bluuebunny/crossref_metadata_2025_split huggingface dataset:
1655 The ‘CCHILDS’ screen: a practical guide to a consultation with refugee and asylum seeking children within the Paediatric Emergency Department (PED)
Authors: Chawla Jaya , Houbby Nour , Davies Sarah , Stewart Charles 
Published: December 2022

Aims, Objectives and BackgroundThe number of refugees worldwide has increased, especially in recent times, due to wars, political instability and economic insecurity with Iran, Eritrea, Albania, Iraq and Syria being the top five countries for asylum applications. Consequently, there are increasing numbers of refugee and asylum-seeking children entering the United Kingdom who face significant barriers to accessing healthcare services. These children often face health risks and therefore have complex health needs. Hence, it is vital for healthcare professionals in the emergency department to adopt a holistic approach to their care as this can have widespread positive implications beyond their clinical presentation and may shape their transition into a new country. This opinion article was undertaken with the aim of highlighting and summarising current best practice recommendations for addressing the needs of this complex patient group.Method and DesignA step-by-step screening tool (figure 1), CCHILDS (Communication, Communicable diseases, Health – physical and mental, Immunisation, Look after (safeguarding), Deficiencies, Sexual health) was formulated. This was created following a review of the literature, consultation with paediatric emergency clinicians and the use of current protocols in related disciplines (e.g. HEADDSS assessment tool). This tool can be used in the emergency setting by healthcare professionals in the assessment of refugee and asylum-seeking children and can serve as an aide memoire to cover the key aspects of a consultation.Abstract 1655 Figure 1Results and ConclusionThis opinion article summarises three main aspects in the assessment of a refugee or asylum-seeking child in the paediatric emergency department. Firstly, the key considerations regarding the child’s background prior to entering the UK and the barriers they may encounter to accessing healthcare. Secondly, the healthcare assessment upon arrival to the emergency department and a framework that could be used for clinical assessment. Finally, the consideration of their long-term healthcare needs and the importance of empowering these young individuals to lead a healthy lifestyle.
1657 Trauma imaging appropriateness in paediatric patients conveyed to a trauma unit compared to a major trauma centre – a retrospective observational study
Authors: Hibberd Owen , Price James , Laurent Amy , Agrawal Shruti , Barnard Edward 
Published: December 2022

Aims, Objectives and BackgroundAppropriate and timely imaging improves trauma outcomes. In adults, the default is whole-body computed tomography (CT). However, in children more selective imaging should be used. In those requiring CT, the national standard is imaging ≤30mins of arrival. The aims of this study were to compare appropriateness of CT and time to initial CT in paediatric trauma patients conveyed directly to a major trauma centre (MTC) with those initially treated in a trauma unit (TU) and then transferred to an MTC.Method and DesignA retrospective observational study in the East of England MTC (2015–2020). All paediatric trauma patients meeting Trauma Audit Research Network (TARN) criteria who arrived at the MTC ≤24hr of injury and underwent CT imaging within 12 hours of arrival were included.Data were obtained from the MTC trauma office and clinical records were independently reviewed by two authors. The Royal College of Radiologists guideline for paediatric trauma was used to assess the appropriateness of the CT imaging strategy.Combined data were stored in a Microsoft Excel sheet and analysed in Prism 9 for macOS (GraphPad). Data are reported as number (percentage), and median [inter-quartile range]. Proportions were compared with a Fisher’s Exact test; differences between median values were compared with a Mann-Whitney U test.Results and ConclusionIn the study period n=315 patients were identified. 229 (72.7%) underwent CT <12hrs and were included in the analysis: n=93 MTC, n=136 TU, table 1. CT imaging was judged as appropriate in n=77/93 (82.8%) MTC and n=104/136 (76.5%) TU scans, p=0.32. The median time to first CT was 35.0 [26.0–75.0] minutes MTC, and 76.0 [48.0–109.0] minutes TU, p<0.0001.Abstract 1657 Table 1CT appropriateness and timing associated with transfer status at a single MTCPrimary Attendance to MTCSecondary Transfer to MTCCT <12 hours of hospital arrival/n(%)93 (41%)136 (59%)Age in years/median [IQR]9.8 [5.4 – 14.1]9.3 [3.5 – 13.8]Male sex/n (%)58 (62%)96 (71%)Injury Severity Score/median/[IQR]18 [10 – 29]16 [15 – 25]Hospital arrival to first CT interval (minutes)/median [IQR]35 [26–75]75 [47–108]CT whole body (% of CT at TU/MTC)47 (51%)47 (35%)CT focussed (% of CT at TU/MTC)46 (49%)89 (65%)CT appropriate (% of CT at TU/MTC)77 (83%)104 (76%)Abbreviations: CT = Computed Tomography; IQR= Interquartile Range; MTC = Major Trauma Centre; TU = Trauma Unit.We have demonstrated room for improvement in paediatric CT trauma imaging appropriateness across the network, but this is not significantly different between the MTC and TUs. However, time to initial trauma CT was significantly shorter in the MTC.
1690 Can triage based interventions reduce length of stay in a paediatric emergency department? A literature review
Authors: Heyningen Carl Leith van 
Published: December 2022

