Annals of emergency medicine
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Comparative Study
Student drivers: a study of fatal motor vehicle crashes involving 16-year-old drivers.
Motor vehicle crashes are the leading cause of death for US teenagers, accounting for 40% of fatalities. The purpose of this study was to compare novice (aged 16 years) and experienced (aged 25 to 49 years) drivers involved in fatal motor vehicle crashes with respect to crash characteristics and driver behaviors. ⋯ Fatal motor vehicle crashes involving novice drivers are characterized by speeding, recklessness, single-vehicle and rollover crashes, and traffic law violations, suggesting that novice drivers bear considerable responsibility for their fatal crashes. Moreover, almost half of 16-year-old drivers involved in fatal motor vehicle crashes were not wearing their safety belts. These data may prove useful in strengthening graduated licensing laws and in improving drivers' education courses and public safety campaigns.
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Length of stay is a measure of efficiency of delivery of care and is an important determinant of patient satisfaction in a pediatric emergency department (ED). Although length of stay is affected by many unmodifiable factors, changes in care processes may lead to improvements in throughput. Evaluating the success of such changes, however, requires an understanding of the effect of other determinants. We determine the factors associated with ED length of stay and estimate the effect of an in-room registration process on throughput time. ⋯ In-room registration leads to a statistically significant and practically meaningful improvement in total length of stay in the pediatric ED. Throughput time can be largely explained by a limited number of factors; our predictive model may facilitate the evaluation of other interventions.
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Randomized Controlled Trial Clinical Trial
Comparison of nasal tampons for the treatment of epistaxis in the emergency department: a randomized controlled trial.
Nasal tampons are commonly used to stop bleeding, yet their insertion is painful. We compare the pain of insertion and removal of 2 commonly used nasal tampons. ⋯ The Rapid Rhino nasal tampon is less painful to insert and easier to remove than the Rhino Rocket, whereas both are similarly effective at stopping nosebleeds.
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Pain is subjective. The pain response is individual and is learned through social learning and experience. Early pain experiences may play a particularly important role in shaping an individual's pain responses. ⋯ Inadequate relief of pain and distress during childhood painful medical procedures may have long-term negative effects on future pain tolerance and pain responses. This article reviews the evidence for long-term negative effects of inadequately treated procedural pain, the determinants of an individual's pain response, tools to assess pain in children, and interventions to reduce procedural pain and distress. Future research directions and a model for conceptualizing and studying pediatric procedural pain are proposed.