OBJECTIVE: To determine the proportion of correct emergency department (ED) diagnoses and of hospital discharge diagnoses, in comparison with final diagnoses at the end of a 30-day follow-up, in patients presenting with nonspecific complaints (NSCs) to the ED; to determine differences between male and female patients in the proportion of missed diagnoses. METHODS: Prospective observational study. Diagnoses made at the ED, hospital discharge diagnoses, and final diagnoses were compared. RESULTS: Of 22,782 nontrauma patients presenting to the ED from May 2007 until May 2009, 9,926 were triaged as emergency severity index level 2 or 3, of whom 789 presented with NSCs. After exclusion of 217 patients, 572 were included for final analysis. The final diagnosis at the end of follow-up was taken to be the correct "gold standard" diagnosis. In 263 (46.0%) patients, this corresponded to the primary ED diagnosis, and in 292 (51%) patients to the hospital discharge diagnosis. The most frequent final diagnoses were urinary tract infections (n = 49), electrolyte disorders (n = 40) and pneumonia (n = 37), and were correctly diagnosed at the ED in 23, 21 and 27 patients, respectively. Of the twelve most common diagnoses (corresponding to 354 patients), functional impairment was most frequently missed. Among these 354 patients, diagnoses were significantly more often missed in women than in men (142 of 231 [62%] women vs 57 of 123 [46%] men, p = 0.004). CONCLUSION: Patients presenting to the ED with NSCs present a diagnostic challenge. New diagnostic tools are needed to help in the diagnosis of these patients.ClinicalTrials.gov registration number: NCT00920491
This article examines the extent to which structuring Emergency Department discharge information improves the ability to recall that information, and whether such benefits interact with relevant prior knowledge. Using three samples of students with different levels of prior medical knowledge, we investigated the amount of information recalled after structured vs. non-structured presentation of information. Across all student samples, the structured discharge information led to a relative increase in recalled items of 17% compared to non-structured discharge information (M = 9.70, SD = 4.96 vs. M = 8.31, SD = 4.93). In the sample with least medical knowledge, however, the structured discharge information resulted in a relative increase in recall by 42% (M = 8.12 vs. M = 5.71). These results suggest that structuring discharge information can be a useful tool to improve recall of information and is likely to be most beneficial for patient populations with lower levels of medical knowledge.
BackgroundNSAID are frequently used and can often cause adverse drug reactions (ADR) ranging from generally mild to sometimes severe and life-threatening reactions. ADRs are in most cases interpreted as pseudo-allergic, presumably non immunologic, but their dynamics and appearance in a subgroup of patients is suggestive for an IgE-mediated mechanism.MethodsIn this study, we retrospectively analysed data of 501 patients from our outpatient clinic population of the past 7 years with ADR to NSAID. Data was evaluated regarding the culprit drug or drugs, type and severity of reactions, age, gender, atopy, number of co-medication, co-morbidity and infections etc. as risk factors. Further, skin test and provocation test results were reviewed for their clinical relevance and reliability.ResultsAcetylsalicylic acid (ASA), paracetamol, diclofenac, mefenamic acid and propyphenazone were found as top five of causative drugs for ADR. The most common symptoms were angioedema, urticaria, pruritus, exanthema and dyspnea. ASA caused dyspnea, angioedema and urticaria in the majority of the cases. Diclofenac was found to be the most common culprit for severe anaphylactic reactions, followed by paracetamol and propyphenazone. Sixty percent of the NSAID reactors suffered from an atopic disease or had an atopic predisposition. There was a significant association between proven hypersensitivity reactions and reaction initiation after drug intake regarding the time interval.ConclusionsOur data suggest that -atopic predisposition is a risk factor for intolerance reaction to NSAID, -ASS accounts for non-immunologic, intolerance reactions, whereas severe anaphylactic reactions to diclofenac and/or propyphenazone seem to be IgE-mediated, -a shorter time interval between drug intake and appearance of symptoms is supportive for clinical relevance and could be an indicator for IgE-mediated ADR. Acknowledgements: FWF project L467-B05.
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