Aims, Objectives and BackgroundIn a busy paediatric emergency department triage decisions are critical to patient flow (see figure 1). In addition to sorting patients by acuity the initiation of early interventions at triage is pivotal. Effective use of triage has the potential to significantly reduce lengths of stay.1,2Method and DesignAdhering to PRISMA guidelines, we utilised the key words ‘children’, ‘triage’ and ‘length of stay’ to search the MEDLINE and COCHRANE databases for relevant studies. Inclusion and exclusion criteria allowed a focused interrogation of the literature over the last two decades. Bibliographies & specialist journals were also searched to prevent important omissions.Results and ConclusionNine studies (two randomised controlled trials, seven non randomised) were found. Interventions included; reallocated staff for triage, a paediatrician in triage and a series of triage nurse initiated treatments, investigations and protocols. Average reductions in emergency department length of stay ranged from four to forty four minutes per patient.The common principle identified was early decision making. Statistical significance was demonstrated with few exceptions. Estimates of bias were low. The quality of evidence was high.Limitations included; uneven benefit (e.g. whilst overall length of stay was reduced, some patients waited longer) and over treatment. Triage nurse initiated treatment stood out as as having the most impact with the least additional cost. There were no adverse incidents.Triage based interventions are an important strategy in reducing the length of stay for children attending an emergency department. Doing so represents a proactive step in tackling the growing problem of overcrowding in the paediatric emergency department.ReferencesHaybarker B (2015). Reducing Emergency Department Length of Stay by System Change. Walden Dissertations and Doctoral Studies [Accessed 27/7/21]RCEM Tackling Emergency Department Crowding December 2015 [Accessed 27/7/21], Available at https://rcem.ac.uk/wp-content/uploads/2021/10/ED_Crowding_Overview_and_Toolkit_Dec2015.pdf
1767 A survey to define the pre-hospital blood resuscitation practices of UK Air Ambulances
Authors: Barnard Ed , Green Laura , Woolley Tom , Stanworth Simon , Cardigan Rebecca , Smith Jason 
Published: December 2022

