bluuebunny/crossref_metadata_2025_split huggingface dataset:
021 Emergency department hypertension, is it real? A systematic review and meta-analysis
Authors: Reynard Charles , Oliver Govind , Berg Patricia van den , Naguib Mina , Body Richard 
Published: April 2023

BackgroundIn 2017 15,379,166 patients attended emergency departments (ED) across the U.K. Attention is focussed on how EDs are struggling to cope with rising demand. However, each attendance presents an ideal screening opportunity for the nation’s second largest cause of avoidable mortality; cardiovascular disease. We sought to evaluate a common cardiovascular prognostic factor measured in the ED.We aimed to conduct a systematic review of the prevalence and reliability of ED hypertensive readings.Method and resultsThe review was conducted in accordance with the PRISMA and was registered on PROSPERO. We planned to conduct a meta-analysis if the data was suitable. Searches were conducted using pre-determined terms using MEDLINE and Embase databases. A hand search of the grey literature was also conducted. Studies eligible for inclusion were those: peer reviewed, conducted in the last 20 years, included a general population, and written in English. Risk of Bias was assessed by the QUIPS tool, and overall quality by GRADE. Searches, screening, data extraction, risk of bias and GRADE assessment were all conducted by two independent researchers.ConclusionsThe search identified 1,071 results, after title and abstract review 47 underwent full text review. A further 26 were excluded following full text review (table 1).Abstract 021 Table 1Characteristics of the included studiesR = retrospective, P = prospective, EPR = electronic patient record, F/U = follow up, H = High risk of bias M = moderate risk of bias, L = Low risk of biasThe outcome of prevalence was extracted from 13 studies. They were dominated numerically by McNaughtonet al’s study of 701,952,422 patients, with the next largest having 7,238. A meta-analysis was conducted and confirmed the prevalence finding of the largest study at 0.24 (95% CI 0.02–0.45) (see figure 1).Abstract 021 Figure 1The persistence at follow of hypertensive ED readings was extracted from 7 studies, a random effects model was conducted demonstrating a pooled persistence of 0.55 (95% CI 0.34–0.75) (see figure 2).Abstract 021 Figure 2Hypertension is common and the persistence of it at follow up adds credibility to ED’s public health potential.
023 For how long should we monitor ED palpitation patients in the outpatient setting?
Authors: Reed Matt , Grubb Neil , Lang Chris , O’Brien Rachel , Simpson Kirsty , Padarenga Mia , Grant Alison , Tuck Sharon , Keating Liza , Coffey Frank , Jones Lucy , Harris Tim , Lloyd Gavin , Gagg James , Smith Jason 
Published: April 2023

BackgroundThe IPED study showed that use of a smartphone-based event recorder (AliveCor) in ED patients presenting with palpitation or pre-syncope, increased the number of patients in whom an ECG was captured during symptoms over five-fold to more than 55% at 90 days (Reed MJet al. Lancet eClinical Medicine 2019; 8: 37–46). The pocket sized AliveCor (now Kardia) mobile (AliveCor, San Francisco, USA) is a monitoring device that requires the patient to trigger the ECG recording. With minimal training, two fingers from each hand are placed on the monitor (which can be connected to the back of a smartphone) for 30 s to take an ECG recording.This pre-planned analysis looked at the time to symptomatic rhythm detection in the intervention (AliveCorgroup)to determine the optimum AliveCor device monitoring period in the outpatient setting.Method and resultsPre-planned sub study analysis of a randomised controlled multi-centre trial. Participants ≥16 years old presenting to 10 UK hospital EDs with palpitation or pre-syncope whose underlying ECG rhythm during these episodes remained undiagnosed after ED assessment were enrolled. Time to symptomatic rhythm detection was recorded and analysed.Conclusions243 participants were recruited over an 18-month period. A symptomatic rhythm was detected at 90 days in 69 (n=124; 55.6%; 95% CI 46.9–64.4%) participants in the intervention (AliveCor) group.92.8% of patients who recorded a symptomatic rhythm during the 90 day period recorded this rhythm during the first 28 days (figure 1/table 1).Abstract 023 Figure 1Time to symptomatic rhythm detection in the intervention (AliveCor) group (n=69)Abstract 023 Table 1Cumulative symptomatic rhythm detection in the intervention (AliveCor) group (n=69)Conclusion: ED palpitation patients discharged with a smartphone-based event recorder such as the AliveCor should be reviewed after 4 weeks to enable efficient device usage and timely treatment if required. Patients in whom a diagnosis has not been made can be re-reviewed at 90 days. (1541 characters/285 words)
028 A comparison of the MACS-ECG algorithm versus contemporary computer algorithms
Authors: Morris Niall , Body Richard 
Published: April 2023

