Articles: emergency-services.
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Randomized Controlled Trial Multicenter Study
A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial.
Testing for pulmonary embolism often differs from that recommended by evidence-based guidelines. ⋯ A handheld decision-support system improved diagnostic decision making for patients with suspected pulmonary embolism in the emergency department.
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Critical care medicine · Nov 2009
Multicenter Study Meta Analysis Comparative StudyAssociation between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia.
To compare the 28-day mortality and hospital length of stay of patients with community-acquired pneumonia who were transferred to an intensive care unit on the same day of emergency department presentation (direct-transfer patients) with those subsequently transferred within 3 days of presentation (delayed-transfer patients). ⋯ Our findings suggest that some patients without major criteria for severe community-acquired pneumonia, according to the recent Infectious Diseases Society of America/American Thoracic Society consensus guideline, may benefit from direct transfer to the intensive care unit. Further studies are needed to prospectively identify patients who may benefit from direct intensive care unit admission despite a lack of major severity criteria for community-acquired pneumonia based on the current guidelines.
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Pediatric emergency care · Nov 2009
Multicenter Study Comparative StudyEpidemiology of psychiatric-related visits to emergency departments in a multicenter collaborative research pediatric network.
Describe the epidemiology of pediatric psychiatric-related visits to emergency departments participating in the Pediatric Emergency Care Applied Research Network. ⋯ Pediatric psychiatric-related visits require more prehospital and emergency department resources and have higher admission/transfer rates than non-psychiatric-related visits within a large national pediatric emergency network.
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Multicenter Study
The national clinical audit of falls and bone health: the clinical management of hip fracture patients.
The standards of care for older people who present with a fractured neck of femur (#NOF) have been defined by previously published national guidelines. To assess compliance with these standards the Healthcare Commission commissioned the Clinical Effectiveness and Evaluation Unit (CEEU) for the Royal College of Physicians to deliver 'The National Clinical Audit of Falls and Bone Health for Older People'. ⋯ There are currently unacceptable wide variations in the delivery of clinical care to older people presenting with a #NOF. Of concern were the long lengths of time in A&E for many patients and the low level of routine access to pre-operative medical assessment. It is hoped that the launch of joint initiatives between the British Orthopaedic Association and the British Geriatric Society aimed at delivering service improvements in this area should lead to improved outcomes.
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Critical care medicine · Nov 2009
Multicenter StudySelection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: An observational, multicenter, prospective study.
To describe intensive care unit referral decisions by emergency room physicians in patients aged > or =80 yrs. ⋯ Emergency and intensive care unit physicians were extremely reluctant to consider intensive care unit admission of patients aged > or =80 yrs, despite the presence of criteria indicating that intensive care unit admission was certainly or possibly appropriate.