Pediatric EM Morsels

JULY 26, 2024

Higher titers in both CSF and serum were associated with poor outcomes. Earlier diagnosis leads to better outcomes. Younger Age at Onset Is Associated With Worse Long-term Behavioral Outcomes in Anti-NMDA Receptor Encephalitis. Epub 2019 Dec 19. It is best to assume the worst and cover for this possibility. 2019.12.016.

Psychiatric 269

Psychiatric Seizures Outcomes Pediatrics 269

RebelEM

SEPTEMBER 7, 2023

BACKGROUND: intracerebral hemorrhage (ICH) makes up 10-15% of all strokes and significantly contributes to overall stroke-related morbidity and mortality ( Hostettler 2019 ). OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. OR 0.07, 95% CI 0.01-0.38,

Seizures 133

Seizures Stroke Outcomes Research 133

Emergency Medicine Journal

MAY 23, 2023

We validated the score in a large patient data set and constructed a model that allows early prediction of the probability of clinical outcomes based on the individual’s NEWS+L Score. The outcomes were hospital death or a composite of hospital death and intensive care unit admission at 24 hours, 48 hours and 72 hours.

Outcomes 40

Outcomes Emergency Department Academics Operations 40

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes. 7 (2019): 654-664. Diastolic Shock Index: A clinically relevant predictor of poor outcome in septic shock?

Shock 52

Shock Outcomes Sepsis Resuscitation 52

NIOSH Science Blog

SEPTEMBER 27, 2023

As of 2019, more than 18 million people, 11.5 % of the United States workforce, were employed in healthcare settings. Everyday healthcare workers face hazardous work conditions due to exposures to infectious agents and hazardous drugs and chemicals.

Outcomes 108

Outcomes 108

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). 2019 Sep;74(9):1186-1190. Epub 2019 Jul 16. Paediatr Anaesth.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

EM Literature of Note

SEPTEMBER 11, 2023

MARISS tried to ascertain predictors of poor outcome in mild stroke, and intravenous thrombolysis was not associated with an effect on the primary outcome. The population included for analysis is the Austrian Stroke Unit Registry from 2018 until 2019, an original cohort of 53,899 patients.

Stroke 112

Stroke Outcomes Wellness 112

Emergency Medicine Journal

JULY 22, 2024

Methods Adult patients transported to a single ED by ambulances and subsequently admitted to the hospital between 1 January 2019 and 18 April 2019 were eligible for inclusion.

Ambulance Services 52

Ambulance Services Hospitals Operations Emergency Department 52

RebelEM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Article: How-Berlemont C, Lamhaut L, Diehl J, et al. 1.15; P= 0.32 1.15; P= 0.31

Hospitals 83

Hospitals Outcomes EKG/ECG Resuscitation 83

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

The Trauma Pro

OCTOBER 4, 2024

Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. J Ped Surg 54:335-339, 2019.

Pediatrics 147

Pediatrics Outcomes Operations Emergency Department 147

Pediatric EM Morsels

SEPTEMBER 22, 2023

McGraw Hill Education; 2019:104-109 Dave S, DAHLSTROM JJ. Orenstein JB, Klein BL, Gotschall CS, Ochsenschlager DW, Klatzko MD, Eichelberger MR. Age and outcome in pediatric cervical spine injury: 11-year experience. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB. References Coleman-Satterfield, TT. 5 th Edition.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

Broome Docs

OCTOBER 6, 2024

Can acutely ill patients predict their outcomes? 2019 Nov 5;322(17):1722. Mols EM, Haak H, Holland M, Schouten B, Ibsen S, Merten H, Christensen EF, Nanayakkara PWB, Nickel CH, Weichert I, Kellett J, Subbe CP, Kremers MNT; Safer@Home Research Consortium. A scoping review. Emerg Med J. 2024 May 28;41(6):342-349. doi: 10.1001/jama.2018.15583.

