Articles: emergency-services.
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Eur. J. Intern. Med. · Jan 2025
A large language model-based clinical decision support system for syncope recognition in the emergency department: A framework for clinical workflow integration.
Differentiation of syncope from transient loss of consciousness can be challenging in the emergency department (ED). Natural Language Processing (NLP) enables the analysis of free text in the electronic medical records (EMR). The present paper aimed to develop a large language models (LLM) for syncope recognition in the ED and proposed a framework for model integration within the clinical workflow. ⋯ The anamnesis model had an AUC of 0·98 for the Italian BERT and 0·97 for Multi BERT. The LLM identified syncope when not explicitly mentioned in the EMR and also recognized common prodromal symptoms preceding syncope. Both models identified syncope patients in the ED with a high discriminative capability from nurses and doctors' notes, thus potentially acting as a tool helping physicians to differentiate syncope from others transient loss of consciousness.
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Band neutrophil count greater than 10 % of the white blood cell differential (bandemia) has been associated with severe infections in emergency department (ED) patients. In January 2023, our ED instituted a critical alert for bandemia. We performed a retrospective chart review of two cohorts of emergency department patients, before and after initiation of critical alert. After critical alert initiation for bandemia, there was a 4.6-fold higher incidence of bandemia with similar baseline patient characteristics.
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Paediatric patients admitted to the inpatient units from the emergency department (ED) are increasing, but the mean length of stay has fallen significantly. We aimed to determine the reasons behind paediatric one-day admissions in Singapore and to assess their necessity. ⋯ Paediatric one-day admissions present an opportunity to develop and implement interventions targeted at the healthcare system, the ED, the paediatric patient and their caregiver, in order to safely slow down and perhaps reverse the trend of increased hospital admissions.
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Pediatric emergency care · Jan 2025
Prehospital Restraint Use in Pediatric Patients With Mental and Behavioral Health Emergencies.
The aims of the study are to characterize children with mental and behavioral health conditions (MBH) transported by emergency medical services (EMS) and examine differences in patient, emergency department (ED), and EMS transport characteristics based on restraint interventions during EMS transport. ⋯ Nearly 1 in 10 pediatric patients experiencing mental health crises and transported by EMS required restraint interventions in the field. Male patients, younger aged children, and those picked up from school represent a distinct and vulnerable population that could benefit from specialized prehospital care to manage agitation.
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Multicenter Study
Dispatch Categories as Indicators of Out-of-Hospital Time Critical Interventions and Associated Emergency Department Outcomes.
Emergency medical services (EMS) systems increasingly grapple with rising call volumes and workforce shortages, forcing systems to decide which responses may be delayed. Limited research has linked dispatch codes, on-scene findings, and emergency department (ED) outcomes. This study evaluated the association between dispatch categorizations and time-critical EMS responses defined by prehospital interventions and ED outcomes. Secondarily, we proposed a framework for identifying dispatch categorizations that are safe or unsafe to hold in queue. ⋯ In general, Determinant levels aligned with time-critical responses; however, a notable minority of lower acuity Determinant level Protocols met criteria for unsafe to hold. This suggests a more nuanced approach to dispatch prioritization, considering both Protocol and Determinant level factors.