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 worldwide, 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 Abstracts are reproduced as published in the respective participating journals and are not peer reviewed or edited by the Hong Kong Journal of Emergency Medicine.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
(The print version of this article has been scheduled for January 2023)
Prevalence and correlates of depression and substance use disorders in emergency department populations: a cross-sectional study at East Africa’s largest public hospital
Iheanacho T, Maciejewski KR, Ogudebe F, Chumo F, Slade T, Leff R, Ngaruiya C
Afr J Emerg Med 2022; 12(4): 307–314
https://doi.org/10.1016/j.afjem.2022.06.008
Introduction: There are persistent gaps in screening, identification, and access to care for common mental disorders in Low- and Middle-Income Countries. An initial step towards reducing this gap is identifying the prevalence, co-morbidities, and context of these disorders in different clinical settings and exploring opportunities for intervention. This study evaluates the prevalence and correlates of depression and substance use disorders among adults presenting to the Emergency Department (ED) of a major national hospital in East Africa.
Methods: This study utilized the World Health Organization’s STEPwise Approach to Surveillance (WHO-STEPS) tool and the Patient Health Questionnaire (PHQ-9) to conduct a cross-sectional survey capturing socio-demographic data, tobacco, and alcohol use and rates of depression in a sample of adults presenting to the ED. Bivariate and multivariate analyses were conducted for each outcome of interest and socio-demographics.
Results: Of 734 respondents, 298 (40.6%) had a PHQ-9 score in the “moderate” to “severe” range indicative of major depressive disorder. About 17% of respondents endorsed current tobacco use while about 30% reported being daily alcohol users. Those with high PHQ-9 score had higher odds of reporting current tobacco use (“severe range” = adjusted odds ratio (aOR) 1.85, 95% CI 1.05, 3.26). Those with a “severe” PHQ-9 scores were 9 times (aOR 2.3-35.3) more likely to be daily drinkers.
Conclusions: Screening and identification of people with depression and substance use disorders in the ED of a large national hospital in Kenya is feasible. This offers an opportunity for brief intervention and referral to further treatment.
Reproduced with permission.
Annals of Emergency Medicine
(The print version of this article has been scheduled for February 2023)
Community first responders’ contribution to emergency medical service provision in the UK
Vanessa Botan, Zahid Asghar, Elise Rowan, Murray D Smith, Gupteswar Patel, Viet-Hai Phung, Ian Trueman, Robert Spaight, Amanda Brewster, Pauline Mountain, Roderick Orner, Aloysius Niroshan Siriwardena
Study objective: We aimed to investigate community first responders’ contribution to emergency care provision in terms of number, rate, type, and location of calls and characteristics of patients attended.
Methods: We used a retrospective observational design analyzing routine data from electronic clinical records from 6 of 10 ambulance services in the United Kingdom during 2019. Descriptive statistics, including numbers and frequencies, were used to illustrate characteristics of incidents and patients that the community first responders attended first in both rural and urban areas.
Results: The data included 4.5 million incidents during 1 year. The community first responders first attended a higher proportion of calls in rural areas compared with those in urban areas (3.90% versus 1.48 %). In rural areas, the community first responders also first attended a higher percentage of the most urgent call categories, 1 and 2. The community first responders first attended more than 9% of the total number of category 1 calls and almost 5% of category 2 calls. The community first responders also attended a higher percentage of the total number of cardiorespiratory and neurological/endocrine conditions. They first attended 6.5% of the total number of neurological/endocrine conditions and 5.9% of the total number of cardiorespiratory conditions. Regarding arrival times in rural areas, the community first responders attended higher percentages (more than 6%) of the total number of calls that had arrival times of less than 7 minutes or more than 60 minutes.
Conclusion: In the United Kingdom, community first responders contribute to the delivery of emergency medical services, particularly in rural areas and especially for more urgent calls. The work of community first responders has expanded from their original purpose—to attend to out-of-hospital cardiac arrests. The future development of community first responders’ schemes should prioritize training for a range of conditions, and further research is needed to explore the contribution and potential future role of the community first responders from the perspective of service users, community first responders’ schemes, ambulance services, and commissioners.
How to cite this article:
Botan V, Asghar Z, Rowan E, et al. Community first responders’ contribution to emergency medical service provision in the UK. Ann Emerg Med 2022. DOI: 10.1016/j.annemergmed.2022.05.025.
