Abstract:
STUDY OBJECTIVE:The literature suggests that the d -dimer is useful in patients suspected of having pulmonary embolism and who have a low pretest probability of disease. A previously defined clinical decision rule, the Wells Criteria, may provide a reliable and reproducible means of determining this pretest probability. We evaluate the interrater agreement and external validity of Wells Criteria in determining pretest probability in patients suspected of having pulmonary embolism. METHODS:This was a prospective observational study. Trained research assistants enrolled patients during 120 random 8-hour shifts. Patients who underwent imaging for pulmonary embolism after a medical history, physical examination, and chest radiograph were enrolled. Treating providers and research assistants determined pretest probability according to Wells Criteria in a blinded fashion. Two d -dimer assays were run. Three-month follow-up for the diagnosis of pulmonary embolism was performed. Interrater agreement tables were created. kappa Values, sensitivities, and specificities were determined. RESULTS:Of the 153 eligible patients, 3 patients were missed, 16 patients declined, and 134 (88%) patients were enrolled. Sixteen (12%) patients were diagnosed with pulmonary embolism. The kappa values for Wells Criteria were 0.54 and 0.72 for the trichotomized and dichotomized scorings, respectively. When Wells Criteria were trichotomized into low pretest probability (n=59, 44%), moderate pretest probability (n=61, 46%), or high pretest probability (n=14, 10%), the pulmonary embolism prevalence was 2%, 15%, and 43%, respectively. When Wells Criteria were dichotomized into pulmonary embolism-unlikely (n=88, 66%) or pulmonary embolism-likely (n=46, 34%), the prevalence was 3% and 28%, respectively. The immunoturbidimetric and rapid enzyme-linked immunosorbent assay d -dimer assays had similar sensitivities (94%) and specificities (45% versus 46%). CONCLUSION:Wells Criteria have a moderate to substantial interrater agreement and reliably risk stratify pretest probability in patients with suspected pulmonary embolism.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Wolf SJ,McCubbin TR,Feldhaus KM,Faragher JP,Adcock DMdoi
10.1016/j.annemergmed.2004.04.002subject
Has Abstractpub_date
2004-11-01 00:00:00pages
503-10issue
5eissn
0196-0644issn
1097-6760pii
S0196064404003385journal_volume
44pub_type
杂志文章abstract:STUDY OBJECTIVE:We derive a prediction rule to identify children at very low risk for intra-abdominal injuries undergoing acute intervention and for whom computed tomography (CT) could be obviated. METHODS:We prospectively enrolled children with blunt torso trauma in 20 emergency departments. We used binary recursive ...
journal_title:Annals of emergency medicine
pub_type: 临床试验,评论,杂志文章,多中心研究
doi:10.1016/j.annemergmed.2012.11.009
更新日期:2013-08-01 00:00:00
abstract::A fatal case of ascending tonic-clonic seizure (ATCS) syndrome resulted from the inadvertent, unrecognized use of a hyperosmolar ionic contrast agent during myelography. The patient presented with lower-extremity myoclonic jerking, agitation, hyperthermia, rhabdomyolysis, and disseminated intravascular coagulation. Em...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70045-9
更新日期:1998-11-01 00:00:00
abstract::Positive-pressure bag-valve-mask ventilation during emergency airway management often results in significant gastric insufflation, which may impede adequate ventilation and oxygenation. Current-generation supraglottic airways have beneficial features, such as channels for gastric decompression while ventilation is ong...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2016.03.016
更新日期:2016-10-01 00:00:00
abstract::Maintaining an unobstructed airway and providing adequate oxygenation and CO2 elimination, by artificial means if necessary, are among the highest priorities in all life-threatening circumstances. How this goal can best be met in the prehospital setting has become a controversial issue. The esophageal obturator airway...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80434-5
更新日期:1984-09-01 00:00:00
abstract:STUDY OBJECTIVE:More than 1,000 patients experience sudden cardiac arrest each day. Treatment for this includes cardiopulmonary resuscitation (CPR_ and emergency medical services (EMS) that provide CPR-basic life support (BLS), BLS with defibrillation (BLS-D), or advanced life support (ALS). Our previous systematic rev...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:
更新日期:1999-10-01 00:00:00
abstract::[Parkhurst DC: Shift change. Ann Emerg Med June 1998;31:785-788.]. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:
更新日期:1998-06-01 00:00:00
abstract::Annals' 25th anniversary is a cause for celebration, but the future imposes a new set of ethical questions and moral dilemmas for emergency physicians. Each physician will need to make personal choices consistent with the courage, judgment, integrity, and dedication of past leaders when dealing with the moral dilemmas...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(97)70035-0
