New tool identifies headache patients at risk of aneurysms in emergency department

Press Release:

A new tool to identify potentially fatal aneurysms in patients with headaches who seem otherwise well will help emergency departments to identify high-risk patients, improve survival rates and cut out unnecessary imaging, according to new research published in CMAJ (Canadian Medical Association Journal)

A bleeding brain aneurysm, referred to medically as a subarachnoid hemorrhage, can cause a sudden headache.

“Although rare, accounting for only 1%-3% of headaches, these brain aneurysms are deadly,” says Dr. Jeffrey Perry, an emergency physician with The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario. “Almost half of all patients with this condition die and about 2/5 of survivors have permanent neurological deficits. Patients diagnosed when they are alert and with only a headache have much better outcomes, but can be challenging to diagnose as they often look relatively well.”

The Ottawa Subarachnoid Hemorrhage Rule was developed by researchers at The Ottawa Hospital, which also created The Ottawa Rules, decision tools used in emergency departments around the world to identify ankle, knee and spine fractures.

The current study, involving 1153 alert adult patients with acute sudden onset headache admitted to 6 university-affiliated hospitals in Canada over 4 years from January 2010 to 2014, validates earlier published research that initially proposed the Ottawa Subarachnoid Hemorrhage Rule.

“Before any clinical decision rule can be used safely, it must be validated in new patients to ensure that the derived ‘rule’ did not come to be by chance, and that it is truly safe,” says Dr. Perry. “This is especially true with a potentially life-threatening condition such as subarachnoid hemorrhage.”

The newly validated rule gives emergency physicians a reliable tool to identify high-risk patients and rule out the condition in low-risk patients without having to order time-consuming imaging.

“We hope this tool will be widely adopted in emergency departments to identify patients at high risk of aneurysm while cutting wait times and avoiding unnecessary testing for low-risk patients,” says Dr. Perry. “We estimate that this rule could save 25 lives in Ontario each year.”

Time limit for stroke thrombectomy may be longer in selected patients

From Reuters:

Removing a stroke-causing clot from a large blood vessel in the brain can improve outcomes in some patients, even when extraction occurs 6 to 24 hours after symptoms develop, according to results of a large new test of the technique.

Until now, studies have suggested that the extraction needs to be performed within 6 hours of the stroke.

 The old time limit may still provide the best outcome, but the new findings of the DAWN trial open the door to clot removal for other patients, particularly people who don’t discover their symptoms until they wake up, making the precise time of onset unknown.

How One Las Vegas ED Saved Hundreds of Lives After the Worst Mass Shooting in U.S. History

From EP Monthly:

The night that Stephen Paddock opened fire on thousands of people at a Las Vegas country music concert, nearby Sunrise Hospital received more than 200 penetrating gunshot wound victims. Dr. Kevin Menes was the attending in charge of the ED that night, and thanks to his experience supporting a local SWAT team, he’d thought ahead about how he might mobilize his department in the event of a mass casualty incident.

Study Suggests Women Less Likely to Get CPR From Bystanders

From US News:

Women are less likely than men to get CPR from a bystander and more likely to die, a new study suggests, and researchers think reluctance to touch a woman’s chest might be one reason.

Only 39 percent of women suffering cardiac arrest in a public place were given CPR versus 45 percent of men, and men were 23 percent more likely to survive, the study found.

It involved nearly 20,000 cases around the country and is the first to examine gender differences in receiving heart help from the public versus professional responders.

Hospitals strained by ailing mental health system

From the Free Press:

An Essentia Health hospital in Brainerd was recently criticized for turning away certain patients with severe mental illnesses from its psychiatric units, but it’s far from the only health center in Minnesota feeling the strain of the state’s ailing mental health care system.

The controversy in Brainerd revolves around patients who’ve been court ordered to receive mental health care. The hospital highlighted in a recent Star Tribune story opted to only take in patients who voluntarily sought treatment to its 16-bed psychiatric unit.

With capacity at a minimum in psychiatric units, the hospital argued the civilly committed patients were taking up beds that could be used for other patients.

US Health Care Reform and Rural America: Results From the ACA’s Medicaid Expansions

From the Journal of Rural Health:

Purpose

Medicaid expansions, prompted by the Affordable Care Act, generated generally positive effects on coverage and alleviated much of the financial burden associated with seeking health care. We do not know if these shifts also extend to the nation’s rural populations.

Methods

Using 2011-2015 Behavioral Risk Factor Surveillance System data, this study compares trend changes for coverage, access to care, and health care utilization in response to Medicaid expansion among urban and rural residents using a difference-in-differences regression approach.

Findings

Following Medicaid expansion, low-income rural and urban residents both experienced reductions in uninsurance; however, the coverage uptake in rural settings (8.5 percentage points [pp], P < .01) was much larger than the uptake in coverage in more urban settings (4.1 pp, P > .10). In spite of larger uptakes in coverage among rural residents, reductions in cost-related barriers to medical care were slightly larger among urban residents, and access to a regular source of medical care (5.2 pp, P < .05) and doctor visitation (4.5 pp, P < .01) were only statistically significant among urban residents.

Conclusions

The ACA Medicaid expansions produced larger gains in coverage for rural residents than urban residents; however, it appears there remain opportunities to improve access to care among potentially vulnerable rural residents.

Observational review of paediatric intraosseous needle placement in the paediatric emergency department.

From the Journal of Pediatric Child Health:

AIM:

Intraosseous (IO) access is a life-saving option during resuscitations in the paediatric emergency department (PED). This study aimed to compare success rates and time to placement for Manual IO versus EZ-IO needles in PED patients ≤8 and >8 kg.

METHODS:

This was a retrospective cross-sectional descriptive study of IO use in a single-centre tertiary PED from 2006 to 2014. Cases were identified through diagnosis codes for IO infusion, cardiopulmonary resuscitation and cardiac arrest and admissions to the intensive care unit. Categorical measures were compared with Z-test for comparison of two proportions and continuous with Student’s t-tests.

RESULTS:

Of 1748 charts screened, 50 had an IO attempted. In patients ≤8 kg, Manual IO had success rate of 55% (17/31) versus 47% (8/17) for EZ-IO (P = 0.61). In patients >8 kg, Manual had success rate of 100% (2/2) versus 93% (14/15) for EZ-IO (P = 0.71). Manual performance was no different for ≤8 kg than >8 kg (P = 0.21), but EZ-IO was less successful for ≤8 kg than >8 kg (P = 0.005). In patients ≤8 kg, Manual IO had a shorter time to placement at 4.5 min versus 12.8 for EZ-IO (P = 0.02).

CONCLUSION:

We observed no difference in performance between Manual and EZ-IO devices in children ≤8 kg, but the Manual IO were placed more quickly. We observed lower success rates with EZ-IO devices in children ≤8 kg compared to >8 kg. Future investigations should focus specifically on training for IO placement in children ≤8 kg.