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    Scapular fractures in the Pan-scan Era.
    Acad Emerg Med 2018 Jan 11. Epub 2018 Jan 11.
    Department of Emergency Medicine, The University of California San Francisco.
    Background: Scapular fractures have been traditionally taught to be associated with significant injuries and major morbidity. As we demonstrated with sternal fracture, pulmonary contusion and rib fracture, increased chest CT utilization and head-to-pelvis CT (pan-scan) protocols in blunt trauma evaluation, however, may diagnose minor, clinically irrelevant scapular fractures, possibly rendering previous teachings obsolete.

    Objectives: To determine the 1) percentages of scapular fractures seen on chest CT only (SOCTO) versus seen on both CXR and CT and of isolated scapular fracture (scapular fracture without other thoracic injuries), 2) frequencies of associated thoracic injury with scapular fracture, and 3) proportion of patients admitted, mortality, hospital length of stay, and injury severity scores (ISS), comparing four patient groups: scapular fracture, non-scapular fracture, scapular fracture SOCTO, and isolated scapular fracture. Read More

    Effectiveness of interventions to decrease image ordering for low back pain presentations in the emergency department: a systematic review.
    Acad Emerg Med 2018 Jan 8. Epub 2018 Jan 8.
    Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.
    Background: Low back pain (LBP) is an extremely frequent reason for patients to present to an emergency department (ED). Despite evidence against the utility of imaging, simple and advanced imaging (i.e. Read More

    What happens next? Recurrence Rates for First Unprovoked Seizures in Children.
    Acad Emerg Med 2018 Jan 2. Epub 2018 Jan 2.
    Departments of Emergency Medicine and Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, MI.
    Seizures represent approximately 1% of all ED visits in the United States. 1 Unprovoked first seizures in children commonly present to the Emergency Department (ED), and even after the neurological exam normalizes, the prospect of recurrence can be a source of great anxiety for caregivers. 2 Compared to febrile seizures, unprovoked seizures carry a higher rate of recurrence and epilepsy. Read More

    The Focused History and Physical - circa 100 BCE.
    Acad Emerg Med 2017 Dec 30. Epub 2017 Dec 30.
    Harvard Medical School Harvard Department of the Classics Cambridge, Massachusetts, USA.
    When modern physicians reflect on 'ancient medicine' or 'Greek medicine,' they typically think of Hippocrates and Galen. Few know of the raging, centuries-long intellectual debates among physicians about what exactly mattered in the treatment of illness, or about a group of physicians whose pattern-based, systematized approach to health and disease was a forerunner of how today's emergency medicine physicians evaluate and treat their patients.Methodist physicians (c. Read More

    Development of a Patient Decision Aid for Syncope in the Emergency Department: the SynDA tool.
    Acad Emerg Med 2017 Dec 30. Epub 2017 Dec 30.
    Mount Sinai Medical Center, Department of Emergency Medicine, 3 East 101st Street, Second Floor, New York, NY, 10029, USA.
    Objectives: To develop a patient decision aid to promote shared decision-making for stable, alert patients who present to the emergency department (ED) with syncope.

    Methods: Using input from patients, clinicians, and experts in the field of syncope, health care design, and shared decision-making, we created a prototype of a paper-based decision aid to engage patients in the disposition decision (admission vs. discharge) after an unremarkable ED evaluation for syncope. Read More

    Sex Differences in Diagnoses, Treatment and Outcomes for Emergency Department Patients with Chest Pain and Elevated Cardiac Troponin.
    Acad Emerg Med 2017 Dec 23. Epub 2017 Dec 23.
    Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
    Objective: While sex differences in the treatment and outcomes of subjects with acute coronary syndromes are well documented, little is known about the impact of cardiac troponin (cTn) levels obtained in the emergency department (ED) on the observed sex differences. We sought to determine whether cTn levels by chest pain features modify sex differences in diagnosis, treatment and outcomes in patients presenting with chest pain suggestive of ischemia.

