bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early clinical predictors of severe acute respiratory syndrome in the emergency department
Authors: Wong W.N. , Sek Antonio C.H. , Lau Rick F.L. , Li K.M. , Leung Joe K.S. , Tse M.L. , Ng Andy H.W. , Stenstrom Robert J. 
Published: July 2016

ABSTRACT

Objectives:
To assess the association of diagnostic predictors available in the emergency department (ED) with the outcome diagnosis of severe acute respiratory syndrome (SARS).

Methods:
This retrospective cohort study describes all patients from the Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical and diagnostic predictors were recorded, along with ED diagnoses. Final diagnoses were established independently based on diagnostic tests performed after the ED visit. Associations of key predictors with the final diagnosis of SARS were described.

Results:
Of 821 patients, 205 had confirmed SARS, 35 undetermined SARS and 581 non-SARS. Multivariable logistic regression showed that the strongest predictors of SARS were abnormal chest x-ray (odds ratio [OR] = 17.4), subjective fever (OR = 9.7), temperature &gt;38°C (OR = 6.4), myalgias (OR = 5.5), chills and rigors (OR = 4.0) and contact exposure (OR = 2.6). In a subset of 176 patients who had a complete blood cell count performed, the strongest predictors were temperature ≥38ºC (OR = 15.5), lymphocyte count &lt;1000 (OR = 9.3) and abnormal chest x-ray (OR = 5.7). Diarrhea was a powerful negative predictor (OR = 0.03) of SARS.

Conclusions:
Two components of the World Health Organization case definition — fever and contact exposure — are helpful for ED decision-making, but respiratory symptoms do not discriminate well between SARS and non-SARS. Emergency physicians should consider the presence of diarrhea, chest x-ray findings, the absolute lymphocyte count and the platelet count as significant modifiers of disease likelihood. Prospective validation of these findings in other clinical settings is desirable.
Proportion of injured alcohol-impaired drivers subsequently convicted of an impaired driving criminal code offence in British Columbia
Authors: Purssell Roy A. , Yarema Mark , Wilson Jean , Fang Ming , Simons Richard , Kasic Sharon , Abu-Laban Riyad B. , Brubacher Jeffrey , Lupu Ioana 
Published: July 2016

ABSTRACTBackground:Alcohol is a frequent contributing factor to motor vehicle collision injuries. Our objective was to determine the proportion of intoxicated drivers hospitalized following motor vehicle crashes who were subsequently convicted of an impaired driving criminal code offence.Methods:We reviewed British Columbia Trauma Registry records from Jan. 1, 1992, to Mar. 31, 2000, and identified drivers of motor vehicles who were hospitalized for treatment of crash-related injuries. Patient identifiers were then used to link with the Insurance Corporation of British Columbia’s (ICBC) contraventions database and the ICBC Traffic Accident System collisions database.Results:Of 6067 patients identified in the Trauma Registry, 4042 had not been administered a blood ethanol test, 209 had no driver’s licence match in the relevant databases and 119 died, leaving 1697 eligible patients. Mean age was 34 years, and 79.6% were male. The average Injury Severity Score was 20, the average hospital stay was 14 days and, among ethanol-positive patients, the mean ethanol level was 34.0 mmol/L (156.4 mg/dL). In patients with levels &gt;17.3 mmol/L, the police had listed ethanol as a contributing factor in 70.6% of cases. Despite this, only 11.0% were convicted of impaired driving and 8.4% of another criminal offence; 10.7% received a 24-hour roadside prohibition, 3.9% received a 90-day administrative driving prohibition and 25.0% were convicted of a contravention of the Motor Vehicle Act. Forty-one percent were not convicted of any offence at all.Conclusions:Intoxicated drivers in British Columbia requiring hospitalization as a result of alcohol-related motor vehicle crashes are seldom convicted of impaired driving or other criminal code offences.
Cardiac concussion (commotio cordis)
Authors: Valani Rahim , Mikrogianakis Angelo , Goldman Ran D. 
Published: July 2016

