Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Recurrent and High-frequency Use of the Emergency Department by Pediatric Patients.
The authors sought to describe the epidemiology of and risk factors for recurrent and high-frequency use of the emergency department (ED) by children. ⋯ Risk factors for recurrent ED use by children include age, race and ethnicity, and insurance status. Although asthma plays an important role in recurrent ED use, acute illnesses account for the majority of recurrent ED visits.
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Observational Study
The Association Between Pretest Probability of Coronary Artery Disease and Stress Test Utilization and Outcomes in a Chest Pain Observation Unit.
Cardiology consensus guidelines recommend use of the Diamond and Forrester (D&F) score to augment the decision to pursue stress testing. However, recent work has reported no association between pretest probability of coronary artery disease (CAD) as measured by D&F and physician discretion in stress test utilization for inpatients. The author hypothesized that D&F pretest probability would predict the likelihood of acute coronary syndrome (ACS) and a positive stress test and that there would be limited yield to diagnostic testing of patients categorized as low pretest probability by D&F score who are admitted to a chest pain observation unit (CPU). ⋯ Physician discretionary decision-making regarding stress test use is associated with pretest probability of CAD. However, based on the D&F score, low-pretest-probability patients who meet CPU admission criteria are very unlikely to have a true-positive stress test or eventually receive a diagnosis of ACS, such that observation and stress test utilization may be obviated.
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The objective was to survey practicing emergency physicians (EPs) across the United States regarding the frequency of using ultrasound (US) guidance in central venous catheter (CVC) placement and, secondarily, to determine factors associated with the use or barriers to the use of US guidance. ⋯ Among EPs, the translation of evidence to clinical practice regarding the benefits of US guidance for CVC placement is poor and still faces many barriers. Training and education are potentially the best ways to overcome such barriers.
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Practice Guideline
A Consensus Parameter for the Evaluation and Management of Angioedema in the Emergency Department.
Despite its relatively common occurrence and life-threatening potential, the management of angioedema in the emergency department (ED) is lacking in terms of a structured approach. It is paramount to distinguish the different etiologies of angioedema from one another and more specifically differentiate histaminergic-mediated angioedema from bradykinin-mediated angioedema, especially in lieu of the more novel treatments that have recently become available for bradykinin-mediated angioedema. ⋯ After rigorous debate, review of the literature, and expert opinion, the following consensus guideline document was created. The document has been endorsed by the American College of Allergy, Asthma & Immunology (ACAAI) and the Society for Academic Emergency Medicine (SAEM).
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Emergency department (ED) crowding negatively affects quality of care and disproportionately affects medium-acuity (Emergency Severity Index [ESI] level 3) patients. The effect of a dedicated area in the ED focused on these patients has not been well studied. ⋯ Implementation of a midtrack area dedicated to caring for uncomplicated medium-acuity (ESI 3) patients was associated with a decrease in overall ED LWBS rates and ED LOS for medium-acuity patients.