Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Review Meta Analysis
The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis.
Acute mesenteric ischemia is an infrequent cause of abdominal pain in emergency department (ED) patients; however, mortality for this condition is high. Rapid diagnosis and surgery are key to survival, but presenting signs are often vague or variable, and there is no pathognomonic laboratory screening test. A systematic review and meta-analysis of the available literature was performed to determine diagnostic test characteristics of patient symptoms, objective signs, laboratory studies, and diagnostic modalities to help rule in or out the diagnosis of acute mesenteric ischemia in the ED. ⋯ The quality of the overall literature base for mesenteric ischemia is varied. Signs, symptoms, and laboratory testing are insufficiently diagnostic for the condition. Only CT angiography had adequate accuracy to establish the diagnosis of acute mesenteric ischemia in lieu of laparotomy.
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Randomized Controlled Trial
Value of Point-of-care Ketones in Assessing Dehydration and Acidosis in Children With Gastroenteritis.
Children with gastroenteritis often develop dehydration with metabolic acidosis. Serum ketones are frequently elevated in this population. The goal was to determine the relationship between initial serum ketone concentration and both the degree of dehydration and the magnitude of acidosis. ⋯ Children with gastroenteritis and dehydration have elevated serum ketone concentrations that correlate with both degree of dehydration and magnitude of metabolic acidosis. Point-of-care serum ketone measurement may be a useful tool to inform management decisions at the point of triage or in the initial evaluation of children with gastroenteritis and dehydration.
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Multicenter Study
Generalizability of a Simple Approach for Predicting Hospital Admission From an Emergency Department.
The objective was to test the generalizability, across a range of hospital sizes and demographics, of a previously developed method for predicting and aggregating, in real time, the probabilities that emergency department (ED) patients will be admitted to a hospital inpatient unit. ⋯ The accuracy of regression models to predict ED patient admission likelihood was shown to be generalizable across hospitals of different sizes, populations, and administrative structures. Each hospital used a unique combination of predictive factors that may reflect these differences. This approach performed equally well when hospital staff coded patient data in real time versus the research team retrospectively.
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Multicenter Study Comparative Study
A Cost-effectiveness Analysis Comparing a Clinical Decision Rule Versus Usual Care to Risk Stratify Children for Intraabdominal Injury After Blunt Torso Trauma.
Modelling implementation of a clinical decision rule to identify children at very low risk of significant intra-abdominal injury after blunt trauma:
- Saved on average US$55 per child.
- Avoided a CT scan in 1 in 10 children.
- Missed 1 in 2,000 intra-abdominal injuries requiring acute intervention.
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Multicenter Study
Developing Emergency Department-based Education About Emergency Contraception: Adolescent Preferences.
The objective was to identify adolescent preferences for emergency department (ED)-based education about emergency contraception. ⋯ Adolescents have specific preferences for how education about emergency contraception would best serve their needs. This information can inform clinicians as they work to improve adolescents' knowledge about pregnancy prevention and emergency contraception in particular.