Annals of emergency medicine
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Multicenter Study
Initial oxygen saturation as a predictor of admission in children presenting to the emergency department with acute asthma.
Previous studies have looked at the relationship between initial oxygen saturation (SaO (2)) and the need for admission in children presenting with an acute asthma exacerbation. If initial SaO (2) value is indeed predictive of admission, then the admission process could be initiated sooner, and time spent in the emergency department could be potentially lessened. ⋯ This large, clinical multicenter study does not support earlier findings that SaO (2) alone is a clinically useful predictor of hospital admission in children who present to the ED with acute asthma.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A randomized controlled trial comparing the hair apposition technique with tissue glue to standard suturing in scalp lacerations (HAT study).
We evaluate a new technique of treating scalp lacerations, the hair apposition technique (HAT). After standard cleaning procedures, hair on both sides of a laceration is apposed with a single twist. This is then held with tissue adhesives. HAT was compared with standard suturing in a multicenter, randomized, prospective trial. ⋯ HAT is equally acceptable and perhaps superior to standard suturing for closing suitable scalp lacerations. Advantages include fewer complications, a shorter procedure time, less pain, no need for shaving or removal of stitches, similar or superior wound healing, and high patient acceptance. HAT has become our technique of choice for suitable scalp lacerations.[Ong Eng Hock M, Ooi SBS, Saw SM, Lim SH. A randomized controlled trial comparing the hair apposition technique with tissue glue to standard suturing in scalp lacerations (HAT study).
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We sought to determine whether knowledge of vital signs changes nurse triage designations (TDs). We also sought to determine whether patient age and ability to communicate modify the effect of vital signs on triage decisions. ⋯ In this sample, 92.1% of the nurses' TDs were not affected by the knowledge of patient vital signs. For the other 7.9%, including many patients from vulnerable populations, the vital signs changed the nurses' assessments of the patients' triage designation. Methods of triage that do not determine vital signs may not adequately reflect the urgency of the patient's presentation.
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Multicenter Study
Criteria for the safe use of D-dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter US study.
We derive a decision rule to partition emergency department patients with suspected pulmonary embolism (PE) into a small, high-risk group (>40% pretest probability) that is unsafe for D -dimer testing and a larger group that is safe to have PE ruled out with either a whole-blood D -dimer plus alveolar deadspace measurement or a quantitative D -dimer assay. ⋯ Simple clinical criteria can permit safe D -dimer testing in the majority of ED patients with suspected PE. These criteria warrant prospective validation.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A randomized, controlled trial of clinical information shared from another institution.
Emergency physicians often must deliver medical care with minimal access to historical clinical information. We demonstrate the feasibility and potential value of increased access to patients' clinical information from another hospital while they are receiving care in the emergency department. ⋯ Our pilot study is the first to demonstrate the feasibility of sharing clinical information between different health care systems. We observed a trend toward cost savings at 1 of 2 hospitals and no differences in the quality measures we studied. Our experience underscores the difficulties inherent in studying the effects of community-wide health care interventions on cost and quality of ED care.