Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial
Predictors of Older Adult Adherence with Emergency Department Discharge Instructions.
Older adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual-level factors associated with adherence with ED discharge instructions among older adult ED outpatients. ⋯ Older adults discharged home from the ED have mixed rates of adherence to discharge instructions. Although it is thought that some subgroups may be higher risk than others, given the opportunity to improve ED-to-home transitions, EDs and health systems should consider providing additional care transition support to all older adults discharged home from the ED.
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Randomized Controlled Trial
Paracetamol or nonsteroidal anti-inflammatory drugs or combination of both analgesics in acute post-trauma pain: a randomized controlled trial.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (also called paracetamol) are the most frequent analgesics used to relieve posttrauma pain in the emergency department (ED). However, the utility of combining both treatments is still controversial. We sought to explore the benefits of combining an NSAID with acetaminophen compared to acetaminophen alone, or NSAID alone, in the treatment of posttraumatic pain of the extremity after discharge from the ED. ⋯ This study found that the combination of a high-dose NSAID with paracetamol does not increase the analgesic effect compared to paracetamol alone. We also found that paracetamol alone is superior to high-dose NSAID alone for posttraumatic extremity pain.
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Clinical guidelines have supported outpatient treatment of low-risk pulmonary embolism (PE) since 2014, but adoption of this practice has been slow. Direct oral anticoagulant (DOAC) therapy for venous thromboembolism (VTE) is now as common as vitamin K antagonist treatment, but data are sparse regarding outcomes for patients with low-risk PE treated with DOACs as outpatients. We conducted a systematic review of literature on outcomes of outpatient management for PE, including comparisons to inpatient treatment and differences by anticoagulant class. ⋯ Among patients with low-risk PE treated as outpatients, few patients experienced major adverse outcomes such as mortality, recurrent VTE, or major bleeding within 90 days.
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Meta Analysis
Machine Learning versus Usual Care for Diagnostic and Prognostic Prediction in the Emergency Department: A Systematic Review.
Having shown promise in other medical fields, we sought to determine whether machine learning (ML) models perform better than usual care in diagnostic and prognostic prediction for emergency department (ED) patients. ⋯ Our review suggests that ML may have better prediction performance than usual care for ED patients with a variety of clinical presentations and outcomes. However, prediction model reporting guidelines should be followed to provide clinically applicable data. Interventional trials are needed to assess the impact of ML models on patient-centered outcomes.
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The COVID-19 pandemic has placed acute care providers in demanding situations in predicting disease given the clinical variability, desire to cohort patients, and high variance in testing availability. An approach to stratifying patients by likelihood of disease based on rapidly available emergency department (ED) clinical data would offer significant operational and clinical value. The purpose of this study was to develop and internally validate a predictive model to aid in the discrimination of patients undergoing investigation for COVID-19. ⋯ The derived predictive models offer good discriminating capacity for COVID-19 disease and provide interpretable and usable methods for those providers caring for these patients at the important crossroads of the community and the health system. We found utilization of the logistic regression model utilizing exposure history, temperature, WBC, and chest X-ray result had the greatest discriminatory capacity with the most interpretable model. Integrating a predictive model-based approach to COVID-19 testing decisions and patient care pathways and locations could add efficiency and accuracy to decrease uncertainty.