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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/30010232/d-dimer-in-adolescent-pulmonary-embolism
#1
Nematullah Sharaf, Victoria B Sharaf, Sharon E Mace, Amy S Nowacki, James K Stoller, John C Carl
BACKGROUND: D-dimer is used to aid in diagnosing adult pulmonary embolism (PE). D-dimer has not been validated in adolescents. Clinicians must balance the risk of over-testing with that of a missed PE. D-dimer may be useful in this context. This study evaluates D-dimer in PE-positive and PE-negative adolescents. METHODS: PE-positive patients <22 years were diagnosed with PE by CT or high-probability V/Q, seen at EDs/hospitals within a 16-hospital system across two states, January 1998-December 2016...
July 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30010230/reliability-of-heartsmap-as-a-tool-for-evaluating-psychosocial-assessment-documentation-practices-in-emergency-departments-for-pediatric-mental-health-complaints-a-methodological-issue
#2
Mehdi Naderi, Shiva Karimi, Farkhonde Salehi
We were interested to read the paper by Gill C and colleagues published in the Jun 2018 issue of Acad Emerg Med. the authors aimed to determine the reliability of HEARTSMAP as a standardized tool for evaluating the quality of psychosocial assessment documentation of pediatric mental health presentations to the emergency department. the inter-rater agreement among reviewers was assessed by using Cohen Kappa statistic. This article is protected by copyright. All rights reserved.
July 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30010223/response-to-reliability-of-heartsmap-as-a-tool-for-evaluating-psychosocial-assessment-documentation-practices-in-emergency-departments-for-pediatric-mental-health-complaints-a-methodological-issue
#3
Carson Gill, Brendan Arnold, Sean Nugent, Alykhan Rajwani, Michael Xu, Tyler Black, Quynh Doan
We thank the authors for their interest in our work and highlighting the limitations of the kappa value. Cohen's kappa statistic is calculated as a ratio of observed and expected (chance) agreement, and we concur that this value is dependent on the number of categories and prevalence in each. Indeed, prevalence approaching 0 or 100% results in high chance agreement, which typically reduces or handicaps the kappa value as the authors correctly identified in the example provided. Thus, such an argument is often raised for justifying a low kappa value in the face of high observed agreement...
July 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30003641/hot-off-the-press-a-novel-algorithm-to-decrease-unnecessary-hospitalizations-in-patients-with-atrial-fibrillation
#4
Justin Morgenstern, Corey Heitz, Chris Bond, William K Milne
This is a retrospective cohort study with a before and after design, comparing the admission rate for patients with AFib during a one-year period before the initiation of a new management algorithm to a one-year period after the algorithm was introduced. Physicians were first instructed to determine whether the AFib was secondary to another important diagnosis, such as sepsis or pulmonary embolism. (These patients were admitted to hospital). Among the patients with primary AFib, physicians assessed for four high-risk criteria: hemodynamic instability, acute heart failure, syncope, and acute coronary syndrome...
July 12, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29972892/development-and-validation-of-a-measure-to-assess-patients-threat-perceptions-in-the-emergency-department
#5
Talea Cornelius, Sachin Agarwal, Othanya Garcia, William Chaplin, Donald Edmondson, Bernard P Chang
OBJECTIVE: Threat perceptions in the Emergency Department (ED) (e.g., patients' subjective feelings of helplessness or lack of control) during evaluation for an acute coronary syndrome (ACS) are associated with the development of posttraumatic stress disorder (PTSD), and PTSD has been associated with medication nonadherence, cardiac event recurrence, and mortality. This study reports the development and validation of a 7-item measure of ED Threat Perceptions in English- and Spanish-speaking patients evaluated for ACS...
July 4, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29971851/multiple-pediatric-head-injury-decision-rules-but-what-should-the-clinician-use
#6
James F Holmes, Peter S Dayan, Nathan Kuppermann
Traumatic brain injury (TBI) is the leading cause of traumatic death in children. As many children with TBIs have subtle symptoms and missed or delayed diagnoses may result in increased morbidity, emergency department clinicians must frequently determine which children require emergent cranial computed tomographic (CT) scanning even after apparently minor blunt head trauma. Overuse of CT scans, however, has important drawbacks, including radiation-induced malignancies. Two large cohorts have documented the association of cranial CT scanning with cancer in children...
July 3, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29969840/building-a-longitudinal-cohort-from-9-1-1-to-1-year-using-existing-data-sources-probabilistic-linkage-and-multiple-imputation-a-validation-study
#7
Craig D Newgard, Susan Malveau, Dana Zive, Joshua Lupton, Amber Lin
OBJECTIVE: To describe and validate construction of a population-based, longitudinal cohort of injured older adults from 911 call to 1-year follow-up using existing data sources, probabilistic linkage, and multiple imputation. METHODS: This was a descriptive cohort study conducted in seven counties in Oregon and Washington from January 1, 2011 through December 31, 2011, with follow-up through December 31, 2012. The primary cohort included all injured adults ≥ 65 years served by 44 EMS agencies...
