Comparison of Ambulance Usage Characteristics in Children Between the Pre-Pandemic and Pandemic Periods in Turkey

Objective: A pandemic is an epidemic of an infectious disease that has spread across a large region of the world and affects many people. In this study, it was aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on ambulance use by pediatric patients in Ankara Province, Turkey. Material and Methods: This retrospective study was conducted in the spring-summer of 2019 and 2020. The electronic medical records of pediatric patients who were transported to the hospital by ambulance were analyzed. Results: It was determined that 49.6% of the 23.201 patients included in the study were transported during the pandemic period. Male gender was higher in both the pandemic and pre-pandemic periods, there was no difference in terms of average age. The rate of forensic cases and refugee patients increased, while that of emergency patients decreased. Both the arrival at the scene time and intervention time were prolonged. Medical cause was the most common cause of emergency calls in both years, however, it increased significantly in 2020. The decrease in cases of traffic accidents, suicides, and other accidents was statistically significant. In the pandemic period, total rate of COVID-19 infection and suspicion was 29.7%. Most of the patients had been referred to a public hospital. Conclusion: It was found that most of the ambulances were used for transporting patients with minor illnesses that did not require immediate medical attention in pandemic period. (English) [ FROM AUTHOR] Amaç: Pandemi, dünyanın geniş bir bölgesine yayılan ve birçok insanı etkileyen bulaşıcı hastalık salgınıdır. Bu çalışmada, Türkiye'nin Ankara ilinde, 2019 koronavirüs hastalığı (COVÍD-19) pandemisinin çocuk hastaların ambulans kullanımına etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif çalışmada 2019 ve 2020 yıllarının bahar-yaz aylarında ambulans ile hastaneye nakledilen çocuk hastaların elektronik tıbbi kayıtları incelendi. Bulgular: Çalışmaya alınan 23201 hastanın %49.6'sının pandemi döneminde nakledildiği belirlendi. Erkek cinsiyet hem pandemi hem de pandemi öncesi dönemlerde daha yüksekti, yaş ortalamaları açısından fark yoktu. Pandemi döneminde adli vaka ve mülteci hasta oranı artarken, acil hasta oranı azaldı. Hem olay yerine gelme süresi hem de müdahale süresi uzadı. Medikal nedenler her iki yılda da en sık acil çağrı nedeniydi, ancak 2020'de önemli ölçüde arttı. Trafik kazası, özkıyım ve diğer kaza vakalarındaki azalma istatistiksel olarak anlamlıydı. Pandemi döneminde toplam kesin ve şüpheli COVÍD-19 enfeksiyonu oranı %29.7'di. Hastaların çoğu devlet hastanesine sevk edildi. Sonuç: Pandemi döneminde ambulansların çoğunun acil tıbbi müdahale gerektirmeyen hafif hastalığı olan hastaları taşımak için kullanıldığı tespit edildi. (Turkish) [ FROM AUTHOR] Copyright of Journal of Pediatric Disease / Cocuk Hastaliklari Dergisi is the property of Turkish Journal of Pediatric Disease and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

SAEM23 Editors‐in‐Chief Welcome

The article offers information on the SAEM 2023 annual meeting, which is considered the first post-COVID gathering, It expresses gratitude for the readers' engagement with the s, which represent the thoughts of over 1300 emergency medicine enthusiasts from various backgrounds and expertise.

Virtual Shadowing: An Effective Approach to Gaining Exposure to the Field of Emergency Medicine.