    Methods: All adults presenting to two hospitals in Vancouver, Canada between May 2008 and Mar 2013 with ischemic chest pain and with cTn testing were included in the study. Read More

    Protocolized Laboratory Screening for the Medical Clearance of Psychiatric Patients in the Emergency Department: A Systematic Review.
    Acad Emerg Med 2017 Dec 20. Epub 2017 Dec 20.
    From the Department of Emergency Medicine (AC, RB, ES, MP J, RS) Kings County Hospital Center, Brooklyn, NY.
    Objective: Emergency department (ED) patients with psychiatric chief complaints undergo medical screening to rule out underlying or comorbid medical illnesses prior to transfer to a psychiatric facility. This systematic review attempts to determine the clinical utility of protocolized laboratory screening for the streamlined medical clearance of ED psychiatric patients by determining the clinical significance of individual laboratory results.

    Methods: We searched PUBMED, EMBASE and SCOPUS using the search terms "Emergency department, Psychiatry, Diagnostic tests, Laboratories, Studies, Testing, Screening, and Clearance" up to June 2017 for studies on adult psychiatric patients. Read More

    ED Treatment of Opioid Addiction: An Opportunity to Lead.
    Acad Emerg Med 2017 Dec 21. Epub 2017 Dec 21.
    Harvard Medical School and Harvard Kennedy School.
    Opioid use disorder (OUD) is the fastest growing substance use disorder in the United States and the main reason for seeking addiction treatment services for illicit drug use throughout the world. The emergency department (ED) is an important point of care for patients with OUD as these patients are often marginalized from traditional primary care services. EDs often serve their primary healthcare needs as well as offering overdose reversal, attention to injuries related to substance use, and entry points into OUD treatment. Read More

    Opening of Psychiatric Observation Unit Eases Boarding Crisis.
    Acad Emerg Med 2017 Dec 20. Epub 2017 Dec 20.
    Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
    Objectives: The objective of this study was to evaluate the effect of a psychiatric observation unit in reducing ED boarding and length of stay for patients presenting with primary psychiatric chief complaints. A secondary outcome was to determine the effect of a psychiatric observation unit on inpatient psychiatric bed utilization.

    Methods: Design and Setting: Before-and-after analysis conducted in a 1541-bed tertiary care academic medical center including an adult ED with annual census over 90,000 between February 2013 and July 2014. Read More

    Material Needs of Emergency Department Patients: A Systematic Review.
    Acad Emerg Med 2017 Dec 21. Epub 2017 Dec 21.
    Ronald O. Perelman Department of Emergency Medicine and Department of Population Health, NYU School of Medicine, New York.
    Background: Interest in social determinants of health (SDOH) has expanded in recent years, driven by a recognition that such factors may influence health outcomes, services use, and health care costs. One subset of SDOH is material needs such as housing and food. We conducted a systematic review of the literature on material needs among emergency department (ED) patients in the United States. Read More

    License.
    Acad Emerg Med 2017 Dec 19. Epub 2017 Dec 19.
    Emergency Medicine, Boston Medical Center.
    Sometimes, the ordinary patient strikes somewhere deep within you. She was, after all, no different from the hundreds of other drug users I've treated. Two and a half short years of residency, and already I'm numb to it. Read More

    Hack's Impairment Index, Response to Comments.
    Acad Emerg Med 2017 Dec 19. Epub 2017 Dec 19.
    Alpert Medical School, Brown University, 55 claverick strm 124, 02903, Providence Rhode IslandUnited States.
    The fact that alcohol intoxication is a tremendous problem with hundreds of thousands of patients presenting to EDs across the country with impairment as a chief complaint and no nationally recognized standard way of evaluating this state (or even language to formally describe their clinical status) emphasizes the importance of this paper. Although the paper describes the performance of Hack's Impairment Index (HII score) in the largest group of alcohol impaired ED patients ever formally assessed for degree of impairment and the first to include patients that ranged from unresponsive to unimpaired, the research was limited in several aspects by restrictions imposed by the hospital and IRB, and the nature of the study population, which all affected study design. Many of these limitations are inherent in any study exploring a new gold standard-in that there is no objective mean for the desired primary outcome of patient safety. Read More

    Key High Efficiency Practices of Emergency Department Providers: A Mixed Methods Study.
    Acad Emerg Med 2017 Dec 18. Epub 2017 Dec 18.
    Department of Emergency Medicine, Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine, Iowa City, IA.
    Objective: The objective of this study was to determine specific provider practices associated with high provider efficiency in community emergency departments (EDs).