ABSTRACTBlunt chest trauma in pediatric patients can result in various injuries to the myocardium. Cardiac concussion (commotio cordis) is seen in patients in whom the precordium has been struck with relatively little force at a vulnerable period of the cardiac cycle. These patients have no predisposing cardiac problems, and autopsy reveals no evidence of heart damage. The usual clinical presentation is that of immediate collapse secondary to a lethal arrhythmia. Prevention is the cornerstone of potentially decreasing the incidence with the aid of safety equipment and, possibly, immediate defibrillation.
Investigation of afebrile neonates with a history of fever
Authors: Brown Lance , Shaw Tania , Moynihan James A. , Denmark T. Kent , Mody Ameer , Wittlake William A. 
Published: July 2016

ABSTRACTObjective:Our objective was to describe clinically significant infections in a cohort of afebrile neonates who underwent an emergency department (ED) septic workup because of the history of a measured fever at home.Methods:Retrospective medical record review of all infants ≤28 days of age who presented to our tertiary care pediatric ED between Jan. 1, 1999, and Aug. 22, 2002, underwent lumbar puncture in the ED, had a reported temperature at home of ≥38°C, and an ED triage temperature of &lt;38°C. Laboratory and radiographic results were tabulated.Results:During the study period, 206 neonates underwent lumbar puncture in our ED. Of these, 108 were excluded because their home temperature was not documented, and 71 were excluded because they were still febrile on presentation to the ED. The study group consisted of the remaining 27 subjects, 4 of whom had received acetaminophen prior to ED arrival. Infections were confirmed in 10 (37%) subjects (3 urinary tract infections, 2 aseptic meningitis, 1 enterovirus meningitis, 1 respiratory syncytial virus bronchiolitis, 1 rotavirus enteritis and 2 pneumonias).Conclusions:Clinically important infections are not uncommon among afebrile neonates undergoing ED septic workup because of a measured fever at home. Some diagnostic testing is warranted in this group, although the clinical utility and indications for specific test modalities remain unclear.
Ethics in the trenches: Part 2. Case studies of ethical challenges in emergency medicine
Authors: Pauls Merril , McRae Andrew , Campbell Sam G. , Dungey Paul 
Published: July 2016

ABSTRACTUnique ethical issues arise in the practice of emergency medicine, and common ethical problems are often more difficult to address in the emergency department than in other medical settings. This article is Part 2 of the Series “Ethics in the Trenches” and it presents and analyses 2 cases — each dealing with an ethical challenge that emergency physicians are likely to encounter. The first case deals with patient refusal of care. When a patient refuses recommended care, the emergency physician must ensure the patient’s decision is informed and that the patient comprehends the implications of his or her choice. The second case deals with patient involvement in criminal activities. Emergency physicians often encounter patients who have engaged in illegal activities. Although certain activities must be reported, physicians should be mindful of their responsibility to protect patient privacy and confidentiality.
The need for a national emergency health services database
Authors: Kennedy Sherry , Young Wendy , Schull Michael J. , Isaac Winston 
Published: July 2016

ABSTRACTObjective:In February 2007, the Health Council of Canada, in its third annual report, emphasized the need for pan-Canadian data on our health care system. To date, no studies have examined the strengths and weaknesses of emergency health services (EHS) administrative databases, as perceived by researchers. We undertook a qualitative study to determine, from a researcher's perspective, the strengths and weaknesses of EHS administrative databases. The study also elicited researchers' suggestions to improve these databases.Methods:We conducted taped interviews with 4 Canadian health services researchers. The transcriptions were subsequently examined for common concepts, which were finalized after discussion with all the investigators.Results:Five common themes emerged from the interviews: clinical detail, data quality, data linkage, data use and population coverage. Data use and data linkages were considered strengths. Clinical detail, data quality and population coverage were considered weaknesses.Conclusion:The 5 themes that emerged from this study all serve to reinforce the call from the Health Council of Canada for national data on emergency services, which could be readily captured through a national EHS administrative database. We feel that key stakeholders involved in emergency services across Canada should work together to develop a strategy to implement an accurate, clinically detailed, integrated and comprehensive national EHS database.
Daily encounter cards facilitate competency-based feedback while leniency bias persists
Authors: Bandiera Glen , Lendrum David 
Published: July 2016

