Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Prescription errors occur frequently in pediatric emergency departments (PEDs).The effect of computerized physician order entry (CPOE) with electronic medication alert system (EMAS) on these is unknown. The objective was to compare prescription errors rates before and after introduction of CPOE with EMAS in a PED. The hypothesis was that CPOE with EMAS would significantly reduce the rate and severity of prescription errors in the PED. ⋯ A CPOE with EMAS was associated with a decrease in overall prescription errors in our PED. Further system refinements are required to reduce the high false-positive alert rates.
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Whether sex affects the mortality of trauma patients remains unknown. The hypothesis of this study was that sex was associated with altered mortality rates in trauma. ⋯ Compared to female trauma patients, male trauma patients had greater 28-day mortality. In particular, ground-level falls had a significant sex difference in mortality, with serious injury to different body regions. Sex differences appeared to be important for fatalities from ground-level falls.
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Computed tomography (CT) utilization has increased rapidly over the past 15 years. CT is the most common source for radiation exposure. ⋯ The amount of radiation delivered to pediatric patients during routine CT examinations of the head and abdomen was low. Regardless, a large proportion of older patients were exposed to elevated effective doses of radiation during abdominal CT.
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The Joint Commission Comprehensive Stroke Center certification requires that magnetic resonance imaging (MRI) be available on site, 24 hours a day, 7 days a week for evaluation of stroke in emergency department (ED) patients. Increased access to advanced diagnostic imaging has been shown to increase utilization, ED length of stay (LOS), and health care costs. EDs nationwide face decisions to pursue certification and increase MRI access. Understanding changes in utilization and the downstream effects may inform these decisions. ⋯ Emergency MRI utilization increased substantially after placement of a fully accessible MRI in the ED. Patients receiving emergency MRI had increased ED LOS, decreased admission rates for some patients (rule-out stroke), and reduced hospital LOS for those admitted. Potential changes in ED patient resource utilization should be considered when determining whether to acquire an MRI for Comprehensive Stroke Center certification.
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Studies have documented increased advanced radiography use in U.S. emergency departments (EDs) for injured patients over the past decade. The authors explored trends in recent years (2007 through 2010) in advanced radiography use, specifically head computed tomography (CT) and nonhead CT scans. ⋯ Advanced radiography use has continued to increase since 2007 in injured patients, and diagnostic yield for nonhead CT has continued to fall. Head CT is more common than CTs of other body areas and may represent an opportunity for reduction given validated clinical decision rules.