As often is the case with new data, this paper raises many unanswered questions. For example, what was the rate of survival with a ‘good’ outcome? How many care home residents suffered a cardiac arrest and were not resuscitated? In how many patients was resuscitation in keeping with their goals and values? Some of these questions are difficult to answer, but they are crucially important.
While these data are a valuable contribution to the literature, I disagree with the authors’ interpretation that closer monitoring of residents and staff Basic Life Support (BLS) competency is the answer. Yes—healthcare professionals should have appropriate training...]]>
First, the study found nearly 21% of individuals had ED contact within 1 month before suicide. This suggests many at-risk patients signal distress through ED visits. However, the analysis omitted the primary reasons for these visits (eg, self-harm, accidental injury, mental disorder) and whether suicide risk assessments were performed. Individuals contemplating suicide often avoid mental health services due to difficulty distinguishing physical from psychological distress, or concerns about stigma and burdening others. Consequently, they may turn to EDs. Yet, strained ED resources and standard triage systems struggle to identify psychological crisis, potentially delaying care. Long waits might deter disclosure. Financial barriers in some systems may also deter help seeking. Subgroup analysis of...]]>
Their call for more research into the reasons for these emergency department attendances, the demographics of those who attended, and any psychiatric assessments and referrals that were made, echoes the research needs we highlighted. As our research letter noted, most of this additional detail will rely on researchers using local care records, rather than the national databases we used. We suspect accurately categorising reasons for attendance will be a complex research challenge, due to physical symptoms arising from mental health distress and the high proportion of people with coexisting serious mental illness and physical health conditions.
Efficiency and feasibility of assessment in emergency scenarios Acute appendicitis is an acute abdominal condition; emergency care hinges on ‘rapid triage’—avoiding delayed surgery from missed diagnoses and unnecessary tests. This study’s TCI assessment requires professional tongue imaging and offline scoring by two evaluators, which takes time. Yet in emergencies, doctors must complete preliminary assessments (history, exam, basic labs) in a relatively short time after a patient’s...]]>
We agree that the tongue itself may represent an important physical sign. The Tongue Coating Index (TCI) in our study should be regarded primarily as a research tool, and we believe that future work should aim to develop a more rapid and clinically feasible assessment method. Our intention was not to advocate for a specific score, but rather to highlight the potential clinical importance of tongue findings as a physical sign. Because this is a diagnostic accuracy study rather than a causal inference study, adjustment for potential confounders was not essential for our primary aim. Nevertheless, our findings suggest that the TCI retains diagnostic utility across a variety of patient backgrounds, which supports its robustness. Furthermore, as highlighted in the Standards for Reporting Diagnostic Accuracy Studies (STARD 2015) guidelines, diagnostic accuracy...]]>