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 Abstracts are reproduced as published in the respective participating journals and are not peer reviewed or edited by the Hong Kong Journal of Emergency Medicine.
An analysis of US Africa command area of operations military medical transportations, 2008–2018
Carius B, Davis WT, Linscomb CD, Escandon MA, Rodriguez D, Uhaa N, Maddry JK, Chung KK, Schauer S
Carius et al. Afr J Emerg Med 2020; 10(1): 13–16.
Introduction: With personnel scattered throughout a continent 3 times larger than the United States, a lack of mature medical facilities necessitates a significant transportation network for medical evacuation in US Africa Command (AFRICOM). We describe medical evacuations analyzed from the US Air Force Transportation Command Regulating and Command & Control Evacuation System (TRAC2ES).
Methods: We performed a retrospective review of all TRAC2ES medical records for medical evacuations from the AFRICOM theater of operations conducted between 1 January 2008 and 31 December 2018. We abstracted free text data entry in TRAC2ES for diagnostic and therapeutic interventions performed prior to the patient movement request.
Results: During this time, there were 963 cases recorded in TRAC2ES originating within AFRICOM. In total, 961 records were complete for analysis. Most patients were male (82%) and military personnel (92%). Most transports originated in Djibouti (72%), and Germany (93%) was the most common destination. Medical evacuations were largely routine (66%), and routine evacuations were proportionally highest among US military personnel compared to all other groups. A small portion of patients were evacuated for battle injuries (4%), compared to non-battle injury (33%) and disease (63%). Within disease, the largest proportion of patient complaints centered on gastrointestinal symptoms (13%), behavioral health (11%), and chest pain (8%). Prior to evacuation, only 55% of patients were documented as receiving any medication. Pain control was documented in 21% of cases, most commonly being nonsteroidal anti-inflammatory drugs (NSAIDs; 7%).
Discussion: Extremely low numbers of battle injuries highlight the unique nature of AFRICOM operations compared to areas with more intense combat operations. Limitations of the dataset highlight the need for a data collection mandate within AFRICOM as within other areas for optimization and performance improvement.
Limited ability of three health literacy screening items to identify adult English- and Spanish-speaking emergency department patients with lower health literacy
Roland C Merchant, Sarah J Marks, Melissa A Clark, Michael P Carey, Tao Liu
https://doi.org/10.1016/j.annemergmed.2020.01.019
Study objective: Brief, easily administered, and valid health literacy assessment tools are needed to optimize health care delivery in the emergency medicine setting. Three health literacy screening items have been proposed to assess health literacy in outpatient settings. We investigated their ability to identify English- and Spanish-speaking adult emergency department (ED) patients with lower health literacy.
Methods: Participants were Spanish- or English-speaking adult patients randomly selected from four geographically spread, US, urban, safety-net EDs. Participants completed the three health literacy screening items, as well as the Short Assessment of Health Literacy—Spanish and English (SAHL-S&E). Test performance characteristics, including receiver operating characteristics area under the curve, of the three health literacy screening items were estimated, as compared with the SAHL-S&E.
Results: According to the SAHL-S&E, 36% of the 1165 English speakers and 35% of the 1605 Spanish speakers had lower health literacy. Areas under the curve for each health literacy screening item individually were as follows: needing others to help read materials (English 0.59, 95% confidence interval (CI) 0.56–0.62; Spanish 0.58, 95% CI 0.56–0.61), problems learning because of difficulty reading (English 0.63, 95% CI 0.60–0.66; Spanish 0.59, 95% CI 0.56–0.62), and confidence with completing forms (English 0.62, 95% CI 0.59–0.65; Spanish 0.60, 95% CI 0.57–0.63). Areas under the curve for the three screening items combined were as follows: English 0.66 (95% CI 0.63–0.70) and Spanish 0.62 (95% CI 0.59–0.64).
Conclusion: The three health literacy screening items performed poorly in identifying adult ED patients with lower health literacy. Higher validity screening measures are needed to better serve the health care needs of this vulnerable population in the ED setting.
Twitter metrics complement traditional conference evaluations to evaluate knowledge translation at a National Emergency Medicine Conference
Stella Yiu, MD; Sebastian Dewhirst, MD; Ali Jalali, MD; A Curtis Lee, PhD; and Jason R Frank, MD, MA(Ed)
Yiu et al. CJEM 2020: 1–7 https://doi.org/10.1017/cem.2020.15
Objectives: Conferences are designed for knowledge translation, but traditional conference evaluations are inadequate. We lack studies that explore alternative metrics to traditional evaluation metrics. We sought to determine how traditional evaluation metrics and Twitter metrics performed using data from a conference of the Canadian Association of Emergency Physicians (CAEP).
Methods: This study used a retrospective design to compare social media posts and tradition evaluations related to an annual specialty conference. A post (“tweet”) on the social media platform Twitter was included if it associated with a session. We differentiated original and discussion tweets from retweets. We weighted the numbers of tweets and retweets to comprise a novel Twitter Discussion Index. We extracted the speaker score from the conference evaluation. We performed descriptive statistics and correlation analyses.