BackgroundThe Manchester Acute Coronary Syndromes ECG (MACS-ECG) model was derived and validated with the aim of providing an objective measure of ECG ischemia in the setting of suspected non-ST-elevation myocardial infarction. We wanted to produce an objective measure to improve existing clinical decision aids such as TMACS or the HEART score. To establish whether the MACS-ECG model warrants further study we compared the diagnostic performance against existing computer algorithms.The MACS-ECG model was derived in a single center cohort and combined a nuanced interpretation of repolarization abnormalities with novel signs of ischemia. These variables were selected using backward logistic regression using SPSS with the primary outcome being NSTEMI.This model was validated in a secondary analysis of the Bedside Evaluation of Sensitive Troponin study (BEST). We recruited patients from 17 Emergency Departments. We included adults with a suspected ACS. We excluded patients with STEMI or obvious non-cardiac cause.The primary outcome was NSTEMI, using the Fourth universal definition of myocardial infarction.In the validation study we also coded the ECG machines interpretation as acute ischemia, infarction or no statement.When the existing ECG algorithms produce an ‘acute ischemia’ statement, the sensitivity (Sn) was 13.3% (8.2–20.0%), specificity (Sp) 93.9% (92.1–95.5%), positive predictive value (PPV) 27.9% (19.1–39.0%) and negative predictive value (NPV) 86.0% (85.2 86.8%).An ‘infarction’ statement produced Sn 21.0% (14.6–28.6), Sp 88.3% (85.8–90.4%), PPV 24.0% (17.9–31.4%) and NPV 86.3% (85.3–87.3%).Combining infarction and ischemia produces the following diagnostic characteristics: Sn 34.3% (26.5–42.7%), Sp 82.2% (79.4–84.8%), PPV 25.4% (20.6–30.9%) and NPV 87.6% (86.2–88.9%).The MACS-ECG model was more specific and sensitive than existing computer algorithims. When it produced an ‘acute ischemia’ statement, the Sn was 22.4% (15.8–30.1%), Sp 95.2% (93.5–96.6%), PPV 45.1% (34.8–55.8%) and NPV 87.4% (86.4–88.4%).
003 Identifying risk of maltreatment in burn injuries in children less than 5 years old
Authors: Javaid Assim , Kemp Alison , Hollén Linda 
Published: April 2023

Background10% of all burns arise from physical abuse or neglect. It can be difficult to identify cases where non-accidental injury should be suspected and Emergency Department (ED) clinicians have a short time to assess a child. Children less than 5 years of age are most at risk of burn injuries, with scalds and contact burns being the most common burn type amongst this group. This study analyses cases of scalds and contact burns that present to ED to determine whether there are any significant differences between factors involved in accidental burns and those referred to social services.Method and resultsA prospective multicentred study was conducted from August 2015 to September 2018. Data were collected from 20 hospital sites across England and Wales for all children who presented with a burn. Children who were less than 5 years old and had suffered a scald or contact burn were included in this study. Comparison of the proportions of cases affected by different agents, mechanisms and locations of injury were made between accidental cases (non-CP) and those cases for which a child protection referral was made (CP) to determine whether there were any significant differences. Chi-squared testing was used for this comparison and statistical significance was set at p<0.05.ConclusionsAfter exclusion criteria were applied, 2056 cases were identified; 1045 non-CP scalds, 103 CP scalds, 816 non-CP contact burns and 92 CP contact burns. Scalds;Hot Waterscalds andUnwitnessedscalds were statistically significantly more likely in CP cases. Contact burns; burns involvingIrons, burnsIndependent of the Child,Unwitnessedburns and burns to the head or trunk were more likely in CP cases than in non-CP cases.There are a number of statistically significant differences between non-CP and CP cases that may alert ED clinicians to consider referral to social services.
034 Early cardiovascular dysfunction drives in-hospital trauma mortality
Authors: Carden Rich , Lockey David , Brohi Karim 
Published: April 2023

