Articles: emergency-department.
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Pediatric emergency care · Feb 2014
Comparative StudyRespiratory Diseases in Pediatric Triage: A Comparison Between a General Emergency Department and a Pediatric Emergency Department.
In this study, the authors have compared data concerning the pediatric triage that is carried out in 2 large emergency departments (EDs) in Rome, one located in a university pediatric clinic with qualified staff and the other one in a general hospital with a high flow of users and pediatric admissions. ⋯ In the light of what we pointed out, it is necessary to implement the educational and informative quality of the triage operators and educators, planning periodical triage training courses to reduce errors. Particular emphasis must be placed on providing pediatric continuing education for nurses practicing in general ED.
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ABSTRACTObjectives:Unenhanced computed tomography (CT) has become a standard imaging technique for uncomplicated renal colic in many countries. The appropriate timing of CT imaging has not been established, and guidelines recommend that this imaging be performed between 1 and 7 days of presentation. The primary objective of this study was to determine the prevalence of alternative diagnosis identified with low-dose unenhanced CT in the emergency department (ED) in patients with suspected uncomplicated renal colic. ⋯ Conclusion:Low-dose unenhanced CT in the ED detects alternative diagnoses in 6% (95% CI 3-10) of patients with suspected uncomplicated renal colic, half of whom are subsequently hospitalized. Our prospective findings, which were similar to those reported in retrospective studies, are a potential argument for a systematic approach to ED imaging in suspected renal colic. Future research involving intervention and control groups would be helpful.
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J Stroke Cerebrovasc Dis · Feb 2014
An emergency department intervention to increase warfarin use for atrial fibrillation.
Emergency department (ED) encounters represent lost opportunities to facilitate anticoagulation for stroke prevention in atrial fibrillation (AF). However, screening of warfarin eligibility in the ED may not be feasible. We evaluated whether a practical quality improvement initiative increased postdischarge warfarin use in ED patients with AF. ⋯ This practical stroke prevention quality improvement initiative was not associated with an increase in warfarin use among ED patients with AF.
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Pediatric neurology · Feb 2014
Comparative Study Observational StudyManagement of pediatric migraine in a tertiary care versus community based emergency department: an observational pilot study.
Because of a lack of guidelines for the management of pediatric migraine in the emergency department setting, marked variations in treatment protocols exist between institutions. We aimed to characterize differences in management strategies for pediatric migraine treatment between a community-based and a tertiary care emergency department. ⋯ Low rates of intravenous combination therapy, antidopaminergic agent, and serotonin agonist use were noted across both hospital settings. Community-based physicians used opiates and obtained neuro-imaging more than those in the academic setting. Standardization of care in the emergency setting coupled with reliable acute care plans that are based on evidenced-based guidelines can allow for better control of episodic migraine and reduce emergency department visits.
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Blood, urine, and cerebrospinal fluid cultures and admission for antibiotics are considered standard management of febrile neonates (0-28 days). We examined variation in adherence to these recommendations across US pediatric emergency departments (PEDs) and incidence of serious infections (SIs) in febrile neonates. ⋯ There was wide variation across US PEDs in adherence to recommended management of febrile neonates. One in 6 febrile neonates was discharged from the PED; discharged patients were less likely to receive testing or antibiotic therapy than admitted patients. A majority of neonates with SI received recommended evaluation and management. High rates of SI in admitted patients but low return rates for missed infections in discharged patients suggest a need for additional studies to understand variation from the current recommendations.