Articles: emergency-department.
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Pediatric emergency care · Oct 2024
Implementation Barriers Encountered During a Universal Suicide Screening Program in Pediatric Emergency Departments.
Because understanding barriers to universal suicide risk screening in pediatric emergency departments (PEDs) may improve both identification and management of suicidal behaviors and ideation, this study assessed barriers to a quality improvement initiative examining the use of a novel computerized adaptive test (CAT), the Kiddie-CAT, in 2 PEDs. ⋯ Although this study was limited by a lack of complete integration into clinical protocols and was complicated by the COVID-19 pandemic impacts on PEDs, the findings suggest that considerable attention needs to be directed both to physician education and to workflow issues that could impede universal screening efforts.
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Low back pain (LBP) is ranked in the top 10 conditions presenting to emergency departments (ED) in Australia. We aimed to investigate ED re-presentation rates and length of stay (LOS) of patients with LBP, including associated factors. ⋯ A re-presentation within 12 months occurs in 7.7% of episodes of LBP in ED. Over one-quarter of patients stayed longer than 4 h.
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Observational Study
Optimizing outcomes: A retrospective analysis of discharge safety for elderly mTBI patients on anticoagulation therapy.
Mild traumatic brain injuries (mTBIs) pose a significant risk, particularly in the elderly population on anticoagulation therapy. The safety of discharging these patients from the emergency department (ED) with a negative initial computed tomography (CT) scan has been debated due to the risk of delayed intracranial hemorrhage (d-ICH). ⋯ In elderly patients on anticoagulation with mTBI and a negative initial CT, admission was associated with a higher risk of d-ICH compared to discharge. These findings have implications for clinical decision-making in this high-risk population.
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Observational Study
Trends in non-focal neurological chief complaints and CT angiography utilization among adults in the emergency department.
Prudent imaging use is essential for cost reduction and efficient patient triage. Recent efforts have focused on head and neck CTA in patients with emergent concerns for non-focal neurological complaints, but have failed to demonstrate whether increases in utilization have resulted in better care. The objective of this study was to examine trends in head and neck CTA ordering and determine whether a correlation exists between imaging utilization and positivity rates. This is a single-center retrospective observational study at a quaternary referral center. ⋯ The percentage of patients who received a scan over the study period increased from 7.89% (422/5351) in 2017 to 13.24% (662/5001) in 2021, representing a 67.4% increase from baseline (OR, 1.14; 95% CI 1.11-1.18; P < .001). The positivity rate, or the percentage of scans ordered that revealed attributable acute pathology, dropped from 16.8% (71/422) in 2017 to 10.4% (69/662) in 2021 (OR, 0.86; 95% CI 0.79-0.94; P = .001), a 38% reduction in positive examinations. Throughout the study period, there was a 67.4% increase in head and neck CTA ordering with a concomitant 38.1% decrease in positivity rate.
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Pediatric emergency care · Oct 2024
Clinical Characteristics, Outcomes, and Interobserver Agreement of Point-of-Care Ultrasound Detected Mesenteric Adenitis in Nonsurgical Pediatric Abdominal Pain: A Retrospective Cohort Study.
Point-of-care ultrasound (POCUS) in the emergency department (ED) may facilitate the diagnosis of nonsurgical sources of abdominal pain after surgical causes are excluded. Identifying mesenteric adenitis is a feasible POCUS application due to its ease of use and speed. However, there are scant data regarding the diagnosis of mesenteric adenitis by POCUS. The objective of this study was to describe the clinical characteristics, outcomes, and interobserver agreement of mesenteric adenitis identified on POCUS in pediatric patients with nonsurgical abdominal pain. ⋯ POCUS can identify mesenteric adenitis, typically a diagnosis of exclusion, in pediatric patients with nonsurgical abdominal pain, both by novice and experienced physician-sonologists. Use of POCUS may help ED clinicians identify a common cause of nonsurgical abdominal pain in children.