A retrospective review of sudden onset severe headache and subarachnoid haemorrhage on the clinical decision unit: looking for a needle in a haystack?

Introduction: Patients commonly present to the Emergency Department with sudden onset acute severe headache, but exclusion of significant secondary causes, particularly subarachnoid haemorrhage (SAH), is vital. The misdiagnosis of SAH is most likely in patients with a normal neurological examination, and the consequences can be disastrous. A noncontrast computed tomography (CT) brain scan is the initial investigation of choice, and most would recommend that, if negative, this be followed by a lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis.

Sustainable working practices and minimizing burnout in emergency medicine.

Sustainable and satisfying working practices in emergency medicine are vital to produce career longevity and prevent premature 'burnout'. A range of strategies is required to ensure success for the individual and the system in which he/she works.

The Clinical Decision Unit has a role to play in the management of acute undifferentiated abdominal pain.

Introduction And Aims: Patients with undifferentiated acute abdominal pain (AAP) frequently present to the Emergency Department (ED). The most common diagnosis is the nonspecific abdominal pain although missed occult surgical pathology in the haemodynamically stable patient with equivocal symptoms and signs is a potential source of morbidity. The objectives of this study were two-fold.

Does computer-aided clinical decision support improve the management of acute abdominal pain? A systematic review.

Acute abdominal pain is a common reason for emergency presentation to hospital. Despite recent medical advances in diagnostics, overall clinical decision-making in the assessment of patients with undifferentiated acute abdominal pain remains poor, with initial clinical diagnostic accuracy being 45-50%. Computer-aided decision support (CADS) systems were widely tested in this arena during the 1970s and 1980s with results that were generally favourable.

Heart-type fatty acid-binding protein predicts long-term mortality and re-infarction in consecutive patients with suspected acute coronary syndrome who are troponin-negative.

Objectives: The purpose of this study was to establish the prognostic value of measuring heart fatty acid-binding protein (H-FABP) in patients with suspected acute coronary syndrome (ACS) (in particular, low- to intermediate-risk patients), in addition to troponin measured with the latest third-generation troponin assay.

Background: We have previously shown that H-FABP is a useful prognostic marker in patients with proven ACS.

Methods: Patients (n = 1,080) consecutively admitted to the hospital with suspected ACS were recruited over 46 weeks.

Screening for pulmonary embolism with a D-dimer assay: do we still need to assess clinical probability as well?

Clinical risk stratification and D-dimer assay can be of use in excluding pulmonary embolism in patients presenting to emergency departments but many D-dimer assays exist and their accuracy varies. We used clinical risk stratification combined with a quantitative latex-agglutination D-dimer assay to screen patients before arranging further imaging if required. Retrospective analysis of a sequential series of 376 patients revealed that no patient with a D-dimer of <275 ng/mL was diagnosed with pulmonary embolism, irrespective of clinical probability.

Clinical decision units: A new development for emergency medicine in the United Kingdom.

Emergency medicine in the United Kingdom is in the midst of significant change and increasing demand. Admissions to the in-hospital bed base cause significant pressure on emergency departments (ED) which face increasing congestion. In Leeds, a city with a population of approximately 800 000, there has been a 15.