bluuebunny/crossref_metadata_2025_split huggingface dataset:
11 External validation of the Dutch prediction model for prehospital triage of trauma patients in South West region of England, United Kingdom
Authors: Shanahan Thomas , Marincowitz Carl , Fuller Gordon , Sheldon Trevor , Quilty Fionn , Turton Emily 
Published: January 2021

Aims/Objectives/BackgroundThis is the first external validation of a European empirically derived prediction model for identifying major trauma in an unselected group of injured patients transported by ambulance in the United Kingdom.Methods/DesignThis study was an external validation of a Dutch prediction model for identifying major trauma using a retrospective cohort of injured patients who ambulance crews transported to hospitals in the South West region of England. Major trauma was defined as Injury Severity Score (ISS)>15.Participants were patients ≥16 years with a suspected injury and transported by ambulance from February 1, 2017 to February 1, 2018. This study had a census sample of cases available to us over a one year period.We tested the accuracy of the prediction model in terms of discrimination, calibration, clinical usefulness, sensitivity and specificity and under- and over triage rates compared to existing trauma triage practices in the South West region.Results/ConclusionsA total of 68 698 adult patients were included in the final external validation cohort. The median age of patients was 72 (i.q.r. 46–84); 55.5% were female; and 524 (0.8%) had an ISS>15. In comparison the Dutch cohort was younger (45 years), more were male (58.3%) and more patients had an ISS>15. (8.8%) The model achieved good discrimination with a C-Statistic 0.75 (95% CI, 0.73 – 0.78). At a maximal specificity of 50% the model resulted in a sensitivity of 86%. The model improved undertriage rates at the expense of increased overtriage rates compared with routine trauma triage methods in the South West of England.The Dutch prediction model for identifying major trauma can lower the undertriage rate to 17%, however it would increase the overtriage rate to 50% in this UK cohort. Further research is needed to determine whether the model can be practically implemented by paramedics and is cost-effective.
160 Study of shortness of breath (SOB) point-of-care biomarker panel in patients presenting with shortness of breath in emergency department
Authors: Jha Tanmay Kumar 
Published: January 2021

AimStudy of shortness of breath (SOB) point-of-care biomarker panel in patients presenting with shortness of breath in Emergency Department.ObjectiveTo study the sensitivity and specificity of SOB point-of-care biomarker panel in diagnosing Acute Coronary Syndrome (ACS), Heart Failure (HF) and Pulmonary Embolism (PE).BackgroundShortness of breath (SOB) is one of the commonest symptoms of patients presenting to the emergency department (ED).The differential diagnosis of SOB is very vast, knowing the frequency and severity potential of ACS, HF and PE should be considered.Methods/Design165 consecutive subjects 18 or more years old, presenting to the ED due to a primary complaint of SOB were included in this prospective study.After detailed history and thorough physical examination, the blood samples of patients included in the study were analysed using a SOB point-of-care biomarker panel (troponin I, myoglobin, CK-MB, D-dimer, and BNP at the time when patient presented with SOB within 15 minutes of patient’s visit to the ED. Thirty-day follow-up for HF, ACS and PE was performed.The following cut offs were used for determining a positive biomarker:myoglobin > 107 ng/mL,CK-MB > 4.3 ng/mL,troponin I > 0.40 ng/mL,D-dimer > 500 ng/mL, andBNP > 100 ng/mL.CTCA, CTPA and 2D Echo were taken as the Gold Standard for the diagnosis of ACS, HF and PE.Results/ConclusionsSALIENT FINDINGSACS:P<0.001Sensitivity=81.2%Specificity=90.6%PPV=78%NPV=92.2%Accuracy=87.8%PE:P<0.001Sensitivity=75%Specificity=94.6%PPV=77.4%NPV=93.1%Accuracy=90.3%HF:P<0.001Sensitivity=69.1%Specificity=66.4%PPV=50.7%NPV=81.1%Accuracy=67.3%ConclusionWe conclude that there is significant correlation between SOB point-of-care biomarker panel diagnosis and final diagnosis.In patients presenting with SOB, one of the three clinical conditions identified by the SOB point-of-care biomarker panel will lead to earlier diagnosis and initiation of specific management.
196 The effect of affect: what we teach our learners about the role of patient induced emotion in clinical reasoning in the ED and why?
Authors: Roy Susie , Skinner Janet , Jaap Alan 
Published: January 2021

