Articles

Presentations to an urban emergency department in Bern, Switzerland associated with acute recreational drug toxicity

Although the recreational use of psychoactive substances is common there is only limited systematic collection of data on acute drug toxicity or hospital presentations. Currently, data from Switzerland are onl...

Authors: Evangelia Liakoni, Sabine Müller, Adrian Stoller, Meret Ricklin, Matthias E. Liechti and Aristomenis K. Exadaktylos

Effect and accuracy of emergency dispatch telephone guidance to bystanders in trauma: post-hoc analysis of a prospective observational study

Emergency medical communication centres (EMCCs) dispatch and allocate ambulance resources, and provide first-aid guidance to on-scene bystanders. We aimed to 1) evaluate whether dispatcher guidance improved by...

Authors: Håkon Kvåle Bakke, Tine Steinvik, Håkon Ruud and Torben Wisborg

The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role

Necrotizing fasciitis (NF) is a devastating soft tissue infection associated with potentially poor outcomes. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been introduced as a diag...

Authors: Ayman El-Menyar, Mohammad Asim, Insolvisagan N. Mudali, Ahammed Mekkodathil, Rifat Latifi and Hassan Al-Thani

The haemodynamic dilemma in emergency care: Is fluid responsiveness the answer? A systematic review

Fluid therapy is a common and crucial treatment in the emergency department (ED). While fluid responsiveness seems to be a promising method to titrate fluid therapy, the evidence for its value in ED is unclear...

Authors: Mohammed H. Elwan, Ashraf Roshdy, Eman M. Elsharkawy, Salah M. Eltahan and Timothy J. Coats

Can we rely on out-of-hospital blood samples? A prospective interventional study on the pre-analytical stability of blood samples under prehospital emergency medicine conditions

Prehospital intravenous access provides the opportunity to sample blood from an emergency patient at the earliest possible moment in the course of acute illness and in a state prior to therapeutic intervention...

Authors: Johannes Prottengeier, Nicola Jess, Frank Harig, Christine Gall, Joachim Schmidt and Torsten Birkholz

Presentations of adult septic patients in the prehospital setting as recorded by emergency medical services: a mixed methods analysis

Current sepsis screening tools rely on vital parameters which are, however, normal in one third of patients with serious infections. Therefore, there is a need to include other variables than vital parameters ...

Authors: Ulrika Margareta Wallgren, Katarina Eva Margareta Bohm and Lisa Kurland

The difficult medical emergency call: A register-based study of predictors and outcomes

Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorizatio...

Authors: Thea Palsgaard Møller, Thora Majlund Kjærulff, Søren Viereck, Doris Østergaard, Fredrik Folke, Annette Kjær Ersbøll and Freddy K. Lippert

The number of displaced rib fractures is more predictive for complications in chest trauma patients

Traumatic rib fractures can cause chest complications that need further treatment and hospitalization. We hypothesized that an increase in the number of displaced rib fractures will be accompanied by an increa...

Authors: Chih-Ying Chien, Yu-Hsien Chen, Shih-Tsung Han, Gerald N. Blaney, Ting-Shuo Huang and Kuan-Fu Chen

Development of the major trauma case review tool

As many as half of all patients with major traumatic injuries do not receive the recommended care, with variance in preventable mortality reported across the globe. This variance highlights the need for a comp...

Authors: Kate Curtis, Rebecca Mitchell, Amy McCarthy, Kellie Wilson, Connie Van, Belinda Kennedy, Gary Tall, Andrew Holland, Kim Foster, Stuart Dickinson and Henry T. Stelfox

Pre-hospital ct diagnosis of subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is associated with higher mortality in the acute phase than other stroke types. There is a particular risk of early and devastating re-bleeding. Patients therefore need urgent ass...

Authors: Maren Ranhoff Hov, Annette Ryen, Katrine Finsnes, Janne Storflor, Thomas Lindner, Jostein Gleditsch and Christian Georg Lund

The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit: a prospective observational study

Transportation by helicopter may reduce time to hospital admission and improve outcome. We aimed to investigate the effect of transport mode on mortality, disability, and labour market affiliation in patients ...

