Canadian Journal of Emergency Medicine 

About: Canadian Journal of Emergency Medicine is an academic journal published by Springer Nature. The journal publishes majorly in the area(s): Emergency department & Medicine. It has an ISSN identifier of 1481-8035. Over the lifetime, 2439 publications have been published receiving 25601 citations. The journal is also known as: Canadian journal of emergency medicine & Journal canadien de la médecine d'urgence.

Understanding receiver operating characteristic (ROC) curves

Abstract: 1conclude that serum levels of neuron-specific enolase (NSE), a biochemical marker of ischemic brain injury, may have clinical utility for the prediction of survival to hospital discharge in patients experiencing the return of spontaneous circulation following at least 5 minutes of cardiopulmonary resuscitation. The authors used a receiver operating characteristic (ROC) curve to illustrate and evaluate the diagnostic (prognostic) performance of NSE. We explain ROC curve analysis in the following paragraphs. The term “receiver operating characteristic” came from tests of the ability of World War II radar operators to determine whether a blip on the radar screen represented an object (signal) or noise. The science of “signal detection theory” was later applied to diagnostic medicine. 2

Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines.

Abstract: The Canadian Emergency Department Triage and Acuity Scale (CTAS) has been widely adopted in emergency departments (EDs) across Canada and abroad since its initial publication in 1999. CTAS continues to be revised and updated on a continuing basis. In 2001, a paediatric version of the CTAS implementation guidelines was developed and published. With the ongoing improvements in computer technology, the increasing demands for clinical and administrative data and the wider application of information technology in EDs, the Canadian Emergency Department Information Systems (CEDIS) committee published a standardized presenting complaint list in 2003. In 2004, a revision of the adult CTAS guidelines that incorporated the CEDIS complaint list and introduced the concept of modifiers to assist nurses in the assignment of the appropriate acuity level was published. Modifiers were divided into 2 types: first order and second order. First order modifiers are defined as modifiers that are broadly applicable to a wide number of different complaints. These include vital sign modifiers (e.g., respiratory distress, hemodynamic stability, level of consciousness and fever), pain severity (e.g., central v. peripheral and acute v. chronic) and mechanism of injury. Second order modifiers are specific to a limited number of complaints. One example of a second order modifier is low blood sugar (BS) (e.g., “BS < 3 mmol/L and/or symptomatic” is a modifier for 3 complaints, including altered level of consciousness, confusion and hypoglycemia; while “BS < 3 mmol/L and asymptomatic” modifies only 1 complaint: hypoglycemia). A CTAS revisions supplement that displayed the entire CEDIS complaint list and the relevant first and second order modifiers was published (in portable document format [PDF] and Microsoft Excel format). A more sophisticated Excel application, Complaint Oriented Triage (COT) was designed (by B.U. and M.B.) in 2007. COT, along with all CTAS publications and supplementary documents, is accessible online at www.caep.ca/template .asp?id=B795164082374289BBD9C1C2BF4B8D32. In December 2006, a new combined adult and paediatric CTAS educational package was made available to certified instructors and their students. The package is maintained on a password-protected website. Research regarding CTAS continues to be published. Studies looking at reliability and validity of CTAS using computerized decision support systems have been generally

Analysis of factors influencing length of stay in the emergency department.

Abstract: Objectives Length of stay (LOS) is a key measure of emergency department (ED) throughput and a marker of overcrowding. Time studies that assess key ED processes will help clarify the causes of patient care delays and prolonged LOS. The objectives of this study were to identify and quantify the principal ED patient care time intervals, and to measure the impact of important service processes (laboratory testing, imaging and consultation) on LOS for patients in different triage levels. Methods In this retrospective review, conducted at a large urban tertiary care teaching hospital and trauma centre, investigators reviewed the records of 1047 consecutive patients treated during a continuous 7-day period in January 1999. Key data were recorded, including patient characteristics, ED process times, tests performed, consultations and overall ED LOS. Of the 1047 patient records, 153 (14.6%) were excluded from detailed analysis because of incomplete documentation. Process times were determined and stratified by triage level, using the Canadian Emergency Department Triage and Acuity Scale (CTAS). Multiple linear regression analysis was performed to determine which factors were most strongly associated with prolonged LOS. Results Patients in intermediate triage Levels III and IV generally had the longest waiting times to nurse and physician assessment, and the longest ED lengths of stay. CTAS triage levels predicted laboratory and imaging utilization as well as consultation rate. The use of diagnostic imaging and laboratory tests was associated with longer LOS, varying with the specific tests ordered. Specialty consultation was also associated with prolonged LOS, and this effect was highly variable depending on the service consulted. Conclusions Triage level, investigations and consultations are important independent variables that influence ED LOS. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting LOS. Improved information systems will facilitate similar ED time studies to assess key processes, lengths of stay and clinical efficiency.

Emergency medicine: A practice prone to error?

Abstract: The last decade has witnessed a rapidly growing public and academic interest in medical error, an interest that has culminated in the emergence of the science of error prevention in health care. The impact of this new science will be felt in all areas of medicine but perhaps especially in emergency medicine (EM). The emergency department's unique operating characteristics make it a natural laboratory for the study of error. These characteristics, combined with the complex and myriad activities of EM, predict vulnerability to a multitude of errors. Overcrowding and other resource limitations impair continuous quality improvement, and many errors result from high decision density, excessive cognitive load and flawed thinking in the decision-making process. A large proportion of these errors have serious outcomes but an even higher proportion are preventable. The historical practice of blaming individuals for errors needs to be replaced by root-cause analysis that identifies process and systemic weaknesses. Quantitative and qualitative methods are needed to detect, describe and classify error at all levels in the system. Research is needed into the processes that underlie EM error. Educational initiatives should be developed at all levels, for everyone from undergraduate trainees to practicing emergency physicians. Changes in societal attitudes will be an important component of the new culture of patient safety. A nationwide reporting system is proposed to disseminate error information expediently. Canadian EM providers are in a pivotal position to provide leadership to the Canadian health care system in this important area.

The Twitter pandemic: The critical role of Twitter in the dissemination of medical information and misinformation during the COVID-19 pandemic.

Abstract: As the world finds itself in the middle of the COVID-19 pandemic, social media has become inundated with content associated with the virus. Although all social media platforms (e.g., Facebook, Instagram, blogs) are currently providing us with medical content, perhaps no other consistently plays a more prominent role in the medical world than Twitter. Emergency medicine (EM) is on the bleeding edge, where practice at the bedside is continually being shared on social media and this pandemic has resulted in immense activity on Twitter. Twitter is a microblogging and social networking service where users post messages using “tweets” that are limited to 240 characters. For well over a decade, Twitter has become increasingly used as a platform where medical practitioners exchange ideas, information, and commentary. The hashtag #FOAMed garners thousands of tweets per hour, and at this momentous period in medical history, no subject is more prominent than COVID-19. With the free-flow of messages and ideas that are not vetted or peer-reviewed, unlike classic medical educational resources, is there a risk of harm? What are the benefits to the EM community from Twitter? Finally, how does the average emergency physician (EP) get the most out of the information out there?