Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Computed Tomography With Intravenous Contrast Alone: The Role of Intra-abdominal Fat on the Ability to Visualize the Normal Appendix in Children.
Computed tomography (CT) with enteric contrast is frequently used to evaluate children with suspected appendicitis. The use of CT with intravenous (IV) contrast alone (CT IV) may be sufficient, however, particularly in patients with adequate intra-abdominal fat (IAF). ⋯ Protocols using CT with IV contrast alone to visualize the appendix can reasonably include weight, age, or both as considerations for determining when this approach is appropriate. However, although IAF will more frequently be adequate in older, heavier patients, highly accurate prediction of IAF adequacy appears challenging solely based on age and weight.
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Reliably abstracting outcomes from free-text electronic health records remains a challenge. While automated classification of free text has been a popular medical informatics topic, performance validation using real-world clinical data has been limited. The two main approaches are linguistic (natural language processing [NLP]) and statistical (machine learning). The authors have developed a hybrid system for abstracting computed tomography (CT) reports for specified outcomes. ⋯ A hybrid NLP and machine learning automated classification system shows promise in coding free-text electronic clinical data.
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Severe sepsis remains a major public health problem both with a high hospital mortality rate and with staggering associated health care expenditures. The past decade has seen new insights into the early resuscitation of severe sepsis and this is an important, controversial, and constantly changing topic to emergency physicians. ⋯ As summarized in this article, the best available experimental evidence suggests that lactate clearance of at least 10% at a minimum of 2 hours after resuscitation initiation is a valid way to assess initial response to resuscitation in severe sepsis. Associative data suggest that lactate normalization during resuscitation is a more powerful indicator of resuscitative adequacy; however, further research on the optimal lactate clearance parameters to use during resuscitation is needed, and many other important questions have yet to be answered.
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Multicenter Study Observational Study
Evaluating Current Patterns of Assessment for Self-harm in Emergency Departments: A Multicenter Study.
The objective was to describe self-harm assessment practices in U.S. emergency departments (EDs) and to identify predictors of being assessed. ⋯ Emergency department assessment of self-harm was highly variable among institutions. Presence of specific assessment policies was associated with higher assessment rates. Assessment varied based upon patient characteristics. The identification of self-harm in 2.7% of ED patients indicates that a substantial proportion of current risk of self-harm may go unidentified, particularly in certain patient groups.
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Early death after emergency department (ED) discharge may signal opportunities to improve care. Prior studies are limited by incomplete mortality ascertainment and lack of clinically important information in administrative data. The goal in this hypothesis-generating study was to identify patient and process of care themes that may provide possible explanations for early postdischarge mortality. ⋯ In this hypothesis-generating study, qualitative research techniques were used to identify clinical and process-of-care factors in patients who died within days after discharge from an ED. These potential predictors will be formally tested in a future quantitative study.