Performance After Concussion in National Hockey League Players.

Context: Concussions in ice hockey players are an interesting area of study due to the fast-paced and high-impact nature of the sport. Recently, researchers have focused on player performance after return from concussion to evaluate subclinical deficits that were previously missed.

Objective: To examine National Hockey League (NHL) player performance from 2013 to 2019 and compare performance before a concussion with performance immediately after recovering to assess the current NHL return-to-play protocol.

Player age and initial helmet contact among American football players.

Objective: Concussions and chronic traumatic encephalopathy (CTE) related to professional football has received much attention within emergency care and sports medicine. Research suggests that some of this may be due to a greater likelihood of initial helmet contact (IHC), however this association has not been studied across all age groups. This study aims to investigate the association between player age and IHC in American football.

Uniformed Services and the Field Hospital Experience During Coronovirus Disease 2019 (SARS-CoV-2) Pandemic: Open to Closure in 30 Days With 1,100 Patients: The Javits New York Medical Station.

Introduction: The surge of SARS-CoV-2-virus infected (COVID-19) patients presenting to New York City (NYC) hospitals quickly overwhelmed and outnumbered the available acute care and intensive care resources in NYC in early March 2020. Upon the arrival of military medical assets to the Javits Convention Center in NYC, the planned mission to care for non-SARS-CoV-2 patients was immediately changed to manage patients with (SARS-CoV-2)COVID-19 and their comorbid conditions.Healthcare professionals from every branch of the uniformed services, augmented by state and local resources, staffed the Javits New York Medical Station (JNYMS) from April 2020.

Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: A meta-analysis.

Background: Awake prone positioning (PP), or proning, is used to avoid intubations in hypoxic patients with COVID-19, but because of the disease's novelty and constant evolution of treatment strategies, the efficacy of awake PP is unclear. We conducted a meta-analysis of the literature to assess the intubation rate among patients with COVID-19 requiring oxygen or noninvasive ventilatory support who underwent awake PP.

Methods: We searched PubMed, Embase, and Scopus databases through August 15, 2020 to identify relevant randomized control trials, observational studies, and case series.

Utility of Ottawa Ankle Rules in an Aging Population: Evidence for Addition of an Age Criterion.

The Ottawa ankle rules (OAR) indicate that any patient with the inability to ambulate up to four steps or with tenderness at either malleoli should receive diagnostic imaging for an acute ankle injury. Current trends indicate that health care providers tend to order more images in practice than necessary according to OAR. The purpose of this study is to analyze OAR in geriatric versus nongeriatric patients.

Incidence of Knee Injuries on Artificial Turf Versus Natural Grass in National Collegiate Athletic Association American Football: 2004-2005 Through 2013-2014 Seasons.

Background: The use of artificial turf in American football continues to grow in popularity, and the effect of these playing surfaces on athletic injuries remains controversial. Knee injuries account for a significant portion of injuries in the National Collegiate Athletic Association (NCAA) football league; however, the effect of artificial surfaces on knee injuries remains ill-defined.

Hypothesis: There is no difference in the rate or mechanism of knee ligament and meniscal injuries during NCAA football events on natural grass and artificial turf playing surfaces.

Increased opioid consumption in diabetics with operative ankle fractures: a retrospective case-control study.

Introduction: Opioids are commonly used for post-operative pain control. It is known that diabetic patients with ankle fractures will experience prolonged healing, higher risk of hardware failure, and an increased risk of infection. However, the opioid requirements amongst this patient cohort have not been previously evaluated.

Mean HEART scores for hospitalized chest pain patients are higher in more experienced providers.

Background: The HEART score has been validated as a predictor of major adverse cardiac events (MACEs) in emergency department patients complaining of chest pain. Our objective was to determine the extent of physician variation in the HEART score of admitted patients stratified by years of experience.

Methods: We performed a retrospective medical record review at an academic tertiary care emergency department to determine HEART score, outcome of hospitalization, and 30-day MACE.

Dynamic motor tracking is sensitive to subacute mTBI.

Effective screening for mild traumatic brain injury (mTBI) is critical to accurate diagnosis, intervention, and improving outcomes. However, detecting mTBI using conventional clinical techniques is difficult, time intensive, and subject to observer bias. We examine the use of a simple visuomotor tracking task as a screening tool for mTBI.

Age-related differences in biomarkers of acute inflammation during hospitalization for sepsis.

The authors aimed to evaluate age-related differences in inflammation biomarkers during the first 72 h of hospitalization for sepsis. This was a secondary analysis of a prospective observational cohort of adult patients (n = 855) from 10 urban academic emergency departments with confirmed infection and two or more systemic inflammatory response syndrome criteria. Six inflammation-related biomarkers were analyzed-chemokine (CC-motif) ligand-23, C-reactive protein, interleukin-1 receptor antagonist, neutrophil gelatinase-associated lipocalin (NGAL), peptidoglycan recognition protein, and tumor necrosis factor receptor-1a (TNFR-1a)-measured at presentation and 3, 6, 12, 24, 48, or 72 h later.

Emergency department variation in utilization and diagnostic yield of advanced radiography in diagnosis of pulmonary embolus.

Background: There is growing pressure to measure and reduce unnecessary imaging in the emergency department.

Objective: We study provider and hospital variation in utilization and diagnostic yield for advanced radiography in diagnosis of pulmonary embolism (PE) and to assess patient- and provider-level factors associated with diagnostic yield.

