Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
Multicenter Study Clinical Trial
Refining Emergency Severity Index triage criteria.
The Emergency Severity Index (ESI) version 3 is a five-level triage acuity scale with demonstrated reliability and validity. Patients are rated from ESI level 1 (highest acuity) to ESI level 5 (lowest acuity). Clinical experience has demonstrated two levels of ESI level 2 patients: those who require immediate intervention and those who are stable to wait for at least ten minutes. Studies have found that few patients are rated ESI level 1, and it has been suggested that revisions to the ESI might result in appropriate reclassification of some sickest level 2 patients as level 1. The purpose of this study was to identify level 2 patients who might be reclassified as level 1 patients. ⋯ Specific clinical findings at triage for a subset of ESI level 2 patients were associated with immediate delivery of lifesaving interventions. Revisions to the ESI level 1 criteria may be beneficial.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Propofol versus midazolam/fentanyl for reduction of anterior shoulder dislocation.
The authors aimed to compare propofol and midazolam/fentanyl for reduction of anterior shoulder dislocations using the modified Kocher's maneuver. ⋯ Propofol appears to be as effective as midazolam/fentanyl for reduction of anterior shoulder dislocation using the modified Kocher's maneuver. However, the advantage of shorter wakening times associated with propofol should be weighed against the possibility of adverse events, particularly respiratory depression and vomiting.
-
Multicenter Study Comparative Study
Attitudes and judgment of emergency physicians in the management of patients with acute headache.
There is little evidence guiding physicians in the evaluation of acute headache to rule out nontraumatic subarachnoid hemorrhage (SAH). The authors assessed emergency physicians in: 1) their pretest accuracy for predicting SAH, 2) their comfort with not ordering either head computed tomography (CT) or lumbar puncture (LP) in patients with acute headache, and 3) their comfort with not ordering head CT before performing LP in patients with acute headache. ⋯ Physicians were able to moderately discriminate SAH from other causes of headache before diagnostic testing.
-
Multicenter Study
A multicenter study of depression among emergency department patients.
The authors sought to determine the 12-month prevalence of depression among emergency department (ED) patients using a single-question screen. ⋯ A 30% 12-month prevalence of depression among ED patients was found. Depressed patients had a distinct sociodemographic and health profile. In the future, awareness of risk factors for depression in the ED setting and use of simple screening instruments could aid in the recognition of depression, with subsequent referral to mental health services.
-
The authors sought to modify and validate a composite assessment evaluation process that assesses resident acquisition of the Accreditation Council for Graduate Medical Education (ACGME) general competencies (GCs). ⋯ By using a structured development process, the authors were able to create valid evaluation items for determining resident acquisition of the ACGME GCs.