Emergency Medicine

Non-technical errors present in two-thirds of emergency general surgery deaths, mostly outside theatre

In a national retrospective cohort of 1,164 emergency general surgery deaths, non-technical errors (NTEs) occurred in 67.9% of cases and comprised 1,053 unique errors. Situational awareness (518/1053) and decision-making errors (431/1053) were most common, driven by missed signs, failure to appreciate severity, and delayed or incorrect interventions. Most NTEs (947/1053, 89.9%) occurred outside the operating theatre and involved both surgical and non-surgical teams. Authors conclude mortality reduction efforts should extend non-technical skills training and mortality-review focus beyond the OR. 1

6-item brief geriatric assessment stratifies older ED patients for admission, LOS, and death

In a 36‑site prospective cohort of 4,657 ED patients aged ≥65, a 6‑item BGA classified patients into low, moderate, and high risk at admission. High‑risk BGA was associated with increased ward admission (RR 1.22) and longer hospital stay (LOS ratio 1.31). Mortality rose across risk strata (MR RR 2.02; HR 3.12 versus low risk). The 6‑item BGA may aid rapid ED risk stratification but requires further prospective validation before routine implementation. 2

International survey shows variable pre-endoscopic AUGIB practices and incomplete guideline adherence

An international survey of 533 clinicians found only 47.1% used a triage system and 60.4% applied risk scores for AUGIB at presentation. Most used restrictive transfusion in stable patients, but this fell to 50.3% in unstable cases, and prokinetic use varied widely. Proton pump inhibitors were commonly prescribed pre-endoscopy (87.1%), while variceal bleeding management had higher adherence to vasoactive agents and antibiotics. The results identify gaps in early risk stratification, transfusion practice, and pharmacologic use, suggesting targets for guideline implementation. 3