Ryan D Pappal, Brian W Roberts, Nicholas M Mohr, Enyo Ablordeppey, Brian T Wessman, Anne M Drewry, Winston Winkler, Yan Yan, Marin H Kollef, Michael S Avidan, Brian M Fuller
STUDY OBJECTIVE: Awareness with paralysis is a devastating complication for patients receiving mechanical ventilation and risks long-term psychological morbidity. Data from the emergency department (ED) demonstrate a high rate of longer-acting neuromuscular blocking agent use, delayed analgosedation, and a lack of sedation depth monitoring. These practices are discordant with recommendations for preventing awareness with paralysis. Despite this, awareness with paralysis has not been rigorously studied in the ED population...
January 20, 2021: Annals of Emergency Medicine
Richard S J Boyle, Richard Body
STUDY OBJECTIVE: We evaluate current evidence for the diagnostic accuracy and safety of the Emergency Department Assessment of Chest Pain Score (EDACS) for patients presenting to the emergency department (ED) with possible acute coronary syndromes. METHODS: MEDLINE, EMBASE, and Cochrane databases were searched for publications reporting data on the EDACS score. No date restrictions were used. Two independent researchers assessed studies for eligibility, bias, and quality...
January 15, 2021: Annals of Emergency Medicine
Arjun Venkatesh, Shashank Ravi, Craig Rothenberg, Jeremiah Kinsman, Jean Sun, Pawan Goyal, James Augustine, Stephen K Epstein
STUDY OBJECTIVE: The measurement of emergency department (ED) throughput as a patient-centered quality measure is ubiquitous; however, marked heterogeneity exists between EDs, complicating comparisons for payment purposes. We evaluate 4 scoring methodologies for accommodating differences in ED visit volume and heterogeneity among ED groups that staff multiple EDs to improve the validity and "fairness" of ED throughput quality measurement in a national registry, with the goal of developing a volume-adjusted throughput measure that balances variation at the ED group level...
January 15, 2021: Annals of Emergency Medicine
Gabriel Wardi, Morgan Carlile, Andre Holder, Supreeth Shashikumar, Stephen R Hayden, Shamim Nemati
STUDY OBJECTIVE: Machine-learning algorithms allow improved prediction of sepsis syndromes in the emergency department (ED), using data from electronic medical records. Transfer learning, a new subfield of machine learning, allows generalizability of an algorithm across clinical sites. We aim to validate the Artificial Intelligence Sepsis Expert for the prediction of delayed septic shock in a cohort of patients treated in the ED and demonstrate the feasibility of transfer learning to improve external validity at a second site...
January 15, 2021: Annals of Emergency Medicine
Tatsuya Norii, Yohsuke Makino, Kana Unuma, Gary M Hatch, Natalie L Adolphi, Sarah Dallo, Danielle Albright, David P Sklar, Darren Braude
STUDY OBJECTIVE: Extraglottic airway devices are frequently used during cardiac arrest resuscitations and for failed intubation attempts. Recent literature suggests that many extraglottic airway devices are misplaced. The aim of this study is to create a classification system for extraglottic airway device misplacement and describe its frequency in a cohort of decedents who died with an extraglottic airway device in situ. METHODS: We assembled a cohort of all decedents who died with an extraglottic airway device in situ and underwent postmortem computed tomographic (CT) imaging at the state medical examiner's office during a 6-year period, using retrospective data...
January 15, 2021: Annals of Emergency Medicine
Michael Gottlieb, Jestin N Carlson
No abstract text is available yet for this article.
January 13, 2021: Annals of Emergency Medicine
Dana R Sax, Dustin G Mark, Jie Huang, Oleg Sofrygin, Jamal S Rana, Sean P Collins, Alan B Storrow, Dandan Liu, Mary E Reed
STUDY OBJECTIVE: We use variables from a recently derived acute heart failure risk-stratification rule (STRATIFY) as a basis to develop and optimize risk prediction using additional patient clinical data from electronic health records and machine-learning models. METHODS: Using a retrospective cohort design, we identified all emergency department (ED) visits for acute heart failure between January 1, 2017, and December 31, 2018, among adult health plan members of a large system with 21 EDs...
