The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
Diagnostic accuracy and reproducibility in the interpretation of Ottawa ankle and foot rules by specialized emergency nurses.
The ED is often confronted with long waiting periods. Because of the progressive shortage in general practitioners, further growth is expected in the number of patients visiting the ED without consulting a general practitioner first. These patients mainly present with minor injuries suitable for a standardized diagnostic protocol. The question was raised whether these injuries can be treated by trained ED nurses (specialized emergency nurses [SENs]). The aim of this study was to evaluate the diagnostic accuracy and reproducibility of SENs in assessing ankle sprains by applying the Ottawa Ankle Rules (OAR) and Ottawa Foot Rules (OFR). ⋯ Specialized emergency nurses are able to assess ankle and foot injuries in an accurate manner with regard to the detection of acute fractures after a short, inexpensive course.
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The purpose of this study was to identify a clinical guideline for the evaluation of nonspecific abdominal pain (NSAP) using history, physical examination, laboratory analysis, acute abdominal series (AAS) radiographs, and nonenhanced helical computed tomography (NHCT) clinical predictor variables (CPVs). ⋯ No clinical guideline was identified exclusive of NHCT that possessed adequate sensitivity for exclusion of UI. NHCT is a rational choice for decision support in the evaluation of NSAP and is likely the single most useful diagnostic adjunct available to augment the clinical evaluation.
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Many studies have demonstrated the importance of performing preventive care in the ED. The primary objective of this study was to identify unmet health needs in the ED of the pediatric patient population. The secondary objective was to determine if the patient's parent or guardian would accept health referrals and bring the child to follow up with a doctor. ⋯ In this study, 12.3% of the patients were found to have unmet health care needs. Insurance status had no bearing on the need for referrals. Assessment in the pediatric population for unmet health care needs was found to be a low-yielding, labor-intensive process.
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The purpose of this study was to determine the frequency of successful closed reduction (CR) of dislocated prosthetic hips performed by emergency physicians (EPs) as well as the incidence of acute complications. ⋯ EPs can safely and successfully perform CR on patients with dislocated total hip arthroplasties.
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To compare a clinical decision rule (San Francisco Syncope Rule [SFSR]) and physician decision making when predicting serious outcomes in patients with syncope. ⋯ Physician judgment is good when predicting which patients with syncope will develop serious outcomes, but contrary to their judgment, physicians still admit a large number of low-risk patients. The SFSR performs better than current physician performance and has great potential to aid physician decision making.