BackgroundPatients admitted to emergency departments with traumatic brain injury (TBI) are commonly being treated with oral anticoagulants. In contrast to patients without anticoagulant medication, no guidelines, scores or recommendations exist for the management of mild traumatic brain injury in these patients. We therefore tested whether age as one of the high risk factors of the Canadian head CT rule is applicable to a patient population on oral anticoagulants.MethodsThis cross-sectional analysis included all patients with mild TBI and concomitant oral anticoagulant therapy admitted to the Emergency Department, Inselspital Bern, Switzerland, from November 2009 to October 2014 (n = 200). Using a logistic regression model, two groups of patients with mild TBI on oral anticoagulant therapy were compared — those with and those without intracranial haemorrhage.ResultsThere was no significant difference in age between the patient groups with (n = 86) and without (n = 114) intracranial haemorrhage (p = 0.078).In univariate logistic regression, GCS (OR = 0.419 (0.258; 0.680)) and thromboembolic event as reason for anticoagulant therapy (OR = 0.486 (0.257; 0.918)) were significantly associated with intracranial haemorrhage in patients with mild TBI and anticoagulation (all p < 0.05). However, there was no association with age (p = 0.078, OR = 1.024 (0.997; 1.051)), the type of accident or additional medication with acetylsalicylic acid or clopidogrel ((both p > 0.05; 0.552 (0.139; 2.202) and 0.256 (0.029; 2.237), respectively).ConclusionOur study found no association between age and intracranial bleeding. Therefore, until further risk factors are identified, diagnostic imaging with CCT remains necessary for mild TBI patients on oral anticoagulation of all ages, especially those with therapeutic anticoagulation because of thromboembolic events.

Studies in Europe have found that immigrants, compared to the local population, are more likely to seek out medical care in Emergency Departments (EDs). In addition, studies show that immigrants utilize medical services provided by EDs for less acute issues. Despite these observed differences, little is known about the characteristics of ED use by North African (NA) immigrants. The main objective of this study was to examine whether there were differences in ED discharge outcomes and psychiatric referrals between NA immigrants and Swiss nationals. A retrospective analysis was conducted using patient records from NA and Swiss adults who were admitted to the ED of the University Hospital in Bern (Switzerland) from 2013–2016. Measures included demographic information as well as data on types of admission. Outcome variables included discharge type and psychiatric referral. A total of 77,619 patients generated 116,859 consultations to the ED, of which 1.1 per cent (n = 1338) were consultations by NA patients. Compared to Swiss national patients, NA patients were younger, with a median age of 38.0 (IQR 28–51 years vs. 52.0 (IQR 32–52) for Swiss and predominantly male (74.4% vs. 55.6% in the Swiss). NA patient admission type was more likely to be “walk-in” or legal admission (7.5% vs 0.8 in Swiss,). Logistic regressions indicated that NA patients had 1.2 times higher odds (95% CI 1.07–1.40, p < 0.003) of receiving ambulatory care. An effect modification by age group and sex was observed for the primary outcome “seen by a psychiatrist”, especially for men in the 16–25 years age group, whereby male NA patients had 3.45 times higher odds (95% CI: 2.22–5.38) of having being seen by a psychiatrist. In conclusion differences were observed between NA and Swiss national patients in ED consultations referrals and outcomes, in which NA had more ambulatory discharges and NA males, especially young, were more likely to have been seen by psychiatrist. Future studies would benefit from identifying those factors underlying these differences in ED utilization.

ObjectivesOutdoor rock climbing has become popular in recent years. However, few data have been published on climbing accidents in Switzerland, even though the Swiss Alps are a major climbing resort.To analyse data on accidents related to outdoor climbing treated in the Emergency Department (ED) of University Hospital Bern, Switzerland.MethodsA retrospective database search for accidents related to outdoor climbing was conducted in the clinical reporting system E.care of the ED of University Hospital Bern for the period April 2012–December 2018.Results78 patients were treated after an accident related to outdoor climbing, which accounted for 1 per 3571 (0.028%) of all ED visits during this period. Mean age was 35.8±10.4 years. 76% of patients were male. Falls were the most common mechanism of injury (64%), followed by rock or ice falling on the climber (21%). Injuries affected multiple body regions (38%) or only the lower limbs (22%). Most injuries were fractures (68%). Mean ISS was 7.5 (1–38), and grade 3 UIAA MedCom injuries were most common (45%). 11 cases of polytrauma occurred and one fatality. 44 patients needed inpatient admission. Mean duration of inpatient stay was 7 days. Mean costs per patient were 12 283 CHF.ConclusionsAccidents related to outdoor climbing accounted for a small number of patients seen in the University ED Bern. Further research should be on a nationwide basis, with collection of specific climbing data like use of a helmet and experience of climbing to inform injury prevention strategies. This should shed further light on this topic, as would a prospective study using the International Alpine Trauma Register.

Zusammenfassung. Gartenarbeit ist eine beliebte Freizeitaktivität in der Schweiz. Pro Jahr werden ungefähr eine Million Nichtberufsunfälle registriert, davon ereignen sich etwa 600 000 zu Hause oder während der Ausübung eines Hobbies, einschliesslich 16 000 Unfällen bei der Gartenarbeit. Ziel dieser retrospektiven Analyse ist die Untersuchung von Gartenarbeitsunfällen. Die Daten wurden aus der elektronischen Datenbank des Universitären Notfallzentrums des Inselspitals Bern gesammelt und retrospektiv ausgewertet. Patienten im Alter von 16 Jahren oder älter, die einen Unfall während der Gartenarbeit als Freizeitaktivität erlitten, wurden in die Analyse eingeschlossen. Jüngere Patienten wurden in einem separaten Notfallzentrum für Kinder und Jugendliche behandelt und somit nicht ausgewertet. Anschliessend wurden die Daten nach Alter, Geschlecht, Triagekategorie, Unfallmechanismus, unfallverursachendem Objekt, betroffenen Körperregionen, Diagnosen, Schweregrad der Verletzung (monotraumatisch, kombiniert mit mehr als einer betroffenen Körperregion oder Polytrauma) und ambulanter oder stationärer Behandlung analysiert. Unfälle bei der privaten Gartenarbeit ereigneten sich vorwiegend bei Erwachsenen im Alter von 40–69 Jahren. Dabei waren Männer häufiger als Frauen betroffen. Die Patienten zogen sich vorwiegend Augenverletzungen und Hautwunden zu. Exponierte Körperstellen wie Augen, Finger, Kopf und Gesicht waren am häufigsten betroffen. Es handelte sich vorwiegend um monotraumatische Verletzungen, die ambulant behandelt werden konnten. Stürze und ähnliche Ereignisse wie Stolpern führten häufig zu Unfällen. Unfälle wurden hauptsächlich durch organisches Material oder durch die fehlerhafte und nachlässige Anwendung von Werkzeugen verursacht. Die Datenanalyse zeigte, dass ein Grossteil der Unfälle durch einfache Präventionsmassnahmen verhindert werden könnten.