Follow

• 

  Differences within a health system: imaging use for suspected pediatric appendicitis

  Nafisa Bhuiyan, Ryan Nierstedt, Michelle Jankowski, Shanna Jones, and Aveh Bastani

  Publication Date: 5-2-2022

  INTRODUCTION
  Ultrasound (US) is the first line imaging used for suspected pediatric appendicitis. However, following equivocal US findings and its lower negative predictive value for ruling out appendicitis, Computed Tomography (CT) imaging is often performed in children. This study investigates the differences in imaging utilization between a community hospital (Beaumont Troy) and a children’s ED hospital (Beaumont Royal Oak), making it the first study to evaluate suspected pediatric appendicitis in Beaumont Health System. It also aims to further characterize differences in patient outcomes such as surgery, length of hospital stay, complications of appendicitis, and highlight the need to reduce unnecessary CT use due to its radiation exposure.

• 

  A Case Report of a Rare COVID-19 Complication: a Subdural Empyema in a Pediatric Female

  Christine Carline, Scott Klein, Christopher Cooley, and Daniel Zoller

  Publication Date: 5-2022

  • There have been few reported cases of intracranial complications in patients with COVID-19 and even fewer cases in children.

  • A subdural empyema (SDE) is an intracranial abscess between the dura and arachnoid mater.

  • A SDE usually occurs due to sinusitis, most commonly the frontal sinus, or acute otitis media

• 

  Evaluation of Implementing ‘Team Strategies and Tools to Enhance Performance and Patient Safety’ in a Community Emergency Department

  Bryson Caskey, Shanna Jones, Sarah Berry, Heather Harris, David Donaldson, and Aveh Bastani

  Publication Date: 5-2-2022

  This study sought to provide an initial evaluation of implementing the program ‘Team Strategies and Tools to Enhance Performance and Patient Safety’ (TeamSTEPPS) in the William Beaumont Troy Emergency Department (ED). TeamSTEPPS integrates teamwork into medical practice by developing tools and strategies within leadership, situation monitoring, mutual support, and communication to increase team performance in order to improve quality, safety, and efficiency of healthcare1,2 (figure 1). It was implemented in the Troy Beaumont ED in 2017. This study was designed to determine if the program is achieving desired outcomes, identify areas for improvement, and add to the limited fund of data on the effectiveness of TeamSTEPPS in community ED’s3-5.

• 

  Journal Club in the Pre-Clinical Years During Medical School

  Kristin Cuadra and Steven Joseph

  Publication Date: 5-2-2022

  INTRODUCTION
  Traditionally, journal clubs have been conducted within graduate medical programs to help integrate evidence-based learning. This study will be focused on beginning to integrate journal club into the pre-clinical years while implementing successful techniques used in past journal clubs. Our hypothesis is that, with a structured review instrument in place to help students analyze clinical articles, students will be able to benefit from monthly journal clubs and fully grasp concepts taught in these pre-clinical years. Overall, the results will contribute significantly in determining the efficacy of journal club and whether or not it can be a valuable tool in medical education.

• 

  Should I Stay or Should I Go: Discharging Low-risk Pulmonary Emboli from the Emergency Department

  Matthew Drogowski, Radwa Koujana, Ali Abou-Alaiwi, David A. Berger, and Danielle Turner-Lawrence

  Publication Date: 4-28-2022

  Introduction

  •Direct oral anticoagulants (DOACs) are effective treatment for pulmonary emboli (PE)1 •Increasing literature suggests the safety of discharging patients with low-risk PEs on DOACs2

• 

  Differences in Small Bowel Obstruction Outcomes in an Academic vs Community Hospital.

