Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
The validity of using multiple imputation for missing out-of-hospital data in a state trauma registry.
To assess 1) the agreement of multiply imputed out-of-hospital values previously missing in a state trauma registry compared with known ambulance values and 2) the potential impact of using multiple imputation versus a commonly used method for handling missing data (i.e., complete case analysis) in a typical multivariable injury analysis. ⋯ Multiply imputed out-of-hospital values for intubation attempt, Glasgow Coma Scale score, systolic blood pressure, and respiratory rate have fair to good agreement with known ambulance values. Multiple imputation also increased precision and reduced bias compared with complete case analysis in a typical multivariable injury model, and it should be considered for studies using out-of-hospital data from a trauma registry, particularly when substantial portions of data are missing.
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Randomized Controlled Trial Comparative Study
Randomized controlled trial of single-operator vs. two-operator ultrasound guidance for internal jugular central venous cannulation.
Use of ultrasound guidance for central line placement generally requires two operators: one to hold the transducer and the other to guide the needle. The authors propose a single-operator technique and compare it with the two-operator technique for placement of internal jugular central lines. ⋯ This one-person technique appears to be equivalent to the standard two-person technique for successful ultrasound-guided internal jugular central venous catheterization with respect to overall success.
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To examine the patterns of antibiotic use for acute respiratory tract infections (ARIs) in acute care settings. ⋯ Acute care settings are important targets for reducing inappropriate antibiotic prescribing. The mechanisms accounting for lower antibiotic prescription rates observed with housestaff-associated visits merit further study.
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To determine whether performance decrements at night actually translate into worsened measures of quality of patient care in the emergency department (ED). Emergency physicians and healthcare workers are sleepier and less cognitively proficient at night than during the day. Despite a lack of data, medical errors have been attributed to these deficits, and pharmacologic solutions recently have been suggested. ⋯ Quality indicators used in this study do not demonstrate marked deficits in patient care occurring at night. A very small, but measurable, increase in early mortality was identified. Improved measures to counter circadian disruption warrant study but may result in minimal improvements in patient care.
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Editorial Comment
Ultrasound is a necessary skill for emergency physicians.