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Emergency Department Education Group Evidence Update
6th December 2016
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New and Updated Cochrane Systematic Reviews
Cerebrolysin for acute ischaemic stroke
Authors' conclusions: The findings of this Cochrane Review do not demonstrate clinical benefits of cerebrolysin for treating acute ischaemic stroke. We found moderate-quality evidence suggesting that serious adverse events may be more common with cerebrolysin use in acute ischaemic stroke.
Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation
Authors' conclusions: Videolaryngoscopes may reduce the number of failed intubations, particularly among patients presenting with a difficult airway. They improve the glottic view and may reduce laryngeal/airway trauma. Currently, no evidence indicates that use of a VLS reduces the number of intubation attempts or the incidence of hypoxia or respiratory complications, and no evidence indicates that use of a VLS affects time required for intubation.
Thrombolysis for acute deep vein thrombosis
Authors' conclusions: Thrombolysis increases the patency of veins and reduces the incidence of PTS following proximal DVT by a third. Evidence suggests that systemic administration and CDT have similar effectiveness. Strict eligibility criteria appears to improve safety in recent studies and may be necessary to reduce the risk of bleeding complications. This may limit the applicability of this treatment. In those who are treated there is a small increased risk of bleeding. Using GRADE assessment, the evidence was judged to be of moderate quality due to many trials having low numbers of participants. However, the results across studies were consistent and we have reasonable confidence in these results.
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New England Journal of Medicine
PERSPECTIVE
Out-of-Network Emergency-Physician Bills — An Unwelcome Surprise
Z. Cooper and F. Scott Morton
N Engl J Med 375:1915, November 17, 2016
Embodying the Three Rs in Fiji
A. Creaton
N Engl J Med 375:1820, November 10, 2016
IMAGES IN CLINICAL MEDICINE
Skin Mottling
D. Contou and N. de Prost
N Engl J Med 375:2187, December 1, 2016
Heterotopic Pregnancy
S. Goettler and R. Zanetti-Dällenbach
N Engl J Med 375:1982, November 17, 2016
NEJM Journal Watch
Journal Watch articles can be accessed using your OpenAthens details, if the article is 3 months post-publication. If you require more recent articles please send this form to clinicallibrarian@uhl-tr.nhs.uk
Shock Index Correlates with Hospitalization and Mortality in General Emergency Department Patients
Jennifer L. Wiler, MD, MBA, FACEP Reviewing Balhara KS et al., Emerg Med J 2016 Nov 24;
A shock index >1.2 was associated with a higher rate of admission and inpatient mortality in this single-institution study.
Bleeding Risk in Patients with Nonvalvular AF on Rivaroxaban Increases with CHA2DS2-VASc Score
Daniel J. Pallin, MD, MPH Reviewing Peacock WF et al., Ann Emerg Med 2016 Nov 29;
No change in practice is warranted, because patients at highest bleeding risk are also the most likely to have net benefit from anticoagulation.
No Benefit from Open Cardiac Massage Following Traumatic Arrest
Calvin A. Brown III, MD, FAAEM Reviewing Bradley MJ et al., J Trauma Acute Care Surg 2016 Nov 81:849
In this prospective observational study, survival was similar for patients undergoing open chest cardiac massage and those receiving only closed chest compressions.
SIRS vs. qSOFA Score in the Emergency Department
Daniel M. Lindberg, MD Reviewing Williams JM et al., Chest 2016 Nov 19;
The systemic inflammatory response syndrome is more sensitive, whereas the quick sequential organ function assessment score is more specific for predicting organ dysfunction and mortality.
Delayed Discharge Summaries = More Readmissions
Christopher M. O'Donnell, MD and Daniel D. Dressler, MD, MSc, SFHM, FACP Reviewing Hoyer EH et al., J Hosp Med 2016 Jun 11:393
A large cohort shows a 1% increase in 30-day readmissions for every 3-day delay in discharge summary completion. |
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Shock Index Correlates with Hospitalization and Mortality in General Emergency Department Patients
Jennifer L. Wiler, MD, MBA, FACEP Reviewing Balhara KS et al., Emerg Med J 2016 Nov 24;
A shock index >1.2 was associated with a higher rate of admission and inpatient mortality in this single-institution study. |
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Systematic Reviews from The Joanna Briggs Institute
Admission (Burn Patient): Assessment
What is the best available evidence regarding what items should be assessed in burn patients on admission?
