Annals of emergency medicine
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Clinical Trial
Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study.
Cervical-spine radiography does not need to be performed on selected blunt trauma patients who are awake, alert, nonintoxicated, do not complain of midline neck pain, and have no tenderness over the bony cervical spine. ⋯ Cervical-spine radiology may not be necessary in patients without spinous tenderness in the neck, intoxication, altered level of alertness, or other severely painful injury. A policy to limit films in such patients would have decreased film ordering by more than one third in this series, while identifying all patients with fracture.
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Hip fractures in awake patients are rarely subtle in their clinical presentation. We report two cases of occult, comminuted, intertrochanteric hip fractures that occurred in awake, elderly patients who were brought to the emergency department for evaluation of other medical conditions. Neither patient complained of hip pain, and both were transported to the ED without spinal immobilization. ⋯ Radiographs of both patients revealed comminuted intertrochanteric hip fractures. In an elderly, nonambulatory patient who may have fallen prior to evaluation, routine radiographs of the pelvis and hip should be performed followed by plain tomography, computed tomography, bone scan, or magnetic resonance imaging as indicated to rule out occult hip fracture. Even comminuted intertrochanteric hip fractures can present in an occult fashion; therefore, a high index of suspicion must be maintained for these injuries.
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Multicenter Study Comparative Study
Serial ECGs are less accurate than serial CK-MB results for emergency department diagnosis of myocardial infarction.
Serial creatine kinase-MB (CK-MB) levels provide more accurate predictive information regarding myocardial infarction than serial ECGs in emergency department patients with chest discomfort and no ST-segment elevation on the initial ECG. ⋯ Serial changes in ECGs during a three- to four-hour interval were associated with the diagnosis of myocardial infarction but were infrequent and less accurate than serial CK-MB levels obtained for the same interval.