scholarly journals Trauma in Children during Lockdown for SARS-CoV-2 Pandemic. A Brief Report

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1131
Author(s):  
Daniela Dibello ◽  
Marcella Salvemini ◽  
Carlo Amati ◽  
Antonio Colella ◽  
Giusi Graziano ◽  
...  
Keyword(s):  
Emergency Department ◽  
Demographic Data ◽  
Anatomical Location ◽  
Minor Trauma ◽  
Outdoor Activities ◽  
Italian Government ◽  
Paediatric Orthopaedic ◽  
Type Of Injury ◽  
Sports Activities ◽  
Worse Prognosis

Purpose: The national lockdown established by the Italian government began on the 11th of March 2020 as a means to control the spread of SARS-CoV-2 infections. The purpose of this brief report is to evaluate the effect of the national lockdown on the occurrence and characteristics of trauma in children during lockdown. Methods: All children admitted to our paediatric orthopaedic unit with a diagnosis of fracture or trauma, including sprains and contusions, between 11 March 2020 and 11 April 2020, were retrospectively reviewed. Their demographic data, type of injury, anatomical location and need for hospitalisation were compared with the equivalent data of children admitted for trauma in the same period of 2018 and 2019. Results: Sixty-nine patients with trauma were admitted in 2020, with a significant decrease in comparison with 2019 (n = 261) and 2018 (n = 289) (p < 0.01). The patients were significantly younger, and the rate of fractures significantly increased in 2020 (p < 0.01). Conclusions: Home confinement decreased admissions to the emergency department for trauma by shutting down outdoor activities, schools and sports activities. However, the rate of fractures increased in comparison with minor trauma, involved younger children and had a worse prognosis.

scholarly journals The Study of Incidence and Characteristics of Patients with Eye-Related Chief Complaints at the Emergency Department of Thammasat University Hospital

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Intanon Imsuwan ◽  
Kumpol Amnuaypattanapon ◽  
Sakchai Vongkittirux ◽  
Yutthaphong Imsuwan
Keyword(s):  
Emergency Department ◽  
Foreign Bodies ◽  
Demographic Data ◽  
Hypertensive Crisis ◽  
University Hospital ◽  
Eye Disease ◽  
Minor Trauma ◽  
Eye Injuries ◽  
Organ Systems ◽  
Chief Complaints

Background. Patients with eye-related chief complaints could be diagnosed not only with eye diseases but also with noneye diseases. This study determines rates and characteristics of patients with eye-related chief complaints at the Emergency Department of Thammasat University Hospital. Methods. The study design is a descriptive retrospective observational study of patients with eye-related chief complaints at the Emergency Department of Thammasat University Hospital in 2017. Demographic data, diagnosis, management, consultation, and disposition were recorded by chart review. Categorical data were reported by percentage. Results. Of the 52081 patients, 704 (1.3%) presented with eye problems. 60% of the patients were males. Patients were classified into three groups which are traumatic eye disease, nontraumatic eye disease, and noneye disease. 75.9% of the patients suffered traumatic injuries. The most common diagnoses of the traumatic eye injuries were foreign bodies at the cornea and conjunctiva and minor trauma to the conjunctiva. The most common mechanisms were foreign bodies in the eyes, cuts, or pierces. The most common causes of the injuries were from metals and housewares. The most common nontraumatic eye diagnoses were conjunctivitis and corneal ulcer. The most common noneye diagnoses were exposure of healthcare providers to secretions from patients, angioedema, and hypertensive crisis. Conclusions. Most of the patients who came to the ER with chief complaints of the eyes could be treated by doctors in the emergency room without consulting ophthalmologists. Chief complaints of the eyes could be the leading symptoms of many organ systems. Emergency physicians should be differentially diagnosed to cover neurologic, cardiovascular, and immunologic problems.

