Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Sepsis is characterized by an initial systemic proinflammatory response leading to endothelial damage and increased capillary permeability. The authors conducted a pilot study to determine if microalbuminuria, measured by the urine albumin:creatinine ratio (ACR), was associated with outcome in emergency department (ED) sepsis patients. ⋯ In this pilot study, microalbuminuria measured by POC ACR was associated with disposition in ED patients with sepsis or severe sepsis. Larger studies using more robust outcomes comparing ACR with validated sepsis biomarkers are needed to elaborate on these results.
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Comparative Study
Effect of a mass casualty incident: clinical outcomes and hospital charges for casualty patients versus concurrent inpatients.
A mass casualty incident (MCI) may strain a health care system beyond surge capacity, affecting patterns of care for casualties and other patients. Prior studies of MCIs have assessed clinical care for casualty patients, but have not examined outcomes or expenditures for noncasualty inpatients in the same time period. ⋯ When adjusted for severity of illness, casualty patients and noncasualty patients receiving concurrent hospital care have significantly longer LOS and higher charges than typical hospital patients at times unaffected by MCIs. Spillover effects from MCIs for noncasualty patients have not been previously described and have implications for clinical and hospital management in MCI and other high-surge circumstances.
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Randomized Controlled Trial
The delivery of a health promotion intervention by a public health promotion specialist improves patient satisfaction in the emergency department.
The objective was to introduce a public health promotion specialist (PHPS) into the hospital emergency department (ED) to provide a brief health promotion intervention to patients and to determine the effect of the initiative on patient satisfaction. ⋯ Health promotion and disease prevention interventions carried out by PHPS in the ED can improve patient satisfaction.
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The specific objectives were: 1) to compare the characteristics and 6-month outcomes of community-dwelling seniors in Quebec, Canada, who visited three different emergency department (ED) types and 2) to explore whether the differences in outcomes by ED type were seen among subgroups of seniors. ⋯ More vulnerable community-dwelling seniors tend to be treated in more specialized EDs, which have worse linkages to community services. Improved linkages between more specialized EDs and the community (physicians, home care, and other services) and increased access to community services may improve outcomes in this population. Seniors treated at more specialized EDs were more likely to experience serious outcomes, but were less likely to make a return outpatient ED visit.
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The objective was to compare outcomes associated with early, late, and no admission to the intensive care unit (ICU) for patients hospitalized with community-acquired pneumonia (CAP). ⋯ This study suggests that late but not early admission to the ICU is associated with higher 28-day mortality for patients hospitalized with CAP. Patients admitted to the ICU have longer hospital LOS in comparison to those managed on the wards, particularly if they are admitted late to the ICU.