Authors: Kamilia S. Funder, Lars S. Rasmussen, Nicolai Lohse, Rasmus Hesselfeldt, Volkert Siersma, Jesper Gyllenborg, Sandra Wulffeld, Ole M. Hendriksen, Freddy K. Lippert and Jacob Steinmetz

Meeting abstracts from the first European Emergency Medical Services congress (EMS2016)

Authors: Alexander White, Han Xian Ng, Wai Yee Ng, Eileen Kai Xin Ng, Stephanie Fook-Chong, Phek Hui Jade Kua, Marcus Eng Hock Ong, Alvilda Thougaard Steensberg, Lars Bredevang Andersen, Mette Mølby Eriksen, Ole Mazur Hendriksen, Thomas Thougaard, Andreas Claesson, J. Lennartsson, L. Svensson, M. Ringh…

Potential benefits of an integrated military/civilian trauma system: experiences from two major regional conflicts

Although differences of opinion and controversies may arise, lessons learned from military conflicts often translate into improvements in triage, resuscitation strategies, and surgical technique. Our fully int...

Authors: Jeffry L. Kashuk, Kobi Peleg, Elon Glassberg, Adi Givon, Irina Radomislensky and Yoram Kluger

Developing quality indicators for physician-staffed emergency medical services: a consensus process

There is increasing interest for quality measurement in health care services; pre-hospital emergency medical services (EMS) included. However, attempts of measuring the quality of physician-staffed EMS (P-EMS)...

Authors: Helge Haugland, Marius Rehn, Pål Klepstad and Andreas Krüger

Should capnography be used as a guide for choosing a ventilation strategy in circulatory shock caused by severe hypothermia? Observational case-series study

Severe accidental hypothermia can cause circulatory disturbances ranging from cardiac arrhythmias through circulatory shock to cardiac arrest. Severity of shock, pulmonary hypoperfusion and ventilation-perfusi...

Authors: Tomasz Darocha, Sylweriusz Kosiński, Anna Jarosz, Paweł Podsiadło, Mirosław Ziętkiewicz, Tomasz Sanak, Robert Gałązkowski, Jacek Piątek, Janusz Konstanty-Kalandyk and Rafał Drwiła

Diagnostic error in the Emergency Department: follow up of patients with minor trauma in the outpatient clinic

The Emergency Department (ED) is prone to diagnostic error. Most frequent diagnostic errors involved “minor” trauma. Our goal was to determine how frequently a missed diagnosis was detected during follow up an...

Authors: Pieter-Jan Moonen, Luc Mercelina, Willem Boer and Tom Fret

Pre-hospital transfusion of packed red blood cells in 147 patients from a UK helicopter emergency medical service

Early transfusion of packed red blood cells (PRBC) has been associated with improved survival in patients with haemorrhagic shock. This study aims to describe the characteristics of patients receiving pre-hosp...

Authors: Richard M. Lyon, Eleanor de Sausmarez, Emily McWhirter, Gary Wareham, Magnus Nelson, Ashley Matthies, Anthony Hudson, Leigh Curtis and Malcolm Q. Russell

Thrombocytopenia on the first day of emergency department visit predicts higher risk of acute kidney injury among elderly patients

Few studies have addressed risk factors for acute kidney injury (AKI) in geriatric patients. We investigated whether thrombocytopenia was a risk factor for AKI in geriatric patients with medical illnesses.

Authors: Chia-Ter Chao, Hung-Bin Tsai, Chih-Kang Chiang and Jenq-Wen Huang

Severity-dependent differences in early management of thoracic trauma in severely injured patients - Analysis based on the TraumaRegister DGU®

Major trauma is associated with chest injuries in nearly 50% of multiple injuries. Thoracic trauma is a relevant source of comorbidity throughout the period of multiply-injured patient care and may require swi...

Authors: J. Bayer, R. Lefering, S. Reinhardt, J. Kühle, N. P. Südkamp and T. Hammer

Recognition of out-of-hospital cardiac arrest during emergency calls — a systematic review of observational studies

The medical dispatcher plays an essential role as part of the first link in the Chain of Survival, by recognising the out-of-hospital cardiac arrest (OHCA) during the emergency call, dispatching the appropriat...

