The American journal of emergency medicine
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Addition of a biomarker panel to a clinical score to identify patients at low risk for appendicitis.
The diagnosis of pediatric acute appendicitis can be difficult. Although scoring systems such as the Pediatric Appendicitis Score (PAS) are helpful, they lack adequate sensitivity and specificity as standalone diagnostics. When used for risk stratification, they often result in large percentages of moderate-risk patients requiring further diagnostic evaluation. ⋯ The addition of negative biomarker test results to patients with a moderate risk of appendicitis based on the PAS can safely reclassify many to a low-risk group. This may allow clinicians to provide more conservative management in children with suspected appendicitis and decrease unnecessary resource utilization.
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Delay in appropriate antibiotic therapy is associated with an increase in mortality and prolonged length of stay. Automatic dispensing machines decrease the delivery time of intravenous (IV) antibiotics to patients in the emergency department (ED). However, when IV antibiotics are not reviewed by pharmacists before being administered, patients are at risk for receiving inappropriate antibiotic therapy. The objective of this study was to determine if a difference exists in the time to administration of appropriate antibiotic therapy before and after implementation of prospective verification of antibiotics in the ED. ⋯ Prompt administration of the appropriate antibiotics is imperative in patients with infections presenting to the ED. The impact of prospective verification of antibiotics by pharmacists led to significant improvement on both empiric selection of and time to appropriate antibiotic therapy.
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Observational Study
Evaluation of proadrenomedullin as a diagnostic or prognostic biomarker of acute appendicitis in children.
A delay in the diagnosis of acute appendicitis (AA), with the added complication of symptoms that mimic other self-limited causes of abdominal pain, can lead to an increase in ruptured appendices and morbimortality. None of the serum biomarkers evaluated to date have shown a predictive value for early diagnosis. ⋯ Although MR-proADM values are higher in children with AA than in children with nonspecific abdominal pain, these values do not help in the early diagnosis of AA. The combination of low C-reactive protein and low MR-proADM levels is useful for the identification of children with a low risk of AA.
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Observational Study
Variation in advanced imaging for pediatric patients with abdominal pain discharged from the ED.
Pediatric abdominal pain visits to emergency departments (ED) are common. The objectives of this study are to assess variation in imaging (ultrasound ±computed tomography [CT]) and factors associated with isolated CT use. ⋯ There are racial and insurance disparities in imaging for pediatric abdominal pain. General EDs are less likely than pediatric EDs to use imaging, but more likely to use isolated CT. Strategies are needed to minimize disparities and improve the use of "ultrasound first."
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Observational Study
The impact of push-dose phenylephrine use on subsequent preload expansion in the ED setting.
The utilization of bolus-dose phenylephrine (PHE) has transitioned to the emergency department (ED) for the treatment of acutely hypotensive patients, despite a paucity of literature in this setting. ⋯ Initial preload IVF expansion was found to be significantly disproportionate, and appears to be associated with an increase number of phenylephrine bolus doses in our study population.