Annals of emergency medicine
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Comparative Study
Can a day 4 bone scan accurately determine the presence or absence of scaphoid fracture?
To evaluate the accuracy of day 4 bone scans in predicting the presence or absence of fracture in patients with "clinical scaphoid fracture." ⋯ Day 4 bone scans are an accurate means of ruling out scaphoid fracture. However, because of a significant number of false-positive scans at day 4, they do not reliably confirm the diagnosis of scaphoid fracture. The bone scans also permitted identification of several other wrist fractures that had not been radiographically apparent.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, randomized trial of epinephrine, metaproterenol, and both in the prehospital treatment of asthma in the adult patient.
To compare the effectiveness and incidence of adverse reactions with three treatment regimens for asthma in adults in the prehospital setting. ⋯ Nebulized metaproterenol is as effective as subcutaneous epinephrine in the prehospital treatment of adult patients with acute asthma. The combination of these two treatments offered no additional clinical benefit in the patients we studied.
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Comparative Study
Clinical decision rules discriminate between fractures and nonfractures in acute isolated knee trauma.
To develop criteria that optimize clinical decisionmaking in the use of radiography after isolated knee trauma in adults. ⋯ Clinical decision rules are effective in detecting knee fractures with 100% sensitivity and with sufficient specificity to eliminate 29% of knee radiographs in the ED. These findings require prospective validation.
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Comparative Study
Paramedic injury severity perception can aid trauma triage.
To compare information contained in standard out-of-hospital trauma triage criteria and standard criteria plus advanced emergency medical technician (EMT) injury severity perception for determination of patient need for trauma center evaluation. ⋯ Standard out-of-hospital triage criteria benefit from inclusion of advanced EMT injury severity perception information.
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To derive a highly sensitive decision rule for the selective use of radiography in acute knee injuries. ⋯ A practical, highly sensitive, and reliable decision rule for the use of radiography in acute knee injuries has been derived. Clinical application should await prospective validation of the rule.