A. Manno, M. Pascale, Michele Cosimo Santoro, A. Saviano, Andrea Benicchi, Maurizio Gabrielli, M. Covino, Francesco Franceschi
Both specialists and trainees in emergency medicine are often unaware of the principles of good suturing. Hands-on training course was proposed to both members of the staff (group A) and trainees (group B) of the emergency department of our hospital. Familiarity with all aspects of the operation, pre-course 0%, postcourse 79% (group A) and 85.71% (group B) - p<0.000); clear economy of movement and maximum efficiency, pre-course 0%, post-course 73.8% (group A) and 89.80% (group B) - p<0.000; fluid moves with instruments and no awkwardness, pre-course 0%, post-course 73.8% (group A) and 89.80% (group B) - p<0.000; obviously planned course of operation with effortless flow from one move to the next, pre-course 0%, post-course 79% (group A) and 89,80% (group B) - p<0.000; strategically used assistants to the best advantage of all time, pre-course 0%, post-course 73,8% (group A) and 89,80% (group B) - p<0.000; improvement in dexterity, 79.5% of students post-course). The course was judged very useful by 94.8% of students. Attending suturing skill courses could be very useful for both trainees and specialists in emergency medicine.
{"title":"Teaching suturing skill to emergency physicians: the experience of a hands-on practical training in a laboratory simulation-based setting","authors":"A. Manno, M. Pascale, Michele Cosimo Santoro, A. Saviano, Andrea Benicchi, Maurizio Gabrielli, M. Covino, Francesco Franceschi","doi":"10.4081/ecj.2023.11417","DOIUrl":"https://doi.org/10.4081/ecj.2023.11417","url":null,"abstract":"Both specialists and trainees in emergency medicine are often unaware of the principles of good suturing. Hands-on training course was proposed to both members of the staff (group A) and trainees (group B) of the emergency department of our hospital. Familiarity with all aspects of the operation, pre-course 0%, postcourse 79% (group A) and 85.71% (group B) - p<0.000); clear economy of movement and maximum efficiency, pre-course 0%, post-course 73.8% (group A) and 89.80% (group B) - p<0.000; fluid moves with instruments and no awkwardness, pre-course 0%, post-course 73.8% (group A) and 89.80% (group B) - p<0.000; obviously planned course of operation with effortless flow from one move to the next, pre-course 0%, post-course 79% (group A) and 89,80% (group B) - p<0.000; strategically used assistants to the best advantage of all time, pre-course 0%, post-course 73,8% (group A) and 89,80% (group B) - p<0.000; improvement in dexterity, 79.5% of students post-course). The course was judged very useful by 94.8% of students. Attending suturing skill courses could be very useful for both trainees and specialists in emergency medicine.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47641009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chiara Busti, Matteo Marcosignori, Francesco Marchetti, Giuseppe Batori, Laura Giovenali, Francesco Corea, Giuseppe Calabrò, Manuel Monti, Federico Germini
Ultrasound measurement of the optic nerve sheath diameter (US ONSD) has been proposed as a method to diagnose elevated intracranial pressure (EICP), but the optimal threshold is unclear. The aim of this study was to assess the accuracy of US ONSD, as compared to head computed tomography (CT), in detecting EICP of both traumatic and non-traumatic origin. We conducted a prospective, cross-sectional, multicenter study. Patients presenting to the emergency department with a suspect of traumatic or non-traumatic brain injury, referred for an urgent head CT, underwent US ONSD measurement. A US ONSD ≥5.5 mm was considered positive. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for three ONSD cut-offs: 5.5 (primary outcome), 5.0, and 6.0 mm. A receiver operating characteristic (ROC) curve was also generated and the area under the ROC curve calculated. Ninetynine patients were enrolled. The CT was positive in 15% of cases and the US ONSD was positive in all of these, achieving a sensitivity of 100% [95% confidence interval (CI) 78; 100] and a negative predictive value of 100% (95% CI 79; 100). The CT was negative in 85% of cases, while the US ONSD was positive in 69% of these, achieving a specificity of 19% (95% CI 11; 29) and a positive predictive value of 18% (95% CI 11; 28). The US ONSD, with a 5.5 mm cut-off, might safely be used to rule out EICP in patients with traumatic and non-traumatic brain injury in the ED. In limited-resources contexts, a negative US ONSD could allow emergency physicians to rule out EICP in low-risk patients, deferring the head CT.