Results: Of a total of 3804 tweets, 2218 (58.3%) were session-specific. Forty-eight percent (48%) of all sessions received tweets (mean = 11.7 tweets; 95% CI 0–57.5; range = 0–401), with a median Twitter Discussion Index score of 8 (interquartile range = 0–27). In the 111 standard presentations, 85 had traditional evaluation metrics and 71 received tweets (p > 0.05), while 57 received both. Twenty (20 of 71; 28%) moderated posters and 44% (40 of 92) posters or oral abstracts received tweets without traditional evaluation metrics. We found no significant correlation between Twitter Discussion Index and traditional evaluation metrics (R = 0.087).
Conclusion: We found no correlation between traditional evaluation metrics and Twitter metrics. However, in many sessions with and without traditional evaluation metrics, audience created real-time tweets to disseminate knowledge. Future conference organizers could use Twitter metrics as a complement to traditional evaluation metrics to evaluate knowledge translation and dissemination.
Clinical characteristics and course in emergency department patients with chronic obstructive pulmonary disease and symptomatic acute venous thromboembolic diseaseSecondary analysis of the ESPHERIA registry
Jorge Carriel Mancilla, Sonia Jiménez Hernández, Francisco Javier Martín-Sánchez, David Jiménez, Manuel Fuentes Ferrer, Pedro Ruiz-Artacho, en representación
del Grupo de Enfermedad Tromboembólica Venosa de la Sociedad Española de Medicina de Urgencias y Emergencias (ETV-SEMES)
http://emergencias.portalsemes.org/descargar/caractersticas-y-evolucin-de-los-pacientes-con-enfermedad-pulmonar-obstructiva-crnica-y-enfermedad-tromboemblica-venosa-aguda-sintomtica-en-urgencias-subanlisis-del-registro-espheria/
Objective: To determine the impact of chronic obstructive pulmonary disease (COPD) on prognosis in patients diagnosed with venous thromboembolic disease (VTED) in Spanish emergency departments.
Methods: Secondary analysis of data from the ESPHERIA (Spanish acronym for Risk Profile of Patients VTED Attended in Spanish Emergency Departments) registry.
Results: A total of 801 patients, 71 (9%) with COPD, were included. Pulmonary thromboembolism was recorded in 77.0% of the patients with COPD (vs in 47.1% of patients without COPD; p < 0.001). Patients with COPD had evidence of right ventricular dysfunction on computed tomography angiography more often than other VTED patients (18.2% vs 13.1%; p < 0.001) and more often required ventilatory support (7% vs 0.5%; p < 0.001). VTED patients with COPD also had a higher rate of readmission or mortality at 180 days (hazard ratio, 1.52; 95% CI 1.00–2.29; p = 0.048)) than patients without COPD.
Conclusion: COPD affects the prognosis of patients diagnosed with VTED in Spanish emergency departments as evidenced by hospital readmission and mortality.
Prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA)-lactate criteria for mortality in adults with suspected bacterial infection in the emergency department of a hospital with limited resources
Sinto R, Suwarto S, Lie KC, et al.
Sinto et al. Emerg Med J 2020: 1–7. DOI: 10.1136/ emermed-2018-208361.
Background: Routine use of the Sequential Organ Failure Assessment (SOFA) score to prognosticate patients with sepsis is challenged by the requirement to perform numerous laboratory tests. The prognostic accuracy of the quick SOFA (qSOFA) without or with lactate criteria has not been prospectively investigated in low and middle income countries. We assessed the performance of simplified prognosis criteria using qSOFA-lactate criteria in the emergency department of a hospital with limited resources, in comparison with SOFA prognosis criteria and systemic inflammatory response syndrome (SIRS) screening criteria.
Methods: This prospective cohort study was conducted between March and December 2017 in adult patients with suspected bacterial infection visiting the emergency department of the Indonesian National Referral Hospital. Variables from sepsis prognosis and screening criteria and venous lactate concentration at enrollment were recorded. Patients were followed up until hospital discharge or death. Prognostic accuracy was measured using area under the receiver operating characteristic curve (AUROC) of each criterion in the prediction of in-hospital mortality.
Results: Of 3026 patients screened, 1213 met the inclusion criteria. The AUROC of qSOFA-lactate criteria was 0.74 (95% CI 0.71–0.77). The AUROC of qSOFA-lactate was not statistically significantly different to the SOFA score (AUROC 0.75, 95% CI 0.72–0.78; p = 0.462). The qSOFA-lactate was significantly higher than qSOFA (AUROC 0.70, 95% CI 0.67–0.74; p = 0.006) and SIRS criteria (0.57, 95% CI 0.54–0.60; p < 0.001).
Conclusion: The prognostic accuracy of the qSOFA-lactate criteria is as good as the SOFA score in the emergency department of a hospital with limited resources. The performance of the qSOFA criteria is significantly lower than the qSOFA-lactate criteria and SOFA score.