Aims/Objectives/BackgroundFew empirical studies explore the contribution of non-clinical factors to perceptions of patient difficulty in EM. Fewer have investigated what students placed in EDs learn about ‘difficult’ patients or what, if anything, clinicians teach about the topic. We looked to address this. Considering these questions is imperative: patients perceived as frustrating report lower satisfaction with their clinical encounter, experience worse health outcomes and seem to be at risk of medical error secondary to faulty clinical reasoning.Methods/DesignWith ethical approval, we undertook three interrelated, qualitative studies to conduct a case study of the undergraduate EM module delivered at Edinburgh University. In the first two, focus groups were used as the method of data collection; five clinician (n=25) and four medical student (n=21) groups were facilitated. In the third, semi-structured interviews with clinicians (n=12) were conducted. All groups/interviews were audio-recorded and transcribed. The data were analysed inductively using reflexive thematic analysis.Results/ConclusionsFrequent attendance, demands, pre-existing relationships and unrealistic expectations contributed to perceived patient difficulty. These were modified by personal and circumstantial factors. Although rarely told, students were aware who these ‘difficult’ patients were through observing behaviours. Critically, clinicians and students alike believed frustration adversely impacted aspects of clinical reasoning. Students struggled when witnessing what they considered ‘bad’ behaviour as it contradicted their previously held ideals of how physicians should act.It seems we teach students to try to internalise emotion yet that it is acceptable to let it negatively impact patient care. To combat this, students sought greater emotional transparency from physicians as well as advice on self-management strategies. Clinicians recognised the benefits of being candid but were afraid of being so. Contributing to this is the culture in medicine being one that mistrusts emotion. Further, both groups desired a formal curriculum addressing emotion in clinical reasoning thus suggesting one is needed.
274 Thrombotic complications in patients with COVID-19 requiring hospitalisation: a single centre prospective service evaluation
Authors: Habeichi Wadhi , Bell Jack , Khawaja Zohaib , Exley Joshua , Horner Daniel 
Published: January 2021

Aims/Objectives/BackgroundEarly experience of the coronavirus pandemic has led to concerns regarding hypercoaguability and increased rates of venous thromboembolic (VTE) disease. As a result, many centres have changed front door thromboprophylaxis risk assessment and prescribing practice. There is no clear evidence that such new approaches are safe, or improve patient outcomes.We sought to establish the incidence of thrombotic complications in all hospitalised patients with confirmed COVID-19, at a UK thrombosis exemplar centre.Methods/DesignA single site prospective service evaluation (Ref: S20HIP17). We identified all patients with COVID-19 who were hospitalised between 1st March and the 31st May 2020, encompassing the UK acceleration, peak and deceleration phases of the pandemic.Standard risk assessment and weight adjusted pharmacological thromboprophylaxis were conducted in accordance with previous national and local guidelines.We report follow up data as of the 1st July (minimum 4 weeks post diagnosis), using an established method for national VTE reporting metrics.Results/ConclusionsA total of 528 hospitalised patients had confirmed COVID-19 during the study period, of which 74 (14.0%) were admitted to critical care. Mean age was 69.6 (SD 16.7) and the median duration of admission 7 days (IQR 16). Mortality was 35.6%.We identified 12 VTE positive episodes at follow up, including 9 pulmonary emboli (PE) and 3 deep vein thromboses (DVT). Over 60% of PE events were isolated segmental or subsegmental thrombi, suggestive of ‘immunothrombosis’ in situ and of questionable clinical significance. VTE event rates for our population were 2.3% overall and 6.8% for those admitted to critical care.Rates of VTE did not appear to differ from pre-pandemic levels (figure 1).Abstract 274 Figure 1Venous thromboembolic (VTE) events over time and proportional hospital acquired thrombosis rates(HAT)We did not find increased rates of clinically significant VTE events in hospitalised patients with COVID-19. Our findings raise questions regarding the merits of unvalidated risk assessment tools and increased thromboprophylaxis dosing strategies in COVID-19 patients.
134 The major incident app- an improved way to contact staff in major incidents
Authors: Hulme Peter , Madden Alannah , Reynard Charlie 
Published: January 2021

