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 Abstracts are reproduced as published in the respective participating journals and are not peer reviewed or edited by the Hong Kong Journal of Emergency Medicine.
African Journal of Emergency Medicine
The official journal of the African Federation for Emergency Medicine, the Emergency Medicine Association of Tanzania, the Emergency Medicine Society of South Africa, the Egyptian Society of Emergency Medicine, the Libyan Emergency Medicine Association, the Ethiopian Society of Emergency Medicine Professionals, the Sudanese Emergency Medicine Society, the Society of Emergency Medicine Practitioners of Nigeria, and the Rwanda Emergency Care Association.
Measuring patient experience in the emergency department: A scoping review
Oyegbile YO, Brysiewicz P
Oyegbile and Brysiewicz. Afr J Emerg Med 2020; 10(4): 249–255.
doi: 10.1016/j.afjem.2020.07.005.
Introduction: Measuring patients’ experience in the emergency department can be an avenue through which the patients are able to evaluate their own care experience, and this may provide guidance for healthcare professionals in addressing quality improvement. This scoping review aimed to identify and examine existing tools that measure patients’ experience in the emergency department.
Methods: A scoping review was carried out to synthesize evidence from a range of studies in order to describe the characteristics of each study and their sample and to describe the tools used to measure patients’ experience in the emergency department.
Results: Out of the 308 articles retrieved, results of the first- and second-level screening yielded 10 articles for inclusion using 9 different experience tools/questionnaire in the emergency department.
Conclusion:Measuring patients’ experience in the emergency department is a global concern; however, research conducted in low-to-middle-income countries is very limited and such research in Africa appears to be absent. Getting consumers of care to evaluate their experience may help healthcare professionals to identify discrepancies in care and plan possible strategies to address them. These descriptors may ultimately be used in developing validated algorithms to assist dispatch decisions. In this way, we hope to expedite the correct level of care to these time-critical patients and prevent the unnecessary dispatch of limitedly available advanced life support paramedics to inappropriate cases.
Reproduced with permission
Annals of Emergency Medicine
(The print version of this article has been scheduled for May 2021)
“The coats that we can take off and the ones we can’t”: The role of trauma-informed care on race and bias during agitation in the emergency department
Isaac K Agboola, Edouard Coupet, Jr, Ambrose H Wong
Abstract
As emergency physicians, we serve as the safety net for the most vulnerable populations that present with behavioral symptoms, and we play a critical role during their care. Agitation, defined as excessive psychomotor activity leading to aggressive and violent behavior, often occurs with behavioral visits. It is a particularly challenging symptom to manage due to inherent safety risks involved. In many situations, however, agitation may be reflective of circumstances of mistreatment and underlying bias that can occur in the out-of-hospital setting and throughout all phases of acute care. We must take caution not to mislabel behaviors irrespective of context and be judicious in the use of physical restraint and chemical sedation on agitated individuals, especially for racial and ethnic minorities and those from disadvantaged populations. Otherwise, we may risk exacerbating the mistreatment and injustice rather than combating them. One potential solution to address the bias that can occur with agitated patient is through the use of trauma-informed care. Trauma-informed care recognizes the presence of trauma symptoms in individuals with agitation and promotes a culture of safety, empowerment, and healing. By mitigating any continued bias in the management of agitation, we can successfully de-escalate and manage agitation symptoms due to trauma experienced by the patient. It is important that we take time to reframe the potentially antagonistic way we approach agitated patients in the emergency department, especially as we re-examine the interactions between law enforcement and civilians in the field.