  Kelly Fahey, Aveh Bastani, Shanna Jones, and Philip Kilanowski-Doroh

  Publication Date: 5-2-2022

  Small bowel obstruction: blockage in small intestine. Adhesions are the most common cause. Accounts for 300,000 hospitalizations in the US annually, and 20% of emergency surgical procedures in patients with abdominal pain. High morbidity and mortality. Average hospital stay of 8 days. 30-day readmission rate of 16%. In-hospital mortality rate of 3%. Costly diagnosis: more than $2 billion spent on admissions for adhesion-related disease in the United States. Clinical presentation: variable, includes abdominal pain, vomiting, constipation, nausea, and abdominal distention. Management. Operative: important if signs of ischemia, peritonitis, or strangulation. Conservative: includes bowel rest, nasogastric decompression, serial examinations, and a water-soluble contrast challenge. Majority of patients (65-80%) with SBO due to adhesions can be successfully managed with non-operative treatment. Wide institutional variation exists with respect to the decision on admitting service. Aim and Objective To understand the differences in admitting service (medicine or surgery) in patients with SBO on morbidity and length of stay in a large academic hospital vs a community hospital.

• 

  A Multimodal Approach to Reducing Opioid Administration in the Emergency Department

  Eddie Ford, Vito Rocco, Shanna Jones, and Patrick Karabon

  Publication Date: 5-2-2022

  INTRODUCTION
  The United States is battling a deadly epidemic against opioid abuse and misuse, which began as a result of pharmaceutical companies purposely downplaying the addictive potential of their opioid medications. In 2016, a Colorado health care system developed a groundbreaking alternative to opioids (ALTO) protocol for acute pain relief in the Emergency Department (ED). This protocol was adapted and implemented in the Beaumont Troy ED and is the focus of this current study. The primary goal of this study is to characterize the impact of the ALTO protocol on the rate of opioid and non-opioid administration in the ED for acute pain relief.

  
  
  

• 

  Prehospital Use of Ketamine in the Pediatric Population

  Ashima Goyal, Revelle Gappy, Remle Crowe, John Frawley, Nai-Wei Chen, and Robert Swor

  Publication Date: 1-2022

• 

  The Current State of Diagnostic Error Education in U.S. Medical Schools

  Dakota Hall, Sandra LaBlance, and Brett Todd

  Publication Date: 5-2-2022

  Diagnostic error has been identified by the Institute of Medicine as a major cause of patient harm. Despite recent focus on the importance of diagnostic error, little is known about how medical schools are educating future physicians, specifically, the extent to which it is taught. We aimed to investigate the current state of diagnostic error education in U.S. medical schools.

• 

  POCUS Refresh- Applying a Modern Pedagogy to Emergency Residency Ultrasound Education

  Steven Johnson, Dorothy Christie Lakis, Jessica Kuxhause, and Amit Bahl

  Publication Date: 4-28-2022

  Objectives

  - To investigate the impact of a modern refresh to our emergency point of care ultrasound (POCUS) curriculum on resident end of rotation exam performance and satisfaction, including both flipped classroom and targeted image review using an interactive application.

• 

  Pediatric COVID-19 leading to MIS-C

  Pradeep Johns, Benjamin Glines, and Adam Vieder

  Publication Date: 5-2022

  Introduction

  • SARS COV-2 infection in pediatric patients can develop into a rare condition known as multisystem inflammatory syndrome in children (MIS-C). In the United States, the incidence of MIS-C is 2 cases per 100,000 pediatric COVID cases.

  • MIS-C is defined by the CDC as a Kawasaki Disease (KD) like illness with the following characteristics: - ≤ 21 years old - Fever ≥ 38° Celsius for ≥ 24 hours - Elevated inflammatory markers (ferritin, ESR, CRP, procalcitonin, d-dimer, fibrinogen, etc) - Evidence of multi-organ dysfunction ≥ 2 organ systems - Symptoms must be otherwise unattributable to an alternative diagnosis - Positive Sars-CoV-2 RT PCR, positive antigen test, or COVID exposure within 40 days of symptom onset.

  • Data from a tertiary pediatric center in New York from 2020 demonstrated that 28% of all pediatric COVID-19 admissions required ICU level of care.

