Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Meta Analysis
Accuracy of Dementia Screening Instruments in Emergency Medicine - A Diagnostic Meta-Analysis.
Dementia is underrecognized in older adult emergency department (ED) patients, which threatens operational efficiency, diagnostic accuracy, and patient satisfaction. The Society for Academic Emergency Medicine geriatric ED guidelines advocate dementia screening using validated instruments. ⋯ ED-based diagnostic research for dementia screening is limited to a few studies using an inadequate criterion standard with variable masking of interpreter's access to the index test and the criterion standard. Standardizing the geriatric ED cognitive assessment methods, measures, and nomenclature is necessary to reduce uncertainties about diagnostic accuracy, reliability, and relevance in this acute care setting. The AMT-4 is currently the most accurate ED screening instrument to increase the probability of dementia and the Brief Alzheimer's Screen is the most accurate to decrease the probability of dementia. Dementia screening as one marker of vulnerability to initiate comprehensive geriatric assessment is warranted based on test-treatment threshold calculations.
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Physician-assisted death (PAD) has long been a strongly debated moral and public policy issue in the United States, and an increasing number of jurisdictions have legalized this practice under certain circumstances. In light of changing terminology, laws, public and professional attitudes, and the availability of published data about the practice, we review key concepts and terms in the ongoing PAD debate, moral arguments for and against PAD, the current legal status of PAD in the United States and in other nations, and data on the reported experience with PAD in those U. ⋯ We then identify situations in which emergency physicians (EPs) may encounter patients who request PAD or have attempted to end their lives with physician assistance and consider EP responses in those situations. Based on our analysis, we offer recommendations for emergency medical practice and professional association policy.
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Previous studies examining access to trauma care use patient residence as a proxy for location and need for services, which could result in a flawed understanding of access to trauma centers. The objective of this study was to examine the geographic access of the U.S. population to trauma centers based on trauma incident locations. ⋯ These findings suggest that greater access to trauma care and significant variations can be observed throughout the 32 study states when using trauma incident location rather than patient residence to calculate access to trauma care. The proposed capacity-to-demand ratio and accessibility ratio can be applied to many other needs assessments in health care.
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Many emergency department (ED) transfers of children may be avoidable. Identifying hospital-level variables associated with avoidable transfers may guide system-level interventions to improve pediatric emergency care. We sought to examine hospital characteristics associated with ED transfers deemed "probably avoidable" in a large state Medicaid program. ⋯ Among pediatric emergency transfers in a large state Medicaid program with a nearly 20% probably avoidable transfer rate, there was significant hospital-level variation in the proportion of probably avoidable transfers. Transfers from hospitals in large metropolitan areas and transfers from hospitals without pediatric-specific capabilities had increased odds of being probably avoidable transfers, such that these hospitals may represent targets for interventions to reduce these transfers.