Can J Emerg Med
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Multicenter Study
A simple intervention to reduce your chance of missing an acute aortic dissection.
Acute aortic dissection (AAD) is a time sensitive, difficult to diagnose, aortic emergency. We sought to explore the quality of history taking in AAD and assess its impact on misdiagnosis. ⋯ Clinicians should ask and document the character, onset, duration, radiation and severity of pain in any patient presenting with chest, abdominal or flank pain. A focused history still remains the keystone to reducing misdiagnosis.
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Multicenter Study Observational Study
Adherence of older emergency department patients to community-based specialized geriatric services.
Our objective was to determine emergency department (ED) patient adherence to outpatient specialized geriatric services (SGS) following ED evaluation by the geriatric emergency management (GEM) nurse, and identify barriers and facilitators to attendance. ⋯ Adherence of older ED patients referred by the GEM team to SGS is suboptimal, and a large proportion of patients decline these referrals in the ED. Future work should examine the efficacy of home-based assessments in a larger confirmatory setting and focus on interventions to increase referral acceptance and address barriers to attendance.
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Multicenter Study
Simulation curricular content in postgraduate emergency medicine: A multicentre Delphi study.
There is increasing evidence to support integration of simulation into medical training; however, no national emergency medicine (EM) simulation curriculum exists. Using Delphi methodology, we aimed to identify and establish content validity for adult EM curricular content best suited for simulation-based training, to inform national postgraduate EM training. ⋯ Delphi methodology allowed for achievement of expert consensus and content validation of EM curricular content best suited for simulation-based training. These results provide a foundation for improved integration of simulation into postgraduate EM training and can be used to inform a national simulation curriculum to supplement clinical training and optimize learning.
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Multicenter Study
Outcomes and emergency medical services resource utilization among patients with syncope arriving to the emergency department by ambulance.
Syncope accounts for 1% of emergency department (ED) visits, yet few experience a serious adverse event (SAE). Two-thirds of syncope patients are transported to the ED by ambulance, placing considerable burden on emergency medical services (EMS), and many of these transports may be unnecessary. We estimated the proportion of syncope patients who fell into a low-risk category based on an ED diagnosis of vasovagal syncope and the absence of EMS intervention, hospitalization, or SAE. ⋯ About 40% of patients transported to the ED by ambulance are at low risk and may not benefit from paramedic care or transport to a hospital. A robust clinical decision tool would help identify patients safe for treat-and-release, diversion to alternative care, or rapid offload into low-acuity ED areas, potentially reducing EMS workload and cost.
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Multicenter Study Observational Study
Potential benefits of incentive spirometry following a rib fracture: a propensity score analysis.
CLINICIAN'S CAPSULEWhat is known about the topic?Literature regarding the impact of incentive spirometry on patients with rib fractures is unclear; there are no recommendations for its use in the emergency department (ED). What did this study ask?The objective of this study was to assess the impact of incentive spirometry on delayed complications in patients with rib fractures in the ED. What did this study find?Unsupervised incentive spirometry use does not have a protective effect against delayed pulmonary complications after a rib fracture. Why does this study matter to clinicians?Clear guidelines for incentive spirometry use for patients with rib fractures and further research to assess its usefulness in other ED populations are needed.