CJEM
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Randomized Controlled Trial
Predictors of persistent concussion symptoms in adults with acute mild traumatic brain injury presenting to the emergency department.
To identify risk factors associated with persistent concussion symptoms in adults presenting to the emergency department (ED) with acute mild traumatic brain injury (TBI). ⋯ Five variables were found to be significant predictors of persistent concussion symptoms. Although mild TBI is mostly a self-limited condition, patients with these risk factors should be considered high risk for developing persistent concussion symptoms and flagged for early outpatient follow-up.
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Safer opioid prescribing remains a crucial issue for emergency physicians. Policy statements and guidelines recommend deliberate risk assessment for likelihood of current or future opioid use disorder prior to prescribing opioids. However, the practice patterns of emergency physicians remain underreported. ⋯ Many Canadian emergency physicians make risk assessments based on gestalt rather than identifying literature-based risk factors. This conflicts with guidelines calling for routine comprehensive assessment. Further efforts should be directed towards education in optimizing risk assessment; and towards system-level initiatives such as clear local prescribing policies, electronic-systems functionality, and developing assessment tools for use in the ED.
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Treatment of acute pain after emergency department (ED) discharge remains a challenge in the opioid crisis context. Our objective was to determine the proportion of patients using opioid vs non-opioid pain medication following discharge from the ED with acute pain, and the association of type of pain medication with average pain intensity before pain medication intake and report of pain relief. ⋯ Overall, opioids appear to be effective and used as intended by the prescribing physician.
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We sought to compare the ability of the prehospital Canadian C-Spine Rule to selectively recommend immobilization in sport-related versus non-sport-related injuries and describe sport-related mechanisms of injury. ⋯ Although equal proportions of sport and non-sport-related injuries were immobilized, a dangerous mechanism was most often responsible for immobilization in sport-related cases. These findings do not address the potential impact of using the Canadian C-Spine Rule to evaluate collegiate or pro athletes assessed by sport medicine physicians. It does support using the Canadian C-Spine Rule as a tool in sport-injured patients assessed by paramedics.
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Attendance at faculty development events are often limited to those with time and interest, but all clinical teachers should have access to continuing faculty development. A multi-channel, asynchronous, digital faculty experience strategy (MAX FacDev) was used to engage busy emergency medicine (EM) teachers associated with a distributed medical education network involving ten geographically distinct teaching sites. An evidence-informed education bundle on key principles for clinical teaching was developed. ⋯ Within 8 months of launching MAX FacDev, there were 1508 podcast listens and 7686 pageviews. An education bundle can efficiently deliver on-demand faculty development. Amplifying key messages via multiple channels increases the reach of faculty development and reinforces the messages.