共查询到20条相似文献，搜索用时 31 毫秒
1.
A.J. Singer M.P. Than S. Smith P. McCullough T.W. Barrett R. Birkhahn M. Reed H.C. Thode W.D. Arnold L.B. Daniels C. de Filippi G. Headden W.F. Peacock 《The American journal of emergency medicine》2017,35(5):704-709
Study objectives
Few studies have prospectively compared multiple cardiac risk prediction scores. We compared the rate of missed acute myocardial infarction (AMI) in chest pain patients prospectively categorized as low risk by unstructured clinical impression, and by HEART, TIMI, GRACE, and EDACS scores, in combination with two negative contemporary cardiac troponins (cTn) available in the U.S.Methods
We enrolled 434 patients with chest pain presenting to one of seven emergency departments (ED). Risk scores were prospectively calculated and included the first two cTn. Low risk was defined for each score as HEART ≤ 3, TIMI ≤ 0, GRACE ≤ 50, and EDACS ≤ 15. AMI incidence was calculated for low risk patients and compared across scores using Χ2 tests and C statistics.Results
The patients' median age was 57, 58% were male, 60% white, and 80 (18%) had AMI. The missed AMI rate in low risk patients for each of the scores when combined with 2 cTn were HEART 3.6%, TIMI 0%, GRACE 6.3%, EDACS 0.9%, and unstructured clinical impression 0%. The C-statistic was greatest for the EDACS score, 0.94 (95% CI, 0.92–0.97).Conclusions
Using their recommended cutpoints and non high sensitivity cTn, TIMI and unstructured clinical impression were the only scores with no missed cases of AMI. Using lower cutpoints (GRACE ≤ 48, TIMI = 0, EDACS ≤ 11, HEART ≤ 2) missed no case of AMI, but classified less patients as low-risk. 相似文献2.
Nathalie Lund Klas Gränsbo Camilla Wernersson Olle Melander 《The American journal of emergency medicine》2017,35(4):610-614
Background
Acute dyspnea affects a large heterogeneous patient group with high mortality and readmission rates.Purpose
To investigate if cardiometabolic biomarkers and clinical characteristics predict readmission and death in patients hospitalized for acute dyspnea.Methods
65 dyspnea patients at a general internal medicine ward were followed for six months. The combined endpoint was readmission or death.Measurements and results
Cardiometabolic biomarkers at admission were related to the endpoint in Cox proportional hazard models (adjusted for sex, age, oxygen saturation, respiratory rate and C-reactive protein (CRP)). The biomarkers tissue-type plasminogen activator (tPA), prolactin (PRL), tumor necrosis factor receptor superfamily member 6 (FAS) and C-C motif chemokine 3 (CCL3) were independently and significantly related to the endpoint and combined into a biomarker risk score (BRS). Each SD increment of the BRS conferred a hazard ratio (HR) of 2.13 (1.39–3.27) P = 0.001. The top vs bottom tertile of the BRS conferred a HR of 4.75 (1.93–11.68) P = 0.001. Dyspnea severity was also associated with worse outcome, HR = 3.43 (1.28–9.20) P = 0.014. However, when mutually adjusted the BRS remained significant (P = 0.004) whereas dyspnea severity was not. The BRS was related to the endpoint among patients with mild to moderate dyspnea (P = 0.016) but not among those with severe dyspnea.Conclusion
A score of tPA, PRL, FAS and CCL3 predicts 6-month death and readmission in patients hospitalized for acute dyspnea and may prove useful to optimize length of stay and follow-up. Although the BRS outweighs dyspnea severity in prediction of the endpoint, its prognostic role is strongest in mild-moderate dyspnea. 相似文献3.
