Prospective Validation of the Ottawa 3DY Scale by Geriatric Emergency Management Nurses to Identify Impaired Cognition in Older Emergency Department Patients.

STUDY OBJECTIVE: Assessment of older emergency department (ED) patients with cognitive impairment is challenging because few tools exist that can be quickly administered by front-line practitioners. Our objective is to validate the Ottawa 3DY Scale, a 4-question screening tool for cognitive impairment, in older ED patients and compare its performance with that of the Animal Fluency Test. METHODS: We conducted a prospective cohort study in 2 EDs and enrolled a convenience sample of patients aged 75 years or older with no history of cognitive impairment. Eligible patients were assessed by geriatric emergency management nurses who administered the Mini-Mental State Examination, ordered with the Ottawa 3DY Scale questions first, followed by the Animal Fluency Test. Mini-Mental State Examination score less than 25 was our criterion standard for cognitive impairment. RESULTS: Study patients (N=238) had a mean age of 81.9 years and were 60.1% women, and 26.5% were admitted to the hospital. The Ottawa 3DY Scale and Mini-Mental State Examination were in agreement for 75.6% of cases, with a sensitivity of 93.8% (95% confidence interval [CI] 77.8% to 98.9%) and specificity of 72.8% (95% CI 66.1% to 78.7%). The Animal Fluency Test score less than 15 and Mini-Mental State Examination score were in agreement for 46.2% of cases, with sensitivity 90.6% (95% CI 73.8% to 97.5%) and specificity 39.3% (95% CI 32.7% to 46.4%). CONCLUSION: Both the Ottawa 3DY Scale and the Animal Fluency Test demonstrated excellent sensitivity versus the Mini-Mental State Examination; however, the Animal Fluency Test exhibited poor specificity. The Ottawa 3DY Scale is an effective tool to screen for cognitive impairment in older ED patients, and its use may facilitate improved care in this vulnerable population.

Survey of current injury prevention practices by registered nurses in the emergency department.

INTRODUCTION: It has been shown that a vast majority of injured patients who seek treatment in emergency departments are seen and released. The events resulting in the individuals seeking treatment may have been preventable and some of the time spent in an emergency department could be used for injury prevention (IP) education. This study sought to determine current IP practices of registered nurses working in an emergency department, to discover whether or not they believed IP was important, and to identify perceived obstacles for incorporating IP education into clinical practice. METHODS: A convenience sample of 150 registered nurses working in the emergency departments of an adult level 1 trauma centre in Ontario, Canada was used. A descriptive survey composed of 10 questions was used. Data analysis was completed using SPSS Version 11.0. RESULTS: Findings suggest current IP strategies are varied, and implemented inconsistently. Evidence indicates educating patients about IP is an important part of the emergency nurse role. However, time, education, and resources were recognized obstacles to implementation. DISCUSSION: A better understanding of registered nurses' current IP practices will guide the development and implementation of a future adult focused injury prevention program for ED patients.

The experience of trauma resuscitation in the emergency department: themes from seven patients.

PURPOSE: Little is known about the patients' experience of trauma resuscitation in the emergency department. Therefore, the purpose of this study was to determine (1) patients' perspectives of the experience of trauma resuscitation in the emergency department; (2) if patients have perceptions of vulnerability during trauma resuscitation in the emergency department; and (3) if there are factors that influence the patients' experience. METHODS: A qualitative study of 7 patients using interpretive phenomenology was conducted in a Level I lead trauma hospital in Ontario, Canada. Inclusion criteria included age >/=18 years; trauma code initiated in the emergency department; Glasgow Coma Scale score >/=13; Revised Trauma Score >/=10; and physically and cognitively capable of participating in an interview in English. The sample included 4 men and 3 women. One-on-one semistructured tape-recorded interviews were conducted on the in-patient Trauma Unit between day 2 and 7 after trauma resuscitation. Follow-up interviews were conducted 7 to 12 months after the initial interview. RESULTS: Four themes were revealed in the data analysis: "I remember," "I was scared," "I felt safe," and "I will be okay." The findings revealed that initial perceptions of vulnerability subsided as a sense of feeling safe became prominent. System factors, such as a clearly identifiable trauma team leader, and caring behaviors, such as touch and tone of voice, were important and contributed to the overall belief that it was a positive experience. CONCLUSION: Both system factors and nursing interventions were important in contributing to the patients' feelings of being safe during trauma resuscitation in the emergency department. The fact that pain was felt or that family was not present, for example, seemed less important to patients than the perception that they were in capable hands and believed they were "safe."

Isolated blunt splenic injury: do we transfuse more in an attempt to operate less?

OBJECTIVE: To determine if blood transfusion requirements in patients with isolated blunt splenic injury (BSI) are greater if they are managed nonoperatively, we did a retrospective case study of patients with isolated BSI who were seen at a Canadian university teaching hospital over a 10-year period. METHOD: Data such as number of units of packed erythrocytes transfused and mortality in the 75 patients with isolated BSI seen from 1992 to 2002 were separated into operative and nonoperative management groups. RESULTS: In the operative management group (n = 10), patients received more transfused erythrocytes (3.0 v. 0.7 units), and a higher proportion of patients were transfused (80% v. 20%). There were no deaths in either group. CONCLUSION: In the management of isolated BSI, initial nonoperative management does not increase patients' requirements for blood transfusion.