bluuebunny/crossref_metadata_2025_split huggingface dataset:
1750 Prediction of 6 month Trauma PROMS using in-hospital data
Authors: Coats Timothy , Bouamra Omar , Edwards Antoniette , Lecky Fiona , Mirkes Evgeny , Sergeant Jamie , Ivan Tyukin 
Published: December 2022

Aims, Objectives and BackgroundTrauma audit has used lived/died as an outcome for 30 years, but Patient Reported Outcome Measures (PROMS) have also been collected by the Trauma Audit and Research Network (TARN) for the past 5 years across major trauma centres. These are measured at 6 months after injury and include two measures of health-related quality of life, EQ5D-5 and GOSE, employment status and three patient experience questions. It is not known if 6-month PROMS can be predicted after major trauma.Method and DesignThe TARN PROMS data was extracted and randomly divided into a model development (training) and a model testing (test) dataset. There is no standard way of using this type of complex data, so three different modelling approaches were used: (1) conventional logistic regression, (2) artificial intelligence (AI) selection of ‘nearest neighbours’, and (3) AI decision trees. The performance of each model was evaluated using the test dataset.Results and ConclusionThere were 5791 patients in the training set and 1447 patients in the test set. All three of the methods achieved an ROC AUC between 0.69 and 0.77 – implying that this might be the limit of prediction based on this type of data. When tested against the binary Glasgow Outcome Score the results are shown in the table 1. The AI method of ‘k Nearest Neighbours’ achieved a balance between sensitivity (72%) and specificity (71%).Abstract 1750 Table 1GOSE Groupk Nearest NeighboursLogistic RegressionDecision treesSensitivity72%91%79%Specificity71%26%65%PPV90%82%39%NPV42%45%91%ROC0.7640.6850.77ROC 95% CI0.733 – 0.7950.648 – 0.723Conclusionpatient reported outcomes at 6 months after injury can be predicted from in-hospital data. This potentially gives a new method for clinical audit and comparison of trauma outcomes using a measure that is more relevant to survivors of major trauma than the current ‘lived/died’.
1375 An analysis of the certified cause of death within one year of serious injury in the Scottish population
Authors: Craig Hannah , Gordon Malcolm WG , Khan Angela 
Published: December 2022

Aims, Objectives and BackgroundTo date, few studies effectively quantify the long-term incidence of death directly related to injury.The absence of detailed mortality data and underlying cause of death information following trauma results in an inadequate understanding and a potential underestimation of the true consequences of injury on an individual and population level.This study takes a nationwide approach to identify the true one-year mortality in patients due to serious injury in Scotland, evaluating survivorship in relation to other pre-existing co-morbidities and incidental causes of death.Method and DesignThis retrospective cohort study assessed the one-year mortality of adult trauma patients with an Injury Severity Score > 9 during 2020 using the Scottish Trauma Audit Group (STAG) registry linked to inpatient hospital data and death certificate records. Patients were divided into three distinct subgroups: death due to injury, death due to another cause, but injury was a contributory factor, and death due to a separate cause. These were subsequently analysed to determine risk factors linked to death. Kaplan-Meier curves and Cox regression were used for survival analysis to evaluate mortality.Abstract 1375 Figure 1Kaplan-Meier survival curve of the 2020 STAG cohort of traumatically injured adult patients who died within 365 days post-trauma hospitalisation stratified by underlying cause of death subgroup: trauma, trauma-contributed and non-traumaResults and Conclusion4056 patients were analysed with a median age 63 years and male predominance (55.2%). 782 patients died within 365 days (19.3%), with 55% occurring post-discharge. 47.7% of all deaths were attributable to trauma, and 35.3% were a direct consequence of injury. Non-traumatic deaths accounted for 20.3% and 79.4% in-hospital and post-discharge deaths respectively, most frequently due to circulatory, neoplastic and respiratory disease (37.7%, 12.3%, 9.1%, respectively). GCS < 8, modified Charlson Comorbidity score > 5, Injury Severity Score >25, Head AIS >3, Sex, and Age were independent risk factors for mortality at one year. Approximately 20% of patients died within 365 days due to trauma. Although early deaths reflect the bulk of trauma-related mortality, our sample demonstrated a significantly higher post-discharge one-year mortality than previously appreciated.
1404 Patients attending the emergency department for blunt thoracic trauma: a validation study of the STUMBL score
Authors: Giamello Jacopo Davide , Martini Gianpiero , Santoro Marco , Prato Davide , Arese Ylenia , Battle Ceri Elisabeth , Driscoll Timothy , Artana Nicoletta , Barutta Letizia , Sciolla Andrea , Lauria Giuseppe 
Published: December 2022

