Minor trauma: A major contributor to emergency department workload

A 46-year-old man presented with a painless mass on his dorsal right foot one week after striking it on a door. A traumatic hematoma was suspected, and needle aspiration of the mass is considered. However, point-of-care ultrasound performed by the emergency physician identified a pseudoaneurysm of the dorsalis pedis artery, a rare condition that can occur after minor trauma or iatrogenic intervention. This report demonstrates how point-of-care ultrasound can be used to identify a pseudoaneurysm of the lower extremity, thereby expediting emergency department workup and preventing potentially dangerous diagnostic procedures.

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Managing Mild Casualties in Mass-Casualty Incidents: Lessons Learned from an Aborted Terrorist Attack

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00004623 ◽

2007 ◽

Vol 22 (3) ◽

pp. 181-185 ◽

Cited By ~ 10

Author(s):

Yuval H. Bloch ◽

Adi Leiba ◽

Nurit Veaacnin ◽

Yohanan Paizer ◽

Dagan Schwartz ◽

...

Keyword(s):

Emergency Department ◽

Terrorist Attack ◽

Mass Casualty ◽

Lessons Learned ◽

Psychiatric Evaluation ◽

Second Phase ◽

Minor Trauma ◽

Medical Specialties ◽

Medical Response ◽

Injured Patients

AbstractIntroduction:Mildly injured and “worried well” patients can have profound effects on the management of a mass-casualty incident. The objective of this study is to describe the characteristics and lessons learned from an event that occurred on 28 August 2005 near the central bus station in Beer-Sheva, Israel. The unique profile of injuries allows for the examination of the medical and operational aspects of the management of mild casualties.Methods:Data were collected during and after the event, using patient records and formal debriefings.They were processed focusing on the characteristics of patient complaints, medical response, and the dynamics of admission.Results:A total of 64 patients presented to the local emergency department, including two critical casualties. The remaining 62 patients were mildly injured or suffered from stress. Patient presentation to the emergency department was bi-phasic; during the first two hours following the attack (i.e., early phase), the rate of arrival was high (one patient every three minutes), and anxiety was the most frequent chief complaint.During the second phase, the rate of arrival was lower (one patient every 27 minutes), and the typical chief complaint was somatic. Additionally, tinnitus and complaints related to minor trauma also were recorded frequently.Psychiatric consultation was obtained for 58 (91%) of the patients. Social services were involved in the care of 47 of the patients (73%).Otolaryngology and surgery consultations were obtained for 45% and 44%, respectively. The need for some medical specialties (e.g., surgery and orthopedics) mainly was during the first phase, whereas others, mainly psychiatry and otolaryngology, were needed during both phases. Only 13 patients (20%) needed a consultation from internal medicine.Conclusions:Following a terrorist attack, a large number of mildly injured victims and those experiencing stress are to be expected, without a direct relation to the effectiveness of the attack. Mildly injured patients tend to appear in two phases. In the first phase, the rate of admission is expected to be higher. Due to the high incidence of anxiety and other stress-related phenomena, many mildly injured patients will require psychiatric evaluation. In the case of a bombing attack, many of the victims must be evaluated by an otolaryngologist.

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Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor trauma

Age and Ageing ◽

10.1093/ageing/afw184 ◽

2016 ◽

Author(s):

Debra Eagles ◽

Jeffrey J. Perry ◽

Marie-Josée Sirois ◽

Eddy Lang ◽

Raoul Daoust ◽

...

Keyword(s):

Emergency Department ◽

Older Patients ◽

Functional Decline ◽

Minor Trauma ◽

Timed Up And Go

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Wound Care Differences in Paediatric Emergency Department: A Questionnaire Based one-centre study Before Developing and Implementing Minor-Trauma Care SOP

10.21203/rs.3.rs-30012/v1 ◽

2020 ◽

Author(s):

Lina Simonyte ◽

Lina Matukynaite ◽

Algirdas Dagys ◽

Lina Jankauskaite

Keyword(s):