Purpose: Shadowing is an important part of medical student education. The COVID-19 pandemic limited medical students' hospital access. At the same time, virtual access to learning experiences has expanded greatly. In response, we implemented a novel virtual shadowing system to provide students with convenient and safe exposure to the Emergency Department (ED). Patients and Methods: Six EM faculty hosted 2-hour virtual shadowing for up to 10 students per experience. Students registered via signupgenius.com. Virtual shadowing was conducted using a HIPAA-compliant ZOOM account on an ED issued mobile telehealth Monitor/iPad. The physician would bring the iPad into the room, obtain consent from patients, and ensure students were able to see the encounter. Between visits, students were encouraged to ask questions using the chat function and microphone. A short de-briefing followed each shift. Each participant received a survey about the experience. The survey consisted of 4 questions for demographics, 9 Likert style questions to assess efficacy, and 2 free response sections for comments and feedback. All survey responses were anonymous. Results: In total, 58 students participated in 18 virtual shadowing sessions with an average of 3-4 students per session. Survey responses were collected between October 20, 2020 and November 20, 2020. The overall response rate was 96.6% (56/58 surveys completed). Of respondents, 46 (82.1%) rated the experience as "effective" or "very effective" at providing exposure to Emergency Medicine. Fifty-three (94.6%) said they would participate in virtual shadowing in the ED again, and 48 (85.7%) would do virtual shadowing in another specialty were it available. Conclusion: We found virtual shadowing to be an easy to implement and effective way for students to shadow physicians in the ED. Even in post-pandemic times, virtual shadowing should be explored as an accessible and effective way to expose students to a broad array of specialties.

[Polytrauma care in air rescue in times of the COVID-19 pandemic: impact and development of case numbers]. / Polytraumaversorgung in der Luftrettung in Zeiten der COVID-19-Pandemie: Auswirkungen und Entwicklung der Fallzahlen.

Background: Changes in patient care occurred as a result of the SARS-CoV­2 virus, and both intrahospital and prehospital care were profoundly affected. Public shutdowns during lockdown periods were intended to prevent overstretching existing resources, resulting in noticeable changes in medical care for both elective treatments and emergency medicine. This study now considered the impact of the COVID 19 pandemic on air ambulance services at a central air ambulance site in 2020 compared to the previous 2 years. Methods: A retrospective evaluation of all missions of the rescue helicopter Christoph 9 in the first COVID-19 pandemic year 2020 in comparison to the years 2018 and 2019 was performed. The mission logs were evaluated for the analysis. Results: There was a 20% reduction in the number of missions in 2020, with primarily internal medicine missions affected. Despite the lockdown periods and reduction in social life, the proportion of trauma deployments remained nearly the same. As expected, the proportion of occupational accidents decreased, and recreational activities resulted in accidents more frequently. Injury or illness severity showed no significant differences. In terms of internal diseases, there was a reduction in alerts for acute coronary syndrome and respiratory emergencies. The proportion of suicide-related injuries remained constant over the years. Conclusion: During the COVID-19 study period, a decrease in the number of deployments and aborted deployments was observed. However, no significant differences in deployment and injury characteristics were observed for trauma-related deployments. These results highlight the importance of air ambulance services to ensure patient care even during pandemic periods.

Implementation of indication-based antibiotic order sentences improves antibiotic use in emergency departments.

INTRODUCTION: Prior data have suggested that suboptimal antibiotic prescribing in the emergency department (ED) is common for uncomplicated lower respiratory tract infections (LRTI), urinary tract infections (UTI), and acute bacterial skin and skin structure infections (ABSSSI). The objective of this study was to measure the effect of indication-based antibiotic order sentences (AOS) on optimal antibiotic prescribing in the ED. METHODS: This was an IRB-approved quasi-experiment of adults prescribed antibiotics in EDs for uncomplicated LRTI, UTI, or ABSSSI from January to June 2019 (pre-implementation) and September to December 2021 (post-implementation). AOS implementation occurred in July 2021. AOS are lean process, electronic discharge prescriptions retrievable by name or indication within the discharge order field. The primary outcome was optimal prescribing, defined as correct antibiotic selection, dose, and duration per local and national guidelines. Descriptive and bivariate statistics were performed; multivariable logistic regression was used to determine variables associated with optimal prescribing. RESULTS: A total of 294 patients were included: 147 pre-group and 147 post-group. Overall optimal prescribing improved from 12 (8%) to 34 (23%) (P < 0.001). Individual components of optimal prescribing were optimal selection at 90 (61%) vs 117 (80%) (P < 0.001), optimal dose at 99 (67%) vs 115 (78%) (P = 0.036), and optimal duration at 38 (26%) vs 50 (34%) (P = 0.13) for pre- and post-group, respectively. AOS was independently associated with optimal prescribing after multivariable logistic regression analysis (adjOR, 3.6; 95%CI,1.7-7.2). A post-hoc analysis showed low uptake of AOS by ED prescribers. CONCLUSIONS: AOS are an efficient and promising strategy to enhance antimicrobial stewardship in the ED.

