Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study Clinical Trial
Refining Emergency Severity Index triage criteria.
The Emergency Severity Index (ESI) version 3 is a five-level triage acuity scale with demonstrated reliability and validity. Patients are rated from ESI level 1 (highest acuity) to ESI level 5 (lowest acuity). Clinical experience has demonstrated two levels of ESI level 2 patients: those who require immediate intervention and those who are stable to wait for at least ten minutes. Studies have found that few patients are rated ESI level 1, and it has been suggested that revisions to the ESI might result in appropriate reclassification of some sickest level 2 patients as level 1. The purpose of this study was to identify level 2 patients who might be reclassified as level 1 patients. ⋯ Specific clinical findings at triage for a subset of ESI level 2 patients were associated with immediate delivery of lifesaving interventions. Revisions to the ESI level 1 criteria may be beneficial.
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Randomized Controlled Trial Comparative Study
Emergency triage: comparing a novel computer triage program with standard triage.
Emergency department (ED) triage prioritizes patients based on urgency of care; however, little previous testing of triage tools in a live ED environment has been performed. ⋯ There was significant discrepancy by nurses using memory-based triage when compared with a computer tool. Triage decision support tools can mitigate this drift, which has administrative implications for EDs.
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Comparative Study
Pilot study: concordance of disposition for hypothetical medical patients in the emergency department.
Emergency physicians (EPs) make dispositions for every patient in the emergency department (ED) and often require agreement from inpatient services to admit medical patients to the hospital. Sometimes disagreements arise. The authors sought to determine in their institution disposition concordance between EPs and admitting medical services of hypothetical ED patients. A second objective was to describe additional information requested by each service. ⋯ In the authors' institution, when presented with identical hypothetical ED patients, EPs would admit more, discharge less, and ask for fewer additional tests than FP or IM physicians. The FP and IM physicians surveyed disposition patients in a similar manner.
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Comparative Study
Adverse events associated with procedural sedation and analgesia in a pediatric emergency department: a comparison of common parenteral drugs.
To compare the frequency and severity of adverse events associated with parenteral drugs commonly used for procedural sedation and analgesia (PSA) in a pediatric emergency department. ⋯ Drug types used in pediatric PSA are associated with different adverse event profiles. Patients receiving ketamine with or without midazolam experienced fewer respiratory adverse events but more vomiting than the commonly used combination of midazolam and fentanyl. Adverse events may occur in any patient receiving parenteral PSA.