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1.
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2.
Sang-Kyoon Han Seok-Ran Yeom Sung-Hwa Lee Soon-Chang Park Hyung-Bin Kim Young-Mo Cho Sung-Wook Park 《The American journal of emergency medicine》2017,35(2):281-284
Objectives
Despite the low diagnostic yield of echocardiogra0, it is often used in the evaluation of syncope. This study determined whether patients without abnormalities in the initial evaluation benefit from transthoracic echocardiogram (TTE) and the clinical factors predicting an abnormal TTE.Methods
This study enrolled 241 patients presenting to the emergency department with syncope. The TTE results were analyzed based on risk factors suggesting cardiogenic syncope in the initial evaluation.Results
Of the 115 patients with at least one risk factor, 97 underwent TTE and 27 (27.8%) had TTE abnormalities. In comparison, of the 126 patients without risk factors, 47 underwent TTE and only 1 (2.1%) had TTE abnormalities. Significantly different factors between patients with normal and abnormal TTE findings were entered in a multiple logistic regression analysis, which yielded age [adjusted odds ratio (aOR), 1.09; 95% CI, 1.02–1.15; p = 0.006], an abnormal electrocardiogram (ECG) (aOR, 7.44; 95% CI, 1.77–31.26; p = 0.010), and a brain natriuretic peptide (BNP) level of > 100 pg/mL (aOR, 2.64; 95% CI, 1.21–5.73; p = 0.011) as independent predictors of TTE abnormalities. The cutoff value of age predicting an abnormal TTE was 59.0 years (area under the curve, 0.777; p < 0.001).Conclusion
A patient who is older than 59 years or has an abnormal ECG or an elevated BNP level may benefit from TTE. Otherwise, TTE should be deferred in patients with no risk factors in the initial evaluation. 相似文献3.
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4.
Keunha Hwang Sung-Bin Chon Jung Gi Im 《The American journal of emergency medicine》2017,35(12):1899-1906
Background
To determine the optimum chest compression site during cardiopulmonary resuscitation (CPR) with regard to heart failure (HF) by applying three-dimensional (3D) coordinates on computed tomography (CT).Methods
This retrospective, cross-sectional study involved adults who underwent echocardiography and CT on the same day from 2007 to 2017. Incomplete CT images or information on HF, cardiac medication between echocardiography and CT, or thoracic abnormalities were excluded. Cases were checked whether they had HF through symptom/sign assessment, N-terminal pro-B type natriuretic peptide, and echocardiography. We set the xiphisternal joint's midpoint as the reference (0, 0, 0) to draw a 3D coordinate system, designating leftward, upward, and into-the-thorax directions as positive. The coordinate of the maximum LV diameter's midpoint (P_max.LV) was identified.Results
Enrolled were 148 patients (63.0 ± 15.1 years) with 87 females and 76 HF cases. P_max.LV of HF cases was located more leftwards, lower, and deeper than non-HF cases (5.69 ± 0.98, ? 1.51 ± 1.67, 5.76 ± 1.09 cm vs. 5.00 ± 0.83, ? 0.99 ± 1.36, 5.25 ± 0.71 cm, all p < 0.05). Fewer HF cases had their LV compressed than non-HF cases (59.2% vs. 77.8%, p = 0.025) when being compressed according to the current guidelines. The aorta (vs. LV) was compressed in 85.5% and 81.9% of HF and non-HF cases, respectively, at 3 cm above the xiphisternal joint. At 6 cm above the joint, the highest allowable position according to the current guidelines, all victims would have their aorta compressed directly during CPR rather than the LV.Conclusions
The lowest possible sternum just above the xiphisternal joint should be compressed especially for HF patients during CPR. 相似文献5.
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6.