更新日期:1997-12-01 00:00:00
abstract:STUDY OBJECTIVE:To determine if intramedullary aspirate from intraosseous needle placement can be used as a source for evaluating blood compatibility. DESIGN:A prospective, nonrandomized, crossover study. SETTING/PARTICIPANTS:Patients admitted to the hematology/oncology service undergoing bone marrow aspiration for m...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82661-7
更新日期:1992-04-01 00:00:00
abstract::The situational crisis is a period of acute disorganization of affective cognitive and behavioral function precipitated by a traumatic life experience. We review the clinical features of a situational crisis and the four phases of the crisis sequence. Special emphasis is placed on the practical principles of treatment...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(83)80513-7
更新日期:1983-05-01 00:00:00
abstract:STUDY OBJECTIVE:We describe the operators, techniques, success, and adverse event rates of adult emergency department (ED) intubation through multicenter prospective surveillance. METHODS:Eighteen EDs in the United States, Canada, and Australia recorded intubation data onto a Web-based data collection tool, with a gre...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2014.10.036
更新日期:2015-04-01 00:00:00
abstract::The traditional use of the American ED, one of unrestricted access by patients and payment for services by insurers, is being questioned in this era of health care reform. Both primary care physicians and managed care organizations have questioned the use of the ED by patients without obvious problems of an emergency ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(97)70164-1
更新日期:1997-09-01 00:00:00
abstract:STUDY OBJECTIVE:Accurate and timely diagnosis of carbon monoxide (CO) poisoning is difficult because of nonspecific symptoms. Multiwave pulse oximetry might facilitate the screening for occult poisoning by noninvasive measurement of carboxyhemoglobin (COHb), but its reliability is still unknown. We assess bias and prec...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2010.12.024
更新日期:2011-07-01 00:00:00
abstract::The ingestion of iron-containing products is a potential toxicologic emergency. The total iron binding capacity (TIBC) has been used widely as a predictor of end-organ toxicity and a guide to the need for deferoxamine therapy. When the TIBC is greater than the serum iron concentration (SIC), it is held that no free ir...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(99)70420-8
更新日期:1999-01-01 00:00:00
abstract::We followed serial plasma baclofen concentrations in a woman who ingested more than 2 g of baclofen in a suicide attempt, the largest ingestion of baclofen reported to date. The plasma clearance of baclofen was characterized by first-order elimination kinetics with a half-life of 8.6 hours. The persistent central nerv...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80388-2
更新日期:1986-07-01 00:00:00
abstract:STUDY OBJECTIVE:Midazolam is widely used for procedural sedation and analgesia. Etomidate has been studied mostly in adults. Our objective is to compare the efficacy of etomidate and midazolam for achieving procedural sedation and analgesia in children. METHODS:A randomized, double-blind, emergency department and orth...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2006.03.004
更新日期:2006-10-01 00:00:00
abstract::Few tools exist that are sufficiently robust to allow manipulation of key input variables to produce casualty estimates resulting from high-consequence events reflecting local or specific regions of concern. This article describes the design and utility of a computerized modeling simulation tool, Electronic Mass Casua...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2008.09.014
更新日期:2009-02-01 00:00:00
abstract:STUDY OBJECTIVE:Continuous positive airway pressure ventilation (CPAP) in appropriately selected patients with acute respiratory failure has been shown to reduce the need for tracheal intubation in hospital. Despite several case series, the effectiveness of out-of-hospital CPAP has not been rigorously studied. We perfo...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.annemergmed.2008.01.006
更新日期:2008-09-01 00:00:00
abstract::We present a case of delay in diagnosis of diaphragmatic rupture and herniation in a pregnant 25-year-old woman. The diaphragmatic rupture was secondary to trauma sustained five months prior to presentation. Subsequent to her accident, she was provided medical care on multiple occasions for symptoms of intractable nau...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(88)80780-7
更新日期:1988-04-01 00:00:00
abstract::This article has been withdrawn at the request of the authors and editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal. ...
