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1.
R. Sagisaka H. Tanaka H. Takyu H. Ueta S. Tanaka 《The American journal of emergency medicine》2017,35(10):1462-1468
Background
Repeated administration of epinephrine is associated with unfavorable cerebral outcome after out-of-hospital cardiac arrests (OHCA), but the timing of epinephrine administration has not been considered.Aim
The aim of the study was to analyze the effects of repeated epinephrine administration after OHCA on favorable cerebral function coded by cerebral performance categories (CPC 1–2).Methods
A nationwide, retrospective, population-based observational study was conducted by using Utstein-style data between 2010 and 2012 in Japan. The total of 11,876 cardiogenic and witnessed OHCA were stratified into 3 categories by the number of times epinephrine was administered (single, double, and three or more). In addition, the time elapsed between the emergency call and the initial epinephrine administration was divided into 3 time intervals (5 to 20 min for the early administration group [EAG], 21 to 26 min for the intermediate administration group [IAG], and 27 to 60 min for the late administration group [LAG]). The primary endpoint was CPC 1–2 at 1 month after cardiac arrest. A multivariable logistic regression was used for analysis.Results
Achievement of CPC 1–2 at 1 month was 4.8% for single, 2.4% for double, and 1.7% for three or more administered doses. For single and three or more administrationConclusion
Repeated epinephrine administration improved CPC 1–2 outcome when epinephrine was administrated within 20 min after an emergency call for witnessed cardiogenic OHCA. 相似文献2.
Mauro Giordano Tiziana Ciarambino Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Luca Rinaldi Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(5):749-752
Study objective
We investigated seasonal prevalence of hyponatremia in the emergency department (ED).Design
A cross-sectional study using clinical chart review.Setting
University Hospital ED, with approximately 28 000 patient visits a year.Type of participants
We reviewed 15 049 patients, subdivided in 2 groups: the adult group consisting of 9822 patients aged between 18 and 64 years old and the elderly group consisting of 5227 patients aged over 65 years presenting to the ED between January 1st, 2014 and December 31st, 2015.Intervention
Emergency patients were evaluated for the presence of hyponatremia by clinical chart review.Measurements and main results
Hyponatremia was defined as a serum sodium level < 135 mmol/l. Mean monthly prevalence of hyponatremia was of 3.74 ± 0.5% in the adult group and it was significantly increased to 10.3 ± 0.7% in the elderly group (p < 0.05 vs adults). During the summer, hyponatremia prevalence was of 4.14 ± 0.2% in adult and markedly increased to 12.52 ± 0.7% (zenith) in elderly patients (p < 0.01 vs adult group; p < 0.05 vs other seasons in elderly group). In the elderly group, we reported a significant correlation between weather temperature and hyponatremia prevalence (r: 0.491; p < 0.05).Conclusion
We observed a major influence of climate on the prevalence of hyponatremia in the elderly in the ED. Decline in renal function, salt loss, reduced salt intake and increased water ingestion could all contribute to developing hyponatremia in elderly patients during the summer. These data could be useful for emergency physicians to prevent hot weather-induced hyponatremia in the elderly. 相似文献3.
