Emergency Medicine Journal最新文献

A brief systematic review was conducted to assess the effectiveness of erector spinae plane block (ESPB) as an analgesic option for adults attending the emergency department with renal colic. MEDLINE and EMBASE databases were searched, and supplementary searches undertaken using Google Scholar and PubMed Medical Subject Headings. Two randomised controlled trials, two case series, one meta-analysis and one individual case were identified. Patient details, key results and study limitations were recorded in table format. Our findings support the use of ESPB as an effective form of analgesia in renal colic for initial treatment and refractory pain. Further studies should include a cost-effectiveness analysis to evaluate the suitability of ESPB for everyday management of renal colic.

Background: The number of trauma patients in the East of England Trauma Network has been steadily increasing since 2013, raising concerns about whether the existing design (one Major Trauma Centre (MTC) with 12 trauma units (TUs)) can effectively meet the region's trauma care needs. This study assessed service capacity and patient pathway utilisation and outcomes to determine if the existing design serves the TN's growing population and changing needs.

Methods: We analysed 9 years (2013-2021) of Trauma Audit and Research Network data to evaluate bed occupancy trends, service outcomes (predicted and realised survival rates and Glasgow Outcome Scale scores), and patient pathway patterns (direct-to-MTC, transfer-to-MTC and direct-to-TU) by patient demographics (age, sex and index of multiple deprivation (IMD) 2019). We used Injury Severity Score (ISS) >15 to define major trauma.

Results: MTC bed occupancy rose steadily, frequently exceeding the planned capacity of 75 beds since 2018. Notably, 61.8% of major trauma patients were managed entirely in TUs. Yet, the direct-to-TU pathway showed a lower mean of realised survival rates compared with predictions despite managing less severe cases compared with direct-to-MTC (mean ISS 21.2 vs 26.2). Significant disparities in access to the MTC (including transfer-to-MTC) were found for elderly patients (23.5% vs 51.3% for younger patients), women (31.4% vs 42.9% for males) and those residing in IMD deciles 1-2 (31.1% vs 39.1% for the rest).

Conclusion: The current network design shows significant capacity demands and disparities in access and outcomes. This highlights the need for strategic service redesign, enhanced TU capabilities and targeted policies to ensure equitable access to specialised trauma care across the network.

Background: Since December 2022, the National Health Service (NHS) has experienced large-scale strikes by staff. The NHS cancels approximately 12 million elective care appointments each year, and around 1 million elective appointments were cancelled due to strikes between 2022 and 2024. During strikes, emergency care is prioritised, and it has been claimed that emergency departments (EDs) run 'better than usual'. The aim of this study was to investigate changes in patient flow into hospitals through the ED during the strike periods.

Methods: Cox proportional hazards modelling was applied to data from two different EDs in the north-west of England to model time between patient arrival at the ED and their subsequent admission. Systematic (linear temporal trend, yearly seasonality, daily seasonality, weekends, ED 'heat') and patient/presentation-level factors (urgency, service referred to, patient age, ethnicity and gender) were controlled for. The impact of different striking professions on patient time to admission was investigated using HRs, where a higher HR indicated faster admission.

Results: Over the analysis period, we observed 61 separate strike days: 40 junior doctor strike days, 11 nursing days, 10 consultant days and 7 ambulance days. Junior doctor and consultant strikes coincided on 4 days. For the type 1 ED, median time to see a clinician was similar on strike and non-strike days (median 2 hours 27 min on strike days (IQR: 1 hour 2 min to 4 hours 53 min), 2 hours 27 min on non-strike days (IQR: 1 hour 5 min to 5 hours 14 min)). Patients were admitted through the ED more quickly on both the junior doctor and consultant strike days compared with non-strike days (HRs: 1.12, 1.28, both p≤0.001). This increased flow was only seen while consultants were striking in the type 2 smaller ED.

Conclusions: These findings suggest that the improved patient flow observed on strike days could be driven by the additional inpatient capacity created through the postponement of elective care. This result indicates that NHS hospital systems could potentially be adjusted to enhance turnaround times and reduce ED crowding.

Background: The widespread use of small and powerful neodymium magnets in consumer products has led to a significant rise in paediatric magnet ingestion. The ingestion of multiple magnets poses serious risks, including bowel obstruction and perforation. Evidence-based Clinical Practice Guidelines (CPGs) are necessary to inform clinicians of the safest and most effective management strategies across a range of healthcare settings.

Aim: This systematic review aims to summarise existing CPGs for diagnosing and managing paediatric magnet ingestion, evaluate the supporting evidence, highlight variation and consensus, and identify areas requiring further research.

Methods: MEDLINE, Scopus, the Cochrane Library, Web of Science and Embase were searched to identify CPGs. Study characteristics, investigation and management recommendations, and indications for conservative management, endoscopy, surgery and discharge with and without follow-up were extracted. Two reviewers independently assessed CPG quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.

Results: 25 CPGs were included. Recommendations varied for diagnostic imaging, management of single and multiple magnet ingestion and the use of conservative, endoscopic or surgical interventions. However, there was consensus that: abdominal X-ray is the preferred first-line imaging modality, conservative management is recommended for asymptomatic single magnets, endoscopic removal is recommended for prepyloric asymptomatic multiple magnets and surgery for symptomatic multiple magnets. AGREE II appraisal revealed poor scores in CPG Applicability, Stakeholder Involvement and Rigour of Development, but strong scores for Editorial Independence. Existing CPGs for paediatric magnet ingestion are based on low-quality evidence or expert consensus.

Conclusions: This review highlights inconsistencies and areas of consensus in current CPGs for paediatric magnet ingestion. Variations underscore the need for standardised, evidence-based guidelines to optimise care for affected children. Future research should focus on addressing gaps in evidence and consensus to ensure consistent management across healthcare settings.