J Emerg Med
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To develop a clinical decision rule for predicting significant chest radiography abnormalities in adult Emergency Department (ED) patients, a prospective, observational study was conducted of consecutive adults (>or=18 years old) who underwent chest radiography for nontraumatic complaints at an urban ED with an annual census of 85,000. The official radiologist interpretation of the film was used as the gold standard for defining radiographic abnormalities. Using predefined criteria and author consensus, patients were divided into two groups: those with clinically significant abnormalities (CSA) and those with either normal or nonclinically significant abnormalities. ⋯ Positive and negative predictive values were 25% (95% CI: 23-27%) and 98% (95% CI: 96-99%), respectively. A highly sensitive decision rule for detecting clinically significant abnormalities on chest radiographs in nontraumatized adults has been developed. If prospectively validated, these criteria may permit clinicians to confidently reduce the number of radiographs in this population.
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Multicenter Study
The failed intubation attempt in the emergency department: analysis of prevalence, rescue techniques, and personnel.
The aims of this study were: To describe the prevalence of Emergency Department (ED) airway management failures requiring rescue maneuvers, to describe successful rescue methods used when the primary method chosen is unsuccessful, and to characterize the roles of emergency physicians and other specialists in rescue airway management. A prospective observational study was conducted of ED airway management in 30 hospitals in the USA, Canada, and Singapore participating in the National Emergency Airway Registry (NEAR) database project. Patients were entered in the study if they underwent ED airway management, the first method chosen was not successful in achieving intubation, and a rescue technique was required. ⋯ In conclusion, a total of 2.7% of emergency intubations required rescue. RSI is the most commonly used first line technique for ED airway management and is also the principal back-up technique when other oral or nasal intubation methods fail. Emergency physicians manage the majority of ED intubations, including those requiring rescue techniques.
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The objectives of this study were to describe the clinical presentations and outcomes of all HIV+ patients who presented to the Emergency Department (ED) with a chief complaint of abdominal pain and to compare the outcomes of those with advanced disease (CD4 < 200/mm(3)) to those with early or middle stage disease (CD4 >or= 200/mm(3)). We conducted a retrospective chart review in an urban municipal hospital ED and included subjects if they were HIV+ and had a chief complaint of abdominal pain. Demographic and clinical data were entered into a standardized database; patients with advanced disease were compared with those with early or middle stage disease. ⋯ Only 8% of patients required intra-abdominal surgical procedures, however, 37% were admitted compared with 18% of patients without HIV disease (p < 0.001). Patients infected with HIV presenting with abdominal pain most often have a non-HIV related cause of abdominal pain and infrequently require surgery. However, HIV+ patients are admitted at twice the rate of the non-HIV infected population.