ABSTRACTObjective:We sought to determine if a novel competency-based daily encounter card (DEC) that was designed to minimize leniency bias and maximize independent competency assessments could address the limitations of existing feedback mechanisms when applied to an emergency medicine rotation.Methods:Learners in 2 tertiary academic emergency departments (EDs) presented a DEC to their teachers after each shift. DECs included dichotomous categorical rating scales (i.e., “needs attention” or “area of strength”) for each of the 7 CanMEDS roles or competencies and an overall global rating scale. Teachers were instructed to choose which of the 7 competencies they wished to evaluate on each shift. Results were analyzed using both staff and resident as the units of analysis.Results:Fifty-four learners submitted a total of 801 DECs that were then completed by 43 different teachers over 28 months. Teachers' patterns of selecting CanMEDS competencies to assess did not differ between the 2 sites. Teachers selected an average of 3 roles per DEC (range 0–7). Only 1.3% were rated as “needs further attention.” The frequency with which each competency was selected ranged from 25% (Health Advocate) to 85% (Medical Expert).Conclusion:Teachers chose to direct feedback toward a breadth of competencies. They provided feedback on all 7 CanMEDS roles in the ED, yet demonstrated a marked leniency bias.
The utility of multiple imaging modalities to diagnose acute aortic dissection
Authors: Hurley Katrina F. , Ducharme James 
Published: July 2016

ABSTRACTA 21-year-old man with Marfan syndrome and known aortic root aneurysm presented to our emergency department with symptoms suggestive of acute aortic dissection. The patient was hemodynamically stable and bilateral upper extremity blood pressures were similar. There was no mediastinal widening on portable chest radiograph. Both contrast CT and retrograde angiography of the aorta failed to identify dissection. Subsequent transesophageal echocardiography demonstrated a Stanford classification type A dissection. This case demonstrates the utility of multiple imaging modalities for identifying aortic dissection in high-risk patients.
Ramsay Hunt syndrome presenting as simple otitis externa
Authors: Kim Daniel , Bhimani Munsif 
Published: July 2016

ABSTRACTRamsay Hunt syndrome is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection occurs in the geniculate ganglion, causing otalgia, auricular vesicles and peripheral facial paralysis. Because these symptoms do not always present at the onset, this syndrome can be misdiagnosed. We report the case of a patient who was diagnosed with simple otitis externa after presenting to the emergency department (ED) with a 3-day history of right-sided otalgia. Her condition subsequently evolved to include right-sided auricular vesicles and right-sided facial weakness. She presented to the ED again after 2 days and was correctly diagnosed with Ramsay Hunt syndrome. We describe the clinical presentation, diagnostic findings and management of this uncommon but important entity.
Caring for victims of intimate partner violence: a survey of Canadian emergency departments
Authors: McClennan Sarah , Worster Andrew , MacMillan Harriet 
Published: July 2016

ABSTRACTObjective:We sought to determine the proportion of Canadian emergency departments (EDs) that have intimate partner violence (IPV) universal screening programs and intervention policies and procedures. Of the EDs with programs, we determined what proportion had made changes in their practices during the past 10 years and since the 2003 Canadian Task Force on Preventive Health Care recommendations.Methods:Using the same sampling methods as a 1994 study, we mailed questionnaires to nurse managers of a stratified, random sample of 250 out of 638 (39%) Canadian EDs and followed up with a series of telephone calls.Results:Of the 250 EDs initially contacted, 6 were excluded before the surveys were mailed. The response rate was 78.3% (191/244). Sixty-one (31.9%) of the studied EDs reported the existence of IPV policies and procedures. In this group, 26 (42.6%) applied universal screening and 13 (21.3%) implemented their screening policies after the 2003 national recommendations were published. When these results were compared with those of the 1994 study, there was no difference in the proportion of EDs with IPV policies and procedures or in the proportion of EDs that applied universal screening.Conclusion:Despite increased research into IPV there was no significant change between 1994 and 2004 in the existence of IPV polices or universal screening in Canadian EDs. Policies and procedures that address appropriate responses to patients exposed to IPV should be a priority, with most emphasis directed toward developing effective interventions to which women can be referred.
Does a waiting room video about what to expect during an emergency department visit improve patient satisfaction?
Authors: Papa Linda , Seaberg David C. , Rees Elizabeth , Ferguson Kevin , Stair Richard , Goldfeder Bruce , Meurer David 
Published: July 2016

ABSTRACT

Objective:
We created an instructional waiting room video that explained what patients should expect during their emergency department (ED) visit and sought to determine whether preparing patients using this video would 1) improve satisfaction, 2) decrease perceived waiting room times and 3) increase calls to an outpatient referral line in an ambulatory population.

