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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/29791967/global-emergency-medicine-a-review-of-the-literature-from-2017
#1
Torben K Becker, Indi Trehan, Alison Schroth Hayward, Braden J Hexom, Sean M Kivlehan, Kevin M Lunney, Payal Modi, Maxwell Osei-Ampofo, Amelia Pousson, Daniel K Cho, Adam C Levine
OBJECTIVES: The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. METHODS: This year, 17,722 articles written in three languages were identified by our electronic search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM...
May 23, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29781559/hot-off-the-press-sgem-215-aortic-dissection-love-will-tear-us-apart
#2
Corey Heitz, Justin Morgenstern, Christopher Bond, William K Milne
This systematic review provides an assessment of the diagnostic accuracy of various historical, physical, and clinical examination features for aortic dissection. 9 articles were included, with moderate to high heterogeneity. Limitations to general practice include risk of selection bias and partial verification bias. Risk scores were included, but their use is not recommended at this time. This article is protected by copyright. All rights reserved.
May 21, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29774966/test-characteristics-of-point-of-care-ultrasound-for-the-diagnosis-of-retinal-detachment-in-the-emergency-department
#3
Daniel J Kim, Mario Francispragasam, Gavin Docherty, Byron Silver, Ross Prager, Donna Lee, David Maberley
Previous studies of point of care ultrasound (POCUS) have reported high sensitivities and specificities for retinal detachment (RD). Our primary objective was to assess the test characteristics of POCUS performed by a large heterogeneous group of emergency physicians (EPs) for the diagnosis of RD. METHODS: This was a prospective diagnostic test assessment of POCUS performed by EPs with varying ultrasound experience on a convenience sample of emergency department (ED) patients presenting with flashes or floaters in one or both eyes...
May 18, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29770528/pain-one-week-after-an-ed-visit-for-acute-low-back-pain-is-associated-with-poor-three-month-outcomes
#4
Benjamin W Friedman, John Conway, Caron Campbell, Polly E Bijur, E John Gallagher
BACKGROUND: Low back pain (LBP) is responsible for more than 2.5 million visits to US emergency departments (EDs) annually. Nearly 30% of patients who present to an ED with acute LBP report functional impairment or pain three months later. These patients are at risk of chronic LBP, a highly debilitating condition. In this study, we assessed whether three variables assessable shortly after symptom onset could independently predict poor three-month outcomes among LBP patients who present to an ED...
May 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29768698/financial-viability-of-emergency-department-observation-unit-billing-models
#5
Christopher W Baugh, Pawan Suri, Christopher G Caspers, Michael A Granovsky, Keith Neal, Michael A Ross
BACKGROUND: Outpatients receive observation services to determine the need for inpatient admission. These services are usually provided without the use of condition-specific protocols and in an unstructured manner, scattered throughout a hospital in areas typically designated for inpatient care. Emergency department observation units (EDOUs) use protocolized care to offer an efficient alternative with shorter lengths of stay, lower costs and higher patient satisfaction. EDOU growth is limited by existing policy barriers that prevent a "two-service" model of separate professional billing for both emergency and observation services...
May 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29757489/emergency-department-discharge-of-pulmonary-embolus-patients
#6
W Frank Peacock, Craig I Coleman, Deborah Diercks, Samuel Francis, Christopher Kabrhel, Catherine Keay, Jeffery Kline, Jacob Manteuffel, Peter Wildgoose, Jim Xiang, Adam J Singer
BACKGROUND: Hospitalization for low risk pulmonary embolism (PE) is common, expensive, and of questionable benefit. OBJECTIVE: Determine if low-risk PE patients discharged from the emergency department (ED) on rivaroxaban require fewer hospital days compared to standard of care (SOC). METHODS: Multicenter, open label randomized trial in low risk PE defined by Hestia criteria. Adult subjects were randomized to early ED discharge on rivaroxaban, or SOC...
May 14, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29754458/integrating-point-of-care-testing-into-a-community-emergency-department-a-mixed-methods-evaluation
#7
Jesse M Pines, Mark S Zocchi, Caitlin Carter, Charles Z Marriott, Matthew Bernard, Leah H Warner
STUDY OBJECTIVE: Point-of-care testing (POCT) is a commonly used technology that hastens the time to laboratory results in emergency departments (ED). We evaluated an ED-based POCT program on ED length of stay and time to care, coupled with qualitative interviews of local ED stakeholders. METHODS: We conducted a mixed-methods study (2012-16) to examine the impact of point-of-care testing in a single, community ED. The quantiative analysis involved an observational before-after study comparing time to laboratory test result (POC troponin or POC chemistry) and ED length of stay after implementation of POCT, using a propensity-weighted interrupted time series analysis (ITSA)...
