Impact of Povidone-iodine Versus Chlorhexidine for Periurethral Cleaning Before Catheterization on Pyuria and Bacteriuria Among Emergency Department Patients

Background: We aimed to determine the effect of periurethral cleaning before catheterization using chlorhexidine and povidone-iodine on bacteriuria and pyuria. Methods: This study was a single-blind clinical trial on a sample selected by convenience sampling. Demographic and clinical questionnaires were completed, and patients were randomly divided into two groups) 36 patients each of povidone-iodine and chlorhexidine using Minimization Software based on confounding variables including age, consciousness level, triage level, nutritional status, and underlying disease. The periurethral areas were cleaned with the given antiseptics and catheterized using standard and sterile procedures. Then, specimens were taken for urinalysis and urine culture immediately, 72 hours, and five days after catheterization. Then, bacteriuria rate, pyuria rate, and the number of microorganisms were determined through examinations. Data analysis was conducted using SPSS version 19. Results: There was no statistically significant difference in the bacteriuria rate between the two groups immediately (P = 0.76), 72 hours (P = 0.22), and five days (P = 0.50) after catheterization. The positive pyuria rate was not significantly different between the two groups immediately after catheterization. However, it was significantly higher in the povidone-iodine group 72 hours (P = 0.03) and five days (P = 0.004) after catheterization. The Mann-Whitney test compared the mean number of microorganisms between the two groups at different times. This test showed no significant difference in the number of microorganisms immediately (P = 0.93), 72 hours (P = 0.43), and five days (P = 0.61) after catheterization. Conclusions: Due to the lower side effects of chlorhexidine than povidone-iodine, it is suggested that similar studies be performed in other hospital wards with more stable patients to obtain more statistically significant results.

Venous Air Microembolism in Chest CT Angiography: Evidence of Normalization of Deviance Phenomenon

Purpose This article provides evidence that detection of venous air microbubbles (VAMB) in chest computed tomography angiography (CTA) can be an indicator for “normalization of deviance” phenomenon in CT. Method and Materials Institutional review board-approved retrospective study, with waiver for informed consent. Contrast-enhanced chest CT performed during 6 months were reviewed for presence of VAMB in venous segments visible in chest CT (subclavian, brachiocephalic vein, superior vena cava) and cardiac chambers. VAMB volumes were quantified through a semiautomatic method (MIAlite plugin for OsiriX), using a region of interest (ROI) covering the bubble. With basal results, protocols for correct injection technique were reinforced, and VAMB were estimated again at 1 and 3 months. Six months later, questionnaires were sent to the CT technologists to inquire about their perception of VAMB. Descriptive measures with central distribution and dispersion were performed; statistical significance was considered at p < 0.05. Results A total of 602 chest CTA were analyzed, 332 were women (55.14%), with a median age of 58 (interquartile range [IQR] 44–72) years. Among those, 16.11% (100 cases) presented VAMB. Most were emergency department patients (51.6%), male (50.3%), with a median age of 54 (IQR 26) years. There was no difference on detection of VAMB regarding sex (p = 0.19), age (p = 0.46), or referral diagnosis (p = 0.35). Mean air bubbles volume was 0.2 mL (range 0.01–3.4 mL). After intervention, the number of exams with VAMB dropped to 3.29 % (3/91) (p < 0.001). On the 6-month query, 50% of the technicians still considered that VMAB is inevitable, and 60% thought that the occurrence is not associated to risk, and therefore, not actionable. Conclusion VAMB are a frequent finding in chest CTA, and being independent from patient-related variables, it is likely due to technical issues such as intravenous access manipulation during the exam. Reduction after reinforcement of proper performance, and certification of a low concern from CT technicians for any risk associated, provides evidence that there is normalization of deviance in this everyday procedure.

Comparison Between Culture-Positive and Culture-Negative Septic Shock in Emergency Department Patients

Culture results in patients with septic shock affect their management strategies. Our study aimed to compare the clinical characteristics and outcomes of patients with culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS). A single-center, retrospective, case-control study included adult patients diagnosed with septic shock in the emergency department between January 1, 2019 and March 31, 2020. They were divided into CNSS and CPSS groups based on their culture results. Patients with CPSS (63.7%, 311/488) and CNSS (36.3%, 177/488) were identified. The CPSS and CNSS groups had comparable clinical outcomes, including mechanical ventilation (29.6% vs. 32.8%, p = 0.46), renal replacement therapy (19.3% vs. 23.2%, p = 0.31), intensive care unit care (51.8% vs. 45.2%, p = 0.16), 30-day (35.7% vs. 36.7%, p = 0.82) and in-hospital mortality (39.5% vs. 41.8%, p = 0.63). The duration (13 [8−19] vs. 16 [10−23], days, p = 0.04) and de-escalation timing (5 [2−10] vs. 9 [7−12], day, p = 0.02) of antibiotic administration in the CNSS group was significantly shorter and earlier than in the CPSS group. Patients with CNSS and CPSS had similar clinical characteristics and adverse outcome proportions. Physicians can evaluate the feasibility of early de-escalation or discontinuation of antibiotic administration in CNSS patients with clinical improvement.

