Accident Emergency Departments Research Articles

"What you Say Matters": Review of Clinical Outcome of Advanced Medical Directives Between Cancer and Non-cancer Patients in a Chinese Culture Society.

Advance medical directives (AMD) are statements made by individuals indicating the life-sustaining treatment that they would refuse in the future when they lost their mental capacity for medical decisions. While the proposal for the AMD legislation is ongoing locally in Hong Kong SAR, there are limited reviews on the clinical outcomes associated with it. To provide a comprehensive review on clinical outcomes of signed AMD. Retrospective, multi-center study, which includes AMD signed within five cluster hospitals. Records of signed AMD from 1st JAN 2020 to 31st DEC 2022 were retrieved from a central registry. Clinical information of each patient was obtained from the electronic patient record. 456 patients with documented AMD were included in the study. 91.6% of AMD were signed by palliative care (PC) team. Majority (74.6%) of the patients were accompanied by family members or friends when AMD were signed. The concordance rate between the AMD and the medical care received was 89.5%. No patient revoked their AMD. Cancer and non-cancer patients showed similar rates of AMD concordance, frequency of Accident & Emergency Department (AED) visits or acute ward admissions, duration of hospital stays in the 30days before death, and prevalence of receiving invasive or intensive treatments. Our study demonstrated that PC team currently plays a pivotal role in AMD completion, and AMD remains important in ensuring patients' care preferences are executed across different medical conditions. With the upcoming AMD legislation in Hong Kong SAR, adequate promotion and education should be launched.

Diaphyseal Humeral Fractures Treated by Bracing versus Dynamic Compression Plate

Objective: To compare the results of humerus shaft fractures treated by functional bracing and dynamic compression plate. Study Design: Cross sectional comparative study. Place and Duration of Study: Department of Orthopaedic Surgery & Traumatology, Liaquat University Hospital Hyderabad/Jamshoro from 1st June 2015 to 31st May 2016. Methodology: Eighty cases selected from accident emergency department and outpatient departments. Cases were divided in two groups; group A (dynamic compression plate) and group B (functional bracing). Patients of either gender with age range 18-50 years with an isolated closed fracture of the humeral shaft, of duration within 2 weeks and who were willing to participate in the study were included in the study while open fractures, bilateral injuries, poly-trauma, pathological fracture, smoker, alcoholic, immune compromised, and history of poor compliance, psychiatric disease were excluded. Results: In conservative group, 32 (80%) were males and 8 (20%) females while in dynamic compression plate group, 30 (75 %) were males and 10 (25%) females with mean age was 35.75±9.083 year. There were 46 (57.5%) patients who sustained fractures following road traffic accidents 16 (20%) cases had fall from height and 18 (22.5 %) cases had after assault. Fracture location was middle third in most of cases in both groups. Mean time for union was 15.45±2.864 and 14.325±3.033 weeks and mean time of follow-up was 48.35±6.436 & 42.52±9.33 weeks in dynamic compression plate and functional bracing groups respectively Conclusion: Plating of humeral shaft fracture was found to be satisfactory method of treatment with high fracture union rates, better functional outcome [DASH Score] and low complication rate as compared to functional bracing group. Keywords: Humeus shaft, Fracture, Dynamic compression plate, DASH score, Conservative, Functional bracing

