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1.
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2.
Jimmy L. Stickles James M. Kempema Lawrence H. Brown 《The American journal of emergency medicine》2018,36(1):24-26
Introduction
The purpose of this study was to evaluate whether increased proliferation of mobile telephones has been associated with decreased MVC notification times and/or decreased MVC fatality rates in the United States (US).Methods
We used World Bank annual mobile phone market penetration data and US Fatality Analysis Reporting System (FARS) fatal MVC data for 1994–2014. For each year, phone proliferation was measured as mobile phones per 100 population. FARS data were used to calculate MVC notification time (time EMS notified – time MVC occurred) in minutes, and to determine the MVC fatality rate per billion vehicle miles traveled (BVMT). We used basic vector auto-regression modeling to explore relationships between changes in phone proliferation and subsequent changes in median and 90th percentile MVC notification times, as well as MVC fatality rates.Results
From 1994 to 2014, larger year-over-year increases in phone proliferation were associated with larger decreases in 90th percentile notification times for MVCs occurring during daylight hours (p = 0.004) and on the national highway system (p = 0.046) two years subsequent, and crashes off the national highway system three years subsequent (p = 0.023). There were no significant associations between changes in phone proliferation and subsequent changes in median crash notification times, nor with subsequent changes in MVC fatality rates.Conclusion
Between 1994 and 2014 increased mobile phone proliferation in the U.S. was associated with shorter 90th percentile EMS notification times for some subgroups of fatal MVCs, but not with decreases in median notification times or overall MVC fatality rates. 相似文献3.
Ebru Biyikli Afsin Emre Kayipmaz Cemil Kavalci 《The American journal of emergency medicine》2018,36(4):647-650
Background
Sepsis is a potentially fatal condition with high treatment costs, and is especially common among the elderly population. The emergency management of septic patients has gained importance.Objective
Herein, we investigated the effect of admission lactate levels and the platelet-lymphocyte ratio (PLR) on the 30-day mortality among patients older than 65 years who were diagnosed with sepsis and septic shock according to the qSOFA criteria at our hospital's emergency department.Methods
This observational study was conducted retrospectively. We obtained information regarding patients' demographic characteristics, comorbid conditions, hemodynamic parameters at admission, initial treatment needs at the emergency department.Results
131 patients received a diagnosis of sepsis and septic shock at our emergency department in two years. Among these, 45% (n = 59) of the patients died within 30 days of admission. Forty (30.5%) patients required mechanical ventilation. There was a significant difference between the survival and non-survival groups with regard to systolic and diastolic blood pressures (p = 0.013 and 0.045, respectively). There were significant differences between the two groups with respect to the Glasgow Coma Scale score (p < 0.001) and BUN levels (p < 0.001). The mortality status according to qSOFA scores was revealed a significant difference between the two groups (p < 0.001).Conclusion
Our results showed that the patients who died within 30 days of admission and those who did not had comparable PLR and lactate levels (p = 0.821 and 0.120, respectively). We opine that serial lactate measurements would be more useful than a single admission lactate measurement for the prediction of mortality. 相似文献4.
Jennica Siddle Peter S. Pang Christopher Weaver Elizabeth Weinstein Daniel O&#x;Donnell Thomas P. Arkins Charles Miramonti 《The American journal of emergency medicine》2018,36(5):843-845
Background
Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery.Study objective
To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization.Methods
This was a retrospective cohort analysis of a quality improvement pilot of patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care. The primary outcome compared acute care utilization (ED visits, observation stays, inpatient visits) 90 days before MIH intervention to 90 days after.Results
Of the 203 patients seen by MIH teams, inpatient utilization decreased significantly from 140 hospitalizations pre-MIH to 26 post-MIH (83% reduction, p = 0.00). ED and observation stays, however, increased numerically, but neither was significant. (ED 18 to 19 stays, p = 0.98; observation stays 95 to 106, p = 0.30) Primary care visits increased 15% (p = 0.11).Conclusion
In this pilot before/after study, MIH significantly reduces acute care hospitalizations. 相似文献5.
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6.
7.
