Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Editorial Comment
Democracy, ambiguity, scrutiny, and evidence-based medicine.
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Randomized Controlled Trial
A randomized, double-blind controlled study of jet lidocaine compared to jet placebo for pain relief in children undergoing needle insertion in the emergency department.
The objectives were to determine whether pretreatment with needleless jet-delivered lidocaine decreases self-reported pain in children undergoing needle insertion in the emergency department (ED) and to explore whether pretreatment with a jet device decreases self-reported pain in children undergoing needle insertion in the ED. ⋯ Jet-delivered lidocaine is no more effective than jet-delivered placebo in providing local anesthesia for needle insertion. Jet lidocaine and jet placebo may provide superior analgesia compared to no local anesthetic pretreatment.
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This study aimed to develop and validate a new method for measuring injury severity, the excess mortality ratio-adjusted Injury Severity Score (EMR-ISS), using the International Classification of Diseases 10th Edition (ICD-10). ⋯ The EMR-ISS showed better calibration and discrimination power for prediction of death than the ICISS in most injury groups. The EMR-ISS appears to be a feasible tool for passive injury surveillance of large data sets, such as insurance data sets or community injury registries containing diagnosis codes. Additional further studies for external validation on prospectively collected data sets should be considered.
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Randomized Controlled Trial
Hybrid simulation combining a high fidelity scenario with a pelvic ultrasound task trainer enhances the training and evaluation of endovaginal ultrasound skills.
In this study, an endovaginal ultrasound (US) task trainer was combined with a high-fidelity US mannequin to create a hybrid simulation model. In a scenario depicting a patient with ectopic pregnancy and hemorrhagic shock, this model was compared with a standard high-fidelity simulation during training sessions with emergency medicine (EM) residents. The authors hypothesized that use of the hybrid model would increase both the residents' self-reported educational experience and the faculty's self-reported ability to evaluate the residents' skills. ⋯ Use of a hybrid simulation model combining a high-fidelity simulation with an endovaginal US task trainer improved residents' educational experience and improved faculty's ability to evaluate residents' endovaginal US and clinical skills. This novel hybrid tool should be considered for future education and evaluation of EM residents.
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Patients of all ages use emergency departments (EDs) for primary care. Several studies have evaluated patient and system characteristics that influence pediatric ED use. However, the issue of proximity as a predictor of ED use has not been well studied. The authors sought to determine whether ED use by pediatric Medicaid enrollees was associated with the distance to their primary care providers (PCPs), distance to the nearest ED, and distance to the nearest children's hospital. ⋯ Geographical variables play a significant role in ED utilization in children, confirming the importance of system-level determinants of ED use and creating the opportunity for interventions to reduce geographical barriers to primary care.