Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Calibration and discrimination indicators alone are insufficient for evaluating the clinical usefulness of prediction models, as they do not account for the cost of misclassification errors. This study aimed to modify the Geriatric Trauma Outcome Score (GTOS) and assess the clinical utility of the modified model using net benefit (NB) and decision curve analysis (DCA) for predicting in-hospital mortality. ⋯ The modified GTOS model exhibited superior predictive ability and clinical utility compared to the original GTOS. NB and DCA offer valuable complementary methods to calibration and discrimination indicators, comprehensively evaluating the clinical usefulness of prediction models and decision strategies.
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The rate of patients who leave without being seen (LWBS) from an emergency department (ED) is a common measurement of quality, operational efficiency, and patient satisfaction. We hypothesized that adding a nonclinical staff role, guest service ambassadors (GSA), to the ED waiting room would decrease LWBS rates and reduce existing differences by race, ethnicity, sex, and primary language for ED patients. ⋯ Although some disparities remain, our study suggests that GSAs may provide an effective strategy to reduce the overall LWBS rate and reduce disparities across diverse demographic groups including BIPOC and female patients.
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The objective was to investigate the predictive ability of traditional clinical, radiological scores, and combined grading systems for 28-day mortality in patients with nontraumatic subarachnoid hemorrhage (SAH). ⋯ Although the GCS and Ogilvy-Carter scales effectively distinguished survivors from nonsurvivors, they were not independent predictors of mortality. The WFNS scale was identified as the most reliable predictor of mortality in aneurysmal SAH patients, followed by the mFS and HHS.
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Following a review of accepted submissions for this special issue of the Society for Academic Emergency Medicine (SAEM)'s collected papers on diagnosis, we offer a commentary on the variety of reports. We use the metaphor of Newton's demonstration that a complex percept like the rainbow can be broken down by prisms, into a collection of different wavelengths of light. Like Feynman, we believe that the beauty of something may be revealed and augmented by reducing it to its constituent parts.