Methods:
This serial cross-sectional study took place over a period of 2 months before (control) and 2 months after the introduction of an educational waiting room video that described a typical patient visit to our ED. We enrolled a convenience sample of adult patients or parents of pediatric patients who were triaged to the ED waiting room; a research assistant distributed and collected the surveys as patients were being discharged after treatment. Subjects were excluded if they were admitted. The primary outcome was overall satisfaction measured on a 5-point Likert scale, and secondary outcomes included perceived waiting room time, and the number of outpatient referral-line calls.

Results:
There were 1132 subjects surveyed: 551 prevideo and 581 postvideo. The mean age was 38 years (standard deviation [SD] 18), 61% were female and the mean ED length of stay was 5.9 hours (SD 3.6). Satisfaction scores were significantly higher postvideo, with 65% of participants ranking their visit as either “excellent” or “very good,” compared with 58.1% in the prevideo group (p = 0.019); however, perceived waiting room time was not significantly different between the groups (p = 0.24). Patient calls to our specialty outpatient clinic referral line increased from 1.5 per month (95% confidence interval [CI] 0.58–2.42) to 4.5 per month (95% CI 1.19–7.18) (p = 0.032). After adjusting for possible covariates, the most significant determinants of overall satisfaction were perceived waiting room time (odds ratio [OR] 0.41, 95% CI 0.34–0.48) and having seen the ED waiting room video (OR 1.41, 95% CI 1.06–1.86).

Conclusion:
Preparing patients for their ED experience by describing the ED process of care through a waiting room video can improve ED patient satisfaction and the knowledge of outpatient clinic resources in an ambulatory population. Future studies should research the implementation of this educational intervention in a randomized fashion.
Reaction in Ontario to Bill 110: Canada’s first mandatory gunshot wound reporting law
Authors: Ovens Howard , Park Hannah , Borgundvaag Bjug 
Published: July 2016

ABSTRACT

Objective:
With the proclamation of Bill 110 in September 2005, Ontario became the first jurisdiction in Canada to mandate that gunshot wounds (GSWs) be reported to authorities. We sought to evaluate the impact of Bill 110, including the awareness of, experience with and opinions about the new law among Ontario emergency physicians (EPs), the public and the police.

Methods:
An online survey was distributed to all members of the Section on Emergency Medicine at the Ontario Medical Association. The public survey consisted of 3 closed questions and was performed by the polling firm Ipsos-Reid by telephone. Police opinion was requested through the Ministry of Community Safety and Correctional Services of the Ontario government.

Results:
The physician response rate was 25%. The great majority of respondents were aware of the law (93%) and willing to comply (88%), but only half were sure of their obligations and the penalties. Since the law had been proclaimed, the majority (51%) had seen at least 1 GSW victim. Seventy-nine percent reported no problems with either the police or the bill, and 86% perceived no change in relations with patients. Six incidents of patients delaying care were reported. Of the public surveyed, two-thirds were aware of the law. After being informed of the law, almost all (95%) expressed support, and the majority (80%) felt it would not change their relationship with their treating physician. All 47 members of the Ontario Provincial Police who were surveyed agreed that Bill 110 is helpful for shooting investigations, 8 reported that they had personally been involved in cases initiated by a report and 6 had been involved in cases where charges were laid or weapons confiscated. Data on actual reports and results of investigations were not available.

