Randomized Controlled Trial of Ondansetron vs. Prochlorperazine in Adults in the Emergency Department

Objective: To compare the effectiveness of ondansetron and prochlorperazine to treat vomiting. Secondary objectives were the effectiveness of ondansetron and prochlorperazine to treat nausea and their tolerability.Methods: This was a prospective, randomized, active controlled, double-blinded study. Using a convenience sample, patients were randomized to either intravenous ondansetron 4mg (n=32) or prochlorperazine 10mg (n=32). The primary outcome was the percentage of patients with vomiting at 0-30, 31-60, and 61-120 minutes after the administration of ondansetron or prochlorperazine. Secondary outcomes were nausea assessed by a visual analog scale (VAS) at baseline, 0-30, 31-60, and 61-120 minutes after the administration of ondansetron or prochlorperazine and the percentage of patients with adverse effects (sedation, headache, akathisia, dystonia) to either drug. We performed statistical analyses on the VAS scales at each time point and did a subgroup analysis to examine if nausea scores were affected if the patient had vomited at baseline.Results: The primary identified cause for nausea and vomiting was flu-like illness or gastroenteritis (19%). The number of patients experiencing breakthrough vomiting at 0-30, 31-60, and 61-120 minutes was similar between groups for these time periods; however, more patients receiving ondansetron experienced vomiting overall (7 [22%] vs. 2[3.2%] patients, p=not significant). Nausea scores at baseline and 0-30 minutes were severe and similar between groups; however, at 31-60 and 61-120 minutes, patients receiving prochlorperazine had better control of nausea (24.9 vs. 43.7 mm, p=0.03; 16.8 vs. 34.3 mm, p=0.05). Sedation scores were similar between groups. There were no cases of extrapyramidal symptoms as assessed by the treating physician and there were four cases of akathisia (prochlorperazine=3 [9%], ondansetron=1[3%]).Conclusion: Prochlorperazine and ondansetron appear to be equally effective at treating vomiting in the emergency department. [West J Emerg Med. 2011;12(1):1-5.

Long-term functional and quality of live assessment following post-traumatic distraction osteogenesis of the lower limb

Limb length discrepancy and segmental bone defects can be difficult problems to manage after fractures of the lower limb. Distraction osteogenesis can be applied to lengthen bone or to bridge intercalary defects by segmental bone transport. The purpose of this study was to assess the functional outcome and long-term quality of life after distraction osteogenesis of the lower limb when applied for post-traumatic problems. Three patients were treated with segmental transport for bone loss secondary to infection and debridement after a tibia fracture. Leg lengthening was performed in 12 patients with consolidated fractures (eight femurs and four tibias). Long-term functional outcomes were evaluated with the Short Form-36 Health Survey (SF-36) and the Lower Extremity Functional Scale (LEFS) in all patients. The mean follow-up was 9 years. Functional outcomes indicated moderate difficulty in patients after segmental transport and a little difficulty in patients after lengthening of consolidated fractures. The SF-36 scores varied two points for physical functioning and one point for bodily pain as compared to the SF-36 norm-based scores. In all other six domains, patient scores were comparable with the general population. In conclusion, the quality of life and functional outcome returned to normal after post-traumatic distraction osteogenesis of the lower limb

Implant removal after internal fixation of a femoral neck fracture: Effects on physical functioning

Objectives: The effect of implant removal after internal fixation of a femoral neck fracture on physical functioning was analyzed. Characteristics of patients who had their implant removed were studied, as it is currently unknown from which type of patients implants are removed and what effect removal has on function. Design: Secondary cohort study alongside a randomized controlled trial. Setting: Multicenter study in 14 hospitals. Patients and Intervention: Patients who had their implant removed after internal fixation of a femoral neck fracture are compared with patients who did not. Main outcome measurements: Patient characteristics and quality of life (Short Form 12, Western Ontario McMaster Osteoarthritis Index) were compared. Matched pairs were selected based on patient/fracture characteristics and prefracture physical functioning. Results: Of 162 patients, 37 (23%) had their implant removed. These patients were younger (median age: 67 vs. 72 years, P 0.024) and more often independently ambulatory prefracture (100% vs. 84%, P 0.008) than patients who did not. They more often had evident implant back-out on x-rays (54% vs. 34%, P 0.035), possibly related to a higher rate of Pauwels 3 fractures (41% vs. 22%, P 0.032). In time, quality of life improved more in implant removal patients [+2 vs. -4 points, Short Form 12 (physical component), P 0.024; +9 vs. 0 points, Western Ontario McMaster Osteoarthritis Index, P 0.019]. Conclusions: Implant removal after internal fixation of a femoral neck fracture positively influenced quality of life. Implant removal patients were younger and more often independently ambulatory prefracture, more often had a Pauwels 3 fracture, and an evident implant back-out. Implant removal should be considered liberally for these patients if pain persists or functional recovery is unsatisfactory. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence

Subtalar versus triple arthrodesis after intra-articular calcaneal fractures

Depending upon initial treatment, between 2 and 30% of patients with a displaced intra-articular calcaneal fracture require a secondary arthrodesis. The aim of this study was to investigate the effect of subtalar versus triple arthrodesis on functional outcome. A total of 33 patients with 37 secondary arthrodeses (17 subtalar and 20 triple) with a median follow-up of 116 months were asked to complete questionnaires regarding disease-specific functional outcome (Maryland Foot Score, MFS), quality of life (SF-36) and overall satisfaction with the treatment (Visual Analogue Scale, VAS). Patient groups were comparable considering median age at fracture, initial treatment (conservative or operative), time to arthrodesis, median follow-up, and post-arthrodesis radiographic angles. The MFS score was similar after subtalar versus triple arthrodesis (59 vs. 56 points; P = 0.79). No statistically significant difference was found for the SF-36 (84 vs. 83 points; P = 0.67) and the VAS (5 vs. 6; P = 0.21). Smoking was statistically significantly associated with a non-union (χ2 = 6.60, P = 0.017). The current study suggests that there is no significant difference in functional outcome between an in situ subtalar or triple arthrodesis as a salvage technique for symptomatic arthrosis after an intra-articular calcaneal fracture. Smoking is a risk factor for non-union

Patient Demographics in Acute Care Surgery at the Ruijin Hospital in Shanghai

Acute Care Surgery is a discipline that includes trauma care, surgical critical care, and emergency surgery. It is organized in different models and provides mainly operative and nonoperative care. The aim of this study was to provide a demographic analysis of the care of surgical patients at the Emergency Department (ED) in a large teaching hospital in Shanghai, where general surgeons and orthopedic surgeons take care for most of all acute surgery. A bilingual questionnaire was developed to collect data for patients referred to the general or orthopedic surgeon in the ED (June–September 2008). Data about the gender, age, diagnosis, diagnostic tools, treatments, and outcomes were collected. A total of 255 questionnaires were collected; the most common diagnoses of patients were infections of abdominal organs and fractures. Complementary diagnostics like X-ray (59%), blood tests (36%), and ultrasound (17%) were frequently used. More than half of the patients were discharged afterwards most of them with followup. This study gives a first overview of acute care surgery of the emergency patients of the ED in a large Chinese metropolitan hospital

Emergency medicine training in the Netherlands, essential changes needed

Since 2008, training for emergency physicians (EPs) in the Netherlands has been based on a national 3-year curriculum. However, it has become increasingly evident that it needs to expand beyond its initial foundations. The training period does not comply with European regulations of a minimum of 5 years. Adjusting to this European standard is a logical step. Experience with the 3-year Dutch training scheme has led to the general conclusion that this training period is too short. Recommendations for essential changes and the basis for their development are presented

Properties of commonly used calcium phosphate cements in trauma and orthopaedic surgery

Introduction Half of the population sustains at least one fracture during their lifetime, and the majority of these fractures heal successfully. Successful fracture healing requires the following five elements; (i) osteogenic cells (e.g., osteoblasts), (ii) osteoinductive stimuli (e.g., bone morphogenetic proteins); (iii) an osteoconductive matrix; (iv) adequate blood and nutrient supply, and (v) sufficient mechanical support. One or more elements can be compromised due to the existence of a bone defect. Bone defects are treated with bone grafts in order to avoid insufficient fracture healing. Insufficient fracture healing is encountered in 5–10% of the fractures, resulting in delayed union, malunion, or non-union

Demographic Analysis of Emergency Department Patients at the Ruijin Hospital, Shanghai

Emergency medicine is an upcoming discipline that is still under development in many countries. Therefore, it is important to gain insight into the organization and patients presenting to the Emergency Department (ED). The aim of this cross-sectional study was to provide an epidemiological description of complaints and referrals of the patients visiting the ED of the Ruijin Hospital in Shanghai, China. A questionnaire was developed and completed for a convenience sample of all patients presenting to the Triage Desk of the ED. The study was performed in June 2008. A total of 2183 questionnaires were completed. The most common complaints were fever (15%), stomach/abdominal pain (15%), vertigo/dizziness (11%), and cough (10%). Following triage, patients were predominantly referred to an internist (41%), neurologist (14%), pulmonologist (11%), or general surgeon (9%). This study provides a better understanding of the reason for the ED visit and the triage system at the ED of the Ruijin Hospital. The results can be used in order to improve facilities appropriate for the specific population in the ED

Functional Outcome After Successful Internal Fixation Versus Salvage Arthroplasty of Patients With a Femoral Neck Fracture

Objectives: To determine patient independency, health-related and disease-specific quality of life (QOL), gait pattern, and muscle strength in patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture. Design: Secondary cohort study to a randomized controlled trial. Setting: Multicenter trial in the Netherlands, including 14 academic and nonacademic hospitals. Patients: Patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture were studied. A comparison was made with patients who healed uneventfully after internal fixation. Intervention: None (observatory study). Main Outcome Measurements: Patient characteristics, SF-12, and Western Ontario McMaster osteoarthritis index scores were collected. Gait parameters were measured using plantar pressure measurement. Maximum isometric forces of the hip muscles were measured using a handheld dynamome

Prehospital interventions: Time wasted or time saved? An observational cohort study management in initial trauma care

Objective: Preclinical actions in the primary assessment of victims of blunt trauma may prolong the time to definitive clinical care. Th