Saee Byel Kang Kyung Su Kim Gil Joon Suh Woon Yong Kwon Kyoung Min You Min Ji Park Jung-In Ko Taegyun Kim 《The American journal of emergency medicine》2017,35(10):1457-1461
Background
The aim of this study was to investigate whether the 1-year survival rate of out-of-hospital cardiac arrest (OHCA) patients with malignancy was different from that of those without malignancy.Methods
All adult OHCA patients were retrospectively analyzed in a single institution for 6 years. The primary outcome was 1-year survival, and secondary outcomes were sustained return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and discharge with a good neurological outcome (CPC 1 or 2). Kaplan-Meier survival analysis and Cox proportional hazard regression analysis were performed to test the effect of malignancy.Results
Among 341 OHCA patients, 59 patients had malignancy (17.3%). Sustained ROSC, survival to admission, survival to discharge and discharge with a good CPC were not different between the two groups. The 1-year survival rate was lower in patients with malignancy (1.7% vs 11.4%; P = 0.026). Kaplan-Meier survival analysis revealed that patients with malignancy had a significantly lower 1-year survival rate when including all patients (n = 341; P = 0.028), patients with survival to admission (n = 172, P = 0.002), patients with discharge CPC 1 or 2 (n = 18, P = 0.010) and patients with discharge CPC 3 or 4 (n = 57, P = 0.008). Malignancy was an independent risk factor for 1-year mortality in the Cox proportional hazard regression analysis performed in patients with survival to admission and survival to discharge.Conclusions
Although survival to admission, survival to discharge and discharge with a good CPC rate were not different, the 1-year survival rate was significantly lower in OHCA patients with malignancy than in those without malignancy. 相似文献4.
Ki Hong Kim Sang Do Shin Kyoung Jun Song Young Sun Ro Yu Jin Kim Ki Jeong Hong Joo Jeong 《The American journal of emergency medicine》2017,35(11):1682-1690
Objectives
It is unclear whether scene time interval (STI) is associated with better neurological recovery in the emergency medical service (EMS) system with intermediate service level.Methods
Adult out-of-hospital cardiac arrest (OHCA) patients with presumed cardiac etiology (2012 to 2014) were analyzed, excluding patients not-resuscitated, occurred in ambulance/medical/nursing facility, unknown STI or extremely longer STI (> 60 min), and unknown outcomes. STI was classified into short (0.0–3.9 min), middle (4.0–7.9 min), long (8.0–11.9 min), and very-long (12.0–59.9 min), respectively. The end point was a good cerebral performance category (CPC) 1 or 2. Multivariable logistic regression by STI group (reference = short) was performed to calculate adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs) for outcomes with or without interaction term (STI 1 prehospital return of spontaneous circulation, (PROSC)).Results
Of 79,832 OHCA patients, 41,054 cases were analyzed; good CPC in the short (3.0%), middle (3.2%), long (3.0%), and very-long (2.9%) STI groups were similar, respectively (p = 0.55). The AORs (95% CI) for good CPC in the final model without interaction term were 0.74 (0.58–0.95) for the middle, 0.51 (0.39–0.67) for the long, and 0.45 (0.33–0.61) for the very-long STI group (reference = short STI). The AORs in PROSC group were 1.18 (0.97–1.44) for middle STI group, 0.72 (0.57–0.92) for long group, and 0.56 (0.42–0.77) for very-long group. The AORs in non-PROSC group were 1.22 (1.06–1.40) for middle STI group, 0.82 (0.70–0.96) for long group, and 0.70 (0.57–0.85) for very-long group.Conclusion
The middle STI (4–7 min) was associated with the highest odds of neurological recovery for patients who could not be restored in the field. The STI may be a clinically useful predictor of good neurology outcome in victims of cardiac arrest. 相似文献5.
Lukasz Szarpak Zenon Truszewski Lukasz Czyzewski Michael Frass Oliver Robak 《The American journal of emergency medicine》2017,35(1):96-100
Introduction
European Resuscitation Council as well as American Heart Association guidelines for cardiopulmonary resuscitation (CPR) stress the importance of uninterrupted and effective chest compressions (CCs). Manual CPR decreases in quality of CCs over time because of fatigue which impacts outcome. We report the first study with the Lifeline ARM automated CC device for providing uninterrupted CCs.Methods
Seventy-eight paramedics participated in this randomized, crossover, manikin trial. We compared the fraction of effective CCs between manual CPR and automated CPR using the ARM.Results
Using the ARM during resuscitation resulted in a higher percentage of effective CCs (100/min [interquartile range, 99-100]) compared with manual CCs (43/min [interquartile range, 39-46]; P < .001). The number of effective CCs decreased less over time with the ARM (P < .001), more often reached the required depth of 5 cm (97% vs 63%, P < .001), and more often reached the recommended CC rate (P < .001). The median tidal volume was higher and hands-off time was lower when using the ARM.Conclusion
Mechanical CCs in our study adhere more closely to current guidelines than manual CCs. The Lifeline ARM provides more effective CCs, more ventilation time and minute volume, less hands-off time, and less decrease in effective CCs over time compared with manual Basic Life Support and might therefore impact outcome. 相似文献6.
