Articles: emergency-department.
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Dog bite injuries may result in pain, infection, emotional distress, dysfunction, and disfiguration, as well as lead to costly health care utilization, such as emergency department (ED) visits, rabies postexposure prophylaxis, and hospitalizations. Although clinical care guidelines exist, to our knowledge risk factors for hospitalization after a dog bite injury have not been examined quantitatively. Quantifying the magnitude of association between modifiable risk factors, such as infection, and hospitalization after a dog bite injury may guide intervention efforts, improve patient outcomes, and reduce unnecessary hospitalizations. ⋯ This study provides a unique, quantitative examination of risk factors for hospitalization after dog bite injury. The relative risk of hospitalization associated with each factor was substantial. The strongest association was for a modifiable risk factor, infection. This finding may inform best practices for initial care of patients with dog bite injuries and the development of novel protocols for following patients to reduce infections and subsequent hospitalizations.
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ABSTRACTObjectives:Unenhanced computed tomography (CT) has become a standard imaging technique for uncomplicated renal colic in many countries. The appropriate timing of CT imaging has not been established, and guidelines recommend that this imaging be performed between 1 and 7 days of presentation. The primary objective of this study was to determine the prevalence of alternative diagnosis identified with low-dose unenhanced CT in the emergency department (ED) in patients with suspected uncomplicated renal colic. ⋯ Low-dose unenhanced CT in the ED detects alternative diagnoses in 6% (95% CI 3-10) of patients with suspected uncomplicated renal colic, half of whom are subsequently hospitalized. Our prospective findings, which were similar to those reported in retrospective studies, are a potential argument for a systematic approach to ED imaging in suspected renal colic. Future research involving intervention and control groups would be helpful.
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To measure emergency department (ED) crowding, the emergency department occupancy ratio (EDOR) was introduced. ⋯ The EDOR is associated with increased 1- to 3-day mortality even after controlling for potential confounders.
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This qualitative study aimed to characterize the barriers to informed discussions between patients and emergency physicians (EPs) about radiation risk from computed tomography (CT) and to identify future interventions to improve patient understanding of CT radiation risk. ⋯ The normative view that radiation from diagnostic CT should be discussed in the ED is shared by patients and physicians, but is challenged by the lack of a structured method to communicate CT radiation risk to ED patients. Our analysis identifies promising interest among physicians and patients to use information guides and electronic order prompts as potential informational tools to overcome this barrier.
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ABSTRACTObjective:Given the recent publication of several large trials and systematic reviews, we undertook a study of the current management of bronchiolitis in Canadian pediatric emergency departments (EDs) and explored physicians' rationale for their treatment decisions. The overarching purpose of this study was to assist in planning a future trial of combined epinephrine and dexamethasone for bronchiolitis. ⋯ Our results indicate that physicians practicing in Canadian pediatric EDs commonly use bronchodilators to manage bronchiolitis but use corticosteroids less commonly. They appear to be uncomfortable using corticosteroids, particularly longer courses, and have a stated preference for a single dose. Any future trial examining the role of corticosteroids in bronchiolitis should carefully consider the issue of steroid dosage.