Current Issue: Volume 18 Issue 5 Archives - The Western Journal of Emergency Medicine

Emergency Department Operations

Magnetic Resonance Imaging Utilization in an Emergency Department Observation Unit

Sánchez, BA, et al.

Emergency department observation units (EDOUs) are a valuable alternative to inpatient admissions for ED patients needing extended care. However, while the use of advanced imaging is becoming more common in the ED, there are no studies characterizing the use of magnetic resonance imaging (MRI) examinations in the EDOU.

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Trends and Characteristics of Emergency Department Visits for Fall-Related Injuries in Older Adults, 2003–2010

Shankar, MD, MSc, MSHP, et al.

One third of older adults fall each year, and falls are costly to both the patient in terms of morbidity and mortality and to the health system. Given that falls are a preventable cause of injury, our objective was to understand the characteristics and trends of emergency department (ED) fall-related visits among older adults. We hypothesize that falls among older adults are increasing and examine potential factors associated with this rise, such as race, ethnicity, gender, insurance and geography.

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Prevalence of Intracranial Hemorrhage after Blunt Head Trauma in Patients on Pre-injury Dabigatran

Chenoweth, MD, MAS, et al.

Dabigatran etexilate was the first direct-acting oral anticoagulant approved in the United States. The prevalence of intracranial hemorrhage after blunt head trauma in patients on dabigatran is currently unknown, complicating adequate ability to accurately compare the risks and benefits of dabigatran to alternative anticoagulants. We aimed to determine the prevalence of intracranial hemorrhage for patients on dabigatran presenting to a Level I trauma center.

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Provider Workforce

Congratulations, You’re Pregnant! Now About Your Shifts . . . : The State of Maternity Leave Attitudes and Culture in EM

MacVane, MD, MPH, et al.

Increasing attention has been focused on parental leave, but little is known about early leave and parental experiences for male and female attending physicians. Our goal was to describe and quantify the parental leave experiences of a nationally representative sample of emergency physicians (EP).

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Societal Impact on Emergency Care

Emergency Department Use across 88 Small Areas after Affordable Care Act Implementation in Illinois

Feinglass, PhD, et al.

This study analyzes changes in hospital emergency department (ED) visit rates before and after the 2014 Affordable Care Act (ACA) insurance expansions in Illinois. We compare the association between population insurance status change and ED visit rate change between a 24-month (2012–2013) pre-ACA period and a 24-month post-ACA (2014–2015) period across 88 socioeconomically diverse areas of Illinois.

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Treatment Protocol Assessment

Head CT for Minor Head Injury Presenting to the Emergency Department in the Era of Choosing Wisely

DeAngelis, MD, et al.

The Choosing Wisely campaign currently recommends avoiding computed tomography (CT) of the head in low-risk emergency department (ED) patients with minor head injury, based on validated decision rules. The objective of this study was to evaluate adherence to the Choosing Wisely campaign’s recommendations regarding head CT imaging of patients with minor head injury in the ED.

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Emergency Physician-performed Transesophageal Echocardiography in Simulated Cardiac Arrest

Byars, MD, et al.

Transesophageal echocardiography (TEE) is a well-established method of evaluating cardiac pathology. It has many advantages over transthoracic echocardiography (TTE), including the ability to image the heart during active cardiopulmonary resuscitation. This prospective simulation study aims to evaluate the ability of emergency medicine (EM) residents to learn TEE image acquisition techniques and demonstrate those techniques to identify common pathologic causes of cardiac arrest.

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Increased Computed Tomography Utilization in the Emergency Department and Its Association with Hospital Admission

Bellolio, MD, MS, et al.

Our goal was to investigate trends in computed tomography (CT) utilization in emergency departments (EDs) and its association with hospitalization. We conducted an analysis of an administrative claims database of U.S. privately insured and Medicare Advantage enrollees. We identified ED visits from 2005 through 2013 and assessed for CT use, associated factors, and hospitalization after CT, along with patient demographics.

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Population Health Research Design

Factors Influencing Participation in Clinical Trials: Emergency Medicine vs. Other Specialties

Kurt, PhD, RN, et al.

This study investigated factors that influence emergency medicine (EM) patients’ decisions to participate in clinical trials and whether the impact of these factors differs from those of other medical specialties. A survey was distributed in EM, family medicine (FM), infectious disease (ID), and obstetrics/gynecology (OB/GYN) outpatient waiting areas. Eligibility criteria included those who were 18 years of age or older, active patients on the day of the survey, and able to complete the survey without assistance.

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Antimicrobial Therapy for Pneumonia in the Emergency Department: The Impact of Clinical Pharmacists on Appropriateness

Faine, PharmD, MS, et al.

Pneumonia impacts over four million people annually and is the leading cause of infectious disease-related hospitalization and mortality in the United States. Appropriate empiric antimicrobial therapy decreases hospital length of stay and improves mortality. The objective of our study was to test the hypothesis that the presence of an emergency medicine (EM) clinical pharmacist improves the timing and appropriateness of empiric antimicrobial therapy for community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP).

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Availability and Accuracy of EMS Information about Chronic Health and Medications in Cardiac Arrest

Foster, BS, et al.

