Prediction of en-route complications during interfacility transport by outcome predictive scores in ED

OBJECTIVE

The objective was to determine the accuracy of the outcome predictive scores (Modified Early Warning Score [MEWS]; Hypotension, Low Oxygen Saturation, Low Temperature, Abnormal ECG, Loss of Independence [HOTEL] score; and Simple Clinical Score [SCS]) in predicting en-route complications during interfacility transport (IFT) in emergency department.

DESIGN

This was a retrospective cohort study.

METHODS

All IFT cases by ambulances with either nurse-led or physician-led escort, occurring between 1 January 2011 and 31 December 2012, were included. Obstetric and pediatric cases (age < 18 years) were excluded. The condition of patients was quantified by using the predictive scores (MEWS, HOTEL, and SCS) at triage station and on ambulance departure. The accuracy of predictive scores was compared by the receiver operating characteristic (ROC) curves.

RESULTS

A total of 659 cases were included. Seventeen cases had en-route complications (2.6%). The complication rate in physician-escorted transport (2.2%) was similar to that in nurse-escorted transport (2.6%). None of the 57 intubated cases had en-route complications. The area under the ROC curve for MEWS was 0.662 (triage) and 0.479 (departure). The accuracy of MEWS at triage was better than that at departure (P = .049). The area under the ROC curve for HOTEL was 0.613 (triage) and 0.597 (departure), and that for SCS was 0.6 (triage) and 0.568 (departure). In general, the predictive scores at triage were better than those on departure.

CONCLUSION

None of the scores had good accuracy in prediction of en-route complications during IFT. MEWS at triage was among the best one already but was not ideal.

Outcome Evaluation on the Use of Nurse-Led Transport Kit in Inter-Facility Transport

Introduction

Transport kit is a key element to ensure safe inter-facility transport (IFT). The kit was generally reported by transport staff to be heavy and inconvenient in accessing the required items.

Objective

This study aimed at evaluating the outcome and the feedback from emergency nurses on the use of a new and lighter nurse-led transport kit (NLTK) in IFT.

Methods

A cross sectional study was carried out in two Accident and Emergency Departments in Hong Kong from 1st January 2008 to 31st March 2008. All cases involving nurse-led IFT were included into the study. Questionnaires for assessing the rating of satisfaction were distributed to the staff after every mission.

Results

Eighty-four questionnaires were returned with a response rate of 80.8%. The overall rating on satisfaction before and after the use of NLTK was 14.6±3.0 and 19±3.2 respectively (mean±SD) with statistically significant improvement in terms of its weight, convenience and spaciousness of kit (p<0.05). Conclusion: The new NLTK is more user-friendly than the traditional kit in nurse-led IFT.

1700 Victims of intimate partner violence: characteristics and clinical outcomes

OBJECTIVE

To investigate the demographics and clinical outcomes of intimate partner violence victims presenting to an emergency department.

DESIGN

Retrospective, observational study.

SETTING

Emergency department of a regional hospital in Hong Kong.

PATIENTS

Adults presented with intimate partner violence during years 1999 to 2004.

RESULTS

We assessed 1695 victims of intimate partner violence with a mean age of 39 (range, 18-84) years, of whom 87% were female. Most of the patients were in the age-group of 31 to 40 years and the overall male-to-female ratio was 1:7. In Tin Shui Wai and Yuen Long districts, such cases appeared to be on the increase. Nearly two thirds (65%) of all the victims presented to the emergency department outside the office hours of medical social workers. Approximately 10% had been abused once before, and 40% more than twice. The head (39%), face (30%), upper limbs (37%), and lower limbs (17%) were commonly the injured parts. The majority (73%) had mild injuries; severe injuries being relatively less common. The latter included lacerations or cuts (6.6%), nasal bone fractures (0.3%), limb fractures (0.8%), and ruptured tympanic membranes (0.9%). In-patient management was undertaken for 8% of the victims, due to physical injury in 68% of these individuals and psychological trauma in the remaining 32%. The hospital admission rate dropped from 12% in 2001 to 4% in 2004.

CONCLUSIONS

Variations in demographic data had a significant impact on future service planning and management of intimate partner violence. Accident and Emergency Department and Emergency Medicine Ward services together with extended social worker support could provide timely, multidisciplinary care to meet the various needs of victims and subsequently reduce hospital admissions.