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"Triage" AND "Emergency"

Susan M Peterson, Cathi A Harbertson, James J Scheulen, Gabor D Kelen
OBJECTIVES: To meet the unique comparative data needs of academic emergency departments, we describe the recent five-year national and regional trends for adult emergency patients' characteristics and operational parameters at academic emergency medical centers. METHODS: Data collected from the recent five-year period academic year (AY) 2012 through AY 2016 of the Academy of Administrators in Academic Emergency Medicine (AAAEM) and the Association of Academic Chairs of Emergency Medicine (AACEM) Academic Emergency Medicine Benchmarking Survey were analyzed for trends in 1) ED volumes and modes of arrival 2) triage acuity level 3) trends in ED professional fee billing and 4) disposition patterns of ED patients including admission rates and walkouts...
August 13, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Monica Chen, Peter Cundy, Georgia Antoniou, Nicole Williams
AIM: To compare trampoline injuries and injury costs sustained at a commercial trampoline park versus private homes presenting to a major Australian children's hospital over a 12-month period. METHODS: Children presenting with a trampoline injury to the paediatric emergency department in 2015 were identified using a keyword search of triage information. A comparison of injuries sustained at a commercial trampoline park and private homes was performed. RESULTS: A total of 392 children presented with injuries, and the majority of injuries (68...
August 9, 2018: Journal of Paediatrics and Child Health
Loren De Freitas, Steve Goodacre, Rachel O'Hara, Praveen Thokala, Seetharaman Hariharan
OBJECTIVES: Patient flow and crowding are two major issues in ED service improvement. A substantial amount of literature exists on the interventions to improve patient flow and crowding, making it difficult for policymakers, managers and clinicians to be familiar with all the available literature and identify which interventions are supported by the evidence. This umbrella review provides a comprehensive analysis of the evidence from existing quantitative systematic reviews on the interventions that improve patient flow in EDs...
August 9, 2018: Emergency Medicine Journal: EMJ
Abhay Venkat, Cecilia Cappelen-Smith, Shabeel Askar, Peter R Thomas, Sonu Bhaskar, Amanda Tam, Alan J McDougall, Suzanne J Hodgkinson, Dennis J Cordato
BACKGROUND: Failure to recognise acute stroke may result in worse outcomes due to missed opportunity for acute stroke therapies. Our study examines factors associated with stroke misdiagnosis in patients admitted to a large comprehensive stroke centre. METHODS: Retrospective review comparing 156 consecutive stroke patients misdiagnosed in emergency department (ED) with 156 randomly selected stroke controls matched for age, gender, language spoken and stroke subtype for the period 2014-2016...
August 9, 2018: Neuroepidemiology
Maanit Shapira, Olga Boico, Asi Cohen, Ruth Sagi, Ada Aharon, Roy Navon, Gali Kronenfeld, Katie Maler, Ester Pri-Or, Michal Stein, Adi Klein, Eran Eden, Kfir Oved
Distinguishing bacterial from viral infections is often challenging, leading to antibiotic misuse, and detrimental ramifications for the patient, the healthcare system and society. A novel ELISA-based assay that integrates the circulating levels of three host-response proteins (TRAIL, IP-10 and CRP) was developed to assist in differentiation between bacterial and viral etiologies. We developed a new protocol for measuring the host-based assay biomarkers using an automated ELISA workstation. The automated protocol was validated and was able to reduce technician hands-on time by 76%, while maintaining high analytical performance...
August 2018: BioTechniques
Betina Franco, Lurdes Busin, Tânia Couto Machado Chianca, Vítor Monteiro Moraes, Ananda Ughini Bertoldo Pires, Amália de Fátima Lucena
OBJECTIVE: To analyze the association between Manchester Triage System flowchart discriminators and nursing diagnoses in adult patients classified as clinical priority I (emergency) and II (very urgent). METHOD: Cross-sectional study conducted in an emergency department in southern Brazil between April and August 2014. The sample included 219 patients. Data were collected from online patient medical records and data analysis was performed using Fisher's exact test or the chi-square test...
August 2, 2018: Revista Gaúcha de Enfermagem
Salim Halabi, Awny Elias, Michael Goldberg, Hilal Hurani, Husein Darawsha, Sharon Shachar, Miti Ashkenazi
BACKGROUND: Door-to-balloon time (DTBT) ≤ 90 minutes has become an important quality indicator in the management of ST-elevation myocardial infarction (STEMI). We identified three specific problems in the course from arrival of STEMI patients at our emergency department to initiation of balloon inflation and determined an intervention comprised of specific administrative and professional steps. The focus of the intervention was on triage within the emergency department (ED) and on increasing the efficiency and accuracy of electrocardiography interpretation...
