Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Diagnostic characteristics of S100A8/A9 in a multicenter study of patients with acute right lower quadrant abdominal pain.
Over the past decade, clinicians have become increasingly reliant on computed tomography (CT) for the evaluation of patients with suspected acute appendicitis. To limit the radiation risks and costs of CT, investigators have searched for biomarkers to aid in diagnostic decision-making. We evaluated one such biomarker, calprotectin or S100A8/A9, and determined the diagnostic performance characteristics of a developmental biomarker assay in a multicenter investigation of patients presenting with acute right lower quadrant abdominal pain. ⋯ In patients presenting with acute right lower quadrant abdominal pain, we found the investigational enzyme-linked immunosorbent assay (ELISA) test for S100A8/A9 to perform with high sensitivity but very limited specificity. We found that shipping effect and delay in analysis resulted in a subsequent rise in test values, thereby increasing the sensitivity and decreasing the specificity of the test. Further investigation with hospital-based laboratory analyzers is the next critical step for determining the ultimate clinical utility of the ELISA test for S100A8/A9 in ED patients presenting with acute right lower quadrant abdominal pain.
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Multicenter Study
Is a standardized questionnaire useful for tubal rupture screening in patients with ectopic pregnancy?
Physical examination, ultrasonography, and laboratory tests fail to reliably establish the preoperative diagnosis of tubal rupture in patients with ectopic pregnancy (EP), leading to a high rate of diagnostic laparoscopy. The aim of this study was to construct and to evaluate a clinical prediction rule for tubal rupture screening based on a self-assessment questionnaire, among patients with EP. ⋯ These results suggest that a standardized questionnaire may contribute to ruling out tubal rupture in patients with EP.
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Randomized Controlled Trial
Effect of electronically delivered prescriptions on compliance and pharmacy wait time among emergency department patients.
The primary objectives were to assess whether electronically delivered prescriptions lead to reduced pharmacy wait time, improved patient satisfaction, and improved compliance with prescriptions. Secondary objectives included determining other reasons for noncompliance and if there was an association between prescription noncompliance and subsequent physician and emergency department (ED) visits. ⋯ Electronically delivered prescriptions significantly minimized pharmacy wait time and improved patient satisfaction at the pharmacy, but did not improve primary compliance with prescriptions.
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In a patient with symptoms of pulmonary embolism (PE), the presence of an elevated pulse, respiratory rate, shock index, or decreased pulse oximetry increases pretest probability of PE. The objective of this study was to evaluate if normalization of an initially abnormal vital sign can be used as evidence to lower the suspicion for PE. ⋯ Clinicians should not use the observation of normalized vital signs as a reason to forego objective testing for symptomatic patients with a risk factor for PE.
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The 24-hour physician coverage of the emergency department (ED) requires shift work, which can result in desynchronosis and cognitive decline. We measured changes in cognition and sleep disturbance in attending emergency physicians (EPs) before and after day and overnight shifts. ⋯ These data indicate that short-term memory appears to decline after day and overnight shifts and confirms the high incidence of disturbed sleep in this population.