A Bird’s Eye View on Firearm Injuries Lady Reading Hospital MTI, Peshawar

Background There is a concern that firearm injuries are very common reported at lady Reading hospital Peshawar MTI, but the there are no contemporary studies. Gunshot wound are persistent burden on community as well as on hospitals Aim: To evaluate trends of firearm injuries reporting to LRH their anatomical distributions and their outcomes. Methods: This prospective randomized study (a pilot project for public health alert) was conducted in Accident & Emergency Department of Lady Reading hospital MTI, Peshawar KPK, from 1st May, 2020 to 1st October, 2020. Hundred patients with firearm injuries to different region shot were included in this study. Data collected on predesigned proforma and entries in HMIS used after stabilizing the patient. A prospective pilot study done over a period of six months from 1st May, 2020 to 1st October, 2020 in trauma section of Accident Emergency department of Lady Reading hospital MTI Peshawar. Results: Patients of all age groups with firearm injuries were included in this study from May 2020 to October 2020. Data was collected on predesigned proforma as well as HMIS (health management information system) of ED department. A total of 100 patients presented to LRH with firearm injuries during six months. Males outnumbered female by 6:1 accounting for 100(85%) of injured. : Domestic violence was found to be the most common reason for the firearm use 44(44%), Don’t know or refuse to share was 29(29%), rivalry 12(12%), land and property conflict 9(9%), street fight 3(3%) accidental gunshots 2%, (n=25) and robbery 1.1% (n=1).The most common firearm used for inflicting injury was pistol (70%), shot gun (2.2%), curiously 16% were either reluctant or were never knowing about the weapon Conclusion: Firearm injuries are common public health problem globally, in our set up situation is more grievous and less highlighted, the most common cause being domestic violence, lack of education, easy availability of arms, illegal or legal weapon ownership making situation worst in the form of premature deaths and disability. Understanding the nature of problem can prevent this violence Keywords: Firearms, violence, gunshot wounds, homicides, suicides

Epidemiological analysis of 1637 cases of animal bite injuries

Background: This study was conducted prospectively over a period of two years in accident and emergency department of Government Medical College, Srinagar. The main objectives of the study included finding out epidemiological aspects of animal bites, categorising bites and analysing associated injuries.Methods: From April 2009 to April 2011, more than 1800 patients presented to accident emergency department with injuries due to human animal conflict. Out of them, 1673 patients had only bite injuries and were treated on out patient basis were included in the study.Results: Study revealed incidence in males (69.27%) being higher than in females. The age group most commonly involved was 0-10 years and rural population (60.72%) was more affected as compared to urban population. Furthermore, dogs were most common (88.46%) animals to be involved in bites. The commonest bite category was class 2 among all the bites (58.57%) while as type 1 was least common (9.74%). Injury pattern showed that most common site of bite was lower limbs, left leg (56.90%) being more common than the right.Conclusions: We conclude from this study that animal bites usually involve age group of less than 10 years. Males and rural population are more commonly involved. Dog is most common animal involved in such conflicts. We found lower limbs are most common sites involved with left lower limb being more commonly bitten as compared to right.

Driver sleepiness, fatigue, careless behavior and risk of motor vehicle crash and injury: Population based case and control study

A few studies have been conducted to determine the relationship between road motor vehicle crashes (MVC) and serious injuries related to tiredness, fatigues and sleeping. To determine the effects of aggressive behaviour, driver sleepiness and fatigue on MVC and related injuries among Turkish population. Population-based case and control study conducted at the accident emergency departments of hospitals and roads. 515 car drivers involved in crashes with injury were admitted to hospital and 1030 car drivers involved while driving on public roads as control group during the study period. The Manchester driver behaviour questionnaire (DBQ) measured the aberrant driving behaviours leading to accidents. Participants completed a fatigue severity scale (FSS) and Stanford Sleeping questionnaire an epworth scale with items related to socio-demographic information, driving experiences, adherence to traffic laws (such as speed limits and seat belt), and drivers’ driving records. In a representative sampling, participant’s age ranged from 25 to 65 and the mean and standard deviation were 36.5 ± 7.8 for cases and 37.0 ± 8.0 for controls. There was a significant difference in both group of drivers regarding BMI, level of education, marital status, driving experience, seat belt use, excessive speed limits, physical activity number of sleeping hours, mobile phone use, and cigarette smoking habit (p = 0.017). Also, there was a significant higher mean score on all the DBQ violation questions among case group in comparison with the control group (p < 0.001). Further, cases had higher prevalence of Epworth sleeping disorders (p < 0.001) and fatigue severity (p = 0.003) compared to control drivers. Multivariate logistic regression revealed that excessive speed, fatigue, lapses, errors, Stanford sleepiness score, violations, mobile phone use and Epworth sleepiness scale were significantly associated with injury involvement in vehicle crash, after adjusting for driving experience and annual mileage. The current study confirmed that drivers with chronic fatigue, acute sleepiness, and careless driver behavior may significantly increases the risk of road crash which can be lead to serious injury.