• 

  The Dark Side of Diverticulitis

  Pradeep Johns and Eric McDowell

  Publication Date: 5-2022

  Introduction • Current guidelines, including the American Gastroenterological Association, have recommended outpatient treatment of uncomplicated diverticulitis. • CT scan for uncomplicated diverticulitis may demonstrate bowel wall thickening (70%), pericolic fat stranding (98%) without evidence of abscess, perforation, or fistula formation • Treating uncomplicated diverticulitis with outpatient oral antibiotics needs to be weighed with the patient's comorbidities, the likelihood of follow-up and signs of sepsis

• 

  ConstiPatED: Evaluation in the Pediatric ED – Practice Patterns and Trends Amongst Provider Types

  Dharshana Krishnaprasadh, Margaret Samberg, Lara Fawaz, Sara Grant, and Margaret Menoch

  Publication Date: 4-28-2022

  Objectives

  -The aim of this study is to describe practice trends by provider type: Pediatric Emergency Medicine (PEM) physicians, Emergency Medicine (EM) physicians, advanced practice providers (APP) and resident/fellows for evaluation and treatment of pediatric constipation.

• 

  Broad Strokes, Dissections in Young Folks: A Case Study

  Jessica Kuxhause and Margaret Menoch

  Publication Date: 4-28-2022

  Objectives

  - Describe incidence of CCADs causing pediatric strokes

  - Classify the presenting histories, signs, and symptoms of patients with CCADs

  - Identify factors delaying diagnosis of CCADs

• 

  The Impact of medical scribes on emergency physician diagnostic testing and diagnosis charting

  Lucas Nelson and Brett R. Todd

  Publication Date: 5-2-2022

  INTRODUCTION
  Since the widespread adoption of electronic medical records (EMRs), medical scribes have been increasingly utilized in emergency department (ED) settings to offload the documentation burden of emergency physicians (EPs). Scribes have been shown to increase EP productivity and satisfaction; however, little is known about their effects on the EP’s diagnostic process. We aimed to assess what effect, if any, scribes have on EP diagnostic test ordering and their documentation of differential diagnoses.

• 

  Imaging for suspected pediatric appendicitis: Can ultrasound alone be trusted?

  Ryan Nierstedt, Nafisa Bhuiyan, Michelle Jankowski, Lauren DeSantis, Aveh Bastani, and Shanna Jones

  Publication Date: 5-2-2022

  INTRODUCTION
  Diagnosis of pediatric appendicitis relies on a combination of laboratory results, diagnostic imaging, and clinician judgement. However, the necessity of CT imaging has been questioned given radiation exposure. Therefore, ultrasound imaging has become a useful diagnostic tool, yet its sensitivity in identifying appendicitis is often lower in comparison to CT. This study aims to determine the sensitivity of US imaging for pediatric appendicitis and if differences exist in the diagnosis of appendicitis utilizing both CT and ultrasound or ultrasound alone.

• 

  Anaphyl Crisis: Rising Rates of Pediatric Anaphylaxis

  Paul Patek, Dalia Owda, and Margaret Menoch

  Publication Date: 4-28-2022

  Objectives

  - Determine the rates of pediatric anaphylaxis in SE Michigan between January 1, 2010 and December 31, 2019

  - Describe the epidemiology of pediatric patients presenting to emergency centers in southeast Michigan with anaphylaxis

• 

  Risk Factors Affecting Delayed Diagnosis of Adult Acute Appendicitis

  Nicholas W. Prewitt and Brett R. Todd

  Publication Date: 5-2-2022

  INTRODUCTION
  The diagnosis of appendicitis is time-sensitive and delays increase the risk of morbidity and mortality through complications, including perforation, gangrene, and abscess formation. Nearly all cases of appendicitis are diagnosed in and admitted through the emergency department (ED). Therefore, improvements in the time to diagnosis of acute appendicitis in the ED may improve patient outcomes. However, it currently remains unclear what factors contribute to prolonged diagnostic times of appendicitis. This study aimed to determine if demographic, environmental, or provider-related factors result in delays in the diagnosis of adult acute appendicitis in the ED.

