Articles: emergency-services.
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Multicenter Study
Utility of hepatic transaminases to recognize abuse in children.
Although experts recommend routine screening of hepatic transaminases (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) in cases of potential child physical abuse, this practice is highly variable. Our objective was to determine the sensitivity and specificity of routine transaminase testing in young children who underwent consultation for physical abuse. ⋯ In the population of children with concern for physical abuse, abdominal injury is an important cause of morbidity and mortality, but it is not so common as to warrant universal imaging. Abdominal imaging should be considered for potentially abused children when either the AST or ALT level is >80 IU/L or with abdominal bruising, distention, or tenderness.
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Multicenter Study Comparative Study
Comparing methods of detecting alcohol-related emergency department presentations.
To assess the strengths and limitations of different methods for detecting alcohol-related emergency department (ED) presentations and to compare the characteristics of patients who present to the ED with an alcohol-related presentation with ED patients who are found to be risky drinkers by a questionnaire. ⋯ Not all patients with an alcohol-related ED presentation usually drink at risky levels, nor do all risky drinkers present to the ED for an alcohol-related reason. The use of routinely recorded nursing triage text detects over a third of alcohol-related ED presentations with no additional burden on busy clinicians. As these data are potentially readily accessible, further research is needed to evaluate their validity for the detection of alcohol-related ED presentations.
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Multicenter Study
Priorities in emergency obstetric care in Bolivia--maternal mortality and near-miss morbidity in metropolitan La Paz.
To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia. ⋯ Pre-hospital barriers remain to be of great importance in a setting of this type, where there is wide availability of free maternal health care. Such barriers, together with haemorrhage in early pregnancy, pre-eclampsia detection and referral patterns, should be priority areas for future research and interventions to improve maternal health. Near-miss upon arrival and near-miss after arrival at hospital should be analysed separately as that provides additional information about factors that contribute to maternal ill-health.
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Since 2003, the Society of Chest Pain Centers (SCPC) has provided hospital accreditation for acute coronary syndrome care processes. Our objective is to evaluate the association between SCPC accreditation and adherence to the American College of Cardiology/American Heart Association (ACC/AHA) evidence-based guidelines for non-ST-segment elevation myocardial infarction (NSTEMI). The secondary objective is to describe the clinical outcomes and the association with accreditation. ⋯ SCPC-accredited hospitals had higher NSTEMI ACC/AHA evidence-based guideline adherence in the first 24 hours of care on 2 of the 5 measures. No difference in outcomes was observed. Further studies are needed to better understand the association between SCPC accreditation and improved care for patients with acute coronary syndrome.
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Multicenter Study
Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study.
Determine current resuscitation practices and outcomes in patients presenting to the emergency department (ED) with sepsis and hypoperfusion or septic shock in Australia and New Zealand (ANZ). ⋯ Management of ANZ patients presenting to ED with sepsis does not routinely include protocolised, ScvO(2)-directed resuscitation. In-hospital mortality compares favourably with reported mortality in international sepsis trials and nationwide surveys of resuscitation practices.