Distracted walking: injuries soar for pedestrians on phones

From Science Codex:

 More than 1,500 pedestrians were estimated to be treated in emergency rooms in 2010 for injuries related to using a cell phone while walking, according to a new nationwide study.

The number of such injuries has more than doubled since 2005, even though the total number of pedestrian injuries dropped during that time. And researchers believe that the actual number of injured pedestrians is actually much higher than these results suggest.

“If current trends continue, I wouldn’t be surprised if the number of injuries to pedestrians caused by cell phones doubles again between 2010 and 2015,” said Jack Nasar, co-author of the study and professor of city and regional planning at The Ohio State University.

Prehospital Systolic Blood Pressure Thresholds: A Community-based Outcomes Study

From Academic Emergency Medicine:

Objectives

Emergency medical services (EMS) personnel commonly use systolic blood pressure (sBP) to triage and treat acutely ill patients. The definition of prehospital hypotension and its associated outcomes are poorly defined. The authors sought to determine the discrimination of prehospital sBP thresholds for 30-day mortality and to compare patient classification by best-performing thresholds to traditional cutoffs.

Methods

In a community-based cohort of adult, nontrauma, noncardiac arrest patients transported by EMS between 2002 and 2006, entries to state hospital discharge data and death certificates were linked. Prehospital sBP thresholds between 40 and 140 mm Hg in derivation (n = 132,624) and validation (n = 22,020) cohorts and their discrimination for 30-day mortality, were examined. Cutoffs were evaluated using the 0/1 distance, Youden index, and adjusted Z-statistics from multivariable logistic regression models.

Results

In the derivation cohort, 1,594 (1.2%) died within 24 hours, 7,404 (6%) were critically ill during hospitalization, and 6,888 (5%) died within 30 days. The area under the receiver operating characteristic (ROC) curve for sBP was 0.60 (95% confidence interval [CI] = 0.59, 0.61) for 30-day mortality and 0.64 (95% CI = 0.62 0.66) for 24-hour mortality. The 0/1 distance, Youden index, and adjusted Z-statistics found best-performing sBP thresholds between 110 and 120 mm Hg. When compared to an sBP ≤ 90 mm Hg, a cutoff of 110 mm Hg would identify 17% (n = 137) more deaths at 30 days, while overtriaging four times as many survivors.

Conclusions

Prehospital sBP is a modest discriminator of clinical outcomes, yet no threshold avoids substantial misclassification of 30-day mortality among noninjured patients.

Resident-Initiated Advanced Triage Effect on Emergency Department Patient Flow

From the Journal of Emergency Medicine:

Background

Emergency Department (ED) overcrowding is a national problem. Initiating orders in triage has been shown to decrease length of stay (LOS), however, nurse, physician assistant, and attending physician advanced triage have all been criticized.

Study Objectives

Our primary objective was to show that Emergency Medicine resident-initiated advanced triage shortens patient LOS. Our secondary objective was to evaluate whether or not resident triage decreases the number of patients who left prior to medical screening (LPTMS).

Methods

This prospective interventional study was performed in a 42-bed, Level III trauma center, academic ED in the United States, with an annual census of approximately 41,000 patients. A junior or senior Emergency Medicine resident initiated orders on 16 weekdays for 6 h daily on patients presenting to triage. Patients evaluated during the 6-h period on other weekdays served as the control. The study was powered to detect a reduction in LOS of 45 min. Multivariable median regression was used to compare length of stay and Fisher’s exact test to compare proportions.

Results

There were 1346 patients evaluated in the ED during the intervention time. Regression analysis showed a 37-min decrease in median LOS for patients on intervention days as compared to control days (p = 0.02). The proportion of patients who LPTMS was not statistically different (p = 0.7) for intervention days (96/1346, 7.13%) compared to control days (136/1810, 7.51%).

Conclusions

Resident-initiated advanced triage is an effective method to decrease patient LOS, however, our effect size is smaller than predicted and did not significantly affect the percent of patients leaving before medical screening.

Bills would allow part-time ER

From the Adirondack Daily Enterprise:

Legislation has been proposed in Albany that would let Adirondack Health run a part-time, off-campus emergency room in Lake Placid – possibly a compromise between a hospital looking to cut costs and a community wanting to keep its ER.

The state nurses’ association, however, condemned the proposal Monday.

Three Injured in Iowa Factory Explosion

From JEMS:

A small explosion at a northeast Iowa factory on Monday injured three workers, including one who was flown to an Iowa City burn unit in critical condition.

NTSB: Financial Pressures Added to Pilot’s Decision to Fly Ill-Fated Organ Transport Flight

From JEMS:

Financial pressures likely contributed to a helicopter pilot’s decision to continue flying through deteriorating weather before crashing in north Florida, killing a Mayo Clinic heart surgeon and technician on their way to retrieve a heart for transplant in 2011, according to a report from the National Transportation Safety Board.