Annals of emergency medicine
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Multicenter Study Comparative Study
A comparison of observed versus documented physician assessment and treatment of pain: the physician record does not reflect the reality.
The Joint Commission requires "appropriate assessment" of patients presenting with painful conditions. Compliance is usually assessed through retrospective chart analysis. We investigate the discrepancy between observed physician pain assessment and that subsequently documented in the medical record. ⋯ Physicians almost always assess and treat patient pain but infrequently record those efforts. The patient's chart is a poor surrogate marker for pain assessment and care by emergency physicians and may not be suitable for use as a compliance assessment tool. Research methodology using retrospective chart analysis may be affected by this phenomenon, suggesting the potential for underestimation of patient pain assessment and treatment by emergency physicians.
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Clinical Trial
Emergency clinician-performed compression ultrasonography for deep venous thrombosis of the lower extremity.
Emergency clinician-performed ultrasonography holds promise as a rapid and accurate method to diagnose and exclude deep venous thrombosis. However, the diagnostic accuracy of emergency clinician-performed ultrasonography performed by a heterogenous group of clinicians remains undefined. ⋯ The overall diagnostic accuracy of single-visit emergency clinician-performed ultrasonography performed by a heterogeneous group of ED clinicians is intermediate but may be improved by pretest probability assessment.
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Preexisting conditions have been found to be an independent predictor of mortality after trauma. However, no consensus has been reached as to what indicator of preexisting condition status should be used, and the contribution of preexisting conditions to mortality prediction models is unclear. This study aims to identify the most accurate way to model preexisting condition status to predict inhospital trauma mortality and to evaluate the potential gain of adding preexisting condition status to a standard trauma mortality prediction model. ⋯ Preexisting condition status is an independent predictor of mortality from trauma that provides a modest improvement in mortality prediction. The total number of preexisting conditions is a good summary measure of preexisting condition status. The Charlson Comorbidity Index is no better than the total number of preexisting conditions and is therefore not recommended for use in trauma mortality modeling.
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Propofol is rapidly becoming one of the most popular procedural sedation and analgesia agents in emergency medicine. However, in many hospitals emergency physicians lack access to this potent sedative. This article details the evidence and politics underlying this area of controversy, the nature and authority of hospital-wide sedation policies, and discussion of the most common criticisms of emergency department use of propofol.