RESUMO
@#BACKGROUND: Emergencies such as road traffic accidents (RTAs), acute myocardial infarction (AMI) and cerebrovascular accident (CVA) are the most common causes of death and disability in India. Robust emergency medicine (EM) services and proper education on acute care are necessary. In order to inform curriculum design for training programs, and to improve the quality of EM care in India, a better understanding of patient epidemiology and case burden presenting to the emergency department (ED) is needed.METHODS: This study is a retrospective chart review of cases presenting to the ED at Kerala Institute of Medical Sciences (KIMS), a private hospital in Trivandrum, Kerala, India, from November 1, 2011 to April 21, 2012 and from July 1, 2013 to December 21, 2013. De-identified charts were systematically sampled and reviewed.RESULTS: A total of 1196 ED patient charts were analyzed. Of these patients, 55.35％ (n=662) were male and 44.7％ (n=534) were female. The majority (67.14％,n=803) were adults, while only 3.85％ (n=46) were infants. The most common chief complaints were fever (21.5％, n=257), renal colic (7.3％,n=87), and dyspnea (6.9％,n=82). The most common ED diagnoses were gastrointestinal (15.5％,n=185), pulmonary (12.3％,n=147), tropical (11.1％,n=133), infectious disease and sepsis (9.9％,n=118), and trauma (8.4％,n=101).CONCLUSION: The patient demographics, diagnoses, and distribution of resources identifi ed by this study can help guide and shape Indian EM training programs and faculty development to more accurately refl ect the burden of acute disease in India.
RESUMO
BACKGROUND:The Broselow? Pediatric Emergency Tape indicates standardized, pre-calculated medication doses, dose delivery volumes, and equipment sizes using color-coded zones based on height-weight correlations. The present study attempted to provide more evidence on the effectiveness of the Broselow? Pediatric Emergency Tape by comparing the tape-estimated weights with actual weights. We hypothesized that the Broselow? Pediatric Emergency Tape would overestimate weights in Indian children aged<10 years, leading to inaccurate dosing and equipment sizing in the emergency setting. METHODS:This prospective study of pediatric patients aged <10 years who were divided into three groups based on actual body weight:<10 kg, 10–18 kg, and >18 kg. We calculated the percentage difference between the Broselow-predicted weight and the measured weight as a measure of tape bias. Concordant results were those with a mean percent difference within 3％. Standard deviation was measured to determine precision. Accuracy was determined as color-coded zone prediction and measured weight concordance, including the percentage overestimation by 1–2 zones. RESULTS:The male-to-female ratio of the patients was 1.3:1. Total agreement between color-coding was 63.18％ (K=0.582). The Broselow? color-coded zone agreement was 74.8％ in the <10 kg group, 61.24％ in the 10–18 kg group, and 53.42％ in the >18 kg group. CONCLUSIONS:The Broselow? Pediatric Emergency Tape showed good evidence for being more reliable in children of the <10 kg and 10–18 kg groups. However, as pediatric weight increased, predictive reliability decreased. This raises concerns over the use of the Broselow? Pediatric Emergency Tape in Indian children because body weight was overestimated in those weighing >18 kg.
RESUMO
BACKGROUND: Hemorrhage is the second leading cause of death in trauma patients preceded only by traumatic brain injury. But hemorrhagic shock is the most common cause of preventable death within 6 hours of admission. Traumatic coagulopathy is a hypocoagulable state that occurs in the most severely injured. International normalized ratio (INR) and its relationship with trauma mortality have not been studied specifically. This study aimed to establish a predictive value of INR for trauma-related mortality. METHODS: A total of 99 trauma patients aged 18–70 years were included in the study. Their INR was determined and patient progression was followed up till death/discharge. According to previous retrospective studies, the cutoff value for INR in our study was kept at 1.5. RESULTS: The total mortality rate of the patients was 16.16％ (16/99). The mean INR was 1.45 with a SD of 1.35. INR was deranged in a total of 14 patients (14.14％). Of these patients, 11 died (78.57％) and 3 survived. INR was deranged in 11 (68.75％) of the 16 patients who died, but 5 deaths (31.25％) had normal INR values. The sensitivity of INR was 69％ (95％CI 41％–88％) and the specificity 96％ (95％CI 90％–99％). The diagnostic accuracy of INR was 92％ (95％CI 85％–96％). Positive predictive value and negative predictive value were 79％ (95％CI 49％–95％) and 94％ (95％CI 87％–98％), respectively. CONCLUSION: Our results showed that INR is a good predictor of mortality in trauma patients.
RESUMO
BACKGROUND: Stroke is a common presentation in geriatric patients in emergency department but rarely seen in pediatric patients. In case of acute ischemic stroke in pediatric age group, management is different from that of adult ischemic stroke where thrombolysis is a good option.METHODS: We report a case of a 17-year-old male child presenting in emergency with an episode of acute ischemic stroke causing left hemiparesis with left facial weakness and asymmetry. The patient suffered from cyanotic congenital heart disease for which he had undergone Fontan operation previously. He had a history of missing his daily dose of warfarin for last 3 days prior to the stroke.RESULTS: The patient recovered from acute ischemic stroke without being thrombolyzed.CONCLUSION: In pediatric patients, acute ischemic stroke usually is evolving and may not require thrombolysis.