Unearthing a provincial medical school and its students – A history of the 1834 ‘School of Practical Medicine and Surgery’ at the Sussex County Hospital, Brighton, England

The 19th century was a period of rapid change in English medical education. Little is known about the important contribution of smaller, hospital-based, provincial medical schools which sprang up to provide important practical training opportunities for students, typically as a foundation for further training and examination in London. One such example is the 1834 Brighton ‘School of Practical Medicine and Surgery’, which was based at the Sussex County Hospital and recognised by the Royal College of Surgeons and Worshipful Society of Apothecaries. Unlike many other 19th century medical schools, the history of the Brighton school is largely undocumented. Although it remained dependent upon London through the ‘College and Hall’ examination system, this article shows that the school's pragmatic and adaptive educational approach allowed it to play an important role in educating future doctors in Brighton from 1834 into at least the early 20th century.

342 Rib Fracture Scoring at The Royal Sussex County Hospital, A Major Trauma Centre

Introduction In April 2017, The Royal Sussex County Hospital introduced rib fracture scoring to help guide the management of rib fractures. Rib fracture score = (number of fractures x number of sides) + age score1 In this study, we audit our adherence to the scoring system and compare our management of chest trauma before and after its implementation. Method All admissions with rib fractures between 1/10/2016- 28/02/2017 (N = 35) and 1/10/2019- 31/01/2020 (N = 41) were recorded. Electronic and written notes were used to retrospectively record multidisciplinary care involvement, analgesics, chest infection and death. Results The pre-intervention cohort had an average age of 55.1 years and rib score of 8.8. The post intervention cohort had an average age of 67.2 years and score of 11.3. Following implementation, 45% of patients had a rib score recorded. Post-intervention, anaesthetic involvement increased by 34.5% and 15.4% more patients received a regional block. Inpatient nights fell from 11.2 to 10.1, mortality rate from 7% to 4% but the incidence of chest infection remained similar. Conclusions The implementation of a rib fracture scoring system has led to greater multidisciplinary care and higher levels of pain management. A larger study is required to assess patient outcome given the change in sample population over time.

480 The prognostic value of D-dimer for COVID-19 outcomes

Aims/Objectives/BackgroundThe diagnosis and management of COVID-19 has presented a novel challenge in the emergency department (ED). Early and sensitive predictors of outcome are needed to improve management of COVID-19 patients. Recent evidence has suggested a role for a COVID-19 associated pro-thrombotic coagulopathy as part of the underlying pathology. The aim was to evaluate the prognostic utility of D-dimer as a biomarker predictive of outcome in COVID-19 patients.Methods/DesignWe retrospectively analysed data for 326 cases of confirmed COVID-19 presenting to our ED at the Royal Sussex County Hospital in Brighton between 13th March and 17th June 2020. During this period 2687 attendances were triaged to the ‘red’ COVID-19 zone with symptoms suspicious for COVID-19, amongst whom 326 admissions were confirmed to have COVID-19 by CT, chest x-radiograph or PCR swab. D-dimers were measured in ED for 265/326. Peak D-dimer measured during admission was collected to evaluate deteriorations subsequent to admission. Receiver-operating characteristic curves were used to determine an optimal cutoff for discrimination.Results/ConclusionsD-Dimer elevation >0.5µg/mL was seen in 93.5% of admitted patients with confirmed COVID-19. Multivariable logistic regression suggested that age >75 (OR=3.01 95% CI 1.65–5.49 p=0.0003) and D-dimer (measured in ED) >1.25µg/mL (OR=2.06 95% CI 1.08–3.93 p=0.0276) were associated with increased mortality. D-dimer measured in ED predicted mortality with sensitivity of 76.5% and specificity of 41.3%. The D-dimer rose by >1.00 for 30/265 patients subsequent to admission of whom 8/30 (26.7%) died (all mortality 16%) and 11/30 (36.7%) were escalated to intensive care. Peak D-dimer measured during admission >3.2µg/mL predicted hospital mortality with 50% sensitivity and 72.4% specificity (OR=2.16 95% CI 1.16–3.99 p=0.0145).The results of this study support the growing argument that a raised D-dimer may play an important role as a prognostic marker in patients with COVID-19, perhaps indicative of a pro-thrombotic coagulopathy within the underlying pathology.

Jersey Maid and Damn Yankee

This chapter focuses on Amelia Norman, who was born around 1818 in a troubled household near the village of Sparta in Sussex County in New Jersey's mountainous northwest. It mentions two of Amelia's brothers, Oliver and Charles Norman, who within days of her attack on Henry Ballard, were raising hell at home in New Jersey. It also talks about how Norman and Charles robbed their neighbors of a few bee skeps, poultry animals, and several gallons of whiskey. The chapter cites how Oliver developed a full-fledged criminal career, engaging in assault, housebreaking, jailbreaking, attempted rape, and theft of more liquor and farm products. It elaborates how Amelia and her siblings could have been affected by the wave of religious fervor and the new ideas about education that pulsed through their village during their childhood.