    Methods: A mixed methods study design was utilized to identify key behaviors associated with efficiency: Stage 1. A convenience sample of sixteen participants (ED medical directors, nurses, advanced practice providers, and physicians) identified provider efficiency behaviors during semi-structured interviews. Read More

    Effectiveness of implementing evidence based interventions to reduce c-spine image ordering in the emergency department: a systematic review.
    Acad Emerg Med 2017 Dec 19. Epub 2017 Dec 19.
    Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, CANADA.
    Objectives: Appropriate use of imaging for adult patients with cervical spine (C-spine) injuries in the emergency department (ED) is a longstanding issue. Guidance for C-spine ordering exists; however, the effectiveness of the decision support implementation in the ED is not well studied. This systematic review examines the implementation and effectiveness of evidence-based interventions aimed at reducing C-spine imaging in adults presenting to the ED with neck trauma. Read More

    Letter to the editor, RE: The Hack Index.
    Acad Emerg Med 2017 Dec 19. Epub 2017 Dec 19.
    New York University.
    We read Hack et al's recent work with great interest.(1) While we applaud the effort to objectively quantify degree of impairment of intoxicated patients using the Hack Impairment Index (HII) in the emergency department, there are some notable limitations to this study which require further discussion.The HII score had a strong agreement with nurses' clinical assessments of intoxication. Read More

    Clinical examination for acute aortic dissection: A systematic review and meta-analysis.
    Acad Emerg Med 2017 Dec 18. Epub 2017 Dec 18.
    Cardiovascular Research Methods Centre, University of Ottawa Heart Institute.
    Introduction: Acute aortic dissection is a life-threatening condition due to a tear in the aortic wall. It is difficult to diagnose and if missed carries a significant mortality.

    Methods: We conducted a librarian assisted systematic review of Pubmed, Medline, Embase and the Cochrane database from 1968 to July 2016. Read More

    Hot Off the Press: SGEM#196: Gastroparesis-I Feel Like Throwing Up.
    Acad Emerg Med 2017 Dec 15. Epub 2017 Dec 15.
    University of Western Ontario, Goderich, Ontario, Canada.
    This randomized controlled trial compared haloperidol along with conventional therapy to placebo along with conventional therapy for gastroparesis in the emergency department. The primary outcomes of pain and nausea scores at 1 hour were significantly improved in the haloperidol group, but not in the placebo group. In this summary, we discuss a quality assessment of the article and summarized the social media commentary from the blog post/podcast. Read More

    Homelessness and Emergency Medicine: A Review of the Literature.
    Acad Emerg Med 2017 Dec 9. Epub 2017 Dec 9.
    Department of Emergency Medicine, Emory University, Atlanta, GA.
    Objectives: We aimed to synthesize the available evidence on the demographics, prevalence, clinical characteristics, and evidence-based management of homeless persons in the emergency department (ED). Where appropriate, we highlight knowledge gaps and suggest directions for future research.

    Methods: We conducted a systematic literature search following databases: PubMed, Ovid, and Google Scholar for articles published between January 1, 1990, and December 31, 2016. Read More

    Impact of a Shared Decision Making Intervention on Health Care Utilization: A Secondary Analysis of the Chest Pain Choice Multicenter Randomized Trial.
    Acad Emerg Med 2017 Dec 8. Epub 2017 Dec 8.
    Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
    Background: Patients at low risk for acute coronary syndrome are frequently admitted for observation and cardiac testing, resulting in substantial burden and cost to the patient and the health care system.

    Objectives: The purpose of this investigation was to measure the effect of the Chest Pain Choice (CPC) decision aid on overall health care utilization as well as utilization of specific services both during the index emergency department (ED) visit and in the subsequent 45 days.

    Methods: This was a planned secondary analysis of data from a pragmatic multicenter randomized trial of shared decision making in adults presenting to the ED with chest pain who were being considered for observation unit admission for cardiac stress testing or coronary computed tomography angiography. Read More

    High Risk Clinical Features for Acute Aortic Dissection: A Case-Control Study.
    Acad Emerg Med 2017 Dec 8. Epub 2017 Dec 8.
    Department of Emergency Medicine, the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario.
    Background: Acute aortic dissection (AAD) is a rare condition with a high mortality that is often missed. The objective of our study was to assess the diagnostic accuracy of clinical and laboratory findings for AAD, in confirmed cases of AAD and in a low-risk control group.

