Articles: emergency-services.
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Asthma is a leading cause of pediatric emergency department visits, yet few tools exist to objectively measure asthma severity. Diaphragmatic ultrasound (DUS) is a novel method of assessing respiratory distress; however, data are lacking for children.Our primary aim was to determine if diaphragmatic excursion (DE), diaphragmatic thickening (DT), or diaphragmatic thickening fraction (TF) correlated with asthma severity as determined by the Pediatric Respiratory Assessment Measure (PRAM) score. Secondarily, we examined if these parameters correlated with need for respiratory support and evaluated interrater reliability. ⋯ In this pilot study, we conclude that DUS may be helpful in assessing severity of asthma. The midaxillary view assessment for DT and TF had the best correlation with asthma severity and the best interrater reliability. Future studies may benefit from focusing on the midaxillary view for DT and TF.
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Health-related social problems may be conceptualized as the presence of either a social risk (i.e., food insecurity as defined by a screening tool) or a social need (i.e., desire for referral to a food program). Identification of social risks may not correlate with patients' desire to receive help. This study aimed to identify and compare patients and families with social risks versus social needs in a pediatric emergency department. ⋯ Both social risks and self-identified social needs should be considered within social care interventions in the pediatric healthcare setting.
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Emergency department (ED) overcrowding presents a global challenge that inhibits prompt care for critically ill patients. Traditional 5-level triage system that heavily rely on the judgment of the triage staff could fail to detect subtle symptoms in critical patients, thus leading to delayed treatment. Unlike previous rivalry-focused approaches, our study aimed to establish a collaborative machine learning (ML) model that renders risk scores for severe illness, which may assist the triage staff to provide a better patient stratification for timely critical cares. ⋯ The traditional 5-level triage system often falls short, leading to under-triage of critical patients. Our models include a score-based differentiation within a triage level to offer advanced risk stratification, thereby promoting patient safety.
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Health care systems are increasingly screening for unmet social needs. The association between patient-reported social needs and health care utilization is not well understood. ⋯ Patient-reported social needs were common and associated with health care utilization patterns. Future research should identify interventions to address unmet social needs to improve health and avoid potentially preventable escalating medical intervention.
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Case Reports
Alien hand syndrome: An atypical presentation of acute left parietal stroke in a community emergency department.
A case of Alien hand syndrome as a presentation of an acute left parietal stroke to improve emergency providers recognition of the condition as a manifestation of acute stroke. We report a case of an 81-year-old female who presented with a complaint of inability to control her right arm accompanied with a subjective sense of right upper extremity numbness and weakness. ⋯ This presentation of stroke is important for emergency providers to recognize as it is uncommon, greater awareness by emergency providers may improve stroke outcomes by early detection and activation of routine acute stroke interventions. In this case report a patient presented with alien hand syndrome, with inability to control her right hand along with a subjective complaint of numbness and reduction in strength in the right upper extremity, found to be due to an acute left parietal stroke that was confirmed by MRI imaging.