Authors: Søren Viereck, Thea Palsgaard Møller, Josephine Philip Rothman, Fredrik Folke and Freddy Knudsen Lippert

Investigation of complications secondary to chest compressions before and after the 2010 cardiopulmonary resuscitation guideline changes by using multi-detector computed tomography: a retrospective study

The purpose of this study was to identify the relationship between the deeper and faster chest compressions suggested by the 2010 cardiopulmonary resuscitation guidelines and complications arising from chest c...

Authors: Jin Ho Beom, Je Sung You, Min Joung Kim, Min Kyung Seung, Yoo Seok Park, Hyun Soo Chung, Sung Phil Chung and Incheol Park

Trials and tribulations: how we established a major incident database

We describe the process of setting up a database of major incident reports and its potential future application.

Authors: S. E. J. Hardy and S. Fattah

Development of a novel information and communication technology system to compensate for a sudden shortage of emergency department physicians

A sudden shortage of physician resources due to overwhelming patient needs can affect the quality of care in the emergency department (ED). Developing effective response strategies remains a challenging resear...

Authors: Kumiko Tanaka, Taka-aki Nakada, Hiroshi Fukuma, Shota Nakao, Naohisa Masunaga, Keisuke Tomita, Yosuke Matsumura, Yasuaki Mizushima and Tetsuya Matsuoka

Prehospital intravenous fentanyl to patients with hip fracture: an observational cohort study of risk factors for analgesic non-treatment

Patients with proximal femoral neck fracture have a high short-term mortality, a high risk of postoperative complications, and impaired quality of life. One of the challenges related to the prehospital treatme...

Authors: Kristian D. Friesgaard, Erika F. Christensen, Hans Kirkegaard, Mette D. Bendtsen, Flemming B. Jensen and Lone Nikolajsen

Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study

Bee and wasp stings are among the most common triggers of anaphylaxis in adults representing around 20% of fatal anaphylaxis from any cause. Data of pre-hospital treatment of bee and wasp induced anaphylactic ...

Authors: Athamaica Ruiz Oropeza, Søren Mikkelsen, Carsten Bindslev-Jensen and Charlotte G. Mortz

External validation of a clinical decision rule: we need events in a population in order to rule them out!

We respond to the Lorton et al. article on external validation of the PECARN study. With an event rate of only 0.6%, we believe that their study failed to confirm the safety of this rule. Such a low number of ...

Authors: Yonathan Freund and Anne-Laure Philippon

The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury

The traditional prehospital management of trauma victims with potential spinal injury has become increasingly questioned as authors and clinicians have raised concerns about over-triage and harm. In order to a...

Authors: Daniel K Kornhall, Jørgen Joakim Jørgensen, Tor Brommeland, Per Kristian Hyldmo, Helge Asbjørnsen, Thomas Dolven, Thomas Hansen and Elisabeth Jeppesen

Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study

Focussed Assessment with Sonography for Trauma (FAST) is a bedside ultrasonography technique used to detect free intraperitoneal fluid in patients presenting with blunt abdominal trauma (BAT) in the emergency ...

Authors: D. Dammers, M. El Moumni, I.I. Hoogland, N. Veeger and E. ter Avest

When a vehicle becomes a weapon: intentional vehicular assaults in Israel

We have recently witnessed an epidemic of intentional vehicular assaults (IVA) aimed at pedestrians. We hypothesized that IVA are associated with a specific injury pattern and severity.

Authors: Gidon Almogy, Asaf Kedar and Miklosh Bala

Is the shock index based classification of hypovolemic shock applicable in multiple injured patients with severe traumatic brain injury?—an analysis of the TraumaRegister DGU^®

A new classification of hypovolemic shock based on the shock index (SI) was proposed in 2013. This classification contains four classes of shock and shows good correlation with acidosis, blood product need and...

Authors: Matthias Fröhlich, Arne Driessen, Andreas Böhmer, Ulrike Nienaber, Alhadi Igressa, Christian Probst, Bertil Bouillon, Marc Maegele and Manuel Mutschler

Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis

The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. pl...

