Injuries following accidents with electric scooters.

INTRODUCTION: Since the introduction of electric scooter (e-scooter) rental services in Denmark in January 2019, injuries following accidents involving e-scooters have increased. Internationally, a few studies have been published examining patient and injury characteristics following accidents involving e-scooters. However, data are limited. The purpose of this study was to describe the injuries, treatment and hospital course following accidents involving e-scooters. METHODS: Prospective collection of data on all persons involved in accidents related to e-scooters who were examined and treated at the Emergency Department of Bispebjerg and Frederiksberg, Denmark, during the period from 30 June 2019 to 30 September 2019. RESULTS: A total of 49 patients, 37 (75.5%) male, 46 riders and three non-riders, with a median age of 26 years (range: 8-56 years) were admitted to the emergency department. Common injuries were head injuries (46.9%) and fractures (26.5%). Most patients (79.6%) were discharged to their home from the emergency department after treatment without further hospital follow-up. CONCLUSIONS: The majority of persons involved in e-scooter accidents are young men. Our results revealed a high frequency of head injuries and fractures. Most patients were discharged to their home after treatment in the emergency department. FUNDING: none. TRIAL REGISTRATION: The study was approved as a quality control project by the Head of the Department of Emergency Medicine and the Head of the Hospital Administration.

Short-stay unit hospitalisation vs. standard care outcomes in older internal medicine patients-a randomised clinical trial.

Background: the effect of hospitalisation in emergency department-based short-stay units (SSUs) has not been studied in older patients. We compared SSU hospitalisation with standard care at an Internal Medicine Department (IMD) in acutely admitted older internal medicine patients. Methods: pragmatic randomised clinical trial. We randomly assigned patients aged 75 years or older, acutely admitted for an internal medicine disease and assessed to be suitable for SSU hospitalisation to SSU hospitalisation or IMD hospitalisation. SSU hospitalisation was provided by a pragmatic 'fast-track' principle. The primary outcome was 90-day mortality. Secondary outcomes included adverse events, change in Lawton Instrumental Activities of Daily Living (IADL) score within 90 days from admission, in-hospital length of stay and unplanned readmissions within 30 days after discharge. Results: between January 2015 and October 2016, 430 participants were randomised (median age 84 years in both groups). Ninety-day mortality was 22(11%) in the SSU group and 32(15%) in the IMD group (odds ratio (OR) 0.66; 95% confidence interval (CI) 0.37-1.18; P = 0.16). When comparing the SSU group to the IMD group, 16(8%) vs. 45(21%) experienced at least one adverse event (OR 0.31; 95% CI 0.17-0.56; P < 0.001); 6(3%) vs. 35(20%) experienced a reduction in IADL score within 90 days from admission (P < 0.001); median in-hospital length of stay was 73 h [interquartile range, IQR 36-147] vs. 100 h [IQR 47-169], (P < 0.001), and 26(13%) vs. 58(29%) were readmitted (OR 0.37; 95% CI 0.22-0.61; P < 0.001). Conclusions: mortality at 90 days after admission was not significantly lower in the SSU group, but SSU hospitalisation was associated with a lower risk of adverse events, less functional decline, fewer readmissions and shorter hospital stay. Trial registration: NCT02395718.

Brief hospitalizations of elderly patients: a retrospective, observational study.

BACKGROUND: Crowded departments are a common problem in Danish hospitals, especially in departments of internal medicine, where a large proportion of the patients are elderly. We therefore chose to investigate the number and character of hospitalizations of elderly patients with a duration of less than 24 hours, as such short admissions could indicate that the patients had not been severely ill and that it might have been possible in these cases to avoid hospitalization. METHODS: Medical records were examined to determine the number of patients aged 75 or more who passed through the emergency department over a period of two months, and the proportion of those patients who were discharged after less than 24 hours. The reasons for the hospitalization, the diagnoses and the treatment given were noted. RESULTS: There was a total of 595 hospitalizations of patients aged 75 or above in the emergency department during the period. Twenty-four percent of the older patients were discharged after less than 24 hours. Of these, 40% were discharged from the emergency department. The most common problems leading to hospitalization were change in contact or level of consciousness, focal neurological change, red, swollen or painful leg conditions, dyspnea, suspected parenchyma surgical disease and problems with the urinary system or catheters. The most common diagnoses given at hospital were chronic cardiovascular disease, bacterial infection, symptoms deriving from bone, muscle or connective tissue, liquid or electrolyte derangement and observation for suspected stroke or transient cerebral ischemia. Eight percent of the patients required telemetry, 27% received intravenous liquids, 30% had diagnostic radiology procedures performed and 3% needed invasive procedures. Other types of treatment given included electrocardiography, laboratory examinations, oxygen supplements, urinary catheterization and medicine administered orally, subcutaneously, as an intramuscular injection or as an inhalation. CONCLUSION: There appears to be a group of patients who cannot be adequately handled with the resources of the primary health care sector, yet who do not belong at the emergency department. Further studies are needed to create a suitable service for these patients, and to improve the continuity of the treatment and the cooperation between hospitals and the primary health care sector.

[Blood test results are available sooner if Point of Care testing is established in an emergency room]. / Afkortede svartider ved patientnær analyse af blodprøver i en akut fællesmodtagelse.

To determine patient priority and degree of urgency with an objective high-quality evaluation, general Point of Care testing (POCT) was established as a novel facility in the emergency department at Holbæk Hospital, a laboratory that provides faster results for common lab tests. When evaluating response time from arrival of the patient to the time at which the test results are available, POCT is not a significantly better test method than ordinary test methods. This indicates that in order to benefit from POCT the time before taking blood samples should be reduced to a minimum. Overcrowding needs to be controlled in order to accomplish this.

Low molecular weight heparin (Innohep) as thromboprophylaxis in outpatients with a plaster cast: a venografic controlled study.

INTRODUCTION: The aim of this study was to investigate the incidence of deep vein thrombosis (DVT) in patients immobilized in plaster cast and the possible efficacy of prophylaxis with low molecular weight heparin (LMWH). MATERIAL AND METHODS: The study was a randomized, assessor-blinded, open multicenter (three centers) study. All patients over 18 years of age with planned plaster cast on a lower extremity of at least 3 weeks were eligible for participation. Written informed consent was obtained from 300 patients and they were randomized to either 3.500 IU anti-Xa of tinzaparin (Innohep) subcutaneously once daily or no prophylaxis. On the day the cast was removed, ascending unilateral venography was performed. Two experienced radiologists, unaware of treatment, assessed the pictures independently. The radiologist had to obtain consensus as to whether DVT was present or not. RESULTS: 300 patients were included (148 in the treatment group and 152 in the control group). Ninety-five were subsequently withdrawn. DVT was diagnosed in 10/99 patients in the treatment group and in 18/106 patients in the control group. This difference is not significant (P=.15, chi(2) test) and the odds ratio was 0.55 (95% confidence interval=0.34-1.26). CONCLUSION: DVT in legs after plaster casting is a big problem, with an incidence of almost 20%. An effective prophylactic regime is required. Once-daily dose of 3.500 IU anti-Xa of tinzaparin was not sufficient.