Canadian Journal of Emergency Medicine
http://caep.ca/resources/cjem/
(The print version of this article has been scheduled for January 2023)
Delayed intracranial hemorrhage after head injury among elderly patients on anticoagulation seen in the emergency department
Sharon Liu, Shelley L McLeod, Clare L Atzema, Peter C Austin, Kerstin de Wit, Sunjay Sharma, Nicole Mittmann, Bjug Borgundvaag, Keerat Grewal
Liu S, McLeod SL, Atzema CL, et al. Delayed intracranial hemorrhage after head injury among elderly patients on anticoagulation seen in the emergency department. Can J Emerg Med 2022. DOI: 10.1007/s43678-022-00392-z.
Introduction: Elderly patients on oral anticoagulation are commonly seen in emergency departments (EDs). Oral anticoagulation, particularly warfarin, is associated with an increased risk of intracranial hemorrhage after head trauma. Data on delayed bleeds in anticoagulated patients are limited. The objective of this study was to examine risk of delayed intracranial hemorrhage in patients presenting to the ED with a head injury anticoagulated with warfarin or a direct oral anticoagulant, compared to patients not anticoagulated.
Methods: Cohort study using administrative data from Ontario of patients ⩾ 65 years presenting to the ED with a complaint of head injury between 2016 and 2018. The primary outcome was delayed intracranial hemorrhage, defined as a new ICD-10 code for intracranial hemorrhage within 90 days of the initial ED visit for a head injury where no intracranial hemorrhage was diagnosed. The main exposure variable was oral anticoagulation use, which was a three-level variable (warfarin, direct oral anticoagulants, or no oral anticoagulation). We used multivariable logistic regression to determine the odds of delayed intracranial hemorrhage based on anticoagulation status.
Results: 69,321 patients were included: 58,233 (84.0%) had not been prescribed oral anticoagulation, 3081 (4.4%) had a warfarin prescription, and 8007 (11.6%) had a direct oral anticoagulant prescription. Overall, 718 (1.0%) patients had a delayed intracranial hemorrhage within 90 days of ED visit for head injury. Among patients not anticoagulated, 586 (1.0%) had a delayed intracranial hemorrhage, 54 (1.8%) patients on warfarin, and 78 (1.0%) patients on a direct oral anticoagulant had a delayed intracranial hemorrhage. There was an increased odds of delayed intracranial hemorrhage with warfarin use compared with no anticoagulation (OR 1.5, 95% CI 1.1–2.1). There was no association between delayed intracranial hemorrhage and direct oral anticoagulant use compared to no anticoagulation (OR 0.9, 95% CI 0.6–1.1).
Conclusions: There was an increased odds of delayed intracranial hemorrhage within 90 days in older ED head injured patients prescribed warfarin compared to patients not on anticoagulation. Direct oral anticoagulant use was not associated with increased risk of delayed intracranial hemorrhage.
Keywords: Head injury, delayed intracranial hemorrhage, anticoagulation, emergency medicine
Emergencias
(The print version of this article has been scheduled for January 2023)
Quality of hospital emergency department care for patients with COVID-19 during the first wave in 2020: the CALUR-COVID-19 study
Sònia Jiménez, Òscar Miró, Aitor Alquézar-Arbé, Pascual Piñera, Javier Jacob, Pere Llorens, Eric Jorge García-Lamberechts, Francisco Javier Martín-Sánchez, Juan González del Castillo, Guillermo Burillo-Putze, en representación de la red de investigación SIESTA
Cited: Jiménez S, Miró O, Alquézar-Arbé A, Piñera P, Jacob J, Llorens P, et al. Estudio CALUR-COVID-19: calidad asistencial en urgencias del proceso de atención a pacientes con COVID-19 durante el primer pico pandémico de 2020. Emergencias 2022; 34: 369–376.
http://emergencias.portalsemes.org/descargar/estudio-calurcovid19-calidad-asistencial-en-urgencias-del-proceso-de-atencin-a-pacientes-con-covid19-durante-el-primer-pico-pandmico-de-2020/
Objectives: To define quality of care indicators and care process standards for treating patients with COVID-19 in hospital emergency departments (EDs), to determine the level of adherence to standards during the first wave in 2020, and to detect factors associated with different levels of adherence.
Methods: We selected care indicators and standards by applying the Delphi method. We then analyzed the level of adherence in the SIESTA cohort (registered by the Spanish Investigators in Emergency Situations Team). This cohort was comprised of patients with COVID-19 treated in 62 Spanish hospitals in March and April 2020. Adherence was compared according to pandemic-related ED caseload pressure, time periods during the wave (earlier and later), and age groups.
