Annals of emergency medicine
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We conduct a prospective independent validation of the San Francisco Syncope Rule to identify emergency department (ED) syncope patients with short-term serious outcomes. ⋯ In this independent validation study, sensitivity and negative likelihood ratio of the San Francisco Syncope Rule were substantially lower than reported in the original studies and suggest that the rule has limited generalizability.
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The rise in emergency department (ED) use in the United States is frequently attributed to increased visits by the uninsured. We determine whether insurance status is associated with the increase in ED visits. ⋯ The rise in ED visits between 1996 and 2003 cannot be primarily attributed to the uninsured. Major contributors to increasing ED utilization appear to be disproportionate increases in use by nonpoor persons and by persons whose usual source of care is a physician's office.
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Emergency department (ED) crowding represents an international crisis that may affect the quality and access of health care. We conducted a comprehensive PubMed search to identify articles that (1) studied causes, effects, or solutions of ED crowding; (2) described data collection and analysis methodology; (3) occurred in a general ED setting; and (4) focused on everyday crowding. Two independent reviewers identified the relevant articles by consensus. ⋯ The results illustrated the complex, multifaceted characteristics of the ED crowding problem. Additional high-quality studies may provide valuable contributions toward better understanding and alleviating the daily crisis. This structured overview of the literature may help to identify future directions for the crowding research agenda.
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A 54-year-old man with an inferior vena cava filter in situ presented to the emergency department (ED) by emergency medical services, with acute onset of severe abdominal, lower back, and leg pain. He had fallen from a ladder 3 days before admission. An abdominal computed tomography scan revealed a large retroperitoneal hematoma and evidence of occlusive thrombus in the inferior vena cava, extending beyond the inferior vena cava filter. ⋯ The patient underwent bilateral fasciotomies of the lower extremities within 3 hours. Postoperatively, he developed extensive tissue necrosis and gangrene, requiring bilateral above-the-knee amputations, and acute renal failure associated with severe rhabdomyolysis, requiring hemodialysis. This case highlights the importance of prompt recognition and treatment of inferior vena cava filter thrombosis.
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The use of tissue plasminogen activator (tPA) in potential stroke victims by emergency physicians is controversial. One factor that may represent a barrier to use is medicolegal concerns resulting from adverse outcomes. The jury verdicts, settlements, and other adjudications associated with tPA and stroke care are assessed to determine the characteristics of these cases, including whether cases arose from adverse consequences associated with tPA or failure to provide tPA. ⋯ The available evidence concerning litigation involving stroke therapy with tPA indicates liability is predominantly associated with failure to provide tPA, rather than adverse events associated with its use.