Aims, Objectives and BackgroundThe use of pre-hospital blood components in the early resuscitation of patients with life-threatening bleeding is becoming more common. Understanding the national utilisation of pre-hospital blood is key to developing research strategies in these systems. The aim of this study was to report the blood resuscitation practices of UK Air Ambulances (AAs).Method and DesignTwo sequential surveys were emailed to all UK AAs using the REDCap (research electronic data capture) system. Data were collected for 12 months during 2019 including: number of patients transported, timings, products carried, and number of patients transfused by aetiology. Data are reported as number (percentage), and mean (± standard deviation).Results and ConclusionNineteen (95.0%) AAs responded, and transported a total of 12,170 patients to hospital during 2019. The mean pre-hospital time (999-call to hospital arrival) was 92.2 (±18.6) minutes. 18 (94.7%) AAs routinely carried blood products, including combinations of red cells, thawed plasma, freeze-dried plasma, and fibrinogen concentrate, table 1. The mean units of red cells and plasma carried were 2.6 (±0.9) and 3.0 (±1.1) respectively.709 (5.8%) adult patients received a prehospital transfusion, of which n=669 (94.4%) had a traumatic aetiology; n=384 (57.4%) and n=183 (27.4%) were transfused ≥2 and ≥4 units respectively. Forty adults received prehospital blood for non-traumatic aetiologies, including: n=18 vascular, n=10 gastrointestinal, n=6 obstetric, n=6 other. In addition, n=24 paediatric patients received a prehospital transfusion; n=23 (95.8%) following trauma.Fifteen (79.0%) UK AAs surveyed wanted to take part in future research investigating the effectiveness of whole blood transfusion.Abstract 1767 Table 1Blood component combinations carried by UK Air Ambulances in 2019, n=19Blood component combinationsNumber of Air Ambulances (% of total)Red cells and freeze-dried plasma7 (36.8%)Red cells and thawed plasma*6 (31.6%)Red cells only3 (15.8%)Freeze-dried plasma only1 (5.3%)Red cells in thawed plasma (RCP)**1 (5.3%)No products1 (5.3%)* One air ambulance carried fibrinogen concentrate in addition to a combination of red cells and thawed plasma. ** RCP was being carried as part of a feasibility trial during 2019.This survey defines current pre-hospital blood transfusion practice in the UK. The majority of AAs carry a combination of red cells and plasma, which are predominantly utilised following traumatic injury. Over three-quarters of UK AAs showed interest in participating in future whole blood research.
1790 Longitudinal coagulation profiles in patients presenting with acute severe traumatic brain injury (TBI): A prospective observational study
Authors: Barrett Liam , Manktelow Anne , Thomas William , Disegna Arthur , Needham Ed , O’Leary Ronan , Boyle Adrian , Curry Nicola , Stanworth Simon , Newcombe Virginia 
Published: December 2022

Aims, Objectives and BackgroundPatients who have sustained a traumatic brain injury (TBI) can have disturbances in coagulation that are distinct from other traumatic bleeding states.1 Coagulopathy is a risk factor for exacerbation of the primary injury, and these patients have less favourable outcomes and increased mortality compared to non-coagulopathic patients.1 Little is known about the longitudinal coagulation changes following TBI.The aim of this pilot study was to investigate the coagulation profiles of patients presenting with severe TBI over the first 7 days following injury.Method and DesignDesign: Prospective observational study25 patients presenting to an UK major trauma centre with TBI between August 2021-March 2022 were recruited <24 hours following injury. Professional and family consultee assent was gained and serial blood samples were collected up to three times per day up to day seven.Coagulation was assessed using thromboelastographs (TEGs) and conventional coagulation tests including Hb, Plt, PT, aPPT and fibrinogen. Pre-hospital, clinical, laboratory and imaging data were collected during the patient admission.Coagulopathy was defined as having an INR >1.2. The longitudinal changes in the coagulation parameters were plotted for the first seven 7 days and graphically represented. This is a pre-liminary analysis.Results and Conclusion25 patients with severe TBI (GCS <12) were recruited. Patients were stratified by their admission INR. 18 patients had an admission INR <1.2 (62% n= 18), and 7 had INR >1.2 (38% n=7). 7 patients who did not have INR >1.2 on their first admission blood test later developed coagulopathy (with an INR >1.2).Further exploration of the trends seen in conventional coagulation tests and TEG’s over time is required and to understand how these changes correlate to the clinical and imaging findings. The utility of viscoelastic studies such as TEG’s in the assessment of TBI associated coagulopathy remains unclear.
1754 A thematic analysis of Twitter posts pre and post-publication of CRASH-3 trial results using Bloom’s Digital Taxonomy. Examining how social media theories impact knowledge translation
Authors: Bhullar Sukhbir Singh , Ahmed Khaleel 
Published: December 2022