Aims, Objectives and BackgroundBlunt thoracic trauma (BTT) is a leading cause of emergency department (ED) trauma-related attendance. The STUMBL score is a prognostic model for BTT, derived and validated in the United Kingdom; this study’s aim was to validate the STUMBL score in an Italian ED.Method and DesignThis single-centre retrospective validation study was conducted in the ED of Cuneo hospital, north-western Italy. All patients with an ED attendance for isolated BTT from 2018 to 2021 were included. Exclusion criteria were: age of under eighteen and the presence of any immediately life-threatening lesion. The primary outcome was the development of trauma-related complications, defined by the occurrence of one or more of the following: in-hospital mortality, pulmonary complications (infection, pleural effusion, haemothorax, pneumothorax, pleural empyema), need for intensive care unit admission, hospital length of stay equal to or greater than seven days. The performance of the STUMBL score was analysed in terms of discrimination with the evaluation of the receiver operating characteristiccurve and calibration with the Hosmer-Lemeshow test and with the calibration belt.Abstract 1404 Figure 1Results and Conclusion745 patients were enrolled (median age 64 [50;78], male/female ratio 1:4, median Charlson comorbidity index 2 [1;4], median STUMBL score 11 [6;17]). 65.2% of patients were discharged home after ED evaluation. 203 patients (27.2%) developed the primary outcome. The STUMBL score was significantly different in patients with complications compared to those without complications (9 [5;13] vs 21 [17;25], p<0.001). The C index of the score for the primary outcome was 0.9 (95% CI 0.88 – 0.93) (figure 1), and the result of the Hosmer-Lemeshow test was 9.01 (p=0.34). STUMBL score = 16 had a negative predictive value of 0.92. In conclusion, this validation study demonstrated that the STUMBL score had excellent discrimination and calibration in predicting the outcome of patients attending the ED with a BTT.
1755 The differential determinants of delivering prehospital emergency anaesthesia within 45-minutes of the 999-call – a multi-centre, retrospective observational study
Authors: Kratz Maria , Price James , Lachowycz Kate , Major Rob , Moncur Lyle , McLachlan Sarah , Keeliher Chris , Steele Alistair , Barnard Ed 
Published: December 2022

Aims, Objectives and BackgroundPrehospital emergency anaesthesia (PHEA) is a necessary intervention for a significant proportion of severely injured trauma patients. The National Institute for Health and Care Excellence (NICE) trauma quality standards include delivery of prehospital emergency anaesthesia (PHEA), where indicated, ≤45-minutes of the 999-call. The aim of this study was to report the differential determinants of meeting this standard in a large regional cohort of trauma patients.Method and DesignA consecutive sample of adult trauma patients undergoing PHEA (2015–2020) at three Helicopter Emergency Medical Services (HEMS) in the East of England. The primary outcome was PHEA ≤45-minutes of 999-call; defined as duration between call ‘pick-up’ and administration of anaesthetic drugs. Data were extracted from all three HEMS electronic medical records (HEMSbase, MedicOne Systems), and combined. Variables included: dispatch type (immediate, interrogate, crew-request), demographics, time of day (day/night), PHEA indication, pre-PHEA physiology.A purposeful selection logistic regression model was used in R (a language and environment for statistical computing). Each variable was first tested in turn to explore the unadjusted association with the outcome. Significant variables were then included in the multivariable analysis. Variables were successively eliminated until only statistically significant variables remained. This was a service evaluation study (EAAA 2021/025).Results and Conclusion1,155 adult trauma patients were included in the analysis. The primary outcome, PHEA ≤45-minute of 999-call, was achieved in n=196 (17.0%) of cases. The data model is under construction. However, there is signal that non-immediate dispatch type, older age, and night-time operations are all associated with a reduced likelihood of delivering PHEA ≤45-minutes of the 999-call.Less than one in five trauma patients receive PHEA ≤45-minutes of the 999-call in the East of England. Results from this project may positively influence dispatch systems in order to increase the timely delivery of prehospital anaesthesia where indicated (pending the complete data model).
1428 What influences decisions and predicts transfer of older care-home residents to the emergency department? A synthesis of qualitative reviews and systematic review
Authors: Marincowitz Carl , Preston Louise , Cantrell Anna , Tonkins Mike , Sabir Lisa , Mason Suzanne 
Published: December 2022

