Reciprocal Abstract Publication

Editor’s note: The Hong Kong Journal of Emergency Medicine has partnered with a small group of selected journals of international emergency medicine societies to share from each a highlighted research study, as selected monthly by their editors. Our goals are to increase awareness of our readership to research developments in the international emergency medicine literature, promote collaboration among the selected international emergency medicine journals, and support the improvement of emergency medicine world-wide, as described in the WAME statement at http://www.wame.org/about/policy-statements#Promoting%20Global%20Health. Abstracts are reproduced as published in the respective participating journals and are not peer reviewed or edited by the Hong Kong Journal of Emergency Medicine.

A descriptive analysis of endotracheal intubation in a South African Helicopter Emergency Medical Service

Stassen S, Lithgow A, Wylie C, Stein C

Stassen et al. Afr J Emerg Med 2018; 8(4): 140–144 https://doi.org/10.1016/j.afjem.2018.07.002

Introduction: Helicopter Emergency Medical Services (HEMS) exists to supplement the operations of ground-based emergency care providers, mainly in high acuity cases. One of the important procedures frequently carried out by HEMS personnel is endotracheal intubation. Several HEMS providers exist in South Africa, with a mix of advanced life support personnel; however, intubation success rates and adverse events have not been described in any local HEMS operation.

Methods: This was a retrospective chart review of intubation-related data collected by a HEMS operation based in Johannesburg over a 16-month period. First-pass and overall success rates were described, in addition to perceived airway difficulty, adverse events, and other data.

Results: Of the 49 cases recorded in the study period, 1 was excluded leaving 48 cases for analysis. Most cases (n = 34, 71%) involved young male trauma patients who were intubated with rapid sequence intubation. The first-pass success rate was 79% (n = 38) with an overall success rate of 98% (n = 47). At least one factor suggesting airway difficulty was present in 29% (n = 14) of cases, with most perceived airway difficulty related to the high prevalence of trauma cases. At least one adverse event occurred in 27% (n = 13) of cases with hypoxemia, hypotension, and bradycardia most prevalently.

Discussion: In this small sample of South African HEMS intubation cases, we found overall and first-pass success rates comparable to those reported in similar contexts.

Annals of Emergency Medicine

(The print version of this article has been scheduled for June 2019)

Research Pioneers in Emergency Medicine—Reflections on Their Paths to Success and Advice to Aspiring Researchers: A Qualitative Study

Wendy C Coates, Lalena M Yarris, Samuel O Clarke, Daniel Runde, Jacqueline Kurth, Emilie Fowlkes, Jaime Jordan

Study objective: Research in basic, translational, and clinical emergency medicine has made great strides since the formalization of emergency medicine as a specialty. Our objective is to identify and analyze strategies used by emergency medicine research pioneers to inform further advancement of research in emergency medicine, particularly for aspiring researchers and those in emerging areas, using emergency medicine medical education as one example.

Methods: This was a prospective, grounded-theory, qualitative study, using a constructivist/interpretivist paradigm. Leading basic science, translational, and clinical emergency medicine researchers who completed residency before 1995 were eligible for structured interviews. Thematic coding followed an iterative process until saturation was reached. A theoretic model was developed and analyzed.

Results: Research pioneers valued advanced methodological training and mentorship. Barriers to funding were lack of recognition of emergency medicine as a specialty, absence of a research history, and lack of training and funding resources. Deliberate interventions to improve emergency medicine research included educational sessions at national meetings, external (to emergency medicine) mentor pairings, targeted funding by emergency medicine organizations, and involvement with funding agencies. Pioneers facilitate research excellence by serving as mentors and allocating funds or protected time to develop researchers. To advance emerging subfields of research in emergency medicine, pioneers recommend advanced methodological training that is specific to the area, deliberate mentorship, and the formation of research consortia to conduct generalizable outcomes-based studies.

Conclusion: Research pioneers in emergency medicine cite mentorship, advanced skills obtained through fellowship or graduate degrees, deliberate collaboration with experienced researchers, support from emergency medicine organizations, and forming networks as the cornerstones of success.

Pain management practices surrounding lumbar punctures in children: a survey of Canadian emergency physicians

Naveen Poonai, Victoria Brzozowski, Antonia S Stang, Amy L Drendel, Philippe Boisclair, Michael Miller, Stuart Harman, Samina Ali; Pediatric Emergency Research Canada (PERC)

Poonai et al. CJEM 2019, 21(2), 199–203

DOI: 10.1017/cem.2018.382

Objective: Lumbar punctures (LPs) are painful for children, and analgesia is recommended by academic societies. However, less than one-third of pediatric emergency physicians (EPs) adhere to recommendations. We assessed the willingness to provide analgesia among pediatric and general EPs and explored patient- and provider-specific barriers.