Yutaka Igarashi Shoji Yokobori Yudai Yoshino Tomohiko Masuno Masato Miyauchi Hiroyuki Yokota 《The American journal of emergency medicine》2017,35(10):1396-1399
Objective
In Japan, the number of patients with foreign body airway obstruction by food is rapidly increasing with the increase in the population of the elderly and a leading cause of unexpected death. This study aimed to determine the factors that influence prognosis of these patients.Methods
This is a retrospective single institutional study. A total of 155 patients were included. We collected the variables from the medical records and analyzed them to determine the factors associated with patient outcome. Patient outcomes were evaluated using cerebral performance categories (CPCs) when patients were discharged or transferred to other hospitals. A favorable outcome was defined as CPC 1 or 2, and an unfavorable outcome was defined as CPC 3, 4, or 5.Results
A higher proportion of patients with favorable outcomes than unfavorable outcomes had a witness present at the accident scene (68.8% vs. 44.7%, P = 0.0154). Patients whose foreign body were removed by a bystander at the accident scene had a significantly high rate of favorable outcome than those whose foreign body were removed by emergency medical technicians or emergency physician at the scene (73.7% vs. 31.8%, P < 0.0075) and at the hospital after transfer (73.7% vs. 9.6%, P < 0.0001).Conclusions
The presence of a witness to the aspiration and removal of the airway obstruction of patients by bystanders at the accident scene improves outcomes in patients with foreign body airway obstruction. When airway obstruction occurs, bystanders should remove foreign bodies immediately. 相似文献7.
Matthew J. Binks Rhys S. Holyoak Thomas M. Melhuish Ruan Vlok Elyse Bond Leigh D. White 《The American journal of emergency medicine》2017,35(10):1542-1546
Background
Hypoxemia increases the risk of intubation markedly. Such concerns are multiplied in the emergency department (ED) and during retrieval where patients may be unstable, preparation or preoxygenation time limited and the environment uncontrolled. Apneic oxygenation is a promising means of preventing hypoxemia in this setting.Aim
To test the hypothesis that apnoeic oxygenation reduces the incidence of hypoxemia during endotracheal intubation in the ED and during retrieval.Methods
We undertook a systematic review of six databases for all relevant studies published up to November 2016. Included studies evaluated apneic oxygenation during intubation in the ED and during retrieval. There were no exemptions based on study design. All studies were assessed for level of evidence and risk of bias. The Review Manager 5.3 software was used to perform meta-analysis of the pooled data.Results
Six trials and a total 1822 cases were included for analysis. The study found a significant reduction in the incidence of desaturation (RR = 0.76, p = 0.002) and critical desaturation (RR = 0.51, p = 0.01) when apneic oxygenation was implemented. There was also a significant improvement in first pass intubation success rate (RR = 1.09, p = 0.004).Conclusion
Apneic oxygenation may reduce patient hypoxemia during intubation performed in the ED and during retrieval. It also improves intubation first-pass success rate in this setting. 相似文献8.
