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Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine

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https://www.readbyqxmd.com/read/28103632/global-health-and-emergency-care-defining-clinical-research-priorities
#1
Bhakti Hansoti, Adam R Aluisio, Meagan A Barry, Kevin Davey, Brian A Lentz, Payal Modi, Jennifer A Newberry, Melissa H Patel, Tricia A Smith, Alexandra M Vinograd, Adam C Levine
OBJECTIVES: Despite recent strides in the development of Global Emergency Medicine (EM), the field continues to lag in applying a scientific approach to identifying critical knowledge gaps and advancing evidence-based solutions to clinical and public health problems seen in emergency departments worldwide. Here, progress on the Global EM research agenda created at the 2013 Academic Emergency Medicine Global Health and Emergency Care Consensus Conference is evaluated and critical areas for future development in emergency care research internationally are identified...
January 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28039951/association-of-hospital-resources-and-imaging-choice-for-appendicitis-in-pediatric-emergency-departments
#2
Katherine Fullerton, Holly Depinet, Sujit Iyer, Matt Hall, Sandra Herr, Inge Morton, Timothy Lee, Marlene Melzer-Lange
OBJECTIVE: Abdominal pain and concern for appendicitis are common chief complaints in patients presenting to the pediatric emergency department (PED)(1) . Although many professional organizations recommend decreasing use of CT and choosing ultrasound as first line imaging for pediatric appendicitis, significant variability persists in imaging utilization(2,3,4) . This study investigated practice variation across children's hospitals in the diagnostic imaging evaluation of appendicitis and determined hospital-level characteristics associated with the likelihood of ultrasound as the first imaging modality...
December 31, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28039943/the-pecarn-tbi-rules-do-not-apply-to-abusive-head-trauma
#3
Julia Nicole Magana, Nathan Kuppermann
The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) prediction rules were developed to identify children at very low risk for clinically-important TBIs (ciTBIs), for whom computed tomography (CT) scans can typically be obviated.(1) The PECARN prediction rules have been validated in several settings and countries.(2-5) The PECARN TBI rules, one developed for children younger than 2 years, and the other for those 2 years and older, rely on accurate patient history and physical examination findings gathered at the time of emergency department (ED) presentation...
December 31, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28008687/hot-off-the-press-which-febrile-children-with-sickle-cell-disease-need-a-chest-x-ray
#4
Justin Morgenstern, Corey Heitz, William K Milne
This retrospective chart review examined the rate of acute chest syndrome (ACS) in febrile children (aged 3 months to 21 years) with sickle cell disease and used recursive partitioning to determine which clinical factors were predictive of a diagnosis of ACS. Over the course of 2 years, 697 children made 1837 visits to one of two pediatric emergency departments. ACS was diagnosed in 185 (10%) of the visits. This article is protected by copyright. All rights reserved.
December 23, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28008693/acute-heart-failure-in-the-ed-just-a-one-night-stand
#5
Peter S Pang, Sean P Collins
It begins with a chief complaint. It almost always ends with an admission. Somewhere in the middle, after the diagnosis is made, we treat patients like it's 1974.(1) Standard therapy hasn't changed. Followed by a ritual washing of hands, we move on to the next patient. This is the state of acute heart failure (AHF) managed in the ED today. This article is protected by copyright. All rights reserved.
December 22, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28008692/a-response-to-diagnostic-performance-of-wells-score-combined-with-point-of-care-lung-and-venous-ultrasound-in-suspected-pulmonary-embolism
#6
Robert R Ehrman, John Z Gallien
We enjoyed the article by Nazerian et al., Diagnostic performance of Wells' Score combined with point-of-care lung and venous ultrasound in suspected pulmonary embolism [1]. We recognize the need to safely exclude the diagnosis of pulmonary embolism (PE) without the use of ionizing radiation through use of evidence-based clinical decision aids (CDAs). We agree that point-of-care ultrasound can play a role in the evaluation of suspected PE. This article is protected by copyright. All rights reserved.
December 22, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28008681/prediction-rule-for-diagnosis-of-pulmonary-embolism-enhanced-by-lung-and-venous-ultrasound-making-confusion-or-increasing-efficiency
#7
Giovanni Volpicelli, Simone Vanni, Cecilia Becattini, Giuseppe Francesco Sferrazza Papa, Chiara Gigli, Stefano Grifoni, Peiman Nazerian
We thank the Authors for their interest in our study [1] and the questions raised. Our response begins from their conclusion: "…we fear that uWells' may create more noise than signal in the already murky PE milieu". We find curious that two strongly evidence based applications of point-of-care ultrasound (POCUS) added to the clinical evaluation might create confusion rather than resolving challenging questions. This article is protected by copyright. All rights reserved.
