Articles: emergency-services.
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Yonsei medical journal · Feb 2025
Artificial Intelligence-Based Early Prediction of Acute Respiratory Failure in the Emergency Department Using Biosignal and Clinical Data.
Early identification of patients at risk for acute respiratory failure (ARF) could help clinicians devise preventive strategies. Analyzing biosignals with artificial intelligence (AI) can uncover hidden information and variability within time series. We aimed to develop and validate AI models to predict ARF within 72 h after emergency department admission, primarily using high-resolution biosignals collected within 4 h of arrival. ⋯ Our AI model demonstrates high predictive accuracy and significant associations with clinical outcomes. Our AI model has the potential to promptly aid in triage decisions. Our study shows that using AI to analyze biosignals advances disease detection and prediction.
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Transfer of patients between hospitals is common, costly, and over 20 % are estimated to be avoidable, meaning patients do not receive specialized interventions once transferred. Older adults are more likely to be transferred and may be at increased risk for developing delirium or other complications due to transfer. We aimed to determine the frequency of potentially avoidable transfer (PAT) among older adults; identify conditions most likely to involve a PAT; and describe factors associated with PAT. ⋯ PATs were common in transfers of older adults, particularly among a subset of neurologic, cardiovascular, and injury-related conditions. These conditions may represent ideal targets for intervention to decrease rates of avoidable transfer. Research exploring hospital variation in transfer practices and the impact of PAT on older adults' health outcomes are also needed.
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Observational Study
Effect of a best practice advisory activated "kit in hand" naloxone distribution program in the emergency department.
We implemented a "kit in hand" naloxone distribution program at emergency department (ED) discharge activated by electronic health record Best Practice Advisory (BPA). The purpose of this study was to evaluate naloxone kit distribution before and after implementation. ⋯ Implementation of a BPA-activated kit in hand naloxone distribution program increases the rate of successful naloxone distribution to patients presenting to the ED following unintentional opioid overdose, a subpopulation at very high risk for recurrence of overdose. Opportunities for program improvement were identified as there were instances where kits were intended to be distributed but barriers in the process existed.
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Case Reports
Neuro-Behcet's Masquerading as Status Epilepticus and Meningoencephalitis in the Emergency Department.
Behcet disease (BD) is a rare small vessel vasculitis that commonly manifests as recurrent painful oral or genital ulcerations, uveitis, and skin lesions. Some patients with BD develop neurological symptoms termed neuro-Behcet's disease. In the emergency department setting, these symptoms can be mistaken for other common acute issues including stroke, infection, epilepsy, multiple sclerosis, toxin ingestion, or psychiatric conditions. ⋯ We present a case of a 28-year-old male with neuro-BD mimicking status epilepticus and meningoencephalitis. He was actively seizing on arrival and febrile at 103.8 F. The patient also had a history of vasculitis, uveitis, and genital lesions which raised suspicion for a rheumatological process. Cerebrospinal fluid samples were obtained and computed tomography of the head revealed no acute findings. The patient was started on treatment for seizure and meningoencephalitis and admitted to neurology for continuous electroencephalogram monitoring with additional consults placed for rheumatology, ophthalmology, and infectious disease. The patient was ultimately diagnosed with neuro-Behcet's disease and treated appropriately. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In a patient presenting with neurological symptoms and signs of rheumatological disease providers should consider neuro-Behcet's disease as a differential diagnosis. This case exemplifies the vital role of reviewing past medical history to expand differential diagnoses and early coordination with specialists so treatment can be initiated early to prevent morbidity and mortality. The case will also review different presentations of this unfamiliar diagnosis for a more comprehensive understanding.
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Emerg Med Australas · Feb 2025
Risk-benefit analysis of a multi-site radiographer comment model for emergency departments.
Critical/urgent X-ray findings are not always communicated in an appropriate time frame to ED physicians. The practice of radiographers alerting referrers to clinically significant image findings (verbally, via image flags or written comment) is noted internationally but risk assessment data is unavailable in the literature. A hybrid radiographer comment and alert model was piloted in New South Wales and a risk-benefit assessment conducted for timely and safe communication of abnormal X-ray appearances to ED physicians. ⋯ The provision of radiographer alerts with a written comment for ED was found to be low risk to patients in the pilot study. Radiographers communicating directly with the emergency team when abnormal image appearances are detected can reduce diagnostic error and improve patient safety and health outcomes.