Composite graft repair in distal finger injuries: emergency room or operating room?

BACKGROUND: Fingertip amputations are common injuries presenting to the emergency room. However, all amputations do not have a chance of replantation, and composite graft is among the salvage treatments in this case. This treatment is both easy to apply and economical. Our study compares the success and cost of composite grafting in the emergency and operating rooms. METHODS: Thirty-six patients who met the criteria were included in the study. The decision on the repair site was made by the sur-geon according to patient compliance and the intensity of the emergency clinic. Demographic and disease information of the patients were recorded. P<0.05 was accepted as the significance level. RESULTS: Twenty-two cases were pediatric patients. Eighteen cases of crush injuries and 22 cases were treated in the emergency room. There was no significant difference in terms of complications, need for additional intervention, and short fingers related to interventions performed in the emergency room and operating room. Interventions in the emergency department were significantly lower in cost and shorter hospitalization times. There was no significant difference in terms of patient satisfaction. CONCLUSION: Composite grafting is a simple and reliable method in fingertip injuries and gives satisfactory results in terms of patient satisfaction. In addition, composite graft application in fingertip injuries in the emergency department will both reduce the cost and prevent hospital infections that may occur due to the reduction in hospitalization.

Pain management practices in the emergency departments in Turkey.

OBJECTIVES: This study aimed to evaluate pain management practices in the emergency departments (EDs) in Turkey and to evaluate the prevalence and etiologies of oligoanalgesia to identify possible improvement strategies. METHODS: This multicenter cross-sectional observational study was conducted in 10 tertiary care hospitals in Turkey. Patients who were admitted to the ED with pain chief complaints were included in the study. Both patients and physicians were surveyed with two separate forms by the research associates, respectively. The patient survey collected data about the pain and the interventions from the patients' perspective. The pain was evaluated using the Numerical Rating Scale. The physician survey collected data to assess the differences between study centers on pain management strategies and physician attitudes in pain management. RESULTS: Ten emergency physicians and 740 patients (male/female: 365/375) enrolled in the study. The median pain score at admission at both triage and ED was 7 (interquartile range: 5-8). The most frequent type of pain at admission was headache (n = 184, 24.7%). The most common analgesics ordered by physicians were nonsteroidal anti-inflammatory drugs (n = 505, 67.9%), and the most frequent route of administration was intramuscular injection (n = 396, 53.2%). About half of the patients (n = 366, 49.2%) received analgesics 10-30 min from ED admission. The posttreatment median pain score decreased to 3 (P < 0.001). About 79.2% of patients did not need a second analgesic administration (n = 589), and opioid analgesics were the most frequently administered analgesic if the second application was required. Physicians prescribed an analgesic at discharge from the ED in 55.6% of the patients (n = 414) and acute pain was present in 7.5% (n = 56) of the patients. CONCLUSION: Our study on the pain management practices in the EDs in Turkey suggested that high rate of intramuscular analgesic use and long emergency room stay durations are issues that should constitute the focus of our quality improvement efforts in pain management.