Emergency Department 112

Emergency Department EMS Research Outcomes 112

Pediatric EM Morsels

JUNE 9, 2023

Specific Therapies for Variceal Hemorrhage : [ Luoto, 2020 ; Castillo, 2019; Garcia-Tsao, 2007 ] Antibiotic prophylaxis (usually for 7 days) Ceftriaxone is reasonable 1st choice. Castillo, 2019 ] Somatostatin (or its analogues, like Octreotide) Guidelines do recommend this… There is great variability in its administration, though.

Pediatrics 152

Pediatrics Head Injuries Airway Management Administration 152

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Outcomes: Primary Outcome: Reduction of dyspnea measured on a verbal dyspnea scale (VDS) from 0 to 10 recorded at enrollment, then at 2, 4, and 5 hours after arrival.

Ultrasounds 130

Ultrasounds Outcomes COPD Hospitals 130

Sensible Medicine

JULY 29, 2024

The background for cash giveaways stem from the association of low income and worse health outcomes. The primary outcome was positive but there were caveats. Importantly, however, there were no differences in health outcome measures, such as BP, BMI, HbA1c or cholesterol level. More than 70% were first-language Spanish speaking.

Outcomes 111

Outcomes Research Sepsis Emergency Department 111

RebelEM

NOVEMBER 30, 2023

Outcomes: Primary Outcome: In-hospital mortality. Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. There was no specified time-frame for the primary outcome, potentially affecting the precision of the findings. May 1, 2019 , A5999-A5999. 2.89, p = 0.01. Hamdon, M.

Sepsis 122

Sepsis Fluid Resuscitation Resuscitation Administration 122

EMDocs

JANUARY 29, 2024

Finally, anticipating and addressing known complications such as seizures, increased intracranial pressure, or cerebral edema with appropriate measures, including antiepileptic drugs or osmotic agents, is essential for improving patient outcomes. Lowering the MAP may mitigate these risks and possibly improve outcomes. Ann Emerg Med.

Stroke 73

Stroke Outcomes EMS Seizures 73

Emergency Medicine Journal

MARCH 21, 2024

’ –Audre Lorde It has been over 4 years since 14 November 2019 when the first documented case of COVID-19 emerged. This has exposed deep-seated racial inequalities that persist in disease burden, healthcare access and outcomes in patients and healthcare professionals alike. ‘It is not our differences that divide us.

Documentation/Coding 52

Documentation/Coding Outcomes 52

EMDocs

SEPTEMBER 30, 2024

Primary outcome: Prescription of ICS on ED discharge from the index visit Secondary outcomes: ICS prescription rates in high-risk subgroups Rates of outpatient follow-up within 30 days of an ED visit for asthma Variation in ICS prescription rates among attending ED physicians. The primary outcome was hospital admission rates.

Outcomes 83

Outcomes Documentation/Coding Academics Administration 83

EMDocs

DECEMBER 1, 2024

The disease is generally mild, but in untreated cases, it can lead to more severe outcomes, especially in patients with underlying conditions such as glucose-6-phosphate dehydrogenase deficiency. Even though the disease often resolves spontaneously, prompt antibiotic therapy is essential for optimal outcomes. pregnant patients).

EMS 75

EMS Infectious Diseases Shock Resuscitation 75

RebelEM

APRIL 22, 2024

Intervention: Target PaO2 = 60 mm Hg Control: Target PaO2 = 90 mm Hg Outcome (primary): Absolute number of days without life support in 90 days defined as the absence of mechanical ventilation, circulatory support, or kidney replacement. Outcomes (secondary): 90-day all-cause mortality. CI) Secondary Outcomes 90-day Mortality 34.7%

Outcomes 75

Outcomes Best Practices EMS Shock 75

Don't Forget the Bubbles

JUNE 17, 2024

High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. At its heart lies an unpleasant reality- a critically unwell child with an anxious carer hoping for a positive outcome. 2019 May 31:bmjqs-2019. 2019 May;27(4):758-64. BMJ Quality & Safety.