Keret Sandra Nahari Meital Merin Ofer Aharonson-Daniel Limor Goldberg Sara Adini Bruria 《The American journal of emergency medicine》2017,35(5):681-684
Background
Though hospitals' operational continuity is crucial, full institutional evacuation may at times be unavoidable. The study's objective was to establish criteria for discharge of patients during complete emergency evacuation and compare scope of patients suitable for discharge pre/post implementation of criteria.Basic procedures
Standards for patient discharge during an evacuation were developed based on literature and disaster managers. The standards were reviewed in a two-round Delphi process. All hospitals in Israel were requested to identify inpatients' that could be released home during institutional evacuation. Potential discharges were compared in 2013–2014, before and after formulation of discharge criteria.Main findings
Consensus exceeding 80% was obtained for four out of five criteria after two Delphi cycles. Average projected discharge rate before and after formulation of criteria was 34.2% and 42.9%, respectively (p < 0.001). Variance in potential dischargeable patients was 31-fold less in 2014 than in 2013 (MST = 8,452 versus MST = 264,366, respectively; p < 0.001). Differences were found between small, medium and large hospitals in mean rate of dischargeable patients: 52.1%, 41.5% and 42.2%, respectively (p = 0.001).Principle conclusions
The study's findings enable to forecast the extent of patients that may be released home during full emergency evacuation of a hospital; thereby facilitating preparedness of contingency plans. 相似文献7.
Kristin Berona Amin Abdi Michael Menchine Tom Mailhot Tarina Kang Dina Seif Mikaela Chilstrom 《The American journal of emergency medicine》2017,35(2):240-244
Purpose
The objectives of this study were to evaluate emergency medicine resident-performed ultrasound for diagnosis of effusions, compare the success of a landmark-guided (LM) approach with an ultrasound-guided (US) technique for hip, ankle and wrist arthrocentesis, and compare change in provider confidence with LM and US arthrocentesis.Methods
After a brief video on LM and US arthrocentesis, residents were asked to identify artificially created effusions in the hip, ankle and wrist in a cadaver model and to perform US and LM arthrocentesis of the effusions. Outcomes included success of joint aspiration, time to aspiration, and number of attempts. Residents were surveyed regarding their confidence in identifying effusions with ultrasound and performing LM and US arthrocentesis.Results
Eighteen residents completed the study. Sensitivity of ultrasound for detecting joint effusion was 86% and specificity was 90%. Residents were successful with ultrasound in 96% of attempts and with landmark 89% of attempts (p = 0.257). Median number of attempts was 1 with ultrasound and 2 with landmarks (p = 0.12). Median time to success with ultrasound was 38 s and 51 s with landmarks (p = 0.23). After the session, confidence in both US and LM arthrocentesis improved significantly, however the post intervention confidence in US arthrocentesis was higher than LM (4.3 vs. 3.8, p < 0.001).Conclusions
EM residents were able to successfully identify joint effusions with ultrasound, however we were unable to detect significant differences in actual procedural success between the two modalities. Further studies are needed to define the role of ultrasound for arthrocentesis in the emergency department. 相似文献8.
Xi Zhang Nicole Rowan Bethann Mangel Pflugeisen Sanjin Alajbegovic 《The American journal of emergency medicine》2017,35(4):594-598
Background
Antibiotics are overprescribed for abnormal urine tests including asymptomatic bacteriuria (AB), contributing to rising antimicrobial resistance rates. Pharmacists reviewed urine cultures daily from emergency department (ED) encounters to assess antibiotic appropriateness. We studied antibiotic prescribing practices and assessed compliance to national guidelines, correlations with urine analysis (UA) components, and opportunities for antimicrobial stewardship in the ED.Methods
This quality improvement project (QIP) was a prospective cohort study at a community hospital ED, with data collected from finalized urine cultures resulting October 30, 2014 through January 5, 2015. Analyses were conducted using Chi-squared and Fisher Exact tests and stepwise multiple logistic regression.Results
Urine cultures from 457 encounters were reviewed, of which 136 met the inclusion criteria as non-pregnant and asymptomatic for urinary tract infection (UTI). 43% of 136 patients were treated with antibiotics, for a total of 426 antibiotic days. Pharmacist interventions for these patients resulted in 122/426 (29%) of potential antibiotic days saved. Factors found to significantly increase the odds of antibiotic prescribing in asymptomatic patients included presence of leukocyte esterase (OR = 4.5, 95% CI: 1.2–17.2; p = 0.03) or nitrites (OR = 10.8, 95% CI: 1.7–68.1; p = 0.01) in the urine and age ≥ 75 (OR = 3.5, 95% CI: 1.2-9.6, p = 0.02).Discussion
Pharmacist intervention in discontinuing or modifying antibiotics for asymptomatic patients with urine cultures reduced unnecessary antibiotic exposure and was a first step in antimicrobial stewardship efforts in the ED. Future work includes limiting urine tests and subsequent antibiotic therapy for non-pregnant asymptomatic patients. 相似文献9.