Disproportionate impact of abortion restriction: Implications for emergency department clinicians.

Individuals experiencing intimate partner violence (IPV) and/or human trafficking (HT) are at increased risk of severe health consequences as a result of legislation criminalizing and/or restricting abortion, which is expected to increase as a result of the Supreme Court decision Dobbs v. Jackson. These risks are further stratified by race, socioeconomics, and other marginalizing demographic attributes. IPV and HT introduce barriers to maintaining physical and mental health, due to control of access to transportation and funds by the abuser, fear of retribution for seeking healthcare, and other barriers. Individuals experiencing IPV or HT often lack reproductive autonomy, as a result of facing reproductive coercion at the hands of their abusers. Following the Dobbs decision, these vulnerable patient populations will face further limitations on their reproductive autonomy and increased obstacles to obtaining an abortion if they medically need or desire one. This will likely result in more patients presenting to the emergency department due to complications from unsafe or unsupervised self-managed abortions, as well as patients being reluctant to report having obtained an unlawful abortion due to fear of legal consequences. This is particularly relevant to individuals experiencing IPV and HT, as they may be more likely to use these methods for obtaining an abortion due to numerous barriers. Emergency medicine clinicians are vital in providing care to these patients, as they frequently present to emergency departments. A multi-pronged approach to better support these patients is essential, involving an increased index of suspicion for IPV, HT or the complications of unsupervised abortion, improved organizational structures, specialized training for staff, improved screening methods, reflection on implicit bias, and recommendations for mindful documentation and legal considerations.

Patiromer utility as an adjunct treatment in patients needing urgent hyperkalaemia management (PLATINUM): design of a multicentre, randomised, double-blind, placebo-controlled, parallel-group study.

INTRODUCTION: Hyperkalaemia is common, life-threatening and often requires emergency department (ED) management; however, no standardised ED treatment protocol exists. Common treatments transiently reducing serum potassium (K+) (including albuterol, glucose and insulin) may cause hypoglycaemia. We outline the design and rationale of the Patiromer Utility as an Adjunct Treatment in Patients Needing Urgent Hyperkalaemia Management (PLATINUM) study, which will be the largest ED randomised controlled hyperkalaemia trial ever performed, enabling assessment of a standardised approach to hyperkalaemia management, as well as establishing a new evaluation parameter (net clinical benefit) for acute hyperkalaemia treatment investigations. METHODS AND ANALYSIS: PLATINUM is a Phase 4, multicentre, randomised, double-blind, placebo-controlled study in participants who present to the ED at approximately 30 US sites. Approximately 300 adult participants with hyperkalaemia (K+ ≥5.8 mEq/L) will be enrolled. Participants will be randomised 1:1 to receive glucose (25 g intravenously <15 min before insulin), insulin (5 units intravenous bolus) and aerosolised albuterol (10 mg over 30 min), followed by a single oral dose of either 25.2 g patiromer or placebo, with a second dose of patiromer (8.4 g) or placebo after 24 hours. The primary endpoint is net clinical benefit, defined as the mean change in the number of additional interventions less the mean change in serum K+, at hour 6. Secondary endpoints are net clinical benefit at hour 4, proportion of participants without additional K+-related medical interventions, number of additional K+-related interventions and proportion of participants with sustained K+ reduction (K+ ≤5.5 mEq/L). Safety endpoints are the incidence of adverse events, and severity of changes in serum K+ and magnesium. ETHICS AND DISSEMINATION: A central Institutional Review Board (IRB) and Ethics Committee provided protocol approval (#20201569), with subsequent approval by local IRBs at each site, and participants will provide written consent. Primary results will be published in peer-reviewed manuscripts promptly following study completion. TRIAL REGISTRATION NUMBER: NCT04443608.

