Accuracy of Emergency Department Chest Pain Patients' Reporting of Coronary Disease History.

Introduction: History is an important component of emergency department risk stratification for chest pain patients. We hypothesized that a significant portion of patients would not be able to accurately report their history of coronary artery disease (CAD) and diagnostic testing.

Methods: We prospectively enrolled a convenience sample of a cohort of adult ED patients with a chief complaint of chest pain.

Predictive Value of Point-of-care Lactate Measurement in Patients Meeting Level II and III Trauma Team Activation Criteria that Present to the Emergency Department: A Prospective Study.

Background: The aim of this study was to investigate the utility of early point-of-care (POC) lactate levels to help predict injury severity and ultimate emergency department (ED) disposition for trauma patients meeting Level II and III activation criteria.

Methods: This was a blinded, prospective cohort study including a convenience sample of patients meeting our triage criteria for Level II or III team activation with stable vital signs. Bedside lactate samples were collected during the secondary survey.

The Influence of Cervical Collar Immobilization on Optic Nerve Sheath Diameter.

Background: Prior research has revealed that cervical collars elevate intracranial pressure (ICP) in patients with traumatic brain injury. Two recent small studies evaluated the change in optic sheath nerve diameter (ONSD) measured by ultrasound as a proxy for ICP following cervical collar placement in healthy volunteers.

Objective: We sought to validate the finding that ONSD measured by ultrasound increases after cervical collar placement within an independent data set.

Costs and Characteristics of Undocumented Immigrants Brought to a Trauma Center by Border Patrol Agents in Southern Texas.

Background: The objective of this study was to evaluate the costs, characteristics, and outcomes of patients brought to a Texas trauma center emergenct department after apprehension by Border Patrol (BP)/Immigration and Customs Enforcement (BP/ICE).

Materials And Methods: This is a secondary analysis of a trauma registry/financial records (1/1/11-12/31/14). Data were extracted utilizing a structured form.

A Comparison of Nonobese Versus Obese Emergency Department Patient Satisfaction Scores Utilizing Standard U.S. Hospital Survey Query Methodology.

Background: Prior research reveals that overweight patients have higher emergency department (ED) utilization rates, longer length of stay, and face increased misdiagnosis risk.

Objective: The objective of this study was to evaluate the association between obesity and ED patient satisfaction.

Methods: This study was a cross-sectional study.

How much risk are emergency department patients willing to accept to avoid diagnostic testing.

Objectives: There is a paucity of research evaluating the risk tolerance of Emergency Department (ED) patients. We hypothesized that a significant percentage of ED patients surveyed would be comfortable with ≥5% risk of adverse outcome if they avoided testing in several hypothetical scenarios.

Materials And Methods: This was a cross-sectional study of a convenience sample of stable inner-city ED patients.

Use of a Dental Vibration Tool to Reduce Pain From Digital Blocks: A Randomized Controlled Trial.

Background And Objectives: The infiltration of local anesthetic is consistently described as painful by patients. Vibration anesthesia has been studied in the dental literature as a promising tool to alleviate the pain from dental nerve blocks. Many of these studies used a specific device, the DentalVibe.

Increased door to admission time is associated with prolonged throughput for ED patients discharged home.

Background: Emergency Department (ED) service evaluations are typically based on surveys of discharged patients. Physicians/administrators benefit from data that quantifies system-based factors that adversely impact the experience of those who represent the survey cohort.

Objective: While investigators have established that admitted patient boarding impacts overall ED throughput times, we sought to specifically quantify the relationship between throughput times for patients admitted (EDLOS) versus discharged home from the ED (DCLOS).

Are patients who call a primary care office referred to the emergency department by non-healthcare personnel without the input of a physician?

Objective. We hypothesized that a significant percentage of patients who are referred to the Emergency Department (ED) after calling their primary care physician's (PCP) office receive such instructions without the input of a physician. Methods.

Prior CT imaging history for patients who undergo PAN CT for acute traumatic injury.

Objective. A single PAN scan may provide more radiation to a patient than is felt to be safe within a one-year period. Our objective was to determine how many patients admitted to the trauma service following a PAN scan had prior CT imaging within our six-hospital system.

Patient understanding of radiation risk from medical computed tomography-A comparison of Hispanic vs. non-Hispanic emergency department populations.

Background. Cultural differences and language barriers may adversely impact patients with respect to understanding the risks/benefits of medical testing. Objective.

Independent evaluation of a simple clinical prediction rule to identify right ventricular dysfunction in patients with shortness of breath.

Background: Many patients have unexplained persistent dyspnea after negative computed tomographic pulmonary angiography (CTPA). We hypothesized that many of these patients have isolated right ventricular (RV) dysfunction from treatable causes. We previously derived a clinical decision rule (CDR) for predicting RV dysfunction consisting of persistent dyspnea and normal CTPA, finding that 53% of CDR-positive patients had isolated RV dysfunction.

Evaluation of pulmonary embolism in the emergency department and consistency with a national quality measure: quantifying the opportunity for improvement.

Background: The National Quality Forum (NQF) has endorsed a performance measure designed to increase imaging efficiency for the evaluation of pulmonary embolism (PE) in the emergency department (ED). To our knowledge, no published data have examined the effect of patient-level predictors on performance.

