Annals of emergency medicine
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Comparative Study
Awareness and use of the Ottawa ankle and knee rules in 5 countries: can publication alone be enough to change practice?
We evaluate the international diffusion of the Ottawa Ankle and Knee Rules and determine emergency physicians' attitudes toward clinical decision rules in general. ⋯ This constitutes the largest international survey of emergency physicians' attitudes toward and use of clinical decision rules. Striking differences were apparent among countries with regard to knowledge and use of decision rules. Despite similar awareness in the United States, Canada, and the United Kingdom, US physicians appeared much less likely to use the Ottawa Ankle Rules. Future research should investigate factors leading to differences in rates of diffusion among countries and address strategies to enhance dissemination and implementation of such rules in the emergency department.
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Randomized Controlled Trial Clinical Trial
Better health while you wait: a controlled trial of a computer-based intervention for screening and health promotion in the emergency department.
We evaluate a computer-based intervention for screening and health promotion in the emergency department and determine its effect on patient recall of health advice. ⋯ Using a self-administered computer-based health risk assessment, the majority of patients in our urban ED disclosed important health risks and requested information. They were more likely than a control group to remember receiving advice on what they could do to improve their health. Computer methodology may enable physicians to use patient waiting time for health promotion and to target at-risk patients for specific interventions.
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Injury to the brain is the leading factor in mortality and morbidity from traumatic injury. The devastating personal, social, and financial consequences of traumatic brain injury (TBI) are compounded by the fact that most people with TBI are young and previously healthy. ⋯ Because most of the pathologic processes that determine outcome are fully active during the first hours after TBI, the decisions of emergency care providers may be crucial. This review addresses new concepts and information in the pathophysiology of TBI and secondary brain injury and demonstrates how emergency management may be linked to neurologic outcome.
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We sought to determine whether sharing an observation unit with scheduled procedure patients would maintain a more consistent unit census and patient/nurse ratio. A secondary objective was to determine the effect of this model on patient length of stay and discharge rates. ⋯ The hybrid model showed better hourly census and nurse resource use rates, with no adverse effect on observation patients. However, scheduled procedure patient length of stay was shorter in this setting.
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We sought to estimate the effect and magnitude of patients with sports-related injuries presenting to hospital emergency departments in the United States and to examine differences in patient and visit characteristics between sports- and nonsports-related injuries. ⋯ Sports-related activities by school-age children and young adults produce a significant amount of emergency medical use in the United States. The ED is an appropriate venue to target injury prevention counseling.