Qiang Zhang Bo Liu Lianxing Zhao Zhijiang Qi Huan Shao Le An Chunsheng Li 《The American journal of emergency medicine》2017,35(10):1555-1560
Objective
The aim of this study was to conduct a meta-analysis to evaluate the efficacy of vasopressin-epinephrine compared to epinephrine alone in patients who suffered out-of-hospital cardiac arrest (OHCA).Methods
Relevant studies up to February 2017 were identified by searching in PubMed, EMBASE, the Cochrane Library, Wanfang for randomized controlled trials(RCTs) assigning adults with cardiac arrest to treatment with vasopressin-epinephrine (VEgroup) vs adrenaline (epinephrine) alone (E group). The outcome point was return of spontaneous circulation (ROSC) for patients suffering from OHCA. Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored.Results
Individual patient data were obtained from 5047 participants who experienced OHCA in nine studies. Odds ratios (ORs) were calculated using a random-effects model and results suggested that vasopressin-epinephrine was associated with higher rate of ROSC (OR = 1.67, 95% CI = 1.13–2.49, P < 0.00001, and total I2 = 83%). Subgroup showed that vasopressin-epinephrine has a significant association with improvements in ROSC for patients from Asia (OR = 3.30, 95% CI = 1.30–7.88); but for patients from other regions, there was no difference between vasopressin-epinephrine and epinephrine alone (OR = 1.07, 95% CI = 0.72–1.61).Conclusion
According to the pooled results of the subgroup, combination of vasopressin and adrenaline can improve ROSC of OHCA from Asia, but patients from other regions who suffered from OHCA cannot benefit from combination of vasopressin and epinephrine. 相似文献9.
Guillaume Gantois Erika Parmentier-Decrucq Thibault Duburcq Raphaël Favory Daniel Mathieu Julien Poissy 《The American journal of emergency medicine》2017,35(11):1672-1676
Introduction
Patients surviving a self-attempted hanging have a total neurological recovery in 57–77% of cases at hospital discharge, but no long-term data are available.Methods
In this observational study, all patients hospitalized post-self-attempted hanging in the intensive care unit (ICU) in a 5-year period were included. Neurological evaluations at 6 and 12 months were performed according to Cerebral Performance Category (CPC) scores. Factors associated with neurological recovery were determined by comparing CPC2 + 3 + 4 (bad recovery) vs. CPC1 (good recovery).Results
Of 231 patients included, 104 (47%) were found to have cardiac arrest (CA). Ninety-five (41%) patients died in the ICU: 93 (89%) in the CA group and 2 (1.6%) in the group without CA. Neurological evaluations at 6 and 12 months were obtained in 97 of the 136 surviving patients. At 6 months, in the CA group (n = 9), the CPC score was 1 for 6 patients, 2 for 2, and 4 for 1 patient. In the group without CA (n = 88), 79 patients had normal neurological status at 6 months and 78 at 12 months. Among these patients, 96% returned home, 77% returned to work, 16 (18%) patients re-attempted suicide within the year. Risk factors of neurological sequelae at 6 months were a CA at the hanging site (P = 0.045), an elevated diastolic blood pressure (87 vs. 70 mm Hg; P = 0.04), a lower initial Glasgow score (4 vs. 5; P = 0.04), and an elevated blood glucose level (139 vs. 113 mg/dL; P < 0.001).Conclusion
Patients surviving a self-attempted hanging who did not have a CA had a good neurological outcome. The rate of suicidal recidivism is particularly important, which justifies joint work with psychiatrists. 相似文献10.