BackgroundImprovements in trauma resuscitation practice have reduced the early in-hospital mortality from haemorrhage and its immediate sequelae. Early cardiovascular dysfunction (CVD) is a poorly understood and under-recognised major contributor to contemporary trauma deaths. The objective of this study was to demonstrate the prevalence and impact of CVD in a population of trauma patients without catastrophic TBI.A review of data collected prospectively at a UK Major Trauma Centre from 2008–2018. Adult trauma patients over the age of 15 were included. CVD was defined as a score of 4 on admission or day 1 of admission using the cardiovascular component of the SOFA score.1042 patients were included, of which 125 (12%) had CVD. The 28-day mortality rate in the total population was 4.8%, and of those 64% had CVD. CVD was associated with a blunt mechanism of injury (81.6%), male gender (81.6%), and a high injury severity score (median=27). In the CVD group the major haemorrhage protocol was activated in 76.8% of patients, and 73.6% received more than 4 units of red blood cells in the first 24 hours.Early CVD was more prevalent than any other single-system dysfunction assessed with the SOFA. All deaths with single organ failure in a SOFA domain other than cardiovascular had concurrent CVD. In predicting 28-day mortality, CVD had an AUROC of .882 (CI=0.810–0.955,p=0.000), odds ratio of 57.2, and sensitivity and specificity of 86.7% and 89.7% respectively. Multiple regression analysis identified admission base deficit, admission systolic blood pressure and heart rate, increased age, blunt mechanism, increased injury severity score, and 24-hour crystalloid administration as strong predictors of developing CVD.Abstract 034 Figure 1Early SOFA domain and mortalityAbstract 034 Figure 2Prevalence of CVD and its contribution to other organ dysfunctionAbstract 034 Table 1DemographicsCVD is the contemporary driver of in-hospital non-head injured trauma mortality. The resuscitation phase is the window of opportunity for discovery of novel treatments.
038 Junior doctors’ perceptions and experiences of the emergency department departmental handover: a qualitative study
Authors: Park Emily , Roy Susie , Skinner Janet 
Published: April 2023

BackgroundIrregular patient volumes, high patient transit and limitless presentations means that Emergency Department (ED) handovers differ from other specialities. Therefore, a degree of handover unfamiliarity results for junior doctors.There is a high prevalence of stress and burnout in both junior doctors and doctors working in Emergency Medicine. Despite this, no literature was identified exploring if handover can be a source of stress. The aim of this study was to explore junior doctors’ perceptions of ED handover and to investigate if it is considered a stressful experience.Non-probabilistic sampling methods were used to recruit doctors working at or below the grade of Speciality Trainee year 2 (ST2) or equivalent in the ED of a major acute teaching hospital. Qualitative, semi-structured interviews were undertaken between March and April 2019 exploring participants’ experiences of ED handover. Interviews were recorded and transcribed verbatim. Using NVivo 12 software, data were analysed thematically using an inductive-deductive approach.10 interviews were undertaken and four themes were identified from the data: ‘stress decreases as familiarity increases’ which included familiarising with handover structure, content and purpose; ‘time pressure is an ongoing stressor’ representing the perceived need to efficiently handover during busy periods and at shift end; ‘handover as a solace’ relating to opportunities to both learn and socialise and ‘it’s nice to be nice’ reflecting the importance of civility.Junior doctors find aspects of ED handover stressful. These include: wanting to make a good impression; unfamiliarity; time pressures and the negative effects of hierarchy. However, handover can also help to ameliorate stress by facilitating opportunities for socialisation, education and morale boosting. Important recommendations for future practice regarding departmental handover can be made, most notably, the need to create a civil and pleasant working environment where doctors can flourish.Abstract 038 Figure 1Four themes explainedAbstract 038 Figure 2Recommendations for future handovers
042 Scottish code red audit report 2015–2017
Authors: Reed Matt , Cooke Claire , McMahon Niall , Hands Katie , Henderson Susan , Knight Eleanor , Latif Munsor , Littlewood Nicola , Todd Naomi , McGarvey Margaret , Hughes Neil , Donald Michael , Rowley Megan , Innes Catherine , Lockhart Symon 
Published: April 2023

