Triage Category Research Articles

Role of Newly Introduced Teledentistry Service in the Management of Dental Emergencies During COVID-19 Pandemic in Qatar: A Cross-Sectional Analysis.

Introduction: The lockdown imposed by the COVID-19 pandemic rendered teledentistry (TD) necessary to maintain the continuity of oral health services and avoid missing emergency dental conditions, while minimizing face-to-face visits. Our objective was to evaluate the ability of a newly introduced triage-based TD service to deliver its goals, by evaluating its processes and outcomes and assessing the demand for TD. Methods: This cross-sectional report assessed the triage processes and outcomes (triage category, referral to emergency/dental facility undertaken, remote medications prescribed, and procedures performed at the point of referral); and evaluated the demand for the newly introduced TD service during 5 months of the first wave of the pandemic. Results: Of 850 calls, about 70.6% of the samples were managed remotely; 29.4% were categorized as emergency/urgent and referred to the emergency/dental facility. Compared with other complaints, orofacial dental pain was the most common reason for the calls (41.6%, p < 0.0001). About 14.71% of callers received prescription for medications remotely. The most demanded disciplines were general dentistry, orthodontics, and oral surgery, respectively (p < 0.0001). Of those referred to a dental facility, 31.84% required no clinical intervention, 28.7% received orthodontic appliance repair, and 14.3% and 11.2% had urgent dental extractions or root canal treatments. Demand on the service fluctuated through various distinct stages of the lockdown. Conclusions: There has been continuous demand for the newly introduced TD service throughout the period of the current report despite the fluctuations, with most complaints managed remotely. TD was effective and suitable for triage, service delivery, and care during the pandemic.

Association of Socioeconomic Status With Outcomes and Care Quality in Patients Presenting With Undifferentiated Chest Pain in the Setting of Universal Health Care Coverage.

BACKGROUNDThis study aimed to assess whether there are disparities in incidence rates, care, and outcomes for patients with chest pain attended by emergency medical services according to socioeconomic status (SES) in a universal health coverage setting.METHODS AND RESULTSThis was a population‐based cohort study of individually linked ambulance, emergency, hospital admission, and mortality data in the state of Victoria, Australia, from January 2015 to June 2019 that included 183 232 consecutive emergency medical services attendances for adults with nontraumatic chest pain (mean age 62 [SD 18] years; 51% women) and excluded out‐of‐hospital cardiac arrest and ST‐segment–elevation myocardial infarction. Age‐standardized incidence of chest pain was higher for patients residing in lower SES areas (lowest SES quintile 1595 versus highest SES quintile 760 per 100 000 person‐years; P<0.001). Patients of lower SES were less likely to attend metropolitan, private, or revascularization‐capable hospitals and had greater comorbidities. In multivariable models adjusted for clinical characteristics and final diagnosis, lower SES quintiles were associated with increased risks of 30‐day and long‐term mortality, readmission for chest pain and acute coronary syndrome, lower acuity emergency department triage categorization, emergency department length of stay >4 hours, and emergency department or emergency medical services discharge without hospital admission and were inversely associated with use of prehospital ECGs and transfer to a revascularization‐capable hospital for patients presenting to non‐percutaneous coronary intervention centers.CONCLUSIONSIn this study, lower SES was associated with a higher incidence of chest pain presentations to emergency medical services and differences in care and outcomes. These findings suggest that substantial disparities for socioeconomically disadvantaged chest pain cohorts exist, even in the setting of universal health care access.

Return visits to the paediatric emergency department.

To determine the rate of unplanned return visits (uRVs) within 48 h to a paediatric ED over a 12-month period and describe the factors associated with these uRV. Retrospective review of electronic data regarding the initial and follow-up visit at a tertiary paediatric hospital ED in Western Australia. The primary outcome was the number of patients who presented for uRV within 48 h of their initial ED visit. Between August 2018 and July 2019, 2322 patients returned to the ED for a uRV comprising 3.4% of 68 352 ED presentations with more than 53% returning with infectious causes. Triage category 3 patients were most likely to represent (OR 1.11, P= 0.029) with 3-month to 1-year old (OR 1.37, P< 0.00001) and 1-5-year old (OR 1.32, P< 0.00001) the commonest age groups. There was seasonal variation in uRVs demonstrating a greater number in the winter months. The percentage of uRVs to overall ED presentations was greater in the summer months (3.8-4.1%). There was a significant increase in uRVs occurring up to 2 weeks after the changeovers in middle-grade ED doctors only. The present study has demonstrated associations between uRV and initial-visit triage category 3, age between 3months and 5 years, and presentations because of infectious illness. Middle-grade doctor changeover was also associated with an increase in uRVs.

