Annals of emergency medicine
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To survey academic departments of emergency medicine concerning their operation and clinical practice. ⋯ Academic departments of emergency medicine have experienced some encouraging trends: an increase in ED patient volume, patient severity, and net clinical revenue during the study period. Midlevel providers continue to be used primarily in fast-track areas of EDs. An area of potential growth for academic departments of emergency medicine is observation medicine, because only one third of academic departments of emergency medicine have such a unit. Academic medical centers have experienced a significant increase in merger activity during the study period.
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A simple screening tool, Identification of Seniors at Risk (ISAR), developed for administration in the emergency department for patients 65 years and older, predicts adverse health outcomes during the 6 months after the ED visit. In this study, we investigated whether the ISAR tool can also predict acute care hospital utilization in the same population. ⋯ The ISAR tool, a 6-item self-report questionnaire, can be used in the ED to identify elderly patients who will experience high acute care hospital utilization as well as adverse health outcomes.
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Comparative Study
Are diagnostic testing and admission rates higher in non-English-speaking versus English-speaking patients in the emergency department?
To determine whether non-English-speaking patients who present to an emergency department have more diagnostic tests ordered, higher admission rate, and longer length of stay in the ED than English-speaking patients for 2 common complaints, chest pain and abdominal pain. ⋯ Significantly more tests are ordered for non-English-speaking patients with abdominal pain in the ED, including 3 times as many abdominal computed tomographic scans. There is no increase in test ordering with non-English-speaking patients with complaints of chest pain in the ED. When comparing English-speaking and non-English-speaking patients, there were no statistically significant differences in admission rates or length of stay in the ED.
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Randomized Controlled Trial Clinical Trial
Randomized trial of inhaled flunisolide versus placebo among asthmatic patients discharged from the emergency department.
Inhaled corticosteroids (ICs) improve airflow and decrease symptoms in patients with chronic asthma. We examined whether high-dose inhaled flunisolide would have similar benefits after an emergency department visit for acute asthma. ⋯ Addition of high-dose inhaled flunisolide to standard therapy does not benefit inner-city patients with acute asthma in the first 24 days after ED discharge. Airway inflammation during acute asthma may require higher doses or more potent anti-inflammatory agents.
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We sought to determine whether the reliability of clinical evaluation for pelvic bone fracture after trauma is compromised by a serum ethanol level of 100 mg/dL or greater. ⋯ In our study, clinical evaluation for pelvic fracture in trauma patients with a Glasgow Coma Scale score of 13 or greater was not compromised by an ethanol level of 100 mg/dL or greater. The most common reason for clinically missed pelvic fractures was the presence of additional painful distracting injuries.