European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The primary purpose of this prospective cohort study was to characterize the use of the Emergency Department (ED) in patients with chronic obstructive pulmonary disease (COPD) exacerbations and determine the factors affecting the revisit of COPD patients. This is a prospective cohort study on ambulatory patients with exacerbated chronic bronchitis in an ED setting. Patients included in the study were above 18 years of age, had a previous diagnosis of COPD, and presented to the ED for the treatment of COPD exacerbation. ⋯ Home oxygen therapy, intensive care admission, previous intubation, increased cough, and the number of ED visits in the previous year were associated with increased risk of revisit in the univariate analysis. Increased cough (odds ratio: 0.232; 95% confidence interval: 0.063-0.853) and the number of ED visits in the previous year (odds ratio: 1.166; 95% confidence interval: 1.005-1.353) were still significant after multivariate analysis. In conclusion, the number of ED visits previous year and increased cough can predict the revisit of a COPD exacerbated patient within 14 days of an ED visit.
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Comparative Study
Comparison of CT head interpretation between emergency physicians and neuroradiologists.
Cranial computed tomography (CT) of the head is widely used in the emergency department 24 h a day. We compared the accuracy of CT head interpretation between staff emergency physicians (EPs) and neuroradiologists. We conducted a health records review of patients who required head CT in the emergency department. ⋯ The weighted kappa for agreement was 0.83 (95% confidence interval 0.76-0.90). None of these patients had adverse outcomes related to EP misinterpretation of the CT head. In conclusion, clinically important findings on CT head are not commonly missed by our EPs and patients rarely have inappropriate disposition.
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This descriptive study presents availability and content of acute pain protocols in emergency departments (EDs) in The Netherlands. Current acute pain protocols were collected and an a priori list of questions was used for analysis. Findings were compared with current international standards. ⋯ Acute pain protocols are lacking in many EDs. Most protocols did not apply current standards. We exposed an area with space for leadership.
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Review Case Reports
A meta-analysis on the utility of peripheral venous blood gas analyses in exacerbations of chronic obstructive pulmonary disease in the emergency department.
The objective of this case-based review is to identify and summarize the relevant evidence for the clinical utility of peripheral venous blood gas (pVBG) analyses in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in the emergency department. Relevant studies were identified using the Cochrane Library, Medline, Embase, and CINAHL databases and by hand searching of references of published articles. Included studies were prospective trials comparing arterial and pVBG results in patients with COPD or respiratory distress that reported at least average differences and/or limits of agreement between the two results in English. ⋯ No studies investigated the role of pVBG analysis in treatment alteration or clinical outcomes. Available evidence suggests that there is good agreement for pH and HCO3 values between arterial and pVBG results in patients with COPD, but not for pO2 or pCO2. Widespread clinical use is limited because of the lack of validation studies on clinical outcomes.