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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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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Annals of Emergency Medicine collaborated with an educational Web site, Academic Life in Emergency Medicine (ALiEM), to host a public discussion featuring the 2014 Annals article on the association between Press Ganey scores and emergency department (ED) analgesia by Schwartz et al. The objective was to curate a 14-day (December 1 through 14, 2014) worldwide academic dialogue among clinicians in regard to preselected questions about the article. Five online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and Google Hangout. ⋯ Of the unique 169 identified tweets, discussion (53.3%) and learning points (32.5%) were the most common category of tweets identified. Common themes that arose in the open-access multimedia discussions included Press Ganey data validity and the utility of patient satisfaction in determining pain treatment efficacy. This educational approach using social media technologies demonstrates a free, asynchronous means to engage a worldwide scholarly discourse.