Annals of emergency medicine
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Randomized Controlled Trial Multicenter Study
Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial.
We assess the efficacy and safety of tamsulosin compared with placebo as medical expulsive therapy in patients with distal ureteric stones less than or equal to 10 mm in diameter. ⋯ We found no benefit overall of 0.4 mg of tamsulosin daily for patients with distal ureteric calculi less than or equal to 10 mm in terms of spontaneous passage, time to stone passage, pain, or analgesia requirements. In the subgroup with large stones (5 to 10 mm), tamsulosin did increase passage and should be considered.
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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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Randomized Controlled Trial
Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial.
More than 1 million patients present to US emergency departments (EDs) annually seeking care for acute migraine. Parenteral antihistamines have long been used in combination with antidopaminergics such as metoclopramide to treat acute migraine in the ED. High-quality data supporting this practice do not exist. We determine whether administration of diphenhydramine 50 mg intravenously+metoclopramide 10 mg intravenously results in greater rates of sustained headache relief than placebo+metoclopramide 10 mg intravenously. ⋯ Intravenous diphenhydramine, when administered as adjuvant therapy with metoclopramide, does not improve migraine outcomes.
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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.