• 

  Cardiac Arrest Patient Length of Stay and Survival in Michigan Hospitals

  Jaemin Song, David A. Berger, James H. Paxton, Joseph B. Miller, Joshua Reynolds, Nai-Wei Chen, and Robert Swor

  Publication Date: 5-2-2022

  INTRODUCTION
  Current guidelines recommend deferring prognostic decisions for at least 72 hours following admission after Out of Hospital cardiac arrest (OHCA). Most non-survivors experience withdrawal of life-sustaining therapy (WLST), and early WLST may adversely impact survival. We sought to characterize the hospital length of stay (LOS) and timing of Do Not Resuscitate (DNR) orders (as surrogates for WLST) to assess their relationship to survival following cardiac arrest.

• 

  Ventricular assist device association in improving outcomes in patients resuscitated from out of hospital cardiac arrest

  Julie Tram, Andrew Pressman, Nai-Wei Chen, David Berger, Joseph Miller, Robert Welch, Joshua Reynolds, James Pribble, Robert Swor, and CARES Surveillance Group

  Publication Date: 5-2-2022

  INTRODUCTION
  There has been continued debate on the efficacy of ventricular assist devices (VAD) on improving survival outcomes in post cardiac arrest patients.
  The objective of this study is to assess whether the use of VAD is associated with improved survival outcome in patients resuscitated from out-of-hospital cardiac arrest in Michigan.

• 

  Assessing Geriatric Patients in the Emergency Department Using A New Trauma Protocol

  Benjamin Travers, Ali Beydoun, Patrick Karabon, Shanna Jones, Michael Opsommer, Aveh Bastani, and David Donaldson

  Publication Date: 5-2-2022

  INTRODUCTION
  The Level III trauma protocol was implemented to reduce time to diagnosis and treatment for elderly patients (defined as patients aged > 65 who are taking anticoagulant/antiplatelet agents) presenting in the ED with a potential head injury after a fall. In 2017, approximately 11.4% of the patients triaged by the new Level III trauma protocol had an intracranial bleed, which is a population that had previously been overlooked as they have a low index of suspicion for an intracranial bleed. This study sought to determine if the recent implementation of the Level III trauma protocol in the Troy Beaumont Emergency Department (ED) has led to better health outcomes for this population.

  .

• 

  A Case Study of Lemeirre’s Syndrome

  Kyle Wesley, Jarred Anderson, and Dawn Zelenka

  Publication Date: 5-2022

  Introduction Lemierre’s syndrome, a rare but severe disease process, is a clinical condition characterized by septic thrombophlebitis of the internal jugular vein most commonly caused by Fusobacterium necrophorum. Lemierre’s syndrome should be suspected in a pediatric or young adult patient who presents with acute signs of septicemia, pneumonia or lateral neck pain preceded by viral upper respiratory symptoms. Diagnosis is confirmed with radiographic evidence of internal jugular thrombophlebitis with either bacteremia or evidence of septic emboli2 . Treatment consists of prolonged targeted antibiotic course and, infrequently, anticoagulation therapy.

• 

  Outcomes for Patients with Congestive Heart Failure and Chronic Kidney Disease Receiving Fluid Resuscitation for Severe Sepsis or Septic Shock

  Melany Wiczorek, Ronny Otero, Steven Knight, Kaitlin Ziadeh, James Blumline, and Zachary Rollins

  Publication Date: 5-2-2022

  INTRODUCTION
  Sepsis core measures are an integral part of sepsis treatment. Current fluid administration guidelines consist of administering at least 30cc/kg of intravenous fluids (IVF) per ideal body weight (IBW) within the first three hours of sepsis diagnosis regardless of pre-existing comorbidities at risk for fluid overload. This study aims to evaluate the outcomes of patients with a history of congestive heart failure (CHF) and/or chronic kidney disease (CKD) who receive fluid resuscitation for the management of severe sepsis or septic shock.