European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Meta Analysis
Effectiveness of nurse-initiated X-ray for emergency department patients with distal limb injuries: a systematic review.
The aim of this study was to systematically review the literature on the effectiveness of nurse-initiated X-ray for emergency department patients with distal limb injuries. The review protocol was registered with PROSPERO and CINHAL, MEDLINE and EMBASE were searched for studies comparing nurse-initiated vs physician-initiated X-ray. Because of heterogeneity of patients, providers and outcomes, a meta-analysis was not performed. ⋯ The quality of evidence for each outcome ranged from very low-to-moderate. Compared with physician-initiated X-ray, nurse-initiated X-ray uses no more resources, is safe and acceptable to patients. Nurse-initiated X-ray did not reduce time to X-ray or waiting time but in some studies, reduced emergency department length of stay and unplanned follow-up.
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Multicenter Study Comparative Study
Drowning in fresh or salt water: respective influence on respiratory function in a matched cohort study.
For the most severe drowned patients, hypoxemia represents one of the major symptoms. As the influence of the type of water (fresh or salt water) on respiratory function is still unclear, the primary endpoint of this multicenter study was to compare hypoxemia according to the type of water. ⋯ Drowning in fresh water was associated with deeper hypoxemia in the initial assessment. Despite this initial difference, latter respiratory and biological parameters or outcome were similar in both groups.
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Multicenter Study
Trend analysis of emergency department malpractice claims in the Netherlands: a retrospective cohort analysis.
Over the past two decades, several quality improvement projects have been implemented in emergency departments (EDs) in the Netherlands, one of these being the training and deployment of emergency physicians. In this study we aim to perform a trend analysis of ED quality of care in Dutch hospitals, as measured by the incidence of medical malpractice claims. ⋯ Even though the number of ED visits increased significantly over the past two decades, the number of malpractice claims filed after an ED visit decreased. Various quality improvement initiatives, including the training and employment of emergency physicians, may have contributed to the observed decrease in claims.
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Several decision aids can 'rule in' and 'rule out' acute coronary syndromes (ACS) in the Emergency Department (ED) but all require measurement of blood biomarkers. A decision aid that does not require biomarker measurement could enhance risk stratification at triage and could be used in the prehospital environment. We aimed to derive and validate the History and ECG-only Manchester ACS (HE-MACS) decision aid using only the history, physical examination and ECG. ⋯ Using only the patient's history and ECG, HE-MACS could 'rule out' ACS in 9.4% of patients while effectively risk stratifying remaining patients. This is a very promising tool for triage in both the prehospital environment and ED. Its impact should be prospectively evaluated in those settings.
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The National Advisory Committee for Aeronautics (NACA) score is used by many emergency medical services to assess the severity of prehospital patients. Little is known about its discriminative performance regarding short-term mortality. ⋯ The NACA score is an efficient way to discriminate victims regarding short-term mortality. Its performance can be enhanced by also integrating epidemiological and clinical parameters into an extended classification rule.