超声测量视神经鞘直径(US ONSD)已被提出作为诊断颅内压升高(EICP)的一种方法，但最佳阈值尚不清楚。本研究的目的是评估US ONSD与头部计算机断层扫描(CT)相比在检测外伤性和非外伤性EICP方面的准确性。我们进行了一项前瞻性、横断面、多中心研究。疑似创伤性或非创伤性脑损伤的患者就诊于急诊科，转介进行紧急头部CT检查，接受US ONSD测量。US ONSD≥5.5 mm为阳性。计算三个ONSD临界值的敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比:5.5(主要结局)、5.0和6.0 mm。生成受试者工作特征(ROC)曲线，并计算ROC曲线下面积。99名患者入组。15%的病例CT为阳性，所有病例US ONSD均为阳性，敏感性达到100%[95%可信区间(CI) 78;100]和100%的阴性预测值(95% CI 79;100)。85%的病例CT为阴性，而其中69%的病例US ONSD为阳性，特异性为19% (95% CI 11;29)，阳性预测值为18% (95% CI 11;28)。US ONSD具有5.5 mm的临界值，可以安全地用于排除急诊科创伤性和非创伤性脑损伤患者的EICP。在资源有限的情况下，US ONSD阴性可以让急诊医生排除低风险患者的EICP，推迟头部CT检查。
{"title":"Accuracy of bedside sonographic measurement of optic nerve sheath diameter for intracranial hypertension diagnosis in the emergency department","authors":"Chiara Busti, Matteo Marcosignori, Francesco Marchetti, Giuseppe Batori, Laura Giovenali, Francesco Corea, Giuseppe Calabrò, Manuel Monti, Federico Germini","doi":"10.4081/ecj.2023.11333","DOIUrl":"https://doi.org/10.4081/ecj.2023.11333","url":null,"abstract":"Ultrasound measurement of the optic nerve sheath diameter (US ONSD) has been proposed as a method to diagnose elevated intracranial pressure (EICP), but the optimal threshold is unclear. The aim of this study was to assess the accuracy of US ONSD, as compared to head computed tomography (CT), in detecting EICP of both traumatic and non-traumatic origin. We conducted a prospective, cross-sectional, multicenter study. Patients presenting to the emergency department with a suspect of traumatic or non-traumatic brain injury, referred for an urgent head CT, underwent US ONSD measurement. A US ONSD ≥5.5 mm was considered positive. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for three ONSD cut-offs: 5.5 (primary outcome), 5.0, and 6.0 mm. A receiver operating characteristic (ROC) curve was also generated and the area under the ROC curve calculated. Ninetynine patients were enrolled. The CT was positive in 15% of cases and the US ONSD was positive in all of these, achieving a sensitivity of 100% [95% confidence interval (CI) 78; 100] and a negative predictive value of 100% (95% CI 79; 100). The CT was negative in 85% of cases, while the US ONSD was positive in 69% of these, achieving a specificity of 19% (95% CI 11; 29) and a positive predictive value of 18% (95% CI 11; 28). The US ONSD, with a 5.5 mm cut-off, might safely be used to rule out EICP in patients with traumatic and non-traumatic brain injury in the ED. In limited-resources contexts, a negative US ONSD could allow emergency physicians to rule out EICP in low-risk patients, deferring the head CT.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135998723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irene P´erez-Regueiro, Lucía Carcedo-Argüelles, E. Fernández Fernández, J. A. García Fernández, A. Lana
Much of the law enforcement work takes place close to the public, often arriving at the scene before medical services in the case of victims of out-of-hospital cardiac arrest. If properly trained, these early care procedures can be powerful mechanisms to improve survival. This paper describes a case of out-of-hospital cardiac arrest assisted by law enforcement officers on the public highway in Asturias-Spain. In addition, a qualitative study was carried out to learn about the experience of the officers during the intervention, their willingness to act in similar emergencies, as well as to gather information about their training and knowledge of basic life support. The case was successfully resolved; however, some errors in the spontaneous execution of the chain of survival and the officers’ statements prompted some recommendations for the mobilization, training and staffing of law enforcement agencies in Spain.