Aims/Objectives/BackgroundMajor incidents are thankfully rare events but require appropriate planning and training to ensure the best response for patients and staff. The method of contacting staff in these incidents is key and needs to be quick, reliable and have excellent response times to be effective. The best method of contacting staff has not been ascertained.The Major Incident App (MIA) is a new way to contact staff in major incidents and sends loud alerts even when phones are on silent mode. This study looks to compare the major incident response times using MIA with the previous way of contacting staff in a major incident- a freely available digital messaging platform (DMP) at Manchester Foundation Trust.Methods/DesignThe decision to declare a major incident or standby was determined by the consultant in Emergency Medicine who was in the department at the time of the incident. The receiving consultants would read the message as soon as they saw it and respond appropriately. After the incidents we conducted a retrospective review of digital communication records to ascertain the time taken for a DMP or MIA message declaring an incident to be seen and read by the receiving consultants.Reading the message within 15 minutes was regarded as an ‘excellent’ response time and within 60 minutes was regarded as a ‘good’ response. These time intervals were determined by the expert opinion of five Major Trauma consultant experts at Manchester Foundation Trust.A Wilcoxon rank sum test was used to compare the two methods.Abstract 134 Figure 1Abstract 134 Figure 2Abstract 134 Table 1Incidents using WhatsAppIncident TypeDateTimeDay of the weekAve Response time minsMedian response times minsSeen within 15 mins (%)Seen within 1hr (%)Simulated 29/3/17 10:38 Wednesday 76.6 30 9/25 (36%) 15/25 (60%) Manchester Arena Attack 22/5/17 22:55 Monday 99.3 9.5 15/26 (57.6%) 20/26 (76.9%) Simulated 16/9/17 10:40 Saturday 79.9 10 18/23(78.2%) 22/23 (95.6%) City centre Fire 30/12/17 17:29 Saturday 30.5 8 17/25 (68%) 21/25 (84%) Simulated 18/9/18 09:35 Tuesday 17.8 4 19/24 (79.1%) 22/24 (91.7%) Multiple Stabbing 11/10/19 12:05 Friday 86.5 33.5 11/28 (39.2%) 16/28 (57.1%) Chemical Incident 11/10/19 13:46 Friday 56.5 21.5 9/26 (34.6%) 20/26 (76.9%) Multiple Stabbing 15/10/19 16:46 Tuesday 23.9 11 15/27 (55.5%) 25/27 (92.6%) New Years Eve multiple traumas 1/1/20 04:14 Wednesday 184.3 219 4/26 (15.3%) 6/26 (23%) Overall 117/230 (50.8%) 167/230 (72.6%) Abstract 134 Table 2Incident using MIAIncident TypeDateTimeDay of the weekAve Response time minsMedian response times minsSeen within 15 mins (%)Seen within 1hr (%)City Centre fight 31/5 20:54 Sunday 1.3 1 22/22 (100%) 22/22(100%) Results/ConclusionsResponse times were significantly better with MIA compared to DMP p-value<0.001 (see Tables 1 and 2) and all messages were seen within 4 minutes. Although the numbers of incidents are small, this study shows that incident response times can be significantly improved with the MIA that alerts phones in silent mode.
389 Significant impact of SARS-CoV-2 on attendances, but not acuity, in a Children’s Emergency Department
Authors: Roland Damian , Jones William 
Published: January 2021