Søren R. Boysen Jessica M. Pang John R. Mikler Cameron G. Knight Hugh A. Semple Nigel A. Caulkett 《The American journal of emergency medicine》2017,35(2):227-233
Introduction
There is a lack of information regarding intraosseous (IO) administration of tranexamic acid (TXA). Our hypothesis was that a single bolus IO injection of TXA will have a similar pharmacokinetic profile to TXA administered at the same dose IV.Methods
Sixteen male Landrace cross swine (mean body weight 27.6 ± 2.6 kg) were divided into an IV group (n = 8) and an IO group (n = 8). Each animal received 30 mg/kg TXA via an IV or IO catheter, respectively. Jugular blood samples were collected for pharmacokinetic analysis over a 3 h period. The maximum TXA plasma concentration (Cmax) and corresponding time as well as distribution half-life, elimination half-life, area under the curve, plasma clearance and volume of distribution were calculated. One- and two-way analysis of variance for repeated measures (time, group) with Tukey's and Bonferonni post hoc tests were used to compare TXA plasma concentrations within and between groups, respectively.Results
Plasma concentrations of TXA were significantly higher (p < 0.0001) in the IV group during the TXA infusion. Cmax occurred at 4 min after initiation of the bolus in the IV group (9.36 ± 3.20 ng/μl) and at 5 min after initiation of the bolus in the IO group (4.46 ± 0.49 ng/μl). Plasma concentrations were very similar from the completion of injection onwards. There were no significant differences between the two administration routes for any other pharmacokinetic variables measured.Conclusion
The results of this study support pharmacokinetic bioequivalence of IO and IV administration of TXA. 相似文献11.
Peter Pruitt Joshua Penn David Peak Pierre Borczuk 《The American journal of emergency medicine》2017,35(2):255-259
Background
Patients with traumatic intracranial hemorrhage and mild traumatic brain injury (mTIH) receive broadly variable care which often includes transfer to a trauma center, neurosurgery consultation and ICU admission. However, there may be a low risk cohort of patients who can be managed without utilizing such significant resources.Objective
Describe mTIH patients who are at low risk of clinical or radiographic decompensation and can be safely managed in an ED observation unit (EDOU).Methods
Retrospective evaluation of patients age ≥ 16, GCS ≥ 13 with ICH on CT. Primary outcomes included clinical/neurologic deterioration, CT worsening or need for neurosurgery.Results
1185 consecutive patients were studied. 814 were admitted and 371 observed patients (OP) were monitored in the EDOU or discharged from the ED after a period of observation. None of the OP deteriorated clinically. 299 OP (81%) had a single lesion on CT; 72 had mixed lesions. 120 patients had isolated subarachnoid hemorrhage (iSAH) and they did uniformly well. Of the 119 OP who had subdural hematoma (SDH), 6 had worsening CT scans and 3 underwent burr hole drainage procedures as inpatients due to persistent SDH without new deficit. Of the 39 OP who had cerebral contusions, 3 had worsening CT scans and one required NSG admission. No patient returned to the ED with a complication. Follow-up was obtained on 81% of OP. 2 patients with SDH required burr hole procedure > 2 weeks after discharge.Conclusions
Patients with mTIH, particularly those with iSAH, have very low rates of clinical or radiographic deterioration and may be safe for monitoring in an emergency department observation unit. 相似文献12.
Joseph B. Miller Richard M. Nowak Brian P. Reed Salvatore DiSomma Prabath Nanayakkara Michele Moyer Scott Millis Harish Kinni Phillip Levy 《The American journal of emergency medicine》2017,35(12):1915-1918
Background
Systemic hemodynamic characteristics of patients with suspected acute ischemic stroke are poorly described. The objective of this study was to identify baseline hemodynamic characteristics of emergency department (ED) patients with suspected acute stroke.Methods
This was a planned analysis of the stroke cohort from a multicenter registry of hemodynamic profiling of ED patients. The registry prospectively collected non-invasive hemodynamic measurements of patients with suspicion for acute stroke within 12 h of symptom onset. K-means cluster analysis identified hemodynamic phenotypes of all suspected stroke patients, and we performed univariate hemodynamic comparisons based on final diagnoses.Results
There were 72 patients with suspected acute stroke, of whom 38 (53%) had a final diagnosis of ischemic stroke, 10 (14%) had hemorrhagic stroke, and 24 (33%) had transient ischemic attack (TIA). Analysis defined three phenotypic clusters based on low or normal cardiac index (CI) and normal or high systemic vascular resistance index (SVRI). Patients with TIA had lower mean CI (2.3 L/min/m2) compared to hemorrhagic or ischemic stroke patients (p < 0.01).Conclusions
The study demonstrates the feasibility of defining hemodynamic phenotypes of ED patients with suspected stroke. 相似文献13.
