J Emerg Med
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Multicenter Study Comparative Study
Emergency department children are not as sick as adults: implications for critical care skills retention in an exclusively pediatric emergency medicine practice.
We wished to compare the acuity of adults vs. children using a representative sample drawn from a geographically isolated region. We retrospectively analyzed Emergency Department (ED) patient logs, billing records, and trauma data from two hospitals serving a geographically isolated region (Santa Barbara, California), and compared the following measures of acuity by age, triage category, rates of admission, billing levels of service, procedures (ED intubation, cardiopulmonary resuscitation, and invasive line placement), and trauma team activations. We analyzed 88,864 patients treated at the two EDs over an 18-month period, of whom 15,589 (17.5%) were children (< 18 years of age). ⋯ No age-based differences were noted in the rates of highest-level trauma team activation or admission directly to the operating room. ED children have overall lower acuity than ED adults-by many measures, several-fold less. These findings may have important implications for ongoing skills retention and proficiency in critical care for practitioners whose ED practice is restricted to representative samples of children.
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Multicenter Study
Feasibility of emergency physician diagnosis of hypertrophic pyloric stenosis using point-of-care ultrasound: a multi-center case series.
Hypertrophic pyloric stenosis (HPS) is an acute abdominal emergency in infants that often presents to Emergency Departments. The clinical diagnosis of HPS relies on palpation of an olive-sized mass in the right upper quadrant of an infant with a history of projectile vomiting. However, studies have shown that clinicians cannot detect the olive in 11% to 51% of cases. ⋯ To our knowledge, there have been no reports documenting the ability of Emergency Physicians to diagnose HPS using point-of-care ultrasound. We present a multi-center case series (n = 8) of HPS diagnosed by Emergency Physician-performed ultrasound. We review the technique of incorporating point-of-care ultrasound into the physical examination of infants with suspected HPS and discuss the possible role of point-of-care ultrasound in the management of these patients.
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Multicenter Study Comparative Study
Comparison of mortality due to severe multiple trauma in two comprehensive models of emergency care: Atlantic Pyrenees (France) and Navarra (Spain).
Injury due to external causes is an important health problem in our society today. Emergency care systems based on the concept of "comprehensive care" can prevent deaths and disabilities as well as limit the severity and pain caused by trauma. ⋯ Despite a more aggressive approach and employment of greater resources, the French comprehensive trauma system does not show greater survival rates among injured patients compared to Navarra, even when controlling for confounding factors like age, injury mechanism, RTS, ISS, and others.
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Multicenter Study Comparative Study
Rural Emergency Medicine: patient volume and training opportunities.
A paucity of board-certified Emergency Physicians practice in rural Emergency Departments (EDs). One proposed solution has been to train residents in rural EDs to increase the likelihood that they would continue to practice in rural EDs. Some within academic Emergency Medicine question whether rural hospital EDs can provide adequate patient volume for training an Emergency Medicine (EM) resident. ⋯ Patient volumes per physician FTE do not differ in rural vs. urban OK hospital EDs, suggesting that an adequate volume of patients exists in rural EDs to support EM resident education. Proportionately fewer board-certified Emergency Physicians staff rural EDs. Opportunities to increase rural ED-based EM resident training should be explored.
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Multicenter Study
Prehospital transport time intervals for acute stroke patients.
Recognizing factors that cause prehospital stroke delays may improve time of presentation to the Emergency Department (ED) and allow earlier treatment of acute stroke patients. ⋯ Prehospital scene time and run times for acute strokes are less when there is diagnostic concordance between dispatchers and paramedics. Time intervals did not differ between missed and recognized strokes.