypothermia, including incidence of pneumonia, bradycardia, and more days ventilated. Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients with Severe Traumatic Brain Injury: The POLAR Randomized Clinical Trial. 2018; 320(21):2211-2220.

Hyperthermia / Hypothermia 61

Hyperthermia / Hypothermia Outcomes Hospitals Emergency Department 61

Don't Forget the Bubbles

DECEMBER 25, 2023

Interpreting Research Outcomes with a Little Bathroom Humour You have learned a method for how to read a research paper , and now you are faced with a bunch of outcomes. There are primary, secondary, composite , and safety outcomes. What are these outcomes? We know there is a bias towards reporting positive outcomes.

Research 83

Research Outcomes Fractures Pediatrics 83

RebelEM

AUGUST 14, 2023

days 2 most common sites of infection were lung (44.8%) and inta-abdominal (32.1%) Majority of infections were community-acquired (≈84%) Over half the patients were on mechanical ventilation (≈53%) Primary Outcome Results: 28-day mortality rate: Placebo 26.1% (230/882) vs. XBJ 18.8% (165/878); P<0.001 The risk difference was 7.3% (95% CI, 3.4-11.2)

Sepsis 98

Sepsis Outcomes Administration EMS 98

RebelEM

JULY 27, 2023

In this group of patients, the use of alteplase poses a fine line of potential benefit (functional outcomes) vs potential harm (symptomatic intracranial hemorrhage). Many patients, however, will have minor strokes (defined as an NIHSS score ≤5). Alteplase: 91.4% Risk Diff: 2.3%; 95% CI -1.5 Alteplase: 0.9% Any Bleeding Events: DAPT: 1.6%

Stroke 98

Stroke Outcomes EMS Hospitals 98

The Skeptics' Guide to EM

OCTOBER 20, 2018

[display_podcast] Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. NEJM 2018 (ClinicalTrials.gov NCT01467466.)

Outcomes 69

Outcomes Emergency Department Pediatrics 69

Intensive Blog

MARCH 13, 2024

This involved thirty-six centres in Japan between 2013 and 2018. This showed a similar rate of survival to discharge (27%), of whom approximately 50% had a favourable neurological outcome on discharge (CPC 1 or 2). RCTs The last few years has seen some notable RCTs with patient important outcomes published (14-16).

CPR 130

CPR Resuscitation Outcomes Hospitals 130

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

Don't Forget the Bubbles

JANUARY 24, 2024

Mortality is high, between 16-43.5% , and neurological outcomes are generally poor amongst survivors. These poor outcomes are related to both the SRSE itself and as a result of the prolonged PICU stay. One study suggests remission in 6 out of 7 patients where it was used, but long-term clinical outcomes remained poor.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

Emergency Medicine Journal

OCTOBER 26, 2023

Background Blood transfusion for bleeding trauma patients is a promising pre-hospital intervention with potential to improve outcomes. Methods Pre-hospital physicians, from two air ambulance sites in the south of England, were interviewed between December 2018 and January 2019.

Blood Transfusions 52

Blood Transfusions Hospitals Outcomes 52

RebelEM

SEPTEMBER 7, 2023

OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. 0.38, p=0.0021) No statistically significant results were reported in the other clinical outcomes studied. The primary outcome was patient-oriented. OR 0.07, 95% CI 0.01-0.38,

Seizures 133

Seizures Stroke Outcomes Research 133

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 137

Stroke Outcomes Hospitals Administration 137

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Outcomes: Primary Outcome: Visual Acuity (VA) Improvement Measured using logarithm of the minimum angle of resolution (logMAR). Within 24 hours after treatment. 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

RebelEM

JANUARY 25, 2024

A 2018 systematic review and meta-analysis of 25 studies focusing on the accuracy of emergency lung ultrasound showed sensitivity of 85-95% and specificity of 75-90% for pneumonia, sensitivity of 78% and specificity of 94% for COPD/asthma, and sensitivity of 75-90% and specificity of 80-90% for acute heart failure [4].

