Cost and Quality of Care at Retail Clinics Key point: Quality scores at retail clinics rivaled those at urgent care centers, physician offices, and EDs. Citation: Mehrotra A, Liu H, Adams JL, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Ann Intern Med. 2009; 151(5): 321-328. Professional organizations have raised concerns about the quality of care that is delivered at store-based retail …
Read MoreAbstracts in Urgent Care: October, 2009
Another Validation of Clinical Assessment and D-Dimer to Rule Out PE Key point: Among patients with low or intermediate risk, the sensitivity and negative predictive value of D-dimer testing were 100%. Citation: Gupta RT, Kakarla RK, Kirshenbaum KJ, et al. D-dimers and efficacy of clinical risk estimation algorithms: Sensitivity in evaluation of acute pulmonary embolism. AJR Am J Roentgenol. 2009; 193: 425-430. Despite research showing that clinically important pulmonary embolism (PE) can be excluded when …
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H1N1 Update: CDC Recommends Seasonal Flu Vaccination for Children Over 6 Months Key point: Get vaccinated! Citation: Fiore AE, Shay DK, Broder K, et al. Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR. July 24, 2009; 58 (Early Release): 1-52. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm. In contrast to last year, when seasonal flu shots for those between 6 months and 18 years of age were “encouraged,” …
Read MoreAbstracts in Urgent Care: July/August, 2009
Early Estimate of Pandemic Potential of Influenza A H1N1 “Swine Flu” Key point: The current virus is transmitted efficiently but probably is less lethal than past pandemic viruses. Citation: Fraser C, Donnelly CA, Cauchemez S, et al. Pandemic potential of a strain of influenza A (H1N1): Early findings. Science. 2009 May 14; e-pub ahead of print. A team of epidemiologists has analyzed the influenza A (H1N1) epidemic in Mexico. Data related to the outbreak were …
Read MoreAbstracts in Urgent Care: June, 2009
Incidence of AMI in Patients with Syncope Key point: In a cohort study of nearly 1,500 patients presented without ST-segment elevation. Citation: McDermott D, Quinn JV, Murphy CE. Acute myocardial infarction in patients with syncope. CJEM. 2009; 11: 156-160. Which patients with syncope require hospital admission? To answer this question, researchers studied the incidence of acute myocardial infarction within 30 days of presentation in a cohort of 1,474 consecutive emergency department patients who presented with …
Read MoreAbstracts in Urgent Care – May 2009
Occult Bacteremia is Rate in Young Children with Unexplained Fever Key point: Since introduction of the pneumococcal vaccine, urinary tract infection has become the most common bacterial infection in children who have fever without localizing signs. Citation: Waddle E, Jhaveri R. Outcomes of febrile children without localizing signs after pneumococcal conjugate vaccine. Arch Dis Child. 2009; 94: 144-147. Occult bacteremia and invasive disease are important concerns in children with unexplained high fever. Investigators retrospectively compared …
Read MoreAbstracts in Urgent Care: April, 2009
Should the Elbow Extension Test Be Used to Rule Out Bony Injury? Key point: Full elbow extension had a negative predictive value for fracture of 98.4% in adults and 95.8% in children. Citation: Appelboam A, Reuben AD, Benger JR, et al. Elbow extension test to rule out elbow fracture: Multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008; 337: a2428. The objective of this study was to determine whether …
Read MoreAbstracts in Urgent Care – March 2009
Beware of Eyewitness Accounts of Syncope or Seizures Key point: Bystanders’ descriptions of acute neurologic events often are simply wrong. Citation: Thijs RD, Wagenaar WA, Middelkoop HAM, et al. Transient loss of consciousness through the eyes of a witness. Neurology. 2008; 71: 1713-1718. Diagnosis of sudden catastrophic illness depends a good deal on eyewitness accounts. But, as criminologists know, eyewitnesses can be unreliable. Now, a team of neurologists in the Netherlands has reconfirmed this finding. …
Read MoreAbstracts in Urgent Care: January 2009
Who Needs a Blood Culture in the ED? Key point: Use of a prediction rule might reduce use of cultures in low-risk patients. Citation: Shapiro NI, Wolfe RE, Wright SB, et al. Who needs a blood culture? A prospectively derived and validated prediction rule. J Emerg Med. 2008; 35(3): 255-264. Although blood cultures often are obtained for patients in the emergency department, little evidence is available to guide patient selection for such testing. Currently, general …
Read MoreAbstracts In Urgent Care: December, 2008
ED Crowding Adversely Affects Patient Satisfaction Key point: Dissatisfaction lasts throughout entire hospital stay. Citation: Pines JM, Iyer S, Disbot M, et al. The effect of emergency department crowding on patient satisfaction for admitted patients. Acad Emerg Med. 2008;15:825-831. Recent studies on emergency department overcrowding have shown adverse patient outcomes when patients are boarded in the emergency department. To address how patient satisfaction relates to ED overcrowding, these authors retrospectively reviewed Press Ganey satisfaction surveys …
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