Can J Emerg Med
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ABSTRACTObjective:To determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents. Methods:A prospective randomized, double-blind, placebo-controlled trial was conducted for patients with suspected appendicitis. The patients were randomized to receive placebo (normal saline intravenous [IV]) infusions over 5 minutes or the study drug (morphine 5 mg IV). ⋯ The perforation rates in each group were also similar (18.9% in the placebo group and 14.3% in the pain control group, p = 0.75). Receiver operating characteristic analysis revealed that the overall diagnostic accuracy in each group was similar (the area under the curve of the placebo group and the pain control group was 0.63 v. 0.61, respectively, p = 0.81). Conclusions:Early pain control in patients with suspected appendicitis does not affect the diagnostic performance of surgical residents.
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In patients presenting with transient ischemic attack in the emergency department, what is the accuracy of the ABCD2 score for predicting stroke? ⋯ The study collaborators sought to externally validate the ABCD2 score as a tool for identifying patients seen in the emergency department with transient ischemic attack who are at high risk for stroke within 7 (primary outcome) and 90 (one of the secondary outcomes) days.
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Emergency department (ED) patients with symptoms of cardiac ischemia often require a second cardiac troponin (cTn) measurement to rule out non-ST elevation myocardial infarction. We measured the total turnaround time and the component event times following the ordering of the second cTn level to ED discharge to identify root causes of delays. ⋯ For ED patients discharged following two normal cTn levels, the laboratory processing time and time from the result being available to the time of ED discharge represent the longest modifiable time periods to reduce ED length of stay.