J Emerg Med
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Comparative Study
How do prudent laypeople define an emergency medical condition?
To determine the public's perception as to the general definition of an emergency medical condition (EMC), and to compare opinions between the general public and healthcare workers (HCW) on which specific medical conditions require emergency department (ED) care, a survey of people at 12 supermarkets and shopping malls in Northern California was conducted over a 6-month period in 1997. Individuals over age 18 were asked in person to complete a survey sheet. It asked participants to choose one of four definitions of "emergency medical condition." In addition, people were asked to determine which of 30 chief complaints they thought needed care in the ED. ⋯ Approximately half uses a conservative federal definition, and half uses patient self-determined need as the definition. Data on which specific conditions need ED care provide additional insight on agreement between the public and HCWs on most problems. Both groups agree that many perceived minor medical complaints do not require ED care.
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Splenic rupture is a rare but potentially deadly complication of colonoscopy. We present the case of a 70-year-old male who presented with abdominal pain, initially stable, almost 2 days after colonoscopy. The patient's clinical status deteriorated shortly after abdominal CT scan identified splenic rupture.
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The objectives of this study were to determine the optimal cutoff value (CV) and utility of a single serum beta human chorionic gonadotropin hormone (HCG) level in assessing the likelihood of ectopic pregnancy (ECP). A retrospective chart review was performed at an urban county hospital. The optimal CV was determined by comparing all available patients diagnosed with ECP and patients diagnosed with threatened abortion (TA) in the Emergency Department (ED) who subsequently delivered a baby at the same hospital. ⋯ When the test was applied to a group of 175 women who presented with pain or bleeding between 6 and 13 weeks EGA, the sensitivity and positive predictive value for an intrauterine pregnancy were 24% and 99.9 %, respectively. However, if this test was applied to all patients regardless of clinical findings, and then an ultrasound (U/S) algorithm was applied to the patients who had an HCG of less than 40K, it would predictably increase the rate of ECPs falsely identified as intrauterine pregnancies (IUPs) by 1%, regardless of the false-positive rate of the U/S algorithm itself. Given the potential morbidity and mortality of undiagnosed ectopic pregnancy, ultimately neither this test nor any other that is less than 100% specific for IUP can be recommended instead of an initial U/S evaluation for patients who present at risk for ECP.
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Clinical Trial Controlled Clinical Trial
Test ordering guidelines can alter ordering patterns in an academic emergency department.
To determine the impact of an educational program designed to modify test ordering behavior in an academic Emergency Department (ED), an observational, before-and-after study was conducted at a university tertiary referral center and Emergency Medicine (EM) residency site. Test ordering standards were developed by EM faculty, RNs, and NPs based upon group consensus and published data. The standards were given to all ED staff beginning February 1996, and included in the evidence-based medicine orientation and educational program for all residents and medical students prior to beginning their rotation. ⋯ Chemistry test ordering frequency showed statistically significant increases. Overall, approximately $50,000 was saved by decreasing test ordering. Test ordering behavior can be modified and maintained by an educational program and may have significant economic effects.