Articles: emergency-services.
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Multicenter Study
Comparison of Machine Learning Optimal Classification Trees With the Pediatric Emergency Care Applied Research Network Head Trauma Decision Rules.
Computed tomographic (CT) scanning is the standard for the rapid diagnosis of intracranial injury, but it is costly and exposes patients to ionizing radiation. The Pediatric Emergency Care Applied Research Network (PECARN) rules for identifying children with minor head trauma who are at very low risk of clinically important traumatic brain injury (ciTBI) are widely used to triage CT imaging. ⋯ If implemented, OCTs may help reduce the number of unnecessary CT scans, without missing more patients with ciTBI than the PECARN rules.
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Multicenter Study
Perspectives of ambulatory patients visiting the emergency department during the Christmas and New Year holiday period: Descriptive survey.
To assess the perceptions of ambulatory patients presenting to the emergency department (ED) of symptom acuity and access to care; the proportion of ambulatory patients who contacted their GPs before attending the ED; and patients' knowledge about whether their GPs provide after-hours or walk-in services. ⋯ A large proportion of ambulatory patients would have seen their GP for their medical issue if they thought that they had same-day or next-day access. There is a need for general and emergency physicians to work together on improving access to acute care services.
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Multicenter Study
Decreasing the Lag Between Result Availability and Decision-Making in the Emergency Department Using Push Notifications.
Emergency department (ED) patient care often hinges on the result of a diagnostic test. Frequently there is a lag time between a test result becoming available for review and physician decision-making or disposition based on that result. We implemented a system that electronically alerts ED providers when test results are available for review via a smartphone- and smartwatch-push notification. We hypothesized this would reduce the time from result to clinical decision-making. ⋯ Implementation of a push notification system for test result availability in the ED was associated with a decrease in lag time between test result and physician decision-making in the examined clinical scenarios. Push notifications were used in only a minority of ED patient encounters.
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Letter Multicenter Study
Emergency department visits for chemical substance-related injuries.
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Multicenter Study Observational Study
Modification of the Emergency Severity Index Improves Mortality Prediction in Older Patients.
Older patients frequently present to the emergency department (ED) with nonspecific complaints (NSC), such as generalized weakness. They are at risk of adverse outcomes, and early risk stratification is crucial. Triage using Emergency Severity Index (ESI) is reliable and valid, but older patients are prone to undertriage, most often at decision point D. The aim of this study was to assess the predictive power of additional clinical parameters in NSC patients. ⋯ Adding the physicians' first impressions to vital signs at decision point D increases predictive power of 30-day mortality significantly. Therefore, a modified ESI could improve predictive power of triage in older patients presenting with NSCs.