Painful Memories: Reliability of Pain Intensity Recall at 3 Months in Senior Patients

Background. Validity of pain recall is questioned in research. Objective. To evaluate the reliability of pain intensity recall for seniors in an emergency department (ED). Methods. This study was part of a prospective multicenter project for seniors (≥65 years old) treated in an ED for minor traumatic injury. Pain intensity (0–10 numerical rating scale) was evaluated at the initial ED visit, at one week (baseline), and 3 months. At three months, patients were asked to recall the pain intensity they had at baseline. Results. 482 patients were interviewed (mean age 76.6 years, SD ± 7.3) and 72.8% were female. Intraclass correlation coefficient between pain at baseline and its recall was 0.24 (95% CI: 0.14–0.33). Senior patients tended to overestimate their pain intensity by a mean of 1.2 (95% CI: 0.9–1.5) units. A stepwise multiple regression analysis showed that the variance of baseline pain recall at 3 months was explained by pain at ED visit (11%), pain at 3 months (7%), and pain at baseline (2%). Conclusion. The accuracy of pain intensity recall after three months is poor in seniors and seems to be influenced by the pain experienced at the time of injury

Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study

Objective To measure the sensitivity of modern third generation computed tomography in emergency patients being evaluated for possible subarachnoid haemorrhage, especially when carried out within six hours of headache onset

Social network analysis as a metric for the development of an interdisciplinary, inter-organizational research team

The development of an interdisciplinary and inter-organizational research team among eight of Canada’s leading emergency, geriatric medicine and rehabilitation researchers affiliated with six academic centers has provided an opportunity to study the development of a distributed team of interdisciplinary researchers using the methods of social network theory and analysis and to consider whether these methods are useful tools in the science of team science. Using traditional network analytic methods, the team of investigators were asked to rate their relationships with one another retrospectively at one year prior to the team’s first meeting and contemporaneously at two subsequent yearly intervals. Using network analytic statistics and visualizations the data collected finds an increase in network density and reciprocity of relationships together with more distributed centrality consistent with the findings of other researchers. These network development characteristics suggest that the distributed research team is developing as it should and supports the assertion that network analysis is a useful science of team science research tool

Hyperosmolar Therapy in Severe Traumatic Brain Injury: A Survey of Emergency Physicians from a Large Canadian Province

<div><p>Introduction</p><p>Worldwide, severe traumatic brain injury is a frequent pathology and is associated with high morbidity and mortality. Mannitol and hypertonic saline are therapeutic options for intracranial hypertension occurring in the acute phase of care. However, current practices of emergency physicians are unknown.</p><p>Methods</p><p>We conducted a self-administered survey of emergency physicians in the province of Québec, Canada, to understand their attitudes surrounding the use of hyperosmolar solutions in patients with severe traumatic brain injury. Using information from a systematic review of hypertonic saline solutions and experts' opinion, we developed a questionnaire following a systematic approach (items generation and reduction). We tested the questionnaire for face and content validity, and test-retest reliability. Physicians were identified through the department head of each eligible level I and II trauma centers. We administered the survey using a web-based interface and planned email reminders.</p><p>Results</p><p>We received 210 questionnaires out of 429 potentials respondents (response rate 49%). Most respondents worked in level II trauma centers (69%). Fifty-three percent (53%) of emergency physicians stated using hypertonic saline to treat severe traumatic brain injury. Most reported using hyperosmolar therapy in the presence of severe traumatic brain injury and unilateral reactive mydriasis, midline shift or cistern compression on brain computed tomography.</p><p>Conclusion</p><p>Hyperosmolar therapy is believed being broadly used by emergency physicians in Quebec following severe traumatic brain injury. Despite the absence of clinical practice guidelines promoting the use of hypertonic saline, a majority of them said to use these solutions in specific clinical situations.</p></div

Factors influencing the intention of use of hyperosmolar solutions.

<p>Factors influencing the intention of use of hyperosmolar solutions.</p

Respondents' demographic characteristics.

<p>Respondents' demographic characteristics.</p