Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Increasing utilisation of Emergency and Acute Care services by children and young people is a worldwide trend. This is thought to be a result of parent and carer desire for more "on demand" health care assessment and not a consequence of increasing severity of disease. A bespoke acuity assessment system in our department allowed us to test this hypothesis. ⋯ In light of the overall total increase in attendances and relative increase in acuity it appears the general cohort of children presenting are more unwell. Given a POPS > 4 is associated with an increased risk of admission for more than 24 hours [1] it can also be concluded that a significant proportion of attendances to the department are 'appropriate'. This article is protected by copyright. All rights reserved.
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The objective was to determine the testing threshold for lumbar puncture (LP) in the evaluation of aneurysmal subarachnoid hemorrhage (SAH) after a negative head computed tomography (CT). As a secondary aim we sought to identify clinical variables that have the greatest impact on this threshold. ⋯ Our decision analysis results suggest a testing threshold for LP after negative CT to be approximately 4.3%, with a range of 1.4% to 9.3% on robust PSA. In light of these data, and considering the low probability of aneurysmal SAH after a negative CT, classical teaching and current guidelines addressing testing for SAH should be revisited.
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Review Meta Analysis
Predictors of Airspace Disease on Chest X-Ray in Emergency Department Patients With Clinical Bronchiolitis: A Systematic Review and Meta-analysis.
An abnormal chest X-ray (CXR) inconsistent with simple bronchiolitis is found in 7%-23% of cases. Despite national guidelines stating "current evidence does not support routine radiography in children with bronchiolitis"; the use of CXR in these patients remains high. Inappropriate use of CXR not only exposes children to excess radiation, but also increases medical costs. The majority of the time, CXRs are obtained to diagnose or rule out pneumonia. We aim to provide an evidence-based approach defining the utility of CXR in bronchiolitis for the diagnosis and treatment of bacterial pneumonia. ⋯ No single predictor of a +CXR was of sufficient accuracy to either support or refute ordering a CXR in a child with clinical bronchiolitis. We provide a decision threshold model to estimate a test threshold for obtaining a CXR and a treatment threshold for administering antibiotics. Application of this model requires the clinician to approximate the empiric benefit of antibiotics based on the clinical situation, highlighting the importance of clinical assessment.
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Review Case Reports
Systematic Molecular Phenotyping: A Path Towards Precision Emergency Medicine?
Precision medicine is an emerging approach to disease treatment and prevention that considers variability in patient genes, environment, and lifestyle. However, little has been written about how such research impacts emergency care. Recent advances in analytical techniques have made it possible to characterize patients in a more comprehensive and sophisticated fashion at the molecular level, promising highly individualized diagnosis and treatment. ⋯ In this article, we briefly review the underpinnings of such studies, note how they already impact acute care, discuss areas in which they might soon be applied, and identify challenges in translation to the emergency department (ED). While such techniques hold much promise, it is unclear whether the obstacles to translating their findings to the ED will be overcome in the near future. Such obstacles include validation, cost, turnaround time, user interface, decision support, standardization, and adoption by end-users.
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Randomized Controlled Trial Comparative Study
Comparison of Four Views to Single View Ultrasound Protocols to Identify Clinically Significant Pneumothorax.
Ultrasound (US) has been shown to be effective at identifying a pneumothorax (PTX); however, the additional value of adding multiple views has not been studied. Single- and four-view protocols have both been described in the literature. The objective of this study was to compare the diagnostic accuracy of single-view versus four-view lung US to detect clinically significant PTX in trauma patients. ⋯ Single-view and four-view chest wall USs demonstrate comparable sensitivity and specificity for PTX. The additional time to obtain four views should be weighed against the absence of additional diagnostic yield over a single view when using US to identify a clinically significant PTX.