December 22, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27992953/age-related-disparities-in-trauma-center-access-for-severe-head-injuries-following-the-release-of-the-updated-field-triage-guidelines
#8
Thomas J Flottemesch, Susan Raetzman, Kevin C Heslin, Katie Fingar, Rosanna Coffey, Marguerite Barrett, Ernest Moy
OBJECTIVE: In 2006, the American College of Surgeons' Committee on Trauma and the Center for Disease Control released field triage guidelines with special consideration for older adults. Additional considerations for direct transport to a Level I or II trauma center (TC) were added in 2011, reflecting perceived undertriage to TCs for older adults. We examined whether age-based disparities in TC care for severe head injury decreased following introduction of the 2011 revisions. METHODS: A pre-post design analyzing the 2009 and 2012 Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) with multivariable logistic regressions considered changes in (1) the trauma designation of the emergency department where treatment was initiated and (2) transfer to a TC following initial treatment at a non-TC...
December 19, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27987314/risk-benefit-and-cost-thresholds-for-emergency-department-testing-a-cross-sectional-scenario-based-study
#9
Arjun Prasad Meka, Jonathan Douglas Porath, Rahul Iyengar, Chelsea Morrow, Angela Fagerlin, William J Meurer
INTRODUCTION: While diagnostic testing is common in the emergency department, the value of some testing is questionable. The purpose of this study was to assess how varying levels of benefit, risk, and costs influenced an individual's desire to have diagnostic testing. METHODS: A survey through Amazon Mechanical Turk presented hypothetical clinical situations: low risk chest pain and minor traumatic brain injury. Each scenario included three given variables (benefit, risk, and cost), that was independently randomly varied over four possible values (0...
December 17, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27976497/prospective-and-explicit-clinical-validation-of-the-ottawa-heart-failure-risk-scale-with-and-without-use-of-quantitative-nt-probnp
#10
Ian G Stiell, Jeffrey J Perry, Catherine M Clement, Robert J Brison, Brian H Rowe, Shawn D Aaron, Andrew McRae, Bjug Borgundvaag, Lisa A Calder, Alan J Forster, George A Wells
OBJECTIVES: We previously developed the Ottawa Heart Failure Risk Scale (OHFRS) to assist with disposition decisions for acute heart failure patients in the emergency department (ED). We sought to prospectively evaluate the accuracy, acceptability, and potential impact of OHFRS. METHODS: This prospective observational cohort study was conducted at six tertiary hospital EDs. Patients with acute heart failure were evaluated by ED physicians for the 10 OHFRS criteria and then followed for 30 days...
December 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27976494/clinical-factors-and-expenditures-associated-with-icd-9-cm-coded-trauma-for-the-us-population-a-nationally-representative-study
#11
Clara E Dismuke, Kinfe G Bishu, Samir Fakhry, Rebekah J Walker, Leonard E Egede
BACKGROUND: There is a lack of information on annual healthcare expenditures both per person and for the US population associated with trauma, as identified by ICD-9-CM codes. METHODS: This paper employed a two part model to estimate the unadjusted and adjusted annual per individual expenditures and population burden of trauma exposure for the US population, using a nationally representative survey of medical care expenditures. In addition, we estimated a logit model to examine the demographic and comorbidity factors associated with the likelihood of experiencing trauma...
December 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27976492/h1-antihistamines-reduce-progression-to-anaphylaxis-among-emergency-department-patients-with-allergic-reactions
#12
T Kawano, F X Scheuermeyer, K Gibo, R Stenstrom, B Rowe, E Grafstein, B Grunau
OBJECTIVES: H1-antihistamines (H1a) can be used to treat ED patients with allergic reactions; however, this is inconsistently done, likely as there is no evidence that this therapy has an impact on serious outcomes. Among emergency department (ED) patients initially presenting with allergic reactions, we investigated whether H1a were associated with lower rates of progression to anaphylaxis. METHODS: This was a retrospective cohort study conducted at two urban Canadian EDs from April 1, 2007 to March 31, 2012...
December 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27976464/methods-for-collecting-paired-observations-from-emergency-medical-services-and-emergency-department-providers-for-pediatric-cervical-spine-injury-risk-factors
#13
Fahd A Ahmad, Hamilton Schwartz, Lorin R Browne, Sherry Lassa-Claxton, Michael Wallendorf, E Brooke Lerner, Nathan Kuppermann, Julie C Leonard
OBJECTIVES: Cervical spine injuries (CSI) after blunt trauma in children are rare but cause substantial morbidity and mortality. Emergency medical services (EMS) and emergency department (ED) providers routinely use spinal precautions and cervical spine imaging respectively during the management of children experiencing blunt trauma. These practices lack evidence, and there is concern that they may be harmful. A pediatric CSI risk-assessment tool is needed to inform EMS and ED provider decision-making...
