Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To characterize the types and external causes of pediatric injury-related visits (IRVs) to emergency departments (EDs), in particular, sports-related injuries. To compare the characteristics of children with IRVs with those with non-IRVs, specifically, differences in IRV rates by race and ethnicity and by health insurance. ⋯ Sports and recreation are the leading external causes of pediatric IRVs to EDs in the United States. There are different patterns of IRVs according to gender, age, race, ethnicity, and insurance. Identification of specific patterns of injury is necessary for the design of effective prevention strategies.
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Clinical Trial
Clinical value of the total white blood cell count and temperature in the evaluation of patients with suspected appendicitis.
The total white blood cell (WBC) count and temperature are often expected to be elevated in patients with appendicitis. Clinicians often use the results of these parameters in making a judgment about the presence or absence of disease. The objective of this study was to assess the discriminatory value of the total WBC count and presenting body temperature in patients presenting to the emergency department (ED) with signs and symptoms suggestive of appendicitis. ⋯ An elevated total WBC count >10,000 cells/mm(3), while statistically associated with the presence of appendicitis, had very poor sensitivity and specificity and almost no clinical utility. There was minimal statistical association between a temperature of >99 degrees F and the presence of appendicitis. The ROC curve suggests there is no value of total WBC count or temperature that has sufficient sensitivity and specificity to be of clinical value in the diagnosis of appendicitis. Clinicians should be wary of reliance on either elevated temperature or total WBC count as an indicator of the presence of appendicitis.
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To examine how emergency department (ED) overcrowding has been defined in the medical literature. ⋯ Although ED overcrowding has been a topic of frequent investigation, current definitions of the problem are often implicit or focus on factors outside of the ED itself. A more consistent approach to defining ED overcrowding would help to clarify the distinctions between causes, characteristics, and outcomes of overcrowding.
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The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. In prior work, this group delineated the priority conditions, described conceptual models, suggested core and risk adjustment measures potentially useful to emergency medical services research, and summarized out-of-hospital pain measurement. In this fifth article in the EMSOP series, the authors recommend specific risk-adjustment measures and outcome measures for use in out-of-hospital research on patients presenting with respiratory distress. ⋯ The EMSOP group recommends use of pulse oximetry, peak expiratory flow rate, and the visual analog dyspnea scale as potential risk-adjustment measures and outcome measures for out-of-hospital research in patients with respiratory distress. Furthermore, using mortality as an outcome measure is also recommended. Future research is needed to alleviate the paucity of validated tools for out-of-hospital outcomes research.
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Brain edema occurs following clinical as well as experimental cardiac arrest (CA) and predicts a poor neurologic outcome. The objective of this study was to determine the expression of cerebral cortex aquaporin (AQP)-4, a member of a family of membrane water-channel proteins, in brain edema formation following normothermic or hypothermic CA. ⋯ Cerebral cortical AQP4 expression is up-regulated after normothermic CA, which is attenuated by hypothermia induced before CA.