July 3, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29953694/clinical-predictors-of-acute-brain-injury-in-carbon-monoxide-poisoning-patients-with-altered-mental-status-at-admission-to-emergency-department
#8
Youn-Jung Kim, Chang Hwan Sohn, Dong Woo Seo, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim
OBJECTIVES: Objective screening tool for patients at a high risk of developing acute brain injury (ABI) is necessary for the proper treatment of carbon monoxide (CO) poisoning patients. The aim of this study is to identify clinical factors that could predict ABI due to CO poisoning in patients with an altered mental status. METHODS: A prospectively collected CO poisoning registry at a single academic medical center was retrospectively analyzed. CO poisoning patients with an altered mental status at the emergency department, defined as unalert on the Alert/responsive to Voice/responsive to Pain/Unresponsive scale, and underwent diffusion-weighted magnetic resonance imaging (DW-MRI) between January 1, 2013, and December 31, 2015, were included...
June 28, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29947453/providers-perceptions-of-caring-for-pediatric-patients-in-community-hospital-emergency-departments-a-mixed-methods-analysis
#9
Michael P Goldman, Ambrose H Wong, Ambika Bhatnagar, Beth L Emerson, Linda L Brown, Marc A Auerbach
BACKGROUND: Approximately 90% of pediatric emergency care is provided in community emergency departments (CEDs) that care for both adults and children. Paradoxically, the majority of pediatric emergency medicine knowledge generation, quality improvement work and clinical training occurs in children's hospitals. There is a paucity of information of perceptions on pediatric care from CED providers. This information is needed to guide the development of strategies to improve CED pediatric readiness...
June 27, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29947451/safety-of-the-combination-of-perc-and-years-rules-in-patients-with-low-clinical-probability-of-pe-a-retrospective-analysis-of-two-large-european-cohorts
#10
Judith Gorlicki, Andrea Penaloza, Boris Germeau, Thomas Moumneh, Anne-Laure Philippon, Jennifer Truchot, Delphine Douillet, Charlotte Steinier, Caroline Soulié, Ben Bloom, Marine Cachanado, Pierre-Marie Roy, Yonathan Freund
BACKGROUND: This study aimed to determine the failure rate of a combination of the PERC and the YEARS rules for the diagnosis of pulmonary embolism (PE) in the emergency department (ED). METHODS: We performed a retrospective analysis of two European cohorts of emergency patients with low gestalt clinical probability of PE (PROPER and PERCEPIC). All patients we included were managed using a conventional strategy (D-dimer test, followed, if positive, by computed tomographic pulmonary angiogram CTPA)...
June 27, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29931705/the-impact-of-maryland-s-global-budget-payment-reform-on-emergency-department-admission-rates-in-a-single-health-system
#11
Jessica E Galarraga, William J Frohna, Jesse M Pines
BACKGROUND: In 2014, the state of Maryland moved away from fee-for-service payments and into a global budget revenue (GBR) structure where hospitals have a fixed revenue target, independent of patient volume or services provided. We assess the effects of GBR adoption on emergency department (ED) admission decisions among adult encounters. METHODS: We used hospital medical record and billing data from adult ED encounters from January 1, 2011 through December 31, 2015, with four Maryland (MD) hospitals and two District of Columbia (DC) hospitals within the same health system...
June 22, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29924893/reliability-of-heartsmap-as-a-tool-for-evaluating-psychosocial-assessment-documentation-practices-in-emergency-departments-for-pediatric-mental-health-complaints
#12
Carson Gill, Brendan Arnold, Sean Nugent, Alykhan Rajwani, Michael Xu, Tyler Black, Quynh Doan
OBJECTIVES: The goal of this study was to assess the reliability of HEARTSMAP as a standardized tool for evaluating the quality of psychosocial assessment documentation of pediatric mental health presentations to the emergency department. In addition, we report on current documentation practices. METHODS: We conducted a retrospective cross-sectional study of pediatric (up to age 17) mental health-related visits to four emergency departments between April 1, 2013 and March 31, 2014...
June 20, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29924431/interruptions-in-emergency-medicine-things-are-not-always-what-they-seem
#13
Scott R Walter
We have all felt the cognitive disjuncture of being interrupted during an important task. Most ED physicians will readily proffer the high frequency and/or burden of interruptions during their work, and of the many observational studies of interruptions in healthcare EDs do indeed have high interruption rates[2]. In experimental psychology, where many of these ideas originated, there is plenty of evidence that interruptions negatively affect performance. Interruptions have been associated with reduced performance on complex tasks[3,4], increased sequence errors[5], increased task completion time and augmented annoyance and anxiety[6]...