Emergency Department ◽

Wound Care ◽

Wound Management ◽

Minor Trauma ◽

Surgical Specialty ◽

Paediatric Emergency Department ◽

Centre Study ◽

Paediatric Emergency ◽

Anonymous Questionnaire ◽

Injury Area

Abstract Background: Paediatric minor traumas/wounds are one of the most common reasons to visit paediatric emergency department (PED). In this study we evaluated how different specialty physicians in PED treat wounds and what methodologies they used before developing a unified wound care SOP.Methods: A prospective Questionnaire based one centre study was conducted in PED of Hospital of Lithuanian University of Health Sciences Kauno Klinikos. All the physicians/fellows working in PED were asked to voluntarily fill anonymous questionnaire after each patient who required wound management.Results: In total, 166 questionnaires were collected and 148 were analysed. Mean age of the patients was 5.91 [3.13-8.13] years. Average laceration length was 1.75 [1.0-2.0] cm. The main injury area was forehead (28.4%), hairy part of the head composed 22.3% of all the wounds. Wounds did not differ in length treated by EM and surgical physicians; GP and paediatricians managed smaller wounds. Most wounds were cleaned with chlorhexidine gluconate or combination with hydrogen peroxide. 33.8% of wounds were sutured. In 12.8% suturing was combined with Steri-Strips™. In 43.2% of the cases no needle methods were used. Suturing was most often chosen by the surgical specialty clinician/fellow (66.7%). 48% of the patients were given anaesthesia (mostly locally). 8.7% of suturing cases received no anaesthesia at all. 4 children were prescribed antibiotics for aftercare. The check-up date for sutures removal was associated with location of the wound. Conclusion: this study revealed differences between various specialty physicians and fellows working in PED with regard to wound management starting with wound cleaning to laceration aftercare and recommendations. Thus, it led to a wound care SOP development seeking unified and evidence-based methodology of wound management and aftercare in PED.

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Professional Liability in a Pediatric Emergency Department

PEDIATRICS ◽

10.1542/peds.87.2.134 ◽

1991 ◽

Vol 87 (2) ◽

pp. 134-137 ◽

Cited By ~ 1

Author(s):

Sally L. Reynolds ◽

David Jaffe ◽

William Glynn

Keyword(s):

Emergency Department ◽

Private Insurance ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Minor Trauma ◽

Professional Liability ◽

Risk Manager ◽

Malpractice Claims ◽

Legal Fees ◽

Attending Physician

The risk of professional liability resulting from care given in the pediatric emergency department is a growing concern. This retrospective study examined the patients, diagnoses, and outcome of all threatened and actual claims that originated in the emergency department of a pediatric teaching hospital from 1977 through 1988. Twenty-five cases were identified by the hospital risk manager from approximately 320 000 visits (8.0 cases/100 000 visits); 22 charts were available for review. Ages of the patients ranged from 2 weeks to 13 years (mean 2.9 years, median 3.0 years). The patients' payment status was private insurance (n = 10), state public aid (n = 5), and no third-party payment source was listed for 7 children. Ten patients (46%) visited the emergency department between midnight and 8:00 AM, when an attending physician was not present. Return visits within 2 weeks for the same complaint occurred in 10 cases. The majority of the patients were discharged home (n = 18), and all of them had appropriate, adequately documented discharge instructions. The final diagnoses fell into four general categories: minor trauma/abuse (n = 7), neoplasms/chronic illnesses (n = 7), infectious diseases (n = 6), and appendicitis (n = 2). Review of the charts before knowledge of the legal outcome raised quality-of-care issues in 41% of the cases (n = 9). The legal claims were categorized as failure to diagnose (n = 16) and inappropriate treatment (n = 6). No claims went to trial, 12 were dropped by the family, 5 patients received some payment, 3 claims were unfounded, and 2 cases remain open. Legal fees incurred in 16 cases over the 10-year period totaled $191 677, and the total payment to families was $43 850. Conclusions: (1) malpractice claims were uncommon in the emergency department studied; (2) a disproportionate number of claims occurred when an attending physician was not in the emergency department; (3) no one specific diagnosis was overrepresented in the majority of claims; (4) visiting the emergency department more than once for the same complaint increased the risk of professional liability; and (5) the cost of the associated legal fees was more than four times the money paid to families.

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Does use of a trauma checklist increase discharges from the emergency department?

Trauma ◽

10.1177/1460408617698510 ◽

2017 ◽

Vol 20 (1) ◽

pp. 52-57

Author(s):

Amani Jambhekar ◽

Ryan Lindborg ◽

Vincent Chan ◽

Daniel Laskey ◽

James Rucinski ◽

...

