The American journal of emergency medicine
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Multicenter Study Comparative Study
Comparison of the age-adjusted and clinical probability-adjusted D-dimer to exclude pulmonary embolism in the ED.
Diagnosing pulmonary embolism (PE) in the emergency department (ED) can be challenging because its signs and symptoms are non-specific. ⋯ The clinical probability-adjusted rule appears to exclude PE in a greater proportion of patients, with a very small reduction in the negative predictive value.
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Multicenter Study Observational Study
Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes.
Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode. ⋯ In older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events.
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Multicenter Study
Emergency department provider and facility variation in opioid prescriptions for discharged patients.
To study the variation in opioid prescribing among emergency physicians and facilities for discharged adult ED patients. ⋯ There was substantial physician and facility variation in opioid prescription for discharged adult ED patients. Emergency physicians were less likely to prescribe opioids when their workload was lower, and this effect diminished at high workload levels. Understanding situational and other factors that explain this variation is important given the rising U.S. opioid epidemic and the need for urgent intervention.
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Multicenter Study Observational Study
Variation in diagnostic testing for older patients with syncope in the emergency department.
Older adults presenting with syncope often undergo intensive diagnostic testing with unclear benefit. We determined the variation, frequency, yield, and costs of tests obtained to evaluate older persons with syncope. ⋯ Variation in diagnostic testing in older patients presenting with syncope exists. The yield and cost per abnormal result for common tests obtained to evaluate syncope are also highly variable. Selecting tests based on history and examination while also prioritizing less resource intensive and higher yield tests may ensure a more informed and cost-effective approach to evaluating older patients with syncope.