Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Review
Early Secondary Neurologic Deterioration After Blunt Spinal Trauma: A Review of the Literature.
The objectives were to review published reports of secondary neurologic deterioration in the early stages of care after blunt spinal trauma and describe its nature, context, and associated risk factors. ⋯ Published reports of early secondary neurologic deterioration after blunt spinal trauma are exceptionally rare and generally poorly documented. High-risk features may include altered mental status and ankylosing spondylitis. It is unclear how often events are linked with spontaneous patient movement and whether such events are preventable.
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Observational Study
A Prospective, Observational Pilot Study of the Use of Urinary Antimicrobial Peptides in Diagnosing Emergency Department Patients With Positive Urine Cultures.
Urinary tract infection (UTI) often represents a diagnostic challenge in the emergency department (ED) where urine culture results are generally not available and other tests demonstrate limited sensitivity and specificity. Antimicrobial peptides (AMPs) are components of the innate immune system that have demonstrated increased urinary levels in response to infection both in children and in adults with chronic UTI. The objective of this study was to determine the relationship between urinary AMP levels and positive urine cultures in adult ED patients with suspected UTI. ⋯ Urinary levels of HNP1-3, HD5, and hBD-2 are significantly greater in the presence of positive urine cultures in ED patients with suspected UTI. These findings are maintained in the high-risk subgroup of older adults.
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A prospective cohort study was conducted using hand motion analysis (HMA) to assess the acquisition and retention of technical proficiency among first-year medical students learning the lumbar puncture (LP) skill in a simulated setting. ⋯ These results show that the majority of students require three to four sessions of deliberate practice to achieve a sustainable level of proficiency in the LP procedure. There is considerable variation in learning progression and retention of technical proficiency. These results have important implications for the design and resource requirements of a competency-based medical education program targeting LP training.
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Patients presenting to the emergency department (ED) with nonspecific complaints are difficult to accurately triage, risk stratify, and diagnose. This can delay appropriate treatment. The extent to which key medical outcomes are at all predictable in these patients, and which (if any) predictors are useful, has previously been unclear. To investigate these questions, we tested an array of statistical and machine learning models in a large group of patients and estimated the predictability of mortality (which occurred in 6.6% of our sample of patients), acute morbidity (58%), and presence of acute infectious disease (28.2%). ⋯ Modeling techniques can be used to derive formalized models that, on average, predict the outcomes of mortality, acute morbidity, and acute infectious disease in patients with nonspecific complaints with a level of accuracy far beyond chance. The models also predicted these outcomes more accurately than did physicians' intuitive judgments of how ill the patients look; however, the latter was among the small set of best predictors for mortality and acute morbidity. These results lay the groundwork for further refining triage and risk stratification tools for patients with nonspecific complaints. More research, informed by whether the goal of a model is high sensitivity or high specificity, is needed to develop readily applicable clinical decision support tools (e.g., decision trees) that could be supported by electronic health records.
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Observational Study
Hand Hygiene Compliance in an Emergency Department: The Effect of Crowding.
Emergency department (ED) crowding results from the need to see high volumes of patients of variable acuity within a limited physical space. ED crowding has been associated with poor patient outcomes and increased mortality. The authors evaluated whether ED crowding is also associated with reduced hand hygiene compliance among health care workers. ⋯ ED hand hygiene compliance was low. Increased time to physician assessment was associated with reduced compliance, suggesting an association between crowding and compliance. Strategies that minimize ED crowding may improve ED hand hygiene compliance.