{"title":"Cardiopulmonary resuscitation by law enforcement agents in Spain: lessons from a mixed methods case study","authors":"Irene P´erez-Regueiro, Lucía Carcedo-Argüelles, E. Fernández Fernández, J. A. García Fernández, A. Lana","doi":"10.4081/ecj.2023.11326","DOIUrl":"https://doi.org/10.4081/ecj.2023.11326","url":null,"abstract":"Much of the law enforcement work takes place close to the public, often arriving at the scene before medical services in the case of victims of out-of-hospital cardiac arrest. If properly trained, these early care procedures can be powerful mechanisms to improve survival. This paper describes a case of out-of-hospital cardiac arrest assisted by law enforcement officers on the public highway in Asturias-Spain. In addition, a qualitative study was carried out to learn about the experience of the officers during the intervention, their willingness to act in similar emergencies, as well as to gather information about their training and knowledge of basic life support. The case was successfully resolved; however, some errors in the spontaneous execution of the chain of survival and the officers’ statements prompted some recommendations for the mobilization, training and staffing of law enforcement agencies in Spain.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45803331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Simonovska, A. Chibishev, Niko Bekarovski, A. Babulovska, Biljana Ivanova, Kiril Naumovski, Kristin Kostadinovski
In the 2020 annual report of the American Association of Poison Control Centers, 2562 toxic exposures to carbamazepine have been reported, 908 resulted in hospitalization, and among these about 5-6% were life-threatening or resulted in significant disability. A 15-year-old female patient was brought under suspicion of alcohol poisoning. The result of alcoholemia was 11.0mg/dL and the toxicological screening for THC, opiates, methadone, tramadol, amphetamine, MDMA, cocaine, benzodiazepines, buprenorphine was negative. At admission she was comatose (GCS=6), with metabolic acidosis, hypotension, rare short-term partial seizures, isochoric and later dilated pupils, body temperature was 36.4°C, with oxygen saturation from 89 up to 93%. Toxicological analysis were immediately extended. After three hours of admission, a result was obtained where the plasma concentration for carbamazepine was 167mmol/L. The patient was quickly prepared for hemodialysis which was performed for four hours. After 8 hours of admission the patient woke up with stable vital parameters.
{"title":"From unknown poisoning to carbamazepine poisoning","authors":"N. Simonovska, A. Chibishev, Niko Bekarovski, A. Babulovska, Biljana Ivanova, Kiril Naumovski, Kristin Kostadinovski","doi":"10.4081/ecj.2023.11270","DOIUrl":"https://doi.org/10.4081/ecj.2023.11270","url":null,"abstract":"In the 2020 annual report of the American Association of Poison Control Centers, 2562 toxic exposures to carbamazepine have been reported, 908 resulted in hospitalization, and among these about 5-6% were life-threatening or resulted in significant disability. A 15-year-old female patient was brought under suspicion of alcohol poisoning. The result of alcoholemia was 11.0mg/dL and the toxicological screening for THC, opiates, methadone, tramadol, amphetamine, MDMA, cocaine, benzodiazepines, buprenorphine was negative. At admission she was comatose (GCS=6), with metabolic acidosis, hypotension, rare short-term partial seizures, isochoric and later dilated pupils, body temperature was 36.4°C, with oxygen saturation from 89 up to 93%. Toxicological analysis were immediately extended. After three hours of admission, a result was obtained where the plasma concentration for carbamazepine was 167mmol/L. The patient was quickly prepared for hemodialysis which was performed for four hours. After 8 hours of admission the patient woke up with stable vital parameters.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42317278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, In the recently published article by McLatchie et al., the authors state that emergency clinicians may miss acute aortic syndrome (AAS) by not considering it as a possibility, being falsely reassured by atypical or resolved symptoms, or mistaking it for other more common conditions.1 The authors emphasise the importance of always considering AAS in the differential diagnosis of chest, back or abdominal pains, collapse, perfusion deficits or neurological compromise and suggest a risk stratification scoring system such as ADD-RS in combination with D-dimer to standardise the approach and help physicians discern which patients to scan. [...]
