Emergency medicine journal : EMJ
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Multicenter Study
Comparison of Glasgow Admission Prediction Score and Amb Score in predicting need for inpatient care.
We compared the abilities of two established clinical scores to predict emergency department (ED) disposition: the Glasgow Admission Prediction Score (GAPS) and the Ambulatory Score (Ambs). ⋯ The GAPS is a significantly better predictor of need for hospital admission than Ambs in an unselected ED population.
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Review Meta Analysis
Do patients with blunt thoracic aortic injury present to hospital with unstable vital signs? A systematic review and meta-analysis.
Blunt thoracic aortic injury (BTAI) is an uncommon diagnosis, usually developing as a consequence of high-impact acceleration-deceleration mechanisms. Timely diagnosis may enable early resuscitation and reduction of shear forces, essential to prevent worsening of the injury prior to definitive management. Death is commonly due to haemorrhagic shock, but clinical features may be absent until sudden and massive haemorrhage. ⋯ Normal vital signs do not rule out aortic injury. A high degree of clinical suspicion and liberal use of imaging is necessary to prevent missed or delayed diagnoses.
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Patients with respiratory distress present a frequent and challenging dilemma for emergency physicians (EPs). The accurate diagnosis and treatment of the underlying pathology is vitally important in these sick patients to ensure the best outcome and minimise harm from unnecessary treatments. ⋯ However, despite advances in techniques and the evidence for the use of LU in the diagnosis of respiratory pathology, it remains poorly understood and rarely used by EPs. This clinical review article provides an overview of LU and its relevance as a diagnostic aid to the detection of respiratory pathology in the Emergency Department (ED).
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A shortcut review was carried out to establish whether the use of intravenous vitamin C can reduce mortality or morbidity in patients diagnosed in the early phases of severe sepsis. Three directly relevant papers were found using the reported search strategy. ⋯ It is concluded that there is insufficient high-quality research to justify the routine use of vitamin C in severe sepsis. Further multicentre, double-blinded randomised controlled trials are required in order to establish the role of vitamin C in sepsis.
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Observational Study
Thirty-day hospital readmissions among mechanically ventilated emergency department patients.
Unplanned 30-day readmissions have a negative impact on patients and healthcare systems. Mechanically ventilated ED patients are at high risk for complications, but factors associated with readmission are unknown. ⋯ Almost one in four mechanically ventilated ED patients are readmitted within 30 days, and readmission is associated with patient-level and institutional-level factors. Strategies must be developed to identify, treat and coordinate care for the most at-risk patients.