Investigating the use of physical restraint of children in emergency departments: A Scandinavian survey.

AIM: The aim of the study is to describe the current frequency of physical restraint and the use of analgesics and sedatives for treating pediatric pain in emergency departments (EDs) in Scandinavia. METHODS: We performed a nation-wide electronic survey asking nurses in the emergency departments in Denmark, Norway, and Sweden about their experience treating children in pain. RESULTS: Responses from 103 Danish, Norwegian and Swedish nurses were included (79% response rate). Physical restraint was reported used at 79% [70.0-85.9] (N = 78) of the surveyed departments (DK: 96%, NO: 67%, SE: 77%) with two participants reporting daily use of physical restraint. Paracetamol was available at all departments and used most frequently. Sedation was available at 88% [78.8-92.0] of the departments with midazolam as the most recurrent sedative (83%, [74.8-89.4]). Seventy-three percent of respondents reported a need for better treatments. Lack of education was the most frequently reported obstacle for providing both pain treatment (29%) and sedation (43%) followed by lack of guidelines. CONCLUSION: Physical restraint of children during painful procedures is used in the majority of Scandinavian emergency departments (79%). There appears to be a lack of local guidelines for both pain treatment and sedation.

Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest: A Danish nationwide observational study.

AIM: Sudden out-of-hospital cardiac arrest (OHCA) is an important public health problem. While several interventions are known to improve survival, the impact of physician-delivered advanced cardiac life support for OHCA is unclear. We aimed to assess the association between prehospital physician involvement and 30-day survival. METHODS: Observational study including persons registered with first-time OHCA of any cause in the Danish Cardiac Arrest Registry during 2005-2012. We used logistic regression analysis to assess the association between 30-day survival and involvement of a physician at any time before arrival at the hospital. Secondary outcomes were 1-year survival and return of spontaneous circulation (ROSC) before arrival at the hospital. The associations were explored in three multivariable models: a model with simple adjustment, a model with multiple imputation of missing variables, and a propensity score model where exposed subjects were matched 1:1 with unexposed subjects on a propensity score reflecting the probability of being assigned to the exposure group. RESULTS: 21,165 persons with OHCA during 2005-2012 were included. Overall, 10.8% of OHCA patients with physician involvement and 8.1% of OHCA patients without physician involvement before arrival at hospital were alive after 30 days, crude odds ratio (OR)=1.37 (95% CI=1.24-1.51), adjusted OR=1.18 (95% CI=1.04-1.34). Physician involvement was also positively associated with ROSC, OR=1.09 (95% CI=1.00-1.19); and with 1-year survival, OR=1.13 (95% CI=0.99-1.29). CONCLUSION: In this large population-based observational study, we found prehospital physician involvement after OHCA associated with better 30-day survival. This association was also found for ROSC, but with less certainty for 1-year survival.