Annals of emergency medicine
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Multicenter Study
Development and Evaluation of a Machine Learning Model for the Early Identification of Patients at Risk for Sepsis.
The Third International Consensus Definitions (Sepsis-3) Task Force recommended the use of the quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score to screen patients for sepsis outside of the ICU. However, subsequent studies raise concerns about the sensitivity of qSOFA as a screening tool. We aim to use machine learning to develop a new sepsis screening tool, the Risk of Sepsis (RoS) score, and compare it with a slate of benchmark sepsis-screening tools, including the Systemic Inflammatory Response Syndrome, Sequential Organ Failure Assessment (SOFA), qSOFA, Modified Early Warning Score, and National Early Warning Score. ⋯ In this retrospective study, RoS was more timely and discriminant than benchmark screening tools, including those recommend by the Sepsis-3 Task Force. Further study is needed to validate the RoS score at independent sites.
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Multicenter Study Observational Study
Identification of Clinical Characteristics Associated With High-Level Care Among Patients With Skin and Soft Tissue Infections.
Serious adverse outcomes associated with skin and soft tissue infections are uncommon, and current hospitalization rates appear excessive. It would be advantageous to be able to differentiate between patients who require high-level inpatient services and those who receive little benefit from hospitalization. We sought to identify characteristics associated with the need for high-level inpatient care among emergency department patients presenting with skin and soft tissue infections. ⋯ A limited number of simple clinical characteristics appear to be able to identify skin and soft tissue infection patients who require high-level inpatient services. Further research is needed to determine whether patients who do not exhibit these criteria can be safely discharged from the ED.
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Multicenter Study Pragmatic Clinical Trial
The Canadian Community Utilization of Stroke Prevention Study in Atrial Fibrillation in the Emergency Department (C-CUSP ED).
Lack of oral anticoagulation prescription in the emergency department (ED) has been identified as a care gap in atrial fibrillation patients. This study seeks to determine whether the use of a tool kit for emergency physicians with a follow-up community-based atrial fibrillation clinic resulted in greater oral anticoagulation prescription at ED discharge than usual care. ⋯ An oral anticoagulation prescription tool was associated with an increase in new oral anticoagulation prescription in the ED, irrespective of whether an atrial fibrillation clinic follow-up was scheduled. The use of an atrial fibrillation clinic was associated with a trend to a higher rate of oral anticoagulation at 6-month follow-up.
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Multicenter Study Observational Study
Emergency Department Crowding Is Associated With Delayed Antibiotics for Sepsis.
Barriers to early antibiotic administration for sepsis remain poorly understood. We investigated the association between emergency department (ED) crowding and door-to-antibiotic time in ED sepsis. ⋯ ED crowding was associated with increased sepsis antibiotic delay. Hospitals must devise strategies to optimize sepsis antibiotic administration during periods of ED crowding.
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Multicenter Study
Use of Pharmacologic Sleep Aids and Stimulants Among Emergency Medicine Staff Physicians in a Canadian Tertiary Care Setting: A Web-Based Survey.
Emergency medicine by its nature requires shift work that follows an erratic and unpredictable pattern. Faced with this challenge, we hypothesize that many emergency physicians have taken steps to minimize their personal sleep deprivation through the use of pharmacologic sleep aids. The extent and nature of pharmacologic sleep aid use in this population is not well studied. We seek to describe the use of pharmacologic sleep aids among practicing emergency physicians in a Canadian tertiary care setting. ⋯ Pharmacologic sleep aid use among Canadian emergency physicians may be more common than previously assumed. This could have implications for physician well-being and performance.