Authors: Hanne H. Henriksen, Elaheh Rahbar, Lisa A. Baer, John B. Holcomb, Bryan A. Cotton, Jacob Steinmetz, Sisse R. Ostrowski, Jakob Stensballe, Pär I. Johansson and Charles E. Wade

Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study

Cushing’s reflex usually results from intracranial hypertension. Although Cushing’s sign can implicate severe traumatic brain injury (TBI) in injured patients, no major investigations have been made. The purpo...

Authors: Tetsuya Yumoto, Toshiharu Mitsuhashi, Yasuaki Yamakawa, Atsuyoshi Iida, Nobuyuki Nosaka, Kohei Tsukahara, Hiromichi Naito and Atsunori Nakao

Complications after surgical management of distal lower leg fractures

Osseous healing of distal lower leg fractures can be prolonged and is often associated with wound healing problems because of the marginal soft - tissue and vascular supply in this area. Postoperative complica...

Authors: Mirjam V. Neumann, Peter C. Strohm, Kilian Reising, Joern Zwingmann, Thorsten O. Hammer and Norbert P. Suedkamp

Adult “termination-of-resuscitation” (TOR)-criteria may not be suitable for children - a retrospective analysis

Only a small number of patients survive out-of-hospital-cardiac-arrest (OHCA). The duration of CPR varies considerably and transportation of patients under CPR is often unsuccessful. Termination-of-resuscitati...

Authors: Victoria Maria Rotering, Sonja Trepels-Kottek, Konrad Heimann, Jörg-Christian Brokmann, Thorsten Orlikowsky and Mark Schoberer

Altered pharmacological effects of adrenergic agonists during hypothermia

Rewarming from accidental hypothermia is often complicated by hypothermia-induced cardiac dysfunction, calling for immediate pharmacologic intervention. Studies show that although cardiac pharmacologic support...

Authors: Erik Sveberg Dietrichs, Georg Sager and Torkjel Tveita

Medical priority dispatch codes—comparison with National Early Warning Score

In Finland, calls for emergency medical services are prioritized by educated non-medical personnel into four categories—from A (highest risk) to D (lowest risk)—following a criteria-based national dispatch pro...

Authors: Marko Hoikka, Sami Länkimäki, Tom Silfvast and Tero I. Ala-Kokko

Warming the head of hypothermic patient – is it always safe?

The head warming in hypothermic victims is an alternative way of heat donation, which does not inhibit shivering and does not impede the access to the patient’s chest. It seems to be a safe method in mild hypo...

Authors: Paweł Podsiadło, Tomasz Darocha and Sylweriusz Kosiński

Outcomes after helicopter versus ground emergency medical services for major trauma--propensity score and instrumental variable analyses: a retrospective nationwide cohort study

Because of a lack of randomized controlled trials and the methodological weakness of currently available observational studies, the benefits of helicopter emergency medical services (HEMS) over ground emergenc...

Authors: Asuka Tsuchiya, Yusuke Tsutsumi and Hideo Yasunaga

Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre

Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of ...

Authors: Tomohide Koyama, Jorunn Skattum, Peder Engelsen, Torsten Eken, Christine Gaarder and Pål Aksel Naess

A statistical analysis protocol for the time-differentiated target temperature management after out-of-hospital cardiac arrest (TTH48) clinical trial

The TTH48 trial aims to determine whether prolonged duration (48 hours) of targeted temperature management (TTM) at 33 (±1) °C results in better neurological outcomes compared to standard duration (24 hours) a...

Authors: Hans Kirkegaard, Asger Roer Pedersen, Ville Pettilä, Jakob Hjort, Bodil Steen Rasmussen, Inge de Haas, Jørgen Feldbæk Nielsen, Susanne Ilkjær, Anne Kaltoft, Anni Nørgaard Jeppesen, Anders Morten Grejs, Christophe Henri Valdemar Duez, Alf Inge Larsen, Valdo Toome, Urmet Arus, Fabio Silvio Taccone…

Do emergency medicine journals promote trial registration and adherence to reporting guidelines? A survey of “Instructions for Authors”

The aim of this study was to evaluate the current state of two publication practices, reporting guidelines requirements and clinical trial registration requirements, by analyzing the “Instructions for Authors”...

