Articles: emergency-department.
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The Emergency Department (ED) is being increasingly utilized as a pathway for management of acute conditions such as the urinary tract infections (UTIs). ⋯ In children presenting to the ED with a primary diagnosis of UTI, total ED charges are increasing at an alarming rate not commensurate with the increase in overall ED visits. While the preponderance of children presenting to the ED for UTI are treated and discharged, 4.7% of patients were admitted to the hospital for further management. The strongest predictors of inpatient admission were pyelonephritis, younger age, male gender, higher comorbidity status, and concurrent hydronephrosis, stone disease, or sepsis. Managing these at-risk patients more aggressively in the outpatient setting may prevent unnecessary ED visits and subsequent hospitalizations, and reduce associated healthcare costs.
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Multicenter Study
Emergency Department Corticosteroid Use for Allergy or Anaphylaxis Is Not Associated With Decreased Relapses.
Corticosteroids (steroids) are often used to mitigate symptoms and prevent subsequent reactions in emergency department (ED) patients with allergic reactions, despite a lack of evidence to support their use. We sought to determine the association of steroid administration with improved clinical outcomes. ⋯ Among ED patients with allergic reactions or anaphylaxis, corticosteroid use was not associated with decreased relapses to additional care within 7 days.
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Multicenter Study
Determination of radiography requirement in wrist trauma.
The purpose of this study was to evaluate predetermined physical examination and function tests recommended to identify severe injury among patients presenting with wrist injury to the emergency department and to establish a reliable clinical decision rule capable of determining the need for radiography in wrist injuries. ⋯ The presence of one of these examination findings increases the likelihood of fracture and is adequate to recommend wrist radiography. In addition, there is a strong possibility of radiography being unnecessary if all 4 test results are negative in patients presenting with wrist injury, potentially preventing many nonessential radiographs being performed.
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Multicenter Study Observational Study
Prognostic value and risk factors of delirium in emergency patients with decompensated heart failure.
Patients with heart failure (HF) seen at the emergency department (ED) are increasingly older and more likely to present delirium. Little is known, however, about the impact of this syndrome on outcome in these patients. We aimed to investigate the prognostic value and risk factors of delirium at admission (prevalent delirium) in ED patients with decompensated HF. ⋯ Prevalent delirium in patients with decompensated HF was a predictor of short-term mortality. Routine identification of delirium in patients at risk, particularly those with greater functional dependence, can help emergency physicians in decision-making and enhance care in patients with decompensated HF.
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Multicenter Study
Management of Discharged Emergency Department Patients with a Primary Diagnosis of Hypertension: A Multicentre Study.
Introduction Many patients are seen in the emergency department (ED) for hypertension, and the numbers will likely increase in the future. Given limited evidence to guide the management of such patients, the practice of one's peers provides a de facto standard. ⋯ Half of surveyed emergency physicians report having a BP threshold to start an antihypertensive; BP levels and number of patient comorbidities were associated with a modification of the decision, while physician characteristics were not. Most physicians recommended follow-up care within seven days of ED discharge.