Determinants of pyelonephritis onset in patients with obstructive urolithiasis

2021 ◽  
pp. 039156032110352
Author(s):  
Georges Abi Tayeh ◽  
Ali Safa ◽  
Julien Sarkis ◽  
Marwan Alkassis ◽  
Nour Khalil ◽  
...  
Keyword(s):  
Emergency Department ◽  
Renal Colic ◽  
Demographic Data ◽  
Vital Signs ◽  
Kidney Injury ◽  
Stone Size ◽  
Positive Urine ◽  
Life Threatening ◽  
Fat Stranding ◽  
Obstructive Pyelonephritis

Background: Acute obstructive pyelonephritis due to urolithiasis represents a medico-surgical emergency that can lead to life-threatening complications. There are still no established factors that reliably predict progression toward acute pyelonephritis in patients presenting with a simple renal colic. Objective: To investigate clinical and paraclinical factors that are associated with the onset of acute obstructive pyelonephritis. Methods: Patients presenting to the emergency department for renal colic with obstructive urolithiasis on imaging were enrolled in the study. Demographic data, vital signs, medical comorbidities, blood test results, urinalysis, and radiological findings were recorded. Obstructive pyelonephritis was defined by the presence of two or more of the following criteria: fever, flank pain or costovertebral angle tenderness, and a positive urine culture. Results: Seventeen patients out of 120 presenting with renal colic, were diagnosed with acute obstructive pyelonephritis (14%). Parameters that were associated with the onset of obstructive pyelonephritis were: diabetes ( p = 0.03), elevated CRP ( p = 0.01), stone size (>5 mm) ( p = 0.03), dilatation of renal pelvis ( p = 0.01), peri-renal fat stranding ( p = 0.02), and positive nitrites on urinalysis ( p < 0.01). Hyperleukocytosis, acute kidney injury, multiple stones, pyuria (>10/mm3), hypertension, and were not associated with the onset of obstructive pyelonephritis. Conclusion: This study showed that known diabetic status, elevated CRP, positive urine nitrites, stone size (>5 mm), pyelic dilatation, and peri-renal fat stranding were associated with the onset of pyelonephritis in patients presenting to the emergency department with obstructive urolithiasis.

Management of sports-related and recreational knee Injuries in children: surgical aspects

2021 ◽  
Vol 15 (8) ◽  
pp. 2460-2467
Author(s):  
Talat Mahmood ◽  
Waqas Ali Khan ◽  
Javaid Iqbal ◽  
Syed Kashif Mehdi ◽  
Hafsa Talat ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Sports Injuries ◽  
Knee Injuries ◽  
Anatomical Location ◽  
Training Tool ◽  
Growth Cartilage ◽  
Training Programmes ◽  
Surgical Aspects ◽  
Type Of Injury ◽  
Immature Skeleton

Sports -related knee injuries are common in children and the management of these injuries continues to evolve. Sports injuries in children affect both growing bone and soft tissues and can result in damage of growth mechanisms with subsequent lifelong, growth disturbance. With an increasing number of paediatric and adolescent athletes presenting with knee injuries. due to sports, a greater demand is put on clinicians and radiologists to assess the specific type of knee injury. Traumatic forces applied to the immature skeleton cause a different type of injury than those seen in adults due to the differences in vulnerability of the musculoskeletal system, especially at the site of the growth cartilage. An overview of several sport-related knee injuries of young athletes are presented, based on anatomical location and their management. The training programmes should be considered an important training tool that growing athletes can adjust to the changes in their bodies and could prevent knee injuries. Keywords: Sports-Related, paediatric, Children, Knee Injuries, Adolescent Sports Players, immature skeleton, growth cartilage.

scholarly journals Lesões Músculo-Esqueléticas em Remadores de Competição

2015 ◽  
Vol 28 (4) ◽  
pp. 427 ◽  
Author(s):  
Francisco Bernardes ◽  
Alfredo Mendes-Castro ◽  
José Ramos ◽  
Ovídio Costa
Keyword(s):  
Statistical Analysis ◽  
Anatomical Location ◽  
Lumbar Region ◽  
Confidence Levels ◽  
Injury Occurrence ◽  
Parametric Statistics ◽  
The Mean ◽  
Occurrence Type ◽  
Location Type ◽  
Type Of Injury

