The American journal of emergency medicine
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Comparative Study
The effect of insurance status, race, and gender on ED disposition of persons with traumatic brain injury.
The objective of this study was to assess the effect of insurance status and demographic characteristics on ED disposition among patients with traumatic brain injury (TBI). Statewide hospital discharge and ED datasets in South Carolina, 1996-2001, were analyzed by primary or secondary diagnosis of TBI in a multivariable logistic regression model. Of 70,671 unduplicated patients with TBI evaluated in the ED, 76% were treated and released; 26% had no insurance. ⋯ However, the uninsured and black females were less likely to be hospitalized after adjusting for demographic, clinical, and hospital characteristics (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.48-0.55 and OR, 0.79; CI, 0.72-0.87, respectively). Although this study does not infer causality, insurance status, race, and gender were significant predictors of hospital admission. These results suggest that inpatient resources are not equitably used.
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We are submitting a case-based presentation illustrating medical errors in the use of epinephrine for the treatment of anaphylaxis. Readers will learn from mistakes made by other emergency caregivers in treating anaphylaxis. The article will specifically review the recommended use of epinephrine in the management of anaphylaxis. ⋯ In the remaining 2 cases, epinephrine use was either omitted or significantly delayed in its administration. Our presentation includes a review of consensus statements regarding the treatment of anaphylaxis with particular regard to the use of epinephrine. We hope that this information will help prevent similar errors from harming other patients.
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The objective of this study was to assess if 10 right upper quadrant (RUQ) ultrasound (US) examinations could be used as a minimum standard for training. This was a retrospective review of patients with suspected gallbladder pathology who underwent resident-performed RUQ US before operative or department of radiology evaluation. Two hundred twenty-four patients were examined using resident-performed RUQ US followed by gold standard evaluations. ⋯ The results of resident-performed RUQ US for gallstones and/or cholecystitis are shown subsequently. Previous suggestions that 10 examinations could be used as a minimum standard for training in focused abdominal sonography for trauma examinations cannot be used for RUQ US. The ACEP 2001 guidelines for 25 examinations are more consistent with the learning curve suggested by our data.