Articles: emergency-department.
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To classify older adults in the emergency department (ED) according to healthcare use and to examine associations between group membership and future ED visits and hospital admissions. ⋯ In older adults released from an ED, group membership was associated with future health services use. Classification of individuals using readily available previous visit data may improve targeting of interventions to improve outcomes.
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Emerg Med Australas · Apr 2014
Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features.
National guidelines for management of intermediate risk patients with suspected acute coronary syndrome, in whom AMI has been excluded, advocate provocative testing to final risk stratify these patients into low risk (negative testing) or high risk (positive testing suggestive of unstable angina). Adults less than 40 years have a low pretest probability of acute coronary syndrome. The utility of exercise stress testing in young adults with chest pain suspected of acute coronary syndrome who have National Heart Foundation intermediate risk features was evaluated. ⋯ Routine exercise stress testing has limited value in the risk stratification of adults less than 40 years with suspected intermediate risk of acute coronary syndrome.
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Geriatric patients are more likely than younger patients to be admitted to the hospital when they present to the emergency department (ED). Identifying trends in geriatric short-stay admission may inform the development of interventions designed to improve acute care for the elderly. ⋯ For all elderly patients, short-stay admissions represented a growing proportion of total admissions, regardless of the definition of short stay. These trends were identified despite the NHDS exclusion of observation status hospitalizations. The increase in short-stay admissions was the most pronounced in the extreme elderly (age ≥ 85 years). Future research is needed to optimize treatment for geriatric patients presenting to the ED, some of whom, with brief observation and appropriate follow-up, may be better cared for without hospitalization.
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Despite a relatively high frequency of appendix nonvisualization when using ultrasound to diagnose appendicitis, many studies either fail to report these results or inconsistently analyze outcomes. ⋯ We suggest reporting ultrasound results using a 3 × 2 table (including nonvisualized findings) but using the traditional 2 × 2 type of analysis for test characteristic calculations. This approach allows for the determination of diagnostic yield and calculation of likelihood ratios when the appendix is not visualized. This approach to reporting should be considered for all types of diagnostic ultrasound studies.
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Although several studies have demonstrated that wait time is a key factor that drives high leave-without-being-seen (LWBS) rates, limited data on ideal wait times and impact on LWBS rates exist. ⋯ Achieving target LWBS rates requires analysis to understand the abandonment behavior and redesigning operations to achieve the target wait times.