Emergency Medicine Journal最新文献

Background: Addressing racial bias in healthcare is crucial for ensuring equitable treatment and outcomes. We aimed to explore implicit (unconscious) racial bias among healthcare professionals in UK emergency departments (EDs).

Methods: BiasED was an online survey disseminated to healthcare professionals working at 16 UK EDs. Participants completed the race (black/white) Implicit Association Test (IAT), which explores potential implicit bias by examining response times for positive and negative associations for white and black people. Differences were measured using the D score (range -2 to 2, where 0 indicates neutral bias and positive scores indicate pro-white bias). Explicit attitudes and stereotypes were also explored by participants' self-report.

Results: 969 healthcare workers participated, including doctors (42%), nurses (43%) and other healthcare professionals (median age 36 years; 66% female; 67% white). Self-report measures indicated little explicit bias, with 87% reporting equal preference for black and white people. Black participants expressed more positive attitudes about black people than white or Asian participants.The IAT indicated a pro-white bias (D=0.32, SD=0.42, p<0.001), considered a small to medium effect. Men (D=0.36) showed more implicit bias than women (D=0.29, p=0.03). White (D=0.34) and Asian (D=0.37) participants showed more bias than black (D=0.09) participants. No significant differences were found between medical professions. Except for black participants, all groups showed a pro-white bias on the IAT.

Conclusion: The study identified evidence of implicit racial bias among healthcare workers in UK EDs. These findings highlight the complex nature of racial attitudes in healthcare and emphasise the need for comprehensive bias awareness and mitigation strategies in emergency care settings. Future research should explore the potential impact of these biases on clinical decision-making and patient outcomes.

Background: Non-communicable diseases (NCDs) are the leading causes of death worldwide. Ongoing global migration increases the proportion of recently arrived migrants in many countries. Yet data on NCD prevalence and care among asylum seekers (AS), a marginalised population with barriers to healthcare access, remain scarce. Emergency departments (EDs) often serve as healthcare access points for vulnerable populations, providing valuable data to identify unmet needs and health inequities. The primary objective of this study was to assess NCD prevalence, along with care, patterns and ED consultation frequency among AS compared with Swiss nationals (SN), with a focus on potential disparities.

Methods: Cross-sectional study at the ED of University Hospital Bern (January 2017 to December 2018). Patients ≥30 years with AS status were matched 1:1 to SN by age (±5 years) and gender. Routine data from electronic medical records included demographics, consultation characteristics and the presence, type and medication of NCDs. Group-level comparisons were performed and sensitivity analyses tested result robustness.

Results: NCD and multimorbidity prevalences did not differ (AS: respectively 34.5% and 10.2% of 420, SN: 36.9% and 9.0% of 445, p=0.475 and 0.322), with cardiovascular diseases most prevalent. Diabetes was more prevalent in AS (9.3% vs 3.8%, p=0.001), particularly among women, while neoplasms and respiratory disease were less frequent. ED consultation frequencies were comparable between AS and SN (each N=538). In both groups, ~10% of ED visits were primarily NCD-related, with similar rates of previously known or unknown NCDs and resource utilisation, while untreated cardiovascular disease or diabetes was more frequent among AS.

Conclusion: Despite similar overall ED consultation frequency and NCD prevalence between groups, higher diabetes prevalence, gender-specific differences and potential chronic care gaps among AS indicate health inequities. EDs play a crucial role in detecting such disparities and can inform inclusive, equity-oriented strategies to strengthen NCD prevention and care continuity for displaced populations.

Background: Injuries represent a major public health burden and are frequently associated with acute alcohol consumption. However, minor injuries are often excluded from previous research, despite accounting for a substantial proportion of the overall injury burden and emergency department (ED) attendances. We aimed to investigate the association between acute alcohol consumption and minor injuries in people presenting to an ED and to identify the alcohol-attributable fraction (AAF) of minor injuries.

Methods: We conducted a prospective case-crossover study in an academic tertiary and level 1 trauma centre in Switzerland over a 4-month period (September to December 2023). Adults aged ≥16 years presenting to the ED with minor injuries were eligible. A total of 526 individuals were screened. The primary objective was the analysis of the association between acute alcohol consumption (within 6 hours before the event) and minor injury risk. The AAF of minor injuries was calculated. Subgroup analysis explored injury risk in relation to drinking patterns, gender and age.

Results: Among 353 included participants, 18.1% reported acute alcohol consumption within 6 hours of injury. Acute alcohol consumption was associated with increased odds of minor injury (OR 2.65, 95% CI 1.67 to 4.18). The AAF for minor injuries was 23%.Exploratory subgroup analysis revealed an increased injury risk among participants reporting chronic binge drinking (OR 3.81, 95% CI 1.82 to 7.99) and women (OR 5.52, 95% CI 2.02 to 15.08).

Conclusions: Acute alcohol consumption significantly increases the risk of minor injuries, with nearly one quarter of cases potentially attributable to acute alcohol consumption. Given the high volume of minor injuries in EDs, systematic screening and brief intervention strategies may represent opportunities to reduce the preventable injury burden.

