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Incentive Spirometry is commonly used for respiratory recovery. The literature on incentive spirometry and its impact on patients with rib fracture is unclear and there are no recommendations regarding its use in the Emergency Department (ED), particularly in rib fracture patients, which are known for increasing the risk of pulmonary complication. Therefore, the objective of this study was to assess the use of incentive spirometry and to measure its impacts on delayed complications in patients discharged from the ED with confirmed rib fracture.
This is a planned sub-study of a prospective observational cohort recruited in 4 Canadians ED between November 2006 and May 2012. Non-admitted patients over 16 y.o. with at least one confirmed rib fracture on radiographs were included. Prescription of incentive spirometry was left to attending physician. Main outcomes were development of pneumonia, atelectasis, and hemothorax within 14 days. Propensity score matching analyses were performed.
439 patients were included and 182 (41.5%) patients received incentive spirometry. There were 99 cases of hemothorax (22.6%), 103 cases of atelectasis (23.5%) and 4 cases of pneumonia (0.9%). The use of incentive spirometry was not protector for hemothorax [RR = 1.03 (0.66–1.64)] and atelectasis or pneumonia [RR = 1.07 (0.68–1.72)].
Our results suggest that unsupervised incentive spirometry use does not have a protective effect against delayed pulmonary complications after rib fracture. Further research should be conducted to assess the usefulness of incentive spirometry in specific injured population in the ED.
Delirium is very frequent in older patients presenting to the emergency department (ED), but is often undetected. The purpose of this study was to evaluate the performance of the French version of the 4 A’s Test (4AT-F) for the detection of delirium and cognitive impairment in older patients.
The study was conducted in four Canadian ED. Participants (n= 320) were independent or semi-independent patients (able to perform ≥5 activities of daily living) aged 65 and older and had an 8-hour exposure to the ED environment. The Telephone Interview for Cognitive Status (TICS-m), the Confusion Assessment Method (CAM) as well as the 4AT-F were administered to patients at the initial interview. The CAM and 4AT-F were then administered twice a day during the patients’ ED or hospital stay. The 4AT-F’s sensitivity and specificity were compared to those of the CAM (for delirium), and to that of the TICS (for cognitive impairment).
Our results suggest that the 4AT-F has a sensitivity of 84% (95% CI: [76, 93]) and a specificity of 74% (95% CI: [70, 78]) for delirium, as well as a sensitivity of 49% (95% CI: [34, 64]) and a specificity of 87% (95% CI: [82, 92]) for cognitive impairment.
The 4AT-F is a fast and reliable screening tool for delirium and cognitive impairment in ED. Due to its quick administration time, it allows a systematic screening of patients at risk of delirium, without significantly increasing the workload of the ED staff.
In the fast pace of the Emergency Department (ED), clinicians are in need of tailored screening tools to detect seniors who are at risk of adverse outcomes. We aimed to explore the usefulness of the Bergman-Paris Question (BPQ) to expose potential undetected geriatric syndromes in community-living seniors presenting to the ED.
This is a planned sub-study of the INDEED multicentre prospective cohort study, including independent or semi-independent seniors (≥65 years old) admitted to hospital after an ED stay ≥8 hours and who were not delirious. Patients were assessed using validated screening tests for 3 geriatric syndromes: cognitive and functional impairment, and frailty. The BPQ was asked upon availability of a relative at enrolment. BPQ’s sensitivity and specificity analyses were used to ascertain outcomes.
A response to the BPQ was available for 171 patients (47% of the main study’s cohort). Of this number, 75.4% were positive (suggesting impairment), and 24.6% were negative. To detect one of the three geriatric syndromes, the BPQ had a sensitivity of 85.4% (95% CI [76.3, 92.0]) and a specificity of 35.4% (95% CI [25.1, 46.7]). Similar results were obtained for each separate outcome. Odds ratio demonstrated a higher risk of presence of geriatric syndromes.
The Bergman-Paris Question could be an ED screening tool for possible geriatric syndrome. A positive BPQ should prompt the need of further investigations and a negative BPQ possibly warrants no further action. More research is needed to validate the usefulness of the BPQ for day-to-day geriatric screening by ED professionals or geriatricians.
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