Aims, Objectives and BackgroundThe proportion of adults aged over 65 is rapidly increasing in developed countries. Care home residents have disproportionate rates of transfer to the ED. An estimated 40% of emergency admissions for care home residents may be for avoidable conditions and up to 8-fold variation in hospitalisations has been identified between care homesWe aimed to synthesise the qualitative research collated in existing reviews relating to the experience of residents, family members and professionals in decisions to transfer care home residents to the ED and identify known factors which predict ED transfer from care homes.Method and DesignTwo systematic reviews were conducted simultaneously. The first identified and synthesised the qualitative evidence presented in existing systematic reviews regarding decisions to transfer residents to the ED. The second identified quantitative factors found to affect likelihood of transfer of residents. Five electronic databases were searched, including: MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and Scopus.Results and ConclusionIn the qualitative component, six previous reviews met the inclusion criteria. Three syntheses were formed : (i) Transfer decisions involve negotiation with unequal power dynamics between residents, family members, care home staff and clinical practitioners (ii) Some transfers occur with the expectation that treatment in hospital will improve outcomes (iii) Some transfers occur due to factors external to the resident with no expectation that hospitalisation will be beneficial.Twenty-six primary studies met the inclusion criteria for the quantitative component. Seven common domains of factors associated with ED transfer were identified: demographics, co-morbidities, medication use, frailty, permanent indwelling devices, advanced directives and care home organisation. Within these domains, male sex, age, presence of specific comorbidities, polypharmacy and quality rating were associated with ED transfer across studies.This provides context for policy makers and researchers developing interventions to reduce hospitalisations or use adjusted rates of hospitalisations as a care home quality indicator.
1491 Determinants of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia
Authors: Price James , Lachowycz Kate , Major Rob , Moncur Lyle , McLachlan Sarah , Keeliher Chris , Steel Alistair , Barnard Ed 
Published: December 2022

Aims, Objectives and BackgroundPrehospital emergency anaesthesia (PHEA) is a safe and necessary procedure for the most seriously injured trauma patients. The avoidance of secondary insults such as hypoxia and hypotension are key to reduce mortality. Despite this, a proportion of patients experience post-intubation hypotension (PIH), for which the determinants remain unclear. This multi-centre study aims to compare the differential determinants of PIH in trauma patients undergoing PHEA.Method and DesignIn this retrospective observational study, across three regional Helicopter Emergency Medical Services (HEMS), data were obtained from the electronic medical records for a consecutive sample of adult trauma patients who underwent PHEA, 2015–2020 inclusive.Hypotension was defined as new systolic blood pressure (SBP) <90mmHg or >10% drop if SBP<90mmHg pre-PHEA, within 10 minutes of PHEA. A purposeful selection logistic regression model was used. Each variable was first tested in turn to explore the unadjusted association with the outcome. Significant variables were then included in the multivariable analysis. Variables were successively eliminated until only statistically significant variables remained. The ARU Research Ethics Panel granted ethical approval (AH-SREP-20–047).Results and ConclusionDuring the study period, 6184 patients were identified. After predefined exclusions, 998 patients were included in the final analysis. 218 (21.8%) patients recorded one or more episodes of PIH, with a peak prevalence at 8 minutes. The variables significantly associated with PIH were: age >55 years, pre-PHEA tachycardia (>100/minute), fluid administration prior to HEMS arrival, and fentanyl omission at induction, table 1.The pseudo-R2 for the final model suggests there is significant variation in the outcome not explained by the captured variables alone. Clinician gestalt appears to successfully identify patients most at-risk of PIH, demonstrated by the omission of fentanyl for this group.Abstract 1491 Table 1Multivariate analysis of variables associated with post-induction hypotension within 10 minutes of prehospital emergency anaesthesiaIn addition to drug-dose modification, pre-PHEA volume administration, cautious haemodynamic observation, and early vasopressor intervention may be warranted to reduce avoidable harm in trauma patients undergoing PHEA.
1423 The positives, the challenges and the impact: an exploration of early careers nurses experiences in the Emergency Department
Authors: Skene Imogen , Power Helen , Murray Esther 
Published: December 2022