Keyword(s):

Emergency Department ◽

Healthcare Costs ◽

Injury Severity ◽

Trauma Patients ◽

Minor Trauma ◽

Exact Test ◽

Traumatic Injuries ◽

Before And After ◽

Discharged Patients ◽

Unpaired Student

Introduction Emergency department (ED) discharge is appropriate for patients with minor traumatic injuries. The objective of this study is to determine if use of a trauma checklist increases identification of patients with minor trauma who are safe for discharge. Methods Data were collected on trauma patients evaluated between 1 April 2015 and 31 January 2016 in two groups before and after introduction of a trauma checklist. The two groups were compared using age, mechanism of injury, and Injury Severity Score (ISS) using unpaired Student t-tests and Fisher’s exact test. Results A total of 841 trauma patients were included; 197 prior to the introduction of the checklist and 644 afterwards. Following the implementation of the trauma checklist, significantly more patients were discharged from the ED (18.2% vs. 7.6%, p = 0.0004). Discharged patients in the pre- and post-checklist groups had similar ISS (1.93 ± 1.49 vs. 1.87 ± 1.90, p = 0.90) and were of similar age (35.27 ± 11.06 vs. 41.99 years ± 18.20, p = 0.17). There was no increase in ‘bounce-backs’ to the ED in the post checklist group despite a significantly higher rate of discharge. Conclusion Use of a trauma checklist allows for better identification of those trauma patients who are safe to discharge from the ED and widespread use may decrease healthcare costs.

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Use of emergency department imaging in patients with minor trauma

Journal of Surgical Research ◽

10.1016/j.jss.2015.11.046 ◽

2016 ◽

Vol 203 (1) ◽

pp. 238-245 ◽

Cited By ~ 5

Author(s):

Gregory E. Tong ◽

Kristan Staudenmayer ◽

Feng Lin ◽

Renee Y. Hsia

Keyword(s):

Emergency Department ◽

Minor Trauma

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Differences between orthopaedic evaluation and radiological reports of conventional radiographs in patients with minor trauma admitted to the emergency department

Injury ◽

10.1016/j.injury.2017.08.054 ◽

2017 ◽

Vol 48 (11) ◽

pp. 2451-2456 ◽

Cited By ~ 6

Author(s):

Michele Catapano ◽

Domenico Albano ◽

Grazia Pozzi ◽

Riccardo Accetta ◽

Sergio Memoria ◽

...

Keyword(s):

Emergency Department ◽

Minor Trauma

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Factors and outcomes associated with paediatric emergency department arrival patterns through the day

Paediatrics & Child Health ◽

10.1093/pch/pxy173 ◽

2018 ◽

Vol 24 (5) ◽

pp. 323-329

Author(s):

Hathami Almubarak ◽

Garth Meckler ◽

Quynh Doan

Keyword(s):

Emergency Department ◽

Resource Allocation ◽

Cross Sectional Study ◽

Time Of Day ◽

Minor Trauma ◽

Patient Acuity ◽

Cross Sectional ◽

Utilization Patterns ◽

Multivariable Regression ◽

Ed Visits

Abstract Introduction Steadily increasing emergency department (ED) utilization has prompted efforts to increase resource allocation to meet demand. Little is known about the distribution and characteristics of patient arrivals by time of day. This study describes the variability and patterns of ED resource utilization related to patient, acuity, clinical, and disposition characteristics over a 24-hour period. Methods Retrospective cross-sectional study of all visits to a tertiary children’s hospital over a 1-year period. We use descriptive statistics to present ED visit details stratified by shift of arrival, and multivariable regression to explore the association between shift of presentation and hospital admission at index and 7-day return ED visits. Results Of 46,942 visits during the study period, 12% arrived overnight, 42% during the day, and 45% during the evening with variability in pattern of shift arrival by day of week. Overnight arrivals had a higher acuity (Canadian Triage and Acuity Scale [CTAS]) and different presenting complaints (more viral infection, less minor trauma) than day and evening arrivals, but similar ED length of stay. Shift of arrival was not associated with admission to hospital, but age, gender, socioeconomic status (SES), and day of week were. Discussion ED utilization patterns vary by shift of arrival. Though overnight arrivals represent a smaller proportion of total daily arrivals, their acuity is higher, and the spectrum of disease differs from day or evening arrivals. Conclusions Understanding variations and patterns of ED utilization by shift of arrival and day of week may be helpful in tailoring resource allocation to more accurately and specifically meet demands.

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