The American journal of emergency medicine
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Observational Study
The diagnostic value of laboratory tests in detecting solid organ injuries in pediatric patients with blunt abdominal trauma: A prospective, observational study.
Computed tomography of the abdomen (CT) is used as the gold standard for detecting solid organ injuries (SOI) after blunt abdominal trauma (BAT). However, patient selection for CT is still controversial due to its potential risks. In this study, we aimed to investigate the usefulness of laboratory tests in the detection or exclusion of SOI in pediatric patients evaluated in the emergency department due to BAT. ⋯ The hematologic laboratory tests are insufficient to rule out solid organ injury in pediatric patient with BAT.
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An artificial intelligence (AI) algorithm has been developed to detect the electrocardiographic signature of atrial fibrillation (AF) present on an electrocardiogram (ECG) obtained during normal sinus rhythm. We evaluated the ability of this algorithm to predict incident AF in an emergency department (ED) cohort of patients presenting with palpitations without concurrent AF. ⋯ We found this AI-ECG AF algorithm to maintain statistical significance in predicting incident AF, with clinical utility for screening purposes limited in this ED population with a low incidence of AF.
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Noninvasive risk assessment is crucial in patients with COVID-19 in emergency department. Since limited data is known about the role of noninvasive parameters, we aimed to evaluate the role of a noninvasive parameter 'SpO2/FiO2' in independently predicting 30-day mortality in patients with COVID-19 and its prognostic utility in combination with a noninvasive score 'CRB-65'. ⋯ SpO2/FiO2 is a promising index in predicting mortality. Addition of SpO2/FiO2 to CRB-65 improved the role of CRB-65 alone, however it performed similar to PSI. The combined noninvasive model of SpO2/FiO2 and CRB-65 may help physicians quickly stratify COVID-19 patients on admission, which is expected to be particularly important in hospitals still stressed by pandemic volumes.
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To analyze trends in admission rates and the proportion of admissions via the ED at rural hospitals in Pennsylvania and to identify factors that may impact admission rates. ⋯ Emergency departments are the gatekeepers of admissions at rural acute care hospitals in Pennsylvania. Many hospitals in rural Pennsylvania, including CAHs, are admitting most of their patients through the ED, concomitant with a significant decline in admissions and admission rates. This highlights the need to strengthen primary care practices serving rural Pennsylvania as well as the need to improve rural emergency and trauma systems. In the short to medium term, policy makers should explore innovative ways to fund smaller hospitals, especially CAHs, to develop level IV trauma center capabilities.
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Case Reports
Toxic benzyl alcohol inhalation: Altered mental status with metabolic acidosis and hyperammonemia.
This report presents the case of a patient whose inhalation exposure to benzyl alcohol led to clinical manifestations similar to toluene intoxication, including sudden altered mental status, metabolic acidosis, hypokalemia, hypophosphatemia, and hyperammonemia. Toxicity from benzyl alcohol inhalation is quite rare, and hyperammonemia associated with renal tubular dysfunction in poisoning cases has not been reported in the past.