The American journal of emergency medicine
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Observational Study
Minor head injury in anticoagulated patients: Outcomes and analysis of clinical predictors. A prospective study.
The optimal management of patients taking oral anticoagulants who experience minor head injury (MHI) is unclear. The availability of validated protocols and reliable predictors of prognosis would be of great benefit. We investigated clinical factors as predictors of clinical outcomes and intracranial injury (ICI). ⋯ Previous retrospective studies showed a lot of negative predictive factors for anticoagulated patients suffering a minor head injury. In our prospective study no clinical factors emerged as predictors of poor clinical outcomes and dICI. So, even if we confirmed a low rate of adverse outcomes, the best management of these patients in ED remains not so clear and future trials are needed.
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Observational Study
When the economy falters, hearts suffer: Economic recessions as a social determinant of health in cardiovascular emergencies.
While the relationships between cardiovascular disease (CVD), stress, and financial strain are well studied, the association between recessionary periods and macroeconomic conditions on incidence of disease-specific CVD emergency department (ED) visits is not well established. ⋯ Macroeconomic trends have a significant relationship with the overall mix of CVD ED visits and represent an understudied social determinant of health.
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Randomized Controlled Trial
Comparisons of the vertical one-handed chest compressions according to the rescuer's handedness.
The vertical one-handed chest compression (OHCC) technique has demonstrated superior compression power and chest compression depth (CCD) compared to conventional OHCC. This study aimed to determine if a rescuer's handedness influences the CCD during the vertical OHCC. ⋯ While vertical OHCC with a dominant hand generated greater force, the rescuer's handedness did not affect the CCD during the vertical OHCC.
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High sensitivity cardiac troponins (hs-cTn) allow earlier identification and exclusion of acute myocardial infarction. We determined if transitioning from contemporary to high sensitivity troponin T (hs-cTnT) would reduce ED length of stay in chest pain (CP) patients. ⋯ Transitioning to a hs-cTnT is associated with a clinically relevant and statistically significant reduction in ED LOS for both discharged and admitted patients with and without CP with no increase in admission or coronary angiography rates.
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While increasing evidence shows that hospice and palliative care interventions in the ED can benefit patients and systems, little exists on the feasibility and effectiveness of identifying patients in the ED who might benefit from hospice care. Our aim was to evaluate the effect of a clinical care pathway on the identification of patients who would benefit from hospice in an academic medical center ED setting. ⋯ This non-interruptive, digitally embedded clinical care pathway provided guidance for ED physicians and APPs to initiate hospice referrals. More patients received social work consultation and were identified as hospice eligible. Those patients admitted to the hospital had a decrease in both ED and hospital admission LOS.