Prognostic/Epidemiologic, level IV.

No abstract

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people’s services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.

BackgroundImprovements in trauma resuscitation practice have reduced the early in-hospital mortality from haemorrhage and its immediate sequelae. Early cardiovascular dysfunction (CVD) is a poorly understood and under-recognised major contributor to contemporary trauma deaths. The objective of this study was to demonstrate the prevalence and impact of CVD in a population of trauma patients without catastrophic TBI.A review of data collected prospectively at a UK Major Trauma Centre from 2008–2018. Adult trauma patients over the age of 15 were included. CVD was defined as a score of 4 on admission or day 1 of admission using the cardiovascular component of the SOFA score.1042 patients were included, of which 125 (12%) had CVD. The 28-day mortality rate in the total population was 4.8%, and of those 64% had CVD. CVD was associated with a blunt mechanism of injury (81.6%), male gender (81.6%), and a high injury severity score (median=27). In the CVD group the major haemorrhage protocol was activated in 76.8% of patients, and 73.6% received more than 4 units of red blood cells in the first 24 hours.Early CVD was more prevalent than any other single-system dysfunction assessed with the SOFA. All deaths with single organ failure in a SOFA domain other than cardiovascular had concurrent CVD. In predicting 28-day mortality, CVD had an AUROC of .882 (CI=0.810–0.955,p=0.000), odds ratio of 57.2, and sensitivity and specificity of 86.7% and 89.7% respectively. Multiple regression analysis identified admission base deficit, admission systolic blood pressure and heart rate, increased age, blunt mechanism, increased injury severity score, and 24-hour crystalloid administration as strong predictors of developing CVD.Abstract 034 Figure 1Early SOFA domain and mortalityAbstract 034 Figure 2Prevalence of CVD and its contribution to other organ dysfunctionAbstract 034 Table 1DemographicsCVD is the contemporary driver of in-hospital non-head injured trauma mortality. The resuscitation phase is the window of opportunity for discovery of novel treatments.