August 2018: Israel Medical Association Journal: IMAJ
Masayasu Horibe, Yuki Ogura, Juntaro Matsuzaki, Tetsuji Kaneko, Takuya Yokota, Osamu Okawa, Yukihiro Nakatani, Eisuke Iwasaki, Toshihiro Nishizawa, Naoki Hosoe, Tatsuhiro Masaoka, Naohisa Yahagi, Shin Namiki, Takanori Kanai
Background: The need for a blood transfusion, defined as hemoglobin < 70 g/L, is the measure for assessing the risk levels in patients with upper gastrointestinal bleeding (UGIB). However, not all patients with a low hemoglobin level have a poor prognosis. Objective: We assessed the clinical predictive factors associated with poor short-term prognosis in patients with a low hemoglobin level. Methods: In this prospective cohort study, all consecutive patients with suspected acute UGIB at Tokyo Metropolitan Tama Medical Center were enrolled between 2008 and 2015...
June 2018: United European Gastroenterology Journal
Waheeb Nasr Naser, Huda Ba Saleem
BACKGROUND: Medical professionals together with other first responder teams are the first to attend an emergency or disaster. Knowledge and training in emergency and disaster preparedness are important in responding effectively. This study aims to assess the current knowledge, attitude and training in emergency and disaster preparedness among Yemeni health professionals. METHOD: A descriptive, cross-sectional, non-probability based study was conducted in Yemen using self-reported on-line and paper surveys in 2017...
August 6, 2018: BMC Emergency Medicine
Hannah Beks, Christopher Healey, Kate G Schlicht
INTRODUCTION: A higher proportion of chronic mental illness is reported for populations residing in inner and outer regional (IOR) areas when compared to major cities in Australia. Conversely, fewer mental health professionals work in IOR areas when compared to major cities indicating poorer access to services for rural populations. Rural emergency departments (EDs) and urgent care centres (UCCs) deliver a broad range of services. Often they are the first point of care for consumers experiencing acute mental health issues...
August 2018: Rural and Remote Health
Annette Ilg, Ari Moskowitz, Varun Konanki, Parth V Patel, Maureen Chase, Anne V Grossestreuer, Michael W Donnino
STUDY OBJECTIVE: Confusion, uremia, elevated respiratory rate, hypotension, and aged 65 years or older (CURB-65) is a clinical prediction rule intended to stratify patients with pneumonia by expected mortality. We assess the predictive performance of CURB-65 for the proximal endpoint of receipt of critical care intervention in emergency department (ED) patients admitted with community-acquired pneumonia. METHODS: We performed a retrospective analysis of electronic health records from a single tertiary center for ED patients admitted as inpatients with a primary diagnosis of pneumonia from 2010 to 2014...
August 2, 2018: Annals of Emergency Medicine
Nadir Ijaz, Matthew Strehlow, N Ewen Wang, Elizabeth Pirrotta, Areeba Tariq, Naseeruddin Mahmood, Swaminatha Mahadevan
BACKGROUND: There is little data describing pediatric emergencies in resource-poor countries, such as Pakistan. We studied the demographics, management, and outcomes of patients presenting to the highest-volume, public, pediatric emergency department (ED) in Karachi, Pakistan. METHODS: In this prospective, observational study, we approached all patients presenting to the 50-bed ED during 28 12-h study periods over four consecutive weeks (July 2013). Participants' chief complaints and medical care were documented...
August 3, 2018: BMC Emergency Medicine
Timothy Gay, Robert P Olympia
Occasionally, students present with chest pain in the school setting. Therefore, it is important to develop a differential diagnosis for chest pain, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department via emergency medical services). This article describes the initial assessment and management of a student presenting with chest pain...
August 3, 2018: NASN School Nurse
Raphael Twerenbold, Johannes Tobias Neumann, Nils Arne Sörensen, Francisco Ojeda, Mahir Karakas, Jasper Boeddinghaus, Thomas Nestelberger, Patrick Badertscher, Maria Rubini Giménez, Christian Puelacher, Karin Wildi, Nikola Kozhuharov, Dominik Breitenbuecher, Ewelina Biskup, Jeanne du Fay de Lavallaz, Dayana Flores, Desiree Wussler, Òscar Miró, F Javier Martín Sánchez, Beata Morawiec, Jiri Parenica, Nicolas Geigy, Dagmar I Keller, Tanja Zeller, Tobias Reichlin, Stefan Blankenberg, Dirk Westermann, Christian Mueller
BACKGROUND: The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned. OBJECTIVES: This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study. METHODS: The authors prospectively enrolled unselected patients in 6 countries presenting to the emergency department with symptoms suggestive of NSTEMI...
