The American journal of emergency medicine
-
Multicenter Study Comparative Study
Unscheduled Care Access in the United States-A Tale of Two Emergency Departments.
Rural communities face challenges in accessing healthcare services due to physician shortages and limited unscheduled care capabilities in office settings. As a result, rural hospital-based Emergency Departments (ED) may disproportionately provide acute, unscheduled care needs. We sought to examine differences in ED utilization and the relative role of the ED in providing access to unscheduled care between rural and urban communities. ⋯ The use and role of EDs by Medicare beneficiaries appears to be substantially different between urban and rural areas. This suggests that the ED may play a distinct role within the healthcare delivery system of rural communities that face disproportionate barriers to care access.
-
Multicenter Study
Supervised classification techniques for prediction of mortality in adult patients with sepsis.
Sepsis mortality is still unacceptably high and an appropriate prognostic tool may increase the accuracy for clinical decisions. ⋯ Deep learning and AI are increasingly used as support tools in clinical medicine. Their performance in a syndrome as complex and heterogeneous as sepsis may be a new horizon in clinical research. SVM and ANN seem promising for improving sepsis classification and prognosis.
-
Comparative Study
A comparison of physician-staffed helicopters and ground ambulances transport for the outcome of severe thoracic trauma patients.
We retrospectively investigated prognostic factors for severe thoracic trauma patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) and ground ambulance using the Japan Trauma Data Bank (JTDB). ⋯ The present study showed that transport by the HEMS improved the survival rate compared to that by a ground ambulance for patients with severe thoracic trauma.
-
Comparative Study
Comparison of the quick SOFA score with Glasgow-Blatchford and Rockall scores in predicting severity in patients with upper gastrointestinal bleeding.
Upper gastrointestinal bleeding is one of the common causes of mortality and morbidity. The Rockall score (RS) and Glasgow-Blatchford score (GBS) are frequently used in determining the prognosis and predicting in-hospital adverse events, such as mortality, re-bleeding, hospital stay, and blood transfusion requirements. The quick Sepsis Related Organ Failure Assessment (qSOFA) score is easy and swift to calculate. The commonly used scores and the qSOFA score were compared and why and when these scores are most useful was investigated. ⋯ Early use of risk stratification scores in upper gastrointestinal bleeding is important due to the high risk of morbidity and mortality. All scoring systems were effective in predicting mortality, the need for intensive care, and re-bleeding. The GBS had a greater predictive power in terms of mortality and transfusion need, the qSOFA score for intensive care need, and the RS for re-bleeding. The simpler, more efficient, and more easily calculated qSOFA score can be used to estimate the severity of patients with upper gastrointestinal bleeding.
-
We sought to examine racial and ethnic disparities in test positivity rate and mortality among emergency department (ED) patients tested for COVID-19 within an integrated public health system in Northern California. ⋯ We report a significant disparity in COVID-19 adjusted test positivity rate and crude mortality rate among Latinx and Black patients, respectively. Results from ED-based testing can identify racial and ethnic disparities in COVID-19 testing, test positivity rates, and mortality associated with COVID-19 infection and can be used by health departments to inform policy.