Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Spontaneous subarachnoid hemorrhage (SAH) is a rare, but serious etiology of headache. The diagnosis of SAH is especially challenging in alert, neurologically intact patients, as missed or delayed diagnosis can be catastrophic. ⋯ Less than one in 10 headache patients concerning for SAH are ultimately diagnosed with SAH in recent studies. While certain symptoms and signs increase or decrease the likelihood of SAH, no single characteristic is sufficient to rule in or rule out SAH. Within 6 hours of symptom onset, noncontrast cranial CT is highly accurate, while a negative CT beyond 6 hours substantially reduces the likelihood of SAH. LP appears to benefit relatively few patients within a narrow pretest probability range. With improvements in CT technology and an expanding body of evidence, test thresholds for LP may become more precise, obviating the need for a post-CT LP in more acute headache patients. Existing SAH clinical decision rules await external validation, but offer the potential to identify subsets most likely to benefit from post-CT LP, angiography, or no further testing.
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Randomized Controlled Trial
A randomized controlled trial evaluating the efficacy of oral sucrose in infants 1 to 3 months old needing intravenous cannulation.
The objective was to compare the efficacy of an oral sucrose versus placebo in reducing pain in infants 1 to 3 months of age during intravenous (IV) cannulation in the emergency department. ⋯ Administration of an oral sucrose solution in infants 1 to 3 months of age during IV cannulation did not lead to statistically significant changes in pain scores. However, the cry time was significantly reduced.
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In-hospital factors contribute more to delayed diagnosis of childhood arterial ischemic stroke (AIS) than prehospital factors. We aimed to explore process and patient factors associated with type of and timing to neuroimaging in childhood AIS in the emergency department (ED). ⋯ Strategies to improve rapid diagnosis of pediatric stroke should include shared regional hospital networks protocols to optimize local imaging strategies and where possible rapid transfer to the tertiary center. Future priorities should include development of pediatric ED physician decision support tools to differentiate stroke from mimics and the development and implementation of rapid ED imaging stroke protocols to improve access to confirmatory MRI scanning.
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Observational Study
Effectiveness of a Multimodal Intervention Program for Older Individuals Presenting to the Emergency Department After a Fall in the Northern French Alps Emergency Network.
Fall-related visits to emergency departments (EDs) are common among older individuals. We aimed to assess effectiveness of a healthcare intervention program for the management of elderly patients admitted to EDs after a fall. ⋯ The intervention program was associated with a decrease of fall recurrence. Further efforts should be made in EDs to ensure a sustained level of satisfactory and long-lasting management of the elderly.