Jae-Hyug Woo Jong June Jeon Seung Joon Choi Jea Yeon Choi Yeon Sik Jang Yong Su Lim Young Sup Shim Su Joa Ahn Ji Hoon Park Sung Soo Lee 《The American journal of emergency medicine》2018,36(12):2139-2143
Objectives
To document the level of interobserver agreement and compare the diagnostic performances of emergency physicians and radiologists at interpreting low radiation CT images of acute appendicitis in adolescents and young adults.Methods
One hundred and seven adolescents and young adult patients (aged 15 to 44 years) that underwent 2-mSv low-dose CT for suspected acute appendicitis between June and December in 2013 were enrolled in this retrospective study. Three emergency physicians and three radiologists with different experiences of low-dose CT independently reviewed CT images. These six physicians rated the likelihood of acute appendicitis using a 5-point Likert scale. We calculated interobserver agreement and compared the diagnostic performances between emergency physicians and radiologists. And diagnostic confidence was also assessed using the likelihood of acute appendicitis.Results
Acute appendicitis was pathologically confirmed in 42 patients (39%); the remaining 65 patients were considered not to have appendicitis. Fleiss' Kappa for reliability of agreement between emergency physicians and radiologists for the diagnosis of acute appendicitis was 0.720 (95% confidence intervals (CI), 0.685–0.726). Pooled areas under the receiver operating characteristics curve (AUC) for a diagnosis of appendicitis were 0.904 and 0.944 for emergency physicians and radiologists, respectively, and these AUC values were not significantly different (95% confidence interval, ?0.087, 0.007; p = 0.0855).Conclusion
The emergency physicians and radiologists showed good interobserver agreement and comparable diagnostic performances for appendicitis in adolescents and adults using low-dose CT images. Low-dose CT could be a useful tool for the diagnosis of appendicitis by emergency physicians. 相似文献8.
Taek Hun Kim Sang Hoon Oh Kyu Nam Park Han Joon Kim Chun Song Youn Soo Hyun Kim Jeeyong Lim Hyung Ki Moon Hyo Joon Kim 《The American journal of emergency medicine》2018,36(12):2187-2191
Introduction
The aim of this study was to identify factors associated with absent hematuria in patients with symptomatic urinary stones.Methods
This retrospective study analyzed the clinical and imaging findings of emergency department patients who underwent computed tomography (CT) for suspected ureteral colic over the past 2 years. All patients also underwent a microscopic urinalysis, and the presence of 4 or more red blood cells/high-power field was defined as microhematuria.Results
A total of 798 patients were included in this study. Of these patients, 750 (94.0%) presented with hematuria, while 48 (6.0%) urine samples did not have evidence of hematuria. The group with an absence of hematuria was more likely to have a lower stone location (located in an area from the distal ureter to the bladder) and perinephric stranding on CT than the hematuria group (75.0% vs. 54.3%, p = 0.005; 47.9% vs. 30.5%, p = 0.012, respectively). The degree of hematuria at each stone location was significantly different (p = 0.001). In multivariate analysis, perinephric stranding (odds ratios (OR) 1.87 [95% confidence interval (CI) 1.01–3.46], p = 0.047), a lower stone location (OR 2.72 [95% CI 1.37–5.36], p = 0.004), and elevated serum blood urea nitrogen (BUN) levels (OR 1.06 [95% CI 1.01–1.12], p = 0.026) were associated with absent hematuria.Conclusions
In this large cohort of patients with renal colic, 6% had no microhematuria. Although some CT findings and elevated BUN were independently associated with hematuria absence, there was no difference in the demographics, time of presentation and degree and location of pain between the groups. 相似文献9.
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10.
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11.
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12.
Se Jong Oh Jin Joo Kim Jae Ho Jang In Cheol Hwang Jae Hyuk Woo Yong Su Lim Hyuk Jun Yang 《The American journal of emergency medicine》2018,36(2):243-247
Introduction
In this study, we retrospectively reviewed the patients' outcomes after cardiac arrest based on age in one center, to determine whether geriatric patients had worse outcomes.Methods
This was a single-center, retrospective cohort study. The patients admitted to the intensive care unit on successful resuscitation after OHCA were retrospectively identified and evaluated.Results
This was a retrospective cohort study of patients over 18 years of-age with return of spontaneous circulation (ROSC) (> 24 h) after cardiac arrest who were admitted to the emergency intensive care unit (EICU) and received post-cardiac arrest care between March 2007 and December 2013. Finally, a total of 295 patients were enrolled during the study period; of these, 79 patients (36.6%) had a good cerebral performance category (CPC). In stepwise multivariate analysis, young age (per 10 years) (odds ratio [OR] 1.42, 95% CI 1.00–1.99, p = 0.044), high hemoglobin level (per 1 g/dL) (OR 1.31, 95% CI 1.07–1.60, p = 0.008), non-diabetic patients (OR 15.21, 95% CI 1.85–125.3, p = 0.01), cardiogenic cardiac arrest (OR 8.68, 95% CI 3.72–20.30, p < 0.001), pre-hospital cardiopulmonary resuscitation (CPR) by bystander (OR 3.61, 95% CI 1.23–10.57, p = 0.019), short time from collapsed to ACLS (per 1 min) (OR 1.12, 95% CI 1.06–1.18, p < 0.001) had good CPC at 6-month post-admission.Conclusion
Elderly patients with OHCA had a poor neurological outcome; but several other factors were also related with the outcome. In decision-making for resuscitation, physicians should consider the patients' physiologic factors as well as age. 相似文献13.
