Safety and Efficiency of a Chest Pain Diagnostic Algorithm With Selective Outpatient Stre…

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Diagnostic Accuracy of Pulmonary Embolism Rule-Out Criteria: A Systematic Review and Meta…

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Sublingual Buprenorphine in Acute Pain Management: A Double-Blind Randomized Clinical Tri…

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Older US Emergency Department Patients Are Less Likely to Receive Pain Medication Than Yo…

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Vital signs: central line-associated blood stream infections-United States, 2001, 2008, and 2009.
Ann Emerg Med. 2011 Nov;58(5):447-50
Authors:
Abstract
BACKGROUND: Health care-associated infections (HAIs) af…

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Hospital Admission Decision for Patients With Community-Acquired Pneumonia: Variability Among Physicians in an Emergency Department.
Ann Emerg Med. 2011 Sep 8;
Authors: Dean NC, Jones JP, Aronsky D, Brown S, Vines CG, Jones BE…

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Adolescents and Young Adults Presenting to the Emergency Department Intoxicated From a Caffeinated Alcoholic Beverage: A Case Series.
Ann Emerg Med. 2011 Aug 3;
Authors: Cleary K, Levine DA, Hoffman RS
We describe a ca…

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Qualitative Analysis of Effective Lecture Strategies in Emergency Medicine.
Ann Emerg Med. 2011 Aug 3;
Authors: Kessler CS, Dharmapuri S, Marcolini E
STUDY OBJECTIVE: We empirically identify those aspects that make an …

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Diabetes Is Not Associated With Increased Mortality in Emergency Department Patients With Sepsis.
Ann Emerg Med. 2011 Jun 15;
Authors: Schuetz P, Jones AE, Howell MD, Trzeciak S, Ngo L, Younger JG, Aird W, Shapiro NI
S…

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Rethinking testing for pulmonary embolism: less is more.
Ann Emerg Med. 2011 Jun;57(6):622-627.e3
Authors: Newman DH, Schriger DL

PMID: 21621091 [PubMed - in process]

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Critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected pulmonary embolism.
Ann Emerg Med. 2011 Jun;57(6):628-652.e75
Authors: Fesmire FM, Brown MD, Espinosa JA,…

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The Financial Consequences of Lost Demand and Reducing Boarding in Hospital Emergency Departments.
Ann Emerg Med. 2011 Apr 20;
Authors: Pines JM, Batt RJ, Hilton JA, Terwiesch C
STUDY OBJECTIVE: Some have suggested tha…

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Emergency Department Management of Patients on Warfarin Therapy.
Ann Emerg Med. 2011 Apr 7;
Authors: Meeker E, Dennehy CE, Weber EJ, Kayser SR
STUDY OBJECTIVE: To characterize warfarin management in the emergency depar…

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Two Days of Dexamethasone Versus 5 Days of Prednisone in the Treatment of Acute Asthma: A Randomized Controlled Trial.

Ann Emerg Med. 2011 Feb 17;

Authors: Kravitz J, Dominici P, Ufberg J, Fisher J, Giraldo P

STUDY OBJECTIVE: Dexamethasone has a longer half-life than prednisone and is well tolerated orally. We compare the time needed to return to normal activity and the frequency of relapse after acute exacerbation in adults receiving either 5 days of prednisone or 2 days of dexamethasone. METHODS: We randomized adult emergency department patients (aged 18 to 45 years) with acute exacerbations of asthma (peak expiratory flow rate less than 80% of ideal) to receive either 50 mg of daily oral prednisone for 5 days or 16 mg of daily oral dexamethasone for 2 days. Outcomes were assessed by telephone follow-up. RESULTS: Ninety-six prednisone and 104 dexamethasone subjects completed the study regimen and follow-up. More patients in the dexamethasone group reported a return to normal activities within 3 days compared with the prednisone group (90% versus 80%; difference 10%; 95% confidence interval 0% to 20%; P=.049). Relapse was similar between groups (13% versus 11%; difference 2%; 95% confidence interval -7% to 11%, P=.67). CONCLUSION: In acute exacerbations of asthma in adults, 2 days of oral dexamethasone is at least as effective as 5 days of oral prednisone in returning patients to their normal level of activity and preventing relapse.

PMID: 21334098 [PubMed - as supplied by publisher]

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Hospital Determinants of Emergency Department Left Without Being Seen Rates.

Ann Emerg Med. 2011 Feb 18;

Authors: Hsia RY, Asch SM, Weiss RE, Zingmond D, Liang LJ, Han W, McCreath H, Sun BC

STUDY OBJECTIVE: The proportion of patients who leave without being seen in the emergency department (ED) is an outcome-oriented measure of impaired access to emergency care and represents the failure of an emergency care delivery system to meet its goals of providing care to those most in need. Little is known about variation in the amount of left without being seen or about hospital-level determinants. Such knowledge is necessary to target hospital-level interventions to improve access to emergency care. We seek to determine whether hospital-level socioeconomic status case mix or hospital structural characteristics are predictive of ED left without being seen rates. METHODS: We performed a cross-sectional study of all acute-care, nonfederal hospitals in California that operated an ED in 2007, using data from the California Office of Statewide Health Planning and Development database and the US census. Our outcome of interest was whether a visit to a given hospital ED resulted in left without being seen. The proportion of left without being seen was measured by the number of left without being seen cases out of the total number of visits. RESULTS: We studied 9.2 million ED visits to 262 hospitals in California. The percentage of left without being seen varied greatly over hospitals, ranging from 0% to 20.3%, with a median percentage of 2.6%. In multivariable analyses adjusting for hospital-level socioeconomic status case mix, visitors to EDs with a higher proportion of low-income and poorly insured patients experienced a higher risk of left without being seen. We found that the odds of an ED visit resulting in left without being seen increased by a factor of 1.15 for each 10-percentage-point increase in poorly insured patients, and odds of left without being seen decreased by a factor of 0.86 for each $10,000 increase in household income. When hospital structural characteristics were added to the model, county ownership, trauma center designation, and teaching program affiliation were positively associated with increased probability of left without being seen (odds ratio 2.09; 1.62, and 2.14, respectively), and these factors attenuated the association with insurance status. CONCLUSION: Visitors to different EDs experience a large variation in their probability of left without being seen, and visitors to hospitals serving a high proportion of low-income and poorly insured patients are at disproportionately higher risk of leaving without being seen. Our findings suggest that there is room for substantial improvement in this outcome, and regional interventions can be targeted toward certain at-risk hospitals to improve access to emergency care.

PMID: 21334761 [PubMed - as supplied by publisher]

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