Articles: emergency-department.
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Diagnostic stewardship is the effort to optimize diagnostic testing to reduce errors while avoiding overtesting and overtreatment. Abdominal pain and appendicitis in children are essential use cases. Delayed diagnosis of appendicitis can be dangerous and even life-threatening, but overtesting is harmful. ⋯ In this retrospective cohort study of 120,000+ ED visits for pediatric abdominal pain, we found that the ratio of visits with cross-sectional imaging to diagnosed cases of appendicitis varied widely across EDs. Delayed diagnosis of appendicitis was uncommon. Adherence to best practices and improved imaging quality may hold promise to improve diagnostic stewardship for children with abdominal pain across EDs.
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The COVID-19 pandemic provided an ideal scenario for studying the care of the elderly population, we implemented a tool named the Geriatric Measure (GM) tool to determine the severity and need for hospitalization. The objective of the study is to evaluate if the results of a brief Geriatric Measure tool are associated with mortality and other outcomes among older adults with COVID-19 treated in the emergency department. Retrospective observational cohort study. ⋯ The proportion of patients who died increased with every category of the GM tool. Patients in category 1 (fit with good functional status) had a mortality of 24.7% versus those in category 4 (frail with poor functional status) who had a mortality of 51%. Our results show an association between our GM tool and mortality among older adults with pneumonia caused by SARS CoV2 and treated in the emergency department, and highlight the need of individualizing care for older patients.
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Patients presenting with suspected acute coronary syndrome (ACS) in the emergency department (ED) require rapid and accurate electrocardiographic (ECG) evaluation. This study aims to assess conventional ECG markers for diagnosing non-ST-elevation ACS (NSTE-ACS) in patients with chest discomfort and right bundle branch block (RBBB). A nested case-control design was employed to compare patients with RBBB admitted to the ED for suspected cardiac ischemia, focusing on those who developed NSTE-ACS versus those who did not. ⋯ In addition, ST-segment depression and non-negative T-waves were significantly more frequent in patients who developed NSTE-ACS, with odds ratios of 5.78 (95% CI 3-11.3), compared to those who did not (p < 0.05). The odds ratios for ST-segment and T-wave changes were 2.81 and 3.47, respectively, with an 80% correct classification rate for predicting NSTE-ACS. Clinicians should closely monitor the presence of an isoelectric ST-segment and positive T-waves in patients with RBBB to assess for potential cardiac ischemia.
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Postponing scheduled surgeries may alleviate emergency department (ED) crowding by increasing inpatient beds for ED patients but the impact of such measures are unclear. We determined if scheduled surgery cancellations for inguinal hernia and gallbladder disease during the coronavirus pandemic affected ED presentations, hospitalizations, and complications. ⋯ Despite a two-month surgery cancellation period, inguinal hernia and gallbladder disease patients demonstrated minimal differences in outcomes. During periods of ED boarding and crowding, scheduled surgery cancellations may be considered with minimal risk of potential adverse patient effects.