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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/28214369/diagnostic-accuracy-of-history-physical-exam-laboratory-tests-and-point-of-care-ultrasound-for-pediatric-acute-appendicitis-in-the-emergency-department-a-systematic-review-and-meta-analysis
#1
Roshanak Benabbas, Mark Hanna, Jay Shah, Richard Sinert
BACKGROUND: Acute appendicitis (AA) is the most common surgical emergency in children. Accurate and timely diagnosis is crucial but challenging due to atypical presentations and the inherent difficulty of obtaining a reliable history and physical examination in younger children. OBJECTIVES: To determine the utility of history, physical exam, laboratory tests, Pediatric Appendicitis Score (PAS) and Emergency Department-Point-of-Care Ultrasound (ED-POCUS) in the diagnosis of AA in ED pediatric patients...
February 18, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28207971/emergency-department-initiated-home-oxygen-for-bronchiolitis-a-prospective-study-of-community-follow-up-caregiver-satisfaction-and-outcomes
#2
Julia Fuzak Freeman, Sara Deakyne, Lalit Bajaj
OBJECTIVE: Retrospective studies performed have shown home oxygen to be a safe alternative to hospitalization for some patients with bronchiolitis living at high altitudes. We aimed to prospectively describe adverse events, follow-up, duration of home oxygen, factors associated with failure, and caregiver preferences. METHODS: This was a prospective observational study of hypoxemic bronchiolitis patients ages 3-18months who were discharged from a tertiary care pediatric emergency department on home oxygen over 3 winters (2011-2014)...
February 16, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28207968/mri-vs-ultrasound-as-the-initial-imaging-modality-for-pediatric-and-young-adult-patients-with-suspected-appendicitis
#3
Daniel Imler, Christine Keller, Shyam Sivasankar, Nancy Ewen Wang, Shreyas Vasanawala, Matias Bruzoni, James Quinn
BACKGROUND: While ultrasound (US), given its lack of ionizing radiation is currently the recommended initial imaging study of choice for the diagnosis of appendicitis in pediatric and young adult patients, it does have significant shortcomings. US is time intensive, operator dependent, and results in frequent inconclusive studies, thus necessitating further imaging, and admission for observation or repeat clinical visits. A rapid focused Magnetic Resonance Imaging (MRI) for appendicitis has been shown to have definitive sensitivity and specificity, similar to Computed tomography (CT) but without radiation and offers a potential alternative to US...
February 16, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28177169/emergency-department-triage-of-traumatic-head-injury-using-brain-electrical-activity-biomarkers-a-multisite-prospective-observational-validation-trial
#4
Daniel Hanley, Leslie S Prichep, Jeffrey Bazarian, J Stephen Huff, Rosanne Naunheim, John Garrett, Elizabeth Jones, David Wright, John O'Neill, Neeraj Badjatia, Dheeraj Gandhi, Kenneth C Curley, Richard Chiacchierini, Brian O'Neil, Dallas C Hack
OBJECTIVES: A brain electrical activity biomarker for identifying traumatic brain injury (TBI) in Emergency Department (ED) patients presenting with high GCS after sustaining a head injury has shown promise for objective, rapid, triage. The main objective of this study was to prospectively evaluate the efficacy of an automated classification algorithm to determine the likelihood of being CT positive, in high functioning TBI patients in the acute state. METHODS: Adult patients admitted to the ED for evaluation within 72 hours of sustaining a closed head injury with GCS 12-15were candidates for study...
February 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28177167/ketamine-as-an-adjunct-to-opioids-for-acute-pain-in-the-emergency-department-a-randomized-controlled-trial
#5
Karen J Bowers, Kelly B McAllister, Meredith Ray, Corey Heitz
OBJECTIVES: This study had five objectives: 1) to measure and compare total opioid use and number of opioid doses in patients treated with opioids versus ketamine in conjunction with opioids. 2) To measure pain scores up to 2 hours after presentation in the ED patient with pain, comparing standard opioid pain control to ketamine in conjunction with opioids. 3) To compare patient satisfaction with pain control using opioids alone versus ketamine in conjunction with opioids. 4) To monitor and compare side effects in patients treated with opioids versus ketamine in conjunction with opioids...
February 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28171688/diagnostic-value-and-effect-of-bedside-ultrasound-in-acute-appendicitis-in-the-emergency-department
#6
Faruk Gungor, Taylan Kilic, Kamil Can Akyol, Gizem Ayaz, Umut Cengiz Cakir, Mehmet Akcimen, Cenker Eken
OBJECTIVE: Early and accurate diagnosis of acute appendicitis (AA) with ultrasound can minimize the morbidity and mortality of the patients. In this regard, ultrasound can help to the emergency physicians (EPs) in the diagnosing process and clinical decision making for AA. Therefore, we primarily aimed to evaluate the effectiveness of point of care ultrasound (POCUS) in clinical decision making of EPs for the diagnostic evaluation for AA in the emergency department (ED). METHODS: The study sample consisted of patients aged >18 years that presented to the ED with an abdominal pain and underwent diagnostic evaluation for AA...