    Methods: This was a historical matched case-control study: participants were adults > 18 years old presenting to two tertiary care emergency departments (EDs) or one regional cardiac referral center. Read More

    Past-year Prescription Drug Monitoring Program Opioid Prescriptions and Self-reported Opioid Use in an Emergency Department Population With Opioid Use Disorder.
    Acad Emerg Med 2017 Nov 22. Epub 2017 Nov 22.
    Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
    Background: Despite increasing reliance on prescription drug monitoring programs (PDMPs) as a response to the opioid epidemic, the relationship between aberrant drug-related behaviors captured by the PDMP and opioid use disorder is incompletely understood. How PDMP data should guide emergency department (ED) assessment has not been studied.

    Objectives: The objective was to evaluate a relationship between PDMP opioid prescription records and self-reported nonmedical opioid use of prescription opioids in a cohort of opioid-dependent ED patients enrolled in a treatment trial. Read More

    A Randomized Double Blind Trial of Needle-free Injected Lidocaine Versus Topical Anesthesia for Infant Lumbar Puncture.
    Acad Emerg Med 2017 Nov 20. Epub 2017 Nov 20.
    Department of Emergency Medicine, Denver Health and Hospital Authority, Denver, CO.
    Objectives: Lumbar punctures (LPs) are commonly performed in febrile infants to evaluate for meningitis, and local anesthesia increases the likelihood of LP success. Traditional methods of local anesthesia require injection that may be painful or topical application that is not effective immediately. Recent advances in needle-free jet injection may offer a rapid alternative to these modalities. Read More

    Evaluation of a Low-risk Mild Traumatic Brain Injury and Intracranial Hemorrhage Emergency Department Observation Protocol.
    Acad Emerg Med 2017 Nov 20. Epub 2017 Nov 20.
    Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
    Objectives: Among emergency physicians, there is wide variation in admitting practices for patients who suffered a mild traumatic brain injury (TBI) with an intracranial hemorrhage (ICH). The purpose of this study was to evaluate the effects of implementing a protocol in the emergency department (ED) observation unit for patients with mild TBI and ICH.

    Methods: This retrospective cohort study was approved by the institutional review board. Read More

    Patient-level Factors and the Quality of Care Delivered in Pediatric Emergency Departments.
    Acad Emerg Med 2017 Nov 18. Epub 2017 Nov 18.
    Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, CA.
    Objective: Quality of care delivered to adult patients in the emergency department (ED) is often associated with demographic and clinical factors such as a patient's race/ethnicity and insurance status. We sought to determine whether the quality of care delivered to children in the ED was associated with a variety of patient-level factors.

    Methods: This was a retrospective, observational cohort study. Read More

    Syncope Prognosis Based on Emergency Department Diagnosis: A Prospective Cohort Study.
    Acad Emerg Med 2017 Nov 14. Epub 2017 Nov 14.
    Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario.
    Objective: Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial ED visit.

    Methods: We prospectively enrolled adult syncope patients at six EDs and excluded patients with presyncope, persistent mental status changes, intoxication, seizure, and major trauma. Read More

    A Risk Assessment Score and Initial High-sensitivity Troponin Combine to Identify Low Risk of Acute Myocardial Infarction in the Emergency Department.
    Acad Emerg Med 2017 Nov 13. Epub 2017 Nov 13.
    Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
    Objectives: Early discharge of patients with presentations triggering assessment for possible acute coronary syndrome (ACS) is safe when clinical assessment indicates low risk, biomarkers are negative, and electrocardiograms (ECGs) are nonischemic. We hypothesized that the Emergency Department Assessment of Chest Pain Score (EDACS) combined with a single measurement of high-sensitivity cardiac troponin (hs-cTn) could allow early discharge of a clinically meaningful proportion of patients.

    Methods: We pooled data from four patient cohorts from New Zealand and Australia presenting to an emergency department with symptoms suggestive of ACS. Read More

    Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial.
    Acad Emerg Med 2017 Nov 10. Epub 2017 Nov 10.
    Emergency Medicine Research Center, Department of Emergency Medicine, Shariati Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
    Objective: We evaluated the efficacy of topical application of the injectable form of tranexamic acid (TXA) compared with anterior nasal packing (ANP) for the treatment of epistaxis in patients taking antiplatelet drugs (aspirin, clopidogrel, or both) who presented to the emergency department (ED).