Aims, Objectives and BackgroundThe intense working environment of the Emergency Department (ED) is exciting and rewarding; but is renowned for high staff turnover and burnout. The wellbeing and retention of the existing workforce is imperative. The purpose of this study was to explore the experiences of early careers nurses in the ED; identify aspects of ED they enjoyed, the challenges and explore potential coping mechanisms used to mitigate negative situations.Method and DesignA qualitative design was used. Eleven semi-structured interviews were conducted with adult and paediatric emergency nurses who had worked in the ED for less than three years. Data were transcribed, coded and analysed using thematic analysis. The setting for this study was an emergency department in a major trauma centre. Data was collected between January-August 2020 following ethical approval.Results and ConclusionFour key themes emerged; (1) Drawn to ED Nursing’ ; (2) ‘Teamwork’; (3)‘Time to care’ and (4) ‘Psychological impact’’. Opportunities for learning and development and being able to provide good levels of patient care were identified important to participants. Challenging aspects of the job included high workloads, exposure to traumatic incidents, violence and aggression. The psychological impact included feelings of burnout, exhaustion, flashbacks, personal growth and perspective. Teamwork, a strong support network and opportunities for formal and informal debrief were identified as helping to mitigate challenging aspects of the jobBy identifying the factors that maintain wellbeing and sustain the workforce, we can promote and support them. The benefits to a stable and well supported workforce in ED are many; improved and sustainable patient care, reduced staff turnover and alleviating pressures on the existing workforce. Research is now drawing on how we can provide psychological support to those who have been faced with caring for patients in a way that challenges their own moral framework.
1723 Diagnostic accuracy of a novel transcriptomic classifier for bacterial and viral infections – an individual patient data meta-analysis
Authors: Uhle Florian ,   Pilot Study Investigator group, Evangelos Giamarellos-Bourboulis, Bauer Wolfgang , Sun Lisa , Chen Uan-I , Sweeney Timothy E , Liesenfeld Oliver 
Published: December 2022

Aims, Objectives and BackgroundArising from demographic differences between healthcare systems, patients in the emergency department (ED) present with a broad range of diagnoses and clinical severities. Independent validation of a novel diagnostic tool is critical to ensure reliable and reproducible clinical performance. So far, three independent cohort studies have validated the performance of the machine-learning classifier IMX-Bacterial/Viral/Non-infected (IMX-BVN) to diagnose bacterial and viral infections; those have been combined to facilitate an individual patient data meta-analysis of performance.Method and DesignED patients (n=1,277) with suspected infection from three international, observational studies (USA/Germany/Greece) were included. Of those, 661 had a unanimous (‘consensus’) ground truth of infection status established by panel adjudication. Quantitative expression of 29-signature mRNAs was measured on a NanoString nCounter® SPRINT system. The classifier BVN version 3 (IMX-BVN-3) was applied to generate scores, which fall into four discrete interpretation bands (very unlikely, unlikely, possible, very likely). Sensitivity, specificity, and corresponding nominal likelihood ratios were calculated with 95% confidence intervals for each interpretation band.Results and Conclusion360 patients (54.4%) were consensus adjudicated to have a bacterial infection (range: 37.9–81.2%) and 153 (23.1%) to have a viral infection (range: 15.3–44.1%). Pooled likelihood ratios of the interpretation bands for bacterial infections were (from ‘very unlikely bacterial’ to ‘very likely bacterial’) 0.082 (0.039–0.176)/0.333 (0.264–0.419)/2.244 (1.598–3.152)/9.459 (5.808–15.404), associated with a rule-in specificity of 0.947 (0.915–0.967) and a rule-out sensitivity of 0.981 (0.960–0.991) in the outer interpretation bands. Pooled likelihood ratios of the interpretation bands for viral infections were (from ‘very unlikely viral’ to ‘very likely viral’) 0.182 (0.102–0.324)/0.292 (0.181–0.471)/0.956 (0.593–1.540)/6.021 (4.636–7.821), associated with a rule-in specificity of 0.884 (0.853–0.909) and rule-out sensitivity of 0.928 (0.876–0.959).The IMX-BVN-3 classifier exhibits strong performance in a combined cohort of patients from different geographies and settings to rule-in and rule-out patients presenting to EDs with suspected bacterial and viral infections.
1716 Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis
Authors: McLatchie Rachel , Wilson Sarah , Reed Matthew , Ticehurst Francoise , Easterford Kathryn , Alawiye Salma , Cowan Alicia , Gupta Aakash 
Published: December 2022

