Articles: emergency-department.
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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.
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J Pediatr Adolesc Gynecol · Jun 2015
Impact of Post-visit Contact on Emergency Department Utilization for Adolescent Women with a Sexually Transmitted Infection.
To understand Emergency Department (ED) utilization patterns for women who received sexually transmitted infection (STI) testing and explore the impact of post-visit telephone contact on future ED visits. ⋯ Contacting women with STI results and counseling them regarding safe sex behaviors may reduce the number of ED patients who return with symptoms or a new exposure necessitating STI testing. The high STI prevalence and frequent return rate suggest that ED interventions are needed.
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Case Reports
A case of the vacuum phenomenon as a mechanism of gas production in the abdominal wall.
A 40-year-old man experienced a collision with a car while driving a motorcycle in which the car was in the opposite lane and made a right turn. The patient was thrown approximately 10 m from the point of collision and, as he exhibited a consciousness disturbance, was transferred to our department. He had a score of 13 on the Glasgow Coma Scale with sinus tachycardia on arrival. ⋯ As representative mimics of free air were not observed during surgery in the present case, we believe that the traumatic impact to the patient's abdomen as a result of the collision caused the accumulation of gas in the abdominal wall due to vacuum phenomenon. Physicians should be aware of this clinical entity to accurately recognize the mechanism of gas formation in patients showing negative laparotomy findings for gas in the abdomen. This unique case adds additional information regarding the documented etiologies of mimics of pneumoperitoneum.
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The aim of this study was to create an overview of the treatment of mallet fingers in Dutch hospitals. ⋯ There is a general consensus on the treatment of uncomplicated mallet fingers. The follow-up treatment of uncomplicated lesions as well as the treatment of complicated mallet fingers should be fields of future research.
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Identification of TBI is extremely difficult and is often missed in the pre-hospital setting. Major trauma triage tool (MTTT) criteria specifies the suspicion of an open or depressed skull fracture as indicating a major trauma patient. However, it is often the case that patients with TBI recorded on the Trauma Audit and Research Network (TARN) data with an ISS>15, indicating major trauma, are not identified by the MTTT. This results in many patients with significant TBI being undertriaged and not receiving definitive care as rapidly as possible. Early intervention in patients suffering TBI is essential in ensuring the best possible outcome. A retrospective clinical record review is being conducted to establish whether there are clinical or behavioural indicators of TBI that could be incorporated into clinical guidance to improve identification. ⋯ This retrospective clinical record review could greatly improve the identification of major trauma patients who have sustained a serious head injury. In turn this will mean more patients being appropriately conveyed to the MTC where specialised neurosurgeons are available.