Hiroki Fukuhara Osamu Ichiyanagi Shinichi Midorikawa Hiroshi Kakizaki Hisashi Kaneko Norihiko Tsuchiya 《The American journal of emergency medicine》2017,35(12):1859-1866
Objective
The CHOKAI and STONE scores are prediction models for ureteral stones. The aims of the present study were to evaluate the diagnostic performance, to examine the optimal cut-off value, and to compare the diagnostic performance of each model.Methods
Patients who presented to our emergency department with renal colic were considered for this prospective study. We analyzed the predictive performance of both STONE and CHOKAI scores at their optimal cut-off values, using receiver operating characteristic (ROC) curve and area under the curve (AUC), as well as sensitivity, specificity, positive likelihood ratio (LR +), and negative likelihood ratio (LR ?) at the optimal cut-off value.Results
Of the 96 patients who met the inclusion criteria, 79 were definitively diagnosed with ureteral stones. All patients were of Japanese descent. The AUC of the CHOKAI score was 0.971 at an optimal cut-off value of 6, showing a sensitivity of 0.911, specificity of 0.941, LR + of 15.49, and LR ? of 0.094. The AUC of the STONE score was 0.873 at an optimal cut-off value of 8, showing a sensitivity of 0.823, specificity of 0.824, LR + of 4.662, and LR ? of 0.215. The AUC of the CHOKAI score was significantly higher than that of the STONE score (p = 0.010). Of the 73 patients with a CHOKAI score of ≥ 6, 98.6% had ureteral stones, and of the 68 patients with a STONE score of ≥ 8, 95.6% had ureteral stones.Conclusions
The simplified CHOKAI score is a useful tool to screen for ureteral stones in patients with renal colic. 相似文献4.
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.
Hiroaki Takada Toru Hifumi Naoki Nishimoto Takashi Kanemura Hayato Yoshioka Ichiro Okada Nobuaki Kiriu Junichi Inoue Yuichi Koido Hiroshi Kato 《The American journal of emergency medicine》2017,35(2):245-248
Objectives
Several reports have compared the efficacy of linezolid (LZD) in Methicillin-resistant Staphylococcus aureus (MRSA) infections with that of vancomycin (VCM); however, these two antibiotics for the treatment of nosocomial MRSA pneumonia in elderly patients has not been well evaluated. The purpose of this study is to evaluate the efficacy and safety of LZD compared with VCM for the treatment of elderly patients with nosocomial MRSA pneumonia in a retrospective chart review of a cohort.Methods
We included 28 consecutive patients aged ≥ 65 years hospitalized with a confirmed diagnosis of MRSA pneumonia and treated with LZD (n = 11) or VCM (n = 17) between November 2010 and May 2015. We collected patient, disease, and laboratory data. The primary outcome was 30-day mortality. The secondary outcomes were the sequential organ failure assessment (SOFA) total, respiratory, renal, coagulation, hepatic, cardiovascular, and central nervous system scores on days 1, 3, 7, and 14.Results
There were no significant differences between the two groups with regard to baseline characteristics. The 30-day mortality rate was significantly lower in the LZD group than in the VCM group (0% vs. 41%, P = .02). The SOFA total score on days 3, 7, and 14 were significantly lower those at baseline in the LZD group (P < .05). The SOFA respiratory score on days 14 was also significantly lower than baseline in the LZD group (P < .05).Conclusion
LZD may be more efficacious than VCM for treating elderly patients with nosocomial MRSA pneumonia. 相似文献7.
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8.
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9.
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10.
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11.
Orli Megged 《The American journal of emergency medicine》2017,35(1):36-38
Aim
Bacteremia is an uncommon complication of urinary tract infection (UTI). The aim of this study was to identify risk factors for bacteremic UTI in pediatric patients.Methods
The medical records of all pediatric patients with UTI between 2013 and 2014 were retrospectively reviewed. Pediatric patients with accompanying bacteremia were compared with pediatric patients with no bacteremia.Results
Five hundred twenty-seven cases of UTI were identified. Blood cultures were taken in 464, 26 (5.6%) of which also were bacteremic. Pediatric patients with bacteremia were more likely to be male (58% vs 28%, P < .01), to be younger than 3 months (54% vs 31%, P = .02), and to have higher creatinine (average 0.77 ± 0.97 vs 0.34 ± 0.24, P < .01). Pediatric patients with bacteremia had higher rate of underlying urologic conditions. The following variables were included in multivariate analysis: age < 3 months, sex, ethnicity, method of urine collection, creatinine, and underlying urologic conditions. Only creatinine (odds ratio, 3.67; 95% confidence interval, 1.69-8.11) was found as an independent risk factor for bacteremia.Conclusions
High creatinine at presentation is a risk factor that might aid in early identification of pediatric patients with high risk for bacteremia and its complications. 相似文献12.