Methods: Retrospective chart review of all adult patients presenting to four hospitals from January 2006 through December 2009 who had a computed tomography or ventilation/perfusion scan to evaluate for PE.

Injury patterns in recreational alpine skiing and snowboarding at a mountainside clinic.

Objective: The purpose of this study was to examine the demographic and injury characteristics of skiing and snowboarding at a mountainside clinic.

Methods: Prospectively collected data of all acutely injured patients at the Big Sky Medical Clinic at the base of Big Sky Ski Area in the Northern Rocky Mountains were reviewed. A total of 1593 patients filled out the study questionnaire during the 1995-2000 and 2009-2010 ski seasons.

The prevalence of quality issues and adverse outcomes among 72-hour return admissions in the emergency department.

Background: Records of patients discharged from the Emergency Department (ED) who return within 72 h and are admitted are often reviewed for potential quality issues.

Objectives: We explored 72-h return admissions and determined the prevalence and predictors for substandard management on the initial visit or any adverse outcome.

Methods: Retrospective review of quality assurance data from 72-h return admissions in three hospitals from 2006-2010 was performed.

Use of the relationship between absolute lymphocyte count and CD4 count to improve earlier consideration of pneumocystis pneumonia in HIV-positive emergency department patients with pneumonia.

Background: The ability to accurately assess the level of immunosuppression in HIV+ patients in the emergency department (ED) is often limited and can affect management of these patients.

Objective: To evaluate the relationship between the absolute lymphocyte count (ALC) and CD4 count in HIV patients admitted through the ED with pneumonia and how utilization of this relationship may affect early consideration and evaluation of Pneumocystis jiroveci pneumonia (PCP).

Methods: Retrospective multicenter 5-year study of HIV+ patients with an ICD-9 diagnosis of pneumonia.

Prevalence of bicycle helmet use by users of public bikeshare programs.

Study Objective: Public bikeshare programs are becoming increasingly common in the United States and around the world. These programs make bicycles accessible for hourly rental to the general public. We seek to describe the prevalence of helmet use among adult users of bikeshare programs and users of personal bicycles in 2 cities with recently introduced bikeshare programs (Boston, MA, and Washington, DC).

Absolute lymphocyte count in the emergency department predicts a low CD4 count in admitted HIV-positive patients.

Objectives: This study sought to determine if the automated absolute lymphocyte count (ALC) predicts a "low" (<200 × 10(6) cells/μL) CD4 count in patients with known human immunodeficiency virus (HIV+) who are admitted to the hospital from the emergency department (ED).

Methods: This retrospective cohort study over an 8-year period was performed in a single, urban academic tertiary care hospital with over 85,000 annual ED visits. Included were patients who were known to be HIV+ and admitted from the ED, who had an ALC measured in the ED and a CD4 count measured within 24 hours of admission.

Relationship between B-type natriuretic peptide and adverse outcome in patients with clinical evidence of sepsis presenting to the emergency department.

Objectives: Myocardial dysfunction is an important aspect of sepsis pathophysiology. B-type natriuretic peptide (BNP) is a neurohormone released from the ventricles in response to myocardial stretch and volume overload. The authors hypothesized that an elevated BNP in patients presenting to the emergency department (ED) with suspected sepsis are at increased risk for development of adverse events.

The diagnostic accuracy of plasma neutrophil gelatinase-associated lipocalin in the prediction of acute kidney injury in emergency department patients with suspected sepsis.

Study Objective: We assess the diagnostic accuracy of plasma neutrophil gelatinase-associated lipocalin (NGAL) to predict acute kidney injury in emergency department (ED) patients with suspected sepsis.

Methods: We conducted a secondary analysis of a prospective observational study of a convenience sample of patients from 10 academic medical center EDs. Inclusion criteria were adult patients aged 18 years or older, with suspected infection or a serum lactate level greater than 2.

Mental health and emergency medicine: a research agenda.

The burden of mental illness is profound and growing. Coupled with large gaps in extant psychiatric services, this mental health burden has often forced emergency departments (EDs) to become the de facto primary and acute care provider of mental health care in the United States. An expanded emergency medical and mental health research agenda is required to meet the need for improved education, screening, surveillance, and ED-initiated interventions for mental health problems.

Physiologic affects of altitude on recreational climbers.

Objectives: Previous analyses of physiologic parameter changes during ascent to altitude have incorporated small numbers of well-trained climbers. The effects of altitude illness are more likely to occur and may come to medical attention more frequently in unacclimatized recreational individuals. We sought to evaluate acute changes in physiologic parameters during ascent to high altitude (14,100 ft) in recreational climbers.

Thoracic impedance vs chest radiograph to diagnose acute pulmonary edema in the ED.

Objective: We sought to investigate the relationship between thoracic impedance (Zo) and pulmonary edema on chest radiography in patients presenting to the emergency department (ED) with signs and symptoms of acute decompensated heart failure (ADHF).

Design: This was a prospective, blinded convenience sample of patients with signs and symptoms of ADHF who underwent measurement of Zo with concomitant chest radiography. Attending physicians blinded to the Zo values interpreted the radiographs, categorizing the severity of pulmonary edema as normal (NL), cephalization (CZ), interstitial edema (IE), or alveolar edema (AE).