Abstract:
OBJECTIVES:Head injury is a common reason for emergency department (ED) attendance. Around 1% of patients have life-threatening injuries, while 80% of patients are discharged. National guidelines (Scottish Intercollegiate Guidelines Network (SIGN)) were introduced in Scotland with the aim of achieving early identification of those with acute intracranial lesions yet safely reducing hospital admissions.This study aims to assess the impact of these guidelines and any effect the national 4-hour ED performance target had on hospital admissions for head injury. SETTING:All Scottish hospitals between April 1998 and March 2016. PARTICIPANTS:Patients admitted to hospital for head injury or traumatic brain injury (TBI) diagnosed by CT imaging identified using administrative Scottish Information Services Division data. There are 275 hospitals in Scotland. In 2015/2016, there were 571 221 emergency hospital admissions in Scotland. INTERVENTIONS:The SIGN head injury guidelines introduced in 2000 and 2009. The 4-hour ED target introduced in 2004. OUTCOMES:The monthly rate of hospital admissions for head injury and traumatic brain injury. STUDY DESIGN:An interrupted time series analysis. RESULTS:The first guideline was associated with a reduction in monthly admissions of 0.14 (95% CI 0.09 to 4.83) per 100 000 population. The 4-hour target was associated with a monthly increase in admissions of 0.13 (95% CI 0.06 to 0.20) per 100 000 population. The second guideline reduced monthly admissions by 0.09 (95% CI-0.13 to -0.05) per 100 000 population. These effects varied between age groups.The guidelines were associated with increased admissions for patients with injuries identified by CT imaging-guideline 1: 0.06 (95% CI 0.004 to 0.12); guideline 2: 0.05 (95% CI 0.04 to 0.06) per 100 000 population. CONCLUSION:Increased CT imaging of head injured patients recommended by SIGN guidelines reduced hospital admissions. The 4-hour ED target and the increased identification of TBI by CT imaging acted to undermine this effect.
journal_name
BMJ Openjournal_title
BMJ openauthors
Marincowitz C,Lecky FE,Morris E,Allgar V,Sheldon TAdoi
10.1136/bmjopen-2018-022279subject
Has Abstractpub_date
2018-12-22 00:00:00pages
e022279issue
12issn
2044-6055pii
bmjopen-2018-022279journal_volume
8pub_type
杂志文章,多中心研究相关文献
BMJ Open文献大全abstract:OBJECTIVE:Few studies have comprehensively examined changes in smoking status and related factors after a disaster. We examined these factors among residents of an evacuation area in Fukushima after the Great East Japan Earthquake. METHODS:The study participants included 58 755 men and women aged ≥20 years who partici...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-018943
更新日期:2018-06-30 00:00:00
abstract:INTRODUCTION:Person-centredness is a philosophy for organising and delivering healthcare based on patients' needs, preferences and experiences. Although widely endorsed, the concept suffers from a lack of detail and clarification, in turn accounting for ambiguous implementation and outcomes. While a conceptual framewor...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-011959
更新日期:2016-07-19 00:00:00
abstract:BACKGROUND:Research on patient safety in emergency medical services (EMS) has mainly focused on the organisation's and/or the EMS personnel's perspective. Little is known about how patients perceive safety in EMS. This study aims to describe the patients' experiences of their sense of safety in EMS. METHODS:A qualitat...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-037488
更新日期:2020-10-21 00:00:00
abstract:OBJECTIVE:Percutaneous pulmonary valve implantation is an alternative to open heart surgery in selected patients with pulmonary outflow tract disorder. The technique may reduce the number of open-chest surgeries in these patients. This study was conducted to understand how the patients and their next-of-kin experienced...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2014-005102
更新日期:2014-07-29 00:00:00
abstract:INTRODUCTION:Severe and persistent mental illness (SPMI) can significantly impact a person's social, personal and professional life. Previous studies have demonstrated pharmacists' roles in mental healthcare; however, limited studies to date have focused on pharmacists' roles in providing healthcare services, specifica...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-038270
更新日期:2020-07-13 00:00:00
abstract:OBJECTIVES:Despite widespread availability of evidence-based guidelines to inform rational use of medicines, considerable unwarranted variation exists in prescribing. A greater understanding of key determinants of contemporary prescribing in UK general practice could inform strategies to promote evidence-based prescrib...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-041460
更新日期:2021-01-11 00:00:00
