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Comparing the demographic data and outcomes of septic shock patients presenting to teaching or non-teaching metropolitan hospitals in the United States

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World Journal of Emergency Medicine 2022年第6期13卷 433-440页

作者： ralph bou chebl Nadim Kattouf Mohamad Assaf Saadeddine Haidar Gilbert Abou Dagher Sarah Abdul Nabi Rana Bachir Mazen El Sayed Department of Emergency Medicine American University of BeirutBeirut 11072020Lebanon

BACKGROUND:Studies looking at the effect of hospital teaching status on septic shock related in-hospital mortality are *** aim of this study was to examine the effect of hospital teaching status on mortality in septic shock patients in the United ***:This was a retrospective observational study,using the Nationwide Emergency Department Sample Database(released in 2018).All patients with septic shock were *** sample logistic regression was performed to assess the impact of hospital teaching status on patient ***:A total of 388,552 septic shock patients were included in the *** average age was 66.93 years and 51.7%were *** of the patients presented to metropolitan teaching hospitals(68.2%)and 31.8%presented to metropolitan non-teaching *** shock patients presenting to teaching hospitals were found to have a higher percentage of medical comorbidities,were more likely to be intubated and placed on mechanical ventilation(50.5%vs.46.9%)and had a longer average length of hospital stay(12.47 d vs.10.20 d).Septic shock patients presenting to teaching hospitals had greater odds of in-hospital mortality compared to those presenting to metropolitan non-teaching hospitals(adjusted odd ratio[OR]=1.295,95%confidence interval[CI]:1.256-1.335).CONCLUSION:Septic shock patients presenting to metropolitan teaching hospitals had significantly higher risks of mortality than those presenting to metropolitan non-teaching *** also had higher rates of intubation and mechanical ventilation as well as longer lengths of hospital stay than those in non-teaching hospitals.

关键词： Sepsis Septic shock In-hospital mortality Hospital teaching status United States Epidemiology Outcome

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Two-point compression ultrasonography: Enough to rule out lower extremity deep venous thrombosis?

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World Journal of Emergency Medicine 2021年第4期12卷 268-273页

作者： ralphe bou chebl Nader El Souki Mirabelle Geha Imad Majzoub Rima Kaddoura Hady Zgheib Department of Emergency Medicine American University of BeirutBeirut 11072020Lebanon

BACKGROUND: Deep venous thrombosis(DVT) is a major cause of morbidity and is a common presenting complaint to the emergency department(ED). Point-of-care two-point compression ultrasonography has evolved as a quick and effective way of diagnosing DVT. The purpose of this study is to validate the prevalence and distribution of venous thrombi isolated to proximal lower extremity veins, other than common femoral and popliteal veins in patients with ***: This is a single-center retrospective study that looked at patients presenting to the ED of a tertiary care hospital between January 2014 and August 2018. The clinical presentation and laboratory and imaging results were obtained using the hospital's electronic medical ***: A total of 2,507 patients underwent a lower extremity duplex ultrasound during the study period. Among them, 379(15%) were included in the study. The percentages of isolated thrombi to the femoral vein and deep femoral vein were 7.92% and 0.53%, respectively. When the patients were stratified into the two groups of isolated DVT and two-point compression DVT, there were no statistically significant differences in the laboratory results between both groups. However, immobilized patients and patients with recent surgeries were more likely to have an isolated ***: Thrombi isolated to proximal lower extremity veins other than the common femoral and popliteal veins make up 8.45% of DVTs. Given this significant number of missed DVTs, the authors recommend the addition of the femoral and deep femoral veins to the two-point compression exam.

关键词： Lower extremity Deep venous thrombosis Emergency department Two-point compression ultrasonography

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Role of urine studies in asymptomatic febrile neutropenic patients presenting to the emergency department

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World Journal of Emergency Medicine 2021年第2期12卷 99-104页

作者： Hady Zgheib Aline El Zakhem Cynthia Wakil Mohamad Ali Cheaito Rola Cheaito Antoine Finianos ralphe bou chebl Rima Kaddoura Nader Al Souky Imad El Majzoub Department of Emergency Medicine American University of Beirut Medical CenterBeirut 11-0236Lebanon Department of Internal Medicine American University of Beirut Medical CenterBeirut 11-0236Lebanon

BACKGROUND: The role of urine studies in the detection of urinary tract infection(UTI) in febrile neutropenic patients with urinary symptoms(having a urinary catheter or having a positive urine analysis) is inarguable. However, the evidence is scarce regarding the indication for urine studies in asymptomatic(i.e., without urinary symptoms) patients with febrile neutropenia(FN) presenting to the emergency department(ED). The aim of this study is to evaluate the need for obtaining urine studies in asymptomatic febrile neutropenic ***: This was a retrospective cohort study conducted on adult cancer patients who presented to the ED with FN and had no urinary symptoms. We included all ED presentations of eligible patients between January 2013 and September 2018. Student's t-test and Wilcoxon rank-sum test were used for continuous data, while Chi-square and Fisher's exact tests were used for categorical data. Participants were divided into two groups based on their urine culture(UC) results: negative and positive UCs. Two cut-offs were used for positive UC results: ≥10~5 cfu/m L and ≥10~4 cfu/m ***: We included 284 patients in our study. The age of our patient population was 48.5±18.5 years. More than two-thirds(68.7%) of patients had severe neutropenia, while only 3.9% and 9.9% of the patients had positive UCs at ≥10~5 cfu/m L and ≥10~4 cfu/m L, respectively. UCs were expectedly positive in most patients with urinalysis(UA) abnormalities. However, 27.3% and 32.1% of patients with positive UCs at ≥10~5 cfu/m L and ≥10~4 cfu/m L respectively had a normal UA. CONCLUSIONS: In our study, the incidence of UTI in adult febrile neutropenic cancer patients who present to the ED without urinary symptoms is low. Consequently, routine urine testing may not be warranted in this population, as it adds unnecessary financial burdens on the patients and delays timely management.

关键词： Adult Cancer Emergency department Febrile neutropenia Urine testing

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