The Scottish Transfusion and Laboratory Support in Trauma (TLST) group previously audited all National Code Red activations between June 1st 2013 and October 31st 2015, generating a number of recommendations to be adopted to optimise the transfusion support given to patients following major trauma in Scotland. A repeat audit was undertaken for all patients for whom a Code Red was activated between 1st November 2015 and 31st December 2017.A clinical and transfusion lead for each centre entered anonymised data onto a secure electronic database (REDCAP; http://www.project-redcap.org) the server of which is held within the University of Edinburgh. This database was maintained by the Edinburgh study team. Each of Scotland’s pre-hospital trauma teams who take patients to hospitals where Code Red Policy is in place, and the receiving hospitals, agreed to enter data into the National Code Red audit for all patients for whom a Code Red was activated during the study period. The project was deemed a service evaluation by the South East Scotland Research Ethics committee (Ref: NR/1408AB11) and therefore did not require full ethics submission. The project was also registered with each hospital’s clinical effectiveness/governance teams where available, and a favourable Caldicott opinion was obtained.Abstract 042 Figure 1Flow chart showing transfusion events and outcomes of code red patientsAbstract 042 Figure 2Ratio of the mean number of concentrated red cells (CRC) and fresh frozen plasma (FFP) transfused to code red patients at 30 minute intervalsAbstract 042 Table 166 activations (24 South-East of Scotland, 32 West, 10 East). Mean age 45 years, 88% male patients. 93% of Code Red patients received blood components with a 300% increase in pre-hospital transfusion (48 patients; 73%); median time from 999 call to Code Red activation reduced to 37 minutes from 70 minutes; 78% patients received pre-hospital TXA (improved from 70%). CRC:FFP ratios improved in comparison to 2013–15. Survival to discharge increased (63% to 66%) despite increased ISS.Code Red practice has improved since our last audit. There are still improvements to be made in TXA administration and time to blood products.
046 Whose pain are we treating? A study comparing ED patients’ expectations of analgesia with ED doctors’ preconceptions
Authors: Raman Rajendra , Fleming Laura 
Published: April 2023

An audit at a Scottish DGH found that large numbers of Emergency Department (ED) patients were being sent home with ‘To Take Out’ (TTO) boxes of Co-Codamol (30/500 mg) – a concerning finding given rising rates of prescription opioid addiction in the UK. Informal conversations suggested that many clinicians were prescribing high-dose codeine because ‘patients expect to be given something they can’t buy over the counter’. A survey-based study was therefore designed to explore this assumption.A short survey (figure 1) was developed to explore ED patients’ expectations of analgesia and knowledge of common painkillers. In the first stage of the study, the survey was circulated among 25 ED prescribers who were asked how they thought ‘most patients’ with mild to moderate pain would answer these questions. In the second stage, 50 ED patients with mild to moderate pain were asked to complete the survey. Prescribers’ and patients’ answers were then compared.Abstract 046 Figure 1There was a significant difference between how prescribers thought ‘most patients’ would answer and how most patients actually answered the questions. Fewer patients expected to be sent home with painkillers than the prescribers predicted (figure 2), and patients were prepared to tolerate significantly more pain than prescribers expected (figure 3). A relatively high number of patients were aware of the addictive potential of codeine, yet some were unaware of the addictive potential of morphine, while others thought that paracetamol and ibuprofen were also addictive. Almost all patients indicated that if a painkiller could lead to addiction, they would expect their ED doctor to inform them of this risk.Abstract 046 Figure 2Abstract 046 Figure 3These results suggest that strong painkillers are sometimes given out on the mistaken assumption that this is what patients expect. Involving patients in shared decision making about TTO analgesia may be a useful strategy to reduce ED opioid dispensing.
047 A review of reviews of emergency department interventions for older people: outcomes, costs and implementation factors
Authors: Oppen James van , Preston Louise , Ablard Suzanne , Woods Helen Buckley , Mason Suzanne , Conroy Simon 
Published: April 2023

