The American journal of emergency medicine
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Randomized Controlled Trial Clinical Trial
Violence prevention in the ED: linkage of the ED to a social service agency.
Interpersonal violence continues to be a problem in the United States, most prominent in the inner-city minority young persons population. The medical approach of "treat 'em and street 'em" philosophy has led to foregoing the psychosocial needs of injured young persons. This study describes a program to link young persons who are victims of interpersonal violence to a healthcare system and a social service agency in an effort to meet their psychosocial needs. ⋯ Nine of the 92 (9.8%) in the control group used services; most of these referrals were for social services (7 of 9 respondents) and the others were healthcare-related. The difference in utilization of services between the treatment and the control groups were found to be significant different (95% confidence interval, 1.41-1.55, significance =.00), and there was a strong positive correlation of using services and case management (Pearson coefficient = 0.728, significance =.00). The referral of young victims of violence from the ED to psychosocial services could be successful using a case management model and an alliance between a healthcare system and a social service agency.
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Randomized Controlled Trial Clinical Trial
Screening with blood urea nitrogen before intravenous contrast.
In some settings, blood urea nitrogen (BUN) values are available well in advance of creatinine values. We wanted to determine whether BUN values can be used to screen for renal insufficiency for the purpose of intravenous contrast administration. From laboratory records, we derived and validated cutpoints for BUN values to detect creatinine values >/=2.0 mg/dL. "Sensitive" and "high-yield" cutpoints were derived using records from 5000 consecutive patients and validated using a random set of 2000 patients. ⋯ BUN >/=20 mg/dL, the "high-yield cutpoint," had sensitivity of 0.98 (95% CI, 0.95-0.99) and specificity of 0.71 (95% CI, 0.69-0.73). Negative likelihood ratios for these cutpoints were 0.005 and 0.03, respectively. BUN values <15-20 mg/dL provide strong evidence against renal insufficiency.