{"title":"Comments on “Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis”","authors":"A. Vercelli, Eleonora Berardi, Erika Poggiali","doi":"10.4081/ecj.2023.11433","DOIUrl":"https://doi.org/10.4081/ecj.2023.11433","url":null,"abstract":"Dear Editor,\u0000In the recently published article by McLatchie et al., the authors state that emergency clinicians may miss acute aortic syndrome (AAS) by not considering it as a possibility, being falsely reassured by atypical or resolved symptoms, or mistaking it for other more common conditions.1 The authors emphasise the importance of always considering AAS in the differential diagnosis of chest, back or abdominal pains, collapse, perfusion deficits or neurological compromise and suggest a risk stratification scoring system such as ADD-RS in combination with D-dimer to standardise the approach and help physicians discern which patients to scan. [...]","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43518576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
One of the rare reasons for acute testicular pain is spermatic vein thrombosis. In the literature, the right side is much less involved than the left side. We report a case of a common symptom with a rare clinical feature. A 28-year-old man presented with acute testicular pain and swelling. Ultrasonography (US) showed focal venous thrombus at the level of the internal ring. The symptoms were resolved after anti-inflammatory therapy, but thrombosis was not. Due to the uncommon existence of spermatic vein thrombosis, the emergency department should be aware of misdiagnosis and the right therapy modalities.
{"title":"Acute testicular pain: right spermatic vein thrombosis. A case report","authors":"Suat Morkuzu, Hidir Kas, Emrah Oz, Cihan Yazar","doi":"10.4081/ecj.2023.11035","DOIUrl":"https://doi.org/10.4081/ecj.2023.11035","url":null,"abstract":"One of the rare reasons for acute testicular pain is spermatic vein thrombosis. In the literature, the right side is much less involved than the left side. We report a case of a common symptom with a rare clinical feature. A 28-year-old man presented with acute testicular pain and swelling. Ultrasonography (US) showed focal venous thrombus at the level of the internal ring. The symptoms were resolved after anti-inflammatory therapy, but thrombosis was not. Due to the uncommon existence of spermatic vein thrombosis, the emergency department should be aware of misdiagnosis and the right therapy modalities.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44015349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The brutal murder of 55-year-old Italian psychiatrist Barbara Capovani in April 2023, at the hands of a man she had assisted during a hospitalization four years prior, produced a wave of emotion within Italian psychiatry, with important echoes in the media. It is the death of a woman at work, a doctor, a psychiatrist, a professional of the National Health Service who has been taking care of serious mental illnesses for years. She was beaten to death by the attacker at the end of her shift at the psychiatric ward of the Santa Chiara Hospital in Pisa as she was untying her bicycle to go home. The man is now in jail on premeditated murder accusations. The day before he had gone to look for her in the hospital without success; the day of the crime he returned, dressed in dark clothes, masked with a hat on his head and a backpack on his shoulders. During his arrest, officers discovered a crossbow and some bolts in his home.