June 20, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29920834/the-heart-pathway-randomized-controlled-trial-one-year-outcomes
#14
Jason P Stopyra, Robert F Riley, Brian C Hiestand, Gregory B Russell, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Stephanie B Elliott, David M Herrington, Gregory L Burke, Chadwick D Miller, Simon A Mahler
OBJECTIVE: To determine the impact of the HEART Pathway on healthcare utilization and safety outomes at 1 year in patients with acute chest pain. METHODS: Adult Emergency Department (ED) patients with chest pain (N=282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, ED providers used the HEART score and troponin measures (0 and 3-hours) to risk stratify patients. Usual care was based on ACC/AHA guidelines. Major adverse cardiac events (MACE: cardiac death, myocardial infarction [MI], or coronary revascularization), objective testing (stress testing or coronary angiography), and cardiac hospitalizations and ED visits were assessed at 1 year...
June 19, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29904986/factors-associated-with-patient-involvement-in-emergency-care-decisions-a-secondary-analysis-of-the-chest-pain-choice-multicenter-randomized-trial
#15
Marc A Probst, Craig F Tschatscher, Christine M Lohse, M Fernanda Bellolio, Erik P Hess
BACKGROUND: Shared decision-making in the Emergency Department (ED) can increase patient engagement for patients presenting with chest pain. However, little is known regarding which factors are associated with actual patient involvement in decision-making or patients' desired involvement in emergency care decisions. We examined which factors were associated with patients' actual and desired involvement in decision-making among ED chest pain patients. METHODS: This is a secondary analysis of data from a randomized trial of a shared decision-making intervention in ED patients with low-risk chest pain...
June 15, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29904982/dissecting-the-evidence-on-aortic-catastrophe
#16
Robert R Ehrman, Mark J Favot, Adrienne Malik
Acute aortic dissection presents a diagnostic challenge for Emergency Physicians. Use of recently published "high-risk" features to identify patients as truly high-risk may lead to over-testing. This article is protected by copyright. All rights reserved.
June 14, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29904981/diagnosing-acute-aortic-dissection-both-an-artery-and-a-science
#17
Robert Ohle
Thank you very much for your interest in our paper. We agree that retrospective nature of this study in isolation does not provide proof of a hypothesis. However taken in context of the evidence as quoted in the paper and the new prospective trial by Nazerian et al, we believe it adds to the conversation that classically reported high risk features do in fact change the likelihood of acute aortic dissection. This article is protected by copyright. All rights reserved.
June 14, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29897639/patient-preferences-regarding-shared-decision-making-in-the-emergency-department-findings-from-a-multi-site-survey
#18
Elizabeth M Schoenfeld, Hemal K Kanzaria, Denise D Quigley, Peter St Marie, Nikita Nayyar, Sarah H Sabbagh, Kyle L Gress, Marc A Probst
OBJECTIVES: As Shared Decision-Making (SDM) has received increased attention as a method to improve the patient-centeredness of emergency department (ED) care, we sought to determine patients' desired level of involvement in medical decisions and their perceptions of potential barriers and facilitators to SDM in the ED. METHODS: We surveyed a cross-sectional sample of adult ED patients at three academic medical centers across the United States. The survey included 32 items regarding patient involvement in medical decisions including a modified Control Preference Scale (CPS) and questions about barriers and facilitators to SDM in the ED...
June 13, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29894013/first-timers
#19
Rob McMickle
I never had the chance to introduce myself to Ms. Jones. She was without a pulse the night she was wheeled into our emergency room by EMS personnel after arresting during dinner with her family. I, a newly-minted medical student, was in the midst of seeing another patient when a monotonic voice over the intercom abruptly interrupted our meeting to announce her pending arrival: "ROSC en route, t-minus five minutes." I left the room to join the rest of the team organizing in the resuscitation bay, confirming their roles in the resuscitation around the gurney and casually going over their plans for the weekend...
June 12, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29888519/understanding-emergency-medicine-physicians-multitasking-behaviors-around-interruptions
#20
Allan Fong, Raj M Ratwani
BACKGROUND: Interruptions can adversely impact human performance, particularly in fast-paced and high-risk environments such as the emergency department (ED). Understanding physician behaviors before, during, and after interruptions is important to the design and promotion of safe and effective workflow solutions. However, traditional human factors based interruption models do not accurately reflect the complexities of real-world environments like the ED and may not capture multiple interruptions and multitasking...
June 11, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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