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10.
Yong Hun Jung Byung Kook Lee Dong Hun Lee Sung Min Lee Yong Soo Cho Kyung Woon Jeung 《The American journal of emergency medicine》2017,35(2):268-273
Purpose
Obesity is a well-known risk factor in various health conditions. We analyzed the association between obesity and clinical outcomes, and its effect on targeted temperature management (TTM) practice for cardiac arrest survivors by calculating and classifying their body mass indexes (BMIs).Methods
We conducted a retrospective data analysis of adult comatose cardiac arrest survivors treated with TTM from 2008 to 2015. BMI was calculated and the cohort was divided into four categories based on the cut-off values of 18.5, 23.0, and 27.5 kg m? 2. The primary outcome was six-month mortality and the secondary outcomes were neurologic outcome at hospital discharge, cooling rate, and rewarming rate.Results
The study included 468 patients. Poor neurologic outcome at discharge and six-month mortality were reported in 311 (66.5%) and 271 (57.9%) patients, respectively. A multivariate logistic analysis showed that an overweight compared to normal BMI was associated with lower probability of six-month mortality (odds ratio [OR], 0.481; 95% confidence interval [CI], 0.274–0.846; p = 0.011) and poor neurologic outcome at discharge (OR, 0.482; 95% CI, 0.258–0.903; p = 0.023). BMI correlated with cooling rate (B, ? 0.073; 95% CI, ? 0.108 to ? 0.039; p < 0.001), but had no association with rewarming rate (B, 0.003; 95% CI, ? 0.001–0.008; p = 0.058).Conclusion
Overweight BMI compared to normal BMI classification was found to be associated with lower six-month mortality and poor neurologic outcome at discharge in cardiac arrest survivors treated with TTM. Higher BMI correlated with a slower induction rate. 相似文献11.
Jawad T. Ali Mitchell J. Daley Nina Vadiei Zachary Enright Joseph Nguyen Sadia Ali Jayson D. Aydelotte Pedro G. Teixeira Thomas B. Coopwood Carlos VR. Brown 《The American journal of emergency medicine》2017,35(4):632-636
Purpose
Thromboelastography (TEG) has been recommended to characterize post-traumatic coagulopathy, yet no study has evaluated the impact of pre-injury anticoagulation (AC) on TEG variables. We hypothesized patients on pre-injury AC have a greater incidence of coagulopathy on TEG compared to those without AC.Methods
This retrospective chart review evaluated all trauma patients admitted to an urban, level one trauma center from February 2011 to September 2014 who received a TEG within the first 24 h. Patients were classified as receiving pre-injury AC or no AC if their documented medications prior to admission included warfarin, dabigatran, or anti-Xa (aXa) inhibitors (apixaban or rivaroxaban). The presence of coagulopathy on TEG or conventional assays was defined by exceeding local laboratory reference standards.Results
A total of 54 patients were included (AC, n = 27 [warfarin n = 13, dabigatran n = 6, aXa inhibitor n = 8] vs. no AC, n = 27). Baseline characteristics were similar between groups, including age (72 ± 13 years vs. 72 ± 15; p = 0.85), male gender (70% vs. 74%; p = 0.76) and blunt mechanism of injury (100% vs. 100%; p = 1). There was no difference in the number of patients determined to have coagulopathy on TEG (no AC 11% vs. AC 15%; p = 0.99). Conventional tests, including the international normalized ratio (INR) and activated partial thromboplastin time (aPTT), identified coagulopathy in a high proportion of anti-coagulated patients (no AC 22% vs. AC 85%; p < 0.01).Conclusion
TEG has limited clinical utility to evaluate the presence of pre-injury AC. Traditional markers of drug induced coagulopathy should guide reversal decisions. 相似文献12.