abstract:OBJECTIVES:Pharmacoepidemiological studies are an important hypothesis-testing tool in the evaluation of postmarketing drug safety. Despite the potential to produce robust value-added data, interpretation of findings can be hindered due to well-recognised methodological limitations of these studies. Therefore, assessme...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-001362
更新日期:2012-09-25 00:00:00
abstract:OBJECTIVE:To obtain in-depth insight into the perceptions of parents and paediatricians in China regarding current procedural pain management on bone marrow aspirations and lumbar punctures in paediatric haemato-oncology department. DESIGN, SETTING AND PARTICIPANTS:This qualitative study was conducted in a 4500-bed un...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-015727
更新日期:2017-09-21 00:00:00
abstract:INTRODUCTION:Preterm babies are among the highest users of parenteral nutrition (PN) of any patient group, but there is wide variation in commencement, duration, and composition of PN and uncertainty around which groups will benefit from early introduction. Recent studies in critically unwell adults and children sugges...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-029065
更新日期:2019-07-09 00:00:00
abstract:OBJECTIVE:To investigate whether high levels of screen time exposure are associated with self-perceived levels of attention problems and hyperactivity in higher education students. DESIGN:Cross-sectional study among participants of the i-Share cohort. SETTING:French-speaking students of universities and higher educat...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2015-009089
更新日期:2016-02-26 00:00:00
abstract:OBJECTIVE:Danish medical registries are widely used for cardiovascular research, but little is known about the data quality of cardiac interventions. We computed positive predictive values (PPVs) of codes for cardiac examinations, procedures and surgeries registered in the Danish National Patient Registry during 2010-2...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-012817
更新日期:2016-12-09 00:00:00
abstract:OBJECTIVES:Moderation of alcohol consumption is included as a class I, level of evidence A recommendation in the current European guidelines for the management of hypertension. We investigated its awareness and self-reported implementation among European physicians across different specialties and workplaces. DESIGN A...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-022026
更新日期:2018-10-21 00:00:00
abstract:OBJECTIVES:(1) To establish the likelihood of dying within 12 months for a cohort of hospital inpatients in New Zealand (NZ) on a fixed census date; (2) to identify associations between likelihood of death and key sociodemographic, diagnostic and service-related factors and (3) to compare results with, and extend findi...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-016880
更新日期:2017-12-06 00:00:00
abstract:OBJECTIVES:Overweight and obesity remain at historically high levels, cluster within families and are established risk factors for multiple diseases. We describe the epidemiology and cross-generational concordance of body composition among Australian children aged 11-12 years and their parents. DESIGN:The population-b...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2018-023698
更新日期:2019-07-04 00:00:00
abstract:BACKGROUND:Cervical cancer rates are higher in low-resourced countries than high, partly due to lower rates of screening. Incidence in Thailand is nearly three times higher than in the USA (16.2 vs 6.5 age-standardised incidence), even with Thailand's universal health coverage, which includes screening, suggesting that...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-031957
更新日期:2019-11-03 00:00:00
abstract:INTRODUCTION:Although guided forms of internet-based cognitive-behavioural therapy (iCBT) result in a substantial reduction in depression, it seems that the most scalable way to deliver iCBT is without guidance. However, direct evidence on the comparison between guided and self-guided iCBT is scarce. Moreover, it is un...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-026820
更新日期:2019-06-05 00:00:00
abstract:OBJECTIVES:To investigate mortality in adults with intellectual disabilities: rates, causes, place, demographic and clinical predictors. DESIGN:Cohort study with record linkage to death data. SETTING:General community. PARTICIPANTS:961/1023 (94%) adults (16-83 years; mean=44.1 years; 54.6% male) with intellectual di...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-036465
更新日期:2020-05-17 00:00:00
abstract:OBJECTIVES:To investigate the impact of gender on multimorbidity in northern Iran. DESIGN:A cross-sectional analysis of the Golestan cohort data. SETTING:Golestan Province, Iran. STUDY POPULATION:49 946 residents (age 40-75 years) of Golestan Province, Iran. MAIN OUTCOME MEASURES:Researchers collected data related ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-013548
更新日期:2017-05-09 00:00:00
