J Emerg Med
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Multicenter Study
Primary care physician and patient factors that result in patients seeking emergency care in a hospital setting: the patient's perspective.
Much has been written about "abuse" and "overutilization" of Emergency Departments (EDs). We undertook to study, from the patient's perspective, physician and patient factors that influence the patient's decision to seek ED care. The study was designed as a convenience cohort, multi-centre survey, conducted in 13 hospitals in the Greater Toronto Area. ⋯ As many as 55% of patients presented to the ED because it was more convenient. Only a minority (23%) of patients felt their acuity of illness warranted an ED visit. Primary care physicians need to play a stronger role in educating their patients about the utilization of emergency care and the services offered in the office setting.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain.
Acute low back pain is a common problem in the emergency department (ED). Effective management of acute pain enhances early rehabilitation and recovery. Given the importance of inflammatory mediators in pain generation and the adverse effects associated with opioids, it is logical to expect that a non-opioid agent with antiinflammatory and analgesic properties would provide excellent analgesia with fewer adverse effects. ⋯ Patients in the ACOD group reported significantly more adverse drug events and serious adverse drug events. Seven patients--all in the ACOD group--withdrew from the study because of adverse drug events. Based on comparable efficacy and a superior adverse event profile, ketorolac was preferable to acetaminophen with codeine for the treatment of acute low back pain in the ED.
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Multicenter Study
One-week survey of pain intensity on admission to and discharge from the emergency department: a pilot study.
The purpose of this pilot study was to determine the incidence and severity of pain intensity in patients 4 years of age and older presenting to the noncritical ward of the emergency department (ED). All patients presenting to the ED of two university hospitals (one general, one pediatric) who were triaged to the noncritical ward during 12 h/day for 1 week were asked to report their pain intensity on admission and again asked just prior to discharge home. The chromatic analogue scale with a range of 0-10 was used as the measure of pain intensity. ⋯ It thus appears that pain is a problem for the majority of patients presenting to the ED. An important percentage of patients leave the ED with more pain than when they arrived. Further investigation is warranted to determine factors predicting poor pain resolution during an ED visit.