December 24, 2020: Annals of Emergency Medicine
Polly E Bijur, Benjamin W Friedman, Eddie Irizarry, Andrew K Chang, E John Gallagher
STUDY OBJECTIVE: We compare the efficacy and adverse effects of 5 oral analgesics in emergency department (ED) patients aged 21 to 64 years with acute musculoskeletal pain. METHODS: This was a randomized clinical trial conducted in 2 urban EDs. Patients received 400 mg ibuprofen/1,000 mg acetaminophen, 800 mg ibuprofen/1,000 mg acetaminophen, 30 mg codeine/300 mg acetaminophen, 5 mg hydrocodone/300 mg acetaminophen, or 5 mg oxycodone/325 mg acetaminophen. The primary outcome was change in pain before administration of medication (baseline) to 1 hour postbaseline...
December 22, 2020: Annals of Emergency Medicine
Salena M Preciado, Adam L Sharp, Benjamin C Sun, Aileen Baecker, Yi-Lin Wu, Ming-Sum Lee, Ernest Shen, Maros Ferencik, Shaw Natsui, Aniket A Kawatkar, Stacy J Park, Rita F Redberg
STUDY OBJECTIVE: We compare clinical management and outcomes of emergency department (ED) encounters by sex after implementation of a clinical care pathway in 15 community EDs that standardized recommendations based on patient risk, using the History, ECG, Age, Risk Factors, and Troponin (HEART) score. METHODS: This was a retrospective analysis of adult ED encounters evaluated for suspected acute coronary syndrome with a documented HEART score from May 20, 2016, to December 1, 2017...
December 21, 2020: Annals of Emergency Medicine
Michael Gottlieb, William G McDowell, Shayna Adams
No abstract text is available yet for this article.
December 21, 2020: Annals of Emergency Medicine
Eugenia C South, Kaytlena Stillman, David G Buckler, Douglas Wiebe
STUDY OBJECTIVE: We evaluate the association between living near a neighborhood shooting and emergency department (ED) utilization for stress-responsive complaints. METHODS: In this location-based before-and-after neighborhood study, we examined variability in ED encounter volume for stress-responsive complaints after neighborhood shooting incidents around 2 academic hospitals. We included patients residing within 1/8- and 1/2-mile-diameter buffers around a shooting (place) if their ED encounter occurred 7, 30, or 60 days before or after the shooting (time)...
December 17, 2020: Annals of Emergency Medicine
Andrew J Latimer, Brenna Harrington, Catherine R Counts, Katelyn Ruark, Charles Maynard, Taketo Watase, Michael R Sayre
STUDY OBJECTIVE: The bougie is typically treated as a rescue device for difficult airways. We evaluate whether first-attempt success rate during paramedic intubation in the out-of-hospital setting changed with routine use of a bougie. METHODS: A prospective, observational, pre-post study design was used to compare first-attempt success rate during out-of-hospital intubation with direct laryngoscopy for patients intubated 18 months before and 18 months after a protocol change that directed the use of the bougie on the first intubation attempt...
December 17, 2020: Annals of Emergency Medicine
Michelle H Orlowski, William E Soares, Kathleen L Kerrigan, Matthew L Zerden
Although induced abortion is generally a safe outpatient procedure, many patients subsequently present to the emergency department, concerned about a postabortion complication. It is helpful for emergency physicians to understand the medications and procedures used in abortion care in the United States to effectively and efficiently triage and treat women presenting with potential complications from an abortion. Furthermore, because many states are experiencing increased abortion restrictions that limit access to care, emergency medicine physicians may encounter more patients presenting after self-managed abortions, which presents additional challenges...
