Articles: emergency-services.
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Observational Study
Cardiopulmonary Ultrasound to Predict Care Escalation in Early Sepsis: A Pilot Study.
It is challenging to identify emergency department (ED) patients with sepsis who will require resources such as positive-pressure ventilation, vasopressors, or intensive care unit (ICU) admission. ⋯ In patients with concern for sepsis early findings of ≥4 B-lines is associated with care escalation. Combining this finding with LVF and RV size assessment improves the positive predictive power and may be useful in rapid identification of patients likely to require care escalation.
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Background: Acute infections and sepsis are a leading cause of death. These patients are primarily encountered at the emergency department (ED), where early assessment for sepsis is necessary to improve outcome. In sepsis, the inflammatory response causes several characteristic pathophysiological changes, including a dysregulated and generalized activation of the endothelium. ⋯ Results : For sepsis, E-selectin and ICAM-1 both showed an area under the receiver operating characteristic (AUROC) of 0.62, lower than procalcitonin with 0.77 (both P < 0.01) and lactate with 0.73 ( P = 0.030 and 0.046, respectively), but similar to CRP with 0.60 ( P = 0.758 and 0.876, respectively). For 28-day in-hospital mortality among patients with infection, ICAM-1 performed best with an AUROC of 0.75. Conclusions : Despite promising results in small studies and specific cohorts, particularly in intensive care units, this large-scale evaluation of four endothelial biomarkers highlights their limited diagnostic utility in a broader inclusion setup design at the earliest possible time point of evaluation.
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Band neutrophil count greater than 10 % of the white blood cell differential (bandemia) has been associated with severe infections in emergency department (ED) patients. In January 2023, our ED instituted a critical alert for bandemia. We performed a retrospective chart review of two cohorts of emergency department patients, before and after initiation of critical alert. After critical alert initiation for bandemia, there was a 4.6-fold higher incidence of bandemia with similar baseline patient characteristics.
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Pediatric emergency care · Jan 2025
Impact of a Helmet Distribution Program in the Pediatric Emergency Department.
Bicycle helmet use has repeatedly been shown to protect riders from serious injury. Despite this, a majority of children and adolescents do not regularly wear helmets. Our primary objective was to determine if an emergency department (ED)-based helmet distribution program could increase the amount of time children report wearing helmets. ⋯ Helmet distribution programs based in the pediatric ED increase rates of bicycle helmet usage among pediatric patients. Additional study is needed to determine effect on head injury prevention.
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Appendicitis is a common surgical emergency in the pediatric population, affecting over 70,000 children per year in the United States alone. While historically practitioners predominately used computed tomography (CT) as the main diagnostic imaging modality, multiple professional societies have released guidelines recommending an ultrasound (US) first strategy when using imaging to confirm suspected appendicitis in pediatric populations. To date, no studies have quantified the change in imaging trends for pediatric appendicitis across the spectrum of healthcare facilities in the United States utilizing the Nationwide Emergency Department Sample (NEDS). ⋯ While there is an increasing trend towards US being used as the first imaging modality to diagnose pediatric appendicitis across the spectrum of facilities included in the NEDS, continued utilization of CT to diagnose appendicitis remains unacceptably high in the pediatric population within the limits of this retrospective study.