Background
Paraphimosis is an acute urologic emergency requiring urgent manual reduction, frequently necessitating procedural sedation (PS) in the pediatric population. The present study sought to compare outcomes among pediatric patients undergoing paraphimosis reduction using a novel topical anesthetic (TA) technique versus PS.Methods
We performed a retrospective analysis of all patients < 18 years old, presenting to a tertiary pediatric ED requiring analgesia for paraphimosis reduction between October 2013 and September 2016. The primary outcome was reduction first attempt success; secondary outcomes included Emergency Department length of stay (ED LOS), adverse events and return visits. Dichotomous outcomes were analyzed by Chi-square testing and multivariate linear regression was used to compare continuous variables.Results
Forty-six patients were included; 35 underwent reduction using TA, 11 by PS. Patient age and duration of paraphimosis at ED presentation did not differ between groups. There was no difference in first attempt success between TA (32/35, 91.4%) and PS groups (9/11, 81.8%; p = 0.37). Mean ED LOS was 209 min shorter for TA patients (148 min vs. 357 min, p = 0.001) and remained significantly shorter after controlling for age and duration of paraphimosis (adjusted mean difference ?198 min, p = 0.003). There were no return visits or major adverse events in either group, however, among successful reduction attempts, PS patients more frequently experienced minor adverse events (7/9 vs. 0/32, p < 0.001).Conclusions
Paraphimosis reduction using TA was safe and effective. Compared to PS, TA was associated with a reduced ED LOS and fewer adverse events. TA could potentially allow more timely reduction with improved patient experience and resource utilization. 相似文献14.
Yuji Shono Tomohiko Akahoshi Satomi Mezuki Kenta Momii Noriyuki Kaku Jun Maki Kentaro Tokuda Tetsuro Ago Takanari Kitazono Yoshihiko Maehara 《The American journal of emergency medicine》2017,35(12):1836-1838
Background and purpose
Accurate diagnosis of acute aortic dissection (AAD) is sometimes difficult because of accompanying central nervous system (CNS) symptoms. The purpose of this study was to investigate the clinical characteristics of Type A AAD (TAAAD) with CNS symptoms.Methods
We retrospectively reviewed the medical records of 8403 patients ambulanced to our emergency and critical care center between April 2009 and May 2014.Results
We identified 59 TAAAD patients for the analysis (mean age, 67.3 ± 10.5 years; 37 (62.0%) male). Eleven patients (18.6%) presented CNS symptoms at the onset of TAAAD, and these patients complained less frequently of typical chest and back pain than those without CNS symptoms (p < 0.0001). Initial systolic and diastolic blood pressure were lower (p = 0.003, and p = 0.049, respectively) and involvement of the supra-aortic artery was more frequent in patients with CNS symptoms (p < 0.0001).Conclusion
Because CNS symptom can mask chest and back pain caused by TAAAD, physicians should always consider the possibility of TAAAD in patients with CNS symptoms in emergency medicine settings. 相似文献15.