Conclusion:
Bill 110 seems to have been broadly accepted by the emergency community and endorsed by the public.
Ophthalmic injuries from a TASER
Authors: Han Jay S. , Chopra Anil , Carr David 
Published: July 2016

ABSTRACTThe TASER (TASER International) is an energy-conducting weapon, that is becoming more frequently used by law enforcement officials to subdue combative individuals. Though generally regarded as a safe alternative, the use of such weapons has been reported to cause serious injuries. We describe a case in which ocular injuries were sustained by impalement with a TASER dart. Emergency physicians should be aware of the potential for serious ophthalmic injuries from TASERs and how such injuries should be managed.
Adherence to emergency department discharge prescriptions
Authors: Hohl Corinne M. , Abu-Laban Riyad B. , Brubacher Jeffrey R. , Zed Peter J. , Sobolev Boris , Tsai Gina , Kretz Patricia , Nemethy Kevin , Bijlsma Jan Jaap , Purssell Roy A. 
Published: July 2016

ABSTRACTObjective:Nonadherence to prescribed medication is associated with increased morbidity and mortality as well as the increased use of health services. The main objective of our study was to assess the incidence of prescription-filling and medication adherence in patients discharged from the emergency department (ED).Methods:This was a prospective, observational study carried out at a Canadian tertiary care ED with an annual census of 69 000. We enrolled a convenience sample of patients being discharged with a prescription. We queried a provincial prescription-dispensing database 2 weeks later to determine whether prescriptions had been filled. We used a standardized follow-up interview to assess adherence and whether or not the patient experienced an adverse drug-related event (ADRE) or an unplanned revisit to an ED or clinic.Results:Of the 301 patients who agreed to participate, follow-up was successful for 258 (85.7%). Fifty-one patients (19.8%, 95% confidence interval [CI] 15.4%–25.1%) failed to fill their discharge prescriptions and 104 (40.3%, 95% CI 34.5%–46.4%) did not adhere to 1 or more medications. Antibiotics were associated with a lower odds ratio (OR) of nonadherence (OR 0.21, 95% CI 0.08–0.52). There was a trend toward increasing nonadherence in patients who reported an ADRE (OR 1.84, 95% CI 0.98–3.48) or had 2 or more medications coprescribed (OR 1.71, 95% CI 0.95–3.09). There was also a trend toward a higher risk of a revisit to an ED or clinic in nonadherent patients (OR 1.75, 95% CI 0.94–3.25).Conclusion:Approximately 4 in 10 patients discharged from the ED did not adhere to his or her prescribed medication. Our results suggest that patients who are prescribed antibiotics are more likely to be adherent, and that further evaluation of the associations between nonadherence, ADREs, the coprescription of 2 or more medications and the use of health services is warranted.
Youth violence secondary prevention initiatives in emergency departments: a systematic review
Authors: Snider Carolyn , Lee Jacques 
Published: July 2016

ABSTRACTObjective:Youth violence continues to trouble Canadians. Emergency department (ED) visits by youth after a violent injury may represent a “teachable moment,” and thus secondary violence prevention interventions may be effective. We conducted a systematic review to identify the success rates of any interventions, the populations likely to benefit and the outcome measures used.Data source:We searched 8 databases (i.e., MEDLINE, EMBASE, PubMed, CINAHL, the Cochrane Database of Systematic Reviews, the ACP Journal Club, DARE and CENTRAL).Study selection:Studies were included if they described and evaluated an intervention, were health care–based and targeted youth who were injured by violence. Two blinded investigators selected 15 articles from 181 abstracts. After full-text review, 8 articles were excluded, leaving 7 articles from 4 intervention programs.Data extraction:All interventions used ED case management of the violently injured patient. One randomized control trial (RCT) demonstrated a significant reduction in reinjury rates (treatment group 8.1% v. control group 20.3%,p= 0.05). Another small RCT found no statistically significant reductions in repeat violence or service use. One retrospective cohort study demonstrated a lower relative risk (RR) in future criminal justice involvement (RR = 0.67, 95% confidence interval 0.45–0.99). A retrospective study of pediatric patients with violent injuries found only 1% of these youth returned with injuries as a result of repeat violence.Data synthesis:Although all 4 case management interventions that we reviewed showed promise in the United States, small sample sizes and incomplete follow-up limited their ability to demonstrate significant decreases in reinjury.Conclusion:Future research is necessary to help EDs capitalize on the opportunity to effectively reduce youth violence.