Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Editorial Comment
Triage of nonurgent patients out of the emergency department.
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To determine the sensitivity and specificity of sinus x-rays of patients clinically diagnosed as having acute sinusitis. ⋯ Sinus x-rays are less sensitive than sinus CT scans for demonstration of radiographic changes consistent with acute sinusitis. Sinus plain films may not be reliable enough to assist with clinical decision making. If severity of patient illness requires diagnostic certainty, more sensitive imaging studies, such as CT scans of the sinuses, should be considered.
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To determine whether clinical parameters and neurologic scores can be used to guide the decision to obtain computed tomography (CT) head scans for ethanol- intoxicated patients with presumed-minor head injuries. ⋯ The prevalence of intracerebral injury in CT scans of ethanol-intoxicated patients with minor head injuries was 8.4%. Commonly used clinical parameters and neurologic scores at presentation and one hour later were unable to predict which patients would have intracerebral injuries and evidenced by CT scans. Our low (1.9%) neurosurgical intervention rate supports the need to develop a selective approach to CT scanning in this population.
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Comparative Study
Positive-outcome bias: comparison of emergency medicine and general medicine literatures.
The existence of positive-outcome bias in the medical literature is well established. Positive-outcome bias in two emergency medicine journals was compared with that found in two general medicine journals. ⋯ There was no significant difference in the proportions of positive-outcome studies published in this sample of the emergency medicine literature compared with the general medicine literature. The potential impact of positive-outcome bias and methods of dealing with the problem are reviewed.
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To determine whether previously developed triage criteria for refusal of care to patients presenting to an emergency department (ED) with nonurgent problems could be validated for an independent patient population. ⋯ The authors were unable to validate a previously developed predictive model for refusal of care to patients presenting to an ED. Refusal of care to selected ED patients based on current guidelines is not a viable solution to overcrowding. Alternative strategies must be sought.