The American journal of emergency medicine
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Comparative Study
Characteristics and outcomes of injured patients presenting by private vehicle in a state trauma system.
Previous studies have demonstrated lower mortality among patients transported to single urban trauma centers by private vehicle (PV) compared with Emergency Medical Services (EMS). We sought to describe the characteristics and outcomes of injured patients transported by PV in a state trauma system compared to patients transported by EMS. ⋯ Nearly 10% of injured patients arrive at trauma centers by private vehicle. Transport of injured patients by EMS was associated with higher mortality than PV transport. This may reflect the effects of prehospital time, prehospital interventions, or other confounders.
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Clinical Trial
Cerebral regional oxygen saturation monitoring in pediatric malfunctioning shunt patients.
Shunt malfunction produces increased intracranial pressure causing decreased cerebral regional perfusion and tissue O(2)sat. Cerebral regional oxygen saturation (rSO(2)) by near-infrared spectroscopy represents tissue perfusion and oxygen saturation. Cerebral rSO(2) is used to detect cerebral ischemia in pediatric clinical settings. ⋯ This study demonstrates reliable cerebral rSO(2) readings in subjects with malfunctioning shunts, with asymmetrical cerebral rSO(2) hemispheric dynamics within subjects.
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The incidence of skin and soft tissue infections requiring incision and drainage has increased. Little evidence exists about the use of procedural sedation (PS) for these procedures in children. Our objective was to determine factors associated with the use of PS during incision and drainage procedures at a tertiary children's hospital. ⋯ Patient age and abscess size are independent predictors of the use of PS for incision and drainage procedures. Provider practice patterns are also independently associated with PS use.
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Emergency department observation units (EDOU) are often used for patients with cellulitis to provide intravenous antibiotics followed by a transition to an oral regimen for discharge. Because institutional regulations typically limit EDOU stays to 24 hours, patients lacking a clinical response within this period will often be subsequently admitted to the hospital for further treatment. ⋯ Patients with cellulitis placed into ED observation status were more likely to fail an observation trial if they had an objective fever in the ED, an elevated lactate, or a cellulitis that involved the hand.