Should transient loss of consciousness in blunt head trauma be a pre-hospital trauma triage criterion?

The objective of this study was to evaluate pre-hospital triage of patients with an isolated brief loss of consciousness (LOC) to a regional trauma center (RTC). Data from a 6-month period were retrospectively reviewed from an existing pre-hospital data collection set. Patients were included if either they or a witness claimed a LOC, but they had regained consciousness to at least a Glasgow Coma Score (GCS) > 13 by the time the paramedics arrived. Endpoints for need for trauma center services included positive head computed tomography (CT) scan, the occurrence of emergency non-orthopedic surgery in < 6 h, admission to a surgical intensive care unit (ICU), or a length of stay (LOS) greater than 3 days for surgical evaluation. There were 655 complete records available for 275 cases of vehicular trauma and 380 cases of non-vehicular trauma. There were 170 (62%) patients in the vehicular group, and 287 (76%) in the non-vehicular group evaluated in the emergency department and discharged. In the vehicular group, only one (0.4%) patient required operative intervention in less than 6 h, three (1.1%) had a positive head CT scan, 10 (3.6%) were admitted to a surgical ICU, and four (1.5%) had a LOS > 3 days. In the non-vehicular trauma group, only one (0.3%) had surgery in < 6 h, eight (2.1%) had a positive CT scan, six (1.6%) were admitted to a surgical ICU or had a LOS > 3 days. Overall, 19 (2.9%, CI 0.018–0.045) patients met any one of the end-point criteria for trauma center utilization; however, only one patient (0.2% CI < 0.0001–0.008) required immediate neurosurgical intervention. Transient LOC, in the absence of any other American College of Surgeons (ACS) trauma triage criteria, triaged 97% of patients to a trauma center, who did not require trauma center services based on our criteria.     

Should ambulant patients be directed to reception or triage first?

Objectives—Developments in triage have led to patients being directed to triage rather than reception upon arrival in A&E. This study aimed to discover if attending triage or reception first, was preferable in terms of timeliness, clarity and safety.

Methods—The study compared two consecutive four week periods during which patients were directed to attend triage first and then reception first. Observers recorded their actions on arrival. Questionnaires recorded the patients' perceptions of each strategy. High priority triage categories were audited during the reception first phase.

Results—1850 patients were observed in the triage first phase with a mean door to triage time of 10.6 minutes, triage to reception 5.3 minutes and door to reception 15.8 minutes. A total of 1522 patients were observed in the reception first phase with a mean door to reception time of 0.5 minutes, reception to triage 12.4 minutes and door to triage of 12.9 minutes. Patients were more likely to present to the appropriate place during the reception first phase (88% versus 34%) and reported better understanding of instructions. No case given triage category one or two suffered an adverse outcome resulting from delay associated with attending reception first.

Conclusion—Directing patients to attend reception first is timely and less confusing. It is safe provided booking in does not delay assessment by more than 15 minutes.

     

Should potassium permanganate be used in wound care?

Potassium permanganate is a mild antiseptic with astringent properties. It is used in dermatology to treat weeping skin conditions. Potassium permanganate tablets are commonly used in clinical practice. The 400 mg (1:1,000) tablets are diluted in four litres of water to give a dilution of 1:10,000 (0.01%) (British Medical Association and Royal Pharmaceutical Society of Great Britain, 2003).