Growth in emergency department self-harm or suicidal ideation presentations in young people: Comparing trends before and since the COVID-19 first wave in New South Wales, Australia.

Self-harm presentations in children and young people have increased internationally over the last decade. The COVID-19 pandemic has the potential to worsen these trends. To describe trends in emergency department self-harm or suicidal ideation presentations for children and young people in New South Wales before and since the COVID-19 pandemic. We studied presentations for self-harm or suicidal ideation by 10- to 24-year-olds to New South Wales emergency departments, using interrupted time series analysis to compare annualised growth before COVID (2015 to February 2020) and since COVID (March 2020 to June 2021). Subgroup analyses compared age group, gender, triage category, rurality and disadvantage. Time series decomposition via generalised additive models identified long-term, seasonal and short-term trends. Self-harm or suicidal ideation presentations by young people in New South Wales increased by 8.4% per annum pre-COVID. Growth accelerated since COVID, to 19.2% per annum, primarily due to increased presentations by females aged 13-17 years (47.1% per annum since COVID, from 290 per 10,000 in 2019 to 466 per 10,000 in 2021). Presentations in males aged 10-24 years did not increase since COVID (105.4 per 10,000 in 2019, 109.8 per 10,000 in 2021) despite growing 9.9% per annum before COVID. Presentation rates accelerated significantly in socio-economically advantaged areas. Presentations in children and adolescents were strongly linked to school semesters. Emergency department self-harm or suicidal ideation presentations by New South Wales young people grew steadily before COVID. Understanding the sustained increase remains a priority. Growth has increased since COVID particularly for adolescent females, but not among adolescent males. Surprisingly, the largest post-COVID increases in annual growth occurred in socio-economically advantaged and urban regions. The COVID-19 pandemic appears to have added new challenges, particularly in females in the developmentally critical early adolescent and teenage years.

Emergency department utilisation by homeless children in Dublin, Ireland: a retrospective review

IntroductionDespite increasing prevalence, European family homelessness remains under-researched.MethodsA retrospective review was performed of homeless children attending a paediatric emergency department in Dublin, Ireland, from 1 January 2017 to 31 December...

Mass Casualty Incident: Do Tactical Tag Bracelets Improve Triage Performance by First Responders? A Randomized Controlled Mass Casualty Incident Simulation and Response of A French Gendarmerie Elite Unit.

Tactical triage replaces primary triage in the exclusion zone in mass murder or terrorist events to prioritize victims requiring life-saving interventions (LSIs) and/or rapid extraction in an environment with a lack of resources and under active threat. French gendarmerie tactical unit medical teams use triage bracelets during mass casualty incidents (MCIs). This study assessed the value of these bracelets in the tactical triage performance of nonhealthcare combat rescue operators in an MCI simulation. To compare triage performance with and without the use of bracelets based on categorization accuracy, LSIs, and time to end triage. Two groups of operators were randomly assigned to participate in an MCI simulation alone (10 simulated patients) with (intervention group) or without (control) bracelets. The primary outcome was triage performance assessed by the mass casualty triage performance assessment tools. The results were measured based on the LSI required, triage category, and time of completion of the task. Secondary outcomes were operator-perceived stress and self-efficacy. Eleven operators (intervention group n = 5, control group n = 6) participated. Triage performance, based on a maximum score of 90, was better for the intervention group [72.200 (SD = 10.330) vs. 57.000 (SD = 12.961), P = .045]. Self-efficacy was increased after the simulation in the intervention group [45.00 47.2 (SD = 4.147) vs. 50.400 (SD = 5.505), P = .034)]. This is the first study to show the best triage performance among nonhealthcare combat rescuers using triage bracelets in an MCI simulation. The small sample size did not allow for external validity of the results. The initially calculated number of participants (N = 12) was not reached for operational reasons. The use of bracelets may have a place in the medico-organizational act of tactical triage during MCIs in exclusion zones. Further studies should be conducted to assess the value of triage bracelets by other first responders, including physician-nurse teams.

