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INTRODUCTION The incidence of low-impact pelvic fractures is rising and continues to be a health burden to the elderly. (1-3) The emergency management of pelvic fractures predominantly focuses on the [...], Objective: We examined the records of patients presenting to the emergency department (ED) with low-impact pelvic fractures. We describe frequency, demographics, management and patient outcomes in terms of ambulatory ability, living independence and mortality. Methods: Patients treated for a pelvic fracture over a 2-year period in Kingston, Ont., were identified. We performed a retrospective hospital record review to distinguish high- versus low-impact injury mechanisms, and to characterize the injury event, ED management and outcomes for patients with low-impact fractures. Results: Of 132 pelvic fractures identified, 77 were low-impact fractures. Patients were predominantly women (82%) with a mean age of 81 years; 96% had some pre-existing medical comorbidity. The pubic rami were most commonly involved (86%). The median length of stay in the ED was 9.4 hours. Twenty-five patients (32%) were admitted to hospital. Ten patients had surgical stabilization, mostly of the acetabulum. Five patients died in hospital, 4 from pneumonia and 1 from myocardial infarction. Eight additional patients died within 1 year of injury. At discharge, only 18% lived independently and 16% walked without aids versus 42% and 38%, respectively, before injury. Conclusion: Low-impact pelvic fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of time and resources in the ED are used during the workup of these patients and while awaiting their disposition from the ED. These injuries are important because they affect independence and seem associated with an increased risk of death. Keywords: pelvic fracture, low-impact trauma, outcomes, falls in elderly, morbidity, mortality Objectif : Nous avons analyse les dossiers de patients s'etant presentes a l'urgence avec une fracture du bassin a faible impact. Nous decrivons la frequence, les donnees demographiques, la prise en charge et le devenir des patients en termes de capacite ambulatoire, d'autonomie et de mortalite. Methodes : Nous avons repere les patients traites pour une fracture du bassin sur une periode de 2 ans a Kingston, en Ontario. Nous avons effectue une analyse retrospective des dossiers medicaux pour faire la distinction entre les mecanismes de blessure a faible impact et a haut impact et caracteriser l'incident a l'origine de la fracture, la prise en charge a l'urgence et le devenir des patients presentant une fracture a faible impact. Resultats : Parmi les 132 fractures du bassin reperees, 77 etaient des fractures a faible impact. Les patients etaient majoritairement des femmes (82 %) et l'age moyen, de 81 ans; 96 % avaient une comorbidite medicale preexistante. Les branches pubiennes etaient le foyer de fracture le plus courant (86 %). La duree mediane de sejour a l'urgence etait de 9,4 heures. Vingt-cinq patients (32 %) ont ete hospitalises. Dix patients ont subi une stabilisation chirurgicale, principalement de l'acetabulum. Cinq patients sont decedes a l'hopital, 4 d'une pneumonie et 1 d'un infarctus du myocarde. Huit autres patients sont decedes dans l'annee suivant la blessure. A la sortie de l'hopital, seulement 18 % des patients vivaient de facon autonome et 16 % marchaient sans aide par rapport a 42 % et 38 %, respectivement, avant le traumatisme. Conclusion : Les fractures du bassin a faible impact touchent principalement les femmes agees presentant des comorbidites preexistantes. On consacre beaucoup de temps et de ressources a l'urgence pour l'investigation et dans l'attente de l'issue de la consultation. Ces blessures sont importantes, car elles affectent l'autonomie et semblent etre associees a un risque accru de deces.

Background: Professional culture is a powerful influence in emergency departments, but incompletely understood. Disasters magnify cultural realities, and as such the COVID-19 pandemic offered a unique opportunity to better understand emergency medicine (EM) values, practices, and beliefs. Methods: We conducted a collaborative ethnography at a tertiary care center during the acute phase of the response to the threat of COVID-19 (March–May 2020). Collaborative ethnography is a method that partners directly with communities during design, data gathering, and analysis to study culture. An ED-based research team gathered data including field notes from 300 h of participant observation and informal interviews, 42 semi-structured interviews, and 57 departmental documents. Data were deductively coded using a previously generated framework for understanding EM culture. Results: Each of seven core values from the original framework were identified in the dataset and further contextualized understanding of EM culture. COVID-19 exacerbated pre-existing tensions and threats to the core values of EM. For example, the desire to provide patient-centered care was impeded by strict visitor restrictions; the ability to treat life-threatening illness was impaired by new resuscitation room layouts and infection control procedures; and subtle changes in protocols had downstream impact on flow and the ability to balance needs and resources at a system level. The cultural values related to teams were protective and strengthened during this time. The pandemic exposed problems with the status quo, underscored inherent tensions between ED values, and highlighted threats to self-identity. Conclusion: COVID-19 has highlighted and compounded existing tensions and threats to the core values of EM, underscoring a critical mismatch between values and practice. Realignment of the realities of ED work with staff values is urgently needed.

Byline: Marco LA Sivilotti, Paul M Paris, Kimberly Cantees, Donald M Yealy, Rob Brison Abstract: [Sivilotti MLA, Paris PM, Cantees K, Yealy DM, Brison R: Studying emergency patients outside the emergency department. Ann Emerg Med April 1996;27:442-447.] Article Note: (footnote) [star] From the Department of Emergency Medicine, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada*; Department of Emergency Medicine University of Pittsburgh Medical Centera ; and Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PennsylvaniaAs.; and the Departments of Emergency Medicine and Public Health, Queens University and Hotel Dieu Hospital, Kingston, Ontario, Canadaa[yen] , [star][star] Address for reprints: Marco LA Sivilotti, MD, Les Cours Mont-Royal, 1001 Place Mont-Royal #1003, Montreal, Quebec, Canada H3A 1P2, a Reprint no. 47/1/72435

[Sivilotti MLA, Paris PM, Cantees K, Yealy DM, Brison R: Studying emergency patients outside the emergency department. Ann Emerg Med April 1996;27:442-447.]