Articles

The danish regions pediatric triage model has a limited ability to detect both critically ill children as well as children to be sent home without treatment – a study of diagnostic accuracy

The Danish Regions Pediatric Triage model (DRPT) was introduced in 2012 and subsequent implemented in most Danish acute pediatric departments. The aim was to evaluate the validity of DRPT as a screening tool t...

Authors: Lotte Høeg Hansen, Christian Backer Mogensen, Lena Wittenhoff and Helene Skjøt-Arkil

The golden hour of acute ischemic stroke

Acute Ischemic Stroke (AIS) treatment has been revolutionised in the last two decades with the increasing use of Intravenous Thrombolysis (IVT) and with the advent of Endovascular therapy (EVT). AIS treatment ...

Authors: Rajiv Advani, Halvor Naess and Martin W. Kurz

Pre-hospital triage performance after standardized trauma courses

The pre-hospital triage process aims at identifying and prioritizing patients in the need of prompt intervention and/or evacuation. The objective of the present study was to evaluate triage decision skills in ...

Authors: Maria Lampi, Johan Junker, Peter Berggren, Carl-Oscar Jonson and Tore Vikström

Under-triage in telephone consultation is related to non-normative symptom description and interpersonal communication: a mixed methods study

Telephone consultation and triage are used to limit the workload on emergency departments. Lack of visual cues and clinical tests put telephone consultations to a disadvantage compared to face-to-face consulta...

Authors: Hejdi Gamst-Jensen, Freddy K. Lippert and Ingrid Egerod

Dispatch and prehospital transport for acute septic patients: an observational study

In order to dispatch ambulances with the correct level of urgency, the dispatch center has to balance the perceived urgency and traffic safety considerations with the available resources. As urgency is not cle...

Authors: Peter Bank Pedersen, Daniel Pilsgaard Henriksen, Søren Mikkelsen and Annmarie Touborg Lassen

Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation

Post-craniotomy intracranial air can be present in patients scheduled for air ambulance transport to their home hospital. We aimed to assess risk for in-flight intracranial pressure (ICP) increases related to ...

Authors: Helge Brändström, Anna Sundelin, Daniela Hoseason, Nina Sundström, Richard Birgander, Göran Johansson, Ola Winsö, Lars-Owe Koskinen and Michael Haney

A novel scoring system for predicting the neurologic prognosis prior to the initiation of induced hypothermia in cases of post-cardiac arrest syndrome: the CAST score

The aim of this study was to develop a scoring system for identifying the post-cardiac arrest syndrome (PCAS) patients with a good potential for recovery prior to the initiation of induced therapeutic hypother...

Authors: Mitsuaki Nishikimi, Naoyuki Matsuda, Kota Matsui, Kunihiko Takahashi, Tadashi Ejima, Keibun Liu, Takayuki Ogura, Michiko Higashi, Hitoshi Umino, Go Makishi, Atsushi Numaguchi, Satoru Matsushima, Hideki Tokuyama, Mitsunobu Nakamura and Shigeyuki Matsui

Do pre-hospital poisoning deaths differ from in-hospital deaths? A retrospective analysis

Most fatal poisonings occur outside the hospital and the victims found dead. The purpose of this study was to determine the general pattern and patient demographics of fatal poisonings in Northern Finland. In ...

Authors: Lauri Koskela, Lasse Raatiniemi, Håkon Kvåle Bakke, Tero Ala-Kokko and Janne Liisanantti

Sex-based differences in outcomes after severe injury: an analysis of blunt trauma patients in China

Experimental research suggests that females have a higher survival rate after trauma, although this claim is controversial. This study sought to determine the role of sex on mortality among trauma patients in ...

Authors: Ziqiang Zhu, Xiaoping Shang, Peiyi Qi and Shengli Ma

Clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ECMO - an observational case series study

Recently, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has become the rewarming treatment of choice in hypothermic cardiac arrest. The detailed indications for extracorporeal rewarming in non-ar...

Authors: Sylweriusz Kosiński, Tomasz Darocha, Anna Jarosz, Aleksander Zeliaś, Mirosław Ziętkiewicz, Paweł Podsiadło, Tomasz Sanak, Kinga Sałapa, Jacek Piątek, Janusz Konstany-Kalandyk, Robert Gałązkowski, Paweł Krawczyk, Łukasz Krzych and Rafał Drwiła

In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study

Pre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer’s qualifications determine efficacy of tracheal intubation, in-ho...

Authors: Helmut Trimmel, Christoph Beywinkler, Sonja Hornung, Janett Kreutziger and Wolfgang G. Voelckel

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Treatment-limiting decisions (TLD) for severe traumatic brain injury (sTBI) have been sparsely studied. This study determine prevalence, main reason for, categories and timing of TLDs in a Norwegian regional t...

Authors: Annette Robertsen, Reidun Førde, Nils Oddvar Skaga and Eirik Helseth

Hypothermia in trauma victims at first arrival of ambulance personnel: an observational study with assessment of risk factors

Hypothermia is common in trauma victims and is associated with increased mortality, however its causes are little known. The objective of this study was to identify the risk factors associated with hypothermia...

Authors: Frédéric Lapostolle, James Couvreur, François Xavier Koch, Dominique Savary, Armelle Alhéritière, Michel Galinski, Jean-Luc Sebbah, Karim Tazarourte and Frédéric Adnet

Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients—still a relevant problem?

Thoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The purpose of this study was to investigate epidemiological data, treatment and outcome o...

Authors: Konstantina Chrysou, Gabriel Halat, Beatrix Hoksch, Ralph A. Schmid and Gregor J. Kocher

The association of patient and trauma characteristics with the health-related quality of life in a Dutch trauma population

It is suggested in literature to use the Health Related Quality of Life (HRQoL) as an outcome indicator for evaluating trauma centre performances. In order to predict HRQoL, characteristics that could be of in...

Authors: Amy Gunning, Mark van Heijl, Karlijn van Wessem and Luke Leenen

Merger of two dispatch centres: does it improve quality and patient safety?

Dispatch centres (DCs) are considered an essential but expensive component of many highly developed healthcare systems. The number of DCs in a country, region, or state is usually based on local history and of...

Authors: Alexandre Moser, Annette Mettler, Vincent Fuchs, Walter Hanhart, Claude-François Robert, Vincent Della Santa and Fabrice Dami

The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products – A systematic review and meta-analysis

Management of the critically bleeding patient can be encountered in many medical and surgical settings. Common for these patients is a high risk of dying from exsanguination secondary to developing coagulopath...

Authors: Mathilde Fahrendorff, Roberto S. Oliveri and Pär I. Johansson

The challenges of military medical education and training for physicians and nurses in the Nordic countries - an interview study

Development and use of e-learning has not taken place to the same extent in military medicine in the Nordic countries. The aim was to explore the similarities and differences in education and training in milit...

Authors: Linda Sonesson, Kenneth Boffard, Lars Lundberg, Martin Rydmark and Klas Karlgren

PreHospital Ambulance Stroke Test - pilot study of a novel stroke test

There is a need for a prehospital stroke test that in addition to high sensitivity for stroke, also is able to communicate stroke severity similar to the National Institute of Health Stroke Scale (NIHSS).

Authors: Gunnar Andsberg, Magnus Esbjörnsson, Arne Olofsson, Arne Lindgren, Bo Norrving and Mia von Euler

Effect of an interactive cardiopulmonary resuscitation assist device with an automated external defibrillator synchronised with a ventilator on the CPR performance of emergency medical service staff: a randomised simulation study

The present study evaluates whether the quality of advanced cardiac life support (ALS) is improved with an interactive prototype assist device. This device consists of an automated external defibrillator linke...

Authors: Rainer Nitzschke, Christoph Doehn, Jan F. Kersten, Julian Blanz, Tobias J. Kalwa, Norman A. Scotti and Jens C. Kubitz

Termination of prehospital resuscitative efforts: a study of documentation on ethical considerations at the scene

Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when...

Authors: Søren Mikkelsen, Caroline Schaffalitzky de Muckadell, Lars Grassmé Binderup, Hans Morten Lossius, Palle Toft and Annmarie Touborg Lassen

External validation of the ROSC after cardiac arrest (RACA) score in a physician staffed emergency medical service system

The return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score may have implications as a quality indicator for the emergency medical services (EMS) system. We aimed to validate this score exte...

Authors: Petteri Kupari, Markus Skrifvars and Markku Kuisma

Blood transfusion and coagulopathy in geriatric trauma patients

Trauma resuscitation has undergone a paradigm shift with new emphasis on the early use of blood products and increased proportions of plasma and platelets. However, it is unclear how this strategy is applied o...

Authors: Brett Mador, Bartolomeu Nascimento, Simon Hollands and Sandro Rizoli

We need to include bystander first aid in trauma research

The chain of trauma survival is a concept that originated in the area of out-of-hospital cardiac arrest (OHCA) and was adapted to the treatment of trauma. In out-of-hospital cardiac arrest research into bystan...

Authors: Håkon Kvåle Bakke and Torben Wisborg

Meeting abstracts from the 7th Danish Emergency Medicine Conference

Authors: Osama Bin Abdullah, Johannes Grand, Astha Sijapati, Petrine Nimskov, Finn Erland Nielsen, Jens Christian Schmidt, Noel Pérez, Tanja Kirkegaard, Marianne Fløjstrup, Mikkel Brabrand, Mathias Galthen-Sørensen, Rasa Ramoskiene, Arman Arshad, Annmarie Lassen, Lars Stubbe Teglbjærg, O. Andersen…

Targeted temperature management in cardiac arrest: survival evaluated by propensity score matching

Targeted temperature management in cardiac arrest was introduced following evidence of increased survival from two controlled trials published in 2002. We wanted to investigate whether the introduction of targ...

Authors: Eirik A. Buanes, Karl O. Hufthammer, Jørund Langørgen, Anne-Berit Guttormsen and Jon-Kenneth Heltne

Prothrombin time is predictive of low plasma prothrombin concentration and clinical outcome in patients with trauma hemorrhage: analyses of prospective observational cohort studies

Fibrinogen and prothrombin have been suggested to become rate limiting in trauma associated coagulopathy. Administration of fibrinogen is now recommended, however, the importance of prothrombin to patient outc...

Authors: Clare A. Balendran, Ann Lövgren, Kenny M. Hansson, Karin Nelander, Marita Olsson, Karin J. Johansson, Karim Brohi, Dietmar Fries and Anders Berggren

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

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

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

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

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

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

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

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

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

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

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