The American journal of emergency medicine
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This project was undertaken to assess academic emergency physicians' awareness of emergency department charges for routine care. A 60-item worksheet requiring estimates of patient charges for selected emergency department services, supplies, medications, and composite scenarios was used. The study was conducted at a university-affiliated academic emergency department and included 20 emergency medicine attendings and 20 emergency medicine residents. ⋯ The average absolute error for attendings and residents were 89% and 105%, respectively. The proportion of those overestimating and underestimating each category were virtually identical in the 2 groups. We conclude from this study that emergency medicine attending physicians and residents do not have a good appreciation of patient charges for routine emergency care.
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The purpose of this study was to document prior emergency department (ED) use and injuries presented by victims of domestic violence (DV) homicides. We identified all female DV homicide cases investigated by Kansas City, Missouri, Police Department (KCPD) officials over 5 years. Medical Records from 12 hospitals were searched to determine how many homicide victims were in the ED within the 2 years preceding their homicide. ⋯ Because nearly half of all women who were victims of a DV-related homicide had been in the ED within 2 years before their deaths, the ED could play an important role in prevention. Approximately one half had documentation at least suggestive of battering. These results suggest the potential for universal screening, and documented safety assessments.
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A 31-year-old woman presented with complaints of increasingly severe right lower quadrant discomfort that had occurred for several days each month over the course of the previous 6 months. A tender mass of the abdominal wall was palpated on physical examination, and subsequent ultrasonography and magnetic resonance imaging disclosed a discrete mass of the body of the right rectus abdominis muscle which was confirmed as endometrial tissue on biopsy. Rectus abdominis endometrioma is a relatively rare cause of abdominal pain which may mimic an acute abdomen. Clinical clues to the diagnosis include previous uterine or gynecological surgery/invasive procedure (with preservation of ovarian function), cyclical nature of the discomfort, and the presence of a palpable mass with or without associated skin color changes.
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The main study objective was to determine if experienced emergency physicians can accurately identify a subgroup of patients with anterior shoulder dislocation for whom prereduction radiographs do not alter patient management. Our prospective study evaluated 97 patients who presented to 2 ski-hill clinics and to our rural emergency department with possible shoulder dislocation between November 1996 and May 1997. Emergency physicians were certain of shoulder dislocation by clinical examination alone in 40 of 59 cases (67.8%) of possible dislocation. ⋯ Prereduction radiographs added 29.6 +/- 12.68 minutes to treatment. We conclude that shoulder dislocation is often readily apparent from history and physical examination. When the experienced emergency physician is certain of the diagnosis of anterior shoulder dislocation, prereduction radiography delays treatment and does not alter management.
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We examined the statistical resources within emergency medicine residency programs, and the attitudes of emergency medicine physician researchers toward activities wherein collaboration with a statistician is useful. Anonymous surveys were mailed to 104 emergency medicine physician researchers (1/program). Sixty-four (62%) responses were analyzed. ⋯ One-quarter of programs employed a full-time statistician. Collaboration among researchers and statisticians was considered sometimes or always useful for protocol development (aims 84%, design 99%, outcomes 99%, procedures 73%, sampling 97%, inclusion criteria 93%, number of subjects 100%); data entry 73%; statistical analysis 100%; and manuscript preparation 86%. Although most emergency medicine residencies lacked statistical resources within their program, physician researchers expressed positive attitudes toward collaboration with a statistician for all aspects of research.