{"title":"Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Repair of partial lacerations of the extensor tendons of the hand.","authors":"M Smith, B Martin","doi":"10.1136/emj.17.4.285","DOIUrl":"https://doi.org/10.1136/emj.17.4.285","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 4","pages":"285"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.285","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21761124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chest pain is a common cause of accident and emergency (A&E) presentation. In the United States, it accounts for 5–6% of new emergency department attendances.1, 2 The principal challenge in these patients is to identify those with an acute coronary syndrome (ACS). Early diagnosis allows effective treatment and inadvertent discharge may have disastrous consequences for patient and doctor: in the United States, between 2–5% of acute myocardial infarctions (AMI) are discharged from the emergency department and 20% of malpractice claims against emergency physicians relate to the management of ACS.3 The problem with the A&E assessment of these patients lies in the limitations of diagnostic tests for acute coronary ischaemia—initial ECG is diagnostic of AMI in only 40–65% of patients and is even less useful in unstable angina.4 Despite recent advances, serum markers for myocardial necrosis detect, at best, 66% of AMIs on arrival.5 Faced with these diagnostic difficulties and the consequences of misdiagnosis, A&E physicians have a low threshold for admitting patients with chest pain in whom the diagnosis is not immediately clear. Some 60–65% of these patients have an eventual diagnosis of non-cardiac chest pain3 and while serious pathology is diagnosed in a minority, this traditional approach to chest pain is both time consuming and expensive. It is against this background that the concept of A&E based chest pain evaluation units emerged—the aim being to provide medically equivalent care at a lower cost for A&E chest pain patients with a probability for ACS that is low, but not sufficiently low to allow discharge. The concept originated in, and has been almost exclusively confined to, the United States. The first chest pain evaluation unit was set up in 1981 and, by 1997, 15% of emergency departments in the US had followed suit.6 The …
{"title":"Chest pain evaluation units.","authors":"G Quin","doi":"10.1136/emj.17.4.237","DOIUrl":"https://doi.org/10.1136/emj.17.4.237","url":null,"abstract":"Chest pain is a common cause of accident and emergency (A&E) presentation. In the United States, it accounts for 5–6% of new emergency department attendances.1, 2 The principal challenge in these patients is to identify those with an acute coronary syndrome (ACS). Early diagnosis allows effective treatment and inadvertent discharge may have disastrous consequences for patient and doctor: in the United States, between 2–5% of acute myocardial infarctions (AMI) are discharged from the emergency department and 20% of malpractice claims against emergency physicians relate to the management of ACS.3\u0000\u0000The problem with the A&E assessment of these patients lies in the limitations of diagnostic tests for acute coronary ischaemia—initial ECG is diagnostic of AMI in only 40–65% of patients and is even less useful in unstable angina.4 Despite recent advances, serum markers for myocardial necrosis detect, at best, 66% of AMIs on arrival.5 Faced with these diagnostic difficulties and the consequences of misdiagnosis, A&E physicians have a low threshold for admitting patients with chest pain in whom the diagnosis is not immediately clear. Some 60–65% of these patients have an eventual diagnosis of non-cardiac chest pain3 and while serious pathology is diagnosed in a minority, this traditional approach to chest pain is both time consuming and expensive.\u0000\u0000It is against this background that the concept of A&E based chest pain evaluation units emerged—the aim being to provide medically equivalent care at a lower cost for A&E chest pain patients with a probability for ACS that is low, but not sufficiently low to allow discharge. The concept originated in, and has been almost exclusively confined to, the United States. The first chest pain evaluation unit was set up in 1981 and, by 1997, 15% of emergency departments in the US had followed suit.6 The …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 4","pages":"237-40"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21761201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Glucose or glucagon for hypoglycaemia.","authors":"R Boyd, B Foëx","doi":"10.1136/emj.17.4.287","DOIUrl":"https://doi.org/10.1136/emj.17.4.287","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 4","pages":"287"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21761127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In covering these objectives we will deal with the following terms: In the first article of this series, we discussed graphical and tabular summaries of single datasets. This is a useful end point in its own right but often in clinical practice we also wish to compare datasets. Carrying this out by simply visually identifying the differences between two graphs or data columns lacks precision. Often therefore the central tendency and variability is also calculated so that more accurate comparisons can be made. It is usually possible to add to the tabular or graphical summary, additional information showing where most of the values are and their spread. The former is known as the central tendency and the latter the variability of the distribution. Generally these summary statistics should not be given to more than one extra decimal place over the raw data. Key point Central tendency and variability are common methods of summarising ordinal and quantitative data ### CENTRAL TENDENCY There are a variety of methods for describing where most of the data are collecting. The choice depends upon the type of data being analysed (table 1). View this table: Table 1 Applicability of measure of central tendency #### Mean This commonly used term refers to the sum of all the values divided by the number of data points. To demonstrate this consider the following example. Dr Egbert Everard received much praise for his study on paediatric admissions on one day to the A&E Department of Deathstar General (article 1). Suitably encouraged, he reviews the waiting time for the 48 paediatric cases involved in the study (table 2). View this table: Table 2 Waiting time for paediatric A&E admissions in one day to Deathstar General Considering cases 1 to 12, the …
