Background:Acute kidney injury (AKI) is associated with increased mortality and dialysis in hospitalized patients but has been little explored in the emergency department (ED) setting.Objective:The objective of this study was to describe the risk factors, prevalence, management, and outcomes in the ED population, and to identify the proportion of AKI patients who were discharged home with no renal-specific follow-up.Design:This is a retrospective cohort study using administrative and laboratory databases.Setting:Two urban EDs in Vancouver, British Columbia, Canada.Patients:We included all unique ED patients over a 1-week period.Methods:All patients had their described demographics, comorbidities, medications, laboratory values, and ED treatments collected. AKI was defined pragmatically, based upon accepted guidelines. The cohort was then probabilistically linked to the provincial renal database to ascertain renal replacement (transplant or dialysis) and the provincial vital statistics database to obtain mortality. The primary outcome was the prevalence of AKI; secondary outcomes included (1) the proportion of AKI patients who were discharged home with no renal-specific follow-up and (2) the combined 30-day rate of death or renal replacement among AKI patients.Results:There were 1651 ED unique patients, and 840 had at least one serum creatinine (SCr) obtained. Overall, 90 patients had AKI (10.7% of ED patients with at least one SCr, 95% confidence interval [CI], 8.7%-13.1%; 5.5% of all ED patients, 95% CI, 4.4%-6.7%) with a median age of 74 and 70% male. Of the 31 (34.4%) AKI patients discharged home, 4 (12.9%) had renal-specific follow-up arranged in the ED. Among the 90 AKI patients, 11 died and none required renal replacement at 30 days, for a combined outcome of 12.2% (95% CI, 6.5%-21.2%).Limitations:Sample sizes may be small. Nearly half of ED patients did not obtain an SCr. Many patients did not have sequential SCr testing, and a modified definition of AKI was used.

Of 1281 consecutive ED patients, 231 (18.0 %) had CXRs obtained, 320 CXRs were analyzed and 611 BBMs sent. All BBMs (100.0%, 95% confidence interval (CI) 99.4-00.0) arrived within two minutes; 595 BBMs (97.4%, 95% CI 95.8-98.4) were replied to within five minutes. Of the 58 CXRs with abnormalities requiring intervention, there were 55 concordances (overall agreement 94.2%, 95% CI 85.9-98.3; kappa 0.95, 95% CI 0.89-1.0) CONCLUSION: Systematic transmission of CXR images from a small ED to a remote large center using mobile phones may be a safe and effective strategy to rapidly communicate important patient information.

P rolonged QT interval (long QTc) predisposes to torsades de pointes, which can present with seizures, syncope, and sudden death. 1 While one-third of emergency department (ED) patients may have a prolonged corrected QT (QTc) interval, 2 often discovered incidentally, clinical significance is uncertain. In hospitalized patients or long-term community studies, long QTc is associated with increased mortality. 1,3 The only ED-based study estimating mortality found that 5% of admitted patients died, although discharged patients-nearly half the cohort-were not evaluated. 2 Our study purpose was to compare the 30-day mortality rate of ED patients with long and normal QTc, including those discharged from the ED.We conducted a retrospective review at two Canadian university-affiliated EDs, an inner-city and cardiology referral center and a community hospital, comparing patients with normal QTc to those with both moderately and severely prolonged QTc. The Providence Health Care ethics board approved this study.At both sites, the MUSE system (GE Healthcare) records electrocardiogram (ECGs) and estimates QTc interval via Bazett. 1 From April 1, 2011, to March 31, 2012, we selected consecutive ED patients > 18 years with prolonged QTc, defined as > 460 milliseconds (female) and > 450 millisecond (male) based on the 98th percentile of normal. 2,4 We used only the first ECG with long QTc during an ED visit. We followed patients for 30 days after the index ED visit; an additional visit during that time frame was counted as a return visit, and a subsequent visit past 30 days was counted as another index visit. To identify a comparison group of non-long QTc patients, we interrogated the ECG database during the same period to identify ECGs with normal QTc.Based on a prior study, 2 we estimated a 5% mortality rate for long QTc patients. To generate 95% confidence intervals (CIs) for a between-group mortality difference of AE1.5%, we required at least 800 patients. We estimated approximately 15,000 ECGs over the study period and assumed one-third 2 would have long QTc; we used a random-number generator to select

commences by informing us that he has often seen phthisis usher itself in without any unequivocal symptom of pulmonary affection, but apparently as "a fever of an inflammatory kind, with quick pulse, hot skin, flushed countenance, whiteThe Boston Medical and Surgical Journal as published byThe New England Journal of Medicine.