journal_title:Annals of emergency medicine
pub_type: 撤回出版物
doi:10.1016/j.annemergmed.2020.04.025
更新日期:2020-06-02 00:00:00
abstract:STUDY OBJECTIVE:The number of freestanding emergency departments (EDs) has increased rapidly in the United States, and there is concern that such entities are located near existing EDs rather than in areas lacking emergency care. In 2018, the Medicare Payment Advisory Commission recommended a reduction in Medicare reim...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2020.07.036
更新日期:2021-01-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the effect of helicopter transport of acute myocardial infarction (AMI) patients after initiation of thrombolysis on bleeding complications through hospital discharge. DESIGN:Prospectively identified incidence (cohort) study. SETTING:Air medical service of tertiary-care teaching hospital. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81433-7
更新日期:1991-08-01 00:00:00
abstract:STUDY OBJECTIVE:We compare 3 methods of hands-only cardiopulmonary resuscitation (CPR) education, using performance scores. A paucity of research exists on the comparative effectiveness of different types of hands-only CPR education. This study also includes a novel kiosk approach that has not previously been studied, ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2018.09.026
更新日期:2019-06-01 00:00:00
abstract::Pulmonary embolism, although uncommon in children, occurs in as many as 104 per 100,000 pediatric patients. Undiagnosed and untreated pulmonary embolism has a high mortality rate; thus, a high index of clinical suspicion and reliable diagnostic modalities are necessary to ensure prompt and accurate diagnosis. We repor...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81131-x
更新日期:1991-01-01 00:00:00
abstract::This clinical policy focuses on critical issues concerning the management of patients presenting to the emergency department (ED) with acetaminophen overdose. The subcommittee reviewed the medical literature relevant to the questions posed. The critical questions are: 1. What are the indications for N-acetylcysteine (...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,实务指引
doi:10.1016/j.annemergmed.2007.06.014
更新日期:2007-09-01 00:00:00
abstract:STUDY OBJECTIVE:We describe and analyze the effectiveness and safety of etomidate for procedural sedation and evaluate the patient's perspective on effectiveness, side effects, and satisfaction. METHODS:We conducted an observational retrospective study of all patients who received etomidate for procedural sedation ove...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2002.123695
更新日期:2002-06-01 00:00:00
abstract::We present the case of a 27-year-old man who sustained a minor head injury and presented with complaints of headache and vomiting. The diagnosis of vertex epidural hematoma is discussed. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70145-8
更新日期:1994-08-01 00:00:00
abstract:STUDY OBJECTIVE:We determine the incidence of serious bacterial infection in infants presenting to the emergency department (ED) with an apparent life-threatening event. METHODS:This was a prospective cohort study of infants younger than 12 months who were treated at an urban children's hospital ED during 1 year and w...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2008.12.037
更新日期:2009-10-01 00:00:00
abstract::Gastrointestinal decontamination has been practiced for hundreds of years; however, only in the past few years have data emerged that demonstrate a clinical benefit in some patients. Because most potentially toxic ingestions involve agents that are not toxic in the quantity consumed, the exact circumstances in which d...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1067/mem.2002.122058
更新日期:2002-03-01 00:00:00
abstract:STUDY OBJECTIVE:Prediction rules for pulmonary embolism use variables explicitly shown to estimate the probability of pulmonary embolism. However, clinicians often use variables that have not been similarly validated, yet are implicitly believed to modify probability of pulmonary embolism. The objective of this study i...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2009.11.010
更新日期:2010-04-01 00:00:00
abstract::In a traditional clinical trial, a fixed number of patients are evaluated before the data are analyzed. This has the disadvantage that more patients may be enrolled than are necessary to achieve a statistically significant result. Sequential statistical techniques provide a method for the analysis of clinical trials s...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82570-3
更新日期:1990-09-01 00:00:00