Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Building A Longitudinal Cohort From 9-1-1 to 1-Year Using Existing Data Sources, Probabilistic Linkage, and Multiple Imputation: A Validation Study.
The objective was to describe and validate construction of a population-based, longitudinal cohort of injured older adults from 9-1-1 call to 1-year follow-up using existing data sources, probabilistic linkage, and multiple imputation. ⋯ A population-based emergency care cohort with long-term outcomes can be constructed from existing data sources with high accuracy and reasonable validity of resulting variables.
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Violence is one of the leading causes of death among youth ages 14 to 24. Hospital- and emergency department (ED)-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing follow-up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants. ⋯ The FYI study demonstrated that achieving high follow-up rates for a difficult-to-track, violently-injured ED population is feasible through the use of established contact strategies and a variety of interview locations. Results have implications for follow-up strategies planned as part of other violence prevention studies.
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D-dimer is used to aid in diagnosing adult pulmonary embolism (PE). D-dimer has not been validated in adolescents. Clinicians must balance the risk of overtesting with that of a missed PE. D-dimer may be useful in this context. This study evaluates D-dimer in PE-positive and PE-negative adolescents. ⋯ This study represents the largest available cohort of adolescent patients examining the diagnostic value of D-dimer for PE. Our results indicate that depending on the threshold selected, D-dimer can be a sensitive test for PE in adolescents and that discriminative value is higher for a cutoff of 750 ng/mL than that for 500 ng/mL. Prospective studies investigating the diagnostic value of D-dimer and a clinical decision rule for PE in pediatrics are needed.
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Observational Study
Evaluation of a Screening Tool for Child Sex Trafficking Among Patients With High-Risk Chief Complaints in a Pediatric Emergency Department.
The objective was to apply and evaluate a screening tool to identify victims of child sex trafficking (CST) in a pediatric emergency department (PED) population. ⋯ Applied to an inner-city PED population of 203 participants with high-risk chief complaints, the screening tool has high sensitivity and high NPV. This makes it appropriate for an initial screening to rule out CST in this high-risk population. Applicability for broader use and additional practice settings are warranted given the significant positivity rate among those presenting with high-risk concerns.
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Multicenter Study
Emergency Department Adult Fiberoptic Intubations: Incidence, Indications, and Implications for Training.
The objective was to describe the frequency, indications, and outcomes of flexible fiberoptic intubations (FFI) performed in the emergency department (ED). ⋯ Emergency department FFI is uncommon and typically used as a nonsurgical alternative for airway obstruction. First-attempt ED FFI is successful in half of cases and in two-thirds of rescue attempts. These data provide an important baseline to help better characterize the nature of FFI as a rare critical procedure in the ED and offer an empiric basis for ongoing discussions on the optimal role of FFI in ED training and practice.