Results: Fourteen quality indicators were identified. Three were adhered to in less than 50% of the patients. Polymerase chain reaction testing for SARS-CoV-2 infection was the indicator most often disregarded, in 29% of patients when the caseload was high vs 40% at other times (P < .001) and in 30% of patients in the later period vs 37% in the earlier period (P = .04). Adherence to the following indicators was better in the later part of the wave: monitoring of oxygen saturation (100% vs 99%, P = .035), electrocardiogram monitoring in patients treated with hydroxychloroquine (87% vs 65%, P < .001), and avoiding of lopinavir/ritonavir treatment in patients with diarrhea (79% vs 53%, P < .001). No differences related to age groups were found.
Conclusions: Adherence to certain quality indicators deteriorated during ED treatment of patients with COVID-19 during the first wave of the pandemic. Pressure from high caseloads may have exacerbated this deterioration. A learning effect led to improvement. No differences related to patient age were detected.
Keywords: COVID-19, emergency department, health care quality, clinical safety, pandemics
(The print version of this article has been scheduled for February 2023)
Emergency department observation of patients with acute heart failure prior to hospital admission: impact on short-term prognosis
María Pilar López Díez, Pere Llorens, Francisco Javier Martín-Sánchez, Víctor Gil, Javier Jacob, Pablo Herrero, Lluís Llauger, Josep Tost, Alfons Aguirre, José Manuel Garrido, Juan Antonio Vega, Marta Fuentes, María Isabel Alonso, María Luisa López Grima, Pascual Piñera, Rodolfo Romero, Francisco Javier Lucas-Imbernón, Juan Antonio Andueza, Javier Povar, Fernando Richard, Carolina Sánchez, Òscar Miró (en representación del grupo ICA-SEMES)
Cited: López Díez MP, Llorens P, Martín-Sánchez FJ, Gil V, Jacob J, Herrero P, et al. Observación en urgencias previa a la hospitalización en pacientes con insuficiencia cardiaca aguda: impacto sobre el pronóstico a corto plazo. Emergencias 2022; 34: 345–351.
http://emergencias.portalsemes.org/descargar/observacin-en-urgencias-previa-a-la-hospitalizacin-en-pacientes-con-insuficiencia-cardiaca-aguda-impacto-sobre-el-pronstico-a-corto-plazo/
Objectives: To analyze whether short-term outcomes are affected when patients diagnosed with acute heart failure (AHF) spend time in an emergency department observation unit (EDOU) before hospital admission.
Methods: Baseline and emergency episode data were collected for patients diagnosed with AHF in the EDs of 15 Spanish hospitals. We analyzed crude and adjusted associations between EDOU stay and 30 day mortality (primary outcome) and in-hospital mortality and a prolonged hospital stay of more than 7 days (secondary outcomes).
Results: A total of 6597 patients with a median (interquartile range) age of 83 (76-88 years) were studied. Fifty-five percent were women. All were hospitalized for AHF (50% in internal medicine wards, 23% in cardiology, 11% in geriatrics, and 16 in other specialties. Of these patients, 3241 (49%) had had EDOU stays and 3350 (51%) had been admitted immediately, with no EDOU stay. Having an EDOU stay was associated with female sex, dementia or chronic obstructive pulmonary disease, long-term treatment with certain drugs for heart failure, greater baseline deterioration in function, and a higher degree of decompensation. Patients in the EDOU group were more often admitted to an internal medicine ward and had shorter stays; cardiology, geriatric, and intensive care admissions were less likely to have had an EDOU stay. Overall, 30 day mortality was 12.6% (13.7% in the EDOU group and 11.4% in the no-EDOU group; P = .004). In-hospital mortality was 10.4% overall (EDOU, 11.1% and no-EDOU, 9.6%; P = .044). Prolonged hospitalization occurred in 50.0% (EDOU, 48.7% and no-EDOU, 51.2%; P = .046). After adjusting for between-group differences, the EDOU stay was not associated with 30 day mortality (hazard ratio, 1.14; 95% CI, 0.99-1.31). Odds ratios for associations between EDOU stay and in-hospital mortality and prolonged hospital stay, respectively, were 1.09 (95% CI, 0.92-1.29) and 0.91 (95% CI, 0.82-1.01).
Conclusion: Although mortality higher in patients hospitalized for AHF who spend time in an EDO, the association seems to be accounted for by their worse baseline situation and the greater seriousness of the decompensation episode, not by time spent in the EDOU.
Keywords: acute heart failure, congestive heart failure, signs, mortality, emergency health services