Authors: Matthew T. Sims, Nolan M. Henning, C. Cole Wayant and Matt Vassar

Post-traumatic acute kidney injury: a cross-sectional study of trauma patients

The causes of post-traumatic acute kidney injury (AKI) are multifactorial, and shock associated with major trauma has been proposed to result in inadequate renal perfusion and subsequent AKI in trauma patients...

Authors: Wei-Hung Lai, Cheng-Shyuan Rau, Shao-Chun Wu, Yi-Chun Chen, Pao-Jen Kuo, Shiun-Yuan Hsu, Ching-Hua Hsieh and Hsiao-Yun Hsieh

Team talk and team activity in simulated medical emergencies: a discourse analytical approach

Communication errors can reduce patient safety, especially in emergency situations that require rapid responses by experts in a number of medical specialties. Talking to each other is crucial for utilizing the...

Authors: Stine Gundrosen, Ellen Andenæs, Petter Aadahl and Gøril Thomassen

Heel pressure ulcer, prevention and predictors during the care delivery chain – when and where to take action? A descriptive and explorative study

Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at...

Authors: Åsa Muntlin Athlin, Maria Engström, Lena Gunningberg and Carina Bååth

Traumatic brain injury patient volume and mortality in neurosurgical intensive care units: a Finnish nationwide study

Differences in outcomes after traumatic brain injury (TBI) between neurosurgical centers exist, although the reasons for this are not clear. Thus, our aim was to assess the association between the annual volum...

Authors: Rahul Raj, Stepani Bendel, Matti Reinikainen, Sanna Hoppu, Teemu Luoto, Tero Ala-Kokko, Sami Tetri, Ruut Laitio, Timo Koivisto, Jaakko Rinne, Riku Kivisaari, Jari Siironen and Markus B. Skrifvars

Hemodynamic, management, and outcomes of patients admitted to emergency department with heart failure

Heart failure is one of the leading reasons for hospitalization in developed countries. Our goal was to describe the hemodynamic vital signs (heart rate and systolic blood pressure) of patients presenting to t...

Authors: Pierre-Géraud Claret, Ian G. Stiell, Justin W. Yan, Catherine M. Clement, Brian H. Rowe, Lisa A. Calder and Jeffrey J. Perry

Analysis of thromboelastography, PT, APTT and fibrinogen in intraosseous and venous samples—an experimental study

Laboratory analysis of coagulation is often important in emergencies. If vascular access is challenging, intraosseous catheterization may be necessary for treatment. We studied the analysis of coagulation para...

Authors: Gunnar Strandberg, Miklós Lipcsey, Mats Eriksson, Norbert Lubenow and Anders Larsson

Which score should be used for posttraumatic multiple organ failure? - Comparison of the MODS, Denver- and SOFA- Scores

Multiple organ dysfunction and multiple organ failure (MOF) is still a major complication and challenge in the treatment of severely injured patients. The incidence varies decisively in current studies, which ...

Authors: Matthias Fröhlich, Arasch Wafaisade, Anastasios Mansuri, Paola Koenen, Christian Probst, Marc Maegele, Bertil Bouillon and Samir G. Sakka

Physical function and pain after surgical or conservative management of multiple rib fractures – a follow-up study

There is scarce knowledge of physical function and pain due to multiple rib fractures following trauma. The purpose of this follow-up was to assess respiratory and physical function, pain, range of movement an...

Authors: Monika Fagevik Olsén, Margareta Slobo, Lena Klarin, Eva-Corina Caragounis, David Pazooki and Hans Granhed

Myocardial function at the early phase of traumatic brain injury: a prospective controlled study

The concept of brain-heart interaction has been described in several brain injuries. Traumatic brain injury (TBI) may also lead to cardiac dysfunction but evidences are mainly based upon experimental and clini...

Authors: Adrien Cuisinier, Claire Maufrais, Jean-François Payen, Stephane Nottin, Guillaume Walther and Pierre Bouzat