Pulse Oxygen Saturation Values in a Healthy School-Aged Population.

Objectives: The purpose of this study was to determine the normal values of oxygen saturation in a healthy school-aged pediatric population.

Methods: This study enrolled students in grades K-8 at an elementary and middle school in Los Angeles. Although all students were invited to participate, only pulse oximetry results among healthy students were included.

Effect of electronically delivered prescriptions on compliance and pharmacy wait time among emergency department patients.

Objectives: The primary objectives were to assess whether electronically delivered prescriptions lead to reduced pharmacy wait time, improved patient satisfaction, and improved compliance with prescriptions. Secondary objectives included determining other reasons for noncompliance and if there was an association between prescription noncompliance and subsequent physician and emergency department (ED) visits.

Methods: In this prospective study, patients discharged from the Ronald Reagan UCLA Medical Center ED with prescriptions for nonnarcotic medications were randomized to a control group who were discharged with standard written prescriptions or an intervention group who had their prescriptions electronically delivered to the pharmacy of their choice.

Selective use of computed tomography compared with routine whole body imaging in patients with blunt trauma.

Study Objective: Routine pan-computed tomography (CT, including of the head, neck, chest, abdomen/pelvis) has been advocated for evaluation of patients with blunt trauma based on the belief that early detection of clinically occult injuries will improve outcomes. We sought to determine whether selective imaging could decrease scan use without missing clinically important injuries.

Methods: This was a prospective observational study of 701 patients with blunt trauma at an academic trauma center.

Emergency medicine and psychiatry agreement on diagnosis and disposition of emergency department patients with behavioral emergencies.

Objectives: The objective was to determine the level of agreement between emergency physicians (EPs) and consulting psychiatrists in their diagnosis and disposition of emergency department (ED) patients with behavioral emergencies.

Methods: The authors conducted a prospective study at a university teaching hospital ED with an annual census of approximately 45,000 patients. During study hours, each time a psychiatric consultation was requested, the emergency medicine (EM) and consulting psychiatry residents were asked to fill out similar short questionnaires concerning their diagnoses and disposition decisions after they consulted with their attending physicians.

Prevalence of herniation and intracranial shift on cranial tomography in patients with subarachnoid hemorrhage and a normal neurologic examination.

Objectives: Patients frequently present to the emergency department (ED) with headache. Those with sudden severe headache are often evaluated for spontaneous subarachnoid hemorrhage (SAH) with noncontrast cranial computed tomography (CT) followed by lumbar puncture (LP). The authors postulated that in patients without neurologic symptoms or signs, physicians could forgo noncontrast cranial CT and proceed directly to LP.

Pediatric emergencies associated with fever.

Fever is defined as a rectal temperature greater than 38.0 degrees C (>100.4 degrees F).

Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation.

Objective: Many trauma centers use the pan-computed tomography (CT) scan (head, neck, chest, and abdomen/pelvis) for the evaluation of blunt trauma. This prospective observational study was undertaken to determine whether a more selective approach could be justified.

Methods: We evaluated injuries in blunt trauma victims receiving a pan-CT scan at a level I trauma center.

Can patients with brain herniation on cranial computed tomography have a normal neurologic exam?

Objectives: Herniation of the brain outside of its normal intracranial spaces is assumed to be accompanied by clinically apparent neurologic dysfunction. The authors sought to determine if some patients with brain herniation or significant brain shift diagnosed by cranial computed tomography (CT) might have a normal neurologic examination.

Methods: This is a secondary analysis of the National Emergency X-Radiography Utilization Study (NEXUS) II cranial CT database compiled from a multicenter, prospective, observational study of all patients for whom cranial CT scanning was ordered in the emergency department (ED).

Management of infants and young children with fever without source.

There is considerable variation in the clinical management of infants and children with FWS. Community pediatricians generally do not follow clinical practice guidelines that are taught and used at academic training institutions. These guidelines are presented in Sidebar 1 (see page 677) and Sidebar 2.

On-call specialists and higher level of care transfers in California emergency departments.

Objectives: To survey California emergency department (ED) medical directors' impressions of on-call specialist availability and higher level of care (HLOC) transfer needs and difficulties and changes since the passage of the Emergency Medicine Treatment and Active Labor Act (EMTALA) final rule in 2003.

Methods: The authors conducted a survey of all California ED medical directors from February to June 2006 with regard to the composition of the ED on-call panel and need for HLOC transfer. ED demographic data were obtained from the California Office of Statewide Health Planning and Development.

Sensitivity of noncontrast cranial computed tomography for the emergency department diagnosis of subarachnoid hemorrhage.

Study Objective: Emergency physicians use noncontrast cranial computed tomographic (CT) imaging of headache patients to identify subarachnoid hemorrhage caused by aneurysms or arteriovenous malformations. Given sufficiently high sensitivity, CT imaging could be used as a definitive diagnostic study in these patients. The purpose of this study is to determine the sensitivity of noncontrast cranial CT in detecting all spontaneous subarachnoid hemorrhages and those caused by aneurysm or arteriovenous malformation.

Parental compliance with after hours telephone triage advice: nurse advice service versus on-call pediatricians.

To compare parental compliance with after-hours triage advice provided by telephone advice nurses and on-call pediatricians, a randomized controlled trial was undertaken at a university general pediatrics practice that enrolled parents or guardians calling for after-hours advice. Advice calls were randomized to a call center advice nurse or the on-call pediatrician. Parental compliance with the triage advice and agreement of the parental report of advice with the pediatrician/nurse report of advice given was evaluated.

Does telephone triage delay significant medical treatment?: Advice nurse service vs on-call pediatricians.

Background: Advice nurse call centers are used to ensure access to medical advice, thereby potentially reducing the costs of health services.

Objective: To determine if medical advice from advice nurses and on-call physicians delays significant medical treatment in a general pediatrics population.

Design: Randomized controlled trial.

Heterogeneous effect of an Emergency Department Expert Charting System.

Study Objective: We compare results from different modules (occupational exposure to blood and body fluids, low back pain, and fever in children) of the Emergency Department Expert Charting System. Each module of this electronic medical record provides real-time advice based on clinical guidelines embedded in the software.

Methods: We used a staggered off-on-off interrupted time-series design with an intent-to-treat analysis to implement the Emergency Department Expert Charting System in a university hospital emergency department for the treatment of fever in children, low back pain, and occupational exposure to blood and body fluids.

Caller satisfaction with after-hours telephone advice: nurse advice service versus on-call pediatricians.

Objective: To compare caller satisfaction with after-hours medical advice provided by a for-profit nurse advice service with advice provided by on-call pediatricians.

Methods: The study setting was the general pediatrics faculty practice of an urban university medical center. Participants were parents or guardians of a population of approximately 6000 children calling for after-hours medical advice over a 10-month period from January 18 to November 20, 2000.