May 13, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29741232/understanding-pediatric-caretakers-views-on-obtaining-medical-care-for-low-acuity-illness
#8
Whitney V Cabey, Judy A Shea, Shreya Kangovi, Danielle Kennedy, Chiamaka Onwuzulike, Joel Fein
BACKGROUND: A significant proportion of low acuity emergency department (ED) visits are by patients under 18 years of age. Results from prior interventions designed to reduce low acuity pediatric ED use have been mixed or poorly sustained, perhaps because they were not informed by patient and caretakers' perspectives. The objective of this study was to explore caretaker decision-making processes, values and priorities when deciding to seek care. METHODS: We conducted semi-structured interviews of caretakers in both emergency and primary care settings, incorporating stimulated recall methodology...
May 9, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29738616/commentary-2018-stroke-guidelines
#9
Andrew D Perron
I read with interest (and some degree of disappointment) the new 2018 Stroke Guidelines published in January of this year that are labeled prominently "Endorsed by SAEM".1 To be clear, my disappointment has nothing to do with the use of tPA in acute ischemic stroke (I am happy to let others lead that charge). I am an admitted agnostic when it comes to the use of tPA (it helps some, it harms others, and we need to be really smart in its use to maximize the former and minimize the latter). Rather, it was notable to me that while the new guidelines touch a large number of specialties (Internal Medicine, Pharmacy, Nutrition, Rehabilitation, Radiology, Neurology, and Interventionalists to name a few), only one specialty merited a new Level 1A recommendation for targeted education This article is protected by copyright...
May 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29738606/author-s-response-to-letter-to-the-editor-for-creation-and-implementation-of-an-outpatient-pathway-for-atrial-fibrillation-in-the-emergency-department-setting-results-of-an-expert-panel
#10
Christopher W Baugh
Thank you for your comments regarding our recent publication. Cardioversion as a default strategy over rate control is a key element of our example pathway, which features both electrical and chemical cardioversion. We discuss that some physicians may prefer chemical cardioversion and the importance of considering patient perspectives in the treatment plan in the text of our paper (page 6). This article is protected by copyright. All rights reserved.
May 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29738108/causes-of-shortness-of-breath-in-the-acute-patient-a-national-study
#11
Zachariah E Hale, Astha Singhal, Renee Y Hsia
BACKGROUND: Dyspnea is a common and ambiguous complaint that results in 3.4 million emergency department visits annually. While learners may encounter lists of differential diagnoses to consider while in training, often these lists are not empirically based. We sought to establish an evidence-based differential diagnosis for dyspnea and to determine whether normal vital signs can rule out a life-threatening diagnosis. METHODS: We analyzed data from the National Hospital Ambulatory Medical Care Survey from 2005-2014 for emergency department visits with a chief complaint of dyspnea and tallied the principal discharge diagnosis...
May 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29738103/bedside-sonography-performed-by-emergency-physicians-to-detect-appendicitis-in-children
#12
Marie Nicole, Marie Pier Desjardins, Jocelyn Gravel
OBJECTIVE: The aim of this study was to evaluate the ability of emergency physicians with various levels of Point of Care Ultrasound (POCUS) experience to detect appendicitis with POCUS among children visiting a pediatric Emergency Department (ED). METHODS: A prospective cohort study was conducted in an urban, tertiary care pediatric ED. Children aged 2 to 18 years old who presented with acute abdominal pain suggesting appendicitis were included. Patients were excluded if they had a history of appendectomy, hemodynamic instability requiring resuscitation, or were transferred with proven diagnosis of appendicitis...
May 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29738102/validation-of-the-brief-confusion-assessment-method-for-screening-delirium-in-elderly-medical-patients-in-a-german-emergency-department
#13
Verena Baten, Hans-Jörg Busch, Caroline Busche, Bonaventura Schmid, Miriam Heupel-Reuter, Evgeniy Perlov, Jochen Brich, Stefan Klöppel
BACKGROUND: Delirium is frequent in elderly patients presenting in the emergency department (ED). Despite the severe prognosis, the majority of delirium cases remain undetected by emergency physicians (EPs). At the time of our study there was no valid delirium screening tool available for EDs in German-speaking regions. We aimed to evaluate the brief Confusion Assessment Method (bCAM) for a German ED during the daily work routine. METHODS: We implemented the bCAM into practice in a German interdisciplinary high volume ED, and evaluated the bCAM's validity in a convenience sample of medical patients aged ≥70 years...