How to cite this article:
Agboola IK, Coupet E, Wong AH. “The coats that we can take off and the ones we can’t”: The role of trauma-informed care on race and bias during agitation in the emergency department. 2021. https://doi.org/10.1016/j.annemergmed.2020.11.021
Canadian Journal of Emergency Medicine
http://caep.ca/resources/cjem/
Opioid and non-opioid pain relief after an emergency department acute pain visit
Raoul Daoust, Jean Paquet, Alexis Cournoyer, Éric Piette, Judy Morris, Justine Lessard, Véronique Castonguay, Gilles Lavigne, Vérilibe Huard, Jean-Marc Chauny
(Scheduled for May 2021 Issue)
Daoust et al. Can J Emerg Med 2021.
doi: 10.1007/s43678-020-00041-3.
Abstract
Objectives: Treatment of acute pain after emergency department discharge remains a challenge in the opioid crisis context. Our objective was to determine the proportion of patients using opioid versus non-opioid pain medication following discharge from the emergency department with acute pain, and the association of type of pain medication with average pain intensity before pain medication intake and report of pain relief.
Methods: This was a prospective cohort study of emergency department patients aged ⩾18 years with an acute pain (⩽2 weeks) who were discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level before each pain medication intake (0–10 numeric rating scale), type of pain medication use (opioid vs non-opioid), and if pain was relieved by the medication used that day. Multilevel analyses were used to compare the effect of type of analgesic used on pain intensity and relief.
Results: A total of 381 participants completed the 14-day diary; 50% were women and median age was 54 years (interquartile range = 43–66). Average daily pain intensity before pain medication intake was significantly higher for patients who used opioids (5.9; 95% confidence interval: 5.7–6.2) as compared to non-opioid analgesics (4.2; 95% confidence interval: 4.0–4.5) or no pain medication (2.2; 95% confidence interval: 1.9–2.5). Controlling for pain intensity, patients using opioids were more likely to report a pain relief (odds ratio = 1.3; 95% confidence interval: 1.1–1.8) as compared to those who used non-opioid analgesics.
Conclusion: Overall, opioids appear to be effective and used as intended by the prescribing physician.
Keywords: Acute pain, pain relief, opioids, emergency department
MAY 2020:
Efficacy of a fast-track pathway for managing uncomplicated renal or ureteral colic in a hospital emergency department: the STONE randomized clinical trial of sonography and testing of a nephrolithiasis episode
Tung Chen Y, Rodríguez Fuertes P, Oliver Sáez P, Villén Villegas T, Buño Soto A, Fernández Calle P, Carballo Cardona C, Cobo Mora J, Jaén Cañadas M, Yan Tong H, Borobia AM
Cited: Tung Chen Y, Rodríguez Fuertes P, Oliver Sáez P, et al. Efficacy of a fast-track pathway for managing uncomplicated renal or ureteral colic in a hospital emergency department: the STONE randomized clinical trial of Sonography and Testing of a Nephrolithiasis Episode. Emergencias 2021; 33: 23–28. http://emergencias.portalsemes.org/descargar/eficacia-de-una-va-de-alta-resolucin-en-la-evaluacin-del-clico-renoureteral-no-complicado-en-un-servicio-de-urgencias-hospitalario-un-ensayo-clnico-aleatorizado-estudio-stone/
Objectives: To evaluate a fast-track pathway utilizing point-of-care testing and sonography as soon as uncomplicated renal or ureteral colic is suspected and to compare the point-of-care clinical pathway to a standard one.
Methods:Unblinded randomized controlled clinical trial in a hospital emergency department. We enrolled patients with suspected uncomplicated renal or ureteral colic and randomized them to a point of care or standard pathway (1:1 ratio). Duration of emergency department stay, treatments, the proportion of diagnoses other than uncomplicated colic, and 30-day complications were analyzed.
Results: One hundred forty patients were recruited between November 2018 and October 2019; data for 124 were analyzed. The mean (standard deviation) total time in the emergency department was 112 (45) min in the point-of-care arm and 244 (102) in the standard arm (P < .001). Treatments, alternative diagnoses, and complication rates did not differ.
Conclusion:The use of a fast-track point-of-care pathway to manage uncomplicated colic in the emergency department is effective and safe. It also reduces the amount of time spent in the emergency department.
