Articles: emergency-services.
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Comparative Study
Effect of gender on the emergency department evaluation of patients with chest pain.
To assess chest pain evaluation as reflected in the documentation of the evaluation process for women vs men in one emergency department (ED). ⋯ The authors' findings do not support the existence of a gender difference in ED chest pain evaluations, as reflected by documentation of the evaluation process. However, men were more likely to be admitted to the hospital for evaluation of coronary artery disease than were women.
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To describe cases of violence related to weapons in a university hospital and urban county ED and to provide related recommendations for ED staff security. ⋯ Emergency department staff should prepare for the possibility of violence by 1) recognizing the danger, 2) rehearsing response mechanisms, and 3) debriefing after incidents. In particular, plans must be made and practiced for the time when external violence follows the surviving victims of gang activity through the "sacrosanct" hospital doors. Protection of patients and ED personnel must be ensured. In many urban settings, appropriately armed security guards must be immediately accessible to the ED staff. Other suggestions for ED protection are given.
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To determine the occurrence of weapon carriage by major trauma patients at a university/county hospital ED. ⋯ ED major trauma patients at one urban trauma center in Los Angeles frequently carry weapons, including automatic military weapons. In addition to violence prevention measures such as weapon confiscation, plans must be made and practiced for the management of violence within the "sacrosanct" hospital doors to protect both patients and ED personnel.
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Pediatric emergency care · Feb 1995
Emergency department visits by children with sickle hemoglobinopathies: factors associated with hospital admission.
Children with sickle cell disease frequently present to the emergency department (ED) for evaluation of fever or management of pain. We retrospectively analyzed all ED visits by children with sickle hemoglobinopathies during 1990, excluding those for trauma. Of 146 visits by 56 children, 73 (50%) were classified as "Painful Events," 43 (29%) as "Febrile Events," 20 (14%) as "Painful and Febrile Events," and 10 (7%) as "Other." Hospital admission occurred for 42% of Painful Events versus 70% of Febrile Events (P = 0.008) and 85% of Painful and Febrile Events (P = 0.002). ⋯ For children evaluated for Febrile Events, age less than six years (P = 0.016) and maximum temperature greater than 39 degrees C (P = 0.011) were associated with subsequent hospitalization, but total white blood cell count and absolute neutrophil count were not. For Painful and Febrile Events, pain less than 24 hours (P = 0.029) was associated with hospital admission, but age, maximum temperature, white blood cell count, and absolute neutrophil count were not. Although prospective studies are needed to validate these data, the identification of factors predictive of hospital admission should expedite ED care to sickle cell patients.
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To evaluate the health outcomes of managed care Medicaid children with non-emergent conditions who were not authorized to be seen in the Pediatric Emergency Department (PED) by their primary care provider. ⋯ Diverting Medicaid children classified as non-emergent in an ER to their MAC providers can be a safe practice short-term. However, denial of a PED visit has no impact on subsequent ER utilization by Medicaid participants and may be associated with higher hospitalization rate. Gatekeeping in this setting does not necessarily change the health care seeking behavior of these patients.