Takayuki Otani Hirotaka Sawano Tomoaki Natsukawa Reiko Matsuoka Masaya Morita Yasuyuki Hayashi 《The American journal of emergency medicine》2017,35(5):685-691
Purpose
The aim of this study was to assess the usefulness of the Global Registry of Acute Coronary Events (GRACE) risk score in predicting in-hospital mortality and neurological outcome of patients resuscitated after out-of-hospital cardiac arrest (OHCA).Methods
We retrospectively analyzed the data of patients admitted to our hospital between October 2009 and October 2015 with OHCA and shockable initial cardiac rhythm who were resuscitated via conventional cardiopulmonary resuscitation. We calculated the GRACE risk score on admission and assessed its usefulness in predicting in-hospital mortality and neurological outcome.Results
Among 91 patients, 42 (46%) had acute myocardial infarction (AMI), 19 (21%) died in-hospital, and 52 (57%) had favorable neurological outcome. Among all the study patients, GRACE risk score was lower in survivors than in non-survivors (median 211 [interquartile range 176–240] vs. 266 [219–301], p < 0.001, respectively) and in favorable than in unfavorable neurological outcome group (202 [167–237] vs. 242 [219–275], p < 0.001, respectively). Multivariate analysis showed significant association between GRACE risk score and favorable neurological outcome (odds ratio, 0.975; 95% confidence interval, 0.961–0.990). Areas under receiver-operating characteristic curves, that describe the accuracy of GRACE risk score in predicting in-hospital mortality and favorable neurological outcome, were both 0.79.Conclusion
GRACE risk score may predict the in-hospital mortality and neurological outcome associated with resuscitated patients with OHCA and shockable initial cardiac rhythm, regardless of the cause of arrest. 相似文献13.
Chih-Chia Hsieh Ching-Chi Lee Hsiang-Chin Hsu Hsin-I Shih Chien-Hsin Lu Chih-Hao Lin 《The American journal of emergency medicine》2017,35(1):39-44
Background/Purpose
To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED).Methods
This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records. The primary and secondary outcome measures were a prolonged hospital stay (>30 days) and the in-hospital crude mortality within 90 days, respectively.Results
For 267 eligible patients (age range 21.0-98.0 years, mean 70.5 ± 15.1 years; male 184, 68.9%), multivariate analysis was used to determine the significant adverse effects of an ED stay >1.0 hour on in-hospital crude mortality (odds ratio 2.19, P < .05), which was thus defined as delayed ICU admission. In-hospital mortality significantly differed between patients with delayed ICU admission and those without delayed admission, as revealed by the Kaplan-Meier survival curves (P < .05). Moreover, a linear-by-linear correlation was observed between the length of ICU waiting time in the ED and the lengths of total hospital stay (r = 0.152, P < .05), ICU stay (r = 0.148, P < .05), and ventilator support (r = 0.222, P < .05).Conclusions
For patients with ARF who required mechanical ventilation support and intensive care, a delayed ICU admission more than 1.0 hour is a strong determinant of mortality and is associated with a longer ICU stay and a longer need for ventilation. 相似文献14.