    Methods: A randomized, parallel-group clinical trial was conducted at two EDs. A total of 124 participants were randomized to receive topical TXA (500 mg in 5 mL) or ANP, 62 patients per group. Read More

    Comparing Statewide and Single-center Data to Predict High-frequency Emergency Department Utilization Among Patients With Asthma Exacerbation.
    Acad Emerg Med 2017 Nov 4. Epub 2017 Nov 4.
    Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
    Background: Previous studies examining high-frequency emergency department (ED) utilization have primarily used single-center data, potentially leading to ascertainment bias if patients visit multiple centers. The goals of this study were 1) to create a predictive model to prospectively identify patients at risk of high-frequency ED utilization for asthma and 2) to examine how that model differed using statewide versus single-center data.

    Methods: To track ED visits within a state, we analyzed 2011 to 2013 data from the New York State Healthcare Cost and Utilization Project State Emergency Department Databases. Read More

    Early Recurrence of First Unprovoked Seizures in Children.
    Acad Emerg Med 2017 Nov 4. Epub 2017 Nov 4.
    Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
    Objectives: The risk of early seizure recurrences after first unprovoked seizures in children is largely unknown. We aimed to determine the rate of seizure recurrence within 14 days of first unprovoked seizures in children and identify associated risk factors. Secondarily, we aimed to determine the risk of recurrence at 48 hours and 4 months. Read More

    Training and Assessing Critical Airway, Breathing, and Hemorrhage Control Procedures for Trauma Care: Live Tissue Versus Synthetic Models.
    Acad Emerg Med 2017 Oct 27. Epub 2017 Oct 27.
    SimPORTAL & CREST, University of Minnesota, Minneapolis, MN.
    Introduction: Optimal teaching and assessment methods and models for emergency airway, breathing, and hemorrhage interventions are not currently known. The University of Minnesota Combat Casualty Training consortium (UMN CCTC) was formed to explore the strengths and weaknesses of synthetic training models (STMs) versus live tissue (LT) models. In this study, we compare the effectiveness of best in class STMs versus an anesthetized caprine (goat) model for training and assessing seven procedures: junctional hemorrhage control, tourniquet (TQ) placement, chest seal, needle thoracostomy (NCD), nasopharyngeal airway (NPA), tube thoracostomy, and cricothyrotomy (Cric). Read More

    Air Ambulance Delivery and Administration of Four-factor Prothrombin Complex Concentrate Is Feasible and Decreases Time to Anticoagulation Reversal.
    Acad Emerg Med 2018 Jan 13;25(1):33-40. Epub 2017 Nov 13.
    Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS.
    Objectives: The objective was to evaluate the feasibility, safety, and preliminary efficacy of four-factor prothrombin complex concentrate (4-factor PCC) administration by an air ambulance service prior to or during transfer of patients with warfarin-associated major hemorrhage to a tertiary care center for definitive management (interventional arm) compared to patients receiving 4-factor PCC following transfer by air ambulance or ground without 4-factor PCC treatment (conventional arm).

    Methods: This was a retrospective chart review of patients presenting to a large academic medical center. All patients presenting to the emergency department (ED) treated with 4-factor PCC from April 1, 2014, through June 30, 2016, were identified. Read More

    Contributions of Academic Emergency Medicine Programs to U.S. Health Care: Summary of the AAAEM-AACEM Benchmarking Data.
    Acad Emerg Med 2017 Oct 26. Epub 2017 Oct 26.
    Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA.
    Objectives: The societal contribution of emergency care in the United States has been described. The role and impact of academic emergency departments (EDs) has been less clear. Our report summarizes the results of a benchmarking effort specifically focused on academic emergency medicine (EM) practices. Read More

    Communicating Value in Simulation: Cost Benefit Analysis and Return on Investment.
    Acad Emerg Med 2017 Oct 26. Epub 2017 Oct 26.
    Emergency Medicine University of Central Florida College of Medicine National Medical Director, SimLEARN Veteran Health Administration, 13800 Veterans Way, Building 13 Orlando, Florida, 32832.
    Value-based health care requires a balancing of medical outcomes with economic value. Administrators need to understand both the clinical and economic effects of potentially expensive simulation programs to rationalize the costs. Given the often-disparate priorities of clinical educators relative to health care administrators, justifying the value of simulation requires the use of economic analyses few physicians have been trained to conduct. Read More

