The American journal of emergency medicine
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Multicenter Study
Concussion diagnoses among adults presenting to three Canadian emergency departments: Missed opportunities.
Patients with concussion commonly present to the emergency department (ED) for assessment. Misdiagnosis of concussion has been documented in children and likely impacts treatment and discharge instructions. This study aimed to examine diagnosis of concussion in a general adult population. ⋯ One in six patients with concussion signs and symptoms were misdiagnosed in the ED. Misdiagnosis was related to injury mechanism, length of stay, and enrolment site. Closer examination of institutional factors is needed to identify effective strategies to promote accurate diagnosis of concussion.
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The emergency department evaluation of patients with abdominal pain is most appropriately directed at identifying acute inflammation, infection, obstruction, or surgical disease. Doing so commonly involves "routine" (and often extensive) diagnostic imaging and laboratory testing. Benign mimics of serious visceral abdominal pain that can be diagnosed by physical exam and confirmed with local anesthetic injections have been identified over the last century. These syndromes derive from painful irritation of the intercostal nerves by a mobile rib below, or from impingement of the cutaneous branches of those same intercostal nerves as they penetrate the abdominal wall. These peripheral neuropathic mimics of visceral abdominal pain continue to go unrecognized and underdiagnosed. ⋯ With proper consideration of and appropriate testing for visceral etiologies, a carefully directed physical examination may yield an affirmative diagnosis in a percentage of these common emergency department patients.
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Comparative Study
Comparison of drug administration logistics between prothrombin complex concentrates and plasma in the emergency department.
Prothrombin complex concentrate (PCC) is used as an alternative to fresh frozen plasma (FFP) for emergency bleeding. The primary objective of this study was to compare the time from order to start of administration between 3-factor PCC (PCC3), 4-factor (PCC4), and FFP in the emergency department (ED). The secondary objective was to evaluate the effect of an ED pharmacist on time to administration of PCCs. ⋯ Time from order to administration is faster with PCC than FFP. ED pharmacist involvement decreases the time from order to administration of PCC.
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Dysphagia is a common problem for patients after an acute stroke which can lead to hospital acquired pneumonia (HAP) increasing morbidity and mortality. The Joint Commission has directed that stroke certified hospitals perform a dysphagia screen at the time of initial presentation. We sought to evaluate if our ED dysphagia screen was correlated with lower rates of pneumonia in acute stroke patients. ⋯ The use of our ED dysphagia screen was associated with a significant reduction in the rates of HAP in both ischemic and hemorrhagic stroke patients. Given the high rates of dysphagia and significant comorbidity and complications for these stroke patients, the use of a screen is warranted.
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Multicenter Study
The early chain of care in bacteraemia patients: Early suspicion, treatment and survival in prehospital emergency care.
Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28days after admission to hospital. Furthermore, the long-term outcome was assessed. ⋯ This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years.