August 7, 2018: Journal of the American College of Cardiology
Silke Walter, Henry Zhao, Damien Easton, Cees Bil, Jonas Sauer, Yang Liu, Martin Lesmeister, Iris Q Grunwald, Geoffrey A Donnan, Stephen M Davis, Klaus Fassbender
Background In recent years, important progress has been made in effective stroke treatment, however, patients living in rural and remote areas have nil or very limited access to timely reperfusion therapies. Aims Novel systems of care to overcome the detrimental treatment gap for stroke patients living in rural and remote regions need to be developed. Summary of review A possible solution to the treatment disparity between stroke patients living in metropolitan and rural areas may involve the use of specially designed aircrafts equipped with the ability to diagnose and treat acute stroke at remote emergency sites...
August 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Kaustubh Limaye, Michael Wall, Sami Uwaydat, Sheharayar Ali, Amir Shaban, Sami Al Kasab, Harold Adams
Central retinal artery occlusion (CRAO) is a medical emergency that, if not treated, may result in irreversible loss of vision. It continues to be an important cause for acute painless loss of vision. Amaurosis fugax or "transient CRAO" has long been considered an equivalent of transient cerebral ischemic event. Animal models, in addition to data from retrospective and randomized clinical studies, provide valuable insights into the time interval for irreversible retinal ischemia. Subset analyses from 2 large studies of patients with CRAO show benefit from treatment with thrombolysis within 6 hours from symptoms onset...
July 27, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Lars Mizera, Katharina Boehm, Martin Duckheim, Patrick Groga-Bada, Meinrad Gawaz, Christine S Zuern, Christian Eick
BACKGROUND: Community-acquired pneumonia (CAP) causes appreciable morbidity and mortality in adults, especially in those ≥65 years of age. At hospital admission, an immediate and reliable risk assessment is necessary to detect patients with possible fatal outcome. OBJECTIVE: We aimed to evaluate markers of the autonomic nervous system based on an electrocardiogram to predict mortality in patients with CAP. METHODS: For this purpose, the deceleration capacity (DC) of heart rate was calculated in 253 patients who presented to the emergency department with CAP...
July 26, 2018: Journal of Emergency Medicine
Audrey Uong, Ariel Brandwein, Colin Crilly, Tamar York, Jahn Avarello, Sandeep Gangadharan
BACKGROUND: Status asthmaticus (SA) is a common reason for admission to the pediatric emergency department (ED). Assessing asthma severity efficiently in the ED can be challenging for clinicians. Adjunctive tools for the clinician have demonstrated inconsistent results. Studies have shown that pulsus paradoxus (PP) correlates with asthma severity. Pleth Variability Index (PVI) is a surrogate measure of PP. OBJECTIVE: We investigated whether PVI at triage correlates with disposition from the ED...
August 2018: Journal of Emergency Medicine
Elena Ferrazzi, Chiara Romualdi, Michele Ocello, Giovanni Frighetto, Matteo Turco, Stefania Vigolo, Fabrizio Fabris, Paolo Angeli, Gianna Vettore, Rodolfo Costa, Sara Montagnese
Daylight saving time (DST) is a source of circadian disruption impinging on millions of people every year. Our aim was to assess modifications, if any, in the number, type, and outcome of Accident & Emergency (A&E) visits/return visits over the DST months. The study included 366,527 visits and 84,380 return visits to the A&E of Padova hospital (Northern Italy) over 3 periods between the years 2007 and 2016: period 1 (2 weeks prior to DST to 19 weeks after), period 2 (2 weeks prior to the return to "winter time" to 4 weeks after), and period 3 (5 consecutive non-DST weeks)...
July 30, 2018: Journal of Biological Rhythms
Joel Neves Briard, Rahel T Zewude, Mahesh P Kate, Brian H Rowe, Brian Buck, Ken Butcher, Laura C Gioia
BACKGROUND: Despite the use of validated prehospital stroke scales, stroke mimics are frequent among patients transported by Emergency Medical Services to the Emergency Department. We aimed to describe the frequency and characteristics of neurological and non-neurological mimics transported to a comprehensive stroke center for acute stroke evaluation. METHODS: This was a retrospective analysis of a database consisting of all consecutive patients with suspected stroke transported to the Emergency Department of a comprehensive stroke center during an 18-month period...
July 26, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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