Articles: emergency-department.
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Observational Study
Estimated Effect of an Integrated Approach to Suspected Deep Venous Thrombosis Using Limited-compression Ultrasound.
Deep vein thrombosis (DVT) is both common and serious, yet the desire to never miss the diagnosis, coupled with the low specificity of D-dimer testing, results in high imaging rates, return visits, and empirical anticoagulation. The objective of this study was to evaluate a new approach incorporating bedside limited-compression ultrasound (LC US) by emergency physicians (EPs) into the workup strategy for DVT. ⋯ Limited-compression US holds promise as one component of the diagnostic approach to DVT, but should not be used as a stand-alone test due to imperfect sensitivity. Tradeoffs in diagnostic efficiency for the sake of perfect sensitivity remain a difficult issue collectively in emergency medicine (EM), but need to be scrutinized carefully in light of the costs of overinvestigation, delays in diagnosis, and risks of empirical anticoagulation.
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Pediatr Crit Care Me · Sep 2014
RBC Transfusions in Children Requiring Intensive Care Admission After Traumatic Injury.
To describe packed RBC utilization patterns in trauma patients admitted to a PICU and study associated outcomes while controlling for severity. ⋯ In pediatric trauma patients, transfusion of packed RBC and use of older RBC units are associated with higher risk of adverse outcomes independent of injury severity.
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The objective of this study was to determine if signs of clinical intoxication were present in patients who had transfer urine drug screens (UDS) performed and to determine the proportion of patients with UDS orders who were actually transferred to another facility. ⋯ Few (<6%) patients demonstrated any clinical characteristics that were consistent with an acute intoxication. Less than 20% of patients who had a transfer UDS were actually transferred to an outside facility corresponding with more than 80% not ordered appropriately according to the ED established guidelines. This number of inappropriate tests represented more than $152 000 of avoidable UDS cost during the study period.
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Observational Study
Racial disparities in insurance reimbursement for physician professional services in the ED.
We sought to determine whether racial disparities exist in emergency physician professional services reimbursement from insurance. We hypothesized that insured adult African American emergency department (ED) visits are reimbursed at a lower level than White visits. ⋯ In this single-center study, professional services reimbursement was lower for African American ED visits compared with those of Whites.
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The objective of the study is to examine the epidemiologic data of closed malpractice medical claims against emergency departments (EDs) in Taiwanese civil courts and to identify high-risk diseases. ⋯ Emergency physicians (EPs) in Taiwan have similar medico-legal risk as American EPs, with an annual risk of being sued of 0.63%. Almost 90% of EPs win their cases but spend 58 months in litigation, and the mean indemnity payment was $134738. Cases with indemnity paid were mostly categorized as having diagnosis errors, with the leading cause of error as failure to order an appropriate diagnostic test.