European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review
Signs and symptoms in adult patients with acute dyspnea: a systematic review and meta-analysis.
Rapid and accurate diagnosis of patients with a new episode of acute dyspnea is a common challenge for Primary Care or Emergency Physicians. ⋯ This systematic review, which only included patients from ED settings, did not identify any single sign or symptom that had acceptable sensitivity to be useful in ruling out a diagnosis of HF, chronic obstructive pulmonary disease, asthma, or pulmonary embolism. Elevated jugular venous pressure (0.88, pooled odds ratio: 7), added third heart sound (0.97), and lung crepitations (0.77, pooled odds ratio: 11) are useful in ruling in HF.
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To assess the diagnostic characteristics of the get up and go test (GUGT) as a stand-alone test and in combination with the Flemish Triage Risk Screening Tool (fTRST) and Rowland questionnaire. One aim was to determine whether the diagnostic accuracy of these instruments could be improved for predicting unplanned emergency department (ED) readmission following ED discharge. ⋯ Neither the objective measure of mobility (GUGT) nor the combined fTRST/GUGT or Rowland/GUGT improved the results. Our analysis shows that the predictive accuracy of the stand-alone, self-reported screening instruments fTRST and Rowland (cut-off=2) is still good. This study also confirmed their previously known limitations.
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Emergency Department (ED) patient arrivals vary daily and change considerably during holidays, posing challenges to resource allocation. Ramadan, during which observant Muslims follow a daily fasting period for ∼30 days, could represent a unique annual circumstance that predictably alters ED arrivals in predominantly Muslim populations. Our study examined an adult and pediatric ED in the United Arab Emirates to determine whether arrival patterns and patient characteristics differed during Ramadan. ⋯ A distinct, predictable pattern of arrivals emerged during Ramadan. EDs serving predominantly Muslim populations or anticipating increases in Muslim patients in their catchment region may benefit from advanced planning for efficient distribution of provider hours during Ramadan.
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Emergency Departments and out-of-hours General Practitioner services collaborate increasingly in Urgent Care Collaborations (UCCs) by sharing one combined entrance and joint triage. The aim of this study is to examine the difference between UCCs and providers who operate separately with respect to the efficiency of patient flow. ⋯ The results indicate that, on average, UCCs do not enhance the efficiency of patient flow. The median LOS and WT are longer in UCCs and more handovers occur in UCCs compared with usual care.