The American journal of emergency medicine
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Various scoring systems are utilized to assess severe trauma patients, with one of the most commonly used tools being the International Classification of Diseases Injury Severity Score (ICISS) criteria derived from the Survival Risk Ratio (SRR) calculated using diagnostic codes. This study aimed to redefine the severe trauma scoring system in Korea based on the SRR for diagnostic codes, and subsequently evaluate its performance in predicting survival outcomes for trauma patients. ⋯ The newly developed ICISS-2020, utilizing a nationwide emergency patient database, demonstrated relatively good performance (accuracy, specificity, PPV, LR+, and AUROC) in predicting survival outcomes for patients with trauma.
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Fewer than 20 % of traumatic brain injury (TBI) cases with traumatic intracranial hemorrhage (ICH) result in clinical deterioration. The Brain Injury Guideline (BIG) criteria were published in 2014 and categorize patients with TBI into three risk groups (BIG 1, 2, and 3) based on CT scan findings, neurological examination, anti-coagulant/platelet medications, and intoxication. Early data is promising, suggesting no instances of neurosurgical intervention or death in the low-risk BIG1 category within 30 days. We sought to externally validate the BIG criteria and identify patients with TBI at low risk of clinical deterioration. We hypothesized that patients meeting the BIG1 low risk criteria have less than a 1 % risk of death or neurosurgical intervention. ⋯ BIG1 criteria identified a low-risk subset of patients with TBI with ICH. However, an upper 95 % CI of 1.9 % does not exclude the risk of neurologic deterioration being <1 %. Validation of these criteria in larger cohorts is warranted.
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This cross-sectional analysis of 86,111 visits for sickle cell disease and vaso-occlusive episodes (VOE) in U.S. pediatric emergency departments between 2013 and 2023 shows increased use of NSAIDs, ketamine, and acetaminophen, with unchanged opioid use. Hospitals with a higher volume of VOE visits more frequently administered opioids. ⋯ Over the past decade, the use of NSAIDs, acetaminophen, and ketamine has increased in the management of VOE in pediatric SCD patients, while opioid use remains consistent. The co-administration of NSAIDs and opioids has also increased, reflecting guideline adherence. Variations in analgesia practices across hospitals underscore the need for standardizing pain management strategies in this population.
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According to the guidelines of the American Heart Association and American College of Emergency Physicians, respectively, there is no indication for immediate lowering of asymptomatic hypertension in the Emergency Department (ED), and no requirement for routine diagnostic testing in these patients. Despite this, asymptomatic hypertension represents a recurring source of referrals for ED evaluation from other healthcare settings, or from patient self-referral, with significant practice variation in the evaluation and treatment of this complaint. ⋯ Our findings redemonstrate that patients presenting to the ED with asymptomatic hypertension are at low risk for short-term complications of hypertension, and that diagnostic testing is low yield in this population. While we were able to achieve reductions in unnecessary testing, further work is needed to educate clinicians and improve adherence to evidence based principles when caring for these patients.
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Case Reports
Treatment of shoulder pain with ultrasound-guided interfascial plane block: A case series.
Shoulder pain is a common presentation to the Emergency Department (ED). Despite an increasing volume of ED visits for shoulder pain, achieving adequate pain control can be challenging. Ultrasound-guided nerve blocks, such as the interscalene nerve block (ISB), are effective but can cause hemidiaphragmatic paresis and motor dysfunction. The interfascial plane block (IPB) is a simple and new regional anesthesia technique that spares the diaphragm, and most upper extremity motor function. ⋯ The ultrasound-guided IPB is a simple, safe, and effective alternative approach to treating shoulder pain in the ED, especially in patients who may not tolerate ISB.