Predictors of early progression to severe sepsis or shock among emergency department patients with nonsevere sepsis.

Background: Progression from nonsevere sepsis-i.e., sepsis without organ failure or shock-to severe sepsis or shock among emergency department (ED) patients has been associated with significant mortality.

Derivation of a clinical risk score for traumatic orbital fracture.

Background: Given that orbital fractures are found in only one of every eight patients receiving computed tomography for acute orbital trauma, we sought to prospectively identify clinical predictors of orbital fracture that may obviate the need for exposing low-risk patients to ionizing radiation.

Methods: Prospective cohort study conducted from July 2007 through October 2009 at two urban emergency departments. Consecutive patients undergoing computed tomography for acute blunt orbital trauma were evaluated on 15 clinical findings before imaging.

Orbital fracture clinical decision rule development: burden of disease and use of a mandatory electronic survey instrument.

Objectives: In preparation for development of a clinical decision rule (CDR) to promote more efficient use of computed tomography (CT) for diagnosing orbital fractures, the authors sought to estimate the annual incidence of orbital fractures in emergency departments (EDs) and the usage of CT to make these diagnoses. The authors also sought to evaluate a mandatory electronic data collection instrument (EDCI) administered to providers to facilitate CDR data collection.

Methods: National estimates were made by analyzing the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS) database, while hospital billing system and coding data were used to make local estimates.

High-volume rapid HIV testing in an urban emergency department.

New Centers for Disease Control and Prevention (CDC) guidelines recommend routine HIV screening in locations including emergency departments. This study evaluates a novel approach to HIV counseling and testing (C&T) in a high-volume inner-city emergency department in terms of the number of patients who can be recruited, tested, test positive, and are linked to care. This prospective evaluation was conducted for 26 months.

Increasing willingness to be tested for human immunodeficiency virus in the emergency department during off-hour tours: a randomized trial.

Objective: To test a model designed to increase willingness of patients presenting to the emergency department off hours to be tested for human immunodeficiency virus (HIV) by using a pretest counseling video as a substitute for face-to-face counseling.

Methods: We conducted a randomized controlled trial comparing the rate of testing in patients randomized to receive video counseling with immediate testing (video group) versus standard care, which was referral to counseling and testing the next day (standard referral group).

Results: Fifty percent of 805 eligible patients consented to participate in the study, indicating willingness to be tested.

Spanish and English video-assisted informed consent for intravenous contrast administration in the emergency department: a randomized controlled trial.

Study Objective: This study determined whether Spanish and English educational videos are superior to routine discussion for informing emergency department (ED) patients about risks, benefits, and alternatives to receiving intravenous contrast for computed tomography (CT).

Methods: A prospective randomized controlled trial was performed on a convenience sample of adult ED patients scheduled to receive intravenous contrast for CT. Patients randomized to the intervention group watched a video in Spanish or English explaining the procedure and its risks, benefits, and alternatives.

Computer-assisted categorizing of head computed tomography reports for clinical decision rule research.

Study Objective: To develop software that categorizes electronic head computed tomography (CT) reports into groups useful for clinical decision rule research.

Methods: Data were obtained from the Second National Emergency X-Radiography Utilization Study, a cohort of head injury patients having received head CT. CT reports were reviewed manually for presence or absence of clinically important subdural or epidural hematoma, defined as greater than 1.

An educational HIV pretest counseling video program for off-hours testing in the emergency department.

Study Objective: Multiple barriers to traditional pretest HIV counseling make HIV testing difficult to accomplish in the emergency department setting in off hours. This study compares the educational effectiveness of a 10-minute pretest counseling video with the usual practice of a session with an HIV counselor.

Methods: This was a prospective randomized controlled trial of adult patients presenting to the urgent care area of a busy inner-city hospital.

Validity of a decision rule to reduce cervical spine radiography in elderly patients with blunt trauma.

Study Objectives: A decision instrument based on 5 clinical criteria has been shown to be highly sensitive in selecting patients who require cervical spine imaging after blunt trauma, while simultaneously reducing overall imaging. We examine the performance of this instrument in the elderly and explore some of the common features of geriatric cervical spine injury (CSI).

Methods: The National Emergency X-radiography Utilization Study (NEXUS) was a prospective, observational, multicenter study conducted at 21 geographically diverse centers.