Annals of emergency medicine
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Review Meta Analysis
Quality Assurance Processes Ensuring Appropriate Follow-up of Test Results Pending at Discharge in Emergency Departments: A Systematic Review.
In many cases, emergency department (ED) care leads to investigations for which there are not final results at patient disposition. The follow-up for these test results pending at discharge, most commonly final diagnostic imaging reports and microbiology cultures, is a significant safety concern for patients and a medicolegal risk for ED practitioners. Our objective is to perform a systematic review of the literature and report on the structure and outcomes of existing ED quality assurance processes to address these test results pending at discharge. ⋯ A variety of quality assurance processes have been described to follow up on ED test results pending at discharge, and we provided recommendations to improve patient care. All ED leaders should consider implementing these according to their local context.
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Review Meta Analysis
Outcome of Immediate Versus Early Antibiotics in Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis.
Debate exists about the mortality benefit of administering antibiotics within either 1 or 3 hours of sepsis onset. We performed this meta-analysis to analyze the effect of immediate (0 to 1 hour after onset) versus early (1 to 3 hours after onset) antibiotics on mortality in patients with severe sepsis or septic shock. ⋯ We found no difference in mortality between immediate and early antibiotics across all patients. Although the quality of evidence across studies was low, these findings do not support a mortality benefit for immediate compared with early antibiotics across all patients with sepsis.
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Review Meta Analysis
The Prognostic Value of Syncope on Mortality in Patients With Pulmonary Embolism: A Systematic Review and Meta-analysis.
Syncope is a presenting symptom in 10% to 20% of patients with pulmonary embolism. We perform a meta-analysis to clarify the prognostic value of syncope on short-term mortality in pulmonary embolism patients and its association with hemodynamic instability. ⋯ The association between syncope and short-term mortality in patients with pulmonary embolism is explained by a difference in hemodynamic instability. This emphasizes the importance of risk stratification by hemodynamic status in pulmonary embolism patients with and without syncope.
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Review Meta Analysis
Point-of-Care Ultrasonography for the Diagnosis of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-analysis.
Skin and soft tissue infections are a common chief complaint in the emergency department. Research has shown that clinical examination alone can be unreliable in distinguishing between cellulitis and abscesses, a distinction that is important because they each require different treatments. Point-of-care ultrasonography has been increasingly studied as a tool to improve the diagnostic accuracy for these skin and soft tissue infections. The primary objective of this systematic review is to evaluate the diagnostic accuracy of point-of-care ultrasonography for abscesses. Subgroup analyses are performed for adult versus pediatric patients and high suspicion versus clinically unclear cases. Secondary objectives include the percentage of correct versus incorrect changes in management and reduction in treatment failures because of point-of-care ultrasonography. ⋯ According to the current data, point-of-care ultrasonography has good diagnostic accuracy for differentiating abscesses from cellulitis and led to a correct change in management in 10% of cases. Future studies should determine the ideal training and image acquisition protocols.