Original Research Archives - Page 25 of 40 - The Western Journal of Emergency Medicine

Population Health Research Design

Validation of ICD-9 Codes for Stable Miscarriage in the Emergency Department

Volume 16, Issue 4, July 2015
Kelly E. Quinley, MD, et al.

International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes have not been validated for identifying cases of missed abortion where a pregnancy is no longer viable but the cervical os remains closed. Our goal was to assess whether ICD-9 code “632” for missed abortion has high sensitivity and positive predictive value (PPV) in identifying patients in the emergency department (ED) with cases of stable early pregnancy failure (EPF).

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Population Health Research Design

How do Medical Societies Select Science for Conference Presentation? How Should They?

Volume 16, Issue 4, July 2015
Thomas M. Kuczmarski, BA, et al.

Nothing has been published to describe the practices of medical societies in choosing abstracts for presentations at their annual meetings. We surveyed medical societies to determine their practices, and also present a theoretical analysis of the topic. We contacted a convenience sample of large U.S. medical conferences, and determined their approach to choosing abstracts. We obtained information from web sites, telephone, and email. Our theoretical analysis compares values-based and empirical approaches for scoring system development.

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Predictors of Linkage to Care for Newly Diagnosed HIV-Positive Adults

Volume 16, Issue 4, July 2015
Erika Aaron, MSN, et al.

Linkage to care following a human immunodeficiency virus (HIV) diagnosis is critical. In the U.S. only 69% of patients are successfully linked to care, which results in delayed receipt of
antiretroviral therapy leading to immune system dysfunction and risk of transmission to others. We evaluated predictors of failure to link to care at a large urban healthcare center in
Philadelphia in order to identify potential intervention targets.

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Differences in Presentation and Management of Pediatric Facial Lacerations by Type of Health Insurance

Volume 16, Issue 4, July 2015
Siraj Amanullah, MD, MPH, et al.

Limited data are available regarding differences in presentation and management
of pediatric emergency department (PED) patients based on insurance status. The objective of the
study was to assess the difference in management of pediatric facial lacerations based on medical
insurance status.

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Emergency Department Operations

Demographic, Operational, and Healthcare Utilization Factors Associated with Emergency Department Patient Satisfaction

Volume 16, Issue 4, July 2015.
Matthew W. Morgan, MD, et al.

The primary aim of this study was to determine which objectively-measured patient
demographics, emergency department (ED) operational characteristics, and healthcare utilization
frequencies (care factors) were associated with patient satisfaction ratings obtained from phone
surveys conducted by a third-party vendor for patients discharged from our ED.

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Critical Care

Is Serum Lactate Necessary in Patients with Normal Anion Gap and Serum Bicarbonate?

Volume 16, Issue 3, May 2015
Daniel Aronovich, DO, et al.

There has been an increase in patients having serum lactate drawn in emergency situations. The objective of this study was to determine whether or not it was necessary to obtain a lactate level in patients with a normal serum bicarbonate level and anion gap. This is a retrospective chart review evaluation of 304 patients who had serum lactate and electrolytes measured in an emergency setting in one academic medical center.

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Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency Department

Volume 16, Issue 3, May 2015
R. Myles Dickason, MD, MPH, et al.

The decision to treat pain in the emergency department (ED) is a complex, idiosyncratic process. Prior studies have shown that EDs undertreat pain. Several studies demonstrate an association between analgesia administration and race. This is the first Midwest single institution study to address the question of race and analgesia, in addition to examining the effects of both patient and physician characteristics on race-based disparities in analgesia administration.

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Reassessing After-Hour Arrival Patterns and Outcomes in ST-Elevation Myocardial Infarction

Volume 16, Issue 3, May 2015
James Langabeer, PhD, MBA, et al.

Differences in after-hours capability or performance of ST-elevation myocardial infarction (STEMI) centers has the potential to impact outcomes of patients presenting outside of regular hours. Using a prospective observational study, we analyzed all 1,247 non-transfer STEMI patients treated in 15 percutaneous coronary intervention (PCI) facilities in Dallas, Texas, during a 24-month period (2010–2012). Controlling for confounding factors through a variety of statistical techniques, we explored differences in door-to-balloon (D2B) and in-hospital mortality for those presenting on weekends vs. weekdays and business vs. after hours.