The 2022 and 2023 Emergency Medicine Residency Match: A Cautionary Tale.

Introduction The emergency medicine (EM) match has undergone significant shifts in 2022 and 2023. While variation in specialty fill rates is expected over time, EM programs noted a significant increase in open positions starting in 2022. Utilizing National Resident Matching Program (NRMP) data over a 10-year period, we identified significant deviations in the emergency medicine match. Methods Shewhart control charts were used to plot the match results over time. A 10-year sample was used to establish the baseline value. From this value, the upper and lower control limits were established. Residency program expansion, decreasing applicant numbers, and changing applicant types were evaluated to detect any non-random changes to the process. Results While the number of EM PGY-1 positions added over time was within the expected range, both the number of unmatched positions and the change in the number of total US MD applicants were outside of this range and are considered to be "out of control." Conclusion It is not yet clear which contributing causes may underlie this sudden change. Several potential etiologies exist, including mismatches in supply and demand for positions, changes in perceptions of the specialty, the effects of COVID-19, and changing workforce needs. Historically similar experiences affecting other specialties, including anesthesia and radiation oncology, are analyzed. Potential solutions for returning to the necessary and usual success of the emergency medicine specialty match are explored.

An Asynchronous Curriculum: Learner Perspectives on Incorporating Asynchronous Learning Into In-Person and Virtual Emergency Residency Didactics.

Background  Didactic education in emergency medicine (EM) residencies has been impacted both by the advent of asynchronous learning and by the shift toward virtual, web-based conference education due to coronavirus disease 2019 (COVID-19). Studies have demonstrated the efficacy of asynchronous education, but few have explored resident opinions about how asynchronous and virtual modifications on conference impact their educational experience.  Objective This study aimed to evaluate resident perceptions of both asynchronous and virtual modifications to a historically in-person didactic curriculum. Methods This was a cross-sectional study of residents of a three-year EM program at a large academic center where a 20% asynchronous curriculum was implemented in January 2020. A questionnaire was administered online with questions assessing how residents perceived their didactic curriculum with regard to convenience, retention of information, work/life balance, enjoyability, and overall preference. Questions compared resident opinions of in-person vs. virtual learning, as well as how the substitution of one hour of asynchronous learning impacted residents' perception of their didactics. Responses were reported on a five-point Likert-type scale.  Results A total of 32 out of 48 residents (67%) completed the questionnaire. When virtual conference was compared to in-person conference, residents favored virtual conference with regard to convenience (78.1%), work-life balance (78.1%), and overall preference (68.8%). They favored in-person conference (40.6%) or felt that the modalities were equivalent (40.6%) with regard to retention of information and favored in-person conference with regard to enjoyability (53.1%). Residents felt that the addition of asynchronous learning to their curriculum increased subjective convenience, work-life balance, enjoyability, retention of information, and overall preference, regardless of whether synchronous conference was virtual or in-person. All 32 responding residents were interested in seeing the asynchronous curriculum continue. Conclusion EM residents value the addition of asynchronous learning to both in-person and virtual didactic curricula. Additionally, virtual conference was favored over in-person conference with regard to work/life balance, convenience, and overall preference. As social distancing restrictions continue to ease post-COVID-19 pandemic, EM residencies may consider adding or maintaining asynchronous or virtual components to their synchronous conference schedule as a means to support resident wellness.