Suicide-related crisis presentations to a rural emergency department: A retrospective cohort study.

The study sought to investigate the profile and characteristics of suicide-related crisis presentations and factors associated with repeat presentations to a rural hospital Emergency Department (ED). This retrospective cohort study examined suicide-related crisis presentation data from a rural ED for the years 2008-2018 inclusive. Descriptive statistical analyses included demographic characteristics and trends over time. Factors associated with increased likelihood to re-present to the ED for suicide-related crisis were identified using Odds Ratio analyses. First Nations People, adolescents and young adults were at increased risk of presentation. Suicidal crisis presentations had increased well beyond that which might be accorded to the catchment's population increase and almost a third of presentations involved individuals re-presenting in suicide-related crisis. Repeat presentation was positively associated with younger age, less acute triage category, discharge to the community and leaving the ED before/during treatment. This study illustrates the importance of flagging, follow-up and support of rural repeat presenters to reduce further suicidal behaviours and presentation. Findings support the need for culturally safe and appropriate interventions and follow-up services. It is recommended to extend approach this to non-ED settings.

Abstract TMP11: Predictors Of Timely Treatment Of Aneurysmal Subarachnoid Hemorrhage - The Reddish Study

Background: Receiving early treatment for aneurysmal subarachnoid hemorrhage (aSAH) is associated with better outcomes for the patient. However, delays in treatment of aSAH are common but the causes are not well understood. We explored predictors of early treatment within 12.5 hours or 24 hours after aSAH. Methods: Consecutive cases of confirmed first-ever aSAH were identified from two Australian tertiary referral centers between 2010 and 2016. We used medical and ambulance records to extract details of participants, including time from onset to definitive treatment of either endovascular coiling or neurosurgical clipping, demographics, severity of aSAH (modified Fisher grade; World Federation of Neurosurgeons Scale [WFNS]), risk factors, pre-hospital care, and presenting symptoms. Factors associated with treatment to secure the aneurysm within 12.5 hours or 24 hours on univariable logistic regression were entered into a multivariable model to identify factors independently associated with (odds ratio [OR], 95% CI) earlier treatment. Results: Among 482 patients (mean [SD] age 54.1 [14.5]; 69.9% female) with aSAH, median (IQR) time to treatment was 19.4 (10.6, 31.0) hours, 30% were treated &lt;12.5h and 62% were treated &lt;24h from onset. In multivariable analyses (see figure), arriving by ambulance, urgent triage category (1-2) and severe aSAH (modified Fisher Scale 3-4) predicted treatment &lt;12.5h and &lt;24h. Less severe aSAH (WFNS score 1-3) and arriving overnight (11pm to 7am) were associated with treatment &lt;24h. In contrast, people with no risk factors for aSAH (smoking, hypertension or alcohol use), presenting with a stiff neck or interfacility transfer more often had treatment ≥12.5h. Conclusions: A substantial proportion of people after aSAH were not treated within timeframes associated with better outcomes. Recognition of the urgency and severity aSAH cases were associated with more timely treatment of aSAH.

Impact of COVID-19 pandemic on ophthalmic presentations to an Australian outer metropolitan and rural emergency department: a retrospective comparative study