Joshua J. Solano Nicole M. Dubosh Philip D. Anderson Richard E. Wolfe Jonathan A. Edlow Shamai A. Grossman 《The American journal of emergency medicine》2017,35(5):753-756
Background
Minimizing and preventing adverse events and medical errors in the emergency department (ED) is an ongoing area of quality improvement. Identifying these events remains challenging.Objective
To investigate the utility of tracking patients transferred to the ICU within 24 h of admission from the ED as a marker of preventable errors and adverse events.Methods
From November 2011 through June 2016, we prospectively collected data for all patients presenting to an urban, tertiary care academic ED. We utilized an automated electronic tracking system to identify ED patients who were admitted to a hospital ward and then transferred to the ICU within 24 h. Reviewers screened for possible error or adverse event and if discovered the case was referred to the departmental Quality Assurance (QA) committee for deliberations and consensus agreement.Results
Of 96,377 ward admissions, 921 (1%) patients were subsequently transferred to the ICU within 24 h of ED presentation. Of these 165 (19%) were then referred to the QA committee for review. Total rate of adverse events regardless of whether or not an error occurred was 2.1%, 19/921 (95% CI 1.4% to 3.0%). Medical error on the part of the ED was 2.2%, 20/921 (95% CI 1.5% to 3.1%) and ED Preventable Error in 1.1%, 10/921 (95% CI 0.6% to 1.8%).Conclusion
Tracking patients admitted to the hospital from the ED who are transferred to the ICU < 24 h after admission may be a valuable marker for adverse events and preventable errors in the ED. 相似文献16.
Rohit P. Shenoi Elizabeth A. Camp Daniel M. Rubalcava Andrea T. Cruz 《The American journal of emergency medicine》2017,35(12):1791-1797
Introduction
Blunt trauma is a leading cause of pediatric morbidity. We compared injuries, interventions and outcomes of acute pediatric blunt torso trauma based on intent.Methods
We analyzed de-identified data from a prospective, multi-center emergency department (ED)-based observational cohort of children under age eighteen. Injuries were classified based on intent (unintentional/inflicted). We compared demographic, physical and laboratory findings, ED disposition, hospitalization, need for surgery, 30-day mortality, and cause of death between groups using Chi-squared or Fisher's test for categorical variables, and Mann-Whitney test for non-normal continuous factors comparing median values and interquartile ranges (IQR).Results
There were 12,044 children who sustained blunt torso trauma: Inflicted = 720 (6%); Unintentional = 9563 (79.4%); Indeterminate = 148 (1.2%); Missing = 1613 (13.4%). Patients with unintentional torso injuries significantly differed from those with inflicted injuries in median age in years (IQR) [10 (5, 15) vs. 14 (8, 16); p-value < 0.001], race, presence of pelvic fractures, hospitalization and need for non-abdominal surgery. Mortality rates did not differ based on intent. Further adjustment using binary, logistic regression revealed that the risk of pelvic fractures in the inflicted group was 96% less than the unintentional group (OR: 0.04; 95%CI: 0.01–0.26; p-value = 0.001).Conclusions
Children who sustain acute blunt torso trauma due to unintentional causes have a significantly higher risk of pelvic fractures and are more likely to be hospitalized compared to those with inflicted injuries. 相似文献17.
Laurent Puy Chantal Lamy Sandrine Canaple Audrey Arnoux Nicolas Laine Ella Iacob Jean-Marc Constans Olivier Godefroy 《The American journal of emergency medicine》2017,35(5):716-719
Background and purpose
Following the reorganization of a University Medical Center onto a single campus, an Intensive Care Unit was created within the adult Emergency Department (ED ICU). We assessed the effects of these organizational changes on acute stroke management and the intravenous administration of recombinant tissue plasminogen activator (IV rtPA), as characterized by the thrombolysis rate, door-to-needle time (DNT) and outcome at 3 months.Methods
Between October 2013 and September 2015, we performed a retrospective, observational, single-center, comparative study of patients admitted for ischemic stroke and treated with IV rtPA during two 321-day periods (before and after the creation of the ED ICU). All patients with ischemic stroke were included. Multivariable logistic regression models were performed. The DNT was stratified according to a threshold of 60 min. A favorable long-term outcome was defined as a modified Rankin score ≤ 2 at 3 months.Results
A total of 1334 ischemic stroke patients were included. Among them, 101 patients received IV rtPA. The frequency of IV rtPA administration was 5.8% (39 out of 676) before the creation of the ED ICU, and 9.3% (62 out of 668) afterwards (odds ratio (OR) [95% confidence interval (CI)]: 1.67 [1.08–2.60]; p = 0.02). Additionally, the DNT was shorter (OR [95%CI]: 4.30 [1.17–20.90]; p = 0.04) and there was an improvement in the outcome (OR [95%CI] = 1.30 [1.01–2.10]; p = 0.045).Conclusion
Our results highlight the benefits of a separate ED ICU within conventional ED for acute stroke management, with a higher thrombolysis rate, reduced intrahospital delays and better safety. 相似文献18.