Aims/Objectives/BackgroundThere have been anecdotal reports that delay in presenting to Children’s Emergency Departments (CED) during COVID19, combined with a reduction in more minor cases, has increased the relative acuity of children in CED.Methods/DesignIn order to determine the impact of SARS-CoV-2 on our tertiary CED we compared attendances, diagnosis at discharge, initial paediatric observation priority score (POPS) and Healthcare Resource Group (HRG) code for the months of March, April and May 2018, 2019 and 2020. POPS is a bespoke early warning-like score and is calculated between 0–16 (0 low acuity;16 high acuity) based on 8 components including vital signs and subjective observations. A large proportion of children presenting have an unrecorded or POPS 0 as they are an injury so a POPS of greater than 0 was used in analysis. A lower HRG scores indicates increased resource utilisation.Results/ConclusionsPresentations in March, April and May 2020 fell compared with previous years with overall HRG weighting slightly increasing to 8.71 from 8.48 (2019) and 8.98 (2018) which is a clinically negligible change. There was a trend for a greater proportion of children with a POPS 0 in 2020 compared to previous years. Mean and median POPS was unchanged (table 1). Children diagnosed with an infectious disease fell by 30.5 attendances per 1000 presentations and soft tissue injuries fell by 10.0 attendances per 1000 presentations comparing 2020 and 2019. There were increases in codes relevant to specific paediatric diagnoses (croup, febrile convulsion etc.) by 11.4 attendances per 1000 presentations in the same time period and fracture/dislocations increased by 9.1 attendances per 1000 presentations.Abstract 389 Table 1Attendances and POPS per month and yearMonthYear of Arrival DateAttendance CountNumber of Children with a POPS >0 (%)Attendance CountMean EWSMedian EWS25th Percentile75th PercentileMarch 2018 4,123 1,682 (40.8) 4,123 5 2.00 1 3 March 2019 5,738 2,443 (42.3) 5,738 6 2.00 1 3 March 2020 3,831 1,638 (42.8) 3,831 6 2.00 1 3 April 2018 4,134 1,436 (34.7) 4,134 5 2.00 1 3 April 2019 5,159 2,066 (40.1) 5,159 5.5 2.00 1 3 April 2020 1,625 778 (47.9) 1,625 4.75 1.00 1 2 May 2018 4,594 1,515 (33.0) 4,594 6.09 2.00 1 3 May 2019 4,957 1,887 (38.1) 4,957 6.09 2.00 1 3 May 2020 2,312 937 (40.5) 2,312 5.8 1.00 1 2 While having a huge impact on childrens’ presentations to Emergency Departments there is no evidence, in our institution, of significantly elevated acuity, or a large change in case-mix, as a result of the COVID19 pandemic compared to previous years.
31 Head home: a prospective cohort study of a nurse led paediatric head injury clinical decision tool at a district general hospital
Authors: Aldridge Patrick , Castle Heather , Russell Emma , Phillips Clare , Guerrero-Luduena Richard , Rout Raj 
Published: January 2021

Aims/Objectives/BackgroundObjectivesTo assess if application of a nurse-led paediatric head injury clinical decision tool would be safe compared to current practice.Background>700,000 children attend UK hospitals’ each year with a head injury. Research indicates <1% undergo neurosurgical intervention. No published evidence for nurse-led discharge of paediatric head injuries exists.Methods/DesignMethods – All paediatric (<17 years) patients with head injuries presenting to our Emergency department (ED) 1st May to 31st October 2018 were prospectively screened by a nurse using a mandated electronic ‘Head Injury Discharge At Triage’ questionnaire (HIDATq). We determined which patients underwent computed tomography (CT) brain and whether there was a clinically important intracranial injury or re-presentation to ED. The negative predictive value of the screening tool was assessed. We determined what proportion of patients could have been sent home from triage using HIDATq.Results/ConclusionsResults - Of 1739 patients screened; 61 had CTs performed due to head injury (6 abnormal) with a CT rate of 3.5% and 2% re-presentations. Of the entire cohort, 1052 screened negative. 1 CT occurred in this group showing no abnormalities. Of those screened negative: 349/1052 (33%) had ‘no other injuries’ and 543/1052 (52%) had ‘abrasions or lacerations’. HIDATq’s negative predictive value for CT was 99.9% (95% Confidence interval (CI) 99.4–99.9%) and 100% (CI 99.0–100%) for intracranial injury. The positive predictive value of the tool was low. Five patients screened negative and re-presented within 72hrs but did not require CT imaging.Conclusion - A negative HIDATq appears safe in our ED. Potentially 20% (349/1739) of all patients with head injuries presenting to our department could be discharged by nurses at triage with adequate safety netting advice. This increases to 50% (543/1739) if patients with lacerations or abrasions were treated and discharged at triage. A large multi-centre study is required to validate the tool.
First pass effect in patients with large vessel occlusion strokes undergoing neurothrombectomy: insights from the Trevo Retriever Registry
Authors: Jadhav Ashutosh P , Desai Shashvat M , Budzik Ronald F , Gupta Rishi , Baxter Blaise , English Joey D , Bartolini Bruno Mario , Krajina Antonin , Haussen Diogo C , Nogueira Raul G , Liebeskind David , Veznedaroglu Erol 
Published: January 2021

