A stab wound to neck is an infrequent but highly important presentation to the ED in Australasia. Injuries to the two large neurovascular bundles that are vital to life might occur with associated injuries to midline aerodigestive structures. A literature review was undertaken to discuss the assessment and management of this injury in the emergency medicine setting.
Results There were 57 presentations of 34 young persons identified. The mean age was 13.4 years, with a female to male ratio of 8:2. A progressive increase in the proportion of presentations in the 0-12 years cohort was identified. 25% presentations were unknown to Child and Adolescent Mental Health Services (CAMHS) at the time of presentation. Anorexia Nervosa Restricting type accounted for the vast majority of presentations (68%), followed by ARFID (14%). 54 out of 57 presentations required admission, and the mean length of admission was 12 days (range 1-41). The average median% BMI on admission was 72% and 80% at discharge. Nearly half of those admitted were discharged to a CAMHS inpatient unit. Evidence of compliance of recording JMARSIPAN parameters was approximately 60% on admission and 43% on discharge.Conclusion This study provides important data regarding patterns of clinical presentation for this high risk population, and will be useful in service planning and development. It confirms an increase in presentations of young persons with restrictive eating disorders over the last 5 years, in particular in the age 0-12 cohort, in line with international trends. Young people are presenting with severe physical complications, and the majority required admission for medical stabilization. In line with services internationally, the study indicates historic deficits in the standards of risk assessment compared to JMARSIPAN guidelines. The Tallaght University Hospital has introduced new Paediatric Guidelines on Management of Anorexia Nervosa in 2019, and we will complete the audit of practice in one year.
Patients with a palliative diagnosis were excluded from this study.Results 87 patients were discharged directly home in the 6 year study period. No patients died within 30 days of discharge. The median PIM 3 score was 0.0139 (IQR 0.0072-0.0347). Of patients admitted diagnoses were 41% Respiratory, 33% Peri-operative, 8% Cardiology, 6% Toxicology, 5% Neurology, 5% Gastrointestinal, 2% Allergy and 1% Trauma. 69 (79%) of patients had a past medical history. In 34 (39%) admissions patients had a tracheostomy. There were no discharges against medical advice. The primary team was informed of discharge for 84 (97%) patients. A documented follow-up plan was recorded for 46 (53%) patients. There was written communication with the patients general practitioner for 22 (25%) patients. 5 (6%) patients were discharged outside the hours of 9:00-17:00. Conclusions For the most part primary teams were informed and the majority of patients had follow-up arranged, however communication with the GP was poor. Following the results of this study a standardised template was introduced at our institution to improve the discharge process.
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