December 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27976457/global-health-and-emergency-care-overcoming-clinical-research-barriers
#14
Adam C Levine, Meagan A Barry, Pooja Agrawal, Herbert C Duber, Mary P Chang, Joy M Mackey, Bhakti Hansoti
OBJECTIVES: There are many barriers impeding the conduct of high-quality emergency care research, particularly in low- and middle-income countries. Several of these barriers were originally outlined in 2013 as part of the Academic Emergency Medicine Global Health and Emergency Care Consensus Conference. This paper seeks to establish a broader consensus on the barriers to emergency care research globally and proposes a comprehensive array of new recommendations to overcome these barriers...
December 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27976450/studying-the-safety-and-performance-of-rapid-sequence-intubation-data-collection-method-matters
#15
Andrea S Rinderknecht, Jenna R Dyas, Benjamin T Kerrey, Gary L Geis, Mona H Ho, Matthew R Mittiga
OBJECTIVE: We sought to describe and compare chart and video review as data collection sources for the study of Emergency Department (ED) Rapid Sequence Intubation (RSI). METHODS: This retrospective cohort study compares the availability and content of key RSI outcome and process data from two sources: chart and video data from 12 months of pediatric ED RSI. Key outcomes included adverse effects (oxyhemoglobin desaturation, physiologic changes, inadequate paralysis, vomiting), process components (number of laryngoscopy attempts, end-tidal CO2 detection), and timing data (duration of pre-oxygenation and laryngoscopy attempts)...
December 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27976448/point-of-care-ultrasound-for-non-angulated-distal-forearm-fractures-in-children-test-performance-characteristics-and-patient-centered-outcomes
#16
Naveen Poonai, Frank Myslik, Gary Joubert, Josiah Fan, Amita Misir, Victor Istasy, Melanie Columbus, Robert Soegtrop, Alex Goldfarb, Drew Thompson, Alexander Sasha Dubrovsky
OBJECTIVES: Distal forearm fractures are the most common fracture type in children. Point-of-care-ultrasound (POCUS) is increasingly being used and preliminary studies suggest it offers an accurate approach to diagnosis. However, outcomes such as pain, satisfaction, and procedure duration have not been explored but may be salient to the widespread acceptance of this technology by caregivers and children. Our objectives were to examine the test performance characteristics of POCUS for non-angulated distal forearm injuries in children and compare POCUS to x-ray with respect to pain, caregiver satisfaction, and procedure duration...
December 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27864915/identification-of-emergency-department-visits-in-medicare-administrative-claims-approaches-and-implications
#17
Arjun K Venkatesh, Hao Mei, Keith Kocher, Mike Granovsky, Ziad Obermeyer, Erica Spatz, Craig Rothenberg, Harlan Krumholz, Zhenqui Lin
OBJECTIVES: Administrative claims datasets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare dataset and to compare this definition to existing operational definitions used by researchers and policymakers...
November 19, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27864896/family-medical-history
#18
Laura J Bontempo
"Is there a family history?" As I stood there watching her cry from pain and fear, that question shattered my soul like a bullet entering a thorax. "Yes, there is a family history. A strong one." This article is protected by copyright. All rights reserved.
November 19, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27860044/faculty-mentoring-practices-in-academic-emergency-medicine
#19
Julie Welch, Stacy Sawtelle, David Cheng, Tony Perkins, Misha Ownbey, Emily MacNeill, Robert Hockberger, Daniel Rusyniak
BACKGROUND: Mentoring is considered a fundamental component of career success and satisfaction in academic medicine. However, there is no national standard for faculty mentoring in academic emergency medicine and a paucity of literature on the subject. OBJECTIVES: To conduct a descriptive study of faculty mentoring programs and practices in academic departments of emergency medicine. METHODS: An electronic survey instrument was sent to 135 department chairs of emergency medicine (EM) in the United States...
November 17, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27859997/minimizing-attrition-for-multi-site-emergency-care-research
#20
Bret A Nicks, Manish N Shah, David H Adler, Aveh Bastani, Christopher W Baugh, Jeffrey M Caterino, Carol L Clark, Deborah B Diercks, Judd E Hollander, Susan E Malveau, Daniel K Nishijima, Kirk A Stiffler, Alan B Storrow, Scott T Wilber, Annick N Yagapen, Benjamin C Sun
Loss to follow-up of enrolled patients (aka attrition) is a major threat to study validity and power. Minimizing attrition can be challenging even under ideal research conditions, including the presence of adequate funding, experienced study personnel, and a refined research infrastructure. Emergency care research is shifting towards enrollment through multi-site networks, but there have been limited descriptions of approaches to minimize attrition for these multi-center emergency care studies. This concept paper describes a stepwise approach to minimize attrition, using a case example of a multi-site emergency department prospective cohort of over 3,000 patients that has achieved a 30-day direct phone follow-up attrition rate of < 3%...
November 17, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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