Aims, Objectives and BackgroundThe purpose of this study is to unpack the cognitive dimensions of learning and the subjective internalisation that resulted from Twitter activity by investigating the following research questions: 1) What types of information were shared on Twitter pre and post-publication of the CRASH-3 trial? and 2) Did this information signify knowledge translation? This topic is important because translation of medical research into medical practice can take up to 20 years and Twitter-aided knowledge translation has the potential to shorten this. This study is the first to analyse tweets thematically through two methods, including Bloom’s Digital Taxonomy (BDT), bringing the realities of Twitter users to the foreground.Method and DesignPre-publication tweets (n=92) and post-publication tweets (n=742) were analysed using 1) Braun & Clarke’s six-step thematic analysis framework and 2) BDT. The highest-order thinking skill (HOTS), during BDT analysis, was assigned following a consensus meeting between two independent coders.Abstract 1754 Table 1BDT HOTSPre-Publicationn (%)Post-Publicationn (%)Remembering80 (86.96%)388 (52.29%)Understanding7 (7.61%)185 (24.93%)Applying1 (1.09%)30 (4.04%)Analysing0 (0%)9 (1.21%)Evaluating3 (3.26%)62 (8.36%)Creating1 (1.09%)68 (9.16%)Results and ConclusionEight overarching themes emerging from the pre-publication phase: emotion and feeling (90.21%), hashtagging (40.21%), tagging (26.09%), education-related information (10.87%), research-related information (9.78%), conference (7.61%), statement (3.26%) and poll (2.17%). 16 overarching themes emerged from the post-publication phase: hashtagging (56.06%), tagging (36.79%), article posting (23.05%), emotion and feeling (21.83%), education-related information (19.54%), summarising (14.42%), notification of results (9.57%), media outlook (7.01%), conference (6.74%), commenting (6.06%), open questions (5.26%), judging (4.99%), research-related information (4.04%), recommending (1.75%), quoting (1.48%) and comparing trials (0.40%). Some tweets applied to more than one category of themes.There was an increase in HOTS during the post-publication phase, signifying an increase in the cognitive dimensions of learning and the subjective internalisation of information. This was likely due to the increase in social media activity and information sharing following the release of trial outcomes. These findings support the role of Twitter, through the social capital model, in facilitating higher-order learning.
1683 Clinical impact of a novel ambulatory computed tomography coronary angiography pathway for patients at a moderate risk of suspected acute coronary syndromes
Authors: Buglass Verity 
Published: December 2022

Aims, Objectives and BackgroundWe implemented a novel ambulatory computed tomography coronary angiography (CTCA) pathway as an alternative to inpatient stay when resolving uncertainty surrounding acute coronary syndrome diagnosis in ‘moderate risk’ patients. Eligible patients were identified automatically, and recommendations ‘pushed’ to the clinician. This novel pathway aimed to reduce the length of stay and pressure on hospital resources. We investigated the uptake of this service and its effects on patient outcomes including length of stay and the use of percutaneous coronary intervention (PCI).Method and DesignWe conducted a retrospective, single-centre service evaluation. Patients were eligible for CTCA if they were moderate risk with T-MACS; troponin <99th percentile; no acute electrocardiogram ischaemia.Data were collected contemporaneously using the T-MACS app as part of routine clinical care for consecutive moderate-risk patients pre- (June 2016 – December 2018) and post-implementation (January 2018 – October 2020) of ambulatory CTCA. The primary outcome was adherence (eligible patients who received an ambulatory CTCA). Secondary outcomes included location and length of stay, time to CTCA, and PCI. We summarised data using descriptive statistics.Results and ConclusionWe identified 1,341 patients eligible for ambulatory CTCA (524 pre-implementation of pathway; 817 post-implementation; 820 [61%] male; mean age 57 [SD 14]). Pre-implementation, 46.6% (n=244) of these patients were admitted to the Ambulatory Care Unit (ACU). Post-implementation, 32% (n=258) were admitted to the ACU; only 7 (1.3%) eligible patients received ambulatory CTCA after implementation of the service. A further 25 ‘moderate risk’ patients received an inpatient CTCA. The median time to ambulatory CTCA from admission was 1 (IQR 0.75–3) day. Five (71.4%) ambulatory CTCAs were abnormal, identifying coronary artery disease. Three patients with abnormal CTCA underwent PCI; only one followed the ambulatory CTCA pathway.Abstract 1683 Figure 1ConclusionsClinicians continued to admit patients to inpatient areas, indicating suboptimal utilisation of the pathway. Future work should focus on identifying barriers to adherence.
1559 Background noise in an Emergency Department: an observational study from staff and patient perspectives
Authors: Coats Timothy , Emar Murad , Smith Ella 
Published: December 2022

