Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To assess the feasibility and effectiveness of an ED-based tuberculosis (TB) screening program. ⋯ An ED-based TB screening program is feasible and can identify many patients requiring treatment. Targeted screening of high-risk groups could reduce the program cost, but would miss some cases.
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Survival analysis is a group of statistical methods used to analyze data representing the time to an event of interest, e.g., the duration of survival after an out-of-hospital cardiac arrest or the length of time a patient stays in the ED. Survival analysis properly accounts for patients who are lost to follow-up and for patients who have not yet experienced the event of interest at the end of the study's observation period (censored data). This article acquaints the reader with the terminology, methodology, and limitations of survival analysis. Specific methods discussed include life tables, the Kaplan-Meier product limit estimate, the log-rank test, and the multivariate Cox proportional hazards model.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized, clinical trial comparing butylcyanoacrylate with octylcyanoacrylate in the management of selected pediatric facial lacerations.
To compare two tissue adhesives, butylcyanoacrylate and octylcyanoacrylate, in the treatment of small (<4 cm) superficial linear traumatic facial lacerations in children. ⋯ In the closure of small linear pediatric facial lacerations, octylcyanoacrylate is similar to butylcyanoacrylate in ease of use and early and late cosmetic outcomes. The superior physical properties of octylcyanoacrylate appear to add little benefit to the management of these selected lacerations. Physician preference and differing costs may dictate use for these small selected lacerations.
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Comparative Study
Retrospective review of emergency department patients with non-variceal upper gastrointestinal hemorrhage for potential outpatient management.
To determine the number of ED patients with non-variceal upper gastrointestinal hemorrhage (NVUGIH) who could have been managed as outpatients through application of previously developed clinical guidelines. ⋯ In a non-HMO urban teaching hospital, 18 patients with NVUGIH met criteria for outpatient management in a six-month period and none developed a complication during a mean in-hospital stay of 2.1 days.
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Subarachnoid hemorrhage (SAH) is a diagnosis often considered in patients presenting to the ED with acute sudden headaches, but with normal physical examinations. Standard of care today is for these patients to be investigated by noncontrast CT scan followed by lumbar puncture (LP) for negative CTs. ⋯ Given reasonable assumptions, for every 100 patients investigated, the "LP-first" model would result in 79 to 83 fewer CT scans and only seven to 11 additional LPs, as compared with traditional strategies. Among ED headache patients meeting LASH criteria, the authors believe use of this model could result in more efficient use of resources, minimal additional morbidity, and equal diagnostic accuracy for SAH.