Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Clinical decision rules have been validated for estimation of pretest probability in patients with suspected pulmonary embolism (PE). However, many clinicians prefer to use clinical gestalt for this purpose. The authors compared the unstructured clinical estimate of pretest probability for PE with two clinical decision rules. ⋯ The unstructured clinical estimate of low pretest probability for PE compares favorably with the Canadian score and the Charlotte rule. Interobserver agreement for the unstructured estimate is moderate.
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One marker of quality emergency medical services care is measured by meeting an 8-minute response time guideline. This guideline was based on results of paramedic response times for nontraumatic cardiac arrest patients and has not been studied in unselected patients. The objective of this study was to evaluate the effect of paramedic response time on survival to hospital discharge in unselected patients in a large urban setting while controlling for a number of potentially important confounders, including level of illness severity. ⋯ A paramedic response time within 8 minutes was not associated with improved survival to hospital discharge after controlling for several important confounders, including level of illness severity. However, a survival benefit was identified when the response time was within 4 minutes for patients with intermediate or high risk of mortality. Adherence to the 8-minute response time guideline in most patients who access out-of-hospital emergency services is not supported by these results.
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It is hypothesized that high ambient noise in the emergency department (ED) adversely affects the ability of the examiner to hear heart and lung sounds. ⋯ This study demonstrated that most of the tested examiners have the ability to hear heart and lung sounds at the extreme of loudness found in one ED.
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Although rare, HIV transmission is one of the most feared consequences of sexual assault. While availability of medications to prevent HIV transmission (HIV nonoccupational postexposure prophylaxis [HIV nPEP]) is increasing, little is known about emergency department (ED) prescribing practices and patient adherence to treatment recommendations. ⋯ HIV nPEP was offered to less than half of sexual assault patients, and few completed treatment. Further studies are needed to evaluate and improve appropriateness of HIV nPEP administration and follow-up.
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Comparative Study
Impact of a transfer center on interhospital referrals and transfers to a tertiary care center.
The partnership of faculty physicians and senior clinical hospital administrators in the decision to accept interhospital transfers has not been fully studied. Transfers to academic medical centers on the basis of economics have been of particular concern. ⋯ The value of an administrator and physician team as partners in the interhospital transfer process was demonstrated. Active management of interhospital transfers supports transfer of patients who require tertiary care or who meet EMTALA criteria, thus conserving limited bed capacity and ensuring financial equity, while caring for the uninsured and underinsured patients throughout the state.