Articles: hospital-emergency-service.
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To assess and compare the diagnostic value of lactate, procalcitonin (PCT) and C-reactive protein (CRP) in low, moderate, and high-risk stratified population applying Mortality in Emergency Department (MEDS) risk score using Bayesian statistical modeling. ⋯ Bayesian statistical model demonstrated the superior diagnostic quality of PCT. For ruling out severe disease, lactate yielded a higher benefit with increased relative gain with negative LR.
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Review Meta Analysis
Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis.
Long bone fractures (LBFs) are among the most frequent traumatic injuries seen in emergency departments. Reduction and immobilization is the most common form of treatment for displaced fractures. Point-of-care ultrasound (PoCUS) is a promising technique for diagnosing LBFs and assessing the success of reduction attempts. This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs. Data source MEDLINE and EMBASE databases were searched through July 19, 2015. Study selection We included prospective studies that assessed test characteristics of PoCUS in 1) the diagnosis or 2) the reduction of LBFs. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Data extraction Thirty studies met inclusion criteria (n=3,506; overall fracture rate 48.0%). Test characteristics of PoCUS for the diagnosis of LBFs were as follows: sensitivity 64.7%-100%, specificity 79.2%-100%, positive likelihood ratio (LR) 3.11-infinity, and negative LR zero-0.45. Sensitivity and specificity for the adequate reduction of LBFs with PoCUS were 94%-100% and 56%-100%, respectively. PoCUS diagnosis of pediatric forearm fractures in 10 studies showed a pooled sensitivity of 93.1% (95% confidence interval [CI], 87.2%-96.4%) and specificity of 92.9% (95% CI, 86.6%-96.4%), and PoCUS diagnosis of adult ankle fractures in four studies showed a pooled sensitivity of 89.5% (95% CI, 77.0%-95.6%) and specificity of 94.2% (95% CI, 86.1%-97.7%). ⋯ PoCUS demonstrates good diagnostic accuracy in all LBFs studied, especially in pooled results of diagnosis of pediatric forearm and adult ankle fractures. PoCUS is an appropriate adjunct to plain radiographs for LBFs.
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The primary objective of this systematic review was to determine the accuracy of point-of-care ultrasonography (POCUS) in diagnosing abscess in emergency department (ED) patients with skin and soft tissue infections (SSTI). The secondary objective was the accuracy of POCUS in the paediatric population subgroup. ⋯ A total of 8 studies of good-to-excellent quality were included in this review. The use of POCUS helps differentiate abscess from cellulitis in ED patients with SSTI.
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Review Meta Analysis
Effect of scribes on patient throughput, revenue, and patient and provider satisfaction: a systematic review and meta-analysis.
Scribes offer a potential solution to the clerical burden and time constraints felt by health care providers. ⋯ We found no difference in length of stay or time to disposition with a small increase in the number of patients per hour seen when using scribes. Potential benefits include revenue and patient/provider satisfaction.
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Review Meta Analysis
The impact of senior doctor assessment at triage on emergency department performance measures: systematic review and meta-analysis of comparative studies.
To determine if placing a senior doctor at triage versus standard single nurse in a hospital emergency department (ED) improves ED performance by reviewing evidence from comparative design studies using several quality indicators. ⋯ This review demonstrates that SDT can be an effective measure to enhance ED performance, although cost versus benefit analysis is needed. The potential high risk of bias in the evidence identified, however, mandates more robust multicentred studies to confirm these findings.