The western journal of emergency medicine
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Multicenter Study Observational Study
Sepsis Bundle Adherence Is Associated with Improved Survival in Severe Sepsis or Septic Shock.
There have been conflicting data regarding the relationship between sepsis-bundle adherence and mortality. Moreover, little is known about how this relationship may be moderated by the anatomic source of infection or the location of sepsis declaration. ⋯ In a large public healthcare system, adherence with severe sepsis/septic shock management bundles was found to be associated with improved survival. Bundle adherence seems to be most beneficial for patients with pneumonia. The overall improved survival in patients who received bundle-adherent care was driven by patients declaring in the ICU. Adherence was not associated with lower mortality in the large subset of patients who declared in the ED, nor in the smaller subset of patients who declared in the ward.
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Most trauma centers order abdominal and pelvic computed tomography (CT) as an automatically paired CT for adult blunt trauma evaluation. However, excessive CT utilization adds risks of excessive exposure to ionizing radiation, the need to work up incidental findings (leading to unnecessary and invasive tests), and greater costs. Examining a cohort of adult blunt trauma patients that received paired abdominal and pelvic (A/P) CT, we sought to determine the diagnostic yield of clinically significant injuries (CSI) in the following: 1) the abdomen alone; 2) the pelvis alone; 3) the lumbosacral spine alone; and 4) more than one of these anatomic regions concomitantly. ⋯ Automatic pairing of A/P CT has very low diagnostic yield for CSI in both the abdomen and pelvis. These data suggest a role for selective CT imaging protocols that image these regions individually instead of automatically as a pair.
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Variability in the use of computed tomography (CT) between providers in the emergency department (ED) suggests that CT is ordered on a provider rather than a patient level. We aimed to evaluate the variability of CT ordering practices for non-traumatic abdominal pain (NTAP) across physicians in the ED using patient-visit and physician-level factors. ⋯ We found minimal physician variability in CT ordering practices for NTAP. Patient-visit factors such as age, arrival mode, admission team, prior CT, ED arrivals in previous four hours, ultrasound, and WBC count were found to largely influence CT ordering practices.
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Pain is the most common complaint for an emergency department (ED) visit, but ED pain management is poor. Reasons for poor pain management include providers' concerns for drug-seeking behaviors and perceptions of patients' complaints. Patients who had objective findings of long bone fractures were more likely to receive pain medication than those who did not, despite pain complaints. We hypothesized that patients who were interhospital-transferred from an ED to an intensive care unit (ICU) for urgent surgical interventions would display objective pathology for pain and thus receive adequate pain management at ED departure. ⋯ Pain control among a group of interhospital-transferred patients requiring urgent operative interventions, was inadequate. Neither demographic nor clinical factors, except MEU/kg TBW, were shown to associate with poor pain management at ED departure. Emergency providers should consider more effective strategies, such as multimodal analgesia, to improve pain management in this group of patients.