Annals of emergency medicine
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To determine the frequency of utilization, yield for brain injury, incidence of missed injury, and variation in the use of computed tomography (CT) for ED patients with minor head injury. ⋯ There was considerable variation among institutions and individual physicians in the ordering of CT for patients with minor head injury. Although emergency physicians were selective when ordering CT, the yield of radiography was very low at all hospitals. None of the cases of "missed" intracranial hematoma came from the lowest ordering institutions, indicating that patients may be managed safely with a selective approach to CT use. These findings suggest great potential for more standardized and efficient use of CT of the head, possibly through the use of a clinical decision rule.
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To determine patient-specific socioeconomic and health status characteristics for patients arriving by ambulance at an emergency department. ⋯ Ambulance use varies by age, clinical severity, income, patient-specific characteristics of physical function, and type of health insurance. Medicaid coverage and frequent ED use are not predictive of increased ambulance use.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of intravenous ketorolac, meperidine, and both (balanced analgesia) for renal colic.
To compare the analgesic efficacy and safety of IV ketorolac, the only nonsteroidal antiinflammatory drug indicated for parenteral use in acute pain in the United States, with IV meperidine and with a combination of the two agents in renal colic. ⋯ IV ketorolac, alone or in combination with meperidine, was superior to IV meperidine alone in moderate and severe renal colic. Because many subjects in all three treatment groups received supplemental meperidine and because response to ketorolac alone cannot be predicted, clinicians may choose to initiate treatment with a ketorolac-meperidine combination.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Forced air speeds rewarming in accidental hypothermia.
To compare the rates of rewarming of forced-air and passive insulation as a treatment for accidental hypothermia. ⋯ Forced air accelerated the rate of rewarming without producing apparent complications in hypothermic patients.
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To determine the correlates of compliance with follow-up appointments and prescription filling after an emergency department visit. ⋯ Not having an appointment made before leaving the ED was an independent correlate of missing follow-up appointments. Lack of insurance and dissatisfaction with discharge instructions were independent correlates of not filling prescriptions.