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Background: Patients with cancer and palliative care needs frequently use the emergency department (ED). ED-based palliative services may extend the reach of palliative care for these patients. Objective: To assess the feasibility and reach of an ED-based palliative intervention (EPI) program. Design: A cross-sectional descriptive study of ED patients with active cancer from January 2017 to August 2017. Subjects: Patients with palliative care needs were identified using an abbreviated 5-question version of the screen for palliative and end-of-life care needs in the ED (5-SPEED). Patients with palliative care needs were then automatically flagged for an EPI as determined by their identified need. Measurements: The primary outcome was the prevalence of palliative care needs among patients with active cancer. Secondary outcomes were the rate of EPI services successfully delivered to ED patients with unmet palliative care needs, ED length of stay (LOS), and repeat ED visits within the next 10 days. Categorical variables were evaluated using chi-squared or Fischer's exact test as appropriate. Continuous variables were evaluated using analysis of variance. Results: Of the 1278 patients with active cancer, 817 (63.9%) completed the 5-SPEED screen. Of the patients who completed the screen, 422 patients (51.7%) had one or more unmet palliative care needs and 167 (39.6%) received an EPI. There were no differences in ED LOS or 10-day repeat ED visit rates between patients who did or did not receive an EPI. Conclusion: This ED-based intervention successfully screened for palliative needs in cancer patients and improved access to specific palliative services without increasing ED LOS.

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Study Objectives: Our objective was to develop a set of physical exam and laboratory findings that in selected pediatric patients, combined with the FAST exam results, were sensitive and specific in detecting intra-abdominal injuries that correlated with CT scan results.Methods: This was a retrospective chart review of all trauma patients aged 0-17 years who were evaluated at an academic American College of Surgeons (ACS) verified Level 1 Adult and Pediatric Trauma center between January 1, 2015 and December 31, 2015. Inclusion criteria were: 1) complaint of blunt abdominal trauma; 2) a FAST exam and an abdominal CT scan performed; and 3) lab diagnostics completed. The included laboratory diagnostics were: blood count, liver function tests and lipase. After reviewing 302 patient records, 133 were included in the final analysis. We reviewed the literature and determined the history, physical exam and cutoff laboratory results to be used in the final analysis. The sensitivity, specificity, PPV and NPV of the FAST exam alone and in combination with the predetermined diagnostic criteria were calculated and the results were analyzed for correlation with CT scan results then reported using the phi-coefficient of correlation.Results: The FAST exam for detecting intra-abdominal injury in our selected patients had a sensitivity of 2.6% (95% CI: 0.7-8.5), a specificity of 97.2% (95% CI: 91.4-99.3), a PPV of 33.3% (95% CI: 1.76%-87.5%), and a NPV of 64.4% (95% CI: 54.4%-73.4%). The FAST exam, combined with our clinical criteria for detecting intra-abdominal injuries in our selected patients, had a sensitivity of 86.2% (95% CI: 67.4%-95.5%), a specificity of 96.4% (95% CI: 79.7%-99.8%), a PPV of 96.2% (95% CI: 78.4%-99.8%), and a NPV of 87.1% (95% CI: 65.2%-95.8%). When combined with the clinical criteria, the FAST exam correlated with the CT scan results (F¼ +0.83; p<0.0001), while the FAST exam alone did not (F¼ -0.01; p¼1).Conclusions: When combined with clinical findings, the FAST exam was sensitive and specific for detecting intra-abdominal injuries in select pediatric patients and correlated with abdominal CT scan findings. These results may be used to guide further imaging decisions in the assessment of pediatric blunt abdominal trauma.

Objectives: Emergency department thoracotomy (EDT) is a rare and challenging procedure. Emergency medicine (EM) residents have limited opportunities to perform the procedure in clinical or educational settings. Standardized, reliable, validated checklists do not exist to evaluate procedural competency. The objectives of this project were twofold: 1) to develop a checklist containing the critical actions for performing an EDT that can be used for future procedural skills training and 2) to evaluate the reliability and validity of the checklist for performing EDT.Methods: After a literature review, a preliminary 22-item checklist was developed and disseminated to experts in EM and trauma surgery. A modified Delphi method was used to revise the checklist. To assess usability of the checklist, EM and trauma surgery faculty and residents were evaluated performing an EDT while inter-rater reliability was calculated with Cohen's kappa. A Student's t-test was used to compare the performance of participants who had or had not performed a thoracotomy in clinical practice. Item-total correlation was calculated for each checklist item to determine discriminatory ability.Results: A final 22-item checklist was developed for EDT. The overall inter-rater reliability was strong (j = 0.84) with individual item agreement ranging from moderate to strong (j = 0.61 to 1.00). Experts (attending physicians and senior residents) performed well on the checklist, achieving an average score of 80% on the checklist. Participants who had performed EDT in clinical practice performed significantly better than those that had not, achieving an average of 80.7% items completed versus 52.3% (p < 0.05). Seventeen of 22 items had an itemtotal correlation greater than 0.2. Conclusions:A final 22-item consensus-based checklist was developed for the EDT. Overall inter-rater reliability was strong. This checklist can be used in future studies to serve as a foundation for curriculum development around this important procedure.