A profile of sports hand injuries in an accident and emergency department.

OBJECTIVE: To establish a profile of sports hand injuries requiring treatment in an urban accident and emergency (A&E) department, and to determine the extent to which these injuries resulted in morbidity. METHODS: A one year prospective observational study at the Royal Victoria Infirmary, Newcastle upon Tyne. All patients presenting to the A&E department between 29 July 1995 and 28 July 1996 with a hand injury sustained during sporting activity and who received follow up by A&E or plastic surgery units were enrolled. Patients were contacted by telephone or post at median of four months after injury (range two to 13) for their assessment of the outcome. RESULTS: 262 cases were enrolled into the study. The median age for males was 21 years (range 7 to 55) and for females 16 (range 9 to 40). Follow up data were obtained by telephone in 206 (79%), and by letter in a further 26 (10%). Fractures were the commonest injury (68%), followed by soft tissue injuries (20%) and dislocations (11%). The thumb was the site affected most commonly overall, and in 10 of 17 ski related injuries; next most frequent sites were little and ring fingers. Males sustained 79% of the injuries, and 54% of these occurred during football. Netball/basketball caused 63% of female injuries. Follow up indicated that mild impairment in terms of pain, stiffness, or deformity was common (45%), while the incidence of moderate pain or serious problems was 11%. CONCLUSIONS: Sporting injuries to the hand commonly require treatment in the A&E department. Telephone/postal follow up of such injuries indicates that significant short term and longer term impairment of function may result. Suitable target areas for injury prevention are secondary schools, football (in males), and netball/basketball.

Satisfaction with the accident and emergency department--a postal survey of general practitioners' views.

OBJECTIVE: To survey general practitioners' opinions of the quality of care offered by an urban accident and emergency (A&E) department. METHODS: A postal questionnaire was used. The questionnaire addressed issues of patient treatment, communications between hospital and GPs, and the GPs' perceptions of patient satisfaction. Questions required graded responses. Response rate was 57% (91 of 160 GPs mailed). RESULTS: 96% and 91% of responders respectively were satisfied with patient assessment and treatment, and 70% were satisfied with the explanation given to the patient. Problems were highlighted in communications between the department and GPs. 68% reported that adult patients always/usually gave their practice a hand written letter detailing their initial A&E attendance. Concerns were expressed about the content, illegibility, and inconvenience of this form. 42% of GPs reported never/rarely receiving a typed summary of patients discharged from the A&E review clinic. 28% of GPs would have appreciated a telephone call from the department on occasions. The areas of most patient dissatisfaction were perceived by GPs as: waiting time (67%), communication (19%), staff attitude (7%), and actual treatment (7%). CONCLUSIONS: A postal survey of local GPs can give valuable information about the quality of care provided by a hospital department. Overall GP satisfaction with the service was high, but there are concerns about aspects of written and telephone communications between the department and GPs, which can be addressed.

Are schools safer for children than public places?

OBJECTIVE: To investigate the frequency and severity of accidents to children in schools. METHODS: Retrospective analysis of accidents occurring in school over a six month period and resulting in attendance at an accident and emergency department. Comparison was made with accidents occurring in public places, RESULTS: During the study period there were 127 school and 251 public place accidents causing fractures or dislocations requiring hospital treatment in 3-16 year old children; 22.4% (127/567) of all injuries at school resulted in fractures or dislocations, as opposed to 20.8% (251/1197) of those sustained in public places. CONCLUSIONS: Injuries at school are a cause for concern as they occur in a supervised environment and this should be the target of accident prevention measures.

A critical look at accident and emergency review clinics.

The reasons for and appropriateness of referral of patients after initial visit to accident & emergency (A&E) follow-up clinics by the A&E doctors were prospectively analysed in 500 patients. Fifteen per cent of patients were judged to have been inappropriately referred. Two main reasons for referral were the need for further treatment and uncertainty about diagnosis and management. The implications of reductions of A&E clinic attendances are discussed.

Architectural glass injuries: a case for effective prevention.

Nine hundred and eighteen patients with glass-related injuries were studied retrospectively. Forty per cent of the injuries were due to architectural glass, which resulted in more severe injuries, required more complicated plastic/surgical repairs and needed longer treatment time. It also produced more disabilities in all age groups. These injuries can be prevented by the use of safety glass in residential buildings, a usage which should be legally enforced as in the USA.

The discharge of elderly patients from an accident and emergency department: functional changes and risk of readmission.

Four hundred and fifty patients aged 75 years or older were followed up after discharge from an accident and emergency department. Forty-three per cent of all patients experienced some loss of functional independence. A small number, 5.6%, were readmitted to hospital within 14 days. This group were significantly less able to perform certain activities of daily living than those not readmitted. Attention to functional assessment by casualty staff may help to prevent readmission to hospital of this frail elderly group of patients.

Accidental poisoning with dapsone.

A patient was admitted with accidental poisoning, after ingesting dapsone (100 mg) 30 tablets with deep cyanosis and tachycrodia. Treatment with ascorbic acid 500 mg orally every 6 hours lead to the recovery.

Management of partial skin thickness burn wounds with Inadine dressings.

In a prospective randomized trial, 213 consecutive patients with less than 10 per cent BSA partial thickness burns were treated as outpatients with either Bactigras (n = 102) (tulle gras dressing with 0.5 per cent Chlorhexidine Acetate B.P.) or Inadine (n = 111) (rayon dressing with 10 per cent povidone iodine ointment). Inadine caused less bleeding on dressing removal but not significantly less. Inadine treated patients required less analgesia, a reduced treatment time, a smaller number of hospital visits and less time off work/normal activities (P = 0.01). Inadine should be more widely used in the management of partial thickness burn wounds.

A comparative study of the injury profile of the elderly patients in an accident and emergency department.

Four hundred and fifteen patients aged over 75 were compared with a comparable group of 351 below 75 adult attenders. The over 75s were referred by 999 call and general practitioners more frequently. They also suffered more fractures and multiple injuries. The implications of these different injury patterns for the accident service are discussed.

Computer-unaided diagnosis of acute abdominal pain in an accident and emergency department.

The initial accident and emergency and final in-patient diagnoses of 200 patients with acute abdominal pain made without computer aid or structured data sheet were compared. Sixty-five per cent were correctly diagnosed and 5% had normal laparotomies. These results compare favourably with those obtained using computer aid and structured history-taking forms. It is suggested that the spotlight should be on the training and experience of doctors making the initial diagnosis rather than on computer aid.

Treatment of fractures of the hallux with a simple splint.

Three hundred patients with fractures of the hallux were randomly treated with either a short plantar splint or spica strapping in a prospective crossover trial. The results showed that more patients preferred the splint and the mean pain score was lower in the group treated with a splint (P less than 0.001). It is concluded that the splint is a cheap and effective method of treatment of fractures of the hallux.

Use of sterile gloves in the management of sutured hand wounds in the A&E department.

In a single-blind, controlled, prospective trial of 242 sutured wounds of the hand in the A&E department there was increased late purulent infection in those treated without gloves. This difference is statistically significant. We recommend wearing of sterile gloves to suture all wounds in A&E departments.