Impact of the First Year of the COVID-19 Pandemic on Pediatric Emergency Department Attendance in a Tertiary Center in South Italy: An Interrupted Time-Series Analysis.

BACKGROUND: The evidence shows a reduction in pediatric emergency department (PED) flows during the early stages of the COVID-19 pandemic. Using interrupted time-series analysis, we evaluated the impact of different stages of the pandemic response on overall and cause-specific PED attendance at a tertiary hospital in south Italy. Our methods included evaluations of total visits, hospitalizations, accesses for critical illnesses and four etiological categories (transmissible and non-transmissible infectious diseases, trauma and mental-health) during March-December 2020, which were compared with analogous intervals from 2016 to 2019; the pandemic period was divided into three segments: the "first lockdown" (FL, 9 March-3 May), the "post-lockdown" (PL, 4 May-6 November) and the "second lockdown" (SL, 7 November-31 December). Our results showed that attendance dropped by a mean of 50.09% during the pandemic stages, while hospitalizations increased. Critical illnesses decreased during FL (incidence rate ratio -IRR- 0.37, 95% CI 0.13, 0.88) e SL (IRR 0.09, 95% CI 0.01, 0.74) and transmissible disease related visits reduced more markedly and persistently (FL: IRR 0.18, 95% CI 0.14, 0.24; PL: IRR 0.20, 95% CI 0.13, 0.31, SL: IRR 0.17, 95% CI 0.10, 0.29). Non-infectious diseases returned to pre-COVID-19 pandemic levels by PL. We concluded that that the results highlight the specific effect of the late 2020 containment measures on transmissible infectious diseases and their burden on pediatric emergency resources. This evidence can inform resource allocation and interventions to mitigate the impact of infectious diseases on pediatric populations and the health-care system.

Emergency Medicine

The coronavirus pandemic stretched healthcare resources and infrastructure worldwide. The Emergency Department (ED) is a crucial component in the frontline response to the pandemic. In this chapter, we discuss the logistical and operational challenges faced, the innovative solutions employed, and the lessons learned in our ED as we strived to overcome this unprecedented challenge. Whilst we will share much of what we learned, what we did, and what we believe was responsible for our many successes, at the same time, we are left with a sadness that our healthcare systems (and ‘our' could be applied locally to our community, nationally to our country, and globally to our planet) were simply not designed nor prepared to properly confront a pandemic. The number of patient deaths we witnessed still feels somewhat incomprehensible and scarring. We do, however, hope that our learnings may help inform decisions at other EDs, help prepare us for future crises, and, if nothing else, confers confidence in the ED's ability to overcome this pandemic. © SBH Health System 2022.

Development and evaluation of a virtual reality training for emergency treatment of shortness of breath based on frameworks for serious games.

Background: Virtual reality (VR) can offer an innovative approach to providing training in emergency situations, especially in times of COVID-19. There is no risk of infection, and the procedure is scalable and resource-efficient. Nevertheless, the challenges and problems that can arise in the development of VR training are often unclear or underestimated. As an example, we present the evaluation of the feasibility of development of a VR training session for the treatment of dyspnoea. This is based on frameworks for serious games, and provides lessons learned. We evaluate the VR training session with respect to usability, satisfaction, as well as perceived effectiveness and workload of participants. Methods: The VR training was developed using the established framework (Steps 1-4) for serious games of Verschueren et al. and Nicholson's RECIPE elements for meaningful gamification. Primary validation (Step 4) was performed at the University of Bern, Switzerland, in a pilot study without control group, with a convenience sample of medical students (n=16) and established measurement tools. Results: The theoretical frameworks permitted guided development of the VR training session. Validation gave a median System Usability Scale of 80 (IQR 77.5-85); for the User Satisfaction Evaluation Questionnaire, the median score was 27 (IQR 26-28). After the VR training, there was a significant gain in the participants' confidence in treating a dyspnoeic patient (median pre-training 2 (IQR 2-3) vs. post-training 3 (IQR 3-3), p=0.016).Lessons learned include the need for involving medical experts, medical educators and technical experts at an equivalent level during the entire development process. Peer-teaching guidance for VR training was feasible. Conclusion: The proposed frameworks can be valuable tools to guide the development and validation of scientifically founded VR training. The new VR training session is easy and satisfying to use and is effective - and is almost without motion sickness.

