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NIHR Signal Closing five emergency departments not linked with increased hospital admissions, though ambulance call-outs increased
Closure of five small emergency departments in England was not associated with change in the number of hospital admissions, urgent care attendances or deaths among the local populations. However, ambulance call-outs increased by 14% relative to comparison areas, with a four-minute increase in the time to reach a hospital with an emergency department. Emergency departments continue to be under high pressure, while staff shortages increase patient safety concerns. One option is to close smaller s...
NIHR Signal Negative pressure dressings are no better than standard dressings for open fractures
Negative pressure wound dressings are neither more nor less effective than standard wound dressings for severe open fractures of the lower leg. Any difference between groups was neither clinically important nor statistically significant. The outcomes included self-rated disability at one year, quality of life and deep surgical site infections at one month which occurred in around 7-8% in each group. Open fractures of the leg, where the broken bone is exposed by the original injury or has burst ...
NIHR Signal Non-urgent attendances to emergency departments are more common among younger adults
Adults aged 16 to 44 years are more likely to attend emergency departments for non-urgent presentations than older adults. They were more than three times more likely to present for non-urgent reasons than those over 65 years.Non-urgent attendances are also more common during out-of-hours periods, especially at night. Emergency departments are consistently under high pressure with long waiting times. Understanding the characteristics of non-urgent attendances that could be managed in the commun...
NIHR Signal The proportion of patients not transported to emergency departments after an ambulance is called varies across the country
Nationally, around half of people making urgent calls for ambulance services are not then taken to hospital. This is called the non-conveyancing rate. But this rate varies two-fold from region to region. There are differences too in what happens to patients not going to hospital. Some places discharge more patients at the scene, offer telephone advice or send to other non-emergency health services like walk-in centres. This NIHR mixed methods study used observation and analysis of routine ambul...
NIHR Signal Adrenaline can restart the heart but is no good for the brain
Treating cardiac arrests with adrenaline during resuscitation by paramedics slightly increases survival compared with placebo. Though adrenaline initially helped restore circulation in a third of cases, 3.2% of people survived to 30 days compared to 2.4% of people in the placebo group. Severe brain damage was nearly twice as likely in those who survived after adrenaline injections. Cardiac arrest occurs when the heart no longer pumps blood around the body, usually due to an irregular heart rhyt...
NIHR Signal Lorazepam confirmed as first-line treatment for stopping prolonged seizures in children
Intravenous lorazepam is as effective as intravenous diazepam for stopping children’s tonic-clonic seizures in hospital. Lorazepam also results in fewer breathing problems than diazepam. Giving antiepileptic drugs intravenously generally stops seizures more quickly than giving the drugs buccally (in the cheek), intranasally (in the nose) or rectally. However, this effect can be cancelled out if administering the drug into the veins takes too long. Two of the 18 included trials were carrie...
NIHR Signal Hypertonic saline as effective as normal saline for trauma patients
Solutions more concentrated than normal, such as hypertonic saline, are as good as those more usually given to trauma patients with severe blood loss. Survival to hospital discharge was the same in patients treated before arrival at the hospital with either type of fluid. There are around 20,000 cases of major trauma per year in England. Outcomes for patients have improved in the UK over the last 25 years, but as there is still room for improvement this review sought to find evidence that suppo...
NIHR Signal Imaging is the only way to diagnose blood clots in pregnancy
No blood test can accurately tell if a pregnant or recently pregnant woman has a blood clot. All pregnant women with a suspected clot should continue to have imaging investigations as per current UK guidelines. This NIHR-funded study recruited 328 pregnant or postpartum women with a suspected blood clot in the lung (pulmonary embolism) or leg (deep vein thrombosis). They had a blood test to measure the levels of 13 biomarkers, such as the D-dimer, to see if they could rule a blood clot in or ou...
NIHR Signal A frailty checklist was completed in only a quarter of older people at hospital admission
Frailsafe is a simple safety checklist offering the opportunity to improve safety and quality of care for frail older people while in hospital. It aims to increase key clinical assessments or practices on things like risk of falls, mobility and delirium, and to facilitate communication between staff. However, the relatively low completion rate highlights the need to understand how this approach can be better embedded in the complex care that is typical of services provided for older people. Com...
NIHR Signal Introducing a primary care risk prediction tool did not reduce emergency admissions
Predicting emergency admissions paradoxically increased hospital admissions from primary care across all risk groups by about 3% overall. The Predictive Risk Stratification Model (PRISM) was evaluated in a trial in general practices in Wales, and there is little evidence it benefits patients by reducing deaths or improving quality of life either. The number of people living to older age with chronic health conditions is growing. Various risk stratification tools have been introduced across the...
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