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 Abstracts are reproduced as published in the respective participating journals and are not peer reviewed or edited by the Hong Kong Journal of Emergency Medicine.
Annals of Emergency Medicine
State of the journal: women first authors, peer reviewers, and Editorial Board Members at Annals of Emergency Medicine
Amy H Kaji, William J Meurer, Tracy Napper, Lise E Nigrovic, William R Mower, David L Schriger, Richelle J Cooper for the Annals of Emergency Medicine Diversity Task Force
Kaji et al. Ann Emerg Med 2019; 74(6): 731–735.
Introduction: Despite the increasing numbers of women working in medicine, the proportion of those promoted to the highest academic leadership positions remains low. Emergency medicine is no exception, despite evidence that women in academic emergency medicine are more likely to be fellowship trained than their male academic emergency medicine colleagues. In addition to there being a systemic gap in research funding for women, they are less likely to publish in peer-reviewed journals. Female first authorship in most high-impact general medical journals (Annals of Internal Medicine, Archives of Internal Medicine, BMJ, Journal of the American Medical Association, and The Lancet) has increased from 27% in 1994 to 37% in 2014, but it has plateaued and declined in other journals, such as the New England Journal of Medicine. In the emergency medicine literature, a 2007 report found that only 18% of first and 17% of last authors were women. More recent reports indicate 26% of first authors in emergency medicine publications were women.
Journal editorial board membership is an important component of academic leadership and is a mark of professional achievement. A 2011 review of 60 journals demonstrated that 16% of editors in chief (10 of 63) were women, and less than one-fifth (18%; 719/4112) of all editorial board members were women. Female representation on editorial boards of medical journals does not mirror the gender composition in the corresponding specialties. The reasons for this gender disparity are likely multifaceted. Both implicit and explicit biases, as well as lack of mentorship and female role models, likely contribute. In their 2007 report Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering, the National Academy of Sciences called for a “reasonable representation of women on editorial boards.”
We report on the state of Annals of Emergency Medicine with respect to the gender distribution among the editorial board and peer reviewer pool, and first authors who are women, overall and by article type. We examined editorial board gender composition as a measure of current gender diversity, and the reviewer pool as a measure of potential future gender diversity, because future editorial board members are commonly selected from the reviewers. Last, we examined the gender of first authors of invited articles in contrast to the gender of first authors of unsolicited articles to determine whether there is bias in the commissioning process.
African Journal of Emergency Medicine
Prognostic performance of electrocardiogram (ECG) abnormalities compared to vital signs in acutely ill patients in a resource-poor hospital in Uganda
Namujwiga T, Nakitende I, Kellett J, Opio M, Lumala A, on behalf of the Kitovu Hospital Study Group
Namujwiga et al. Afr J Emerg Med 2019; 9(2): 64–69.
Background: There are few reports of electrocardiogram (ECG) findings and their prognostic value in acutely ill patients admitted to low-resource hospitals in sub-Saharan Africa.
Methods: We undertook an observational study of acutely ill medical patients admitted to a low-resource hospital in Uganda. Vital signs were used to calculate the National Early Warning Score (NEWS), and all ECGs were assessed using Tan et al.’s scoring system as described in Clin Cardiol 2009;32:82–86.
Results: There were 1361 ECGs performed, covering 68% of all acutely ill medical patients admitted to the hospital during the study. The most common ECG abnormality was a prolonged QTc interval (42% of all patients) and left ventricular hypertrophy (13.5%). Compared to the 519 patients (38%) with no Tan score abnormality, the 842 (62%) patients with one or more abnormalities were more likely to die in hospital (odds ratio (OR) = 2.82; 95% confidence interval (CI) = 1.50–5.36) and within 30 days of discharge (OR = 2.46; 95% CI = 1.50–4.08). There was no relationship between age and mortality; however, after adjustment by logistic regression, any NEWS ⩾ 1 on admission, a Tan score of ⩾ 1, and male sex, all remained clinically significant predictors of both in-hospital and 30-day mortality.
Discussion: The majority of acutely ill medical patients admitted in a low-resource hospital in sub-Saharan Africa had ECG abnormalities, of which prolonged QTc and left ventricular hypertrophy were most common. Those with any Tan score abnormality were twice as likely to die as those without an abnormality.
Canadian Journal of Emergency Medicine
Examining return visits to the emergency department after concussion in Canada
Laura Morrison, MD; Rachel Taylor, MScPT, MD; Mathew Mercuri, MSc, PhD; Jennifer Thompson, MD
Objective: The purpose of this study was to identify (1) the proportion of patients discharged from the emergency department (ED) with a diagnosis of concussion and return within 14 days and (2) the characteristics that prompt a return.