Examination of narratives from emergency department presentations to identify road trauma, crash and injury risk factors for different age groups.

Road trauma represents a high proportion of injury-related emergency department presentations. Narrative text recorded in the emergency department could provide useful information to monitor road trauma and to identify crash and injury risk factors by age group. To examine the Public Health Real-time Emergency Department Surveillance System (PHREDSS) to identify road users (i.e. motor vehicle drivers, motor vehicle passengers, motorcyclists, pedal cyclists and pedestrians), and crash (e.g. vehicle speed) and injury risk factors (e.g. non-restraint use) by age group. Narrative text from the PHREDSS in New South Wales, Australia, during 1 January 2006 to 31 December 2012 was reviewed. A keyword search of all emergency department presentations potentially identified 388,991 road trauma-related presentations and between 6,420 motorbike crashes to 138,889 motor vehicle accident emergency department presentations. Potential crash and injury risk factors were also identified. This exploratory study demonstrated the capability of information from PHREDSS to be used to support injury prevention efforts in road safety.

Abstracts “From Qatar to the World”

Background: Ocular trauma is a significant problem in pediatric patients. Also, leads to visual loss throughout the world there are no data of pediatric ocular trauma in Arabian Gulf Countries in the current literature. Aim: To study the epidemiology, mechanism, causes and outcome of serious ocular trauma requiring hospital admission, in children below 16 years of age. Study design: A retrospective cohort study. Subjects: All pediatric patients (up to 16 years of age) presenting with ocular injuries to a tertiary care pediatric ophthalmology and Pediatric Accident Emergency Department January 1, 2005 to December 30,2009.

Clinical pattern of pediatric ocular trauma in fast developing country

Ocular trauma is a significant problem in pediatric patients. Also, leads to visual loss throughout the world there are no data of pediatric ocular trauma in Arabian Gulf Countries in the current literature. To study the epidemiology, mechanism, causes and outcome of serious ocular trauma requiring hospital admission, in children below 16years of age. A retrospective cohort study. All pediatric patients (up to 16years of age) presenting with ocular injuries to a tertiary care pediatric ophthalmology and Pediatric Accident Emergency Department 1 January 2005 to 30 December 2009. Each file was studied to find out the demographic data, mechanism and cause of injury. The definitions and classifications of ocular trauma in our study were modified from the Ocular Trauma Classification Group guidelines and Birmingham Eye Trauma Terminology Presenting and final visual acuity were recorded along with details of anterior and posterior segment evaluation. Hundred and six files of the children admitted to ophthalmology ward with the diagnosis of ocular trauma between 2005 and 2009 were reviewed. Majority were boys (77.4%). The mean age at admission was 6.63years. A higher incidence of ocular trauma was noted in children above 5years than those below (58.5%). Most number of trauma occurred at home (42.5%, n=45) followed by street (35.8% n=34), school (12.3%, n=13), sporting area (5.7%, n=6). Also, eight patients (8.5%) involved in Road Traffic Accidents (RTA). Closed globe injury occurred more frequently than open globe injury (59.4% vs. 40.6%). Initial visual acuity was more than 6/60 in (55.6%) patients of closed globe while in open globe injury was (37.3%). Final visual acuity was more than 6/18 in (82.5%) patients of closed globe injury group and in (63%) patients of open globe injury group. Severe impairment of vision was found in (11.6%) and blindness (4.7%) only in open globe injury group. Most eye injuries in children are preventable so this reflects the importance of health education, adult supervision and application of appropriate measures that is necessary for reducing the incidence and severity of trauma.

Self-referrals to the A&E department during out-of-hours: Patients’ motives and characteristics

Objective To determine self-referrals’ motives to visit the accident & emergency departments (AED) and to compare their characteristics to patients contacting the GP cooperative. Methods Postal questionnaires were send to AED self-referrals and logistic regression analysis was used to contrast self-referrals to patients contacting the GP cooperative. Results For a study population of 62,000, during 4 months, 5547 contacts were registered with the GP cooperative, along with 808 AED contacts, 344 of whom (43%) were self-referrals. Main reasons to visit the AED were the perceived need for diagnostic facilities and the conviction that the hospital specialist was best qualified to handle the problem. Dissatisfaction with the GP cooperative among respondents was high. Self-referral to the AED was positively associated with injury, age between 15 and 64, musculoskeletal, cardiovascular and respiratory problems, and distance to the GP centre. Conclusion Self-referrals emerge as patients with a strong preference for the AED, mainly based on assumptions on quality of care and necessary facilities. Practice implications While self-referrals may, in part, make motivated and appropriate choices to visit the AED, new integrated care models should be studied that can adequately deflect those who are eligible for GP care.

