Articles: emergency-department.
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Emerg Med Australas · Jun 2015
Multicenter StudyImproved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed.
To describe and compare characteristics and outcomes of patients who arrive by ambulance to the ED. We aimed to (i) compare patients with a delayed ambulance offload time (AOT) >30 min with those who were not delayed; and (ii) identify predictors of an ED length of stay (LOS) of >4 h for ambulance-arriving patients. ⋯ Patients arriving to the ED via ambulance and offloaded within 30 min experience better outcomes than those delayed. Given that offload delay is a modifiable predictor of an ED LOS of >4 h, targeted improvements in the ED arrival process for ambulance patients might be useful.
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Observational Study
ED prognostication of comatose cardiac arrest patients undergoing therapeutic hypothermia is unreliable.
Therapeutic hypothermia (TH) improves patient survival with good neurologic outcome after cardiac arrest. The value of early clinician prognostication in the emergency department (ED) has not been studied in this patient population. ⋯ Physicians poorly prognosticate both survival and neurologic outcome in comatose OHCA patients undergoing TH. Premature prognostication in the ED is unreliable and should be avoided.
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Emerg Med Australas · Jun 2015
Last drinks: A study of rural emergency department data collection to identify and target community alcohol-related violence.
The present study summarises the methodology and findings of a pilot project designed to measure the sources and locations of alcohol-related harm by implementing anonymised 'last drinks' questions in the ED of a rural community. ⋯ This pilot demonstrates the feasibility and reliability of implementing sustainable 'last drinks' data collection methods in the ED, and the ability to effectively map the source of alcohol-related ED attendances in a rural community.
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Pediatric emergency care · Jun 2015
Does Extreme Leukocytosis Predict Serious Bacterial Infections in Infants in the Post-Pneumococcal Vaccine Era? The Experience of a Large, Tertiary Care Pediatric Hospital.
Extreme leukocytosis, defined as a peripheral white blood cell count greater than 25,000/mm, may alarm clinicians and prompt extensive evaluation in infants with fever, especially in the pediatric emergency department. ⋯ All well-looking febrile infants with white blood cell greater than 25,000/mm should undergo a chest radiograph unless there are clear physical findings that indicate a different etiology. Urine culture should be considered in women. C-reactive protein can have an added value in the differential diagnosis.
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Inpatient hospital costs represent nearly a third of heath care spending. The proportion of inpatients visits that originate in the emergency department (ED) has been growing, approaching half of all inpatient admissions. Injury is the most common reason for adult ED visits, representing nearly one-quarter of all ED visits. ⋯ There is great variation in inpatient admission decisions for moderately injured patients in the ED. Decisions appear to be dominated by clinical factors such as injury characteristics and comorbidities; however, nonclinical factors, such as type of insurance, hospital size, and trauma center designation, also play an important role.