However, little is known about the field availability or accuracy of information of chronic health conditions or chronic medication treatments in emergent circumstances, especially when the patient cannot serve as an information resource. We evaluated the prehospital availability and accuracy of specific chronic health conditions and medication treatments among out-of-hospital cardiac arrest (OHCA) patients.

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Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions

Carmel, MD, et al.

Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center.

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Pediatric Patients Discharged from the Emergency Department with Abnormal Vital Signs

Winter, MPH, et al.

Children often present to the emergency department (ED) with minor conditions such as fever and have persistently abnormal vital signs. We hypothesized that a significant portion of children discharged from the ED would have abnormal vital signs and that those discharged with abnormal vital signs would experience very few adverse events.

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Predictors of Return Visits Among Insured Emergency Department Mental Health and Substance Abuse Patients, 2005–2013

Lee, MD, MS, et al.

Our goal was to describe the pattern and identify risk factors of early-return ED visits or inpatient admissions following an index mental health and substance abuse (MHSA)-related ED visit in the United States.

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Effect Of A “No Superuser Opioid Prescription” Policy On ED Visits And Statewide Opioid Prescription

Kahler, MD, MS, et al.

The U.S. opioid epidemic has highlighted the need to identify patients at risk of opioid abuse and overdose. We initiated a novel emergency department- (ED) based interventional protocol to transition our superuser patients from the ED to an outpatient chronic pain program. The objective was to evaluate the protocol’s effect on superusers’ annual ED visits.

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Loaded Questions: Internet Commenters’ Opinions on Physician-Patient Firearm Safety Conversations

Knoepke, PhD, MSW, et al.

Medical and public health societies advocate that healthcare providers (HCPs) counsel at-risk patients to reduce firearm injury risk. Anonymous online media comments often contain extreme viewpoints and may therefore help in understanding challenges of firearm safety counseling. To help inform injury prevention efforts, we sought to examine commenters’ stated opinions regarding firearm safety counseling HCPs.

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Using Geospatial Mapping to Determine the Impact of All-Terrain Vehicle Crashes on Both Rural and Urban Communities

Qin, BA, et al.

Deaths and injuries from all-terrain vehicle (ATV) crashes result in approximately 700 deaths each year and more than 100,000 emergency department (ED) visits. The purpose of this study was to determine ATV crash patterns within a state, and to compare and contrast characteristics of these crashes as a function of crash-site rurality.

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Pediatric Exposures to Topical Benzocaine Preparations Reported to a Statewide Poison Control System

Vohra, MD, et al.

Topical benzocaine is a local anesthetic commonly used to relieve pain caused by teething, periodontal irritation, burns, wounds, and insect bites. Oral preparations may contain benzocaine concentrations ranging from 7.5% to 20%. Pediatric exposure to such large concentrations may result in methemoglobinemia and secondarily cause anemia, cyanosis, and hypoxia.

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What Did You Google? Describing Online Health Information Search Patterns of ED patients and Their Relationship with Final Diagnoses

McCarthy, MD, MS, et al.

Emergency department (ED) patients’ Internet search terms prior to arrival have not been well characterized. The objective of this analysis was to characterize the Internet search terms patients used prior to ED arrival and their relationship to final diagnoses.

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Diagnostic Accuracy of Ultrasound for Identifying Shoulder Dislocations and Reductions: A Systematic Review of the Literature

Gottlieb, MD, et al.

Patients with shoulder dislocations commonly present to the emergency department. Ultrasound has the potential to save time, radiation exposure, healthcare costs, and possible need for re-sedation. We conducted this systematic review to compare the diagnostic accuracy of ultrasound compared with plain radiography in the assessment of shoulder dislocations.

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Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department

Hitti, MD, et al.

Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%–38%. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions.

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Critical Care

Sepsis Definitions: The Search for Gold and What CMS Got Wrong

Kalantari, DO, et al.

On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. These core measures are controversial among healthcare providers. This article will address that there is no gold standard definition for sepsis, severe sepsis or septic shock and the CMS-assigned definitions for severe sepsis and septic shock are premature and inconsistent with evidence-based definitions.

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Critical Care

Appropriateness of Bolus Antihypertensive Therapy for Elevated Blood Pressure in the Emergency Department

Miller, MD, MS, et al.

Administration of bolus intravenous (IV) antihypertensive treatment to lower BP in patients without a true hypertensive emergency is a wasteful practice that is discouraged by hypertension experts; however, anecdotal evidence suggests this occurs with relatively high frequency. Accordingly, we sought to assess the frequency of inappropriate IV antihypertensive treatment in ED patients with elevated BP absent a hypertensive emergency.

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Critical Care

Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events?

Durfey, MD, et al.

The electrocardiogram (ECG) is often used to identify which hyperkalemic patients are at risk for adverse events. However, there is a paucity of evidence to support this practice. This study analyzes the association between specific hyperkalemic ECG abnormalities and the development of short-term adverse events in patients with severe hyperkalemia.

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Critical Care

Duration of Mechanical Ventilation in the Emergency Department

Angotti, MD, et al.

Due to hospital crowding, mechanically ventilated patients are increasingly spending hours boarding in emergency departments (ED) before intensive care unit (ICU) admission. This study aims to evaluate the association between time ventilated in the ED and in-hospital mortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS).

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