Keywords: Colic, renal or ureteral, point-of-care ultrasound, point-of-care testing
Annals of Emergency Medicine
(The print version of this article has been scheduled for June 2021)
The Ambulance Cardiac Chest Pain Evaluation in Scotland Study (ACCESS): A prospective cohort study
Jamie G Cooper, MD, James Ferguson, MD, Lorna Donaldson, Kim Black, Kate Livock, Judith Horrill, MSc, Elaine Davidson, MSc, PhD, Neil W. Scott, MSc, PhD, Amanda J. Lee, PhD, Takeshi Fujisawa, PhD, Kuan Ken Lee, MD, Atul Anand, MD, PhD, Anoop S. V. Shah, MD, PhD, Nicholas L. Mills, MD, PhD
Study objective: We determine whether risk stratification in the out-of-hospital setting could identify patients with chest pain who are at low and high risk to avoid admission or aid direct transfer to cardiac centers.
Methods: Paramedics prospectively enrolled patients with suspected acute coronary syndrome without diagnostic ST-segment elevation on the electrocardiogram. The HEAR score was recorded, and out-of-hospital samples were obtained to measure cardiac troponin I (cTnI) level on a point-of-care device. HEAR and History, Electrocardiogram, Age, Risk Factors, and Troponin scores less than or equal to 3 and greater than or equal to 7 were defined as low and high risk for major adverse cardiac events at 30 days.
Results: Of 1,054 patients (64 years (standard deviation 15 years); 42% women), 284 (27%) experienced a major adverse cardiac event at 30 days. The HEAR score was calculated in all patients, with point-of-care cTnI testing available in 357 (34%). A HEAR score less than or equal to 3 identified 32% of patients (334/1,054) as low risk, with a sensitivity of 84.9% (95% confidence interval: 80.7%–89%), whereas a score greater than or equal to 7 identified just 3% of patients (30/1,054) as high risk, with a specificity of 98.7% (95% confidence interval: 98%–99.4%). A point-of-care History, Electrocardiogram, Age, Risk Factors, and Troponin score less than or equal to 3 identified a similar proportion as low risk (30%), with a sensitivity of 87.0% (95% confidence interval: 80.7%–93.4%), whereas a score greater than or equal to 7 identified 14% as high risk, with a specificity of 94.8% (95% confidence interval: 92.3%–97.3%).
Conclusion: Paramedics can use the HEAR score to discriminate risk, but even when used in combination with out-of-hospital point-of-care cTnI testing, the History, Electrocardiogram, Age, Risk Factors, and Troponin score does not safely rule out major adverse cardiac events, and only a small proportion of patients are identified as high risk.
How to cite this article:
Cooper JG, Ferguson J, Donaldson L, et al. The Ambulance Cardiac Chest Pain Evaluation in Scotland Study (ACCESS): A prospective cohort study. 2021. https://doi.org/10.1016/j.annemergmed.2021.01.012
Canadian Journal of Emergency Medicine
http://caep.ca/resources/cjem/
Predictors of persistent concussion symptoms in adults with acute mild traumatic brain injury presenting to the emergency department
Catherine Varner, Cameron Thompson, Kerstin de Wit, Bjug Borgundvaag, Reaves Houston, Shelley McLeod
(Scheduled for May 2021 Issue)
Varner et al. Can J Emerg Med 2021.
doi: 10.1007/s43678-020-00076-6.
Abstract
Objective: To identify risk factors associated with persistent concussion symptoms in adults presenting to the emergency department with acute mild traumatic brain injury.
Methods: This was a secondary analysis of a randomized controlled trial conducted in three Canadian emergency departments whereby the intervention had no impact on recovery or healthcare utilization outcomes. Adult (18–64 years) patients with a mild traumatic brain injury sustained within the preceding 48 h were eligible for enrollment. The primary outcome was the presence of persistent concussion symptoms at 30 days, defined as the presence of ⩾3 symptoms on the Rivermead Post-concussion Symptoms Questionnaire.