<p><strong>Introduction:</strong> The objective of this study was the assessment of the injuries occurred over the competitive rowing lifetime of Portuguese senior rowers.<br /><strong>Material and Methods:</strong> We sent a questionnaire to all Portuguese senior rowers medalled in the national championships during the 2013-2014 season. We analysed biometric variables, anatomic location, type and circumstances of injury occurrence, type of treatment provided and time of inactivity. For statistical analysis we used parametric and non-parametric statistics with 95% confidence levels (p &lt; 0.05).<br /><strong>Results:</strong> The questionnaire was answered by 18 of the 18 female and 74 of the 77 male rowers. Females had significantly lower ages, heights and weights and rowed more often sculling boats (p &lt; 0.05). The number of years of practice, as well as the number of injuries per rower was similar, for both females and males. The mean age at the first injury was significantly lower in females (p &lt; 0.001), who also had more progressive lesions than acute ones, although not significantly. In both, the most frequent anatomical location and type of injury were the lumbar region and muscular pathology, with a higher occurrence in winter and spring, during land training. Females<br />sustained longer periods of inactivity, but not significantly.<br /><strong>Discussion:</strong> The results that were different from those reported by other authors may be related with differences in the studied populations or with other factors that need to be clarified.<br /><strong>Conclusion: </strong>The injuries sustained by the Portuguese competitive rowers, probably associated with a lower competitive exposure of our athletes, were less severe than those generally reported in the literature.</p>

Gunshot Injuries to the Extremity: Is Immediate General Surgery Presence Needed?

2018 ◽  
Vol 84 (9) ◽  
pp. 1450-1454
Author(s):  
Brian G. Harbrecht ◽  
Keith R. Miller ◽  
Amirrezat Motameni ◽  
Matthew V. Benns ◽  
Matthew C. Bozeman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Injury Severity ◽  
Demographic Data ◽  
Gunshot Wounds ◽  
Operative Intervention ◽  
General Surgeon ◽  
Vascular Repair ◽  
Body Regions ◽  
Trauma Activation

Gunshot wounds (GSW) are becoming increasingly prevalent in urban settings. GSW to the trunk mandate full trauma activation and immediate surgeon response because of the high likelihood of operative intervention. Extremity GSW proximal to the knee/elbow also require full trauma activation based on American College of Surgeons Committee on trauma standards. However, whether isolated extremity GSW require frequent operative intervention is unclear. We evaluated GSW at our Level I trauma center from January 2012 to December 2016. Demographic data and injury patterns were abstracted from the trauma registry and charts. The number of GSW increased yearly but the age, gender, Injury Severity Score and injury pattern did not change (P = ns, not shown). There were 504 GSW that included an extremity and 194 (38%) involved multiple body regions. There were 310 GSW (62%) isolated to an extremity and 176 were proximal to the elbow/knee. If proximal GSW had an Emergency Department systolic blood pressure <90 mm Hg, 53 per cent underwent vascular repair, 12 per cent had soft tissue repair, and 29 per cent required no operation. If proximal GSW had an Emergency Department blood pressure >90 mm Hg, 57 per cent underwent orthopedic repair, 22 per cent required no surgery, and only 13 per cent required vascular repair (P < 0.01). In the absence of other criteria for full trauma activation such as shock, the need for the immediate presence of a general surgeon to perform emergency surgery for a GSW isolated to the extremity is low.

scholarly journals LO66: Solid organ donation from the emergency department: A death review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S31-S32
Author(s):  
J. McCallum ◽  
R. Yip ◽  
S. Dhanani ◽  
I. Stiell
Keyword(s):  
Emergency Department ◽  
Organ Donation ◽  
Primary Outcome ◽  
Organ Procurement ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Solid Organ ◽  
Organ Donors ◽  
Organ Procurement Organization

