Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
Multicenter Study
Best Evidence in Emergency Medicine (BEEM) Rater Scores Correlate With Publications' Future Citations.
The "BEEM" (best evidence in emergency medicine) rater scale was created for emergency physicians (EPs) to evaluate the physician-derived clinical relevance score of recently published, emergency medicine (EM)-related studies. BEEM therefore is designed to help make EPs aware of studies most likely to confirm or change current clinical practice. ⋯ To the best of our knowledge, the BEEM rater score is the only known measure of clinical relevance. It has a high interrater reliability and face validity and correlates with future citations. Future research should assess this instrument against alternative constructs of clinical relevance.
-
Observational Study
Parental Anxiety at Initial Acute Presentation Is Not Associated With Prolonged Symptoms Following Pediatric Concussion.
Anxiety modulates symptom perception in adults following concussion, prolonging the time to full recovery. The authors sought to determine whether parental anxiety was associated with persistent postconcussive symptoms (PCS) in their children following concussion. ⋯ Parental anxiety at time of acute presentation does not appear to be associated with prolongation of postconcussive symptoms in their children. However, parents of persistently symptomatic children remain significantly more anxious than those whose children's symptoms have resolved. Future research should attempt to reduce the familial burden of concussion through expectation management strategies.
-
Observational Study
Near-infrared Spectroscopy Assessment of Tissue Saturation of Oxygen in Torsed and Healthy Testes.
The objective was to assess whether testicular torsion is associated with low testicular tissue saturation of oxygen (StO2 ) as measured by transscrotal near-infrared spectroscopy (NIRS) and to compare the differences in NIRS values between testicles of the same patient, both in patients with testicular torsion and in healthy controls. ⋯ While pilot animal investigations support a potential role for transscrotal NIRS for the detection of testicular torsion, this first clinical translation of animal findings reveals that the investigated, transcutaneous, reflectance geometry NIRS device failed to demonstrate symmetric oxygenation of left and right testes in healthy controls and also failed to demonstrate depressed tissue saturation of oxygen values in patients with confirmed testicular torsion. While limited by a small sample size, other problems such as inability to calibrate depth of measurement of StO2 may have led to falsely elevated readings in patients with torsion.
-
Using computed tomography (CT) to evaluate patients with chest symptoms is common in emergency departments (EDs). This article describes recent trends of CT use in U.S. EDs for patients presenting with symptoms common to acute pulmonary embolism (PE). ⋯ Computed tomography use in ED visits by patients with chest symptoms increased dramatically from 2001 to 2007 and seems to have leveled off in subsequent years. The low PE diagnosis-to-CT ratio suggests that EDs may need to promote evidence-based use of CT.
-
Expanding insurance coverage is designed to improve access to primary care and reduce use of emergency department (ED) services. Whether expanding coverage achieves this is of paramount importance as the United States prepares for the Affordable Care Act. ⋯ Since CHIP, adolescent non-ED outpatient visits have increased, while ED visits have remained unchanged. In comparison to young adults, expanding insurance coverage to adolescents improved use of health care services and suggests a shift to non-ED settings. Expanding insurance through the Affordable Care Act of 2010 will likely increase use of outpatient services, but may not decrease ED volumes.