Emergency department admissions Kumasi, Ghana: Prevalence of alcohol and substance use, and associated trauma.

Introduction: Alcohol and substance use (ASU) are significant contributors to global morbidity, mortality, and health resource utilization. We sought to describe the frequency of ASU use among adult injured patients presenting to the Komfo Anokye Teaching Hospital Emergency Department (KATH ED) and to describe injury mechanism and site among injured patients.

Methods: A cross-sectional study was carried out for six months in 2016 involving all trauma patients and altered mental status patients presenting to the ED in Kumasi, Ghana.

The preventability of trauma-related death at a tertiary hospital in Ghana: a multidisciplinary panel review approach.

Introduction: The purpose of the study was to determine the preventable trauma-related death rate (PDR) at Komfo Anokye Teaching Hospital in Kumasi, Ghana three years after initiation of an Emergency Medicine (EM) residency.

Method: This was a retrospective, cross-sectional study. A multidisciplinary panel of physicians completed a structured implicit review of clinical data for trauma patients who died during the period 2011 to 2012.

Harmful alcohol use among injured adult patients presenting to a Ghanaian emergency department.

We performed a nested convenience sample survey of harmful alcohol use among injured patients aged 18 years and older treated in the Komfo Anokye Teaching Hospital (Kumasi, Ghana) emergency department (ED). Data from the Alcohol Use Disorder Identification Test, alcohol breath or saliva tests, patient demographics and injury characteristics were collected from an administered survey and medical chart review. A total of 403 subjects were surveyed, and 107 (27%; 95% CI 22 to 31) reported harmful alcohol use.

Diagnostic accuracy of the Kampala Trauma Score using estimated Abbreviated Injury Scale scores and physician opinion.

Background: The Kampala Trauma Score (KTS) has been proposed as a triage tool for use in low- and middle-income countries (LMICs). This study aimed to examine the diagnostic accuracy of KTS in predicting emergency department outcomes using timely injury estimation with Abbreviated Injury Scale (AIS) score and physician opinion to calculate KTS scores.

Methods: This was a diagnostic accuracy study of KTS among injured patients presenting to Komfo Anokye Teaching Hospital A&E, Ghana.

Frequency of Alcohol Use Among Injured Adult Patients Presenting to a Ghanaian Emergency Department.

Study Objective: Injuries are the cause of almost 6 million deaths annually worldwide, with 15% to 20% alcohol associated. The frequency of alcohol-associated injury varies among countries and is unknown in Ghana. We determined the frequency of positive alcohol test results among injured adults in a Ghanaian emergency department (ED).

Analysis of the Nature of IRB Contingencies Required for Informed Consent Document Approval.

The University of Michigan Human Research Protection Program formed a six-member committee to analyze the nature of Institutional Review Board (IRB) staff and board contingencies for the approval of informed consent documents. Of the 100 studies examined, 87% had one or more informed consent contingencies. "Omissions" in documentation (40%) and "better clarity" (24%) accounted for the majority, while "word-smithing" accounted for only 10%.

GLass intact Assures Safe cervical Spine protocol.

Background: Selective cervical spine immobilization performed by Emergency Medical Services (EMS) is being utilized with increasing frequency. These protocols, although very sensitive, still include subjective data such as "mild cervical discomfort." The aim of this study is to create an objective clinical decision rule that would enhance the selective approach for cervical spine immobilization in patients aged 16-60 years.

An economic toolkit for identifying the cost of emergency medical services (EMS) systems: detailed methodology of the EMS Cost Analysis Project (EMSCAP).

Calculating the cost of an emergency medical services (EMS) system using a standardized method is important for determining the value of EMS. This article describes the development of a methodology for calculating the cost of an EMS system to its community. This includes a tool for calculating the cost of EMS (the "cost workbook") and detailed directions for determining cost (the "cost guide").

Risk adjustment measures and outcome measures for prehospital trauma research: recommendations from the emergency medical services outcomes project (EMSOP).

Objectives: The objectives were to conduct a comprehensive, systematic review of the literature for risk adjustment measures (RAMs) and outcome measures (OMs) for prehospital trauma research and to use a structured expert panel process to recommend measures for use in future emergency medical services (EMS) trauma outcomes research.

Methods: A systematic literature search and review was performed identifying the published studies evaluating RAMs and OMs for prehospital injury research. An explicit structured review of all articles pertaining to each measure was conducted using the previously established methodology developed by the Canadian Physiotherapy Association ("Physical Rehabilitation Outcome Measures").

A survey of emergency physicians' fear of malpractice and its association with the decision to order computed tomography scans for children with minor head trauma.

Objective: The objective of the study was to determine whether fear of malpractice is associated with emergency physicians' decision to order head computed tomography (CT) in 3 age-specific scenarios of pediatric minor head trauma. We hypothesized that physicians with higher fear of malpractice scores will be more likely to order head CT scans.

Methods: Board-eligible/board-certified members of the Michigan College of Emergency Physicians were sent a 2-part survey consisting of case scenarios and demographic questions.

