The American journal of emergency medicine
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We present a multicenter validation of a modified Manchester Triage System (MTS) flowchart for pediatric patients who present with headache to the emergency department. A prospective observational study was conducted across 5 European pediatric emergency departments. The standard MTS headache flowchart and a modified MTS headache flowchart were tested in the participating centers, and results were compared with triage categories identified by either the physician at the end of the clinical examination or the reference classification matrix (RCM). Fifty-three patients were enrolled in the preimplementation phase and 112 in the postimplementation phase. When compared with physician's triage and RCM, the modified MTS flowchart demonstrated good sensitivity (79% and 70%, respectively), specificity (77% and 76%, respectively), and a high positive likelihood ratio (9.14 and 16.75, respectively) for the identification of low-risk children. ⋯ Our modified headache flowchart is safe and reliable in pediatric emergency settings, especially for lower classes of urgency.
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Multicenter Study
Underrecognition of cervical Neisseria gonorrhoeae and Chlamydia trachomatis infections in pregnant patients in the ED.
The purposes of this study were to (1) quantify the frequency of underrecognized Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections in pregnant women tested in the emergency department (ED), (2) describe the characteristics of those not treated during the initial visit, and (3) determine how many pregnant women with acute cervicitis were lost to follow-up. ⋯ Further study is warranted to enhance point-of-contact testing and identify better mechanismsfor contact and follow-up after ED discharge and more liberal policies to treat less symptomatic patients empirically.