European Journal of Emergency Medicine 

About: European Journal of Emergency Medicine is an academic journal published by Lippincott Williams & Wilkins. The journal publishes majorly in the area(s): Emergency department & Medicine. It has an ISSN identifier of 0969-9546. Over the lifetime, 2569 publications have been published receiving 35475 citations. The journal is also known as: Journal of the European Society for Emergency Medicine & Eur. J. Emerg. Med..

The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope.

Abstract: OBJECTIVES The objectives of the present study were to examine the degree and the sources of mental distress and the coping strategies adopted by healthcare workers (HCW) of emergency departments (ED) in Hong Kong during the outbreak of severe acute respiratory syndrome (SARS). METHODS Questionnaires were sent to all doctors, nurses and healthcare assistants (HCA) working in the ED of all public hospitals. The overall degree of mental distress was measured by a single-item 11-point Likert scale. The source of distress was measured by an 18-item questionnaire, which was designed based on the experience of clinical psychologist colleagues providing counselling to staff taking care of SARS patients. The Brief Cope questionnaire was used to study coping strategies adopted by staff. RESULTS A total of 1260 questionnaires were sent out and the response rate was approximately 37%. The mean overall distress level was 6.19 out of a 10-point scale. The mean overall distress levels for doctors, nurses and HCA were 5.91, 6.52 and 5.44, respectively (F(2,420)=6.47, P<0.005). The overall distress level for nurses was significantly higher than for HCA (P<0.005) but not doctors. The overall distress level was highly and significantly correlated with the six sources of distress: vulnerability/loss of control (r=0.68); health of self (r=0.62); spread of virus (r=0.60); health of family and others (r=0.59); changes in work (r=0.46); being isolated (r=0.45). The scores for nurses were significantly higher than for doctors in terms of the six sources of distress (all P values <0.01). HCA were significantly higher than doctors (but not nurses) in worrying about their family's and others' health (P<0.05). In terms of coping strategies, doctors were significantly more likely than nurses and HCA to use planning (P<0.05 and <0.01 respectively); nurses were significantly more likely than doctors to use behavioural disengagement (P<0.01); whereas HCA were significantly more likely than doctors to use self distractions (P<0.05). CONCLUSIONS SARS had caused a significant level of distress among ED staff. The distress level was highest for nurses, followed by doctors and HCA. The three most important variables that could account for the distress level were loss of control/vulnerability, fear for self-health and spread of the virus. Overall, the more frequently adopted coping strategies were acceptance, active coping, and positive framing.

Decreased health care quality associated with emergency department overcrowding

Abstract: The objective of this study was to assess the influence of overcrowding on health care quality provided by emergency departments (ED). The study was carried out in an urban, university tertiary care hospital. All patients seen at the internal medicine unit (IMU) of the ED who returned during the following 72 hours, and those who died in the ED rooms were included in the study. During a consecutive period of 2 years (104 weeks), we prospectively quantified the number of weekly visits, revisits and deaths. We calculated revisit and mortality rates (in respect of percentage of all visited patients) for each week. Correlation between the number of weekly visits, and revisit and mortality rates was assessed using a simple linear regression model. We consigned 81,301 visits, 1137 revisits and 648 deaths; mean (+/- SD) number of weekly visits, revisits and deaths were 782 (68), 10.93 (3.97) and 6.23 (3.04) respectively; weekly revisit rate was 1.40% (0.48%) and weekly mortality rate was 0.79% (0.36%). We observed a significant, positive correlation between mortality rates and weekly number of visits (p = 0.01). Although a similar trend was also found for revisit rates, such an increase did not reach statistical significance (p = 0.06). It is concluded that since revisit and mortality rates constitute good health care quality markers, present data demonstrate that ED overcrowding implies a decrease in the health care quality provided by it.

Chief complaints in medical emergencies: do they relate to underlying disease and outcome? The Charité Emergency Medicine Study (CHARITEM).

Abstract: Objectives: To evaluate the relationship between chief complaints and their underlying diseases and outcome in medical emergency departments (EDs). Methods: All 34 333 patients who attended two of the EDs of the Charite Berlin over a 1-year period were included in the analysis. Data were retrieved from the hospital information system. For study purposes, the chief complaint (chest pain, dyspnoea, abdominal pain, headache or 'none of these symptoms') was prospectively documented in an electronic file by the ED-physician. Documentation was mandatory. Results: The majority of patients (66%) presented with 'none of these symptoms', 11.5% with chest pain, 11.1% with abdominal pain and 7.4% with dyspnoea. In total, 39.4% of all patients were admitted to the hospital. The leading diagnosis was acute coronary syndrome (50.7%) for chest pain in-patients and chronic obstructive pulmonary disease (16.5%) and heart failure (16.1%) for in-patients with dyspnoea. The causes of abdominal pain in in-patients were of diverse gastrointestinal origin (47.2%). In-hospital mortality of in-patients was 4.7%. Patients with chest pain had significantly lower in-hospital mortality (0.9%) than patients with dyspnoea (9.4%) and abdominal pain (5.1%). Conclusion: The majority of emergency patients lack diagnosis-specific symptoms. Chief complaints help preselect patients but must not be mistaken as disease specific. Mortality largely differs depending on the chief complaint. In chest pain patients, standardized processes may be one factor that explains the low mortality in this group.

Infodemic and the spread of fake news in the COVID-19-era.

Abstract: Saturday 14 March, while the pandemic due to SARSCoV-2 spread widely in Europe, the French Minister of Health, Oliver Véran tweeted: ‘The intake of anti-inflammatory drugs (ibuprofen, cortisone, ...) could be a factor in worsening the infection. If you have a fever, take acetaminophen. If you are already taking anti-inflammatory drugs or in doubt, ask your doctor for advice’ [1]. As the hours go by, the tweet garnered the consent of more and more ‘followers’, and, 3 days later, the ‘re-tweets’ were over 40 000. The University Hospital of Vaud in Lausanne – among others – considered the news as authentic and correct, so claims: ‘For the current state of knowledge, the use of anti-inflammatory drugs (ibuprofen, ketoprofen, naproxen, diclofenac, etc.) is not recommended in case of influenza-like illness possibly caused by COVID-19. Paracetamol is recommended in the event of fever requiring treatment’. In the transmission of the news, one of the ‘accused’ classes of drugs was exonerated (e.g. any reference to cortisone disappeared). At the same time, the preference given to paracetamol became quite a strong recommendation [2]. The British Medical Journal also felt compelled to relaunch the news, reporting some expert opinions on this matter [3].