February 7, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28170159/a-novel-emergency-department-based-community-notification-method-for-clinical-research-without-consent
#7
Gerald F O'Malley, Patricia Giraldo, Kenneth Deitch, Elizabeth Andrea Aguilera, Sorin Cadar, Claudia Lares, Rika Nagakuni O'Malley, Nino Oqroshidze, Manisha Verma, Carl Chudnofsky
Providing and receiving informed consent to critically ill or moribund subjects is ethically and practically challenging.(1) Historically the concept of autonomy requires research subjects to receive and provide informed consent prior to participating in clinical research. The nature of resuscitation research prevents two-way communication and ethical informed consent. In 1996 the FDA released a set of guidelines allowing for exception from informed consent (EFIC) for emergency research, provided certain requirements are met (21 CF 50...
February 7, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28170143/prevalence-of-brain-injuries-and-recurrence-of-seizures-in-children-with-post-traumatic-seizures
#8
Mohamed K Badawy, Peter S Dayan, Michael G Tunik, Frances M Nadel, Kathleen A Lillis, Michelle Miskin, Dominic A Borgialli, Michael C Bachman, Shireen M Atabaki, John D Hoyle, James F Holmes, Nathan Kuppermann
OBJECTIVES: Computed tomography (CT) is often used in the emergency department (ED) evaluation of children with post-traumatic seizures (PTS); however, the frequency of traumatic brain injuries (TBI) and short-term seizure recurrence is lacking. Our main objective was to evaluate the frequency of TBI on CT and short-term seizure recurrence in children with PTS. We also aimed to determine the associations between the likelihood of TBI on CT with the timing of onset of PTS after the traumatic event and duration of PTS...
February 7, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28170141/response-to-letter-to-the-editor
#9
Catherine Varner
We kindly thank the journal for the opportunity to respond to the recent comments made regarding our manuscript entitled, "Cognitive rest and graduated return to usual activities versus usual care for mild traumatic brain injury: a randomized controlled trial of emergency department discharge instructions." This article is protected by copyright. All rights reserved.
February 7, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28170134/mild-traumatic-brain-injury-is-something-missing-when-comparing-cognitive-rest-and-graduated-return-to-usual-activities-versus-usual-care
#10
Vaitsa Giannouli
I read with great interest the article by Varner et al.(1) which aims to determine in a simple, concise, and neat way if mild traumatic brain injury (MTBI) patients randomized to graduated return to usual activity discharge instructions have a decrease in their Post Concussion Symptom Score (PCSS) two weeks after MTBI, compared to patients who receive usual care MTBI discharge instructions. This article is protected by copyright. All rights reserved.
February 7, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28170122/utility-of-serum-biomarkers-in-the-diagnosis-and-stratification-of-mild-traumatic-brain-injury
#11
Lawrence M Lewis, Derek Schloemann, Linda Papa, Robert Fucetola, Jeffrey Bazarian, Miranda Lindburg, Robert Welch
OBJECTIVE: To compare test characteristics of a single serum concentration of glial fibrillary acidic protein (GFAP), S-100β, and ubiquitin carboxyl terminal hydrolase L1 (UCH-L1), obtained within 6 hours of head injury, to diagnose mild traumatic brain injury (mTBI) in head-injured subjects. METHODS: Adults aged 18-80 who presented to one of seven EDs with a blunt closed head injury, underwent head CT within 4 hours of injury, and had blood drawn for biomarker analysis within 6 hours of injury were eligible...
February 7, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28168774/when-i-get-like-that-put-a-gun-to-my-head
#12
Nancy Lutwak, Curt Dill
Yesterday a 95 year old man with prostate carcinoma and widespread bone metastases was brought to the emergency department because of blood in his urine after he pulled on his foley. At triage he was febrile and hypotensive, moaning incoherently which was not a change in mental status. Despite IV fluid hydration and pressors his blood pressure remained low. This article is protected by copyright. All rights reserved.
February 7, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28164409/emergency-physician-knowledge-attitudes-and-behavior-regarding-acep-s-choosing-wisely-recommendations-a-survey-study
#13
Michelle P Lin, Thomas Nguyen, Marc A Probst, Lynne D Richardson, Jeremiah D Schuur
OBJECTIVE: In 2013, the American College of Emergency Physicians joined the Choosing Wisely campaign; however, its impact on emergency physician behavior is unknown. We assessed knowledge, attitudes and self-reported behaviors regarding the Choosing Wisely recommendations. METHODS: We performed a cross-sectional survey of emergency physicians at a national meeting. We approached 819 physicians; 765 (93.4%) completed the survey. RESULTS: As a result of the Choosing Wisely campaign, most respondents (64...
