The American journal of emergency medicine
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Comparative Study Clinical Trial
The diagnostic efficacy of cardiac CTA combined with D-dimer assay for the detection of left atrial thrombus in patients with atrial fibrillation.
We aimed to evaluate a combination diagnostic method of single-phased, single-contrast injection cardiac computed tomography angiography CTA combined with age-adjusted D-dimer assay for diagnosis of left atrial/left atrial appendage (LA/LAA) thrombus in comparison to transesophageal echocardiography (TEE) in patients with atrial fibrillation. The addition of D-dimer to the CTA is to increase specificity, since CTA is part of the combined method. ⋯ The combination diagnostic method comprising single-phase, single-contrast injection cardiac CTA and age-adjusted D-dimer assay had good diagnostic efficacy for the detection of LA/LAA thrombus in patients with AF. The combination diagnostic method had significantly better specificity and PPV than cardiac CTA alone. The presented diagnostic approach could potentially facilitate rapid diagnosis or exclusion of left atrial thrombus under emergency situation or when TEE is un-available, with good diagnostic efficacy and no TEE related risks.
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To determine demographic and clinical risk factors associated with boarding (length of stay ≥24 h) for pediatric mental health emergency department (ED) visits. ⋯ Insurance status, presentation month, restraint use, autism or developmental delay comorbidity, prior psychiatric hospitalization, and reason for presentation are associated with pediatric mental health ED boarding. Resources should be directed to improve the mental health care system for children with identified risk factors for boarding.
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The objective of this study was to determine the effectiveness and safety of four-factor prothrombin complex concentrate (4F-PCC) for the reversal of factor Xa inhibitors in patients with traumatic intracranial hemorrhage (ICH). ⋯ Patients with a higher ISS received 4F-PCC preferentially, which led to an apparent mortality benefit the no reversal group. After adjusting for baseline differences between groups, there was no difference in mortality, functional recovery, hospital and ICU LOS, or thromboembolic complications.
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Letter Observational Study
Reduction in unnecessary CT scans head-injury in the emergency department using an FDA cleared device.