Entries Tagged as 'Eur J Emerg Med'
Home hospitalization unit: an alternative to standard inpatient hospitalization from the emergency department.
Eur J Emerg Med. 2009 Jun;16(3):121-3
Authors: Salazar A, Estrada C, Porta R, Lolo M, Tomas S, Alvarez M
OBJECTIVE: To assess the characteristics of the patients admitted to a home hospitalization unit (HHU) after a first emergency department (ED) visit. METHODS: This was a descriptive, retrospective study. The setting of the study was the ED of a 500-bed teaching hospital, which treats 125 000 emergency visits per year. HHU admits patients from the ED when hospitalization is imminent. Participants were all patients attending our ED from 1 January 2005 to 31 December 2005 and finally admitted to HHU. Variables were age, sex, diagnostic, mean length of stay, and readmission rate. RESULTS: A cohort composed of 250 patients admitted to HHU directly from the ED was identified. Mean age was 75 years. One hundred and fifty-eight were males (63%). The most common diagnoses were acute exacerbation of chronic obstructive pulmonary disease (127 of 250 patients, 50.8%), acute exacerbation of chronic heart failure (32 of 250 patients, 12.8%), pneumonia (24 of 250 patients, 9.6%), urinary tract infection (20 of 250 patients, 8%), and leg deep venous thrombosis (14 of 250 patients, 5.6%). Mean length of stay was 8 days. Readmission rate was 9%. CONCLUSION: A HHU proved to be effective and safe for acutely ill individuals who required hospitalization.
PMID: 19262397 [PubMed - indexed for MEDLINE]
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Performance of the Wells and Revised Geneva scores for predicting pulmonary embolism.
Eur J Emerg Med. 2009 Feb;16(1):49-52
Authors: Calisir C, Yavas US, Ozkan IR, Alatas F, Cevik A, Ergun N, Sahin F
OBJECTIVE: The objective of the study was to compare two scoring methods to predict the risk of pulmonary embolism (PE) as diagnosed with computed tomography angiography (CTA) and/or CT venography (CTV). METHODS: Prospectively over a 8-month period, emergency department patients and hospital inpatients with suspected PE were consecutively examined and their Wells and Revised Geneva scores calculated to stratify them into a risk group for PE probability. Then all patients were examined with CTA and CTV to determine the presence or absence of PE, as diagnosed by experienced radiology staff physicians. RESULTS: During the study period, 167 patients were suspected of having a PE and were interviewed for the calculation of their Wells and Revised Geneva scores. All patients underwent CTA or CTV, but the images of only 148 patients were adequate enough to make a certain diagnosis regarding PE. The data of these 148 patients were used for the study. The rates of PE in high, moderate, and low PE risk groups determined according to the Wells score and the Revised Geneva score were 89.6, 26.4, 7.8 and 83.3, 25.6, 0%, respectively. Among both inpatients and ED patients the area under the Wells score receiver operating characteristic curve was higher (P=0.04). When data from only ED patients were analyzed (104 patients) the scoring systems was not significantly different (P=0.07). CONCLUSION: The Wells rule seems to be more accurate among both inpatients and emergency department patients. The Revised Geneva score can be used in emergency department patients with high reliability.
PMID: 18931619 [PubMed - indexed for MEDLINE]
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Status epilepticus: a modern approach to management.
Eur J Emerg Med. 2008 Aug;15(4):187-95
Authors: Kinirons P, Doherty CP
Status epilepticus (SE) is a common medical emergency. Two problems continue to militate against improved outcome in SE, namely, failure to recognize the wide spectrum of clinical presentation and failure to treat in an appropriately aggressive and timely manner. In this study, we aim to provide a clear understanding of the clinical presentation of SE, as well as providing an evidence-based review of the pathophysiological consequences of prolonged seizures, enabling the reader to adopt a rational approach to its management. We discuss current best practice for the management of SE as well as discussing alternative strategies, and briefly explore possible future therapeutic interventions.
PMID: 19078813 [PubMed - indexed for MEDLINE]
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Is that a lung edge? A case of simulated pneumothorax and survey of emergency physicians’ awareness of this phenomenon.
Eur J Emerg Med. 2008 Jun;15(3):166-8
Authors: Mukherjee N, Taylor SG
BACKGROUND AND OBJECTIVES: We encountered a case whereby an 18-year-old boy presented to the Emergency Department with a stab wound to the left posterior chest. Chest X-ray (CXR) showed what appeared to be a pneumothorax and chest drain insertion was considered. It was confirmed subsequently that this apparent pneumothorax was due to a linear artefactual projection from the edge of the oxygen mask reservoir bag. We set out to investigate whether our colleagues would have misdiagnosed this artefact and what their initial treatment plan would have been. METHODS: Four clinical scenarios were presented with accompanying radiographs, one of which was the case described above. Doctors were asked to examine the CXRs and accompanying scenarios, describe the radiograph findings and describe initial treatments they would perform. RESULTS: Twenty-three doctors (two consultants, five middle grades, and 16 senior house officers) were recruited. Two (9%) doctors indicated the ‘mask sign’ as a possible artefact. Nine (39%) reported the CXR as demonstrating a pneumothorax and recommended large bore chest drain insertion. CONCLUSION: Our results show that almost half of our colleagues would have carried out tube thoracostomy when no pneumothorax was actually present. In a situation where a pneumothorax is a clinical possibility we would recommend either temporarily removing the oxygen mask if clinically stable, or fixing the reservoir bag outwith the field of the CXR by means of adhesive tape to avoid any misinterpretation of this ‘mask sign’.
PMID: 18460959 [PubMed - indexed for MEDLINE]
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Unexpected mortality in patients discharged from the emergency department following an episode of nontraumatic chest pain.
Eur J Emerg Med. 2008 Feb;15(1):3-8
Authors: Geraldine McMahon C, Yates DW, Hollis S
BACKGROUND: Chest pain is the second most common presenting complaint seen in the emergency department. Following evaluation in the emergency department, many of these patients are discharged with a diagnosis of nonspecific chest pain. Our hypothesis is that this group of patients has a high prevalence of ischaemic heart disease. METHODS: This was a prospective follow-up study of mortality in 786 patients who presented to an emergency department in the UK with an episode of nontraumatic chest pain and were discharged without further inpatient assessment. Observed mortality was compared with expected mortality in age-matched and sex-matched local population. RESULTS: The observed mortality of the study group was consistently higher than expected throughout the study period. The 5-year mortality rates for men and women under the age of 65 years were more than double the expected rates for the local population [relative risk of 2.1 (95% confidence interval: 1.4-2.8) and 2.6 (1.4-3.8), respectively]. This increase was less marked in male and female patients aged 65 years or more [relative risk of 1.2 (0.9-1.5) and 1.5 (1.2-1.8), respectively]. Ischaemic heart disease accounted for almost 50% of male deaths in the study group. This compared with an expected rate of less than 30% of male deaths in the local population. An excess of cardiac deaths was not seen in women. INTERPRETATION: Patients discharged from the emergency department following an episode of acute chest pain have significantly reduced 5-year survival. We conclude that further evaluation of this group to establish the prevalence of risk factors is important to support the strategic implementation of appropriate prevention programmes.
PMID: 18180659 [PubMed - indexed for MEDLINE]
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