Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To be able to predict, at the time of triage, whether a need for hospital admission exists for emergency department (ED) patients may constitute useful information that could contribute to systemwide hospital changes designed to improve ED throughput. The objective of this study was to develop and validate a predictive model to assess whether a patient is likely to require inpatient admission at the time of ED triage, using routine hospital administrative data. ⋯ A model for predicting the risk of immediate hospital admission at triage for all-cause ED patients was developed and validated using routinely collected hospital data. Early prediction of the need for hospital admission at the time of triage may help identify patients deserving of early admission planning and resource allocation and thus potentially reduce ED overcrowding.
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Comparative Study
A population-based study of the association between socioeconomic status and emergency department utilization in Ontario, Canada.
The relative effects of socioeconomic status (SES) and health status on emergency department (ED) utilization are controversial. The authors examined this in a setting with universal health coverage. ⋯ In a setting with universal health insurance, worse health status is the largest predictor of ED utilization, but low SES is independently associated with increased use of the ED, regardless of visit urgency. This study lends support to findings in other health systems that those using EDs are more ill and more disadvantaged.
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The interpretation and optimal application of the myriad of diagnostic modalities at the emergency physician's (EP's) disposal is a core challenge of clinical practice. Connecting the wealth of scientific literature that informs our understanding of test performance, including elements of the history and the physical examination, is a daunting task. ⋯ This commentary discusses the potential impact of the first installment in the "evidence-based diagnostics" series of the journal, highlighting how this work complements existing resources of evidence-based medicine. In addition, a vision is presented for how the insight from this series can achieve integration into the clinical and academic mission of emergency medicine.
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Randomized Controlled Trial
Nebulized budesonide added to standard pediatric emergency department treatment of acute asthma: a randomized, double-blind trial.
The goal was to determine if adding inhaled budesonide to standard asthma therapy improves outcomes of pediatric patients presenting to the emergency department (ED) with acute asthma. ⋯ For children 2 to 18 years of age treated in the ED for acute asthma, a single 2-mg dose of budesonide added to standard therapy did not improve asthma severity scores or other short-term ED-based outcomes.
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This study examined how frequently inhaled corticosteroids (ICS) are prescribed at discharge in U.S. emergency departments (EDs) for children presenting with asthma exacerbations. ⋯ Inhaled corticosteroids are infrequently prescribed for children with asthma at discharge from U.S. EDs. Other than the fall season, there are no identified demographic or clinical factors associated with the likelihood of ICS prescriptions. ED clinicians should consider interventions to increase ICS prescriptions for children with persistent asthma.