Aims, Objectives and BackgroundNoise is a contributing factor to miscommunication, which may be exacerbated by wearing personal protective equipment. There has been little research on noise in the Emergency Department (ED).We aimed to (1) identify the noise levels experienced by staff and patients in different areas of an emergency department over the 24-hour cycle, (2) examine the impact of cubicle doors on the background noise experienced by the patient, and (3) assess the impact of monitor alarms on staff and patient noise levels.Method and DesignUsing a standardised protocol, an observational study monitoring of staff and patient experience of noise was carried out in 3 areas of the ED (a resuscitation room, an area of patient cubicles with solid doors and an area of patient cubicles with curtains).The overall distributions of noise levels in each area were described and circadian variation plotted. The proportion of time that background noise was above key cutoff values known to impair communication was calculated (45dB and 65dB).Non-parametric methods were used to compare: (1) a patient cubicle with curtains compared to a solid door, (2) having the door open or closed, and (3) staff and patient exposure a monitor alarm.Abstract 1559 Table 1AreaOverall noise level (dB).Median (IQ range)Proportion of time >45dB(raised voice)Proportion of time >65dB(shouting)Blue Patient Cubicle (curtain)45 (41 – 51)51%2%Red Patient Cubicle (door)41 (37 – 47)30%2%ER Patient Cubicle (door)50 (49 – 54)100%6%Blue Staff Desk53 (48 – 58)88%7%Red Staff Desk55 (51 – 60)96%7%ER Staff Desk50 (45 – 56)76%5%Results and ConclusionIn a large urban teaching hospitalEmergency Department noise was greater than 45dB for staff between 76% and 96% of the time (30% to 100% for patients). There was little difference across the 24hr cycle. A door decreased the noise experienced by patients, but only if left closed. In the resuscitation rooms monitor alarms were much louder for patients than for staff.Noise levels likely to impair communication are present in the ED for most of the time. Staff awareness and improved design of both buildings and equipment might mitigate this negative acoustic environment.
1490 Intubation success in prehospital emergency anaesthesia: a retrospective observational analysis of the Inter-Changeable Operator Model (ICOM)
Authors: Price James , Lachowycz Kate , Steel Alistair , Moncur Lyle , Major Rob , Barnard Ed 
Published: December 2022

Aims, Objectives and BackgroundPre-Hospital emergency anaesthesia (PHEA) is a complex procedure with significant risks. First-pass intubation success (FPS) is recommended as a quality indicator in pre-hospital advanced airway management. Previous data demonstrating significantly lower FPS by non-physicians does not distinguish between non-physicians operating in isolation or within physician teams. In several UK HEMS, the role of the intubating provider is interchangeable between the physician and critical care paramedic – termed the Inter-Changeable Operator Model (ICOM). The objectives of this study were to compare first-pass intubation success rate between physicians and critical care paramedics (CCP) in a large regional, multi-organisational dataset of trauma PHEA patients, and to report the application of the ICOM.Method and DesignA retrospective observational study of consecutive trauma patients ≥16 years old who underwent PHEA at two different ICOM Helicopter Emergency Medical Services in the East of England, 2015–2020. Data are presented as number (percentage) and median [inter-quartile range]. Fisher’s exact test was used to compare proportions, reported as odds ratio (OR (95% confidence interval, 95%CI)), p-value.Results and ConclusionIn the study period, 13,654 patients were attended. 674 (4.9%) trauma patients ≥16 years old who underwent PHEA were included in the final analysis: the median age was 44 [28–63] years old, and 502 (74.5%) were male. There was no significant difference in the FPS rate between physicians and CCPs – 90.2% and 87.4% respectively, OR 1.3 (95%CI 0.7–2.5), p=0.38. The cumulative first, second, third, and fourth-pass intubation success rates were 89.6%, 98.7%, 99.7%, and 100%. Patients who had a physician-operated initial intubation attempt weighed more and had a higher heart rate, compared to those who had a CCP-operated initial attempt.In an ICOM setting, we demonstrated 100% intubation success in adult trauma patients undergoing PHEA. There was no significant difference in first-pass intubation success between physicians and CCPs.