BackgroundTo analyse ophthalmic presentations to an outer metropolitan and a rural emergency department (ED) during the first wave of the COVID-19 pandemic in New South Wales (NSW), Australia.MethodsA retrospective comparative study of ophthalmic emergency presentations to Campbelltown Hospital (fifth busiest NSW metropolitan ED; population 310,000) and Bowral and District Hospital (rural ED; population 48,000) before and during COVID-19 was conducted. Patient demographics, triage category, referral source, diagnosis, length of stay, departure status, and follow-up location were assessed from coding data between March 1st to May 31st in 2019 and 2020, corresponding to the peak case numbers and restrictions during the first wave of the COVID-19 pandemic in NSW. Differences before and during COVID-19 were analysed using chi-squared tests or independent sample t-tests.ResultsThere was no change in ophthalmic presentations at Campbelltown (n = 228 in 2019 vs. n = 232 in 2020; + 1.75%, p = 0.12) and an increase at Bowral (n = 100 in 2019 vs. n = 111 in 2020; + 11%, p < 0.01) during COVID-19. Urgent ophthalmic presentations (Triage Category 3) decreased at Bowral (p = 0.0075), while non-urgent ophthalmic presentations (Triage Category 5) increased at both hospitals (Campbelltown p < 0.05, Bowral p < 0.01).ConclusionsThere was no change in the total number of ophthalmic presentations to an outer metropolitan and an increase to a rural ED during the first wave of the COVID-19 pandemic in New South Wales, Australia. A change in the type of ophthalmic presentations at these peripheral EDs suggest that a high demand for ophthalmic services remained despite the pandemic and its associated gathering and movement restrictions. A flexible healthcare delivery strategy, such as tele-ophthalmology, may optimise patient care during and after COVID-19.

German emergency department measures in 2018: a status quo based on the Utstein reporting standard

BackgroundCompelling data on clinical emergency medicine is required for healthcare system management.The aim of this survey was to describe the nationwide status quo of emergency care in Germany at the healthcare system level using the Utstein reporting template as the guideline to measure the data collected.MethodsThis cross-sectional survey collected standardized data from German EDs in 2018. All 759 of the EDs listed in a previously collected ED Directory were contacted in November 2019 using the online-survey tool SoSci Survey.Exclusively descriptive statistical analyses were performed. Absolute as well as relative frequencies, medians, means, ranges, standard deviations (SD) and interquartile ranges (IQR) were reported depending on distribution.Main ResultsA total of 150 questionnaires of contacted EDs were evaluated (response rate: 19.8%). Hospitals had a median of 403 inpatient beds (n=147). The EDs recorded a median of 30,000 patient contacts (n=136). Eighty-three EDs (55%) had observation units with a median of six beds. The special patient groups were pediatric patients (< 5 years) and older patients (> 75 years) with a median of 1.7% and 25%, respectively. Outpatients accounted for 55%, while 45% were admitted (intensive care unit 5.0%, standard care unit 32.3%, observation unit 6.3%) and 1.2% transferred to another hospital.ConclusionsThe use of the Utstein reporting template enabled the collection of ED descriptive parameters in Germany. The data can provide a baseline for upcoming reforms on German emergency medicine, and for international comparisons on admission rates, initial triage categories, and patient populations.

Accuracy of Emergency Severity Index in older adults.

Background and importanceEmergency Severity Index is a five-level triage tool in the emergency department that predicts the need for emergency department resources and the degree of emergency. However, it is unknown whether this is valid in patients aged greater than or equal to 65 years.ObjectiveThe aim of the study was to compare the accuracy of the Emergency Severity Index triage system between emergency department patients aged 18–64 and greater than or equal to 65 years.Design, settings, and participantsThis was a retrospective observational cohort study of adults who presented to a Finnish emergency department between 1 February 2018 and 28 February 2018. All data were collected from electronic health records.Outcome measures and analysisThe primary outcome was 3-day mortality. The secondary outcomes were 30-day mortality, hospital admission, high dependency unit or ICU admission, and emergency department length of stay. The area under the receiver operating characteristic curve and cutoff performances were used to investigate significant associations between triage categories and outcomes. The results of the two age groups were compared.Main resultsThere were 3141 emergency department patients aged 18–64 years and 2370 patients aged greater than or equal to 65 years. The 3-day mortality area under the curve in patients aged greater than or equal to 65 years was greater than that in patients aged 18–64 years. The Emergency Severity Index was associated with high dependency unit/ICU admissions in both groups, with moderate sensitivity [18–64 years: 61.8% (50.9–71.9%); greater than or equal to 65 years: 73.3% (63.5–81.6%)] and high specificity [18–64 years: 93.0% (92.0–93.8%); greater than or equal to 65 years: 90.9% (90.0–92.1%)]. The sensitivity was high and specificity was low for 30-day mortality and hospital admission in both age groups. The emergency department length of stay was the longest in Emergency Severity Index category 3 for both age groups. There was no significant difference in accuracy between age groups for any outcome.ConclusionEmergency Severity Index performed well in predicting high dependency unit/ICU admission rates for both 18–64 years and greater than or equal to 65-year-old patients. It predicted the 3-day mortality for patients aged greater than or equal to 65 years with high accuracy. It was inaccurate in predicting 30-day mortality and hospital admission for both age groups.

