Annals of emergency medicine
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Multicenter Study
Validation of the Ottawa Knee Rule in children: a multicenter study.
The main objective of this study was to determine the sensitivity and specificity of the Ottawa Knee Rules when they were applied to children. The secondary objective was to determine post hoc whether use of the rules would reduce the number of knee radiographs ordered. ⋯ The Ottawa Knee Rules are valid in children and have the potential to decrease the use of radiography in children with knee injuries.
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A cohort of 4,729 junior college students in Taiwan was studied to determine risk factors for increased severity of motorcycle injuries. ⋯ At the time of motorcycle crashes, factors such as being on rural roads, collisions with a heavier object, some motorcycle makes, darkness, and greater speeds increased the severity of motorcycle injuries among these young adult riders.
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Multicenter Study
Assessing substance abuse treatment need: a statewide hospital emergency department study.
Health care providers in hospital emergency departments rarely take substance abuse histories or assess associated treatment need. This study compares documentation of psychoactive drug-related diagnoses for adult ED patients in medical records with treatment need assessed through self-report, toxicologic screening, and Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria. ⋯ EDs can be important venues for detecting persons in need of substance abuse treatment.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Case finding and referral model for emergency department elders: a randomized clinical trial.
Elderly emergency department patients have complex medical needs and limited social support. A transitional model of care adapted from hospitals was tested for its effectiveness in the ED in reducing subsequent service use. ⋯ An ED-based transitional model of care reduced subsequent nursing home admissions but did not decrease overall service use for older ED patients. Further studies are needed to determine the best models of care for this setting and for at-risk patients.
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Multicenter Study
Validity of a decision rule to reduce cervical spine radiography in elderly patients with blunt trauma.
A decision instrument based on 5 clinical criteria has been shown to be highly sensitive in selecting patients who require cervical spine imaging after blunt trauma, while simultaneously reducing overall imaging. We examine the performance of this instrument in the elderly and explore some of the common features of geriatric cervical spine injury (CSI). ⋯ The prevalence of CSI, and especially odontoid fracture, is relatively increased among geriatric patients with blunt trauma. The NEXUS decision instrument can be applied safely to these patients, with an expected reduction in cervical imaging comparable with that achieved in nongeriatric patients.