Emergency medicine journal : EMJ
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Observational Study
Association between the number of endotracheal intubation attempts and rates of adverse events in a paediatric emergency department.
Challenges in emergent airway management in children can affect intubation success. It is unknown if number of endotracheal intubation attempts is associated with rates of adverse events in the paediatric ED setting. ⋯ Increasing number of endotracheal intubation attempts was associated with higher odds of adverse events. Efforts to optimise first attempt success in children undergoing intubation may mitigate this risk and improve clinical outcomes.
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Observational Study
Need for pharmacological analgesia after cast immobilisation in children with bone fractures: an observational cross-sectional study.
Bone fractures are a common reason for children and adolescents to seek evaluation in the ED. Little is known about the pain experienced after cast immobilisation and discharge from the ED and its optimal management. We aimed to investigate the administration of pharmacological analgesia in the first days after cast immobilisation and to identify possible influencing variables. ⋯ Although some studies recommend scheduled analgesic treatment after discharge for bone fractures, this study would suggest analgesia on demand in children with non-displaced fractures, limiting scheduled analgesia to children with displaced fractures.
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Emergency physicians use diagnostic and prognostic tests on a daily basis to assess for life-threatening illness and to inform clinical decisions. Current and new tests must be scientifically evaluated for their diagnostic utility. We discuss the evaluation of diagnostic and prognostic tests using the Bayesian likelihood ratio (LR) and logistic regression diagnostic odds ratio (OR) frameworks. ⋯ The concepts of diagnostic multivariate testing also underlie the framework of clinical decision rules which have gained acceptance in emergency medicine. Clinical decision rules can be viewed as a subanalysis within the joint LR framework. Ultimately, a variety of approaches may be acceptable and even complementary to assess a diagnostic test, each with its own merits and limitations.