Femoral fractures in children related to motor vehicle injuries

Summary The aim of this study is to determine the incidence of injuries in children aged from 1 to 16 years old who sustain a femoral fracture associated with a motor vehicle accident in the State of Qatar. It is a retrospective descriptive case series study conducted in the Accident Emergency Department at the Hamad General Hospital, State of Qatar, from January 1992 to December 2004. A total of 256 subjects aged 1–16 years with femoral fractures, secondary to a motor vehicle accidents were studied. All of them were seen at the Accident Emergency Department (AED), Critical Care, and Physiotherapy Departments of the Hospital. The socio-demographic information and the details of the injury of the studied subjects were collected. Of the 256 children, 82% of them were boys and 18% were girls with a male to female ratio of 4.6:1. Most femoral fractures were secondary to automobile-pedestrian accidents (43.4%), followed by motor vehicle crashes (30.1%). Of the 256 fractured femurs, 38 were open (15%) and 218 were closed (85%). Two hundred and ninety-eight associated injuries occurred in 240 patients (93.8%). Non-femoral fractures were common (46.6%), followed by soft-tissue injuries (21.5%) and head injuries (14.4%). The lower limbs were most commonly involved with associated fractures (38.1%), followed by upper limbs (27.4%) and soft-tissue injuries (21.4%). The incidence of intra-abdominal injury was 5.4%. Ninety children (35.2%) developed 1 or more complications. Furthermore, there was a statistically significant correlation between the duration of hospital stay and the fracture site ( r =0.820, p =0.01), and between age ( r =0.295, p =0.01) and type of injury ( r =0.241, p =0.01). The study revealed that the fracture of the femur secondary to motor vehicle accidents is a common injury among children in Qatar. There was an increased incidence of lower and upper limb injuries associated with femoral fracture in children involved in motor vehicle injuries. One third of the children developed one or more complications. Complications of injuries influenced the length of stay in hospital.

Completeness of medical records in emergency trauma care and an IT-based strategy for improvement

The medical trauma record, produced in the Accident & Emergency Departments (AEDs) receives much attention from both health-care professionals and parties interested in quality of care. While it is an important data source for health-care professionals in their everyday work, and for quality assessment by third parties, the (paper) medical record is usually negatively evaluated because of incompleteness. In this article, we show that completeness is relative to the purpose for which the record is used. We distinguish two contexts in which the trauma record is used: the primary-care process at the AED, and assessment and monitoring of trauma care. Incompleteness of the medical record is valued differently in these contexts. Especially with regard to the information demands of quality assessment, and more specifically the national trauma registry, the work processes in the AED have not evolved sufficiently as yet. Information technology has great power to improve completeness and to facilitate quality assessment, but it cannot solve the problem of incompleteness in itself. One solution we propose is to restructure the recording process by introducing a clerk. This clerk could also be a nurse or physician who is temporarily released from direct patient care.

Camel Racing Injuries Among Children

The aim of this study is to determine the frequency and severity of camel racing injuries among children aged 5 to 15 years during the period 1992 to 2003 in the State of Qatar. Case series. The study was conducted in the Hamad General Hospital, State of Qatar, from January 1992 to December 2003. A total of 275 subjects aged 5 to 15 years with camel racing injuries who were seen at the Accident Emergency Department, Critical Care, and Physiotherapy Departments of the Hamad General Hospital were studied. The sociodemographic information and the details of the injury of the studied subjects were collected. The Abbreviated Injury Scale system was used to determine the severity of injury. Overall, 275 camel racing injuries were reported among boys aged 5 to 15 years. The majority of patients were Sudanese (91.3%). The most commonly injured locations were upper limb (23.2%), lower limb (21.1%), and head (20.7%), followed by other injury locations. Seventeen patients were disabled as a result of their injury, and another 3 injuries were fatal. This study revealed that 34% of injuries were considered to be minor, 22.1% moderate, 18.1% serious, 11.6% critical, and 6.4% maximum. The injury severity caused by the camel racing significantly affected the length of hospital stay. At present, the government is serious about this problem, and there is a draft of proposed legislation intended to prevent the employment of children below the age of 12 as camel jockeys.