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Variability in the Initial Costs of Care and One-Year Outcomes of Observation Services

Volume 16, Issue 3, May 2015
Ibrahim Abbass, RPh, PhD

The use of observation units (OUs) following emergency departments (ED) visits as a model of care has increased exponentially in the last decade. About one-third of U.S. hospitals now have OUs within their facilities. While their use is associated with lower costs and comparable level of care compared to inpatient units, there is a wide variation in OUs characteristics and operational procedures. The objective of this research was to explore the variability in the initial costs of care of placing patients with non-specific chest pain in observation units (OUs) and the one-year outcomes.

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Physician Documentation of Sepsis Syndrome Is Associated with More Aggressive Treatment

Volume 16, Issue 3, May 2015
Lisa R. Stoneking, MD, et al.

Timely recognition and treatment of sepsis improves survival. The objective is to examine the association between recognition of sepsis and timeliness of treatments.Patients whose emergency physicians articulated sepsis syndrome in their documentation or who launched the sepsis order set received antibiotics sooner and received more total volume of fluid.

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Association of Insurance Status with Health Outcomes Following Traumatic Injury: Statewide Multicenter Analysis

Volume 16, Issue 3, May 2015
Vatsal Chikani, MPH, BHMS, et al.

Recognizing disparities in definitive care for traumatic injuries created by insurance status may help reduce the higher risk of trauma-related mortality in this population. Our objective was to understand the relationship between patients’ insurance status and trauma outcomes.We collected data on all patients involved in traumatic injury from eight Level I and 15 Level IV trauma centers, and four non-designated hospitals through Arizona State Trauma Registry between January 1, 2008 and December 31, 2011.

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Rapid Diagnosis of Nonconvulsive Status Epilepticus Using Reduced-Lead Electroencephalography

Volume 16, Issue 3, May 2015
Jay M. Brenner, MD, et al.

Electroencephalography (EEG) is indicated for diagnosing nonconvulsive status epilepticus (NCSE) in a patient who has altered level of consciousness after a motor seizure. A study in a neonatal population found 94% sensitivity and 78% specificity for detection of seizure using a single-lead device. This study aims to show that a reduced montage EEG would detect 90% of seizures detected on standard EEG.

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Prehospital Care

Rapid Extrication versus the Kendrick Extrication Device (KED): Comparison of Techniques Used After Motor Vehicle Collisions

Volume 16, Issue 3, May 2015
Joshua Bucher, MD, et al.

This is a small experiment that showed decreased patient neck movement using a KED versus RE but resulted in increased patient movement in obese patients. Further studies are needed to determine if the KED improves any meaningful patient outcomes in the era of increased evidence-based medicine in emergency medical services.

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Prehospital Care

Self-Reported Provider Safety in an Urban Emergency Medical System

Volume 16, Issue 3, May 2015
Molly Furin, MD, MS

No recent data describes the frequency of physical or verbal assaults or which providers have increased fear for their safety. This information may help to guide interventions to improve safety. Our objective was to describe self-reported abuse and perceptions of safety and to determine if there are differences between gender, shift, and years of experience in a busy two-tiered, third service urban EMS system.

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Prehospital Care

Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times

Volume 16, Issue 3, May 2015
Justin C. Stowens, MD, et al.

Brief, early notification of STEMI by paramedics through 9-1-1 dispatchers achieves earlier CCL activation in a hospital system already using EMS-directed CCL activation. This practice significantly decreased DTB and yielded a higher percentage of patients meeting the DTB≤60 minutes quality metric.

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Prehospital Care

Knowledge and Beliefs of EMS Providers toward Lights and Siren Transportation

Volume 16, Issue 3, May 2015
Joseph Tennyson, MD, et al.

The use of warning lights and siren (WLS) increases the risk of ambulance collisions. Multiple studies have failed to demonstrate a clinical benefit to the patients. We sought to investigate the degree to which providers understand the data and incorporate it into their practice.

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Healthcare Utilization

Understanding Why Patients Return to the Emergency Department after Mild Traumatic Brain Injury within 72 Hours

Volume 16, Issue 3, May 2015
Latha Ganti, MD, MS, et al.

Approximately 5% of adult patients who present to the ED for mTBI will return within 72 hours of discharge for further care. Clinicians should identify at-risk individuals during their initial visits and attempt to provide anticipatory guidance when possible.

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Characteristics of Patients That Do Not Initially Respond to Intravenous Antihypertensives in the Emergency Department: Subanalysis of the CLUE Trial

Volume 16, Issue 2, March 2015
Caroline E. Freiermuth, MD et al.

Hypertensive emergency has a high mortality risk and the treatment goal is to quickly lower blood pressure with intravenous (IV) medications. Characteristics that are associated with non-response to IV antihypertensives have not been identified. The objective is to identify patient characteristics associated with resistance to IV antihypertensives.

