ABSTRACT
Background: Pleural infection has a considerable healthcare burden with an average hospital stay of 14 days. There have been no randomised trials on the use of therapeutic thoracentesis (TT) for initial pleural fluid drainage. Aim(s): To assess the feasibility of a full-scale trial of chest tube vs TT for pleural infection. The primary outcome was defined as the acceptability of randomisation (ad priori defined as successful if >=50% of eligible patients were randomised). Method(s): Adult patients admitted with a pleural effusion related to infection and meeting recognised criteria for drainage were eligible. Participants were randomised (unblinded) to chest tube insertion or TT. Patients were followed up at 90 days. Result(s): From September 2019 and June 2021, 51 patients were diagnosed with complex parapneumonic effusion/empyema. Eleven patients met the inclusion criteria for trial and 10 patients were randomised (91%). The COVID-19 pandemic had a significant impact on recruitment. Patients randomised to TT had a shorter overall mean hospital stay (5.4 days, SD 5.1) compared to the chest tube control group (13 days, SD 6.0), p=0.04. Total number of pleural procedures required per patient were similar, 1.2 in chest tube group and 1.4 in TT group. No patients required surgical referral. Adverse events were similar between the groups with no readmissions related to pleural infection. Data completeness was high with no protocol deviations. Conclusion(s): The ACTion trial met its prespecified feasibility criteria for patient acceptability. The suggestion that TT can reduce hospital length of stay requires further investigation.
ABSTRACT
Introduction: The societal changes triggered by the COVID-19 pandemic and resultant lockdowns have the potential to alter the incidence and nature of injuries within affected populations. We aimed to investigate these changes within metropolitan London and the impact lockdown had on London’s Air Ambulance’s (LAA) response to incidents. Methods: This retrospective cohort study compared data from all LAA missions in the two-month period following instigation of the first UK national lockdown in 2020 to the equivalent period in 2019. Patient demographics, nature and severity of injuries, incident details and LAA mission parameters were assessed. Results: LAA saw a significant reduction in the mean (standard deviation) of activations per week under lockdown (32.75 [4.95] vs. 54.25 [4.53], p < 0.001). The distribution of patients across different trauma aetiologies differed significantly under lockdown, with proportionately more injuries resulting from domestic violence (DV) (0.7% vs. 3.8%) and deliberate self-harm (DSH) (16.5% vs. 12.4%), although the absolute number of DSH fell. Significantly fewer incidents occurred in central areas of London, but injury severity was unaffected by lockdown. After adjustment for confounders, lockdown was associated with shorter drive times, but not overall response times. There was no association between lockdown and aetiology or severity of injuries. Conclusion: The COVID-19 pandemic and ensuing UK national lockdown had a substantial impact on major trauma patterns within London and the subsequent LAA response. The feared rise in suicide was not observed, but there was a notable increase in DV frequency.