of low doses of droperidol, and its effectiveness in treating acute migraine headaches in the emergency department (ED) as well for sedation. Our objective was to evaluate mortality and QTc prolongation among patients who received droperidol. Methods: This was an observational cohort study of all droperidol administrations in the ED from 1/1/2012 through 4/19/2018 at an academic quaternary center with 77,000 visits. The primary endpoint was mortality within 24 hours of droperidol administration. Secondary endpoints included QTc length up to 6 months before droperidol and within 24 hours after droperidol administration. A random sample of 10% was manually reviewed to assess the accuracy of the electronic data retrieval. QTc>500 msec was considered prolonged in both males and females. Results: Zero deaths attributable to droperidol administration were recorded within 24 hours from the entire cohort of 6,881 visits. Among the manually reviewed records (N¼796), the median droperidol dose was 0.625 mg, representing 52.1% visits with this dose. 40.5% (N¼322) of patients received a dose close to 2.5 mg, and 2.4% (N¼19) received 5 mg of droperidol. There were 2.9% (N¼23) documented cases of akathisia, that resolved with diphenhydramine in every case. Visits over the study time period with an ECG within 6 months before droperidol administration and within 24 hours following droperidol were reviewed. There were 2,080 patients with EKG obtained within 6 months prior and 1,631 with and EKG within 24 hours after administration. There were 77 patients who had a QTc 500 prior to droperidol administration, and 43 patients with an ECG within 24 hours following droperidol administration that demonstrated a QTc 500, including 8 with a QTc 500 within 6 months before droperidol. Conclusion: We found no increased mortality among the 6,881 patients who received droperidol. QTc was prolonged in 0.7% of cases after droperidol administration, and this did not result in patient significant outcomes. Our study confirms the findings by The Clinical Guideline Committee of the American Academy of Emergency Medicine which found no evidence that low-dose droperidol was unsafe for use in the ED.
HIV screening in the emergency department (ED), including universal screening irrespective of risk assessments, has shown strong promise in past studies, identifying many new cases of HIV infection among those who lack access to traditional HIV testing services. Yet, over the years a consistent set of challenges and limitations have presented themselves in settings throughout the United States. We review considerations for evaluating and improving the success of ED-based HIV screening programs in the United States. K E Y W O R D S emergency department, HIV screening, linkage to care Since 2006, the U. S. Centers for Disease Control and Prevention (CDC) has recommended that emergency departments in the United States should conduct universal HIV screening without regard to patientreported HIV risk in settings with high HIV prevalence. 1 These guidelines expanded on those CDC made earlier to include recommendations for opt-out testing, along with discouraging requirements for pretest counseling and separate written consent for HIV screening. 1,2 The CDC stated the new guidelines were meant, among other things, to increase HIV screening participation among ED patients, as well as encourage hospitals and clinical staff to screen their patients for HIV.
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