Introduction: A significant gap exists between the number of people waiting for an organ and donors. There are currently 1,628 people awaiting organ donation in Ontario alone. In 2018 to date, 310 donors have donated 858 organs. The purpose of this study was to determine whether there were missed donors in the Emergency Department (ED) and by what percent those missed donors would increase organ donation overall. Methods: This was a health records and organ donation database review of all patients who died in the ED at a large academic tertiary care center with 2 campuses and 160,000 visits per year. Patients were included from November 1, 2014 – October 31, 2017. We collected data on demographics, cause of death, and suitability for organ donation. Data was cross-referenced between hospital records and the provincial organ procurement organization called Trillium Gift of Life Network (TGLN) to determine whether patients were appropriately referred for consideration of donation in a timely manner. Potential missed donors were manually screened for suitability according to TGLN criteria. We calculated simple descriptive statistics for demographic data and the primary outcome. The primary outcome was percentage of potential organ donors missed in the Emergency Department (ED). Results: There were 606 deaths in the ED from November 1, 2014 – October 31, 2017. Patients were an average of 71 years old, 353 (58%) were male, and 75 (12%) died of a traumatic cause. TGLN was not contacted in 12 (2%) of cases. During this period there were two donors from the ED and 92 from the ICU. There were ten missed potential donors. They were an average of 67 years, 7 (70%) were male, and 2 (20%) died of a traumatic cause. In all ten cases, patients had withdrawal of life sustaining measures for medical futility prior to TGLN being contacted for consideration of donation. There could have been an addition seven liver, six pancreatic islet, four small bowel, and seven kidney donors. The ten missed ED donors could have increased total donors by 11%. Conclusion: The ED is a significant source of missed organ donors. In all cases of missed organ donation, patients had withdrawal of life sustaining measures prior to TGLN being called. In the future, it is essential that all patients have an organ procurement organization such as TGLN called prior to withdrawal of life sustaining measures to ensure that no opportunity for consideration of organ donation is missed.

scholarly journals P083: Why do older adults in assisted living facilities use the emergency department: are all these visits necessary?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S106-S106
Author(s):  
E. Losier ◽  
A. McCollum ◽  
P. Jarrett ◽  
R. McCloskey ◽  
P. Nicholson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Assisted Living ◽  
Demographic Data ◽  
Care Home ◽  
Functional Decline ◽  
Retrospective Chart Review ◽  
Community Services ◽  
Level 3 ◽  
Ed Visits ◽  
One Year

Introduction: Special Care Home (SCH) residents require supervision for activities of daily living but not regular nursing care. Emergency Department (ED) use by seniors in SCHs is poorly studied. A recent study in Nova Scotia found seniors represented over 20% of ED visits. We studied SCH resident ED visits in a community with a population of 30,000 aged over 65 years and with 785 SCH beds, to define reasons for ED visits to a tertiary ED, and if these could be avoided. Methods: We performed a retrospective chart review of SCH residents’ visits to an ED (SCH-ED) which has 56,000 total ED (TED) visits over one year. Reasons for visit, admission data, and avoidability were collected. A geriatrician and ED physician independently reviewed visits. Initial disagreement on avoidability (27%) was adjudicated through case discussion. Results: Demographic data revealed 344 ED visits by 111 SCH residents over one year; 37% of visits resulted in admission. 13.9% of residents visited the ED on at least one occasion (average 3.1 visits); mean age 78.4 years; female 66.7%; ambulance arrival 91.0%. The three most common chief complaints were shortness of breath, weakness and abdominal pain. Most SCH-ED visits were Canadian Triage and Acuity Scale (CTAS) Level 3 (63.4%, TED 53.3%). Of CTAS Level 3 visits, 35.3% were admitted (TED 12.9%). SCH-ED visits were avoidable in 40.6% of cases. Gastrointestinal (18%), pain (16.5%), falls, functional decline or injury (14%) and respiratory (12%) were the most common avoidable diagnostic groups, accounting for 57% of total SCH visits. Conclusion: ED visits by SCH residents demonstrated increased acuity and admission rates with a high number of repeat visits. Of all SCH-ED visits, 40% were potentially avoidable. Further study may determine if improved community services reduces ED visits or hospital admission. Gastrointestinal, respiratory, falls and pain diagnoses may be important areas of focus.

scholarly journals P015: Implementing the Canadian CT Head Rule in a community emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S83-S83
Author(s):  
G. Bock ◽  
R. Setrak ◽  
S. Freeman
Keyword(s):  
Emergency Department ◽  
Demographic Data ◽  
Ct Scans ◽  
P Value ◽  
Relative Reduction ◽  
Exclusion Criteria ◽  
Head Ct ◽  
Preliminary Results ◽  
Ct Head ◽  
Significant Injury

