Articles: hospital-emergency-service.
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Scaphoid fractures are the most common carpal fracture, representing 70% of carpal bone fractures. The diagnostic accuracy of physical examination findings and emergency medicine (EM) imaging studies for scaphoid fracture has not been previously described in the EM literature. Plain x-rays are insufficient to rule out scaphoid fractures in a patient with a suggestive mechanism and radial-sided tenderness on physical examination. This study was a meta-analysis of historical features, physical examination findings, and imaging studies for scaphoid fractures not visualized on plain x-ray in adult emergency department (ED) patients, specifically to address which types of imaging tests should be recommended in patients with persistent concern for acute fracture after ED discharge. ⋯ Except for the absence of snuffbox tenderness, which can significantly reduce the probability of scaphoid fracture, history and physical examination alone are inadequate to rule in or rule out scaphoid fracture. MRI is the most accurate imaging test to diagnose scaphoid fractures in ED patients with no evidence of fracture on initial x-rays. If MRI is unavailable, CT is adequate to rule in scaphoid fractures, but inadequate for ruling out scaphoid fractures.
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Review Meta Analysis
Systematic review and meta-analysis of routine total body CT compared with selective CT in trauma patients.
Full-body CT scanning is increasingly being used in the initial evaluation of severely injured patients. We sought to analyse the literature to determine the benefits of full-body scanning in terms of mortality and length of time spent in the emergency department (ED). ⋯ We eagerly await the results of randomised controlled trials. Firm clinical outcome data are expected to emerge in the near future, though data on cost and radiation exposure will be needed before definitive conclusions can be made.
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To perform a meta-analysis identifying studies instituting protocolized hemodynamic optimization in the emergency department (ED) for patients with severe sepsis and septic shock. ⋯ Protocolized hemodynamic optimization in the ED for patients with severe sepsis and septic shock appears to reduce mortality.
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Meta Analysis Comparative Study
Effectiveness of inhaled corticosteroids in the treatment of acute asthma in children in the emergency department: a meta-analysis.
This meta-analysis aimed to compare the treatment of an acute asthma attack in children in the emergency department (ED) with inhaled corticosteroids (ICS) versus placebo or oral systemic corticosteroids (SC) as assessed by the hospital admission rates. ⋯ ICS treatment of children with acute asthma exacerbations showed a similar rate of hospitalization as those treated by SC.
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Acta Anaesthesiol Scand · Sep 2013
Review Meta AnalysisHandover of patients: a topical review of ambulance crew to emergency department handover.
Handover has major implications for patient care. The handover process between ambulance and emergency department (ED) staff has been sparsely investigated. The purpose of this paper is, based on a literature review, to identify and elaborate on the major factors influencing the ambulance to ED handover, and to bring suggestions on how to optimize this process. ⋯ The handover of patients to the ED has the potential to be improved. Cultural issues and a lack of professional recognition of handover importance need to be approached. Multidisciplinary training in combination with a structured tool may have a potential for changing the culture and improving handover.