Methods: To quantify the prevalence of avoidable imaging in ED patients with suspected PE, we performed a prospective, multicenter observational study of ED patients evaluated for PE from 2004 through 2007 at 11 US EDs.

Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism.

Objectives: Available D-dimer assays have low specificity and may increase radiographic testing for pulmonary embolism (PE). To help clinicians better target testing, this study sought to quantify the effect of risk factors for a positive quantitative D-dimer in patients evaluated for PE.

Methods: This was a prospective, multicenter, observational study.

Clinical features from the history and physical examination that predict the presence or absence of pulmonary embolism in symptomatic emergency department patients: results of a prospective, multicenter study.

Study Objective: Prediction rules for pulmonary embolism use variables explicitly shown to estimate the probability of pulmonary embolism. However, clinicians often use variables that have not been similarly validated, yet are implicitly believed to modify probability of pulmonary embolism. The objective of this study is to measure the predictive value of 13 implicit variables.

12-lead ECG findings of pulmonary hypertension occur more frequently in emergency department patients with pulmonary embolism than in patients without pulmonary embolism.

Study Objective: Acute pulmonary embolism can produce abnormalities on ECG that reflect severity of pulmonary hypertension. Early recognition of these findings may alter the estimated pretest probability of pulmonary embolism and prompt more aggressive treatment before hemodynamic instability ensues, but it is first important to test whether these findings are specific to patients with pulmonary embolism. We hypothesize that ECG findings consistent with pulmonary hypertension would be observed more frequently in patients with pulmonary embolism.

Potential impact of adjusting the threshold of the quantitative D-dimer based on pretest probability of acute pulmonary embolism.

Objectives: The utility of D-dimer testing for suspected pulmonary embolism (PE) can be limited by test specificity. The authors tested if the threshold of the quantitative D-dimer can be varied according to pretest probability (PTP) of PE to increase specificity while maintaining a negative predictive value (NPV) of >99%.

Methods: This was a prospective, observational multicenter study of emergency department (ED) patients in the United States.

Risk of thromboembolism varies, depending on category of immobility in outpatients.

Study Objective: Immobility predisposes to venous thromboembolism, but this risk may vary, depending on the underlying cause of immobility.

Methods: This was a prospective, longitudinal outcome study of self-presenting emergency department (ED) patients who were from 12 hospitals and had suspected venous thromboembolism. Using explicit written criteria, clinicians recorded clinical features of each patient in the ED by using a Web-based data form.

Independent evaluation of an out-of-hospital termination of resuscitation (TOR) clinical decision rule.

Objectives: Recently, investigators described a clinical decision rule for termination of resuscitation (TOR) designed to help determine whether to terminate emergency medical services (EMS) resuscitative efforts for out-of-hospital cardiac arrests (OOHCA). The authors sought to evaluate the hypothesis that TOR would predict no survival for patients in an independent cohort of patients with OOHCA.

Methods: This was a retrospective cohort analysis conducted in the state of Arizona.

Bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest in the Hispanic vs the non-Hispanic populations.

Study Objective: The aim of this study is to compare rates of bystander cardiopulmonary resuscitation (CPR) for Hispanic and non-Hispanic out-of-hospital cardiac arrest (OOHCA) victims in Arizona.

Methods: This is a secondary analysis of consecutive OOHCA victims prospectively enrolled into our statewide OOHCA quality improvement database between November 2004 and November 2006. Continuous data are presented as means +/- SDs and analyzed using t tests; categorical data are presented as frequency of occurrence and analyzed using chi(2).

Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest.

Context: Out-of-hospital cardiac arrest is a major public health problem.

Objective: To investigate whether the survival of patients with out-of-hospital cardiac arrest would improve with minimally interrupted cardiac resuscitation (MICR), an alternate emergency medical services (EMS) protocol.

Design, Setting, And Patients: A prospective study of survival-to-hospital discharge between January 1, 2005, and November 22, 2007.

Ability of citizens in a senior living community to perform lifesaving cardiac skills and appropriately utilize AEDs.

The objective of this study was to assess the ability of citizens in a senior living community (SLC) to perform adequate cardiopulmonary resuscitation (CPR) and appropriately utilize an automated external defibrillator (AED) in a simulated cardiac arrest scenario (SCAS). This study was a prospective, observational study; a convenience sample of SLC residents aged > 54 years was enrolled. Subjects were presented with a SCAS (adult mannequin, bystander available to assist, AED visible).

Do patients with recurrent headaches attempt abortive therapy before their emergency department visit?

Headache is one of the most frequent symptoms prompting an emergency department (ED) visit. For many patients this is an exacerbation of a recurrent or chronic headache pattern. Our objective in this study was to determine if ED patients with recurrent headaches attempt abortive analgesics before seeking ED care.

Emergency medicine practitioner knowledge and use of decision rules for the evaluation of patients with suspected pulmonary embolism: variations by practice setting and training level.

Background: Several clinical decision rules (CDRs) have been validated for pretest probability assessment of pulmonary embolism (PE), but the authors are unaware of any data quantifying and characterizing their use in emergency departments.

Objectives: To characterize clinicians' knowledge of and attitudes toward two commonly used CDRs for PE.

Methods: By using a modified Delphi approach, the authors developed a two-page paper survey including 15 multiple-choice questions.