Introduction: The Canadian CT Head Rule (‘the rule’) is widely used across the country and its use is specifically recommended by Choosing Wisely Canada. Studies in Canadian hospitals have shown appropriate declines in CT scans when decision tools have been made readily available and useable at the point of care. Research into the implementation of the Canadian CT Head Rule in particular has shown that barriers to its use include an inability to accurately recall each criteria and forgetting to attempt to apply the rule altogether. In an attempt to provide our clinicians with effective access to the rule, we modified CT requisitions and order procedures to facilitate the use of the rule for every head CT in our emergency department (ED). Methods: A quality improvement (QI) approach was used to pilot, implement, and evaluate the modified CT requisition at our hospital. Several Plan-Do-Study-Act cycles involving stakeholders in the hospital resulted in iterative changes to the requisition leading to the implemented version. The new requisition required physicians to indicate which rules or exclusion criteria were met and this was made mandatory for all head CTs ordered. Demographic data was collected on all patients presenting to the ED on age, gender, CTAS level, disposition, and length of stay. Data on which exclusion criteria were appropriate, the rules met leading to CT scans, whether each requisition was used appropriately, and whether there was a significant injury found was collected for each patient receiving a head CT after implementation. Results: In our primary outcome (% of ED visits receiving a head CT), preliminary results have demonstrated a relative reduction in head CT ordering of 10.9%. Our study at completion is powered to detect a ~10% relative change in ordering behaviour, and a Chi square of the data to date yields a P-value of 0.0147. There are no significant differences in visit volume or any of the demographics collected to date. Final results including analysis are anticipated in March, 2016. Conclusion: Preliminary results on this simple, no-cost intervention are very promising. The reduction in head CTs ordered suggests that with mandated access to an easy-to-use, well validated decision tool, ED physicians have been able to confidently defer scans that have a very low risk of having any significant injury present, reducing cost, radiation exposure, and perhaps time in department.

Incidence and characteristics of emergency department presentations during immune checkpoint inhibitor therapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14164-e14164
Author(s):  
Daniel Arnold Smith ◽  
Kai Laukamp ◽  
Melanie Campbell ◽  
Robert Devita ◽  
Ariel Ann Nelson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Overall Survival ◽  
Anticancer Agents ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Demographic Data ◽  
Cancer Type ◽  
Primary Cancer ◽  
Oncology Patients ◽  
Ed Visits

e14164 Background: Immune checkpoint inhibitors (ICIs) have emerged as a novel class of anticancer agents with unique response and toxicity profiles. Oncology patients undergoing ICI therapy can present acutely with cancer- or treatment-related complications, but knowledge of these acute clinical presentations is limited. The objective of this study was to investigate the features of emergency department (ED) presentations of patients undergoing ICI therapy. Methods: A retrospective chart review was performed of 1044 adult oncology patients at a single institution from 2010-2018 who underwent treatment with one or more ICI. The number of patient visits to the ED during and up to one month following ICI treatment was recorded, in addition to various clinical and demographic data. These data were compared based on stratification by number of ED visits (0 visits, 1 visit, or ≥2 visits) using Likelihood Ratio Chi-Square and Mann–Whitney U tests. Results: Mean age for the 1044 patients receiving ICI therapy was 64±13 years, with 57% males and 43% females. Primary cancer distribution included 42.0% lung, 24.2% melanoma, 6.9% head & neck, 5.1% kidney, 4.0% bladder, and 17.8% other malignancy. 83.4% of patients were treated with a single ICI, 14.9% with 2 ICIs, and 1.2% with 3-4 ICIs. 56.0% of patients had no ED visits during their treatment duration, 27.0% had 1 ED visit, and 17.0% had ≥2 ED visits. Patients with lung, kidney, and bladder cancer were more likely to present to the ED (p = < 0.001). Black ethnicity was the only demographic feature associated with more ED visits (p = 0.017). Patients receiving ≥2 ICIs or monotherapy with nivolumab, pembrolizumab, or atezolizumab more frequently presented to the ED compared to other ICIs (p = < 0.001). Patients with 1 or ≥2 ED visits had longer durations of ICI therapy (136±12 days and 216±15 days, respectively) compared to patients with no ED visits (127±8 days) (p = < 0.001). Patients with no ED visits also demonstrated better overall survival (p = < 0.001). Conclusions: More frequent ED visits during ICI therapy is statistically associated with several key clinical factors, including primary cancer type, ethnicity, specific ICI agent, ICI therapy duration, and overall survival.

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