CJEM
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Randomized Controlled Trial Multicenter Study
Decision support for computed tomography in the emergency department: a multicenter cluster-randomized controlled trial.
Clinical decision support may facilitate evidence-based imaging, but most studies to date examining the impact of decision support have used non-randomized designs which limit the conclusions that can be drawn from them. This randomized trial examines if decision support can reduce computed tomography (CT) utilization for patients with mild traumatic brain injuries and suspected pulmonary embolism in the emergency department. This study was funded by a competitive public research grant and registered on ClinicalTrials.gov (NCT02410941). ⋯ Voluntary decision support addressing many commonly cited barriers to evidence-based imaging did not significantly reduce CT utilization or improve diagnostic yield but was limited by low rates of participation and high baseline rates of selective imaging. Demonstrating value to clinicians through interventions that improve workflow is likely necessary to meaningfully change imaging practices.
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Randomized Controlled Trial
A randomized double-blind trial comparing the effect on pain of an oral sucrose solution versus placebo in children 1-3 months old needing bladder catheterization.
The efficacy of oral sweet solutions to decrease pain in infants during painful procedures remains uncertain. This study aimed to compare the efficacy of an oral sucrose solution versus placebo in reducing pain during bladder catheterization in infants in the Emergency Department (ED). ⋯ In infants undergoing bladder catheterization in the ED, administration of an oral sweet solution was not associated with lower pain as measured by the FLACC and NIPS scales. Participants' heart rate variations and crying times did not change when sucrose was provided.
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Randomized Controlled Trial
Self-assessment of functional status in older emergency department patients: a cross-over randomized pilot trial.
To assess the inter-rater reliability and feasibility of the self-assessed Older Americans Resources and Services scale compared to its administration by a research assistant in older Emergency Department (ED) patients. ⋯ Our results indicate that self-assessment of functional status by older ED patients is feasible, and good-to-moderate inter-rater reliability results were obtained. A self-assessed score may identify patients in need of further geriatric/functional assessment who may otherwise have been left unscreened.
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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.