Fever Incidence Is Much Lower in the Morning than the Evening: Boston and US National Triage Data.

Introduction: In this observational study, we evaluated time-of-day variation in the incidence of fever that is seen at triage. The observed incidence of fever could change greatly over the day because body temperatures generally rise and fall in a daily cycle, yet fever is identified using a temperature threshold that is unchanging, such as ≥38.0° Celsius (C) (≥100.

The daily, weekly, and seasonal cycles of body temperature analyzed at large scale.

We performed large-scale analyses of circadian and infradian cycles of human body temperature, focusing on changes over the day, week, and year. Temperatures (= 93,225) were collected using temporal artery thermometers from a Boston emergency department during 2009-2012 and were statistically analyzed using regression with cyclic splines. The overall mean body temperature was 36.

A unique case of bradycardia recognized by wearable technology as first presentation of complete heart block.

Wearable technology has advanced significantly, and the proposed health benefits have been widely touted. Most of the discussion has been surrounding the identification and diagnosis of asymptomatic atrial fibrillation. However, the heart monitoring functions of the wearable technology can also identify other abnormalities as well.

Human temperatures for syndromic surveillance in the emergency department: data from the autumn wave of the 2009 swine flu (H1N1) pandemic and a seasonal influenza outbreak.

Background: The emergency department (ED) increasingly acts as a gateway to the evaluation and treatment of acute illnesses. Consequently, it has also become a key testing ground for systems that monitor and identify outbreaks of disease. Here, we describe a new technology that automatically collects body temperatures during triage.

Evaluating the effect of emergency residency training on productivity in the emergency department.

Background: Resident productivity, defined as patients seen per unit time, is one measure that is used to assess the performance and educational progress of residents in the emergency department (ED). One published study suggested that emergency residency training (EM) does not improve productivity compared with that in other specialties, including internal medicine (IM).

Objectives: This study assesses how EM and IM trainees perform in the ED and illustrates how resident productivity changes through the academic year.

Eliminating routine oral contrast use for CT in the emergency department: impact on patient throughput and diagnosis.

This study aimed to assess the effect of eliminating routine oral contrast use for abdominopelvic (AP) computed tomography (CT) on emergency department (ED) patient throughput and diagnosis. Retrospective analysis was performed on patients undergoing AP CT during 2-month periods prior to and following oral contrast protocol change in an urban, tertiary care ED. Patients with inflammatory bowel disease, prior gastrointestinal tract-altering surgery, or lean body habitus continued to receive oral contrast.

Should creatine kinase-MB index be eliminated in patients with indeterminate troponins in the ED?

Objectives: The objective of this study is to determine whether creatine kinase-MB (CK-MB) index (CK-MBi) is useful in the evaluation of acute myocardial infarction (AMI) in patients with indeterminate troponin (Tn) in the emergency department (ED).

Methods: A retrospective cohort study was conducted of patients at an urban academic ED with over 55 000 annual visits who underwent Tn T (Roche, Indianapolis, IN) and CK-MB testing. One year of ED patients who had Tn testing were identified, and their corresponding CK-MBi was examined to find patients with indeterminate Tn (0.

Emergency department abnormal vital sign "triggers" program improves time to therapy.

Background: Implementation of rapid response systems to identify deteriorating patients in the inpatient setting has demonstrated improved patient outcomes. A "trigger" system using vital sign abnormalities to initiate evaluation by physician was recently described as an effective rapid response method.

Objectives: The objective was to evaluate the effect of a triage-based trigger system on the primary outcome of time to physician evaluation and the secondary outcomes of therapeutic intervention, antibiotics, and disposition in emergency department (ED) patients.

Use of separate venipunctures for IV access and laboratory studies decreases hemolysis rates.

Emergency department (ED) patients routinely undergo placement of a saline lock device (SLD) with the aspiration of blood for laboratory testing. Drawing blood through a SLD may result in hemolysis of sample, repeated venipuncture and increased ED length of stay (LOS). The objective of this study was to examine if separate venipunctures for intravenous (IV) access and laboratory studies decrease the rate of hemolysis and ED LOS.

