Annals of emergency medicine
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To determine the concordance rate of plain radiograph interpretations by pediatric emergency physicians and pediatric radiologists, to evaluate the effect of incorrect radiologic diagnosis on patient management, and to evaluate the necessity and cost-effectiveness of routine follow-up review of all plain radiographs by a radiologist. ⋯ Radiograph interpretations by pediatric emergency physicians were generally accurate, and no adverse outcomes occurred as a result of misinterpretation. Clinical assessment probably assisted these physicians in interpreting the radiographs of high-risk patients. Judicious consultation with a radiologist during the initial presentation of a high-risk patient, when deemed warranted by the pediatric emergency physician, will help the emergency physician deliver high-quality, cost-effective health care. Given the overall clinical accuracy rate of radiograph interpretations by the pediatric emergency physicians and the cost of routine review of all plain radiographs in the ED by a radiologist, routine review versus selective specialty consultation must be further evaluated.
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To determine the clinical value of routine computed tomography (CT) of the head in patients with normal mental status after minor head trauma. ⋯ Routine CT of the head in patients with history of LOC/amnesia but no symptoms or signs of depressed skull fracture has minimal clinical value and is not warranted. Patients with symptoms of head injury or apparent depressed skull fracture should undergo head CT because a small number will require surgery.
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To assess the prevalence of misrepresented citations among emergency medicine residency applicants and to determine whether misrepresentation increases as the number of citations increases. ⋯ Emergency medicine residency applications may contain misrepresented citations. The number of misrepresentations in this study increased as the number of citations increased.
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We compared the cost-effectiveness of two single-dose treatment strategies for adolescents with uncomplicated Neisseria gonorrhoeae cervicitis. ⋯ over the range of efficacy by the 95% confidence intervals of both drugs, our analysis demonstrated no clear cost advantage for either. The economic effects of accidental needlestick do not change this conclusion. Compared with the IM alternative, oral cefixime is painless to the patient and simpler for the practitioner to administer. Oral cefixime also eliminates the psychologic effects associated with needlesticks in health care workers. For these reasons, we favor the use of oral cefixime for uncomplicated gonococcal cervicitis in adolescents.
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Ingestion of methanol or ethylene glycol is a toxicologic emergency. The osmolal gap has been widely advocated as a screen for serum methanol or ethylene glycol. Unfortunately, for several reasons the osmolal gap fails in this capacity. ⋯ Third, ethylene glycol has such a large molecular weight that even toxic amounts may contribute minimally to a patient's overall osmolality. Finally, because of metabolism, little ethylene glycol or methanol may be present when a patient presents with toxicity. These limitations invalidate the osmolal gap as a screen for ethylene glycol or methanol ingestion.