BackgroundOlder people’s emergency care is an international public health priority and remains sub-optimal in the UK. Strategies are needed to manage older patients sensitively and effectively. We reviewed emergency care interventions, evaluating evidence for outcomes, costs, and implementation.Method and resultsWe developed and registered (with PROSPERO, CRD42018111461) a review of reviews protocol. Screening was according to inclusion criteria for subject and reporting standards. Data were extracted and summarised in tabular and narrative form. Quality was assessed using AMSTAR2 and Joanna Briggs Institute tools. Due to intervention and outcome heterogeneity, findings were synthesised narratively. McCusker’s Elder-Friendly Emergency Department assessment tool was used as a classification framework.ConclusionsEighteen review articles and three conference abstracts fulfilled inclusion criteria. The majority were systematic reviews, with four using meta-analysis. Fourteen reviews reported interventions initiated or wholly delivered within the ED, and four focussed on quality indicators or patient preferences.Confidence was limited to each review’s interpretation of primary studies. Descriptions of interventions were inconsistent, and there was high variability in reporting standards. Interventions mostly focussed on screening and assessment, discharge planning, referrals and follow-up, and multi-disciplinary team composition and professional activities. 26 patient and health service outcomes were reported, including admissions and readmissions, length of stay, mortality, functional decline, and quality of life.Our review of reviews demonstrated that the current, extensive evidence base of review studies lacks complexity, with limited or no evidence for the effectiveness of interventions; reviews commonly called for more primary research using rigorous methods. There is little review evidence for factors influencing implementation.There was evidence that among interventions initiated in ED, those continued into the community yielded better outcomes. Service metrics (as valued by care commissioners) were evaluated as intervention outcomes more frequently than person-centred attributes (as valued by older people). Interventions were broadly holistic in nature.
050 Introduction of a quality of trauma care patient reported experience measure during weekly trauma governance review meetings
Authors: Owen Matthew , Graham Blair , Smith Jason 
Published: April 2023

The 2005 Darzi Report stated that Patient Safety, Clinical Effectiveness and Patient Experience should be afforded parity when evaluating services. Positive Patient Experience (PEx) is correlated with improved outcomes across a wide range of conditions. In our hospital, we conduct weekly governance review of trauma cases, but no PEx element was previously included.This pilot study has the primary aim of evaluating PEx and incorporating this into weekly trauma meetings, specifically identifying strengths and vulnerabilities in service provision. A secondary aim was to stimulate improvement of the trauma system based on feedback received.The setting for this pilot study was the Peninsula Trauma Network Major Trauma Centre at University Hospitals Plymouth NHS Trust. The 13-item validated Short Form Quality of Trauma Care Patient Reported Experience Measure (SF-QTACPREM), originally developed by Bobrovitzet al, was directly administered to trauma patients able to provide informed consent from November 2018 onwards. Items are equally weighted. A positive response is assigned 7.69%, a neutral response 3.85% and a negative response, 0%. By consensus, a target overall PEx score of >90% has been determined.PEx data have been successfully incorporated into trauma meetings. Data are presented in meetings via a visual dashboard (figure 1). Cumulative data are compiled into an aggregate PEx data slide (figure 2).Abstract 050 Figure 1Patient experience dashboardAbstract 050 Figure 2Aggregate dataCurrent mean average PEx Score (n=30) is 81.79% (Range 46.15%–100%). Aggregate data reveal that communication domains tend to score lower whereas technical domains involving medical care score more highly. Provision of mental health support following injury has been identified as a priority area for improvement.As a direct result of negative reported experience or a low PEx score, specialist trauma nurses return to address patient concerns, increasing service responsiveness in real-time. In the future, it is hoped that this pilot will be expanded to include all network trauma patients.