Impact of COVID-19 lockdown on self-harm and violence among patients presenting to the emergency department.

IMPORTANCE: Considering the resurgence of COVID19 and the rapid spread of new and deadlier strains across the globe understanding the incidence and pattern of violence and self harm tendencies during this period might help in formulating better contingency plans for future lockdowns. A deeper look at the available data shows that there is a significant dearth of research into self-harm & violence during the COVID-19 pandemic. OBJECTIVE: To identify the incidence and sociodemographic characteristics of self-harm and violence during the COVID19 lockdown and compare with a control group from the previous year. DESIGN: A cross-sectional retrospective observational study. SETTING: Tertiary care teaching hospital. PARTICIPANTS: All patients presenting to the emergency department (ED) with self harm and violence during the COVID-19 lockdown period between March 24-June 30, 2020 and March 24-June 30, 2019. EXPOSURE: The COVID-19 lockdown period. MAIN OUTCOME (S) AND MEASURE (S): The hypothesis being tested was formulated before the study. The null hypothesis tested was a decline in number of self-harm and violence cases during the lockdown. RESULTS: A total of 828 patients were analysed over both the time periods, out of which 30% (248) were females while 70% (580) were males. Increases in self-harm and violence were 12.71% and 95.32% respectively per 1000 ED admissions. A significant correlation was found between the COVID-19 lockdown and the increased incidence (X2 (1, N = 828) = 9.2, p < .05). An increase of violence by known individuals and between partners was seen. Intimate partner violence also increased to 7%. X2 (3, N = 662) = 21.03, p < .05. In the self harm dataset an increase in mortality, ICU admissions and decision to leave against medical advice was noted (X2 (4, N = 166) = 24.49, p < .05). Increase in the use of alcohol prior to acts of self harm and violence was noted. CONCLUSIONS: Increase in the incidence of cases of self-harm and violence reported to the ED was noted during the lockdown period. Upgradation of health-care and law enforcement infrastructure maybe needed to deal with similar circumstances in a more efficient manner. TRIAL REGISTRATION: N/A.

Using Canadian CT head rule in a developing nation: Validation and comparing utilisation by emergency physicians and neurosurgeons.

OBJECTIVE: The objective of this study was to test the validity of the Canadian CT Head rule (CCHR) in cases of minor traumatic brain injury (TBI) in an Indian emergency department (ED). A secondary objective was to compare of the patterns of neuroradiology references between the emergency physician (EP) and the neurosurgeon. METHODS: The study was prospectively conducted between July 2019 and July 2020. Patients satisfying the inclusion criteria were subjected to CCHR and the result was documented. The neurosurgeon was consulted for the final decision. In case of disagreement between the neurosurgeon and the EP, the decision of neuro-radiology was taken by the neurosurgeon. RESULTS: A total of 101 patients satisfied the inclusion criteria. 62 subjects fulfilled the CCHR. Out of 62 subjects who fulfilled the CCHR criteria, 46 (74.1%) were reported to have normal CT scans, while 16 had either haemorrhages (n = 12) or contusions (n = 4). All the subjects who didn't fulfil the CCHR (n = 39), were reported to have normal CT scans. The EPs used CCHR in all cases of mild TBI while the neurosurgeons chose to get CT brains in all the subjects based of clinical gestalt. CCHR had an observed sensitivity of 100% and specificity of 45.8%. CONCLUSION: The CCHR has 100% sensitivity as a screening tool for patients requiring CT brains in case of TBI though the specificity is found to be rather low (45.8%). EPs show a higher level of awareness and inclination to use CDRs in cases of minor TBI to direct the decision for neuro-radiology, in comparison to neurosurgeons. ED residents reported comfort in mobile application based usage of the rule.