The American journal of emergency medicine
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Observational Study
Comparing biomarkers of traumatic shock: the utility of anion gap, base excess, and serum lactate in the ED.
Biomarkers such as serum lactate, anion gap (AG), and base excess (BE) have been shown to be of use in determining shock in patients with seemingly normal vital signs. We seek to determine if these biomarkers can be used interchangeably in patients with trauma in the emergency setting based on their test characteristics and correlation to each other. ⋯ This study demonstrates that the biomarkers have similar test characteristics which may make them interchangeable as indicators for the presence of occult shock in patients with trauma. Lactate and BE correlate well with each other; however, AG was not as strongly correlated with either.
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The Traumatic Bleeding Severity Score (TBSS) was developed to predict the need for massive transfusion (MT). The aim of this study is evaluation of clinical thresholds for activation of a MT protocol using the gray zone approach based on TBSS. ⋯ The TBSS is highly accurate in predicting the need for MT, and a risk classification for needing MT was created based on TBSS.
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The study aimed to identify the presence of peritoneal penetration in management of anterior abdominal stab wound by using computed tomography (CT) tractography. ⋯ The procedure may be used for some selected cases of hemodynamically stable patient with anterior abdominal stab wounds to abstain from local wound exploration.
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Observational Study
The prognostic value of serum pregnancy-associated plasma protein A level at the initial ED presentation in elderly patients with community-acquired pneumonia.
This study aims to compare serum pregnancy-associated plasma protein A (PAPP-A) levels in surviving and nonsurviving elderly patients with community-acquired pneumonia (CAP), investigating whether PAPP-A is correlated with CAP prediction scores and whether PAPP-A can successfully predict 28-day mortality rates in elderly patients. ⋯ Serum PAPP-A level is valuable for predicting mortality and the severity of the disease among elderly patients with CAP at ED admission. Thus, PAPP-A might play a further role in the clinical assessment of the severity of CAP.
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The objective of this study is to determine the ways in which preanalytic factors related to physiologic status can affect the complete blood cell count (CBC) in patients referring to an emergency department (ED). ⋯ On interpreting CBC results in patients admitted to the ED, physicians must consider the effect of physiologic variables on Hb level (mainly hydration status) and WBC count (mental and physical stress).