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The Society for Academic Emergency Medicine’s Annual Meeting was held May 9-12, 2012 in Chicago, Illinois.  The Research Forum featured 746 Abstracts, and 37 Innovations in Emergency Medicine education presentations.  We selected the 10 we thought had the most potential to impact the practice of emergency physicians.
              

The Impact Rating Scale
*    Interesting, practice changing for some
**    Moderate impact, practice changing for many
***    High impact, practice changing for most
****    A must read, practice changing for all
*****    Landmark project, practice changing for all

 

****
Policy-driven Improvements in Crowding: System-level Changes Introduced by a Provincial Health Authority and Its Impact on Emergency Department Operations in 15 Centers

[Abstract #1]
What were they looking for?
Whether a hospital over-capacity protocol would improve ED throughout.
Methods
Multi-center, before-and-after study. Three triggers: ED bed occupancy>110%, >35% ED stretchers occupied by patients waiting for inpatient bed or dispo decision and no stretcher available for high acuity patients. When this occurred, boarded patients were moved to an inpatient unit regardless of whether a bed was available to them.
Results
ED LOS for admitted patients decreased from 17.2 hrs to 11.6 hrs. Avg time from ED arrival to physician assessment decreased from 113.2 minutes to 99.3 minutes. LWBS decreased from 4.0% to 3.8%.
Why this could change your practice
The full-capacity protocol based on the Viccellio model appears to work across a variety of disparate institutions. This appears to be a simple, straight-forward, low-cost and low-risk solution to ED crowding.


****
The Usefulness of the 3-Minute Walk Test in Predicting Adverse Outcomes in ED Patients with Heart Failure and COPD

[Abstract #140]
What were they looking for?
To determine whether a simple 3-minute walk test for pts with HF and COPD could predict serious adverse events.
Methods
1,504 patients, prospective cohort at 6 institutions. After treatment, each patient underwent a 3-minute supervised walk test. Pox HR and Borg scores were monitored.
Results
Walk test HR>110 had an odds ratio of 1.9 for heart failure patients and “too ill to start the walk test” had an OR of 3.5 for COPD patients.
Why this could change your practice
This is an easy to administer, low-cost test that is effective in risk stratifying patients with heart failure and COPD.


***
A Comparison of Cosmetic Outcomes of Lacerations of the Trunk and Extremity Repaired Using Absorbable Versus Nonabsorbable Sutures

[Abstract #6]
What were they looking for?
To compare cosmetic outcome of lacerations using absorbable versus nonabsorbable sutures in children and adults.
Methods
Randomized, prospective cohort of 100 patients. 10 day f/u visit to determine complications. 90 day f/u visit to have a photograph of the wound with 2 blinded plastic surgeons evaluating the cosmetic outcome.
Results
No differences in rates of infection, dehiscence or keloid. Mean VAS for absorbable (55.76mm) was not statistically different from the nonabsorable group (55.9mm).
Why this could change your practice
While this study was small, it would be reasonable to consider absorbable sutures for uncomplicated lacerations of the trunk and extremities.

***
Safety of Droperidol for Sedation of Acute Behavioural Disturbance

[Abstract #700]
What were they looking for?
To investigate the effects of high-dose droperidol for sedation in the ED.
Methods
424 patient were given droperidol. EKG’s were available on 273 of those patients. Mean dose was 10 mg IM (range 5-30 mg).
Results
A total of 4 (1%) QTs were on the “at-risk” line. Transient hypotension occurred in 8 patients (3%) and no arrhythmias were detected.
Why this could change your practice
In this study, droperidol was safe in the IM dose range of 5-30 mg.


***
Meta-analysis of Magnetic Resonance Imaging for the Diagnosis of Appendicitis

[Abstract #338]
What were they looking for?
Meta-analysis of studies since 2005 evaluating the use of MRI to dx appendicitis
Methods
PubMed database was utilized – data extracted by 1 investigator and confirmed by another. 11 studies met criteria, total of 626 subjects included. A majority of the subjects were pregnant.
Results
Sensitivity (96.9%), Specificity (96.7%), PPV (94.8%) and NPV (98%) were all excellent. 33/626 subjects had equivocal MRIs.
Why this could change your practice
MRI appears to be a reasonable alternative to CT scans to determine the diagnosis of appendicitis and should be considered in patients for whom CT has an unacceptably high risk:benefit ratio.


