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Biomedical subjects

C H Dearden

Publications and source records attributed to C H Dearden.

14 recordsLinked to original sources
PubMed1999

Plastic bullet injuries in Northern Ireland: experiences during a week of civil disturbance.

BACKGROUND: Plastic bullets were introduced to Northern Ireland for riot-control purposes in 1973. Their use has been controversial, with a number of fatalities. In the week beginning July 7, 1996, some 8,000 plastic bullets were fired during widespread rioting. METHODS: Details of injuries attributed to plastic bullets were obtained retrospectively from patient notes for the period July 8 to 14, 1996, in six hospitals. A total of 172 injuries in 155 patients were recorded. RESULTS: Nineteen percent of injuries were to the face/head/neck, 20% were to the chest or abdomen, and 61% were to the limbs. Abbreviated Injury Scale scores ranged from I to 3. Forty-two patients were admitted for hospitalization, three to intensive care units. No fatalities occurred. CONCLUSION: Plastic bullet impact to the abdomen or above may cause life-threatening injuries. Below this site, major trauma is unlikely.

Abbreviated Injury Scale↗
PubMed1999

Markers for domestic violence in women.

OBJECTIVE: To determine injury patterns and characteristics specific to domestic violence in women who present to the accident and emergency (A&E) department. DESIGN: A retrospective case note review of all female assaults over a one year period. The subjects were women who disclosed that their injuries were due to assaults by either a current or a previous male partner. Controls were female assault victims not injured by domestic violence. SETTING: A medium sized urban A&E department. RESULTS: There were 500 female assaults out of 48,169 new attendances. Domestic violence was disclosed in 103 cases. The following features were significantly associated with domestic violence in women: multiple injuries (p < 0.001) (especially to the head and arms), fractures (p < 0.05), loss of consciousness (p < 0.05), abdominal injuries (p < 0.05), pregnancy (p = 0.01), injury occurring on "stairs" (p = 0.01), and general practitioner referral (p < 0.01). CONCLUSIONS: Women who have been assaulted are more likely to have been injured during domestic violence if they sustain multiple injuries (including fractures), abdominal injuries, have lost consciousness, or have been referred by their general practitioner. These markers may help medical staff to identify more cases of undisclosed domestic violence. The markers need to be tested further in a prospective study.

Adolescent↗
PubMed1996

The accident and emergency department as a single portal of entry for the reassessment of all trauma patients transferred to specialist units.

127 patients who were transferred to a regional referral centre for specialist treatment within 48 h of serious injury were reassessed on arrival in the receiving accident and emergency department by a trauma team. 80 transferred patients (63%) required intervention in the accident and emergency department to complete assessment or resuscitation. In view of the well recognised difficulties in managing patients with multiple trauma and the possibility that initially occult injuries may become clinically significant during transport, transferred trauma patients should be reassessed in the accident and emergency department of the receiving hospital by a trauma team consisting of senior medical staff experienced in all aspects of trauma care.

Emergency Medicine↗
PubMed1996

Short stay observation patients: general wards are inappropriate.

OBJECTIVE: To assess the efficiency of a short stay observation ward attached to the accident and emergency (A&E) department of a main teaching hospital. METHODS: The study was done on 107 patients admitted to the A&E observation ward and 107 similar patients admitted to general wards after closure of the observation ward. Patients of 13 years and over who required short term admission to hospital for observation or investigation were included. RESULTS: Patients admitted to the A&E observation ward were seen sooner by a senior doctor, had fewer investigations, and had a shorter stay in hospital than similar patients admitted to the general wards. CONCLUSIONS: The A&E observation ward was more efficient than the general acute wards at dealing with short stay patients.

Emergency Service, Hospital↗
PubMed1996

Amniotic fluid embolism: emergency management.

A case of successful outcome is described in a patient with amniotic fluid embolism presenting to the accident and emergency department. Diagnostic features and guidelines for management are outlined.

Adult↗
PubMed1996

An evaluation of telemedical support for a minor treatment centre.

A low-cost telemedicine link was established from an accident and emergency department in Belfast to support nurse practitioners running a minor treatment centre (MTC) in London. During the 12 months before the introduction of the telemedicine link, 6729 patients were seen in the MTC. Of these, 155 (2.3%) were referred to the nearest accident and emergency department and 802 (11.9%) were referred to their general practitioner (GP). During the first 12 months of the use of the telemedicine link, 9972 patients were seen in the MTC. Of these, 147 (1.5%) were referred to the accident and emergency department and 383 (3.8%) were referred to their GP. During the evaluation period, 51 patients were seen using the telemedicine link, representing 0.5% of all MTC attenders during that period. The total number of teleconsultations was less than expected. The reasons for this difference include random variation, but could also include confidence resulting from the presence of the link and a training effect. The telemedicine link for trauma and minor injuries was an extremely cost-effective way of providing medical expertise to cover the clinical risk of the 0.5-1.5% of the case load that required expert medical opinion. The direct costs of on-site medical staff would have been 50,000 pounds per annum, excluding overhead charges. The annual cost of the videolink, including overheads, was 7250 pounds, amounting to a saving of some 42,000 pounds per annum.