Acute Pain Assessment Inadequacy in the Emergency Department: Patients’ Perspective

For many patients, acute pain is a common cause to seek treatment in an Emergency Department (ED). An inadequate assessment could cause inappropriate pain management. The aim of this study was to describe and explain patients’ perceptions of acute pain assessment in the Emergency Department. The data were collected from ED patients (n = 114). Patients reported that nurses were asking about intensity of pain at rest, but only 52% during movement. According to the patients, the most common tools to assess acute pain were the verbal rating scale (VRS; 54% of patients), numerical rating scale (NRS; 28% of patients), and visual analogue scale (VAS; 9.7% of patients). Over twenty per cent of patients stated that ED nurses did not ask about the intensity of pain after analgesic administration. Twenty-four per cent of the patients were not pleased with nursing pain assessment in the ED. The assessment of acute pain is still inadequate in the ED. Therefore, ED nurses need to be more attentive to systematic acute pain management of patients in the ED.

Suicide Risk in Adolescents During the COVID-19 Pandemic

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic created high levels of psychological distress and may have increased suicide risk. METHODS: We used the 4-item Ask Suicide-Screening Questions (ASQ) to assess suicide risk among all patients 12 to 24 years of age at a children’s hospital. We compared demographics, encounter type (telehealth or face-to-face [F2F]), and screening results from April to June 2020 (T2) to those from April to June 2019 (T1). RESULTS: Fewer patients were seen at T2 than T1 (17 986 vs 24 863). A greater proportion of visits at T2 were by telehealth (0% vs 43%). The rate of positive suicide screens was higher in T2 than in T1 (12.2% vs 11.1%, adjusted odds ration [aOR], 1.24; 95% confidence interval [CI], 1.15–1.35). The odds of a positive screen were greater for older patients (aOR of 1.12 for age in years; 95% CI, 1.10–1.14), female patients (aOR, 2.23; 95% CI, 2.00–2.48), patients with public versus private insurance (aOR, 1.88; 95% CI, 1.72–2.07), and lower for Black versus White patients (aOR, 0.85; 95% CI, 0.77–0.95). Rates of positive screens were highest among inpatients (20.0%), intermediate for emergency department patients (14.4%), and lowest in outpatient clinics (9.9%) (P &lt; .05). CONCLUSIONS: Rates of positive suicide risk screens among adolescents rose in the pandemic’s early months with differences related to sociodemographics and visit type. Changes in health care delivery highlight the complexities of assessing and responding to mental health needs of adolescents. Additional research might determine the effects of screening methods and patient populations on screening results.

A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection

Objective We aimed to compare the modified National Early Warning Score (mNEWS), quick Sequential Organ Failure Assessment (qSOFA) score, modified Systemic Inflammatory Response Syndrome (mSIRS) score, and modified Search Out Severity (mSOS) score in predicting mortality and sepsis among patients suspected of first observed infections in the emergency department. The modified scores were created by removing variables for simplicity.Methods This was a prospective cohort study that enrolled adult patients presenting at the emergency department with signs and symptoms suggesting infection. The mNEWS, qSOFA score, mSIRS score, and mSOS score were calculated using triage data. The SOFA score was a reference standard for sepsis diagnosis. All patients were monitored for up to 30 days after the initial visit to measure each scoring system’s ability to predict 30-day mortality and sepsis.Results There were 260 patients included in the study. The 30-day mortality prediction with mNEWS ≥5 had the highest sensitivity (91.18%). The highest area under the receiver operating characteristic curve (AUC) for the 30-day mortality prediction was mNEWS (0.607), followed by qSOFA (0.605), mSOS (0.550), and mSIRS (0.423). The sepsis prediction with mNEWS ≥5 had the highest sensitivity (96.48%). The highest AUC for the sepsis prediction was also mNEWS (0.685), followed by qSOFA (0.605), mSOS (0.480), and mSIRS (0.477).Conclusion mNEWS was an acceptable scoring system screening tool for predicting mortality and sepsis in patients with a suspected infection.