J Emerg Med
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Observational Study
Falls and Implementation of NEXUS in the Elderly (The FINE Study).
The incidence of cervical spine injuries (CSI) in people over 65 years of age from low-energy mechanisms is far greater than in younger populations. Algorithms and decision rules exist for selection of trauma patients requiring cervical spine imaging. ⋯ In our study, the NEXUS decision instrument was not a valid tool to rule out imaging for patients > 65 years of age presenting after a fall from standing height or less. We advocate the liberal use of CT imaging of the cervical spine in this cohort of patients to rule out cervical spine injury.
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Randomized Controlled Trial
A Randomized Controlled Trial of Intravenous Haloperidol vs. Intravenous Metoclopramide for Acute Migraine Therapy in the Emergency Department.
Emergency Department (ED) headache patients are commonly treated with neuroleptic antiemetics like metoclopramide. Haloperidol has been shown to be effective for migraine treatment. ⋯ Intravenous haloperidol is as safe and effective as metoclopramide for the ED treatment of migraine headaches, with less frequent need for rescue medications.
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A well-functioning primary care system has the capacity to provide effective care for patients to avoid nonurgent emergency department (ED) use and related costs. ⋯ These findings highlight the improvement in ambulatory care quality as the potential target area to effectively reduce nonurgent ED care costs.