Objective: The optimal timing of epinephrine during out-of-hospital cardiac arrest (OHCA) remains uncertain, particularly for neurological recovery. We examined the association between time-to-epinephrine and clinical outcomes in adult OHCA in Korea.

Methods: We conducted a nationwide retrospective cohort of emergency medical service (EMS)-treated, non-traumatic adult OHCA (2019-2021). Patients were classified as early (≤20 min) or delayed (>20 min) based on arrest-to-first epinephrine. The primary outcome was favourable neurological status at discharge (Cerebral Performance Category (CPC) 1-2); secondary outcomes were return of spontaneous circulation (ROSC) and survival to discharge. We applied 1:1 propensity-score matching and multivariable logistic regression, including continuous (per 1-minute and 5-minute delays) and 5-minute bin analyses of time-to-epinephrine, with effect modification assessed by initial rhythm.

Results: Among 10 726 patients, 3589 (33.5%) received epinephrine within 20 min. In the matched cohort (n = 5,734), delayed administration was associated with lower survival (4.46% vs 7.74%; aOR 0.56, 95% CI 0.44-0.71) and lower likelihood of favourable neurological outcome (2.13% vs 3.77%; aOR 0.56, 95% CI 0.40-0.79), compared with early administration. In continuous models, each 1-minute delay was associated with lower odds of good CPC (aOR 0.964, 95% CI 0.942 to 0.987); a 5-minute delay corresponded to aOR 0.833 (95% CI 0.741 to 0.937) and bin-wise estimates showed a marked drop beyond 30 min (aOR 0.048, 95% CI 0.006 to 0.393).

Conclusion: Early epinephrine administration within 20 min of cardiac arrest onset was associated with higher rates of ROSC, survival to discharge and favourable neurological recovery in this EMS setting. These findings support the importance of timely advanced life support delivery, including early epinephrine, although cautious interpretation is warranted.

Background: Knife-related deaths in children present a serious public health challenge. This study reports the demographics and preinjury, injury and postinjury factors associated with death in children and young people (CYP), under the age of 18 years, who died of knife wounds in England between 2019 and 2024.

Methods: A retrospective cohort review of the English National Child Mortality Database between April 2019 and March 2024. Rates of death were corrected for population size using the 2021 census. Preinjury, injury and postinjury factors associated with death are reported descriptively.

Results: 145 CYP died of knife wounds. The mean age was 14.4 years (SD 4.2) and 90.3% (n=131) were male. The rates of death per 100 000 CYP, per year were highest in children of 'Black/Black British' ethnicity (1.40 (95% CI 1.03 to 1.86)), with an incidence rate ratio (IRR) of 13.29 (95% CI 8.23 to 20.00), compared with CYP of 'White' ethnicity. Children living in the most deprived areas, had a greater than seven times higher risk of death (IRR 7.48 (95% CI 3.22 to 17.29), compared to CYP living in the least deprived areas. Of the 57 cases available for detailed analysis, injuries to the chest and neck were responsible for the fatal injuries in 75.9% of cases (n=44) and 60.3% (n=35) died before reaching hospital. A thoracotomy was performed in 56.9% (n=33) of cases. Prior to death, 75.4% (n=43) had been known to social services and 57.9% (n=33) had experienced domestic violence and abuse. Neurodiversity or mental health concerns were reported in 50.9% (n=29) of CYP.

Conclusions: Death of CYP secondary to knife wounds occurred in all regions of England. Many children are exposed to adverse childhood experiences before death and known to statutory services. The identification of interventions to decrease the risk to children from knife violence remains a priority.

Emergency departments (EDs) and NHS ambulance services often serve as the first and only point of contact with healthcare for individuals from deprived communities, marginalised populations and other groups that face inequalities in both access to, and quality of healthcare. These include ethnic minorities, people experiencing homelessness, asylum seekers, sex workers, individuals transitioning from criminal justice settings as well as older adults, children and pregnant women. These populations face disproportionate burdens of disease and systemic barriers to care. Integration of Public Health into Urgent and Emergency Care (UEC) services presents an opportunity to address these challenges.These issues cannot be solved by UEC services alone. EDs and ambulance services, however, are uniquely positioned to identify and address health inequalities by building close relationships with local authorities, primary care, social care and voluntary, community and social enterprises to support preventive efforts, help people before they need to come to ED, reduce repeat attendances and improve patients' experiences and outcomes.Health inequalities cost the NHS billions of pounds each year. Embedding public health in EDs is not just a clinical improvement-it is an economically sound, ethically responsible, equity intervention that addresses the social determinants of health and ensures the most vulnerable receive timely, tailored support.EDs and NHS ambulance services are more than services for time of crisis-they are places of opportunity. By embedding public health principles into emergency care, we can transform emergency care into engines of equity, resilience and prevention. Investing in public health within these settings is not only the right thing to do for patient outcomes and health equity-it is ultimately cost-effective, reducing demand on UEC and improving population health in the long term.