Yan-ling Li Jun-rong Mo Nga-man Cheng Stewart S.W. Chan Pei-yi Lin Xiao-hui Chen Colin A. Graham Timothy H. Rainer 《The American journal of emergency medicine》2018,36(6):988-992
Objective
The diagnosis of shock in patients presenting to the emergency department (ED) is often challenging. We aimed to compare the accuracy of experienced emergency physician gestalt against Li's pragmatic shock (LiPS) tool for predicting the likelihood of shock in the emergency department, using 30-day mortality as an objective standard.Method
In a prospective observational study conducted in an urban, academic ED in Hong Kong, adult patients aged 18 years or older admitted to the resuscitation room or high dependency unit were recruited. Eligible patients had a standard ED workup for shock. The emergency physician treating the patient was asked whether he or she considered shock to be probable, and this was compared with LiPS. The proxy ‘gold’ or reference standard was 30-day mortality. The area under the receiver operating curve (AUROC) was used to predict prognosis. The primary outcome measure was 30-day mortality.Results
A total of 220 patients fulfilled the inclusion criteria and were included in the analysis. The AUROC for LiPS (0.722; sensitivity = 0.733, specificity = 0.711, P < 0.0001) was greater than emergency physician gestalt (0.620, sensitivity = 0.467, specificity = 0.774, P = 0.0137) for diagnosing shock using 30-day mortality as a proxy (difference P = 0.0229). LiPS shock patients were 6.750 times (95%CI = 2.834–16.076, P < 0.0001) more likely to die within 30-days compared with non-shock patients. Patients diagnosed by emergency physicians were 2.991 times (95%CI = 1.353–6.615, P = 0.007) more likely to die compared with the same reference.Conclusions
LiPS has a higher diagnostic accuracy than emergency physician gestalt for shock when compared against an outcome of 30-day mortality. 相似文献14.
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15.
Jeff Dubin Eric Kiechle Matt Wilson Christian Timbol Rahul Bhat Dave Milzman 《The American journal of emergency medicine》2017,35(1):122-125
Background
The HEART score has been validated as a predictor of major adverse cardiac events (MACEs) in emergency department patients complaining of chest pain. Our objective was to determine the extent of physician variation in the HEART score of admitted patients stratified by years of experience.Methods
We performed a retrospective medical record review at an academic tertiary care emergency department to determine HEART score, outcome of hospitalization, and 30-day MACE. Electrocardiograms were graded by consensus between 3 physicians. We used analysis of variance to determine the difference in mean HEART scores between providers, Fisher's exact test to determine difference in MACE by duration of training, and logistic regression to determine predictors of low-risk admission (HEART score ≤ 3).Results
The average mean HEART score for 19 full-time physicians was 4.41 (SD 0.43). Individually, there was no difference in mean scores (P = .070), but physicians with 10-15 years of experience had significantly higher mean scores than those with 0-5 years of experience (mean HEART score 4.65 vs 3.93, P = .012). Those with 10-15 years of experience also had a significantly higher proportion of MACE in their admitted cohort (15.3%, P = .002).Conclusions
More experienced providers admitted higher-risk patients and were more likely to admit patients who would experience a MACE. More research is needed to determine whether adding the HEART score for clinical decision making can be used prospectively to increase sensitivity for admitting patients at high risk for MACE and to decrease admissions for chest pain in lower-risk patients by less experienced providers. 相似文献16.
William F. Paolo Rhonaldo Silaban Long Nguyen Susan Wojcik William Grant 《The American journal of emergency medicine》2018,36(11):1986-1992
Objective
Computerized tomography (CT) is often employed to diagnose or rule out certain suspected abdominal pathologies. The aim of this study is to compare emergency physicians' estimated post-test disease probabilities to the probabilities obtained for similar diagnostic tests as reported in the literature.Methods
Physicians were asked to estimate pre and posttest probabilities before and after CT scan results in patients with nontraumatic abdominal and pelvic pain. The actual post-test probability was calculated using published likelihood ratios and compared to physician judgment.Results
210 patient encounters were included. In the negative CT group, physicians' median pre-test probability was 40% with a post-test probability of 0%, while the actual post-test probability is 4.2% (p < 0.001). Physicians' median pre-test probability for a positive CT was 70% with a post-test probability of 100%, while the actual post-test probability is 98% (p < 0.001). The diverticulitis subgroup had no significant differences between physician and actual post-test probabilities. The post-op abscess subgroup had significant differences in post-test probabilities in both the negative CT (30% difference, p = 0.028) and positive CT subgroups (?37% difference, p = 0.003).Conclusions
When applying the probability theory of disease, physicians tend to overestimate the power of CT scanning. The difference in physician and actual post-test probabilities may be small or not clinically significant in diseases with good positive and negative likelihood ratios such as in diverticulitis; however, this difference may be large and clinically significant in diseases with poor likelihood ratios such as in post-op abscess. 相似文献17.
