Articles: emergency-services.
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The authors investigated whether models using time series methods can generate accurate short-term forecasts of emergency department (ED) bed occupancy, using traditional historical averages models as comparison. ⋯ Both a sinusoidal model with AR-structured error term and a seasonal ARIMA model were found to robustly forecast ED bed occupancy 4 and 12 hours in advance at three different EDs, without needing data input beyond bed occupancy in the preceding hours.
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Multicenter Study Comparative Study
Effect of prehospital triage on revascularization times, left ventricular function, and survival in patients with ST-elevation myocardial infarction.
Shorter reperfusion times lead to better outcomes in patients with ST-elevation myocardial infarction (STEMI). We assessed the efficacy of prehospital triage with bypass of community hospitals and early activation of the cardiac catheterization team on revascularization times, left ventricular (LV) ejection fraction, and survival. Patients with STEMI (624) were divided into 3 groups determined by site of triage: ambulance field triage (163), interventional center emergency department (202), and 3 community hospital emergency departments (259). ⋯ With time-dependent Cox regression modeling the difference in survival was significant only during the first week after STEMI (p = 0.020). Every extra minute of symptom onset to reperfusion time was associated with a relative risk of long-term mortality of 1.003 (95% confidence interval 1.000 to 1.006, p = 0.027). In conclusion, field triage of patient with STEMI decreased revascularization times, which preserved LV function, and improved early survival.
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To determine the efficacy of the abbreviated Mortality in Emergency Department Sepsis (MEDS) score, the Modified Early Warning (MEW) score and near-patient-test (NPT) lactate levels in predicting 28-day mortality in adult emergency department (ED) patients with sepsis. ⋯ These results demonstrate the efficacy of the abbreviated MEDS score, the MEW score and NPT venous lactate levels in predicting 28-day mortality in ED patients with sepsis. The abbreviated MEDS score was found to be the best performing risk assessment model which, with prospective validation, may aid early clinical decision-making in ED patients with sepsis and might affect the outcome from sepsis.
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Multicenter Study
Variations and gaps in management of acute asthma in Ontario emergency departments.
Variation in hospitalization rates for acute asthma in Ontario may reflect gaps between evidence and current emergency department (ED) management. We investigated ED management of asthma and differences in practice patterns for pediatric (< 20 years old) and adult (> or = 20 years old) patients in Ontario EDs. ⋯ Knowledge translation initiatives are warranted to increase adherence with best practices in emergency management of asthma (such as objective assessment of airflow rates, use of systemic steroids, and referrals) in order to reduce variations in care and improve outcomes of severe acute asthma.
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Multicenter Study Comparative Study
Lessons from the "Clean Baby 2007" pediatric decontamination drill.
Children have unique needs and are at risk of being exposed to hazardous materials and necessitating decontamination. A drill was conducted to identify problems that arise in the decontamination of children and develop recommendations for effective age appropriate decontamination. ⋯ This drill identified several key areas of concern; including the need to maintain children's warmth by using heaters and sufficient body coverings and to increase staffing to better focus on age-specific requirements such as psychosocial needs that included anxiety, modesty, and keeping families together. These needs may compromise effective decontamination. Pediatric decontamination protocols and interventions addressing all these concerns should be further studied and implemented.