Computed tomography of the brain in predicting outcome of traumatic intracranial haemorrhage in Malaysian patients.

Head injury is a significant economic, social and medical problem all over the world. Road accidents are the most frequent cause of head injury in Malaysia with highest risk in the young (15 to 24 years old). The associated outcomes include good recovery, possibility of death for the severely injured, which may cause disruption of the lives of their family members. It is important to predict the outcome as it will provide sound information to assist clinicians in Malaysia in providing prognostic information to patients and their families, to assess the effectiveness of different modes of treatment in promoting recovery and to document the significance of head injury as a public health problem. A total of 103 cases with intracranial haemorrhage i.e. intracerebral haemorrhage, extradural haemorrhage, subdural haemorrhage, intraventricular haemorrhage, haemorrhagic contusion and subarachnoid haemorrhage, following motor vehicle accidents was undertaken to study factors contributing to either good or poor outcome according to the Glasgow Outcome Scale. Patients below 12 years of age were excluded. The end point of the study was taken at 24 months post injury. The selected variables were incorporated into models generated by logistic regression techniques of multivariate analysis to see the significant predictors of outcome as well as the correlation between the CT findings with GCS. Significant predictors of outcome were GCS on arrival in the accident emergency department, pupillary reflex and the CT scan findings. The CT predictors of outcome include ICH, EDH, IVH, present of SAH, site of ICH, volumes of EDH and SDH as well as midline shift.

Assessment of repair of facial lacerations

A survey of senior nurses in 100 randomly selected large (< 30 000 new patients/year) UK Accident & Emergency Departments (AED) was undertaken to investigate which grade of staff/specialty sutured facial lacerations and to obtain an inter-specialty perspective of standards of care. Of the 80 hospitals whose AED senior nurse responded, half had resident oral and maxillofacial surgeons but only 20% had resident plastic surgeons. Lacerations were mainly sutured by AED doctors (55% of hospitals), oral and maxillofacial surgeons (21%), plastic surgeons (12%) and AED nurses (11%). Overall the highest standard of care was considered to be provided by oral and maxillofacial and plastic surgery registrars and the lowest by nurses and consultants. Overall, oral and maxillofacial surgery services were ranked first, plastic surgery second and A&E third. Monofilament polypamide was the most favoured suture material, but polybutester and polypropylene were also widely used.

Dislocation of scaphoid and fractured capitate in a child

A 6-year-old girl was playing near a stack of paving slabs which collapsed. One of the falling slabs struck the dorsum of her left forearm. The child’s parents brought her to the accident and emergency department where she was seen by a senior house officer who noted that the wrist was mis-shapen, bruised and tender with a reduced range of movement. A radiograph was requested which was thought to show no bony injury; the patient was treated with a Tubigrip and sling. The subsequent consultant radiologist’s report concurred with the opinion of the SHO. The patient continued to complain of pain in her wrist and was referred back to the accident emergency department by her GP 3 weeks later. There had been no further injury. On this occasion it was noted that there was a tender bony prominence over the volar aspect of her left wrist with reduced flexion and extension of the joint. A further radiograph was interpreted as showing a fractured capitate and the patient was treated with a plaster-of-Paris backslab and referred to the fracture clinic for follow-up. When she attended the clinic the diagnosis of a fractured capitate was confirmed, but there was an additional suspicion of a dislocated schaphoid (Figures I, 2). Arrangements were made to admit the child for operation the following day. Fipre 3 shows the wrist radiograph of an uninjured 6-year-old for comparison. Exploration through an axial incision over the volar swelling revealed a pseudo capsule around a bony prominence between the radial artery and flexor pollicis longus. This was opened revealing