Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Hirsch's h-index (h) attempts to measure the combined academic impact and productivity of a scientist by counting the number of publications by an author, ranked in descending order by number of citations, until the paper number equals the number of citations. This approach provides a natural number or index of the number of publications and the number of citations per publication. H was first described in physics and was demonstrated to be highly predictive of continued academic activity, including recognized measures of scientific excellence such as membership in the National Academy of Sciences and being a Nobel laureate. Citation rates, research environments, and years of experience all affect h, making any comparisons appropriate only for scientists working in the same field for a similar time period. The authors are unaware of any report describing the distribution of h among academic emergency physicians (AEPs). ⋯ The h-index can be used to characterize the academic productivity of AEPs. An h/year of 0.5 or greater is characteristic of the most productive EPs and represents only 10% of all AEPs. The 12-year h-index of top-performing EPs was strongly related to their future academic productivity. The distribution of h among EPs may provide a means for individual investigators and academic leaders to evaluate performance and identify EPs with future success in EM research.
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Dizziness and vertigo account for about 4 million emergency department (ED) visits annually in the United States, and some 160,000 to 240,000 (4% to 6%) have cerebrovascular causes. Stroke diagnosis in ED patients with vertigo/dizziness is challenging because the majority have no obvious focal neurologic signs at initial presentation. The authors sought to compare the accuracy of two previously published approaches purported to be useful in bedside screening for possible stroke in dizziness: a clinical decision rule (head impulse, nystagmus type, test of skew [HINTS]) and a risk stratification rule (age, blood pressure, clinical features, duration of symptoms, diabetes [ABCD2]). ⋯ HINTS substantially outperforms ABCD2 for stroke diagnosis in ED patients with AVS. It also outperforms MRI obtained within the first 2 days after symptom onset. While HINTS testing has traditionally been performed by specialists, methods for empowering emergency physicians (EPs) to leverage this approach for stroke screening in dizziness should be investigated.
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Review Meta Analysis
Triple Rule-out Computed Tomographic Angiography for Chest Pain: A Diagnostic Systematic Review and Meta-Analysis.
The objective was to compare the image quality, diagnostic accuracy, radiation exposure, and contrast volume of "triple rule-out" (TRO) computed tomography (CT) to other diagnostic modalities commonly used to evaluate patients with nontraumatic chest pain (dedicated coronary, pulmonary embolism [PE], and aortic dissection CT; invasive coronary angiography; and nuclear stress testing). ⋯ Triple rule-out CT is highly accurate for detecting coronary artery disease. Given the low (<1%) prevalence of PE and aortic dissection in the included studies, and the increased radiation and contrast exposure, there are insufficient data to recommend use of TRO CT in the diagnosis of these conditions.