Annals of emergency medicine
-
Multicenter Study
Challenges in enrollment of minority, pediatric, and geriatric patients in emergency and acute care clinical research.
Emergency department (ED) -based clinical research has the potential to include patient populations that are typically underrepresented in clinical research. The objective of this study is to assess how emergency clinical care and research processes, informed consent, and patient demographic factors (age, sex, and ethnicity/race) affect enrollment and consent in clinical research in the ED. ⋯ In a large academic ED, minority, pediatric, and geriatric patients were less likely to be enrolled in acute care clinical research studies than middle-aged whites. Enrollment and consent strategies designed to enhance research participation in these important patient populations may be necessary to address disparities in the development and application of evidence-based emergency and acute care.
-
Randomized Controlled Trial
DIAL: a telephone brief intervention for high-risk alcohol use with injured emergency department patients.
Brief interventions for high-risk alcohol use for injured emergency department (ED) patients have demonstrated effectiveness and may have a more pronounced effect with motor vehicle crash patients. We report on 3-month outcome data of a randomized controlled trial of injured patients, using a novel model of telephone-delivered brief interventions after ED discharge. ⋯ Telephone brief interventions decreased impaired driving in our treatment group. Telephone brief intervention appears to offer an alternative mechanism to deliver brief intervention for alcohol in this at-risk ED population.
-
Multicenter Study
Is the combination of negative computed tomography result and negative lumbar puncture result sufficient to rule out subarachnoid hemorrhage?
Current clinical practice assumes a negative computed tomography (CT) head scan result and a negative lumbar puncture result together are adequate to rule out subarachnoid hemorrhage in patients with acute headache. Our objective is to determine the sensitivity of a negative CT result combined with a negative lumbar puncture result to exclude subarachnoid hemorrhage. ⋯ To our knowledge, this is the largest prospective study evaluating the accuracy of a strategy of CT and lumbar puncture to rule out subarachnoid hemorrhage in alert ED patients with an acute headache. This study validates clinical practice that a negative CT with a negative lumbar puncture is sufficient to rule out subarachnoid hemorrhage.
-
Emergency physicians use noncontrast cranial computed tomographic (CT) imaging of headache patients to identify subarachnoid hemorrhage caused by aneurysms or arteriovenous malformations. Given sufficiently high sensitivity, CT imaging could be used as a definitive diagnostic study in these patients. The purpose of this study is to determine the sensitivity of noncontrast cranial CT in detecting all spontaneous subarachnoid hemorrhages and those caused by aneurysm or arteriovenous malformation. ⋯ Noncontrast CT imaging exhibits inadequate sensitivity to serve as a sole diagnostic modality in detecting spontaneous subarachnoid hemorrhage caused by aneurysm or arteriovenous malformation.
-
Attrition rates in emergency medicine have been reported as high as 25% in 10 years. The number of women entering emergency medicine has been increasing, as has the number of female medical school graduates. No studies have identified factors that increase female emergency physician career satisfaction. We assess career satisfaction in women emergency physicians in the American College of Emergency Physicians (ACEP) and identify factors associated with career satisfaction. ⋯ Most of the ACEP female physicians surveyed were satisfied with their career choice of emergency medicine. Opportunities for career advancement, fairness in financial compensation, and schedule flexibility were key factors in career satisfaction among female emergency physicians.