Longitudinal Trends in the Prevalence of Diabetes Mellitus in an Urban Emergency Department

Objective: The objective of this study was to examine the longitudinal trends in diabetes mellitus (DM) in emergency department (ED) patients and evaluate the factors associated with those trends. Methods: We conducted a retrospective analysis of all patients who presented to the ED from 2006 to 2011. The presence...

Survival of Trauma Victims Transported by Helicopter Who Required Cardiopulmonary Resuscitation Within the First Hour of Hospital Arrival

Objectives: The purpose of the study was to review the impact on survival of trauma victims who were transported via helicopter ambulance versus ground transportation and who received cardiopulmonary resuscitation (CPR) within 1 hour of hospital arrival. Methods: A retrospective analysis of the trauma patients who underwent CPR within...

SMJ Response

As emergency medicine physicians, we are aware of the dreaded recurring patient: the “regulars,” “frequent flyers,” “repeaters,” “frequent visitors,” and “superusers.” The problem, however we name it, is recidivism. Recidivism is “a tendency to relapse into a previous condition or mode of behavior; especially: relapse into criminal...

Familiarity Breeds Contempt: “Frequent Fliers” in Medicine

To the Editor: “Oh, he is here again after swallowing some razor blades,” thought the emergency department (ED) team members when Mr R presented to the ED with suicidal ideation and abdominal pain. As per the routine, he was placed in the psychiatry unit of the ED while he...

Waiting in the Accident and Emergency Department: Exploring Problematic Experiences

Objectives: To investigate the relation between perceived waiting times and patients’ overall ratings of accident and emergency departments (A&Es) and to explore which patients view waiting times as problematic. Methods: A cross-sectional survey was held in 21 A&Es in the Netherlands. From each A&E, a random sample of patients...

Evaluating Violent Person Management Training for Medical Students in an Emergency Medicine Clerkship

Objectives: Violence is a significant problem facing healthcare workers in the United States, particularly in emergency departments (EDs). Education is key to providing a safe environment for workers to ensure their ability to recognize and respond to violent patients and visitors. We studied the effects of a video podcast–based...

Commentary on “Two Types of Prehospital Systems Interventions that Triage Low-Acuity Patients to Alternative Sites of Care”

Throughout the developed world, availability of care in an emergency department (ED), often as part of an inpatient care facility, is a staple ofthe social safety net. In the United States annual usage rates continue to climb, with a record 134 million visits nationwide in 2012.1 Of these patients,...

Two Types of Prehospital Systems Interventions that Triage Low-Acuity Patients to Alternative Sites of Care

Objectives: This study retrospectively compared alternatives for navigating low-acuity patients in two emergency medical services systems. System A involved a response to every 9-1-1 request with an “evaluate, treat, and refer” process, in which paramedics decided whether patients could be treated on-scene and referred to a primary care provider...

Commentary on “Factors Associated with Emergency Department Visits in Asthma Exacerbation”

Although the more regular use of inhaled corticosteroids (ICS) in patients with moderate to severe asthma has led to a reduction in admission rates for exacerbations,1 rates of emergency department (ED) visits remain unacceptably and inexplicably high.2 Previous work has shown that nonwhite race, low socioeconomic status, and greater...

Effectiveness of an Urban Emergency Department Call-Back System in the Successful Linkage to Treatment of Sexually Transmitted Infections

Objectives: There is a high incidence of asymptomatic sexually transmitted infections (STIs) in emergency department (ED) patients. There is no historical indication, physical examination finding, or rapidly available laboratory testing specific for detecting STIs in women. This study was conducted to describe the performance of an ED call-back system...

Factors Associated with Emergency Department Visits in Asthma Exacerbation

Objectives: Despite quality improvement initiatives to prevent asthma-related emergency department (ED) visits, rates have not declined. We sought to determine factors associated with ED visits in an underserved population. Methods: We performed a case–control analysis of asthma patients at three ambulatory care centers serving low-income populations. Cases consisted of...

Commentary on “Effectiveness of an Urban Emergency Department Call-Back System in the Successful Linkage to Treatment of Sexually Transmitted Infections”

In this issue of the Southern Medical Journal, Lolar and colleagues studied an emergency department (ED) setting with a policy that all patients with symptoms of sexually transmitted infections (STIs) are treated.1 Asymptomatic patients who were tested and not treated in the ED were entered into a call-back system...

EMS Patients and Walk-In Patients Presenting With Severe Sepsis: Differences in Management and Outcome

Objectives: Sepsis is a significant problem. The differences between patients with sepsis who walk into the emergency department (ED) and those who are transported via emergency medical services (EMS) have not been clarified. The aim of the study was to determine whether there was a difference in outcome between...

CME Article: Emergency Department Orthopedics Observation Unit as an Alternative to Admission

Objectives: Inclusion of select orthopedic problems in the orthopedics observation unit (OOU) may reduce hospital admissions. Our system allows OOU status for 24 hours, but the effect on admissions is unknown. Our primary hypothesis was that we could predict which OOU patients required admission based on the presence of...

CME Article: Commentary on “Emergency Department Orthopedics Observation Unit as an Alternative to Admission”

It is 22:58 on Monday night. You walk into your shift in the emergency department (ED) and are greeted by the charge nurse who tells you, ‘‘We already have 22 holders down here, 11 waiting to be seen, and triage is full.’’ As you chuckle to yourself, thinking, ‘‘There...

CME Article: Creating a State Medical Response System for Medical Disaster Management: The North Carolina Experience

The purpose of this work was to examine the creation and evolution of the North Carolina state medical response system (SMRS). During the past 30 years, states and local communities have developed a somewhat incongruent patchwork of medical disaster response systems. Several local or regional programs participated in the...

Serum Biomarkers for Traumatic Brain Injury

There is a lack of reliable serum biomarkers for routine use in the diagnostic workup of people with traumatic brain injury. Multiple biomediators and biomarkers have been described in the pertinent literature in recent years; however, only a few candidate molecules have been associated with high sensitivity and high...

Epidemiology of the Reported Severity of Cottonmouth (Agkistrodon piscivorus) Snakebite

Objective: The goal of this study was to analyze trends in the annual rates of reported medical outcomes of cottonmouth (Agkistrodon piscivorus) snakebites in the United States, published in the annual reports of the American Association of Poison Control Centers in the course of 29 years. Methods: This was...

Commentary on “Epidemiology of the Reported Severity of Cottonmouth (Agkistrodon piscivorus) Snakebite”

In this issue of the Southern Medical Journal, Walter and colleagues have reviewed trends of cottonmouth (Agkistrodon piscivorus) snakebite severity as reported in the annual reports of the American Association of Poison Control Centers.1, The stated goal of the study was to examine medical outcomes of these snakebites 18...

Significance of High- and Low-Distal Energy Forearm Fractures

Objective: To determine in men and women aged 50 years or older the proportion of distal forearm fractures related to high- or low-energy events and subsequent fracturing. Methods: We reviewed records of patients presenting to emergency departments and urgent care facilities with distal forearm fractures occurring during a 7-year...