Ultrasounds 130

Ultrasounds Outcomes COPD Hospitals 130

Pediatric EM Morsels

AUGUST 9, 2024

Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. If not treated early, then increased risk of poor outcomes and death. Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Hussain, 2023 ] Leads to >300,000 perinatal deaths / year globally.

Hyperthermia / Hypothermia 152

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 152

Sensible Medicine

SEPTEMBER 18, 2023

The title gives away the results: Here is what they did: They took 159 patients who had severe TR and were operated on from 2004-2018. They then looked at a primary outcome of death. Earlier surgery may improve outcomes in these high-risk patients. These were operations solely for the tricuspid valve. vs 18.2% ; P =.036).

Operations 121

Operations Academics Shock Outcomes 121

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. SECONDARY OUTCOMES At day 28 , ceftriaxone group had (vs placebo): Lower VAP risk (20% vs 36%); hazard ratio 0.62 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 126

CDC Outcomes Radiology Radiology 126

The Skeptics' Guide to EM

JULY 30, 2022

CT is generally the first choice of imaging, the “abdominal series” of plain X-rays have been demonstrated to have poor predictive value, but a 2018 meta-analysis found 92.4% AEM July 2022 * Population: Patients with ICD-10 coding “intestinal obstruction” from 2018 National Hospital Ambulatory Medical Care Survey. sensitivity and 96.6%

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Methods This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands. The primary outcome was the proportion of patients requiring more than one reduction attempt.

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

RebelEM

AUGUST 7, 2023

Approximately half of the ICU patients with delirium received haloperidol in a cohort study published in 2018 (5) however the use of haloperidol is not supported by practice guidelines due to evidence of its effect being limited (6). 2018; PMID: 30346242 Salluh JI et al. Intensive Care Med 2018; PMID: 29767323 Devlin JW et al.

Outcomes 52

Outcomes Hospitals EMS Administration 52

Don't Forget the Bubbles

JULY 22, 2024

The 2018 PREVIEW trial reported a significant reduction in length of stay (LOS) in children given prednisolone in Australia (24-71 months, mean 41 months) compared to placebo. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS).

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

ALiEM

DECEMBER 8, 2023

Incidence, etiology, management, and outcomes of flank hernia: review of published data. 2018 Apr;22(2):353-361. Epub 2018 Jan 27. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32310432. Zhou DJ, Carlson MA. doi: 10.1007/s10029-018-1740-1. PMID: 29380158.

Academics 60

Academics Emergency Department Outcomes Wellness 60

Emergency Medicine Journal

AUGUST 23, 2023

Methods We conducted a before and after, retrospective, observational study using anonymised, routinely collected, patient-level data from a single English NHS ED between April 2018 and December 2019. We used interrupted time series models to study and estimate the impact of removing the 4-hour access standard.

Hospitals 73

Hospitals Research Outcomes 73

Sensible Medicine

SEPTEMBER 23, 2024

They also found that the largest difference between truncated and nontruncated trials occurred when the truncated trials had fewer than 500 outcome events. In 2018, three modern trials comparing asa vs placebo for primary prevention were published. This difference easily met statistical significance. All were nonsignificant.

Stroke 89

Stroke Academics Outcomes Shock 89

ACEP Now

JULY 7, 2023

2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity. Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Benjamin EJ, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

EB Medicine

JUNE 20, 2022

Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome. 2018 Mar 20;319(11):1168. 2018 Feb 26;11:23-32. Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome.

Outcomes 52

Outcomes 52

The Skeptics' Guide to EM

MARCH 2, 2019

Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. Clinical Question #1: Are superglottic airway devices non-inferior to endotracheal intubation in OHCA with regards to neurologic outcome?

Airway Management 52

Airway Management CPR Hyperthermia / Hypothermia Outcomes 52