{"title":"The murder of a psychiatrist in Italy raises problems for all of us","authors":"C. Fraticelli","doi":"10.4081/ecj.2023.11512","DOIUrl":"https://doi.org/10.4081/ecj.2023.11512","url":null,"abstract":"The brutal murder of 55-year-old Italian psychiatrist Barbara Capovani in April 2023, at the hands of a man she had assisted during a hospitalization four years prior, produced a wave of emotion within Italian psychiatry, with important echoes in the media. It is the death of a woman at work, a doctor, a psychiatrist, a professional of the National Health Service who has been taking care of serious mental illnesses for years. She was beaten to death by the attacker at the end of her shift at the psychiatric ward of the Santa Chiara Hospital in Pisa as she was untying her bicycle to go home. The man is now in jail on premeditated murder accusations. The day before he had gone to look for her in the hospital without success; the day of the crime he returned, dressed in dark clothes, masked with a hat on his head and a backpack on his shoulders. During his arrest, officers discovered a crossbow and some bolts in his home.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45296477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Road traffic accident has become a public health concern. More than 80% injury-related deaths occurred in low-middle income countries (LMICs). Despite its importance, emergency care accessibility for road crash victims is still questionable. This study aims to review emergency care accessibility from approachability, acceptability, availability, affordability, and appropriateness dimensions for crash victims. This is a scoping review with literatures extracted from ScienceDirect, ProQuest, and Scopus. Articles analyzed using PCC (Problem/Population, Concept, Context) of scoping review. 1544 articles identified from databases of which 81 are relevant for full-text screening. The final 12 articles were eligible to be reviewed. Although emergency care is available in most areas, its existence was not well-known. Victims and helpers are treated unfairly in emergency care. Emergency care system also lacks clear coordination and it does not give appropriate treatment in timely manner. There was little evidence of how accessible emergency care to crash victims. Most studies only examined the availability of emergency care without comparing its actual utilization and other determinants impacting its accessibility. Future study should aim to assess approachability, acceptability, affordability, and appropriateness of emergency care. Strengthening emergency care from all dimensions is important to ensure its accessibility.
{"title":"Emergency care accessibility for road accidents victims: a review","authors":"A. Rahvy, Ascobat Gani","doi":"10.4081/ecj.2023.11257","DOIUrl":"https://doi.org/10.4081/ecj.2023.11257","url":null,"abstract":"Road traffic accident has become a public health concern. More than 80% injury-related deaths occurred in low-middle income countries (LMICs). Despite its importance, emergency care accessibility for road crash victims is still questionable. This study aims to review emergency care accessibility from approachability, acceptability, availability, affordability, and appropriateness dimensions for crash victims. This is a scoping review with literatures extracted from ScienceDirect, ProQuest, and Scopus. Articles analyzed using PCC (Problem/Population, Concept, Context) of scoping review. 1544 articles identified from databases of which 81 are relevant for full-text screening. The final 12 articles were eligible to be reviewed. Although emergency care is available in most areas, its existence was not well-known. Victims and helpers are treated unfairly in emergency care. Emergency care system also lacks clear coordination and it does not give appropriate treatment in timely manner. There was little evidence of how accessible emergency care to crash victims. Most studies only examined the availability of emergency care without comparing its actual utilization and other determinants impacting its accessibility. Future study should aim to assess approachability, acceptability, affordability, and appropriateness of emergency care. Strengthening emergency care from all dimensions is important to ensure its accessibility.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44885313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Morelli, Erika Poggiali, Eva Ioannilli, P. De Mitri, A. Corvi, G. Cervellin, A. Vercelli
Spinal cord injury without radiographic abnormality (SCIWORA) is a rare post-traumatic myelopathy, more frequently seen in paediatric population and elderly. Clinical manifestation can range from transient isolated paraesthesia to quadriplegia. Due to its rarity in adults and the broad spectrum of neurological manifestations, SCIWORA actually represents a challenge for emergency physicians. Early diagnosis and timely intervention are crucial for the patient’s prognosis avoiding permanent neurological deficits. Magnetic resonance imaging (MRI) plays a pivotal role in the diagnosis, management and prognosis of SCIWORA, being the golden standard technique to identify spinal cord injuries. To highlight the importance of in-depth neurological examination and early diagnosis of SCIWORA, we describe the case of a 53-year-old woman who presented to our emergency department following a forward fall down the stairs with a minor head injury.