Artificial Intelligence in Emergency Medicine: Viewpoint of Current Applications and Foreseeable Opportunities and Challenges.

Emergency medicine and its services have reached a breaking point during the COVID-19 pandemic. This pandemic has highlighted the failures of a system that needs to be reconsidered, and novel approaches need to be considered. Artificial intelligence (AI) has matured to the point where it is poised to fundamentally transform health care, and applications within the emergency field are particularly promising. In this viewpoint, we first attempt to depict the landscape of AI-based applications currently in use in the daily emergency field. We review the existing AI systems; their algorithms; and their derivation, validation, and impact studies. We also propose future directions and perspectives. Second, we examine the ethics and risk specificities of the use of AI in the emergency field.

Higher SARS-CoV-2 detection of oropharyngeal compared with nasopharyngeal or saliva specimen for molecular testing: a multicentre randomised comparative accuracy study.

BACKGROUND: Testing is critical for detecting SARS-CoV-2 infection, but the best sampling method remains unclear. OBJECTIVES: To determine whether nasopharyngeal swab (NPS), oropharyngeal swab (OPS) or saliva specimen collection has the highest detection rate for SARS-CoV-2 molecular testing. METHODS: We conducted a randomised clinical trial at two COVID-19 outpatient test centres where NPS, OPS and saliva specimens were collected by healthcare workers in different orders for reverse transcriptase PCR testing. The SARS-CoV-2 detection rate was calculated as the number positive by a specific sampling method divided by the number in which any of the three sampling methods was positive. As secondary outcomes, test-related discomfort was measured with an 11-point numeric scale and cost-effectiveness was calculated. RESULTS: Among 23 102 adults completing the trial, 381 (1.65%) were SARS-CoV-2 positive. The SARS-CoV-2 detection rate was higher for OPSs, 78.7% (95% CI 74.3 to 82.7), compared with NPSs, 72.7% (95% CI 67.9 to 77.1) (p=0.049) and compared with saliva sampling, 61.9% (95% CI 56.9 to 66.8) (p<0.001). The discomfort score was highest for NPSs, at 5.76 (SD, 2.52), followed by OPSs, at 3.16 (SD 3.16) and saliva samples, at 1.03 (SD 18.8), p<0.001 between all measurements. Saliva specimens were associated with the lowest cost, and the incremental costs per detected SARS-CoV-2 infection for NPSs and OPSs were US$3258 and US$1832, respectively. CONCLUSIONS: OPSs were associated with higher SARS-CoV-2 detection and lower test-related discomfort than NPSs for SARS-CoV-2 testing. Saliva sampling had the lowest SARS-CoV-2 detection but was the least costly strategy for mass testing. TRIAL REGISTRATION NUMBER: NCT04715607.

Sensitivity and specificity of monocyte distribution width (MDW) in detecting patients with infection and sepsis in patients on sepsis pathway in the emergency department.