***
Use of Single Dose of Intramuscular Methadone for Acute Opioid Withdrawal

[Abstract #610]
What were they looking for?
To quantify the efficacy of IM methadone in Opioid Withdrawal.
Methods
Convenience sample of 77 patients. Avg dose of 10.3 mg IM Methadone (range 5-20 mg).
Results
Mean Clinical Opiate Withdrawal Scale score decreased from 11.19 (pre-Methadone) to 4.83 (post-Methadone). There were 3 adverse events noted (1 hypoxia, 2 who had moderate sedation).
Why this could change your practice
Low dose IM Methadone appears to be a reasonable alternative for patients with Opiate Withdrawal presenting to the ED.


**
Direct Bedding, Bedside Registration, and Patient Pooling to Improve Pediatric Emergency Department Length of Stay

[Abstract #217]
What were they looking for?
The authors sought to measure the effect of direct bedding, bedside registration and patient pooling on Pediatric ED wait times, LOS and pt satisfaction.
Methods
Before-and-after study where the aforementioned metrics were measures. Of note, attending physician coverage was decreased by 9% during this time and daily patient volume increased by 3%.
Results
Median time to be seen by a physician decreased by 20%, median LOS for discharged patients decreased by 15% and median time until decision-to-admit decreased by 10%. Press-Ganey satisfaction scores increased by 5 points.
Why this could change your practice
In this study, direct bedding, bedside registration and patient pooling had significant impact on flow and patient satisfaction.


**
Impact of Health Care Reform in Massachusetts on Emergency Department and Hospital Utilization

[Abstract #250]
What were they looking for?
To examine the effect of MA health reform on ED and hospital utilization.
Methods
Used databases from the MA Division of Health Care Finance and Policy Acute Hospital Case Mix Databases. Before-and-after study.
Results
Rate of uninsured decreased from 6.2% to 3.7% in the ED group. Small increase in ED utilization during this period was noted but no change in hospitalizations.
Why this could change your practice
The MA model should help instruct the rest of the US on what to expect with upcoming changes in health care law. Specifically, a small but noticeable increase in ED visits may be forthcoming.

**
Derivation of a Simplified Pulmonary Embolism Triage Score (PETS) to Predict the Mortality in Patients with Confirmed Pulmonary Embolism from the Emergency Medicine Pulmonary Embolism in the Real World Registry (EMPEROR)

[Abstract #263]
What were they looking for?
To derive a 4-variable prognostic model of mortality for patients with confirmed PE.
Methods
Using the EMPEROR database, data was derived from 1438 patients. Logistic regression identified 4 variables that were associated with higher 30-day mortality:
1. WBC>11,000
2. RR>23
3. H/O malignancy
4. SBP<90
Results
PETS LOW group had 0.5% mortality vs 10.2% in PETS HIGH group
Why this could change your practice
This is a simple prediction rule that may be used to risk stratify patients with PE.


**
Cannabinoid Hyperemesis: Relevance to Emergency Medicine

[Abstract #542]
What were they looking for?
To identify patients with cannabinoid hyperemesis and quantify their resource utilization.
Methods
Multicenter, ambispective cohort study over a 2-yr period of 20 patients.
Results
70% of patients reported compulsive warm bathing. Patients had the following utilizations: mean CT scans (5.3), abd/pelvic ultrasounds (3.8), abd radiographs (5.5), ED visits (17.3), hospital admissions (6.8).  
Why this could change your practice
Patients with cannabinoid hyperemesis utilize ED and hospital resources at alarming rates. Multi-disciplinary involvement in the care of these patients is reasonable.

 

Dr. Breyer is an Associate Program Director at the Denver Health Residency in Emergency Medicine and an Assistant Professor of Emergency Medicine at the University of Colorado School of Medicine.  His research interests include medical education, feedback and ultrasound. Dr. Breyer may be contacted at This email address is being protected from spambots. You need JavaScript enabled to view it. .


Dr. Kowalenko is the Director of Continuous Professional Development and an Associate Professor of Emergency Medicine at the University of Michigan.  His research interests include hemorrhagic shock, cardiovascular disease, education and workplace violence.  Dr. Kowalenko may be contacted at This email address is being protected from spambots. You need JavaScript enabled to view it. .


 

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