Emergency Medical Services↗
PubMed1995

Emergency delays.

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Emergency Service, Hospital↗
PubMed1995

Unnecessary delays in accident and emergency departments: do medical and surgical senior house officers need to vet admissions?

Work was carried out to determine whether patients requiring emergency medical or surgical admission to hospital via accident and emergency (A&E) departments benefit from initial assessment by the ward senior house officer (SHO) as well as the A&E SHO. Two comparable consultant-led A&E departments sharing the same catchment population and receiving similar numbers of new patients each year were studied. A panel of four consultants audited the A&E notes and in-patient records of consecutive emergency medical and surgical patients admitted to two hospitals over the same 6 month period. In one hospital patients were seen and admitted by the A&E SHO alone. In the other hospital patients were seen by the A&E SHO and the medical or surgical SHO from the admitting unit. Diagnostic errors, inappropriate admissions to hospital and admission of patients to inappropriate wards were used as outcome measures. There was no significant difference in the rates of diagnostic error or inappropriate admissions between those patients seen by an A&E SHO only, and those seen in A&E by the A&E and ward SHOs. Detaining emergency medical and surgical patients in the A&E department for further assessment by ward SHOs does not alter inappropriate admission rate or improve diagnostic accuracy.

Emergency Service, Hospital↗
PubMed1993

Transatlantic perspectives of trauma systems.

The need for centralized management of acute trauma was evaluated in a 1-year prospective study in Northern Ireland. All patients with an Injury Severity Score > 15 who reached hospital alive were included. The sample population was approximately 1 million people. A total of 239 patients entered the study, of whom 74 died. An audit panel considered that 3-15 per cent of deaths were preventable. There was no significant difference in the preventable mortality rate between any hospital or groups of hospitals. There was a high level of consultant involvement, especially in small hospitals. A system in which patients with acute trauma bypass the nearest hospital to reach a trauma centre may be neither beneficial nor cost-effective in Northern Ireland. Upgrading of the present system with stabilization of the patient and emergency surgery at the nearest hospital before transfer is recommended.

Adolescent↗
PubMed1992

Mixed sex wards.

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Female↗
PubMed1992

Delays in care of the critically injured.

Prehospital and resuscitation periods and times to emergency surgery were studied in major trauma victims over two 12-month periods to identify factors causing delay in emergency care. Eighteen patients required emergency surgery in the first group and 13 in the second. The mean presurgery time (i.e. time from arrival in the accident and emergency department to surgery) was 117 min in the first group and 111 min in the second. Causes of delay included a sequential approach to resuscitation and investigation, limited staff and theatre availability, and failure to call the trauma team. Times for resuscitation and times to surgery could be reduced by earlier decision-making, alerting key personnel promptly and performing tasks in parallel.

Critical Care↗
PubMed1990

Improving the care of patients with major trauma in the accident and emergency department.

OBJECTIVE: To determine whether improvement in the care of victims of major trauma could be made by using the revised trauma score as a triage tool to help junior accident and emergency doctors rapidly identify seriously injured patients and thereby call a senior accident and emergency specialist to supervise their resuscitation. DESIGN: Comparison of results of audit of management of all seriously injured patients before and after these measures were introduced. SETTING: Accident and emergency department in an urban hospital. PATIENTS: All seriously injured patients (injury severity score greater than 15) admitted to the department six months before and one year after introduction of the measures. RESULTS: Management errors were reduced from 58% (21/36) to 30% (16/54) (p less than 0.01). Correct treatment rather than improvement in diagnosis or investigation accounted for almost all the improvement. CONCLUSIONS: The management of seriously injured patients in the accident and emergency department can be improved by introducing two simple measures: using the revised trauma score as a triage tool to help junior doctors in the accident and emergency department rapidly identify seriously injured patients, and calling a senior accident and emergency specialist to supervise the resuscitation of all seriously injured patients. IMPLICATIONS: Care of patients in accident and emergency departments can be improved considerably at no additional expense by introducing two simple measures.

Adult↗
PubMed1985

The resuscitation of the severely injured in the accident and emergency department--a medical audit.

An audit of the medical care of the severely injured was conducted in the Accident and Emergency Department of the Royal Victoria Hospital, Belfast. Over a 6-month period the management of all patients admitted with an Injury Severity Score of 16 or over was critically assessed. Errors of management which occurred in 21 of the 36 patients are discussed. They were mainly related to the fact that 78 per cent of the patients arrived outside normal office hours when only inexperienced junior doctors staffed the department. The findings have drawn our attention to the need for both altering staffing arrangements and improving training in our department.

Adult↗