Annals of emergency medicine
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Multicenter Study Observational Study
The Prevalence of Bruising Among Infants in Pediatric Emergency Departments.
Bruising can indicate abuse for infants. Bruise prevalence among infants in the pediatric emergency department (ED) setting is unknown. Our objective is to determine prevalence of bruising, associated chief complaints, and frequency of abuse evaluations in previously healthy infants presenting to pediatric EDs. ⋯ Bruising prevalence in children 12 months and younger who were evaluated in pediatric EDs was low, increased within age strata, and was most often associated with a trauma chief complaint. Most bruised infants did not undergo an abuse evaluation.
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We evaluated thromboembolic events after vitamin K antagonist reversal in post hoc analyses of pooled data from 2 randomized trials comparing 4-factor prothrombin complex concentrate (4F-PCC) (Beriplex/Kcentra) with plasma. ⋯ The incidence of thromboembolic events after vitamin K antagonist reversal with 4F-PCC or plasma was similar and independent of coagulation factor levels; small differences in the number of thromboembolic event subtypes were observed between treatment groups.
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Observational Study
Injury Severity Score Inflation Resulting From Pan-Computed Tomography in Patients With Blunt Trauma.
All articles that demonstrate a mortality benefit from liberal pan-computed tomography (CT) use in patients with blunt trauma have relied on Injury Severity Score (ISS) to control for morbidity. This mortality benefit may be artifact, the result of an increased use of a sensitive diagnostic modality rather than a true benefit. We quantify the magnitude of ISS inflation in patients with blunt trauma who are undergoing routine pan-CT compared with patients who receive more selective scanning. ⋯ Although the median ISS for our study was lower than that of previous studies claiming a mortality benefit, ISS inflation appears to be a real phenomenon and may confound studies that use ISS to control for morbidity.
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We describe the results of an emergency department (ED) hepatitis C virus testing program that integrated birth cohort screening and screening of patients with a history of injection drug use, as well as physician diagnostic testing, according to national guidelines. ⋯ This ED screening and diagnostic testing program found a high prevalence of hepatitis C virus antibody positivity across all groups. Challenges encountered with hepatitis C virus screening included result disclosure, confirmatory testing, and linkage to care. Our results warrant continued efforts to develop and evaluate policies for ED-based hepatitis C virus screening.
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Comparative Study
Comparison of Mortality and Costs at Trauma and Nontrauma Centers for Minor and Moderately Severe Injuries in California.
We examine differences in inpatient mortality and hospitalization costs at trauma and nontrauma centers for injuries of minor and moderate severity. ⋯ For patients admitted to hospitals for minor and moderate injuries, hospitalization costs in this study population were higher at trauma centers than nontrauma centers, after adjustments for patient clinical-, demographic-, and hospital-level characteristics. Mortality was a rare event in the study population and did not significantly differ between trauma and nontrauma centers.