Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To characterize the types and external causes of pediatric injury-related visits (IRVs) to emergency departments (EDs), in particular, sports-related injuries. To compare the characteristics of children with IRVs with those with non-IRVs, specifically, differences in IRV rates by race and ethnicity and by health insurance. ⋯ Sports and recreation are the leading external causes of pediatric IRVs to EDs in the United States. There are different patterns of IRVs according to gender, age, race, ethnicity, and insurance. Identification of specific patterns of injury is necessary for the design of effective prevention strategies.
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To examine how emergency department (ED) overcrowding has been defined in the medical literature. ⋯ Although ED overcrowding has been a topic of frequent investigation, current definitions of the problem are often implicit or focus on factors outside of the ED itself. A more consistent approach to defining ED overcrowding would help to clarify the distinctions between causes, characteristics, and outcomes of overcrowding.
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The Society for Academic Emergency Medicine believes that protection of human subjects is vital in emergency medicine research and that, whenever feasible, informed consent is at the heart of that protection. At the same time, the emergency setting presents unique barriers to informed consent both because of the time frame in which the research is performed and because patients in the emergency department are a vulnerable population. This report reviews the concept of informed consent, empirical data on patients' cognitive abilities during an emergency, the federal rules allowing exemption from consent under certain circumstances, issues surrounding consent forms, and the new Health Insurance Portability and Accountability Act regulations as they relate to research. ⋯ Sometimes resuscitation and other emergency medicine research must be conducted without the ability to obtain consent. In these cases, special protections of subjects under the exception from consent guidelines must be followed. Protection of research subjects is the responsibility of every researcher in emergency medicine.
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Comparative Study
Ethanol and illicit drugs do not affect the diagnostic utility of base deficit and lactate in differentiating minor from major injury in trauma patients.
Base deficit (BD) and lactate are valuable screening tools for injured patients. They reflect the degree of oxygen debt and have been shown to predict outcome. Intake of ethanol and illicit drugs may further derange acid-base status. The authors evaluated the effect of blood alcohol level (BAL) and illicit drugs on admission BD and lactate levels in trauma patients. ⋯ The presence of ethanol and/or illicit drugs did not affect the ability of BD or lactate to identify patients with major injuries.
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Clinical Trial
Clinical value of the total white blood cell count and temperature in the evaluation of patients with suspected appendicitis.
The total white blood cell (WBC) count and temperature are often expected to be elevated in patients with appendicitis. Clinicians often use the results of these parameters in making a judgment about the presence or absence of disease. The objective of this study was to assess the discriminatory value of the total WBC count and presenting body temperature in patients presenting to the emergency department (ED) with signs and symptoms suggestive of appendicitis. ⋯ An elevated total WBC count >10,000 cells/mm(3), while statistically associated with the presence of appendicitis, had very poor sensitivity and specificity and almost no clinical utility. There was minimal statistical association between a temperature of >99 degrees F and the presence of appendicitis. The ROC curve suggests there is no value of total WBC count or temperature that has sufficient sensitivity and specificity to be of clinical value in the diagnosis of appendicitis. Clinicians should be wary of reliance on either elevated temperature or total WBC count as an indicator of the presence of appendicitis.