Effect of two different FDA-approved D-dimer assays on resource utilization in the emergency department.

Background: The D-dimer assay has been shown to be an appropriate test to rule out pulmonary embolism (PE) in low-risk patients in the emergency department (ED). Multiple assays now are approved to measure D-dimer levels. Studies have shown a newer assay, Tina-quant, to have similar diagnostic accuracy to the VIDAS assay.

Creatine kinase-MB does not add additional benefit to a negative troponin in the evaluation of chest pain.

Objective: The aim of this study was to determine whether current troponin assay alone can be used for initial screening for acute myocardial infarction (AMI) and whether creatine kinase-MB (CK-MB) can safely be eliminated from this evaluation in the emergency department (ED).

Methods: A retrospective cohort study of patients who had cardiac troponin T (Roche, Basel, Switzerland) and CK-MB ordered at an urban academic level 1 trauma center with more than 55,000 annual visits. Patients with troponin testing in the ED were identified over a period of 12 months, and corresponding CK-MB indexes were examined identifying patients with negative troponins (<0.

Eliminating amylase testing from the evaluation of pancreatitis in the emergency department.

Background: Alterations in serum biomarkers have been used to evaluate for pancreatitis in the emergency department (ED). Studies have shown lipase to be as sensitive and more specific than amylase in diagnosing pancreatitis and that amylase plus lipase does not improve accuracy over lipase alone.

Objective: To determine effects of interventions to decrease ordering of amylase in the evaluation of pancreatitis.

Morbidity and Mortality conference in Emergency Medicine.

Background: Morbidity and Mortality conferences (M&M) are used to meet many of the Core Competencies required by the Accreditation Council of Graduate Medical Education for residency training programs. This study seeks to describe and quantify different types of M&M conferences among Emergency Medicine (EM) training programs.

Methods: A confidential survey was e-mailed to the Program Directors (PD) or Assistant PD of all United States (US) Emergency Medicine residency training programs with functional e-mail addresses listed in the Society for Academic Emergency Medicine residency catalog.

Is a postintubation chest radiograph necessary in the emergency department?

Background: Postintubation chest X-rays (CXR) are standard practice in emergency department (ED) intubations. In the operating room, it is not usually a standard practice to confirm endotracheal tube placement with a CXR.

Aims: We seek to study the utility of postintubation CXR in ED patients.

Isolated, spontaneous superior mesenteric and celiac artery dissection: case report and review of literature.

Spontaneous, isolated dissection of the superior mesenteric artery (SMA) and celiac artery (CA) is rare. Although there are known risk factors, there is no particular mechanism that is common to vascular dissections. The objectives of this study were to review the current literature on diagnosis and treatment of isolated SMA and CA dissection, and to review aortic complications in giant cell arteritis, Takayasu arteritis, and polyarteritis nodosa.

Klebsiella pneumoniae liver abscess: an emerging problem in North America.

Background: Before the 1980s, Escherichia coli was the most common cause of pyogenic liver abscess, but more recently, Klebsiella pneumoniae has emerged as the most common organism in the United States and Taiwan.

Objective: Our goal is to present a case of K. pneumoniae liver abscess (KLA) and review the risk factors, presenting symptoms, complications, and treatment of this disease that is emerging in North America.

Tick paralysis.

The one tick-borne disease that rarely comes under the auspices of the infectious disease specialist is not caused by an infectious agent, but is tick paralysis. This condition is caused by tick bite and typically presents as a flaccid ascending paralysis. This article discusses this entity partly because of completeness, but also because tick paralysis, or tick toxicosis as it is sometimes called, is worth the infectious disease consultant's consideration.

Evaluation of end-tidal carbon dioxide role in predicting elevated SOFA scores and lactic acidosis.

The development of organ dysfunction is a key contributor to morbidity and mortality in sepsis. End-tidal carbon dioxide levels measured by non-invasive end-tidal capnography (ETCO2) may provide a rapid assessment of a patient's underlying metabolic status. The objective of this study was to explore the association between ETCO2 and (1) organ dysfunction [sequential organ failure assessment (SOFA) score], and (2) serum lactate levels in febrile emergency department (ED) patients.