    Hot Off the Press: Prehospital Advanced Cardiac Life Support for Out-of-hospital Cardiac Arrest.
    Acad Emerg Med 2017 Oct 16. Epub 2017 Oct 16.
    University of Western Ontario, Goderich, Ontario, Canada.
    This retrospective cohort study examined the rate of survival to hospital discharge among adult patients with out-of-hospital cardiac arrest, comparing patients who received care only from basic cardiac life support (BCLS)-trained emergency medical service (EMS) crews to patients who had an advanced cardiac life support (ACLS)-trained EMS crew on scene at some point during the resuscitation. There was no difference in the primary outcome of rate of survival to hospital discharge (10.9% with ACLS care and 10. Read More

    Peripheral Intravenous Cannula Insertion and Use in the Emergency Department: An Intervention Study.
    Acad Emerg Med 2018 Jan 20;25(1):26-32. Epub 2017 Nov 20.
    Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
    Objectives: The objective was to examine cannulation practice and effectiveness of a multimodal intervention to reduce peripheral intravenous cannula (PIVC) insertion in emergency department (ED) patients.

    Methods: A prospective before and after study and cost analysis was conducted at a single tertiary ED in Australia. Data were collected 24 hours a day for 2 weeks pre- and post implementation of a multimodal intervention. Read More

    Fluid Resuscitation in Patients With Severe Burns: A Meta-analysis of Randomized Controlled Trials.
    Acad Emerg Med 2017 Oct 11. Epub 2017 Oct 11.
    Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
    Objectives: Fluid resuscitation is the mainstay treatment to reconstitute intravascular volume and maintain end-organ perfusion in patients with severe burns. The use of a hyperosmotic or isoosmotic solution in fluid resuscitation to manage myocardial depression and increased capillary permeability during burn shock has been debated. We conducted a systematic review and meta-analysis to compare the efficacies of hyperosmotic and isoosmotic solutions in restoring hemodynamic stability after burn injuries. Read More

    Behavioral Changes in Children After Emergency Department Procedural Sedation.
    Acad Emerg Med 2017 Oct 9. Epub 2017 Oct 9.
    Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
    Objective: The purpose of this study was to determine the proportion of children undergoing procedural sedation for fracture reduction in the emergency department (ED) observed to experience negative postdischarge behaviors. Predictors of negative behaviors were evaluated, including anxiety.

    Methods: This was a prospective cohort study of children receiving intravenous ketamine sedation for ED fracture reduction. Read More

    What's Next for Acute Heart Failure Research?
    Acad Emerg Med 2018 Jan 13;25(1):85-93. Epub 2017 Nov 13.
    Division of Cardiology, Stony Brook University Medical Center, Stony Brook, NY.
    Each year over one million patients with acute heart failure (AHF) present to a United States emergency department (ED). The vast majority are hospitalized for further management. The length of stay and high postdischarge event rate in this cohort have changed little over the past decade. Read More

    Excited Delirium: A Systematic Review.
    Acad Emerg Med 2017 Oct 9. Epub 2017 Oct 9.
    Emergency Department, Lausanne University Hospital CHUV, Lausanne, Switzerland.
    Objective: We aimed to clarify the definition, epidemiology, and pathophysiology of excited delirium syndrome (ExDS) and to summarize evidence-based treatment recommendations.

    Methods: We conducted a systematic literature search of MEDLINE, Ovid, Web of Knowledge, and Cochrane Library for articles published to March 18, 2017. We also searched the gray literature (Google Scholar) and official police or medical expert reports to complete specific epidemiologic data. Read More

    Clinical Vignettes Inadequate to Assess Impact of Implicit Bias: Concerning Limitations of a Systematic Review.
    Acad Emerg Med 2017 Dec 14;24(12):1531-1532. Epub 2017 Nov 14.
    Department of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.

    A Collaborative In Situ Simulation-based Pediatric Readiness Improvement Program for Community Emergency Departments.
    Acad Emerg Med 2017 Oct 4. Epub 2017 Oct 4.
    Division of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT.
    Background: More than 30 million children are cared for across 5,000 U.S. emergency departments (EDs) each year. Read More

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