The American journal of emergency medicine
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Comparative Study
Pulmonary embolism and COVID-19: A comparative analysis of different diagnostic models performance.
Pulmonary embolism (PE) is a common complication of SARS-CoV-2 infection. Several diagnostic prediction rules based on pretest probability and D-dimer have been validated in non-COVID patients, but it remains unclear if they can be safely applied in COVID-19 patients. We aimed to compare the diagnostic accuracy of the standard approach based on Wells and Geneva scores combined with a standard D-dimer cut-off of 500 ng/mL with three alternative strategies (age-adjusted, YEARS and PEGeD algorithms) in COVID-19 patients. ⋯ None of the diagnostic prediction rules are reliable predictors of PE in COVID-19. Our data favour the use of a D-dimer threshold of 500 ng/mL, considering that higher thresholds increase specificity but limits this strategy as a screening test.
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Acute heart failure (HF) exacerbation is a serious and common condition seen in the Emergency Department (ED) that has significant morbidity and mortality. There are multiple clinical decision tools that Emergency Physicians (EPs) can use to reach an appropriate evidence-based disposition for these patients. ⋯ This article discusses evidence-based disposition of patients in acute decompensated HF presenting to the ED. Knowledge of these factors and risk tools can assist emergency clinicians in determining appropriate disposition of patients with HF.
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Multicenter Study
Clinical prediction rule of termination of resuscitation for out-of-hospital cardiac arrest patient with pre-hospital defibrillation given.
To derive a clinical prediction rule of termination of resuscitation (TOR) for out-of-hospital cardiac arrest (OHCA) with pre-hospital defibrillation given. ⋯ The 2-criteria TOR rule for OHCA patients with pre-hospital defibrillation had a high specificity and PPV for predicting death on or before ED arrival.
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In the current national opioid crisis, where 10% of the US population has or has had a substance use disorder (SUD), emergency department (ED) clinicians are challenged when treating pain in the ED and when prescribing pain medications to these patients on discharge as there is concern for contributing to the cycle of addiction. The objective of this study was to examine whether acute pain is treated differently in patients with and without current or past SUD by quantifying the amount of opioid analgesia given in the ED and prescribed on discharge. ⋯ Overall, ED clinicians gave opioids less frequently to SUD+ patients in the ED and on discharge from the ED compared to SUD- patients with acute pain secondary to acute fracture.
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Acute diverticulitis (AD) is a common disease with various outcomes. When AD is diagnosed in the emergency department (ED), the ED clinician must determine the patient's treatment strategy whether the patient can be discharged, needs to be admitted to the general ward, ICU, or needs surgical consultation. This study aimed to identify potential risk factors for clinically important outcomes (CIOs) and to develop a prediction model for CIOs in AD to aid clinical decision making in the ED. ⋯ A prediction model for clinically important outcomes of AD visiting a single ED showed good discrimination and calibration power with an acceptable range.