The American journal of emergency medicine
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Multicenter Study Observational Study
Evaluation of the patients with flank pain in the emergency department by modified STONE score.
Computed tomography (CT) is generally used for ureteral stone diagnosis. Unnecessary imaging use should be reduced to prevent increased radiation exposure and lower costs. For this reason, scoring systems that evaluate the risk of ureteral stones have been developed. In this study, we aimed to investigate the diagnostic accuracy of the modified STONE score (MSS) and its ability to predict ureteral stones. ⋯ The modified STONE score has high diagnostic performance in suspected urinary stone cases. This scoring system can assist clinicians with radiation reducing decision-making.
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Alteplase is the standard of care for early pharmacologic thrombolysis after acute ischemic stroke (AIS). Alteplase is also considered a high-alert medication and is fraught with potential for error. We sought to describe the difference in medication error rates in in patients receiving alteplase for acute ischemic stroke from regional hospitals compared to patients receiving alteplase at the Comprehensive Stroke Center. ⋯ The error rate of alteplase infusion for ischemic stroke is high, particularly in patients from referring centers. Errors may be associated with adverse events. Further education and administration safeguards should be implemented to decrease the risk of medication errors.
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Observational Study
Racial/ethnic disparities in emergency department wait times in the United States, 2013-2017.
Previous research shows that Black and Hispanic patients have longer ED wait times than White patients, but these data do not reflect recent changes such as the Affordable Care Act. In addition, previous research does not account for the non-normal distribution of wait times, wherein a sizable subgroup of patients seen promptly and those not seen promptly experience long wait times. ⋯ Minority patients were less likely to wait to be seen, but waited longer if not seen promptly. These data exhibit that ED wait time disparities persist for African American and Hispanic patients and extend this observation to Asian patients.
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Management of massive pulmonary embolism in patients with hemodynamic instability encompasses the use of fibrinolytics. Use of fibrinolytic therapy is currently recommended in this patient population by ACCP, AHA, and EHA if treatment benefit outweighs the risk of bleeding. There is currently no data challenging or exploring the risk of using fibrinolytic therapy for the management of massive PE in patients with a history of intracranial hemorrhage. ⋯ In patients with a history of intracranial hemorrhage, catheter guided fibrinolytic and thrombectomy may be effective treatment options of massive pulmonary embolism.