PURPOSE: Monocyte distribution width (MDW) is a biomarker for the early identification of sepsis. We assessed its accuracy in patients presenting with suspected sepsis in the emergency department (ED). METHODS: This was a single gate, single centre study in consecutive adults (≥ 18 years) admitted to the ED with suspected sepsis and clinical history compatible with infection, between 01 January and 31 December 2020 (n = 2570). RESULTS: The overall median MDW was 22.0 (IQR 19.3, 25.6). Using Sepsis-3 (qSOFA) to define sepsis, the Area Under Curve (AUC) for a receiver operator characteristic (ROC) relationship was 0.59 (95% CI 0.56, 0.61). Discrimination was similar using other clinical scores, and to that of C-reactive protein. At an MDW cutoff of 20.0, sensitivity was 0.76 (95% CI 0.73, 0.80) and specificity 0.35 (95% CI 0.33, 0.37) for Sepsis-3. MDW showed better performance to discriminate infection, with AUC 0.72 (95% CI 0.69, 0.75). At MDW 20.0, sensitivity for infection was 0.72 (95% CI 0.70, 0.74) and specificity 0.64 (95% CI 0.59, 0.70). A sensitivity analysis excluding coronavirus disease (COVID-19) admissions (n = 552) had no impact on the AUC. MDW distribution at admission was similar for bacteraemia and COVID-19. CONCLUSIONS: In this population of ED admissions with a strong clinical suspicion of sepsis, MDW had a performance to identify sepsis comparable to that of other commonly used biomarkers. In this setting, MDW could be a useful additional marker of infection.

A Novel Emr-Based Care Pathway for Nephrolithiasis: Development and 1 Year Utilization

INTRODUCTION AND OBJECTIVE: Patients with acute renal colic due to stones frequently visit the ED. With limited ED resources due to the COVID-19 pandemic, we developed a best practice management pathway within our electronic medical records (EMR) to provide consistent, expeditious and appropriate care for patients with nephrolithiasis. The objective of this study is to describe the development and 1 year outcomes of our EMR Care Pathway for nephrolithiasis. METHOD(S): Our hospital system is composed of many centers. To standardize best practice care, we convened a clinical consensus group, with key stakeholders in emergency medicine, urology, interventional and diagnostic radiology to develop a pathway for the initial work up and management of acute renal colic. AUA guidelines, current literature, and expert consensus across specialties were used to develop the pathway to guide work up and management. Risk assessment tools, and criteria for specific imaging modalities, lab work, and pain protocols were outlined. Criteria for routine discharge with follow-up, including pre-populated links for referrals, indications for urology consult, hospital admission and urgent decompression (stent versus nephrostomy tube) were provided. Data was gathered through the EMR analytics team and descriptive statistics were performed. RESULT(S): The Care Pathway was utilized 944 times from August 3, 2021-September 17, 2022 at 11 different hospitals or care centers (Table 1). Usage increased overtime (r2=0.77). The majority of usage was in the ED (892, 94.4%). A total of 194 providers utilized the Pathway with the majority being residents (64, 33.0%). The pathway included care of 505 unique patients, with 106 primary diagnosis key words triggering pathway use. 139 Urology referrals were placed through the pathway with 124 new 28 day prescriptions of tamsulosin. CONCLUSION(S): An EMR-integrated care pathway has been readily utilized in our system and may augment triage and best practice management of patients presenting with stone disease. Further studies are needed to understand the full impact on outcomes.

Knowledge, perceptions and preventive practices towards COVID-19 early in the outbreak among Jimma university medical center visitors, Southwest Ethiopia

Background Novel-coronavirus disease-2019 (COVID-19) is currently a pandemic and public health emergency of international concern, as avowed by the World Health Organization (WHO). Ethiopia has become one of the affected countries as of March 15, 2020. Objective This study aimed to assess the knowledge, perceptions, and practices among the Jimma University medical center (JUMC) visitors in Jimma town. Methods A cross-sectional study was conducted on 247 sampled visitors, from 20–24 March 2020. Consecutive sampling was used to recruit the participants. The study tools were adapted from WHO resources. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Descriptive statistics were used to describe the status of knowledge, perception, and practices. Logistic regression was executed to assess the predictors of dominant preventive practices. Results Of the 247 respondents, 205 (83.0%) knew the main clinical symptoms of COVID-19. 72.0% knew that older people who have chronic illnesses are at high risk of developing a severe form of COVID-19. About 95.1% knew that the COVID-19 virus spreads via respiratory droplets of infected people, while 77 (31.2%) of the respondents knew about the possibility of asymptomatic transmission. Only 15 (6.1%) knew that children and young adults had to involve preventive measures. Overall, 41.3% of the visitors had high knowledge. The majority, 170(68.8%), felt self-efficacious to controlling COVID-19. 207(83.3%) believed that COVID-19 is a stigmatized disease. Frequent hand washing (77.3%) and avoidance of shaking hands (53.8%) were the dominant practices. Knowledge status and self-efficacy (positively), older age, and unemployment (negatively) predicted hand washing and avoidance of handshaking. Conclusions The status of knowledge and desirable practices were not sufficient enough to combat this rapidly spreading virus. COVID-19 risk communication and public education efforts should focus on building an appropriate level of knowledge while enhancing the adoption of recommended self-care practices with special emphasis on high-risk audience segments.

