Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Review Meta Analysis
Triple Rule-out Computed Tomographic Angiography for Chest Pain: A Diagnostic Systematic Review and Meta-Analysis.
The objective was to compare the image quality, diagnostic accuracy, radiation exposure, and contrast volume of "triple rule-out" (TRO) computed tomography (CT) to other diagnostic modalities commonly used to evaluate patients with nontraumatic chest pain (dedicated coronary, pulmonary embolism [PE], and aortic dissection CT; invasive coronary angiography; and nuclear stress testing). ⋯ Triple rule-out CT is highly accurate for detecting coronary artery disease. Given the low (<1%) prevalence of PE and aortic dissection in the included studies, and the increased radiation and contrast exposure, there are insufficient data to recommend use of TRO CT in the diagnosis of these conditions.
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Multicenter Study
Patient choice in the selection of hospitals by 9-1-1 emergency medical services providers in trauma systems.
Reasons for undertriage (transporting seriously injured patients to nontrauma centers) and the apparent lack of benefit of trauma centers among older adults remain unclear; understanding emergency medical services (EMS) provider reasons for selecting certain hospitals in trauma systems may provide insight to these issues. In this study, the authors evaluated reasons cited by EMS providers for selecting specific hospital destinations for injured patients, stratified by age, injury severity, field triage status, and prognosis. ⋯ Emergency medical services transport patterns among injured patients are not random, even after accounting for field triage protocols. The selection of hospitals appears to be heavily influenced by patient or family choice, which increases with patient age and involves inherent differences in patient prognosis.
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Pneumonia hospitalization rates are frequently reported as a measure of pneumonia disease burden in the United States. However, a detailed understanding of pneumonia burden in all health care settings, including the emergency department (ED), is essential for measuring the full effect of this disease on the population and planning and evaluating interventions to reduce pneumonia-related morbidity. The aim of this study was to quantify pneumonia-attributable ED visits in the United States among children and adults during the 3-year period July 2006 through June 2009. ⋯ Pneumonia accounts for 2.2% of ED visits in the United States and results in approximately seven to eight ED visits per 1000 persons per year. A substantial proportion of pneumonia cases diagnosed in the ED are managed in treat-and-release ED outpatient visits, highlighting that enumeration of ED visit rates provides important complementary information to hospitalization rates for the assessment of pneumonia burden.
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As residents, we constantly strive to independently manage our patients and develop care plans, while the role of the attending faculty varies between complete supervision and control, to allowing complete autonomy. This concept of attending physicians allowing appropriate autonomy so that residents can develop independence in their practice has been termed entrustment. Patients' and instructors' entrustment of responsibility reflects upon one's preparedness to assume professional responsibility after graduation. ⋯ Some experiences have been incredible as we develop our styles of practice, while others have been incredibly frustrating and soured the learning environment. As third-year residents, we studied the factors that allow faculty to foster an appropriate amount of entrustment and conducted discussions with multiple residents on this topic. We have found several themes of how this can be done well and share these ideas with a goal of improving autonomy for emergency medicine residents.