Samantha Dankoff Patricia Li Adam J. Shapiro Terry Varshney Alexander S. Dubrovsky 《The American journal of emergency medicine》2017,35(4):615-622
Objectives
Primary objective was to characterize lung ultrasound findings in children with asthma presenting with respiratory distress to the emergency department (ED). Secondary objectives included correlating these findings with patients' clinical course in the ED.Methods
Eligible patients 2–17 years of age, underwent a lung ultrasound by the study sonographer between November 2014 to December 2015. Positive lung ultrasound was defined as the presence of ≥ 1 of the following findings: ≥ 3 B-lines per intercostal space, consolidation and/or pleural abnormalities. The treating physician remained blinded to ultrasound findings; clinical course was extracted from the medical chart.Results
A total of sixty patients were enrolled in this study. Lung ultrasound was positive in 45% (27/60) of patients: B-line pattern in 38%, consolidation in 30% and pleural line abnormalities in 12%. A positive lung ultrasound correlated with increased utilization of antibiotics (26% vs 0%, p = 0.03), prolonged ED length of stay (30% vs. 9%, p = 0.04) and admission rate (30% vs 0%, p = 0.03). Inter-rater agreement between novice and expert sonographers was excellent with a kappa of 0.92 (95% CI: 0.84–1.00).Conclusions
This study characterized lung ultrasound findings in pediatric patients presenting with acute asthma exacerbations; nearly half of whom had a positive lung ultrasound. Positive lung ultrasounds were associated with increased ED and hospital resource utilization. Future prospective studies are needed to determine the utility and reliability of this tool in clinical practice. 相似文献13.
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14.
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15.
Payman Moharamzadeh Seyedhossein Ojaghihaghighi Mohsen Amjadi Farzad Rahmani Arezoo Farjamnia 《The American journal of emergency medicine》2017,35(12):1922-1925
Objective
Local forms of the tranexamic acid have been effective in treating many haemorrhagic cases. So that the aim of the current study is to assess the effectiveness of local tranexamic acid in controlling painless hematuria in patients referred to the emergency department.Methods
This is a randomized, double-blind clinical trial study, which was conducted on 50 patients with complaints of painless lower urinary tract bleeding during June 2014 and August 2015. The patients were randomly divided into two groups of 25 people each, one group receiving tranexamic acid and the other given a placebo. During bladder irrigation, local tranexamic acid and the placebo were injected into the bladder via Foley catheter. Patients were examined over 24 h in terms of the amount of normal saline serum used for irrigation, level of hemoglobin, and blood in urine.Results
In this study it was observed that consumption of tranexamic acid significantly decreased the volume of used serum for bladder irrigation (P = 0.041) and the microscopic status of urine decreased significantly in terms of the hematuria after 24 h (P = 0.026). However, the rate of packed cell transfusion and drop in hemoglobin levels showed no significant difference in both groups of patients (P ? 0.05).Conclusion
The results of this study showed that tranexamic acid could significantly reduce the volume of required serum for bladder irrigation to clear urine, but it had no significant effect on the drop in serum hemoglobin levels. 相似文献16.
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
Background
Motor vehicle–related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States.Objectives
To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED).Methods
We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015. Electronic health records were reviewed and data extracted using a standardized review process.Results
A total of 145 motocross-related ED visits (143 unique patients) were included. Overall, 95.2% of patients were men with a median age of 25 years. Sixty-seven visits (46.2%) were associated with head or spine injuries. Forty-three visits (29.7%) were associated with head injuries, and 46 (31.7%) were associated with spine injuries. Among the 43 head injuries, 36 (83.7%) were concussions. Seven visits (16.3%) were associated with at least 1 head abnormality identified by computed tomography, including skull fracture (n = 2), subdural hematoma (n = 1), subarachnoid hemorrhage (n = 4), intraparenchymal hemorrhage (n = 3), and diffuse axonal injury (n = 3). Among the 46 spine injuries, 32 (69.6%) were acute spinal fractures. Seven patients (4.9%) had clinically significant and persistent neurologic injuries. One patient (0.7%) died, and 3 patients had severe TBIs.Conclusion
Adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries with considerable morbidity and mortality. Almost half had head or spine injuries (or both), with permanent impairment for nearly 5% and death for 0.7%. 相似文献17.