abstract:INTRODUCTION:Recent studies suggest that endoplasmic reticulum stress may play a critical role in the pathogenesis of amyotrophic lateral sclerosis (ALS) through an altered regulation of the proteostasis, the cellular pathway-balancing protein synthesis and degradation. A key mechanism is thought to be the dephosphoryl...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2016-015434
更新日期:2017-08-11 00:00:00
abstract:OBJECTIVE:To examine the effects of a consultant-led, community-based chronic obstructive pulmonary disease (COPD) service, based in a highly deprived area on emergency hospital admissions. DESIGN:A longitudinal matched controlled study using difference-in-differences analysis to compare the change in outcomes in the ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-032931
更新日期:2020-05-27 00:00:00
abstract:OBJECTIVE:To examine the role of dietary intake and physical activity in muscle strength among adolescents. DESIGN:Cross-sectional analysis. SETTING:The Malaysian Health and Adolescents Longitudinal Research Team (MyHeART) study. PARTICIPANTS:Fifteen-year-old secondary school children who have given consent and who ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-026275
更新日期:2019-06-27 00:00:00
abstract:OBJECTIVE:To assess the seroprevalence of recent/acute and past exposure to rubella virus infection and associated risk factors among pregnant women. DESIGN:A hospital-based cross-sectional study. SETTING:The study was conducted in two public hospitals in Hawassa City, Southern Ethiopia. PARTICIPANTS:A total of 422 ...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2017-016824
更新日期:2017-10-05 00:00:00
abstract:INTRODUCTION:Rapid, robust and continually updated evidence synthesis is required to inform management of COVID-19 in pregnant and postpartum women and to keep pace with the emerging evidence during the pandemic. METHODS AND ANALYSIS:We plan to undertake a living systematic review to assess the prevalence, clinical ma...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-041868
更新日期:2020-12-02 00:00:00
abstract:INTRODUCTION:Raised blood pressure (BP) is common after stroke and is associated with a poor prognosis, yet trials of BP lowering in the immediate poststroke period have not demonstrated a benefit. One possible explanation for this may be that BP variability (BPV) rather than absolute levels predicts outcome, as BPV is...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-025301
更新日期:2019-02-19 00:00:00
abstract:OBJECTIVE:The 2010 healthcare reform in England introduced primary care-led commissioning in the National Health Service (NHS) by establishing clinical commissioning groups (CCGs). A key factor for the success of the reform is the provision of excellent commissioning support services to CCGs. The Government's aim is to...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2014-005970
更新日期:2014-10-15 00:00:00
abstract:BACKGROUND:The utilisation of available cross-European data for secondary data analyses on physical activity, sedentary behaviours and their underlying determinants may benefit from the wide variation that exists across Europe in terms of these behaviours and their determinants. Such reuse of existing data for further ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-017489
更新日期:2017-10-22 00:00:00
abstract:OBJECTIVE:Proton pump inhibitors (PPIs) are widely used, and their use is associated with increased risk of adverse events. However, whether PPI use is associated with excess risk of death is unknown. We aimed to examine the association between PPI use and risk of all-cause mortality. DESIGN:Longitudinal observational...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-015735
更新日期:2017-07-04 00:00:00
abstract:INTRODUCTION:Hamstring injury among athletes often results in significant morbidity. Currently, there are controversies regarding the clinical use of platelet-rich plasma (PRP) for the treatment of acute hamstring injury. METHODS AND ANALYSIS:This study is a single-centre double-blind randomised placebo-controlled tri...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-039105
更新日期:2020-08-20 00:00:00
abstract:OBJECTIVE:To determine the relationship between biomarkers of exposure, disease and susceptibility, and early health effects and long-term diseases related to occupational manganese (Mn) exposure. DESIGN:Baseline survey of a longitudinal cohort study of workers in a ferromanganese refinery. PARTICIPANTS:A total of 18...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2014-005070
更新日期:2014-07-03 00:00:00
abstract:OBJECTIVES:In recent years, the involvement of pharmacy technicians in medication reconciliation has increasingly been investigated. The aim of this study was to assess the implications on professional roles and collaboration when a best possible medication history (BPMH) at admission is obtained by pharmacy technician...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2017-020566
更新日期:2018-05-17 00:00:00