Emergency medicine journal : EMJ
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Multicenter Study
Factors influencing time to computed tomography in emergency department patients with suspected subarachnoid haemorrhage.
CT has excellent sensitivity for subarachnoid haemorrhage (SAH) when performed within 6 hours of headache onset, but it is unknown to what extent patients with more severe disease are likely to undergo earlier CT, potentially inflating estimates of sensitivity. Our objective was to evaluate which patient and hospital factors were associated with earlier neuroimaging in alert, neurologically intact ED patients with suspected SAH. ⋯ Time from headache onset to imaging is moderately associated with positive imaging for SAH. Delay to hospital presentation accounts for the largest fraction of time to imaging, especially those without SAH. These findings suggest limited opportunity to reduce lumbar puncture rates simply by accelerating in-hospital processes when imaging delays are under 2 hours, as diagnostic yield of imaging decreases beyond the 6-hour imaging window from headache onset.
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Multicenter Study Comparative Study
One-two-triage: validation and reliability of a novel triage system for low-resource settings.
To validate and assess reliability of a novel triage system, one-two-triage (OTT), that can be applied by inexperienced providers in low-resource settings. ⋯ OTT can be reliably applied and performs as well as ESI compared with gold standard, but requires fewer resources and less experience.
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Multicenter Study
Prevalence and predictors of hospital prealerting in acute stroke: a mixed methods study.
Thrombolysis can significantly reduce the burden of stroke but the time window for safe and effective treatment is short. In patients travelling to hospital via ambulance, the sending of a 'prealert' message can significantly improve the timeliness of treatment. ⋯ Up to half of the patients presenting with suspected stroke in this study were prealerted by EMS staff, regardless of eligibility, resulting in disagreements with ED staff during handover. Aligning the expectations of EMS and ED staff, perhaps through simplified prealert protocols, could be considered to facilitate more appropriate use of hospital prealerting in acute stroke.
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Multicenter Study Observational Study
Can transcutaneous carbon dioxide pressure be a surrogate of blood gas samples for spontaneously breathing emergency patients? The ERNESTO experience.
It is known that the arterial carbon dioxide pressure (PaCO2) is useful for emergency physicians to assess the severity of dyspnoeic spontaneously breathing patients. Transcutaneous carbon dioxide pressure (PtcCO2) measurements could be a non-invasive alternative to PaCO2 measurements obtained by blood gas samples, as suggested in previous studies. This study evaluates the reliability of a new device in the emergency department (ED). ⋯ Our results show that PtcCO2 measured by the TCM4 device could not replace PaCO2 obtained by arterial blood gas analysis.
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Multicenter Study
MARRIED-cocaine score: validating a tool for detecting the risk of ED revisit in cocaine users.
According to a previous study, 17% of patients who attended an emergency department (ED) following cocaine use returned to the same ED over the next year for a problem related to drug use. This previous study proposed a scale (Multicenter Assessment of the Revisit Risk In the Emergency Department (MARRIED)-cocaine score) to quantify the risk of ED revisit. The aim of the present study was to validate this scale by analysing a new set of patients attending for cocaine use in nine Spanish EDs. ⋯ The MARRIED-cocaine score has a moderate discriminative capacity to predict revisit among patients who attend the ED for cocaine drug-related emergencies, and allows classification of patients according to the risk of ED revisit.