The American journal of emergency medicine
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Multicenter Study Comparative Study
Unscheduled Care Access in the United States-A Tale of Two Emergency Departments.
Rural communities face challenges in accessing healthcare services due to physician shortages and limited unscheduled care capabilities in office settings. As a result, rural hospital-based Emergency Departments (ED) may disproportionately provide acute, unscheduled care needs. We sought to examine differences in ED utilization and the relative role of the ED in providing access to unscheduled care between rural and urban communities. ⋯ The use and role of EDs by Medicare beneficiaries appears to be substantially different between urban and rural areas. This suggests that the ED may play a distinct role within the healthcare delivery system of rural communities that face disproportionate barriers to care access.
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Multicenter Study
Discharge in Pandemic: Suspected Covid-19 patients returning to the Emergency Department within 72 hours for admission.
Coronavirus disease 2019 (Covid-19) has led to unprecedented healthcare demand. This study seeks to characterize Emergency Department (ED) discharges suspected of Covid-19 that are admitted within 72 h. ⋯ Several factors emerge as associated with 72-h ED return admission in subjects suspected of Covid-19. These should be considered when assessing discharge risk in clinical practice.
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Multicenter Study Observational Study
Weather and temporal models for emergency medical services: An assessment of generalizability.
Emergency medical services (EMS) response volume has been linked to weather and temporal factors in a regional EMS system. We aimed to identify if models of EMS utilization incorporating these data are generalizable through geographically disparate areas in the United States. ⋯ With minor differences, regional models demonstrated consistent associations between dispatches and time and weather variables. Findings demonstrate the generalizability of associations between these variables with respect to EMS use. Weather and temporal factors should be considered in predictive modeling to optimize EMS staffing and resource allocation.
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Multicenter Study
Supervised classification techniques for prediction of mortality in adult patients with sepsis.
Sepsis mortality is still unacceptably high and an appropriate prognostic tool may increase the accuracy for clinical decisions. ⋯ Deep learning and AI are increasingly used as support tools in clinical medicine. Their performance in a syndrome as complex and heterogeneous as sepsis may be a new horizon in clinical research. SVM and ANN seem promising for improving sepsis classification and prognosis.
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Multicenter Study
Does pain severity predict stone characteristics or outcomes in emergency department patients with acute renal colic?
After initial emergency department (ED) management of acute renal colic, recurrent or ongoing severe pain is the usual pathway to ED revisits, hospitalizations and rescue interventions. If index visit pain severity is associated with stone size or with subsequent failure of conservative management, then it might be useful in identifying patients who would benefit from early definitive imaging or intervention. Our objectives were to determine whether pain severity correlates with stone size, and to evaluate its utility in predicting important outcomes. ⋯ Pain severity is not helpful in predicting stone size or renal colic outcomes. More severe pain does not indicate a larger stone or a worse prognosis.