Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Review Meta Analysis
Efficacy of ketorolac in the treatment of acute migraine attack: a systematic review and meta-analysis.
This review was designated to evaluate the efficacy of parenteral ketorolac in treating acute migraine headache. ⋯ Ketorolac may have similar efficacy to phenothiazines and metoclopramide in treating acute migraine headache. Ketorolac may also offer better pain control than sumatriptan, dexamethasone, and sodium valproate. However, given the lack of evidence due to inadequate number of trials available, future studies are warranted.
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Multicenter Study
Pre and post transfer computed tomography imaging in Canadian trauma centers: a multi-center retrospective cohort study.
Multiple clinical practice guidelines recommend minimizing radiation in trauma patients but there is a knowledge gap on the importance of this problem for trauma transfers. We aimed to estimate the incidence of pretransfer and repeat posttransfer computed tomography (CT) overall and in patients with an indication for immediate transfer, to assess interhospital practice variation, to identify predictors, and to quantify the influence of pretransfer CT on time to transfer. Methods We conducted a retrospective multicenter cohort study on patients transferred to major trauma centers from 2013 to 2019. Multilevel generalized linear regression was used to generate intraclass correlation coefficients (ICCs) to assess interhospital variation, multilevel logistic regression to generate odds ratios for each predictor, and geometric mean ratios to quantify the influence of CT on time to transfer. Results Of 18,244 patients included, 8501 (47%) had a pretransfer CT and one-quarter (26%) had a repeat posttransfer CT. Interhospital variation was moderate for pretransfer CT (5%-66%, ICC 12.5%) and for repeat posttransfer CT (7%-44%, ICC 14.7%). Pretransfer imaging was more frequent in elders and in males and repeat posttransfer imaging decreased over the study period but was more frequent in patients transferred in from Level III/IV centers than nondesignated hospitals. Time to transfer was doubled in patients who had a pretransfer CT. ⋯ Results suggest that pretransfer CT and repeat posttransfer CT are frequent and are subject to significant practice variation. In addition, pretransfer CT is associated with increased times to transfer though additional studies are needed to demonstrate causation. These results highlight potential opportunities to reduce low-value imaging for trauma transfers.
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Gender and sexual harassment in emergency medicine (EM) is persistent in the workplace but remains underreported. Barriers to reporting in EM are largely unknown. This study explored barriers to reporting gender and sexual harassment among EM faculty and residents and potential improvements to reporting systems. ⋯ Significant barriers to reporting exist and deter individuals from reporting. Given the negative consequences of ongoing gender and sexual harassment, emergency departments and institutions must take responsibility to reduce barriers and support individuals throughout the reporting process.
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Observational Study
High Prevalence of Fluoroquinolone-Resistant UTI Among US Emergency Department Patients Diagnosed with Urinary Tract Infection, 2018-2020.
Uropathogen resistance, fluoroquinolone-resistance (FQR), and extended spectrum beta-lactamase (ESBL), has been observed to be emerging worldwide with prevalences above recommended thresholds for routine empirical treatment. The primary aim of our study was to determine the prevalence of FQR from a geographically diverse sample of United States emergency departments (EDs). ⋯ FQ-resistant E. coli is widely prevalent across US sites highlighting the need for ongoing monitoring of antimicrobial resistance and, at some locations, modification of empirical treatments.