Methods: A health records review was conducted on adult patients with a discharge diagnosis of a concussion who accessed care through Hamilton Health Sciences EDs and Urgent Care Centre in 2016. Subsequent data were collected from those who returned to the ED within 14 days. Clinical characteristics of returners were compared to those of non-returners.
Results: Of the 389 patients included in the study, 38 (10%) returned within 14 days. Patients who sustained a concussion in a sport-related context or were referred to a specialized clinic were less likely to return (p = 0.03). Those who suffered an assault-related concussion were more likely to return (p = 0.01). Of those who did return, 42% received a computed tomography (CT) scan with normal results, and 42% were given new discharge instructions.
Conclusion: Approximately 10% of patients diagnosed with a concussion in a Canadian hospital setting returned to the ED within 14 days of their index visit. Our study suggests the opportunity to reduce this burden to both the health care system and the patient through careful discharge instructions outlining anticipated symptoms following a concussion (specifically, headache) or referral to a concussion clinic.
Emergencias
Drowning: epidemiology, prevention, pathophysiology, resuscitation, and hospital treatment
Cristian Abelairas-Gómez, Michael J Tipton, Violeta González-Salvado, Joost JLM Bierens
Abelairas-Gómez et al. Emergencias 2019; 31: 270–280.
This narrative review discusses the evidence relevant to key aspects of drowning, which is defined by the World Health Organization as the process of respiratory difficulty caused by submersion/immersion in liquid. The length of time the victim is submerged is a key factor in survival and neurologic damage. Although respiratory distress and hypoxia are the main events, other complications affecting various systems and organs may develop. Drowning is one of the main causes of accidental death worldwide, yet deaths from drowning are underestimated and morbidity is unknown. Prevention is essential for reducing both mortality and morbidity, but if prevention fails, the speed of access to and the quality of prehospital and hospital care will determine the prognosis. It is therefore essential to understand the factors and mechanisms involved in these emergencies.
Emergency Medicine Journal
Let the kids play: gamification as a cardiopulmonary resuscitation (CPR) training methodology in secondary school students. A quasi-experimental manikin simulation study
Otero-Agra M, Barcala-Furelos R, Besada-Saavedra I, Peixoto-Pino L, Martínez-Isasi S, Rodríguez-Núñez A
Otero-Agra et al. Emerg Med J 2019; 36: 653–659.
doi:10.1136/emermed-2018-208108
Objective: Gamification is a non-evaluation and competition-based training methodology with high emotional involvement. The goal of this study was to evaluate gamification methodology as compared with other existing methodologies when teaching cardiopulmonary resuscitation (CPR) to secondary school students.
Methods: In all, 489 secondary school students from two high schools in Spain participated in this randomized block quasi-experimental study in February 2018. The students were classified into different groups. Each group received CPR training with a different methodology: GAM (gamification-based training as a compulsory but non-tested academic activity to learn by playing in teams, with instructor and visual feedback), EVA (training based on subsequent evaluation as a motivational incentive, with instructor and visual feedback), VFC (visual feedback complementary, training based on a non-compulsory and non-tested academic activity, with instructor and visual feedback), and TC (traditional complementary, training based on a non-compulsory and non-tested academic activity, with instructor feedback). After a week, each student performed a 2 min hands-only CPR test and quality of CPR was assessed. Visual feedback in training and CPR variables in test were provided by the QCPR Instructor App using a Little Anne manikin, both from Laerdal (Norway).
Results: GAM (89.56%; 95% confidence interval (CI) = 86.71–92.42) methodology resulted in significantly higher scores for CPR quality than VFC and TC (81.96%; 95% CI = 78.04%–85.88%; and 64.11%; 95% CI = 58.23–69.99). GAM (61.77%; 95% CI = 56.09–67.45) methodology also resulted in significantly higher scores for correct rate than VFC and TC (48.41%; 95% CI = 41.15%–55.67%; and 17.28%; 95% CI = 10.94–23.62); 93.4% of GAM methodology participants obtained >50 mm of compression mean depth which was a significantly higher proportion than among students in VFC and TC (78.0% and 71.9%). No differences between GAM and EVA were found. A confidence level of 95% has been assigned to all values.
Conclusion: GAM methodology resulted in higher CPR quality than non-tested methods of academic training with instructor feedback or visual feedback. Gamification should be considered as an alternative teaching method for Basic Life Support (BLS) in younger individuals.