Tomer Begaz David Elashoff Tristan R. Grogan David Talan Breena R. Taira 《The American journal of emergency medicine》2017,35(10):1426-1429
Study objectives
To compare diagnostic test ordering practices of NPs with those of physicians in the role of Provider in Triage (PIT).Methods
This was a secondary analysis of data from a prospective RCT of waiting room diagnostic testing, where 770 patients had diagnostic studies ordered from the waiting room. The primary outcome was the number of test categories ordered by provider type. Other outcomes included total tests ordered by the end of ED stay, and time in an ED bed. We compared variables between groups using t-test and chi-square, constructed logistic regression models for individual test categories, and univariate and multivariate negative binomial models.Results
Physicians ordered significantly more diagnostic test categories than NPs (1.75 vs. 1.54, p < 0.001). By the end of their ED stay, there was no significant difference in total test categories ordered between provider type: physician 2.67 vs. NP 2.53 (p = 0.08), using a nonbinomial model, incidence rate ratio (IRR) 1.07 (0.98–1.17). Patient time in an ED bed was not significantly different between physicians and NPs (NP 244 min, SD = 133, Physicians 248 min, SD = 152) difference 4 min (? 24.3–16.1) p = 0.688.Conclusion
NPs in the PIT role ordered slightly less diagnostic tests than attending physicians. This slight difference did not affect time spent in an ED bed. By the end of the ED stay, there was no significant difference in total test categories ordered between provider types. PIT staffing with NPs does not appear to be associated with excess test ordering or prolonged ED patient stays. 相似文献19.
Mauro Giordano Tiziana Ciarambino Emanuela Lo Priore Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(11):1691-1694
Study objective
We investigated the serum sodium correction rate on length of hospitalization and survival rate, in severe chronic hyponatremic patients at the Emergency Department (ED).Design
An observational study using clinical chart review.Setting
The ED of the University Hospital of Marcianise, Caserta, Italy with approximately 30,000 patients visits a year.Type of participants
We reviewed sixty-seven patients with severe hyponatremia subdivided in 2 subgroups: group A consisting of 35 patients with serum sodium correction rate < 0.3 mmol/h and group B consisting of 32 patients with serum sodium correction rate between < 0.5 and ≥ 0.3 mmol/h.Intervention
Emergency patients were evaluated for serum sodium correction rate for hyponatremia by clinical chart review.Measurements and main results
Severe hyponatremia was defined as a serum sodium level < 120 mmol/l. Mean serum sodium correction rate of hyponatremia was of 0.17 ± 0.09% in group A and 0.41 ± 0.05% in group B (p < 0.001 vs group A). The length of hospital stay was 10.7 ± 3.7 days for group A, and it was significantly decreased to 3.8 ± 0.4 days for group B (p < 0.005 vs group A). In addition we observed that correction rate of hyponatremia in group A was associated with a significantly lower survival rate (25%) in comparison to group B (60%) (p < 0.001 vs group A).Conclusion: We observed that serum sodium correction rate ≥ 0.3 and < 0.5 mmol/h was associated with a shorter length of hospital stay and a major survival rate. 相似文献20.
Lucas Oliveira J. e Silva M. Fernanda Bellolio Elisa M. Smith David J. Daniels Christine M. Lohse Ronna L. Campbell 《The American journal of emergency medicine》2017,35(10):1485-1489