Epidemiology of mass casualty incidents in a tertiary care trauma center in eastern India: A retrospective observational study.

OBJECTIVES:Disasters and mass casualty incidents (MCIs) that cause substantial mortality and morbidity have been increasing worldwide. The emergency department (ED) services manage MCIs by optimizing triage and providing health care with required resources. The present study attempted to describe the epidemiological characteristics and outcomes of MCIs presenting to the ED.METHODS:The present retrospective observational study was conducted at the ED of a tertiary care hospital on patients of MCI for 4 years from 2017 to 2021. The data were extracted from the ED disaster records and other paper-based patient records. Information on patient demography, date and time of arrival, mode of transport, method of arrival (direct or referral), type and mechanism of MCI, ED management, and outcome were recorded. Statistical analysis was performed using R, version 4.1.0.RESULTS:Analysis of 21 MCIs was conducted. Road traffic accidents (RTAs) were the predominant cause of MCIs. The majority of MCI victims, except for those of blast injuries, were men. The victims in medical emergencies were significantly younger than those in other MCI groups (P < 0.001). The majority of patients were brought to ED through ambulance services (n = 120 [47.1%]), followed by private vehicles (n = 112 [44.2%]). Most of the MCI victims (n = 143 [56.2%]) were brought to the ED during evening hours (4 pm–8 pm). The majority of victims belonged to the “Red” triage category (n = 110 [43.3%]). The injury severity score was significantly higher (P = 0.014) in the disaster group than in other trauma MCI groups (20 vs. 17). Autorickshaw occupants were the most common victims of mass casualty RTAs (n = 38 [40%]). Suturing (n = 97 [50%]) and dressing (n = 167 [88%]) were the most common ED procedures required by the victims of trauma MCIs. Of the total, 167 (66%) patients were discharged from the ED, 47 (19%) patients were admitted to wards, 13 (5%) patients were admitted to intensive care units, and 24 (9%) patients got referred to other centers. In addition, two patients died in the ED during treatment, whereas one patient was brought dead.CONCLUSIONS:RTAs dominate the MCIs and are affecting the young producative male population. The present study exhibited the severity of the cases in MCIs and their impact in the health-care setting, therefore signifying the importance of standardized MCI management protocols.

CDC field triage criteria accurately predicts outcomes in high impact trauma.

:Background:The precision of emergency medical services (EMS) triage criteria dictates whether an injured patient receives appropriate care. The trauma triage protocol is a decision scheme that groups patients into triage categories of major, moderate and minor. We hypothesized that there is a difference between trauma triage category and injury severity score (ISS).Methods:This retrospective, observational study was conducted to investigate a difference between trauma triage category and ISS. Bivariate analysis was used to test for differences between the subgroup means. The differences between the group means on each measure were analyzed for direction and statistical significance using ANOVA for continuous variables and chi square tests for categorical variables. Logistic and linear regressions were performed to evaluate factors predicting mortality, ICU length of stay.Results:With respect to trauma triage category, our findings indicate that minor and moderate triage categories are similar with respect to ISS, GCS, ICU LOS, hospital LOS, and mortality. However, after excluding for low impact injuries (falls), differences between the minor and moderate categories were evident when comparing to ISS, GCS, ICU LOS, and hospital LOS. Additionally, after excluding for low impact injures, ISS, ICU LOS, and hospital stay were found to correlate well with trauma triage category. Conclusions:In this retrospective, observational study significant differences were not seen when comparing ISS with the trauma triage categories of moderate and minor during our initial analysis. However, a difference was found after excluding for low impact injuries. These findings suggest that CDC criteria accurately predicts outcomes in high impact trauma.

Pattern of pediatric emergency visits during lockdown -Impact of COVID-19 pandemic in Jodhpur City, India.

