Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To test whether the reduction in ankle radiograph ordering was sustained during a 12-month period after a formal trial to introduce the Ottawa ankle rules. ⋯ Compliance with the Ottawa ankle rules was sustained during a 12-month postintervention surveillance period when physicians did not know they were being observed. Physicians will continue to use a simple clinical guideline once it has been learned.
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To determine the significance of a low out-of-hospital systolic blood pressure (SBP) reading in blunt trauma patients who have a normal SBP upon ED arrival. ⋯ The injured patients who were hypotensive in the out-of-hospital setting but normotensive upon ED arrival were more severely injured and had more potential for blood loss than were the patients who were normotensive both in the out-of-hospital setting and in the ED. Out-of-hospital hypotension may be a clinical predictor of severe injury, even in the face of normal ED SBP. Prospective studies are indicated to validate this hypothesis.
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To determine the utility of the Miller criteria (presence of headache, nausea, vomiting, and signs of depressed skull fracture) for predicting the need for CT in patients with minor head trauma and a Glasgow Coma Scale score (GCS) of 14. ⋯ The use of the Miller criteria as the only criteria for screening patients with a GCS of 14 after minor head trauma who require a head CT scan is not recommended. While the authors have identified ethanol intoxication as one confounding factor, further refinement of this risk-stratification tool is required.
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Emergency Management of Trauma, Edited by Thomas A. Scaletta and Jeffrey J. ⋯ Paris House Calls, Rounds, and Healings: A Poetry Casebook By David L. Schiedermayer Tucson Airway Cam Video Series, Volume I: Orotracheal Intubation Produced by Richard Levjtan and Michael Higgins, with Ahmed Badr and Steven Blanks (assistant producers).
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To determine how often the results of urine and blood cultures led to changes in antibiotic therapy for patients discharged from the hospital with the diagnosis of pyelonephritis. ⋯ Urine cultures are useful in directing antibiotic therapy in patients with the discharge diagnosis of acute pyelonephritis and support a change in therapy in 5% of cases. Among the patients in this study, blood cultures results did not lead to changes in antibiotic therapy. These findings warrant prospective, multicenter evaluation.