May 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29737590/improving-an-outpatient-pathway-for-the-emergency-management-of-atrial-fibrillation-and-flutter
#14
David R Vinson, Nelya Lugovskaya, Manvi R Nagam
We commend Baugh et al for their treatment pathway for the emergency department (ED) management of atrial fibrillation (AF) and flutter (AFL) (combined AFF).1 This will help clinicians facing bedside management decisions. It will also provide a model for ED leaders and key stakeholders creating a multidisciplinary comprehensive emergency care pathway for their own medical centers. Three issues on pharmacologic cardioversion, however, warrant clarification. This article is protected by copyright. All rights reserved...
May 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29729100/immune-related-adverse-events-in-cancer-patients
#15
Daniel J Pallin, Christopher W Baugh, Michael A Postow, Jeffrey M Caterino, Timothy B Erickson, Gary H Lyman
The US Food and Drug Administration has approved immune checkpoint inhibitors and chimeric antigen receptor T cells (CAR-T cells) as immunotherapy strategies for cancer. These therapies cause a wide variety of adverse events, which mimic other disease states, and may emerge months after completion of treatment. This is important because ascertaining a past medical history of cancer treatment within the past year becomes necessary for many presentations. This narrative review summarizes the biology, pathophysiology and adverse events associated with checkpoint inhibitors and CAR-T cells, and provides a rational approach to management...
May 5, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29710413/automated-pulmonary-embolism-risk-classification-and-guideline-adherence-for-computed-tomography-pulmonary-angiography-ordering
#16
Christian A Koziatek, Emma Simon, Leora I Horwitz, Danil V Makarov, Silas W Smith, Simon Jones, Soterios Gyftopoulos, Jordan L Swartz
BACKGROUND: The assessment of clinical guideline adherence for the evaluation of pulmonary embolism (PE) via computed tomography pulmonary angiography (CTPA) currently requires either labor-intensive, retrospective chart review or prospective collection of PE risk scores at the time of CTPA order. The recording of clinical data in a structured manner in the electronic health record (EHR) may make it possible to automate the calculation of a patient's PE risk classification and determine whether the CTPA order was guideline concordant...
April 30, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29701893/complex-febrile-seizures-lumbar-puncture-and-central-nervous-system-infections-a-national-perspective
#17
Jane Lee, Amy M DeLaroche, Alexander T Janke, Nirupama Kannikeswaran, Phillip D Levy
OBJECTIVES: To determine the national lumbar puncture (LP) practice patterns relative to the incidence of central nervous system (CNS) infections among children presenting to the emergency department (ED) with complex febrile seizures (CFS). METHODS: Retrospective study of ED visits for CFS from 2007 to 2014 in patients aged 0 to 5 years using a national sample. Primary outcomes include the frequency of LP, incidence of CNS infections, and ED disposition. RESULTS: Of 28,810 ED visits for CFS (44...
April 27, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29701889/emergency-department-adult-fiberoptic-intubations-incidence-indications-and-implications-for-training
#18
Emily M Hayden, Daniel J Pallin, Susan R Wilcox, James A Gordon, Jestin N Carlson, Ron M Walls, Calvin A Brown
BACKGROUND: To describe the frequency, indications and outcomes of flexible fiberoptic intubations (FFI) performed in the emergency department (ED). METHODS: From the National Emergency Airway Registry (NEAR), we identified all encounters during 7/1/02 through 12/31/12 with the use of FFI. We determined patient, provider and intubation characteristics, success and failure rates, and modes of intubation rescue. RESULTS: Among 17,910 intubations of patients >15 years old at 13 EDs, FFI was used in 204 cases (1...
April 27, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29696770/likelihood-ratios-for-the-emergency-physician
#19
Paul Peng, Andrew Coyle
The concept of likelihood ratios was introduced more than 40 years ago, yet this powerful metric has still not seen wider application or discussion in the medical decision-making process. There is concern that clinicians-in-training are still being taught an over-simplified approach to diagnostic test performance, and have limited exposure to likelihood ratios. Even for those familiar with likelihood ratios, they might perceive them as mathematically-cumbersome in application, if not difficult to determine for a particular disease process...
April 26, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29689638/elegy-for-my-friend-c-christopher-king-md
#20
Brent R King
I was working a shift when I heard that you were gone. It was a Tuesday, and cold for a Spring day It seemed right that I should be doing what meant so much to both of us; working with residents and seeing patients, as if you had signed out to me that morning and I was carrying on your work. This article is protected by copyright. All rights reserved.
April 24, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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