{"title":"Spinal Cord Injury without Radiographic Abnormality (SCIWORA): a case report and literature review","authors":"N. Morelli, Erika Poggiali, Eva Ioannilli, P. De Mitri, A. Corvi, G. Cervellin, A. Vercelli","doi":"10.4081/ecj.2023.11233","DOIUrl":"https://doi.org/10.4081/ecj.2023.11233","url":null,"abstract":"Spinal cord injury without radiographic abnormality (SCIWORA) is a rare post-traumatic myelopathy, more frequently seen in paediatric population and elderly. Clinical manifestation can range from transient isolated paraesthesia to quadriplegia. Due to its rarity in adults and the broad spectrum of neurological manifestations, SCIWORA actually represents a challenge for emergency physicians. Early diagnosis and timely intervention are crucial for the patient’s prognosis avoiding permanent neurological deficits. Magnetic resonance imaging (MRI) plays a pivotal role in the diagnosis, management and prognosis of SCIWORA, being the golden standard technique to identify spinal cord injuries. To highlight the importance of in-depth neurological examination and early diagnosis of SCIWORA, we describe the case of a 53-year-old woman who presented to our emergency department following a forward fall down the stairs with a minor head injury.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46537787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mickail Zinchuk, M. Beghi, G. Castelpietra, S. Ferrari, E. Pashnin, A. Guekht
We aimed to compare psychiatric hospital visits during the COVID-19 quarantine period with the same period in 2019, to reveal the predictors of underutilization of mental health services. We then investigated the fluctuation of telemedicine service during the quarantine period. The retrospective study included patients with non-psychotic mental disorders who consecutively visited the Moscow clinic. The number of outpatient visits, inpatient admissions, sociodemographic factors were analyzed. We assessed the sample within two periods - the “quarantine period” (March 30 - June 9, 2020) and “control period” (March 30 - June 9, 2019). Psychiatric visits decreased in older, retired and disabled persons, and increased among the unemployed. In multivariate analysis, the reduction became significant for the number of inpatient admissions. Telemedicine calls gradually increased from the start of the service, but decreased towards the end of the quarantine. In conclusion, referrals to outpatient and inpatient psychiatric services decreased during the quarantine period, with newly established TMS potentially compensating for that decrease. The strongest factor associated with visits during the pandemic is employment status.
{"title":"The impact of COVID-19 quarantine on mental health: an observational study from an outpatient service for non-psychotic patients in Russia (Moscow)","authors":"Mickail Zinchuk, M. Beghi, G. Castelpietra, S. Ferrari, E. Pashnin, A. Guekht","doi":"10.4081/ecj.2023.10994","DOIUrl":"https://doi.org/10.4081/ecj.2023.10994","url":null,"abstract":"We aimed to compare psychiatric hospital visits during the COVID-19 quarantine period with the same period in 2019, to reveal the predictors of underutilization of mental health services. We then investigated the fluctuation of telemedicine service during the quarantine period. The retrospective study included patients with non-psychotic mental disorders who consecutively visited the Moscow clinic. The number of outpatient visits, inpatient admissions, sociodemographic factors were analyzed. We assessed the sample within two periods - the “quarantine period” (March 30 - June 9, 2020) and “control period” (March 30 - June 9, 2019). Psychiatric visits decreased in older, retired and disabled persons, and increased among the unemployed. In multivariate analysis, the reduction became significant for the number of inpatient admissions. Telemedicine calls gradually increased from the start of the service, but decreased towards the end of the quarantine. In conclusion, referrals to outpatient and inpatient psychiatric services decreased during the quarantine period, with newly established TMS potentially compensating for that decrease. The strongest factor associated with visits during the pandemic is employment status.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42655982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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