Aims, Objectives and BackgroundAcute aortic syndrome (AAS) is a rare, life-threatening emergency affecting approximately 4000 people per year in the UK, has an ED misdiagnosis rate as high as 38% and around one quarter of cases are not diagnosed until 24 hours after presenting to the ED.It presents in many atypical ways, posing a significant diagnostic conundrum for the emergency department (ED) clinician and risk of litigation. We sought to understand the reasons why AAS was missed in ED by conducting a case series review of patients with misidentified AAS presenting to three UK EDs over a 10-year period.Method and DesignWe identified missed diagnoses of AAS using searches of ED morbidity and mortality records, post-mortem reports, complaints, Electronic Patient Records (EPRs) and Radiology records from three UK EDs.Results and ConclusionBetween 1.1.2011–31.12.2020, 43 cases were identified across three EDs (1.4 cases/yr/dept).The most common diagnosis was Type A aortic dissection (22; 51%).The most common incorrect presumed diagnoses made were acute coronary syndrome (ACS, 12; 28%), pulmonary embolism (PE, 5; 12%) and ‘non-specific chest pain’ (5; 12%).In 31 of the 43 cases (72%) there was no evidence from the notes of consideration of AAS in the differential diagnosis. In 10 of the 43 cases (23%), AAS was clearly considered, but the clinician appears to have been falsely reassured by clinical findings, normal chest x-ray, or atypical or resolved symptoms.Only 63% (27/43) presented with chest pain and 16% (7/43) had no pain. 65% (28/43) documented sudden onset of symptoms.This case series reinforces the RCEM/RCR recommendation that ‘All clinicians working in the emergency department should be made aware of the difficulties in excluding the diagnosis of thoracic aortic dissection.’ Further research is required to improve ED diagnostic pathways for this group of patients.
1456 Fatal propranolol overdoses reported to the UK National Poisons Information Service (NPIS) over 5 years 01/01/2017–31/12/2021
Authors: Williams Hayley , Jagpal Pardeep , Sandilands Euan , Gray Laurence , Thanacoody Ruben , Bradberry Sally 
Published: December 2022

Aims, Objectives and BackgroundPropranolol is widely prescribed and between 2007 and 2017 dispensing in the UK increased by some 41%. In the same period, deaths in England and Wales following propranolol overdose increased by 205%.Method and DesignWe retrospectively reviewed cases of fatal propranolol poisoning reported to the UK NPIS, between 01/01/2017 and 31/12/2021 to understand the demographics of these exposures, the doses involved and treatments administered.Results and ConclusionThere were 46 fatalities (aged 14–70 years) with 57% (n=26) of them being less than 40 years of age, and the majority of these being female (77%; n=20). Thirteen cases involved propranolol only and in the 33 cases of mixed overdose the mean number of co-ingestants was two, with a maximum of 13. An antidepressant was co-ingested in 21 cases. The reported dose of propranolol ingested was documented in 23/46 cases, median 3,200 mg (IQR 1,920–4,480 mg) and in three patients exceeded 7,000 mg. Cardiac arrest prior to contact with the NPIS was recorded in 41/46 cases. Fourteen (34%) occurred in hospital and twenty-three out-of-hospital (56%). Patients received: sodium bicarbonate (n=30, 65%), glucagon bolus and/or infusion (n=38, 83%), high dose insulin/dextrose (n=36, 78%), inotropes or vasopressors (n=36, 78%), intralipid (n=25, 54%) and ECMO was commenced in two cases. The dose of insulin administered was known in 15 cases (median dose 4 unit/kg/hour). Doses more than or equal to 8 unit/kg/hour were given in 7 cases (maximum 10 unit/kg/hour in three cases).Young adults particularly females accounted for the majority of fatalities. In almost half of all cases an antidepressant was co-ingested. Clinicians should be aware of the potential for rapid deterioration and severe clinical outcomes following propranolol overdose. Rapid access to expert clinical advice is available through the National Poisons Information Service and is strongly recommended in order to optimise use of available treatments.