Journal of Emergency Medicine, Trauma and Acute Care - Volume 2016, Issue 1

Background/Introduction: Oligoanalgesia is a common phenomenon in the Emergency Department (ED) with children being especially at risk. However, the extent to which pediatric patients are being undertreated for acute pain in relation to their adult counterparts is not well understood, especially in general (i.e., mixed adult and pediatric) EDs. This study was designed to compare the pain medication received by adult and pediatric patients with appendicitis presenting to a general ED. Methods: A retrospective chart review of 165 patients, 92 adult (mean age: 35.7 ± 15.7 years) and 73 pediatric (mean age: 11.0 ± 3.0 years) with a discharge diagnosis of “appendicitis” were included in this study. Demographic information as well as data regarding type, timing, and received amount of pain medication were collected. Adult and pediatric data were then compared using independent t-test or chi-square analysis. Effect sizes were also calculated. Results: Pediatric patients were significantly more likely than adult patients to not receive any analgesia during their ED stay (58.9% vs 20.7%, p>0.001, Cramer's V = 0.39). They were also significantly less likely to receive opioid analgesics, compared to adults (27.4% vs. 71.7%, p>0.001, Cramer's V = 0.44). Finally, mean pain scores recorded at presentation were significantly lower for children vs. adults (6.5 vs 7.2 out of 10, p = 0.015, r = 0.20). Conclusion: In this sample, pediatric patients with appendicitis presenting to a general emergency department received less opioid pain medication, and less pain medication in general, than their adult counterparts.

Background: Non-residents visiting an area often have limited local knowledge of the natural environmental conditions, exacerbating their risk of unintentional injuries. The aim of this study was to determine the impact of unintentional injuries of non-Welsh residents presenting to the Emergency Department of a regional trauma unit in South Wales. Methods: A retrospective hospital database review was undertaken from 2006 to 2014. All patients presenting to the ED with a non-Welsh postcode, with a diagnosis of unintentional injury were included in the study. Data collected included age, sex, time of year of presentation, injury mechanism, body part injured and patient outcome. Descriptive data were recorded and analysed. Results: From 2006 to 2014, overall attendance of non-Welsh residents to the ED was 4323. A total of 2961 (68%) patients were male, with a median age of 28 (IQR: 18–47). The most common time of year for non-Welsh resident presentations to the ED was the summer. A mechanical fall was the most commonly reported mechanism of injury. There was a significantly higher prevalence of mechanical falls and alleged assaults in the non-resident cohort, when compared to residents presenting with unintentional injuries (both p < 0.001). Conclusions: This is the first study to investigate unintentional injuries of non-Welsh residents and their impact on an ED in the UK. Further prospective research is needed in order to investigate whether the introduction of new public health policies impact on ED services in tourist areas in the UK.

Introduction: Traumatic haemorrhagic shock can be difficult to diagnose. Models for predicting critical bleeding and massive transfusion have been developed to aid clinicians. The aim of this review is to outline the various available models and report on their performance and validation. Methods: A review of the English and non-English literature in Medline, PubMed and Google Scholar was conducted from 1990 to September 2015. We combined several terms for i) haemorrhage AND ii) prediction, in the setting of iii) trauma. We included models that had at least two data points. We extracted information about the models, their developments, performance and validation. Results: There were 36 different models identified that diagnose critical bleeding, which included a total of 36 unique variables. All models were developed retrospectively. The models performed with variable predictive abilities–the most superior with an area under the receiver operating characteristics curve of 0.985, but included detailed findings on imaging and was based on a small cohort. The most commonly included variable was systolic blood pressure, featuring in all but five models. Pattern or mechanism of injury were used by 16 models. Pathology results were used by 15 models, of which nine included base deficit and eight models included haemoglobin. Imaging was utilised in eight models. Thirteen models were known to be validated, with only one being prospectively validated. Conclusions: Several models for predicting critical bleeding exist, however none were deemed accurate enough to dictate treatment. Potential areas of improvement identified include measures of variability in vital signs and point of care imaging and pathology testing.

Regional blocks provide adequate analgesia in trauma patients. The aim of this study was to review the current practice of emergency department physicians in the use of regional blocks.

A cross-sectional survey was conducted among emergency department physicians and anesthesiologists. The response rate was 100% (n = 107). 79% (n = 57) of the anesthesiologists were found to provide regional blocks however, 48.5% (n = 17) of emergency physicians administer local blocks. Only 2.8% of emergency physicians held a formal qualification in regional anesthesia.

There is a need to train ED physicians in regional blocks so that the pain in trauma patients can be managed early.