Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The reasons why some clinical decision rules (CDRs) become widely used and others do not are not well understood. The authors wanted to know the following: 1) To what extent is widespread use of a new, relatively complex CDR an attainable goal? 2) How do physician perceptions of the new CDR compare with those of a widely used rule? 3) To what extent do physician subgroups differ in likelihood to use a new rule? ⋯ Widespread use of a relatively complex rule is possible. Older and part-time physicians were less likely to have seen the Canadian C-Spine Rule but not less likely to use it once they had seen it. Targeting hard-to-reach subpopulations while stressing the safety and convenience of these rules is most likely to increase use of new CDRs.
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Randomized Controlled Trial
An emergency department intervention to increase booster seat use for lower socioeconomic families.
To evaluate the effectiveness of booster seat education within an emergency department (ED) setting for families residing in lower socioeconomic neighborhoods. ⋯ Education in a pediatric ED did not convince parents to purchase and use booster seats; however, the combination of education with installation significantly increased booster seat use in this population.
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To describe and analyze the intubating conditions and hemodynamic effects of etomidate in patients undergoing rapid sequence intubation (RSI) in the emergency department. ⋯ Etomidate appears to provide appropriate intubating conditions in a heterogeneous group of patients undergoing RSI in the emergency department. Hemodynamic stability appears to be present following administration of this agent, even in patients with low pre-RSI blood pressure. This attribute must be weighed against potential adverse effects of this agent, including adrenal suppression.
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To evaluate the effect of diagnostic soft-tissue ultrasound (US) on management of emergency department (ED) patients with clinical cellulitis. ⋯ Soft-tissue US changes physician management in approximately half of patients in the ED with clinical cellulitis. US may guide management of cellulitis by detection of occult abscess, prevention of invasive procedures, and guidance for further imaging or consultation.
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Clinical practice guidelines and computerized provider order entry (CPOE) have potential for improving clinical care. Questions remain about feasibility and effectiveness of CPOE in the emergency department (ED). However, successful implementations in other settings typically incorporate decision support functions that are lacking in many commercially available ED information systems. ⋯ Adherence to an ACS guideline did not improve with implementation of a commercial ED information system without provision for patient-specific decision support. This suggests that the lack of patient-specific decision-support functionality in most current ED information system products may hamper progress in the development of effective decision support.