ABSTRACTObjectives:To study the impact of lockdown during novel coronavirus disease-19 (COVID-19) pandemic on Pediatric Emergency visits.Methods:In this retrospective study, we compared the data regarding demographic details, triage category, underlying primary organ system involvement and outcomes among pediatric emergency visits of April-May 2019 and 2020. Results are expressed in means and proportions. Chi-square test was applied to compare the proportion in two groups.Results:We observed decrease in number of patients during lockdown period as compared to previous year (792 vs 506, decrease by 36%). There was significant increase in respiratory (P = 0.001, CI 2.66-11.6), and hematological emergencies (P < 0.001, CI 2.96-9.23) Road traffic accident (RTA) were decreased significantly (P = 0.005, CI 0.6-3.06). Unintentional injuries were comparable to previous year (P = 0.14, CI -0.86-6.19), though children being at home.Conclusion:During lockdown, number of pediatric emergency visits was reduced and also lead to delayed presentation. Parents should be informed about utilizing telemedicine services available during this period and avoid delaying in going to hospitals in emergency conditions.

Emergency department presentations and 30-day mortality in patients from residential aged care facilities.

Objective To describe patterns of emergency department (ED) presentations and predictors of 30-day mortality in patients referred from a residential aged care facility (RACF). Methods A retrospective analysis of linked state-wide emergency, inpatient and death data from 136 public ED hospitals in New South Wales, Australia. Data were collected from the NSW Emergency Department Data Collection database, the NSW Admitted Patient Data Collection database and the NSW Registry of Births, Deaths and Marriages. All patients aged ≥65 years presenting to the ED from a RACF between January 2017 and July 2018 were included. ED diagnosis categories, re-admission rates within 30 days and 30-day all-cause mortality were measured. Results In total, 43 248 presentations were identified. The most common ED diagnosis categories were: injury (26.48%), respiratory conditions (14.12%) and cardiovascular conditions (10.74%). Prolonged ED length of stay was associated with higher adjusted hazard ratios for 30-day all-cause mortality after adjustments for age Charlson Comorbidity Index, triage category and diagnosis category (HR 1.10 95% CI 1.05-1.14 P < 0.001). Conclusions A large proportion of ED presentations from RACFs were for injuries associated with falls and chest infections. There was a range of both high- and low-urgency presentations. Both the 30-day mortality and re-admission rates were high. Predictors of increased mortality included prolonged length of stay in the ED and re-admission within 30 days. The findings are useful in informing discussion around improving access to care in RACFs and coordination of healthcare providers in this cohort.

ESI Triage Distribution in U.S. Emergency Departments.

The accurate triage of arriving emergency department (ED) patients is a key component of emergency nursing practice. Overtriage assignment of patients misallocates scarce resources in a time of department overcrowding, whereas patient undertriage can create risks for negative patient outcomes secondary to care delays. Limited evidence is available regarding ED triage accuracy. It is estimated that appropriate adherence to the Emergency Severity Index (ESI) triage tool and assigning triage categories could be as low as 60% (McFarlane, 2019a, 2019b). The purpose of this retrospective observational study was to examine the 2019 triage distribution of 954,847 ED encounters at 25 hospitals. Comparisons were then made with the spreads identified in the ESI Implementation Handbook (Gilboy, Tanabe, Travers, & Rosenau, 2020). Study results reflect the presence of wide variations in distribution when compared with the expected spread published by Gilboy et al. (2020). These variations illustrate the need for further facility-level evaluation. ESI Level 2 percentages varied from as little as 2.6% to as high as 69% of each facility's ED visit population. Examining an individual facility's annualized triage distribution may serve as a swift method in determining whether additional investigation into triage accuracy is warranted. EDs must implement and sustain an ongoing quality control program to achieve and maintain triage inter- and intrarater reliability. Further research is needed on the value of triage inaccuracy with real-time feedback on nurses' clinical decision-making and patient outcomes. It is also imperative that the expected and observed ESI triage distribution in U.S. EDs is updated when established accuracy quality control programs are present.

Association between COVID-19 restrictions and emergency department presentations for paediatric mental health in Victoria, Australia.