Methods: We surveyed physicians in the Pediatric Emergency Research Canada (PERC) or Canadian Association of Emergency Physicians (CAEP) databases from 1 May 2016 to 1 August 2016, regarding hypothetical scenarios for a 3-week-old infant, a 3-year-old child, and a 16-year-old child requiring an LP. The primary outcome was the willingness to provide analgesia. Secondary outcomes included the type of analgesia, reasons for withholding analgesia, and their perceived competence performing LPs.

Results: For a 3-week-old infant, 123/144 (85.4%) pediatric EPs and 231/262 (88.2%) general EPs reported a willingness to provide analgesia. In contrast, the willingness to provide analgesia was almost universal for a 16-year-old (144/144 (100%) of pediatric EPs and 261/262 (99.6%) of general EPs) and a 3-year-old (142/144 (98.6%) of pediatric EPs and 256/262 (97.7%) of general EPs). For an infant, the most common barrier cited by pediatric EPs was the perception that it produced additional discomfort (13/21, 61.9%). The same reason was cited by general EPs (12/31, 38.7%), along with unfamiliarity surrounding analgesic options (13/31, 41.9%).

Conclusion: Compared to a preschool child and adolescent, the willingness to provide analgesia for an LP in a young infant is suboptimal among pediatric and general EPs. Misconceptions and the lack of awareness of analgesic options should be targets for practice-changing strategies.

Differences in emergency department care of adults with a first epileptic seizure versus a recurrent seizure: a study of the ACESUR (Acute Epileptic Seizures in the Emergency Department) registry

Cesáreo Fernández Alonso, Raúl Alonso Avilés, Manuel Liñán López, Félix González Martínez, Manuel Fuentes Ferrer, Belén Gros Bañeres; en representación del grupo ACESUR

Alonso et al. Emergencias 2019; 31: 91–98.

http://emergencias.portalsemes.org/descargar/registro-acesur-atencin-de-pacientes-adultos-con-crisis-epilpticas-en-servicios-de-urgencias-diferencias-entre-primer-episodio-y-recurrencia/

Objective: To describe the characteristics of care received by patients who come to the emergency department with a first epileptic seizure versus a recurrent seizure in a patient with diagnosed epilepsy.

Methods: Acute Epileptic Seizures in the Emergency Department (ACESUR) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling on even days in February and July 2017 and on odd days in April and October 2017. Patients were aged 18 years or older and had an emergency department diagnosis of epileptic seizure. We recorded clinical variables and details related to care given during each patient’s visit, including whether the event was a first or recurrent seizure.

Results: A total of 664 patients attended by 18 Spanish emergency departments were entered into the ACESUR registry. In all, 229 (34.5%) were first seizures and 435 (65.5%) were recurrences. Patients who were attended for first seizures were older, consulted for a wider variety of reasons, and were transported in ambulances (p < .001, all comparisons). Care received differed between patients with first seizures versus recurrent seizures. Specific complementary testing was more likely in patients with first seizures (adjusted odds ratio (aOR), 13.94; 95% confidence interval (CI), 29–26.7; p < .001), and they were more often hospitalized or stayed longer in the emergency department, (aOR, 1.69; 95% CI, 1.11–2.58; p = .015). Pharmacologic treatment did not differ between the groups, either in the acute phase or for prevention (aOR, 1.40; 95% CI, 0.94–2.09; p = .096). Antiepileptic drugs were given to 100 patients (43.7%) after a first seizure and were restarted or changed in 142 patients with recurrent seizure (32.6%).

Conclusion: The clinical characteristics of adults attended for a first epileptic seizure differ from those of patients with diagnosed epilepsy who were attended for recurrent seizures in Spain. The care received also differs.

Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

Barnard Barnard, Daniel D Sandbach, Tracy L Nicholls, Alastair W Wilson, Ari Ercole

Barnard, et al. Emerg Med J 2019.

DOI:10.1136/emermed-2018-208165

Background: Out-of-hospital cardiac arrest (OHCA) is prevalent in the United Kingdom. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement.

Methods: An analysis of 9109 OHCA attended in East of England between 1 January 2015 and 31 July 2017 was done. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for non-traumatic cardiac arrest (NTCA) and traumatic cardiac arrest (TCA). Two Utstein outcome variables were used: survival to hospital admission and hospital discharge.

Results: The incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95% CI 26.7%–28.6%) and the overall survival to discharge was 7.9% (95% CI 7.3%–8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% versus 19.3% p =0.001 and 8.0% versus 3.8% p = 0.012, respectively. Determinants of NTCA and TCA survival were different and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge, but not at admission, and the likelihood of bystander CPR was dependent on geographical socioeconomic status. An air ambulance was associated with increased survival to both hospital admission and discharge in NTCA, but only with survival to admission in TCA.

Conclusion: NTCA and TCA are clinically distinct entities with different predictors for outcome—future OHCA reports should aim to separate arrest etiologies. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.