Articles: emergency-services.
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Multicenter Study
Multicenter study of adolescent suicide attempts by poisoning: social, epidemiological, and clinical characteristics.
To evaluate the social, epidemiological, and clinical characteristics of patients brought to Spanish pediatric emergency departments (EDs) after suicide attempts by poisoning. A secondary objective was to identify risk factors for moderate-severe poisoning. ⋯ Pediatric ED visits for suicide attempts by poisoning occur mainly in adolescent girls, and a majority have a medical history of a psychiatric diagnosis, prior suicide attempts, or self-harm behaviors. They have also often experienced bullying. Characteristics that distinguish patients with moderate-severe poisoning are the presence of an adjustment disorder and the use of opioids and antidiabetic drugs, which confer risk for greater severity.
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Emerg Med Australas · Dec 2024
Multicenter StudyIs clinician reported practice in Western Australian emergency departments aligned with direct discharge pathway protocols for minor self-limiting fractures? A multi-centre professional survey.
To determine ED clinician's current management for five common minor self-limiting fractures (MSLF) and evaluate practice against evidence-informed direct discharge pathway (DD) protocols. ⋯ Survey results suggested system wide variation in ED fracture management practice and target areas for service improvement. Avenues for service improvement could include hospital wide agreed management plans for specific fractures and support for less experienced clinicians.
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Multicenter Study
Epidemiologic and clinical characteristics and course of acute heart failure and cardiogenic shock diagnosed in emergency departments.
To describe the characteristics of patients diagnosed with acute heart failure (AHF) in emergency departments (EDs) who develop cardiogenic shock (CS) not associated with ST-segment elevation acute coronary syndrome (STACS). ⋯ CS occurring outside a context of STACS is uncommon in ED patients with AHF and is related to poorer functional class. More of these patients have valve disease, hyponatremia, and non-STACS as a precipitant. Nearly 40% die in hospital. Almost a third die in the ED.
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Multicenter Study Observational Study
Subarachnoid haemorrhage in the emergency department (SHED): a prospective, observational, multicentre cohort study.
People presenting to the ED with acute severe headache often undergo investigation to exclude subarachnoid haemorrhage (SAH). International guidelines propose that brain imaging within 6 hours of headache onset can exclude SAH, in isolation. The safety of this approach is debated. We sought to externally validate this strategy and evaluate the test characteristics of CT-brain beyond 6 hours. ⋯ Our data suggest a very low likelihood of SAH after a negative CT-brain scan performed early after headache onset. These results can inform shared decision-making on the risks and benefits of further investigation to exclude SAH in ED patients with acute headache.
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Multicenter Study
Implementation, Clinical Benefit and Safety of a D-Dimer-Focused Pulmonary Embolism Testing Pathway in the Emergency Department.
Computed tomography pulmonary angiogram (CTPA) is overused during pulmonary embolism (PE) testing in the emergency department (ED), whereas prediction rules and D-dimer are underused. We report the adherence, clinical benefit, and safety of a D-dimer-only strategy to guide need for PE imaging in the ED. ⋯ In this Canadian ED study, the uptake of a D-dimer-only PE testing strategy was high. Implementation was associated with higher imaging yield and a D-dimer level of less than 500 ng/mL safely excluded PE.