Leadership 104

Leadership Resuscitation Teamwork Patient Safety 104

PulmCCM

SEPTEMBER 21, 2023

But there’s been surprisingly little data from randomized trials to identify more precise targets in the middle: The MAPAS trial (2019) suggested rapid lowering of blood pressure in acute ischemic stroke was unhelpful, a target of 161-180 mm Hg might be beneficial, and pressures 181-200 mm Hg resulted in more intracranial hemorrhage.

Stroke 105

Stroke Outcomes 105

EMDocs

NOVEMBER 13, 2024

Older age, recurrent episodes of SBP, hepatorenal syndrome, hepatic encephalopathy, acute kidney injury (AKI), concurrent GI bleeding, and higher MELD scores are predictors of worse outcomes. Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies. 2019 Jan 14;11:13-22.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 80

EMDocs

AUGUST 22, 2024

Certified interpreter use can improve communication and patient outcomes. Conducting research regarding best practices for improving health outcomes for NELP patients. Pearls NELP patients have worse health outcomes despite widespread language-access policies. April 2019. 45:446-458. Taira B, et al. 23:1214-1222.

Documentation/Coding 82

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 82

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

Don't Forget the Bubbles

OCTOBER 2, 2024

2019 Mar;20(3S) The Question Which hyperosmolar agent – 3% Hypertonic Saline or Mannitol – is more effective at reducing intracranial pressure (ICP) and increasing cerebral perfusion pressure (CPP) in paediatric traumatic brain injury (TBI)? Results: The pooled data showed no statistical difference in survival or neurological outcomes.

Administration 48

Administration Outcomes Pediatrics Research 48

Emergency Medicine Journal

JUNE 20, 2024

The associations between where you live and your health outcomes are increasingly understood. In 2019, it was estimated that the extra costs to the NHS of socioeconomic inequality were £4.8 Healthy life expectancy is more than 18 years lower for people living in the most deprived areas compared with the least deprived.

Outcomes 40

Outcomes 40

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 104

Outcomes Research Pediatrics Hospitals 104

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

RebelEM

OCTOBER 2, 2023

No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 tests/hr (0.8 Traditional: 1.0 tests/hr (0.8 Pre-Intervention: 1.0 tests/hr (0.9

Operations 105

Operations Academics Outcomes Fluid Resuscitation 105

Emergency Medicine Journal

JANUARY 22, 2024

Methods A single-centre, randomised trial of intubations of stable patients with uncomplicated airways was conducted from 15 September 2019 to 31 May 2021 in the All India Institute of Medical Sciences, Bhubaneswar, India. Secondary outcomes were intubation success, ease of intubation and complications.

Outcomes 40

Outcomes 40

RebelEM

NOVEMBER 6, 2023

to 1mg/kg/hr) Information regarding the vasopressors used in the study is as follows: Norepinephrine equivalents = norepinephrine mcg/kg/min + (phenylephrine mcg/kg/min/10) + epinephrine mcg/kg/min + (vasopressin units/min x2.5)

Shock 72

Shock Administration Academics Hospitals 72

Emergency Medicine Journal

OCTOBER 26, 2023

Background Blood transfusion for bleeding trauma patients is a promising pre-hospital intervention with potential to improve outcomes. Methods Pre-hospital physicians, from two air ambulance sites in the south of England, were interviewed between December 2018 and January 2019.

Blood Transfusions 52

Blood Transfusions Hospitals Outcomes 52

RebelEM

AUGUST 14, 2023

days 2 most common sites of infection were lung (44.8%) and inta-abdominal (32.1%) Majority of infections were community-acquired (≈84%) Over half the patients were on mechanical ventilation (≈53%) Primary Outcome Results: 28-day mortality rate: Placebo 26.1% (230/882) vs. XBJ 18.8% (165/878); P<0.001 The risk difference was 7.3% (95% CI, 3.4-11.2)

Sepsis 98

Sepsis Outcomes Administration EMS 98

RebelEM

AUGUST 12, 2024

PMID: 36038001 Clinical Question: In patients undergoing cardiac surgery with cardiopulmonary bypass, does the administration of intravenous amino acid therapy lead to lower occurrence of postoperative AKI when compared to placebo?

Outcomes 81

Outcomes Hospitals Operations Shock 81