Results: Of the 241 patients who completed follow-up, median (interquartile range) age was 33 (25–50) years, and 147 (61.0%) were female. At 30 days, 49 (20.3%) had persistent concussion symptoms. Using multivariable logistic regression, headache at emergency department presentation (odds ratio: 7.7; 95% confidence interval: 1.6–37.8), being under the influence of drugs or alcohol at the time of injury (odds ratio: 5.9; 95% confidence interval: 1.8–19.4), the injury occurring via bike or motor vehicle collision (odds ratio: 2.9; 95% confidence interval: 1.3–6.0), history of anxiety or depression (odds ratio: 2.4; 95% confidence interval: 1.2–4.9), and numbness or tingling at emergency department presentation (odds ratio: 2.4; 95% confidence interval: 1.1–5.2), were found to be independently associated with persistent concussion symptoms at 30 days.
Conclusion: Five variables were found to be significant predictors of persistent concussion symptoms. Although mild traumatic brain injury is mostly a self-limited condition, patients with these risk factors should be considered high risk for developing persistent concussion symptoms and flagged for early outpatient follow-up.
Keywords: Mild traumatic brain injury, concussion, persistent concussion symptoms
African Journal of Emergency Medicine
The official journal of the African Federation for Emergency Medicine, the Emergency Medicine Association of Tanzania, the Emergency Medicine Society of South Africa, the Egyptian Society of Emergency Medicine, the Libyan Emergency Medicine Association, the Ethiopian Society of Emergency Medicine Professionals, the Sudanese Emergency Medicine Society, the Society of Emergency Medicine Practitioners of Nigeria, and the Rwanda Emergency Care Association.
An analysis of the descriptors of acute myocardial infarction used by South Africans when calling for an ambulance from a private emergency call center
Buma C, Saunders C, Watermeyer J, Stassen W
Buma et al. Afr J Emerg Med 2020; 10(4): 203–208.
doi: 10.1016/j.afjem.2020.06.012
Introduction: Acute myocardial infarction is a time-sensitive emergency. In resource-limited settings, prompt identification and management of patients experiencing acute myocardial infarction in the pre-hospital setting may minimize the negative consequences associated with overburdened emergency medical and hospital services. Expedited care thus, in part, relies on the dispatch of appropriate pre-hospital medical providers by emergency medical dispatchers. Identification of these patients in call centers is challenging due to a highly diverse South African society, with multiple languages, cultures, and levels of education. The aim of this study was therefore, to describe the terms used by members of the South African public when calling for an ambulance for patients suffering an acute myocardial infarction.
Methods:In this qualitative study, we performed content analysis to identify keywords and phrases that callers used to describe patients who were experiencing an advanced life support paramedic-diagnosed acute myocardial infarction. Using the unique case reference number of randomly selected acute myocardial infarction cases, original voice recordings between the caller and emergency medical dispatcher at the time of the emergency were extracted and transcribed verbatim. Descriptors of acute myocardial infarction were identified, coded, and categorized using content analysis and quantified.
Results: Of the 50 randomly selected calls analyzed, five were not conducted in English. The descriptors used by callers were found to fall into three categories; Pain: Thorax, No pain: Thorax and Ill-health. The code that occurred most often was no pain, heart related (n = 16; 23.2%), followed by the code describing pain in the chest (n = 15; 21.7%).
Conclusion:South African callers use a consistent set of descriptors when requesting an ambulance for a patient experiencing an acute myocardial infarction. The most common of these are non-pain descriptors related to the heart. These descriptors may ultimately be used in developing validated algorithms to assist dispatch decisions. In this way, we hope to expedite the correct level of care to these time-critical patients and prevent the unnecessary dispatch of limitedly available advanced life support paramedics to inappropriate cases.
Reproduced with permission
