European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Multicenter Study Observational Study
Emergency department procedural sedation: the London experience.
The aim of this study was to develop a procedural sedation guideline and an audit tool to identify the medications chosen, the incidence of predefined adverse events and the factors associated with their occurrence. ⋯ Procedural sedation and analgesia can be safely and effectively performed in the ED by appropriately trained emergency physicians.
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Multicenter Study Comparative Study
Reliability of electronic recording of waiting times in the emergency department: a prospective multicenter study.
We aimed to evaluate the reliability of waiting times (WT) measures electronically retrieved. We prospectively collected true WT in four emergency departments during 20 predefined 2-h inclusion periods, and compared them with the electronically retrieved waiting time (ERWT). We assessed agreement with calculation of rate of outliers (difference exceeding 20 min), bias, and its 95% limits of agreements, and associated Bland and Altman plot. ⋯ Bland and Altman plot showed a good agreement, and we report 7% of outliers. Using ERWT, 14 patients (5%) were misclassified as having their target WT exceeded or not. ERWT agree well with the true WT, although the significant rate of outlier and misclassification calls for caution in their interpretation.
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Multicenter Study
Emergency medical services interval and mortality in significant head injury: a retrospective cohort study.
Recent interest has focused on reorganizing emergency medical services (EMS) for English traumatic brain injury (TBI) patients, with bypass of nonspecialist hospitals and direct transportation to distant neuroscience centres. This may expedite specialist neurocritical care and neurosurgical interventions, but risks harms from prehospital deterioration and delayed resuscitation. We therefore aimed to investigate the effect of EMS interval on outcome following head injury. ⋯ The lack of observed association between EMS interval and mortality may not preclude bypass of significant TBI patients, with concomitantly prolonged primary transfers from the scene of injury to distant specialist centres. However, given the limitations of registry data, our results should be interpreted with caution.
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Multicenter Study
Accuracy of oxygen tissue saturation values in assessing severity in patients with sepsis admitted to emergency departments.
Near-infrared spectrometry assesses hemoglobin saturation of oxygen in tissues (StO2). Although it may provide additional information on local microcirculation function, the usefulness of near-infrared spectrometry in septic patients is debated. This study evaluated whether baseline StO2 value is useful in septic patients admitted to the emergency department with a diagnosis of severe sepsis. ⋯ This study fails to show any value of StO2 baseline at triage for early detection of severe sepsis in emergency patients.
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Multicenter Study Observational Study
The utility of copeptin in the emergency department for non-ST-elevation myocardial infarction rapid rule out: COPED-MIRRO study.
To evaluate whether the addition of copeptin measurement to the first troponin determination allows non-ST-elevation acute myocardial infarction to be ruled out in patients consulting the emergency department (ED) for nontraumatic chest pain (NTCP) suggestive of acute coronary syndrome (ACS) whose first electrocardiogram and troponin determination are nondiagnostic, thereby avoiding a second determination of troponin and shortening ED stay. ⋯ The determination of copeptin on arrival to the ED in patients with NTCP suggestive of ACS, in addition to routine troponin determination, does not allow the presence of myocardial infarction to be ruled out quickly and safely and does not avoid ED stay for a second determination of troponin.