Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era.
The epidemiology of bacterial meningitis in children in the era of widespread heptavalent conjugate pneumococcal vaccination (PCV7) is unknown. ⋯ Although now a rare infectious disease in United States, bacterial meningitis still causes substantial morbidity in affected children. Despite the introduction of PCV7, S. pneumoniae remains the most common cause of bacterial meningitis in U.S. children, with approximately half of cases due to nonvaccine serotypes.
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The objective was to evaluate the prevalence of limited health literacy and its association with sociodemographic variables in emergency department (ED) patients. ⋯ In this sample, one-quarter of ED patients would be expected to have difficulty understanding health materials and following prescribed treatment regimens. Advanced age and low socioeconomic status were independently associated with limited health literacy. The ability of a significant subgroup of ED patients to understand health information, especially during illness or injury, requires further study.
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The authors performed a systematic review to evaluate published literature on diagnostic performance of emergency physician-performed ultrasonography (EPPU) for the diagnosis and exclusion of deep venous thrombosis (DVT). ⋯ Systematic review of six studies suggests that EPPU may be accurate for the diagnosis of DVT compared with radiology-performed ultrasound (US). However, given the methodologic limitations identified among the primary studies, the estimates of diagnostic test performance may be overly optimistic. Further research into EPPU for suspected DVT is needed before it can be adopted into routine clinical practice.
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T-wave abnormalities on electrocardiograms (ECGs) are common, but their ability to predict 30-day cardiovascular outcomes at the time of emergency department (ED) presentation is unknown. The authors determined the association between T-wave abnormalities on the presenting ECG and cardiovascular outcomes within 30 days of presentation in patients with potential acute coronary syndromes (ACSs). ⋯ In patients with potential ACS presenting to the ED, T-wave abnormalities are associated with higher rates of 30-day cardiovascular events.
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Untreated hypertension (HTN) is a major public health problem. Screening for untreated HTN in the emergency department (ED) may lead to appropriate treatment of more patients. The authors investigated the accuracy of identifying HTN in the ED, the proportion of ED patients with untreated HTN, patient characteristics predicting untreated HTN, and provider documentation of untreated HTN. ⋯ Untreated HTN was common in the ED but rarely documented. Providers can use ED blood pressures along with patient characteristics to identify those with untreated HTN for referral to primary care.