Treatment patterns and frequency of key outcomes in acute severe asthma in children: a Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study.

RATIONALE: Severe acute paediatric asthma may require treatment escalation beyond systemic corticosteroids, inhaled bronchodilators and low-flow oxygen. Current large asthma datasets report parenteral therapy only. OBJECTIVES: To identify the use and type of escalation of treatment in children presenting to hospital with acute severe asthma. METHODS: Retrospective cohort study of children with an emergency department diagnosis of asthma or wheeze at 18 Australian and New Zealand hospitals. The main outcomes were use and type of escalation treatment (defined as any of intensive care unit admission, nebulised magnesium, respiratory support or parenteral bronchodilator treatment) and hospital length of stay (LOS). MEASUREMENTS AND MAIN RESULTS: Of 14 029 children (median age 3 (IQR 1-3) years; 62.9% male), 1020 (7.3%, 95% CI 6.9% to 7.7%) had treatment escalation. Children with treatment escalation had a longer LOS (44.2 hours, IQR 27.3-63.2 hours) than children without escalation 6.7 hours, IQR 3.5-16.3 hours; p<0.001). The most common treatment escalations were respiratory support alone (400; 2.9%, 95% CI 2.6% to 3.1%), parenteral bronchodilator treatment alone (380; 2.7%, 95% CI 2.5% to 3.0%) and both respiratory support and parenteral bronchodilator treatment (209; 1.5%, 95% CI 1.3% to 1.7%). Respiratory support was predominantly nasal high-flow therapy (99.0%). The most common intravenous medication regimens were: magnesium alone (50.4%), magnesium and aminophylline (24.6%) and magnesium and salbutamol (10.0%). CONCLUSIONS: Overall, 7.3% children with acute severe asthma received some form of escalated treatment, with 4.2% receiving parenteral bronchodilators and 4.3% respiratory support. There is wide variation treatment escalation.

The impact of social media on a major international emergency medicine conference.

OBJECTIVE: To report on the presence and use of social media by speakers and attendees at the International Conference on Emergency Medicine (ICEM) 2012, and describe the increasing use of online technologies such as Twitter and podcasts in publicising conferences and sharing research findings, and for clinical teaching. METHODS: Speakers were identified through the organising committee and a database constructed using the internet to determine the presence and activity of speakers on social media platforms. We also examined the use of Twitter by attendees and non-attendees using an online archiving system. Researchers tracked and reviewed every tweet produced with the hashtag #ICEM2012. Tweets were then reviewed and classified by three separate authors into different categories. RESULTS: Of the 212 speakers at ICEM 2012, 41.5% had a LinkedIn account and 15.6% were on Twitter. Less than 1% were active on Google+ and less than 10% had an active website or blog. There were over 4500 tweets about ICEM 2012. Over 400 people produced tweets about the conference, yet only 34% were physically present at the conference. Of the original tweets produced, 74.4% were directly related to the clinical and research material of the conference. CONCLUSIONS: ICEM 2012 was the most tweeted emergency medicine conference on record. Tweeting by participants was common; a large number of original tweets regarding clinical material at the conference were produced. There was also a large virtual participation in the conference as multiple people not attending the conference discussed the material on Twitter.

Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 2: Dexamethasone for reduction of migraine recurrence.

A short-cut review was carried out to establish whether the administration of dexamethasone reduced the risk of recurrence of migraine headaches at 24 h. Three hundred and fifteen articles were found using the reported search including two systematic reviews and meta-analyses. A total of nine trials was included between the two meta-analyses. One trial was included in both analyses from the abstract data but had subsequently been published with further patient data. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated (table 2). It is concluded that the administration of dexamethasone reduces the risk of recurrence at 24 h in patients presenting to an emergency department with a migraine headache.

Hypothermia is a significant medical risk of mass participation long-distance open water swimming.

OBJECTIVE: To document the prevalence of hypothermia in a mass participation endurance open water swimming event and to determine demographic and individual factors that may predict failure to finish the race and hypothermia. METHODS: A prospective observational study in competitors in a 19.2-km open water swimming race in Perth, Western Australia. Pre-race information collected included age, sex, training and race experience, medical history, and body mass index (BMI). Body temperatures at 5 minutes postrace were measured using an equilibrated oral- or rectal-reading low-range glass mercury thermometer. Logistic regression was used to develop models predicting hypothermia (defined as a temperature of <35 degrees C) and failure to finish the race. RESULTS: One hundred and nine competitors (70 male, 39 female) with a combined mean age of 38.4 +/- 12.1 years were studied. Hypothermia was the most common race-related illness, identified in 26 of 35 swimmers screened as requiring temperature measurement, including 5 who required short-stay hospital care and 2 who required critical care transfer. Longer race duration (odds ratio [OR] 1.77, 95% CI 1.10-2.84, P = .018) was associated with an increased risk of hypothermia, and higher BMI (OR 0.57, 95% CI 0.41-0.79, P = .001) was associated with a decreased risk of hypothermia. Weak predictors of failure to finish were age (OR 1.06, 95% CI 1.01-1.11, P = .012) and hours spent training (OR 1.08, 95% CI 1.01-1.16, P = .025). CONCLUSIONS: Hypothermia is a common condition affecting mass participation long-distance open water swimmers. Increased BMI appears to be protective against hypothermia, while prolonged duration of the swim predicts an increased risk of hypothermia. The weak predictors of failing to finish are of questionable clinical significance.

Tympanic thermometry is unsuitable as a screening tool for hypothermia after open water swimming.

OBJECTIVE: Mass participation in competitive open water swimming is becoming increasingly popular. The purpose of this study was to determine whether infrared emission detection (IRED) tympanic temperature measurement taken in participants approximately 1 minute following a long-distance open water swimming event is a suitable screening tool for hypothermia. METHODS: We studied 15 males and 7 females who completed the 20-km Rottnest Channel Swim off the coast of Perth, Western Australia. Following the swim, each athlete was clinically assessed for hypothermia through the observation of gait, cognitive processing, and demeanor. Approximately 1 minute following the swim, participants underwent temperature measurement using one of two IVAC Core Check 2090 IRED tympanic thermometers set to core equivalent mode. Further tympanic readings and an oral temperature reading were taken at 5 minutes post swim in subjects triaged to the medical tent after the initial clinical screen. RESULTS: At 1 minute post event, the average tympanic temperature measurement was 28.9 degrees C (95% CI, 28.3-29.7), while at 5 minutes postevent it was 31.6 degrees C (95% CI, 31.1-32.2). The average oral temperature at 5 minutes post event was 34.3 degrees C (95% CI, 33.7-34.7). The difference between the screening tympanic and oral temperatures was statistically significant (P = 0.000). CONCLUSIONS: Infrared emission detection tympanic thermometry is unsuitable as a screening tool for hypothermia following a prolonged open water swim because it substantially overestimates the incidence and severity of hypothermia in participants.