BackgroundFirst pass effect (FPE), defined as near-total/total reperfusion of the territory (modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3) of the occluded artery after a single thrombectomy attempt (single pass), has been associated with superior safety and efficacy outcomes than in patients not experiencing FPE.ObjectiveTo characterize the clinical features, incidence, and predictors of FPE in the anterior and posterior circulation among patients enrolled in the Trevo Registry.MethodsData were analyzed from the Trevo Retriever Registry. Univariate and multivariable analyses were used to assess the relationship of patient (demographics, clinical, occlusion location, collateral grade, Alberta Stroke Program Early CT Score (ASPECTS)) and device/technique characteristics with FPE (mTICI 2c/3 after single pass).ResultsFPE was achieved in 27.8% (378/1358) of patients undergoing anterior large vessel occlusion (LVO) thrombectomy. Multivariable regression analysis identified American Society of Interventional and Therapeutic Neuroradiology (ASITN) levels 2–4, higher ASPECTS, and presence of atrial fibrillation as independent predictors of FPE in anterior LVO thrombectomy. Rates of modified Rankin Scale (mRS) score 0–2 at 90 days were higher (63.9% vs 53.5%, p<0.0006), and 90-day mortality (11.4% vs 12.8%, p=0.49) was comparable in the FPE group and non-FPE group. Rate of FPE was 23.8% (19/80) among basilar artery occlusion strokes, and outcomes were similar between FPE and non-FPE groups (mRS score 0–2, 47.4% vs 52.5%, p=0.70; mortality 26.3% vs 18.0%, p=0.43). Notably, there were no difference in outcomes in FPE versus non-FPE mTICI 2c/3 patients.ConclusionTwenty-eight percent of patients undergoing anterior LVO thrombectomy and 24% of patients undergoing basilar artery occlusion thrombectomy experience FPE. Independent predictors of FPE in anterior circulation LVO thrombectomy include higher ASITN levels, higher ASPECTS, and the presence of atrial fibrillation.
T-dualization of Gödel string cosmologies via Poisson–Lie T-duality approach
Authors: Eghbali Ali , Naderi Reza , Rezaei-Aghdam Adel 
Published: January 2021

AbstractUsing the homogeneous Gödel spacetimes we find some new solutions for the field equations of bosonic string effective action up to first order in $$\alpha '$$

α
′

including both dilaton and axion fields. We then discuss in detail the (non-)Abelian T-dualization of Gödel string cosmologies via the Poisson–Lie (PL) T-duality approach. In studying Abelian T-duality of the models we get seven dual models in such a way that they are constructed by one-, two- and three-dimensional Abelian Lie groups acting freely on the target space manifold. The results of our study show that the Abelian T-dual models are, under some of the special conditions, self-dual; moreover, by applying the usual rules of Abelian T-duality without further corrections, we are still able to obtain two-loop solutions. We also study the Abelian T-duality of Gödel string cosmologies up to $$\alpha '$$

α
′

-corrections by using the T-duality rules at two-loop order derived by Kaloper and Meissner. Afterwards, non-Abelian duals of the Gödel spacetimes are constructed by two- and three-dimensional non-Abelian Lie groups such as $$A_2$$

A
2

, $$A_2 \oplus A_1$$

A
2

⊕

A
1

and $$SL(2, \mathbb {R})$$

S
L
(
2
,
R
)

. In this way, the PL self-duality of $$AdS_3 \times \mathbb {R}$$

A
d

S
3

×
R

space is discussed.
A response to criticisms on “CMB constraints cast a shadow on CSL model”
Authors: Martin Jérôme , Vennin Vincent 
Published: January 2021

AbstractOur recent letter “Cosmic Microwave Background Constraints Cast a Shadow On Continuous Spontaneous Localization Models” (Martin and Vennin Phys Rev Lett 124:080402, 2020, arXiv:1906.04405) has recently been criticised in Ref. (Bengochea et al. Eur Phys J C 80:1021, 2020a) (see also Ref. Bengochea et al. 2020b, arXiv:2006.05313). In this reply, we explain why the arguments presented in those articles are either incorrect or a confirmation of the robustness of our results.
Short-scale quantum kinetic theory including spin–orbit interactions
Authors: Ekman R. , Al-Naseri H. , Zamanian J. , Brodin G. 
Published: January 2021

Abstract
We present a quantum kinetic theory for spin-1/2 particles, including the spin–orbit interaction, retaining particle dispersive effects to all orders in $$\hbar $$
ħ
, based on a gauge-invariant Wigner transformation. Compared to previous works, the spin–orbit interaction leads to a new term in the kinetic equation, containing both the electric and magnetic fields. Like other models with spin–orbit interactions, our model features “hidden momentum”. As an example application, we calculate the dispersion relation for linear electrostatic waves in a magnetized plasma, and electromagnetic waves in a unmagnetized plasma. In the former case, we compare the Landau damping due to spin–orbit interactions to that due to the free current. We also discuss our model in relation to previously published works.

Graphic abstract