Annals of emergency medicine
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Review Comparative Study
Performance of helical computed tomography without oral contrast for the detection of gastrointestinal injuries.
We describe the performance of helical abdominal computed tomography (CT) scan without oral contrast for the detection of blunt gastrointestinal injuries. ⋯ Helical abdominal CT scan without oral contrast identified nearly three fourths of patients with blunt gastrointestinal injuries who were selected for abdominal CT scanning. Sensitivity of this diagnostic test improves in the subset of patients with major gastrointestinal injuries.
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Multicenter Study Comparative Study
Nontraumatic out-of-hospital hypotension predicts inhospital mortality.
Out-of-hospital hypotension may signify need for intensive resuscitation and rapid diagnosis on emergency department (ED) arrival. We hypothesized that nontraumatic out-of-hospital hypotension confers risk of inhospital mortality. ⋯ The inhospital mortality rate after out-of-hospital, nontraumatic hypotension is high and reproducible. Future research should focus on ED clinical protocols to ensure appropriate resuscitation and investigation of etiology of out-of-hospital hypotension.
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Comparative Study
Lack of utility of telemetry monitoring for identification of cardiac death and life-threatening ventricular dysrhythmias in low-risk patients with chest pain.
Low-risk patients with chest pain are often admitted to monitored beds; however, the use of telemetry beds in this cohort is not evidence based. We tested the hypothesis that monitoring admitted low-risk patients with chest pain for dysrhythmia is low yield (<1% detection of life-threatening dysrhythmias requiring treatment). ⋯ The routine use of telemetry monitoring for low-risk patients with chest pain is of limited utility. Admission to nonmonitored beds might help alleviate ED crowding without increasing risk of adverse events caused by dysrhythmia in patients with a Goldman risk of less than 8%, an initial troponin I level of less than 0.3 ng/mL, and a creatine kinase-MB level of less than 5 ng/mL.
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Comparative Study
Validation of a novel severe acute respiratory syndrome scoring system.
In a pilot study conducted during March 14 to April 2, 2003, 2 severe acute respiratory syndrome (SARS) screening scores were developed for predicting SARS among febrile patients presenting to the emergency department (ED). The objective of this study is to validate these scoring systems with a different set of patients. ⋯ This prospective study validated the scoring system previously developed by using a different cohort. The scoring systems could be applied to settings where mass screening of SARS is needed during future outbreaks.
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Comparative Study
Predictive model of diagnosing probable cases of severe acute respiratory syndrome in febrile patients with exposure risk.
Since the World Health Organization issued a global alert about severe acute respiratory syndrome (SARS) on March 12, 2003, the illness has become a major public health challenge worldwide. The objective of this study is to identify the clinical risk factors of SARS and to develop a scoring system for early diagnosis. ⋯ Certain symptoms and laboratory tests indicate higher risk of febrile probable SARS. In nonendemic areas, the febrile patients with recent contact with SARS or travel history to endemic areas could be screened for the probability of SARS by the use of clinical and symptom scores.