Samir Haydar Matthew Spanier Patricia Weems Samantha Wood Tania Strout 《The American journal of emergency medicine》2017,35(11):1730-1733
Objectives
The Quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score has been shown to accurately predict mortality in septic patients and is part of recently proposed diagnostic criteria for sepsis. We sought to ascertain the sensitive of the score in diagnosing sepsis, as well as the diagnostic timeliness of the score when compared to traditional systemic inflammatory response syndrome (SIRS) criteria in a population of emergency department (ED) patients treated in the ED, admitted, and subsequently discharged with a diagnosis of sepsis.Methods
Electronic health records of 200 patients who were treated for suspected sepsis in our ED and ultimately discharged from our hospital with a diagnosis of sepsis were randomly selected for review from a population of adult ED patients (N = 1880). Data extracted included the presence of SIRS criteria and the qSOFA score as well as time required to meet said criteria.Results
In this cohort, 94.5% met SIRS criteria while in the ED whereas only 58.3% met qSOFA. The mean time from arrival to SIRS documentation was 47.1 min (95% CI: 36.5–57.8) compared to 84.0 min (95% CI: 62.2–105.8) for qSOFA. The median ED “door” to positive SIRS criteria was 12 min and 29 min for qSOFA.Conclusions
Although qSOFA may be valuable in predicting sepsis-related mortality, it performed poorly as a screening tool for identifying sepsis in the ED. As the time to meet qSOFA criteria was significantly longer than for SIRS, relying on qSOFA alone may delay initiation of evidence-based interventions known to improve sepsis-related outcomes. 相似文献15.
Ning Zhang Jianhua Liu Zeliang Qiu Yiping Ye Jian Zhang Tianzheng Lou 《The American journal of emergency medicine》2017,35(1):1-6
Purpose
To assess the efficacy of Shenfu injection (SFI) for enhancing cellular immunity and improving the clinical outcomes of patients with septic shock.Methods
Patients with sepsis were randomly assigned to receive either SFI at a dose of 100 mL every 24 hours for 7 consecutive days or a placebo in addition to conventional therapy. The immunologic parameters were collected on days 1, 3, and 7 after the above treatments, and the clinical outcomes were updated for 28 days.Results
Of these160 patients, 3 were excluded from the analysis due to protocol violation and withdrawal of consent; thus, 157 completed the study (78 in the SFI group and 79 in the placebo group). We found that SFI increased both CD4+ and CD8+ T cells in peripheral blood and up-regulated HLA-DR expression in monocytes (P < .05). Furthermore, SFI was also found to restore ex vivo monocytic tumor necrosis factor α and interleukin 6 proinflammatory cytokine release in response to the endotoxin (P < .05). Importantly, the SFI group showed better clinical outcomes than did the placebo group in terms of the duration of vasopressor use (P = .008), Acute Physiology and Chronic Health Evaluation II score (P = .034), Marshall score (P = .01), and length of intensive care unit stay (10.5 ± 3.2 vs 12.2 ± 2.8 days; P = .012). However, the 28-day mortality rate was not significantly different between the SFI (20.5%; 16/78) and placebo groups (27.8%; ?22/79; P = .28).Conclusion
These findings suggest that SFI can enhance the cellular immunity of patients with septic shock and could be a promising adjunctive treatment for patients with septic shock. 相似文献16.
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17.
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
Purpose
The aim of this study is to compare the effectiveness of active recovery in form of running or foam rolling on clearing blood lactate compared to remain sitting after a water rescue.Method
A quasi experimental cross-over design was used to test the effectiveness of two active recovery methods: foam rolling (FR) and running (RR), compared with passive recovery (PR) on the blood lactate clearance after performing a water rescue. Twelve lifeguards from Marín (Pontevedra) completed the study. The participants performed a 100-meter water rescue and a 25-minute recovery protocol.Results
The post recovery lactate levels were significantly lower for foam rolling (4.4 ± 1.5 mmol/l, P = 0.005, d = 0.94) and running (4.9 ± 2.3 mmol/l, P = 0.027, d = 1.21) compared with resting (7.2 ± 2.5 mmol/l); there was no significant difference between foam rolling and running (P = 1.000).Conclusions
We found that surf lifesavers clear out blood lactate more efficient when performing an active recovery protocol. Foam rolling is an effective method of increasing the rate of blood lactate clearance. These two recovery methods are also adequate for surf lifeguards as they do not interfere with the surveillance aspect of their job. 相似文献18.
