Articles: emergency-services.
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Existing screening tools for sepsis in children are limited by suboptimal sensitivity. Our objective was to develop a new, more sensitive screening tool for pediatric septic shock by enhancing 2 aspects of the 4-point Liverpool quick Sequential Organ Failure Assessment (LqSOFA) tool. ⋯ The qPS4, with 2 enhancements to the LqSOFA, demonstrated overall improved sensitivity and specificity for pediatric septic shock.
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80 % of Americans wish to die somewhere other than a hospital, and hospice is an essential resource for providing such care. The emergency department (ED) is an important location for identifying patients with end-of-life care needs and providing access to hospice. The objective of this study was to analyze a quality improvement (QI) program designed to increase the number of patients referred directly to hospice from the ED, without the need for an observation stay and without access to in-hospital hospice. ⋯ In this largest study to date on direct ED-to-hospice discharges, a QI program focused on workflow optimization, education, and EMR modification was insufficient to significantly impact ED-to-hospice discharges. Future efforts to increase hospice transitions from the ED should investigate methods to improve patient identification, the impact of in-hospital hospice programs, and coordination with hospital and community teams to support home-based care for those desiring to remain there.
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Traffic accidents are significant causes of death and serious injury in children. Children's clinical findings are more subtle and there is a risk of faster deterioration. On the other hand, radiation sensitivity due to imaging is also high. These challenging factors highlight the importance of approaching pediatric trauma cases. In our study, we aimed to contribute to current approaches by examining the clinical course and profiles of children involved in traffic accidents. This study aimed to analyze the profiles and clinical courses of children involved in road traffic accidents. ⋯ In-vehicle accidents were the most frequent type of accident, and children under 4 years old had a higher incidence of in-car accidents than other age groups. Males made up 60 % of the cases, with boys having higher rates of motorcycle and extra-vehicular accidents compared to girls. While most children had no injuries from the accidents, those who did generally recovered well with outpatient monitoring. On the other hand, 89 % of patients underwent imaging at a high rate.
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Observational Study
Usefulness of mid-regional pro-adrenomedullin for stratifying risk in emergency department patients with solid tumors attended for febrile neutropenia secondary to chemotherapy.
To analyze the usefulness of mean mid-regional pro-adrenomedullin (MR-proADM) level to stratify risk in emergency department patients with solid tumors attended for febrile neutropenia after chemotherapy. To compare risk prediction with MR-proADM to that of conventional biomarkers and scores on the Multinational Association for Supportive Care in Cancer (MASCC) score. ⋯ Risk stratification in cancer patients with febrile neutropenia is essential for decision-making in the ED. MR-proADM was the best predictor of serious complications in these patients, and combining it with any of the other variables did not improve prediction.
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Emergency department (ED) screening for child physical abuse has been widely implemented, with uncertain effects on child abuse identification. Our goal was to determine the effect of screening on referrals to child protective services (CPS) identifying abuse. ⋯ Routine screening did not affect initial or subsequent referrals to CPS.