Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Review Meta Analysis
Ultrasound for the Diagnosis of Shoulder Dislocation and Reduction: A Systematic Review and Meta-Analysis.
Shoulder dislocations are a common injury prompting presentation to the emergency department. Point-of-care ultrasound (POCUS) is a diagnostic tool for shoulder dislocations, which has the potential to reduce time to diagnosis and reduction, radiation exposure, and health care costs. This systematic review sought to evaluate the diagnostic accuracy of POCUS for diagnosing shoulder dislocations. ⋯ POCUS is a sensitive and specific tool for the rapid identification of shoulder dislocations and reductions, as well as for the detection of associated fractures. POCUS should be considered as an alternate diagnostic tool for the diagnosis and management of shoulder dislocations.
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Review Meta Analysis
Pet Therapy in the Emergency Department and Ambulatory Care: A Systematic Review and Meta-Analysis.
Pet therapy, or animal-assisted interventions (AAIs), has demonstrated positive effects for patients, families, and health care providers (HCPs) in inpatient settings. However, the evidence supporting AAIs in emergency or ambulatory care settings is unclear. We conducted a systematic review to evaluate the effectiveness of AAIs on patient, family, and HCP experience in these settings. ⋯ Limited evidence is available on the effectiveness of AAIs in emergency and ambulatory care settings. Rigorous studies using global experience-oriented (or patient-identified) outcome measures are required.
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Review Meta Analysis
Benefits and safety of transdermal glyceryl trinitrate in acute stroke: a systematic review and meta-analysis of randomised trials.
Transdermal glyceryl trinitrate (GTN) has potential beneficial properties in acute stroke including intracerebral hemorrhage (ICH) and possible clinical benefits suggested in ultra-early stroke (≤6 h). Our meta-analysis updated the evidence on its safety and benefits in acute stroke. ⋯ Transdermal GTN reduces BP in acute stroke but does not alter clinical outcomes even in ultra-early stroke (≤6 h).
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Review Meta Analysis
Major adverse cardiac events after ED evaluation of chest pain patients with advanced testing: systematic review and meta-analysis.
Our primary objective was to describe the risk of major adverse cardiac events (MACE) at 1, 6, and 12 months after a negative coronary computed tomography angiogram (cCTA), electrocardiogram (ECG) stress test, stress echocardiography, and myocardial perfusion scintigraphy (MPS) in low- to intermediate-risk patients. ⋯ Patients presenting with chest pain who have a coronary CTA showing < 50% stenosis, negative ECG stress test, stress echocardiography, or stress myocardial perfusion scan in the past 12 months can be discharged without any further risk stratification if their ECG and troponin are reassuring given low MACE.
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Ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition, and rapid diagnosis is necessary to facilitate early surgical intervention. We sought to evaluate the accuracy of presenting symptoms, physical examination signs, computed tomography with angiography (CTA), and point-of-care ultrasound (PoCUS) for diagnosis of rAAA. ⋯ Classic clinical symptoms associated with rAAA have poor sensitivity, and their absence does not rule out the condition. CTA has reasonable accuracy, but misses some cases of rAAA. PoCUS is a valuable tool that can help guide the need for urgent transfer to a vascular center in patients suspected of having rAAA.