Race had an independent association with diabetes prevalence and glycemic control. Our study does not support two prominent theories that economic and insurance status are the main factors in diabetes disparities, as we attempted to control for economic status and nearly every patient had insurance. It will be important for future analysis to explore how health care system factors affect these observed gaps in quality.

No abstract

Background: Inpatient falls are a patient safety concern. Limited data exist on the utility of head computed tomography (CT) for inpatient falls. The New Orleans Criteria (NOC) is a validated tool to determine the appropriateness of neuroimaging in the emergency department for falls with minor head injury. This study aimed to evaluate whether the NOC could be applied to inpatient falls. Methods: This retrospective cohort study assessed 1 year of inpatient falls with injury at 5 inpatient facilities. Records were reviewed for demographic data, fall circumstances, laboratory results, components of the NOC, and head CT results. Cohorts included positive NOC (≥1 NOC finding) and negative NOC. Sensitivity and specificity were calculated for the NOC alone, NOC plus coagulopathy, and NOC or coagulopathy for acute intracranial process. Results: Of 332 inpatient falls with injury, 188 (57%) received a head CT. Of the 250 (75.3%) NOC-positive cases, 159 (63.6%) received a head CT. Of all patients who received a head CT, 7 (2.1%) showed a significant acute intracranial process. The NOC was positive in 6 of the 7 cases (sensitivity 85.7% and specificity 23.8%); the other case had a significant coagulopathy. New Orleans Criteria or coagulopathy had 100% sensitivity and 23.4% specificity. Conclusions: Our findings show that use of the NOC to evaluate potential intracranial injury in inpatient falls is limited. Adding criteria to the NOC may improve its test characteristics, with a sensitivity of 100% for the NOC or coagulopathy, suggesting potential clinical utility.

Interviews When should I plan on scheduling interviews with residency programs? (Louis Binder, MD) The heaviest interview months for residency interviews in Emergency Medicine are in December and January. Some residencies may extend interview invitations earlier (October or November) to especially well qualified applicants, to students already on site undertaking away electives at that institution, or to applicants well known to the institution (i.e. students from their home school, repeat applicants, or those with clinical or research experience at the site). If you are offered an early interview and it is convenient to accept, go ahead. However, for planning purposes, anticipate that the majority of your interviews will occur in December and January, and plan accordingly for time off, flexible rotations that will allow absences for interviews, and so forth. If you are planning to undertake a lot of out of town interviews around the country, it is generally a good idea to plan for time off in December and/or January in order to block travel for interviews and to avoid compromise of clerkship experiences and responsibilities. If you are planning fewer interviews that are predominantly close to home, you may be able to work them around your clerkship obligations, particularly if your clerkship at that time can be a flexible one regarding necessary absences and makeups with you for missed experiences. What is the best time to interview? Author #1: (Peter DeBlieux, MD; Sam Keim, MD; Carey Chisholm, MD) There's no consensus on this issue. Unlike what is advocated in Iserson's book, many of us feel that the last week of interview season is a bad choice…the program directors are tired, you are tired, and spontaneity is lost. There is also no bad weather buffer. There is a "learning curve" over 2 to 3 interviews, so perhaps target your "front runner" programs after you complete several. I particularly enjoy the time in December before the holiday season…and likewise would avoid the week after New Years.