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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Comparative Study
Distinguishing fecal appendicular peritonitis from purulent appendicular peritonitis.
Fecal appendicular peritonitis (FAP) is a poorly studied, rare form of acute appendicitis, corresponding to peritoneal inflammation with the presence of feces secondary to ruptured appendix. The purpose of this study was to describe FAP and to compare FAP with purulent appendicular peritonitis (PAP). ⋯ FAP is associated with significantly more severe morbidity compared to PAP. Clinicians must be familiar with this form of appendicitis in order to adequately inform their 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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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.
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Letter Randomized Controlled Trial
Time to successful completion of simulated pediatric lumbar puncture in lateral vs seated position: Comparison in novice providers.