42nd International Symposium on Intensive Care and Emergency Medicine

The proceedings contain 369 papers. The topics discussed include: effective FiO2 delivered by a new frugal CPAP system with low oxygen needs: from bench to clinical observations;effect of non invasive respiratory support on interstitial lung disease with acute respiratory failure: a systematic review and meta analysis;causes of mortality of severe COVID 19 patients receiving high flow oxygen therapy;patient ventilator interaction during noninvasive ventilation with helmet: a comparison between pressure support ventilation and the new neural pressure support (NPS) software;tidal volume measurement during non invasive respiratory support by helmet continuous flow CPAP is feasible and accurate in a bench model;delayed intubation with high flow nasal cannula in COVID: a comparison between a first and second pandemic wave;outcomes following application of high flow nasal cannula and non invasive ventilation during the second COVID 19 wave in Singapore;ventilator avoidance among critically ill COVID 19 patients with acute respiratory distress syndrome;and mortality rate, intensive care unit length of stay and time to orotracheal intubation of COVID 19 patients under different non invasive ventilatory therapies: retrospective cohort study.

SARS-CoV-2-related bronchiolitis: a multicentre international study.

BACKGROUND: Bronchiolitis is the main acute lower respiratory tract infection in infants. Data regarding SARS-CoV-2-related bronchiolitis are limited. OBJECTIVE: To describe the main clinical characteristics of infants with SARS-CoV-2-related bronchiolitis in comparison with infants with bronchiolitis associated with other viruses. SETTING, PATIENTS, INTERVENTIONS: A multicentre retrospective study was conducted in 22 paediatric emergency departments (PED) in Europe and Israel. Infants diagnosed with bronchiolitis, who had a test for SARS-CoV-2 and were kept in clinical observation in the PED or admitted to hospital from 1 May 2021 to 28 February 2022 were considered eligible for participation. Demographic and clinical data, diagnostic tests, treatments and outcomes were collected. MAIN OUTCOME MEASURES: The main outcome was the need for respiratory support in infants testing positive for SARS-CoV-2 compared with infants testing negative. RESULTS: 2004 infants with bronchiolitis were enrolled. Of these, 95 (4.7%) tested positive for SARS-CoV-2. Median age, gender, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative infants. Human metapneumovirus and respiratory syncytial virus were the viruses most frequently detected in the group of infants negative for SARS-CoV-2.Infants testing positive for SARS-CoV-2 received oxygen supplementation less frequently compared with SARS-CoV-2-negative patients, 37 (39%) vs 1076 (56.4%), p=0.001, OR 0.49 (95% CI 0.32 to 0.75). They received less ventilatory support: 12 (12.6%) high flow nasal cannulae vs 468 (24.5%), p=0.01; 1 (1.0%) continuous positive airway pressure vs 125 (6.6%), p=0.03, OR 0.48 (95% CI 0.27 to 0.85). CONCLUSIONS: SARS-CoV-2 rarely causes bronchiolitis in infants. SARS-CoV-2-related bronchiolitis mostly has a mild clinical course.