December 16, 2020: Annals of Emergency Medicine
Amy Elliott, Nick Taub, Jay Banerjee, Faisal Aijaz, Will Jones, Lucy Teece, James van Oppen, Simon Conroy
STUDY OBJECTIVE: We determine whether the Clinical Frailty Scale applied at emergency department (ED) triage is associated with important service- and patient-related outcomes. METHODS: We undertook a single-center, retrospective cohort study examining hospital-related outcomes and their associations with frailty scores assessed at ED triage. Participants were aged 65 years or older, registered on their first ED presentation during the study period at a single, centralized ED in the United Kingdom...
December 13, 2020: Annals of Emergency Medicine
Lucas B Chartier, Howard Ovens, Emily Hayes, Brittany Davis, Lisa Calder, Michael Schull, Jonathan Dreyer, Olivia Ostrow
The Emergency Department Return Visit Quality Program was launched in Ontario, Canada, to promote a culture of quality. It mandates the province's largest-volume emergency departments (EDs) to audit charts of patients who had a return visit leading to hospital admission, including some of their 72-hour all-cause return visits with admission and all of their 7-day ones with sentinel diagnoses (ie, acute myocardial infarction, subarachnoid hemorrhage, and pediatric sepsis), and submit their findings to a governmental agency...
November 13, 2020: Annals of Emergency Medicine
Joshua B Gaither, Daniel W Spaite, Bentley J Bobrow, Samuel M Keim, Bruce J Barnhart, Vatsal Chikani, Duane Sherrill, Kurt R Denninghoff, Terry Mullins, P David Adelson, Amber D Rice, Chad Viscusi, Chengcheng Hu
STUDY OBJECTIVE: We evaluate the effect of implementing the out-of-hospital pediatric traumatic brain injury guidelines on outcomes in children with major traumatic brain injury. METHODS: The Excellence in Prehospital Injury Care for Children study is the preplanned secondary analysis of the Excellence in Prehospital Injury Care study, a multisystem, intention-to-treat study using a before-after controlled design. This subanalysis included children younger than 18 years who were transported to Level I trauma centers by participating out-of-hospital agencies between January 1, 2007, and June 30, 2015, throughout Arizona...
November 10, 2020: Annals of Emergency Medicine
Aaron J Ruberto, Marco L A Sivilotti, Savannah Forrester, Andrew K Hall, Frances M Crawford, Andrew G Day
STUDY OBJECTIVE: Little is known about the cause or optimal treatment of hyperemesis in habitual cannabis users. Anecdotal evidence supports the use of haloperidol over traditional antiemetics for this newly recognized disorder. We compare haloperidol with ondansetron for cannabis hyperemesis syndrome. METHODS: We randomized cannabis users with active emesis to either haloperidol (with a nested randomization to either 0.05 or 0.1 mg/kg) or ondansetron 8 mg intravenously in a triple-blind fashion...
November 5, 2020: Annals of Emergency Medicine
David A Talan, Sukhjit S Takhar, Anusha Krishnadasan, William R Mower, Daniel J Pallin, Manish Garg, Jon Femling, Richard E Rothman, Johanna C Moore, Alan E Jones, Frank Lovecchio, Jonathan Jui, Mark T Steele, Amy M Stubbs, William K Chiang, Gregory J Moran
STUDY OBJECTIVE: Enterobacteriaceae resistant to ceftriaxone, mediated through extended-spectrum β-lactamases (ESBLs), commonly cause urinary tract infections worldwide, but have been less prevalent in North America. Current US rates are unknown. We determine Enterobacteriaceae antimicrobial resistance rates among US emergency department (ED) patients hospitalized for urinary tract infection. METHODS: We prospectively enrolled adults hospitalized for urinary tract infection from 11 geographically diverse university-affiliated hospital EDs during 2018 to 2019...
October 30, 2020: Annals of Emergency Medicine
Teng-Yao Yang, Kuo-Chih Chen, Chee-Fah Chong
No abstract text is available yet for this article.
February 2021: Annals of Emergency Medicine
Kim T Vuong, Brendon C Mitchell, Kathryn H Pade, Mylinh T Nguyen, Margaret B Nguyen, Atim Uya
No abstract text is available yet for this article.
February 2021: Annals of Emergency Medicine
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