Shuang Wu Yan-min Yang Jun Zhu Jia-meng Ren Juan Wang Han Zhang Xing-hui Shao 《The American journal of emergency medicine》2017,35(11):1589-1594
Objectives
The aim of this study was to evaluate factors of digoxin use and its relation to mortality in ED patients with atrial fibrillation (AF).Methods
The Chinese AF registry enrolled 2016 AF patients from 20 representative EDs, and the period of study was one year. Predictors of digoxin use and its relation to mortality were assessed by logistic and Cox regression analyses.Results
Digoxin was assigned in 609 patients (30.6%), and younger age, lower body mass index values, and existence of permanent AF, heart failure (HF), chronic obstructive pulmonary disease, and valvular heart disease were identified to be factors associated with digoxin use. During the follow-up, compared to patients without digoxin therapy, digoxin-treated patients had significantly higher risk of all-cause death (17.2% vs. 13.0%, P = 0.012) and cardiovascular death (15.1% vs. 6.7%, P < 0.001), but similar risk of sudden cardiac death (1.1% vs. 0.7%, P = 0.341). However, after adjustment for related covariates, digoxin use was no longer notably associated with increased all-cause mortality (hazards ratio [HR] 0.973, 95% confidence interval [CI] 0.718–1.318) and cardiovascular death (HR 1.313, 95% CI 0.905–1.906). Besides, neutral associations of digoxin treatment to mortality were obtained in relevant subgroups, with no interactions observed between digoxin and gender, HF, valvular heart disease, or concomitant warfarin treatment in mortality risk.Conclusions
In ED patients with AF, digoxin was more frequently assigned to vulnerable patients with concomitant HF or valvular heart disease, and digoxin use was not related to a significantly increased risk of mortality. 相似文献18.
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19.
Ihsan Yigit Metin Atescelik Mustafa Yilmaz Mehmet Cagri Goktekin Mehtap Gurger Nevin Ilhan 《The American journal of emergency medicine》2017,35(12):1895-1898
Objective
We aimed to determine the levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1) in patients admitted to the emergency department with impaired consciousness due to metabolic or neurological reasons.Materials – methods
The study included 80 patients with ischemic stroke (IS), 40 patients with intracranial hemorrhage (ICH), 80 patients with metabolic disorder induced impaired consciousness (MDIC) and 40 healthy controls.Results
The levels of UCH-L1 [median (IQR)] were as follows: 5.59 ng/mL (3.90–9.37) in IS, 5.44 ng/ml (4.01–13.98) in ICH, 3.34 ng/ml (2.29–5.88) in MDIC and 3.94 ng/ml (3.31–7.95) in healthy volunteers. Significantly higher levels were detected in IS and ICH than in MDIC and healthy volunteers. In ROC curve analysis, we detected 63.75% sensitivity and 62.5% specificity (AUC = 0.626, p < 0.0199, 95% CI: 0.533–0.713) with a cutoff value of 4.336 ng/ml for IS and 75% sensitivity and 55% specificity (AUC = 0.664, p < 0.0071, 95% CI: 0.549–0.766) with a cut-off value of 4.036 ng/ml for ICH. However, the sensitivity and specificity for MDIC was 36.25% and 77.5%, respectively, with a cut-off value of 3.256 ng/ml (AUC = 0.525, p = 0.6521, 95% CI: 0.432–0.617). UCH-L1 levels were found to increase significantly with increasing time between the onset of symptoms and blood sampling (r = 0.345, p < 0.001). However, no correlation was found between UCH-L1 levels and age (r = 0.014, p = 0.833), GCS (r = ? 0.115, p = 0.074), mRS (r = 0.063, p = 0.475) and NIHSS (r = 0.056, p = 0.520).Conclusion
In this study, we detected significantly higher levels of UCH-L1 in patients with IS and ICH compared to patients with MDIC and healthy volunteers. 相似文献20.
Anton Kalén Alexandra Pérez-Ferreirós Roberto Barcala-Furelos María Fernández-Méndez Alexis Padrón-Cabo Jose A. Prieto Andrés Ríos-Ave Cristian Abelairas-Gómez 《The American journal of emergency medicine》2017,35(12):1887-1891