Postconcussive symptoms and neurocognitive function after mild traumatic brain injury in children.

Objectives: We describe children's postconcussive symptoms (PCSs), neurocognitive function, and recovery during 4 to 5 weeks after mild traumatic brain injury (MTBI) and compare performance and recovery with those of injured control group participants without MTBIs.

Methods: A prospective, longitudinal, observational study was performed with a convenience sample from a tertiary care, pediatric emergency department. Participants were children 10 to 17 years of age who were treated in the emergency department and discharged.

Characteristics of a mild head injury subgroup with extreme, persisting distress on the Rivermead Postconcussion Symptoms questionnaire.

Unlabelled: Kirsch NL, de Leon MB, Maio RF, Millis SR, Tan-Schriner CU, Frederiksen S. Characteristics of a mild head injury subgroup with extreme, persisting distress on the Rivermead Postconcussion Symptoms Questionnaire.

Objective: To examine baseline variables and identify characteristics of participants with extremely high reports of symptoms (ie, outliers) 12 months after mild head injury (MHI).

Baseline predictors of fatigue 1 year after mild head injury.

Objective: To compare reports of fatigue 12 months after minor trauma by participants with mild head injury (MHI) with those with other injury, and identify injury and baseline predictors of fatigue.

Design: An inception cohort study of participants with MHI and other nonhead injuries recruited from and interviewed at the emergency department (ED), with a follow-up telephone interview at 12 months.

Setting: Level II community hospital ED.

Health status, not head injury, predicts concussion symptoms after minor injury.

Objective: Postconcussion (PC) syndrome etiology remains poorly understood. We sought to examine predictors of persistent PC symptoms after minor injury.

Methods: Health status, symptom, and injury information were obtained on a sample of patients presenting to the emergency department after minor injury.

Caregiver adherence to follow-up after an emergency department visit for common pediatric illnesses: Impact on future ED use.

Background: Access to primary care is often a problem for children living in urban areas and the rate of emergency department (ED) use can be high. For acute childhood illnesses, primary care follow-up is often recommended to prevent subsequent ED visits.

Methods: We conducted an observational study of 455 children with common childhood illnesses, between 6 weeks and 8 years of age, presenting to 1 of 3 EDs, and discharged to the community.

One-year medical outcomes and emergency department recidivism after emergency department observation for cocaine-associated chest pain.

Study Objective: Chest pain is the most common complaint among cocaine users who present to the emergency department (ED) seeking care, and many hospital resources are applied to stratify cocaine users in regard to future cardiac morbidity and mortality. Little is known about the longitudinal cardiac and noncardiac medical outcomes of cocaine users who have been stratified to an ED observation period after their ED visit. We examine 1-year cardiac outcomes in a low- to intermediate-risk sample of patients with cocaine-associated chest pain in an urban ED, as well as examine ED recidivism at 1 year for cardiac and noncardiac complaints.

Postmortem computed tomography as an adjunct to autopsy for analyzing fatal motor vehicle crash injuries: results of a pilot study.

Background: Detailed fatal injury data after fatal motor vehicle crashes (MVC) are necessary to improve occupant safety and promote injury prevention. Autopsy remains the principle source of detailed fatal injury data. However, procedure rates are declining because of a range of technical, ethical, and religious concerns.

Predictors of violence following Emergency Department visit for cocaine-related chest pain.

This study examined 1-year violence outcomes among non-injured patients treated in the Emergency Department (ED) for cocaine-related chest pain. An urban Level I ED required patients with chest pain (age 60 and younger) provide a urine sample for cocaine testing. Cocaine-positive consenting patients (n=219) were interviewed in the ED; 80% completed follow-up interviews over 12-months (n=174; 59% male, 79% African-American, mean age=38.

Internet referrals for adolescent violence prevention: an innovative mechanism for inner-city emergency departments.

Internet referrals provide a potential solution to limited staff time in emergency departments for health education. One hundred fifteen adolescents were surveyed and referred to a violence prevention website; 22% logged on the website. Although this study bears replication, Internet referral may be a low-intensity intervention that could compliment other violence prevention strategies among adolescents.

An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization.

Objective: Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices.

Methods: ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.

Comparison of teen driver fatality rates by vehicle type in the United States.

Objectives: To compare national fatality rates for teen drivers by vehicle type.

Methods: Fatality rates were calculated for 16- to 19-year-old drivers by vehicle type using data from the Fatal Analysis Reporting System (1999-2003) and estimates of miles driven from the National Household Transportation Survey (2001). Relative fatality risks for teen drivers of sports utility vehicles (SUVs) and pickups were calculated using passenger cars as a reference.

Past-year violence typologies among patients with cocaine-related chest pain.

This study examines a consecutive cohort of patients (n = 219) presenting to an urban Emergency Department (ED) for cocaine-related chest pain (June 2002 to February 2005). Patients were interviewed regarding violence, substance use, and psychosocial factors. Significant markers of violence were increases in: past-year medical service use, binge drinking, marijuana use, cocaine diagnosis, but not cocaine use days.