Best Practice Recommendation: The admission of a burn patient requires assessment of the same factors that would be
assessed for any other trauma patients, as well as a number of specific and unique items.
Burn specific items include; Burn size (TBSA), depth, location and source, the presence of
inhalation injury, the presence of smoke or toxic gases, admission hyperglycemia, and
admission hypothermia. (Grade B)
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DynaMed
Topic: Dizziness - differential diagnosis
Review of a new approach to the diagnosis of acute dizziness in adult patients can be found in Emerg Med Clin North Am 2016 Nov;34(4):717
Review of using the physical exam to diagnose patients with acute dizziness and vertigo can be found in J Emerg Med 2016 Apr;50(4):617
Topic: Sepsis treatment in adults
Increased cardiac output in response to passive leg raising may help predict response to fluid administration in patients with hemodynamic instability presenting to emergency room (JAMA 2016 Sep 27)
Topic: Cardiac arrest in children
Tracheal intubation during CPR associated with reduced survival to hospital discharge in children with in-hospital cardiac arrest (JAMA 2016 Nov 1)
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Embed Health Daily Bulletin
Care for older people with frailty
The Royal College of General Practitioners and the British Geriatrics Society have published Integrated care for older people with frailty: innovative approaches in practice. This report focuses on how GPs and geriatricians are collaborating to design and lead innovative schemes to improve the provision of integrated care for older people with frailty. It highlights 13 case studies from across the UK including schemes to help older people remain active and independent, provide better services in the community and support patients in hospital.
Alcohol control policies
Public Health England has published The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies: An evidence review. It provides a broad and rigorous summary of the types and prevalence of alcohol-related harm, as well as presenting evidence for the effectiveness and cost-effectiveness of alcohol control policies. Public Health England has also published statistical data which highlights the estimated number of working years of life lost in 2015 due to alcohol, broken down by cause of death.
Reducing winter pressures on accident and emergency departments
The House of Commons health committee has published Winter pressure in accident and emergency departments Third Report of Session 2016–17. This report is calling on the Government to make sure that sufficient funding is available to support the infrastructure investment required to ensure that type 1 emergency departments are fit for purpose, and to review the real terms cuts to NHS capital budgets in the spending review. The Committee is also asking for NHS Improvement to consider the steps that it can take this winter to ensure that all A&E departments are properly staffed and for Health Education England to look again at the long term sustainability of staffing, including for paramedics, within major emergency departments and the ambulance service.
Urgent and emergency care pilot reports
As part of their plans to explore how they might comment on the quality of care across a local health and care system, the Care Quality Commissions has published reports of two pilots which explore what this could look like for urgent and emergency care. The reports focus on urgent and emergency care systems in South Warwickshire and in Airedale, Wharfedale, Craven & Bradford. In both areas the CQC looked at the contribution of the services that support people with urgent and emergency care needs, including NHS 111, A&E departments, ambulance services, GP practices, GP out of hours-services and care homes and how well they worked together for the benefit of the local population.
Revised ectopic pregnancy guideline published
The Royal College of Obstetricians and Gynaecologists and the Association of Early Pregnancy Units has published Diagnosis and Management of Ectopic Pregnancy (Green-top Guideline No. 21). This guideline replaces The Management of Tubal Pregnancy, which was published in 2004. The guideline provides evidence-based information on the diagnosis and management of ectopic pregnancies, including the surgical, pharmacological or conservative treatment options available and the level of support that should be offered to women.
Statistics
Provisional accident and emergency quality indicators for England – August 2016, by provider
Provisional monthly hospital episode statistics for admitted patient care, outpatient and accident and emergency data – April 2016 – September 2016
Bulletins
Public Health England Emergency department bulletin
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