Objective To determine the association between coronavirus disease 2019 (COVID-19) restrictions and paediatric mental health emergency department presentations. Methods Secondary analysis of Victorian Emergency Minimum Dataset data from 38 Victorian public hospital emergency departments. Paediatric patients (birth to <18 years) attending emergency departments with an International Classification of Disease-Australian Modification (ICD-10-AM) diagnosis of a mental health problem between 1 January 2018 and 31 October 2020 were included. We compared pre-COVID-19 (1 January 2018-27 March 2020) to the COVID-19 period (28 March-26 October 2020) to examine the number of mental health presentations by patient age, socioeconomic status, location, and emergency department triage category. A Poisson regression prediction model was built for each diagnosis group to predict the presentation number in the COVID-19 period, assuming the pandemic and associated restrictions had not happened. Results There were 15 898 presentations (589 presentations/month on average) in the pre-COVID-19 period and 4747 presentations (678 presentations/month on average) in the COVID-19 period. Compared with predicted presentations, there was an increase in observed presentations for eating disorders throughout lockdown (on average, an increase of 36 presentations/month) and for anxiety (11/month) and self-harm (18/month). There were no meaningful changes for mood disorders or developmental and behavioural problems, and presentations for substance abuse mostly fell. Conclusions Pandemic restrictions were associated with increased emergency department presentations for eating disorders and, to a lesser extent, anxiety and self-harm. Given the ongoing pandemic, clinicians and policy makers must work together to find timely, accessible solutions to better manage these conditions.

MANAGING MASS CASUALTIES IN LIMITED RESOURCE SETTING: A COMPARISON BETWEEN A PERIPHERAL HOSPITAL AND FORWARD TREATMENT CENTER

Objective: To share our experience of handling mass casualties at remote locations with an aim to help formulate a policy regarding future training of doctors.&#x0D; Study Design: Case series.&#x0D; Place and Duration of Study: Combined Military Hospital Thal Pakistan, from Jan 2016 to Sep 2018, including three months in Forward Treatment Center in operational areas.&#x0D; Methodology: The injuries due to war trauma were included in our study. Resource management and changes made to accommodate the influx of mass trauma that required damage control surgery were described.&#x0D; Results: A total of 16 casualties from two mass casualty incidents at two medical centers were included in our study. There was no difference in triage class (p=0.96). Splinter injury limbs were most common injury. One patient required damage control surgery done at Combined Miliary Hospital with most requiring hemostasis prior to transport (8 at Combined Military Hospital versus 3 at Forward Treatment center), p=0.346.&#x0D; Conclusion: Most of mass casualties at our hospital were minor injuries requiring immediate first aid. In addition, the damage control resuscitation and surgery done at these remote locations may have helped prevent mortality and morbidity in the more severely injured.

Measuring sustainable practice change of the sepsis guideline in one emergency department: A retrospective health care record audit

Aims and objectivesTo explore the longitudinal impact of the New South Wales Sepsis guideline on time to antibiotics, triage assessment and emergency management before and four years after guideline implementation. BackgroundGlobally, sepsis continues to be a significant cause of mortality and morbidity within hospitals. To reduce avoidable adverse patient outcomes the corner stone has been to improve the early recognition and management of sepsis. The New South Wales government in Australia introduced sepsis guidelines into Emergency Departments. However, the longitudinal impact of the sepsis guideline, has never been conducted. MethodsA 12-month retrospective randomised health care record audit of adult patients with a sepsis diagnosis was conducted 12-months before and four years after implementation of the sepsis guideline. ResultsThis study demonstrated sustained improvement in allocation of urgent triage categories in the follow-up group (n = 43; 53.1%) and a reduction in the median time to antibiotics from 189 min to 102 min (p ≤ 0.001) after the implementation of the sepsis guideline. ConclusionThe study has demonstrated the sepsis guideline has improved a sustained change in early assessment, recognition and management of patients presenting with sepsis in one tertiary referral Emergency Department.

Evaluating the impact of an enhanced triage process on the performance and diagnostic yield of oesophageal physiology studies post COVID-19

ObjectivesThe COVID-19 pandemic significantly impacted on the provision of oesophageal physiology investigations. During the recovery phase, triaging tools were empirically recommended by national bodies for prioritisation of referrals amidst rising...