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Young Patients with Suspected Uncomplicated Renal Colic are Unlikely to Have Dangerous Alternative Diagnoses or Need Emergent Intervention

Volume 16, Issue 2, March 2015
Elizabeth M. Schoenfeld, MD et al.

In the United States there is debate regarding the appropriate first test for new-onset renal colic, with non-contrast helical computed tomography (CT) receiving the highest ratings from both Agency for Healthcare Research and Quality and the American Urological Association. This is based not only on its accuracy for the diagnosis of renal colic, but also its ability to diagnose other surgical emergencies, which have been thought to occur in 10–15% of patients with suspected renal colic, based on previous studies.

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Change in Intraocular Pressure During Point-of-Care Ultrasound

Volume 16, Issue 2, March 2015
Cameron Berg, MD et al.

Point-of-care ocular ultrasound (US) is a valuable tool for the evaluation of traumatic ocular injuries. Conventionally, any maneuver that may increase intraocular pressure (IOP) is relatively contraindicated in the setting of globe rupture. Some authors have cautioned against the use of US in these scenarios because of a theoretical concern that an US examination may cause or exacerbate the extrusion of intraocular contents. This study set out to investigate whether ocular US affects IOP. The secondary objective was to validate the intraocular pressure measurements obtained with the Diaton® as compared with standard applanation techniques (the Tono-Pen®).

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Disaster Response Team FAST Skills Training with a Portable Ultrasound Simulator Compared to Traditional Training: Pilot Study

Volume 16, Issue 2, March 2015
Michael T. Paddock, DO, MS et al.

Pre-hospital focused assessment with sonography in trauma (FAST) has been effectively used to improve patient care in multiple mass casualty events throughout the world. Although requisite FAST knowledge may now be learned remotely by disaster response team members, traditional live instructor and model hands-on FAST skills training remains logistically challenging. The objective of this pilot study was to compare the effectiveness of a novel portable ultrasound (US) simulator with traditional FAST skills training for a deployed mixed provider disaster response team.

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Asking for a Commitment: Violations during the 2007 Match and the Effect on Applicant Rank Lists

Volume 16, Issue 2, March 2015
H. Gene Hern, MD, MS et al.

Applicants to residency face a number of difficult questions during the interview process, one of which is when a program asks for a commitment to rank the program highly. The regulations governing the National Resident Matching Program (NRMP) match explicitly forbid any residency programs asking for a commitment.

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Can Emergency Physicians Perform Common Carotid Doppler Flow Measurements to Assess Volume Responsiveness?

Volume 16, Issue 2, March 2015
Lori A. Stolz, MD et al.

Common carotid flow measurements may be clinically useful to determine volume responsiveness. The objective of this study was to assess the ability of emergency physicians (EP) to obtain sonographic images and measurements of the common carotid artery velocity time integral (VTi) for potential use in assessing volume responsiveness in the clinical setting.

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Virtual Alternative to the Oral Examination for Emergency Medicine Residents

Volume 16, Issue 2, March 2015
Jillian McGrath, MD et al.

The oral examination is a traditional method for assessing the developing physician’s medical knowledge, clinical reasoning and interpersonal skills. The typical oral examination is a face-to-face encounter in which examiners quiz examinees on how they would confront a patient case. The advantage of the oral exam is that the examiner can adapt questions to the examinee’s response. The disadvantage is the potential for examiner bias and intimidation. Computer-based virtual simulation technology has been widely used in the gaming industry. We wondered whether virtual simulation could serve as a practical format for delivery of an oral examination. For this project, we compared the attitudes and performance of emergency medicine (EM) residents who took our traditional oral exam to those who took the exam using virtual simulation.

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Non-thrombotic Abnormalities on Lower Extremity Venous Duplex Ultrasound Examinations

Volume 16, Issue 2, March 2015
Srikar Adhikari, MD, MS et al.

Emergency physician-performed compression ultrasonography focuses primarily on the evaluation of the proximal veins of the lower extremity in patients with suspected deep venous thrombosis (DVT). A detailed sonographic evaluation of lower extremity is not performed. The objective of this study was to determine the prevalence of non-thrombotic findings on comprehensive lower extremity venous duplex ultrasound (US) examinations performed on emergency department (ED) patients.

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Structured Communication: Teaching Delivery of Difficult News with Simulated Resuscitations in an Emergency Medicine Clerkship

Volume 16, Issue 2, March 2015
Sangeeta Lamba, MD et al.

The objective is to describe the implementation and outcomes of a structured communication module used to supplement case-based simulated resuscitation training in an emergency medicine (EM) clerkship.

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