Darren Yap Miane Ng Madhu Chaudhury Nik Mbakada 《The American journal of emergency medicine》2018,36(1):171.e1-171.e3
Introduction
Blunt chest injury is a common presentation to the emergency department. However, a delayed hemothorax after blunt trauma is rare; current literature reports a delay of up to 30 days. We present a case of 44-day delay in hemothorax which has not been previously reported in current literature.Case report
A 52-year-old Caucasian male first presented to the emergency department complaining of persistent right sided chest pain 2 weeks after having slipped on a wet surface at home. His initial chest X-ray showed fractures of the right 7th and 8th ribs without a hemothorax or pneumothorax.He returned 30 days after the initial consultation (44 days post-trauma) having increasing shortness of breath. A chest X-ray this time revealed a large right hemothorax and 1850 ml of blood drained from his chest.There was a complete resolution of the hemothorax within 48 h and the patient was discharged after a 6-week follow-up with the chest physicians.Discussion
Delayed hemothorax after blunt trauma is a rare clinical occurrence but associated with significant morbidity and mortality. The management of delayed hemothorax includes draining the hemothorax and controlling the bleeding.Why should an emergency physician be aware of this?
Emergency physicians should be vigilant and weary that hemothorax could be a possibility after a chest injury despite a delay in presentation. A knowledge of delayed hemothorax will prompt physicians in providing important advice, warning signs and information to patients after a chest injury to avoid a delay in seeking medical attention. 相似文献18.
Mofiyinfolu Sokoya Justin Eagles Tyler Okland Dylan Coughlin Hannah Dauber Christopher Greenlee Andrew A. Winkler 《The American journal of emergency medicine》2018,36(5):780-783
Introduction
The effect of marijuana on human health has been studied extensively. Marijuana intoxication has been shown to affect performance, attention span, and reaction time. The public health relationship between trauma and cannabis use has also been studied, with mixed conclusions. In this report, the effect of marijuana legalization on many aspects of facial trauma at two hospitals in Denver, Colorado is examined.Methods
A retrospective review of the electronic medical records was undertaken. Mann-Whitney U tests were used to compare age of patients before and after legalization, and chi squared analyses were used to compare mechanism of injury, and fracture types before and after recreational marijuana legalization in Denver, Colorado. Geographical location of patients was also considered.Results
No significant increase was found in race before and after marijuana legalization (p = 0.19). A significant increase in age was found before (M = 39.54, SD = 16.37), and after (M = 41.38, SD = 16.66) legalization (p < 0.01). Maxillary and skull base fracture proportions significantly increased following legalization (p < 0.001 and p < 0.001 respectively). No significant differences were seen in the proportion of patients who lived in urban and rural counties before and after legalization (p > 0.05).Conclusion
Public health efforts should be directed towards educating residents and visitors of Colorado on the effects and toxicology of marijuana. More epidemiologic studies are needed for further assessment of the long-term effects of the legalization of marijuana on the population. 相似文献19.
Inanc Karakoyun Ayfer Colak Fatma Demet Arslan Aybike Gunaslan Hasturk Can Duman 《The American journal of emergency medicine》2017,35(11):1677-1681
Introduction
The incidence of heart failure (HF) has reached epidemic levels in western populations, and the majority of these patients are admitted to hospitals through the emergency department (ED). We aimed to aid clinicians assessing natriuretic peptide (NP) levels in cases with suspected HF. In this study, we investigated the effect of anemia on amino-terminal pro-BNP (NT-proBNP) and on B-type natriuretic peptide (BNP) levels.Methods
This retrospective study examined patients who were admitted to the ED with suspected HF. After admission, the treating physician requested complete blood count and creatinine tests with NT-proBNP (n = 2.637) or BNP (n = 11.159). The exclusion criteria were used to minimize the factors that could affect the NT-proBNP and BNP results. We examined the data using the Mann-Whitney U test, Chi-square test, Spearman correlation test, and multivariate linear regression analyses.Results
The NT-proBNP and BNP levels were statistically higher in the groups with anemia (p = 0.016 and p = 0.009, respectively). There was a statistically significant negative correlation between hemoglobin and NP levels (r = ? 0.272, p < 0.001 for NT-proBNP and r = ? 0.179, p < 0.001 for BNP). The results indicated that advanced age and low hemoglobin levels were significantly associated with the increase in NT-proBNP (p = 0.024 and p = 0.004, respectively). Advanced age, low hemoglobin and low GFR-MDRD levels were significantly associated with the increase in BNP (p < 0.001, p = 0.002 and p = 0.013, respectively).Discussion
The data suggest that clinicians examining patients admitted to the ED with suspected HF should consider that anemia could lead to increases in NT-proBNP and BNP levels. 相似文献20.