Emergency Medicine Journal最新文献

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.

Background: It has been recommended that prehospital rapid sequence intubation (PH-RSI) be performed in locations that provide 360-degree access to the patient. We aimed to examine the success and complication rate of PH-RSI by location of intubation as well as the effect on scene time.

Methods: We conducted a single-centre, retrospective cohort study of patients with attempted PH-RSI over a 96-month period. Locations compared were intubation within the road ambulance, outside the vehicle on a stretcher, on the ground and in other locations. The primary outcome was the occurrence of major intubation complications by location. Secondary outcomes were first-pass success, time to intubation from patient contact and total scene time. Modified Poisson with robust SE variance and quantile regressions was used to adjust for confounding variables.

Results: Of 413 patients, major intubation complications occurred in 60 (14.5%, 95% CI 11.3% to 18.3%) patients. Patients intubated on the ground were twice as likely to have complications than patients intubated on a stretcher outside the vehicle (p=0.023) in the unadjusted analysis. First-pass success intubations occurred in 400 (96.9%, 95% CI 94.7% to 98.3%). Adjusted time from contact to intubation was not different (p=0.864) but total scene time was significantly shorter for patients intubated inside an ambulance compared with outside on a stretcher (median difference -4.0 min, 95% CI -6.5 to 1.5; p=0.002).

Conclusions: Intubating selected patients within an ambulance had similar complication rates to intubation on a stretcher outside the vehicle but was associated with a small reduction in on-scene time.

Background: Rising demand and limited capacity in primary care are often cited as reasons for the increasing pressure on emergency departments (EDs). The COVID-19 pandemic further strained but also reshaped healthcare services and their accessibility. However, an equally critical yet often overlooked factor is the increasing complexity of cases. This study assessed ED attendance trends for the Northwest London (NWL) population between February 2017 and September 2023, before, during and after the pandemic lockdown measures (March 2020-March 2021) in the UK as a whole and across sociodemographic and multimorbidity profiles.

Method: We used the Whole System Integrated Care data warehouse in NWL. We conducted a segmented time-series quasi-Poisson regression for weekly ED attendance for two periods, before and after the pandemic lockdown measures, adjusting for seasonality and autocorrelation. We stratified the model by age, sex and quintiles of the 2019 Index of Multiple Deprivation. We analysed ED attendance trends by multimorbidity groups.

Results: There were 3 365 279 ED attendances from February 2017 to September 2023. Before the pandemic, there was a statistically significant annual growth rate of 3.4% (rate ratio (RR) 1.034; CI 1.026 to 1.042), with a rising trend in attendance observed in all patient groups. After the pandemic, the overall trend stabilised (RR 1.002; CI 0.993 to 1.009). However, attendances have continued to rise for older age groups (61-75 years and 76+ years) and have increased for patients with multimorbidity and complex multimorbidity. Meanwhile, attendance has declined for the least deprived. For the other patient groups, attendance has plateaued.

Conclusion: Following the pandemic, total ED attendances stabilised, but have continued to rise for older people, particularly those requiring complex care. This has implications for hospital capacity and places an increased strain on urgent and emergency care. We used high-quality representative population-level linked patient records data. The study was observational with limited causality. Further research should explore specific reasons behind these changes.