{"title":"An introduction to everyday statistics--2.","authors":"P Driscoll, F Lecky, M Crosby","doi":"10.1136/emj.17.4.274","DOIUrl":"https://doi.org/10.1136/emj.17.4.274","url":null,"abstract":"In covering these objectives we will deal with the following terms:\u0000\u0000\u0000\u0000\u0000\u0000In the first article of this series, we discussed graphical and tabular summaries of single datasets. This is a useful end point in its own right but often in clinical practice we also wish to compare datasets. Carrying this out by simply visually identifying the differences between two graphs or data columns lacks precision. Often therefore the central tendency and variability is also calculated so that more accurate comparisons can be made.\u0000\u0000It is usually possible to add to the tabular or graphical summary, additional information showing where most of the values are and their spread. The former is known as the central tendency and the latter the variability of the distribution. Generally these summary statistics should not be given to more than one extra decimal place over the raw data.\u0000\u0000Key point \u0000\u0000Central tendency and variability are common methods of summarising ordinal and quantitative data \u0000\u0000### CENTRAL TENDENCY\u0000\u0000There are a variety of methods for describing where most of the data are collecting. The choice depends upon the type of data being analysed (table 1).\u0000\u0000View this table:\u0000\u0000 Table 1 \u0000Applicability of measure of central tendency \u0000\u0000\u0000\u0000#### Mean\u0000\u0000This commonly used term refers to the sum of all the values divided by the number of data points. To demonstrate this consider the following example. Dr Egbert Everard received much praise for his study on paediatric admissions on one day to the A&E Department of Deathstar General (article 1). Suitably encouraged, he reviews the waiting time for the 48 paediatric cases involved in the study (table 2).\u0000\u0000View this table:\u0000\u0000 Table 2 \u0000Waiting time for paediatric A&E admissions in one day to Deathstar General \u0000\u0000\u0000\u0000Considering cases 1 to 12, the …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 4","pages":"274-81"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.274","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21761119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anaesthetic training in accident and emergency.","authors":"J J O'Donnell","doi":"10.1136/emj.17.4.309","DOIUrl":"https://doi.org/10.1136/emj.17.4.309","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 4","pages":"309"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21761672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Feigning dystonia to feed an unusual drug addiction.","authors":"B Dooris, C Reid","doi":"10.1136/emj.17.4.311","DOIUrl":"https://doi.org/10.1136/emj.17.4.311","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 4","pages":"311"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21761678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Ingested coins and metal detection.","authors":"S. Maurice, K. Mackway-Jones","doi":"10.1136/EMJ.17.4.282-A","DOIUrl":"https://doi.org/10.1136/EMJ.17.4.282-A","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 4 1","pages":"282-3"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/EMJ.17.4.282-A","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64230263","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}
Report by John Butler, Specialist Registrar Search checked by Simon Carley, Specialist Registrar A 19 year old man attends the emergency department having been assaulted in a night club. He has sustained an isolated head injury with no loss of consciousness and is fully alert …
{"title":"Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Regional anaesthesia for femoral shaft fractures in children.","authors":"R Williams, P Wallman","doi":"10.1136/emj.17.4.283","DOIUrl":"https://doi.org/10.1136/emj.17.4.283","url":null,"abstract":"Report by John Butler, Specialist Registrar Search checked by Simon Carley, Specialist Registrar \u0000\u0000A 19 year old man attends the emergency department having been assaulted in a night club. He has sustained an isolated head injury with no loss of consciousness and is fully alert …","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 4","pages":"283-4"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21761121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Early management of displaced nasal fractures.","authors":"T Gilpin, S Carley","doi":"10.1136/emj.17.4.286","DOIUrl":"https://doi.org/10.1136/emj.17.4.286","url":null,"abstract":"","PeriodicalId":73580,"journal":{"name":"Journal of accident & emergency medicine","volume":"17 4","pages":"286"},"PeriodicalIF":0.0,"publicationDate":"2000-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/emj.17.4.286","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21761125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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