Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine the effect of intravenous (IV) magnesium sulfate on the length of stay (LOS) for children admitted with sickle cell pain crisis. ⋯ IV magnesium appears to decrease the LOS for children with sickle cell pain crisis.
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Pelvic ultrasound performed by emergency physicians can identify a definite diagnosis in the majority of symptomatic first-trimester pregnant patients on the initial emergency department (ED) visit. However, a significant minority of such patients are diagnosed as having an indeterminate pregnancy state requiring further testing and consultation. The authors investigated the final outcome of patients with an initial indeterminate ED first-trimester pelvic ultrasound examination in the setting of an interdepartmental protocol to rule out ectopic pregnancy. ⋯ The outcome of symptomatic first-trimester patients with indeterminate ED pelvic ultrasounds is poor, with significantly high rates of embryonic demise and ectopic pregnancy. However, those indeterminate patients with the eventual diagnosis of ectopic pregnancy have a higher rate of medical methotrexate treatment and a reduced rate of invasive surgical treatment compared with ectopic pregnancy patients diagnosed at initial ED visit.
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To determine predictors of asthma morbidity in African American patients with asthma. Proxies for asthma morbidity were emergency department (ED) visits for asthma and hospitalizations for asthma. ⋯ It appears that African American patients with asthma who had previous hospitalizations for asthma within the past year or use a peak flow meter daily (a marker for more severe asthma) are more likely to visit the ED in the future or to be hospitalized for asthma, respectively. These patients need to be targeted and treated more aggressively to improve asthma care and decrease morbidity. The apparent protective effect of the presence of pets on reducing ED visits is unclear at this time, and the findings need to be replicated and evaluated further.
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Observational studies assessing the effect of a particular treatment or exposure may be subject to bias, which can be difficult to eliminate using standard analytic techniques. Multivariable models are commonly used in observational research to assess the relationship between a certain exposure or treatment and an outcome, while adjusting for important variables necessary to ensure comparability between the groups. Large differences in the observed covariates between two study groups may exist in observational studies in which the investigator has no control over who was allocated to each treatment group, and these differences may lead to biased estimates of treatment effect. ⋯ The authors present three methods for integrating propensity scores into observational analyses using a database collected on head-injured trauma patients. The article details the methods for creating a propensity score, analyzing data with the score, and explores differences between propensity score methods and conventional multivariable methods, including potential benefits and limitations. Graphical representations of the analyses are provided as well.