February 6, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28146297/development-of-a-patient-centered-outcome-measure-for-emergency-department-asthma-patients
#14
Margaret E Samuels-Kalow, Karin V Rhodes, Mira Henien, Emily Hardy, Thomas Moore, Felicia Wong, Carlos A Camargo, Carolyn T Rizzo, Cynthia Mollen
BACKGROUND: Measuring outcomes of emergency care is of key importance, but current metrics, such as 72-hour return visit rates, are subject to ascertainment bias, incentivize over-testing and over-treatment at initial visit, and do not reflect the full burden of disease and morbidity experienced at home following ED care. There is increasing emphasis on including patient-reported outcomes, but the existing patient-reported measures have limited applicability to emergency care. OBJECTIVE: To identify concepts for inclusion in a patient-reported outcome measure for ED care, and assess differences in potential concepts by health literacy...
February 1, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28145602/feasibility-of-informed-consent-for-ct-in-acute-trauma-patients
#15
Nicole Moore, Nadia Zuabi, Bhavesh Patel, Mark I Langdorf, Robert M Rodriguez
BACKGROUND/OBJECTIVE: Computed tomography (CT) is common for trauma victims, but is usually done without informing patients of potential risks or obtaining informed consent. The objective of this study was to determine the feasibility of two elements (time and normal level of alertness) necessary for informed consent for CT in adult trauma patients. METHODS: We conducted this prospective observational, two-phase cohort study at two urban, Level 1 trauma centers...
February 1, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28145094/toward-precision-diagnostics
#16
Christian Rose, Robert M Rodriguez
In January 2015 President Obama announced funding for the Precision Medicine Initiative, a multifaceted program that seeks to develop an individualized approach to disease prevention and treatment. Accounting for individual variability, precision medicine aims to deliver "the right treatment at the right dose to the right patient at the right time", embracing human variation and its drivers: inheritance, exposures, lifestyle, and life experience.(1,2) Beyond treatment innovations, full realization of the benefits of precision medicine and individualized health care will require refinements to diagnostic practice - the medical history, physical examination, and diagnostic tests...
February 1, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28145070/a-systematic-review-of-instruments-to-identify-mental-health-and-substance-use-problems-among-children-in-the-emergency-department
#17
Amanda S Newton, Amir Soleimani, Scott W Kirkland, Rebecca J Gokiert
OBJECTIVE: Specialized instruments to screen and diagnose mental health problems in children and adolescents are not yet standard components of clinical assessments in emergency departments (EDs). We conducted a systematic review to investigate the psychometric properties, accuracy, and performance metrics of instruments used in the ED to identify pediatric mental health and substance use problems. METHODS: We searched seven electronic databases and the grey literature for psychometric validation studies, diagnostic studies, and cohort studies that assessed any instrument to screen for or diagnose mental illness, emotional or behavioral problems, or substance use disorders...
February 1, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28109033/a-quality-improvement-initiative-to-decrease-the-rate-of-solitary-blood-cultures-in-the-emergency-department
#18
Joseph Choi, Sahand Ensafi, Lucas Brien Chartier, Oliver Van Praet
OBJECTIVES: Best practice guidelines recommend that at least two sets of blood cultures (BCs) be sent when blood cultures are required. However, high rates of solitary BCs are still common in the emergency department (ED). The aim of this study was to evaluate the efficacy of different quality improvement initiatives aimed at reducing the rate of solitary blood cultures being sent to the lab on patients ultimately discharged from our ED. METHODS: This was a multi-centre, multi-phase, prospective study evaluating a comprehensive education-based intervention and a second intervention that combined a computerized forcing function along with a brief education-based intervention...
January 20, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28109012/the-impact-of-a-soiled-airway-on-intubation-success-in-the-emergency-department-when-using-the-glidescope-or-the-direct-laryngoscope
#19
John C Sakles, G Judson Corn, Patrick Hollinger, Brittany Arcaris, Asad E Patanwala, Jarrod M Mosier
BACKGROUND: To determine the impact of a soiled airway on first pass success when using the GlideScope video laryngoscope or the direct laryngoscope for intubation in the emergency department. METHODS: Data were prospectively collected on all patients intubated in an academic emergency department from July 1, 2007 to June 30, 2016. Patients ≥18 years of age, who underwent rapid sequence intubation with the GlideScope or the direct laryngoscope were included in the analysis...
January 20, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28109011/individual-physician-penalties-resulting-from-violation-of-emtala-a-review-of-office-of-the-inspector-general-patient-dumping-settlements-2002-2015
#20
Sophie Terp, Brandon Wang, Brian Raffetto, Seth A Seabury, Michael Menchine
OBJECTIVE: To describe characteristics of civil monetary penalty settlements levied by the Office of the Inspector General (OIG) against individual physicians related to violation of the Emergency Medical Treatment and Labor Act (EMTALA). METHODS: Descriptions of all civil monetary penalty settlements between 2002 and 2015 were obtained from the OIG. Characteristics of settlements against individual physicians related to EMTALA violations were described including settlement date, location, amount, whether there was an associated hospital settlement, the medical specialty of the physician involved, and the nature of the allegation...
January 20, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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