Michal Laufer-Perl Ofer Havakuk Yacov Shacham Arie Steinvil Sivan Letourneau-Shesaf Ehud Chorin Gad Keren Yaron Arbel 《The American journal of emergency medicine》2017,35(2):201-205
Background
Sex differences in heart diseases, including acute coronary syndrome, congestive heart failure, and atrial fibrillation, have been studied extensively. However, data are lacking regarding sex differences in pericarditis and myopericarditis patients.Objectives
The purpose of the study was to evaluate whether there are sex differences in pericarditis and myopericarditis patients as well.Methods
We performed a retrospective, single-center observational study that included 200 consecutive patients hospitalized with idiopathic pericarditis or myopericarditis from January 2012 to April 2014. Patients were evaluated for sex differences in prevalence, clinical presentation, laboratory variables, and outcome. We excluded patients with a known cause for pericarditis.Results
Among 200 consecutive patients, 55 (27%) were female. Compared with men, women were significantly older (60 ± 19 years vs 46 ± 19 years, P < .001) and had a higher rate of chronic medical conditions. Myopericarditis was significantly more common among men (51% vs 25%, P = .001). Accordingly, men had significantly higher levels of peak troponin (6.8 ± 17 ng/mL vs 0.9 ± 2.6 ng/mL, P < .001), whereas women presented more frequently with pericardial effusion (68% vs 45%, P = .006). Interestingly, women had a significantly lower rate of hospitalization in the cardiology department (42% vs 63%, P = .015). Overall, there were no significant differences in ejection fraction, type of treatment, complications, or in-hospital mortality.Conclusions
Most patients admitted with acute idiopathic pericarditis are male. In addition, men have a higher prevalence of myocardial involvement. Significant sex differences exist in laboratory variables and in hospital management; however, the outcome is similar and favorable in both sexes. 相似文献19.
Rossana Rosa Lilian M. Abbo Kenley Raney Hansel E. Tookes Mark Supino 《The American journal of emergency medicine》2017,35(3):397-401
Objective
To calculate the emergency department (ED)-level Escherichia coli percentage of isolates susceptible to commonly used antibiotics and to determine the risk factors associated with inadequate empiric antibiotic therapy among patients treated for urinary tract infections (UTIs) in our ED.Methods
Retrospective cohort study conducted at a large tertiary teaching hospital. Participants included patients older than 18 years of age who had a urine culture with growth of > 100,000 colonies of E. coli. Demographic and therapeutic choices associated with inadequate empiric antibiotic therapy were explored. Antimicrobial susceptibility pattern of E. coli isolates recovered from ED patients were calculated, and stratified by gender and age.Results
A total of 300 unique patients had E. coli bacteriuria during the study period. Among patients who received at least one dose of antibiotic in the ED, variables independently associated with an increased risk of inadequate empiric therapy were age (relative risk [RR] 1.016; 95% confidence interval [CI] 1.001–1.031; P = 0.032), male gender (RR 2.507; 95% CI 1.470–4.486; P = 0.001), and use of fluoroquinolones (RR 2.128; 95% CI 1.249–3.624 P = 0.005). Sub-group analysis of patients discharged from the ED showed that definitive therapy with nitrofurantoin decreased the risk of inadequate empiric antibiotic therapy by 80% (RR 0.202; CI 0.065–0.638; P = 0.006). ED-level antibiograms showed differences in antimicrobial susceptibility of E. coli by age and gender.Conclusions
Development of ED-level antimicrobial susceptibility data and consideration of patients' clinical characteristics can help better guide selection of empiric antibiotic therapy for the treatment of UTIs. 相似文献20.
Lukasz Szarpak Zenon Truszewski Lukasz Czyzewski Michael Frass Oliver Robak 《The American journal of emergency medicine》2017,35(1):96-100