Although the present study has limitations, it appears to show that CRP has limited diagnostic utility for the detection of bacteraemia in ED patients.
A higher rate of EDOU management failure in SSTIs than the generally accepted rate of 15% was observed in most studies identified by this review. Risk factors identified were varied, but presence of a fever and elevated inflammatory markers were commonly associated with failure of EDOU admission by multiple studies. Recognition of risk factors and the increased application of clinical decision tools may help to improve disposition of patients at high risk for clinical deterioration or management failure.
Patients with supraventricular tachycardia (SVT) commonly present to the emergency department (ED). Current guidelines [1,2] do not recommend routine pathology testing and a report on the topic has questioned their role. A systematic review concluded that troponin testing is commonly performed with a high proportion of positive fi ndings, but these results were not associated with major adverse cardiac events. [3] The conclusions of this review were limited by paucity of data and heterogeneity among studies. Unnecessary and/or inappropriate investigations in the ED have been associated with adverse effects. False-positive results or incidental findings may lead to unnecessary investigation, at the risk of the true pathology being ignored. It is also important with respect to utilisation of resources, particularly in Australia where costs to the health care system are substantially borne by the taxpayer. [4] Evidence-based implementation of protocols for investigations, education program for medical staff and audit/feedback processes have been previously associated with safe and efficient diagnostic practices. [5] Among patients presenting to the ED with SVT, we aimed to describe adjunct investigations and assess whether the results of such investigations influenced management in the ED.
Pleuritic pain, a sharp discomfort near the chest wall exacerbated by inspiration is associated with a number of pathologies. Pulmonary embolus and infection are two common causes but diagnosis can often be challenging, both for experienced physicians and trainees. The underlying anatomy and pathophysiology of such pain and the most common aetiologies are presented. Clinical symptoms and signs that may arise alongside pleuritic pain are then discussed, followed by an introduction to the diagnostic tools such as the Wells’ score and current guidelines that can help to select the most appropriate investigation(s). Management of pulmonary embolism and other common causes of pleuritic pain are also discussed and highlighted by a clinical vignette.
Transfer of care or overstay after admission to ESSU was high among patients with cellulitis. Variables independently associated with transfer of care or overstay were obesity, i.v. drug use, elevated white blood cell count and elevated C-reactive protein. Awareness of these variables can inform appropriate guidelines for ESSU admission, potentially improving patient flow and reducing length of stay in the ED and hospital.
Imputation of the observed P-value and effect size within the likelihood ratio and power function are together a maneuver to recenter the H A distribution about the observed estimate ð b dÞ. As the authors imply, this effectively reconfigures their alternative hypothesis from the composite H A : dO0 to the simple HThe resulting likelihood ratio (their dLR) is thus maximized and represents an upper bound on the evidence against H 0 for the one-sided case. Furthermore, reparameterization of the power function in this manner fixes ''marginal power'' at 0.5 for all cases, invalidating the authors' assertion that ''the dLR incorporates study power,'' as it is merely a transformation of the P-value.Similar approaches to determining the Bayes factor bound for a given P-value have been longstanding in the Bayesian literature [7e9], where distributed priors yield average power ð1 À bÞ in the predata expressions [4]. In the present case, however, evaluation of the evidence relative to the a posteriori H 0 A divorces inference from any prior effect estimate, from which power would have been computed. Recognition of the dLR as a bound for the a priori composite H A will prevent its misinterpretation as an externally valid (regarding priors) measure of evidence.
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