- Email: [email protected]
348 Bougie-Assisted Tube Thoracostomy Placement: A Novel Technique
Research Forum Abstracts NYC Department of Transportation and mapped using shapefiles to verify lane/path availability. We used spatial analysis to identify statistically significant clusters of high and low ISS. We selected a-priori two motor vehicle traffic and bicyclist dense roads (First and Second Avenues) with recently installed bicycle routes to compare the distribution of ISS for events occurring prior to and after installation. Results: After screening for eligibility, 839 patients qualified for inclusion. In the period prior to installation of bike lanes and protected paths, 21 bicyclist versus motor vehicle incidents occurred on First and Second Avenues; all were mildly severe. In the period after installation, 45 incidents occurred including 6 moderately injured, 1 severely injured, and 1 critically injured. Multivariable ordinal logistic regression modeling revealed that, holding all other variables constant, bike lane availability was associated with nearly 70% increased log odds of a bicyclist having a more severe injury (ie, moving up one level in ISS categories) compared to having no lane or path available (AOR 1.70 95% CI 1.08- 2.67). There was no difference in the log odds of having a more severe injury when protected paths were available (AOR 1.27 95% CI 0.67-2.41). Conclusion: Installation of demarcated bike lanes was associated with an increase in severe injuries among bicyclists presenting to our NYC trauma center. Installation of protected paths was not associated with significant differences in injury severity. These results may be due to increased bicycle rider volumes and speeds. Additional exposure data are necessary to fully characterize the impact of bike lanes and protected paths on injury severity.
346
superior in determining the presence of occult shock. The main objective of this study was to determine whether shock index or serum lactate is better at detecting the presence of occult shock in trauma pateints. Methods: The electronic medical record of patients admitted to the trauma service in 2014 after being treated for Tier 1 trauma activations where reviewed for demographic data, shock index and initial serum lactate. The administration of more than 2 units of packed red blood cells was used as the gold standard for the presence of shock. Results: There were 373 patients included in this study. Of these 52 patients required the administration of greater than 2 units of packed red blood cells. The average Injury Severity Score was >15. Table demonstrates the differences between the test characteristics of the shock index and serum lactate for determining the presence of occult shock. We found that serum lactate is superior to the shock index at determining the presence of occult shock in trauma patients. Conclusion: These findings suggest that though shock index is capable of determing the presence of shock in patients who have grossly abnormal vital signs, the ratio lacks the capability to determine the presence of occult shock. Serum lactate should be used to make decisions regarding the hemodynamic/perfusion status of the patient.
Anterior Shoulder Dislocation Reduction in the Emergency Department: Is There a Best Technique?
Stoesz AE, Zwank MD, Stuck LH, Ward CM/Regions Hospital, Saint Paul, MN; HealthPartners Institute for Education & Research, Bloomington, MN
Study Objectives: Anterior shoulder dislocations occur with an estimated incidence rate of 24 per 100,000 person-years in the United States. Although more than 90% of these shoulders are successfully reduced in the emergency department (ED), practitioners do not agree on the best reduction technique. Our aim was to ascertain first attempt success rates of different reduction techniques at an academic urban trauma center. Secondarily, we looked at usage of different methods of analgesia and sedation. Methods: We retrospectively reviewed the medical records of all patients over age 15 who presented to the ED over a three-year period with an isolated anterior shoulder dislocation. We recorded the reduction technique used, type of analgesia used, and number of attempts need for successful reduction. Results: Two hundred forty patients met inclusion criteria for the study. The reduction technique could be identified in the medical record in 156 patients (65%). Providers utilized the Milch/Hennepin (abduction/external rotation) technique most often (71 patients, 30%), followed by the Stimson (prone extension/traction) technique (52 patients, 22%). Other techniques used included the traction-countertraction/ Hippocratic method (20 patients), the Kocher (external rotation) method (9 patients) and the Cunningham (shoulder massage/traction) method (4 patients). In our population, the Milch technique reduced the shoulder on the first attempt in 74.6% of patients and 32% of those patients had procedural sedation. The Stimson technique had a 60% first attempt success rate with no patients receiving procedural sedation. The traction/countertraction method had a 61.5% first attempt success rate but 75% of patients received procedural sedation. Twenty-four shoulders could not be reduced in the ED and required orthopedic consultation. Conclusion: The results of this study suggest that the Milch technique may be superior to Stimson or Hippocratic methods for reducing anterior shoulder dislocations; however, the Stimson technique never required procedural sedation. The majority of patients were reduced in the emergency department without orthopedic assistance.
347
Detecting Occult Shock in Trauma Patients: A Comparison of Serum Lactate versus Shock Index
Arslan A, Flax L, Nunez P, Kanter M, Fraser R, Caputo N, Simon R/Lincoln Medical and Mental Health Center, Bronx, NY; Lincoln Medical Center, Bronx, NY
Study Objectives: Trauma is the leading cause of death of patients aged 1-44 in the United States. Early identification of serious injury leads to better outcomes for these patients. Vital signs have been shown to be inadequate in helpung the physician determine the presence of occult shock. The shock index is a ratio of heart rate to systolic blood pressure and has been validated to be of use in detecting the presence of shock. Serum lactate has been demonstrated to determine the presence of hypoperfusion in patients suffering trauma. Knowing that hypoperfusion does not always equate to hypotension and normotension does not always equate to normoperfusion, the question remains as to whether serum lactate or the shock index is
Volume 66, no. 4s : October 2015
348
Bougie-Assisted Tube Thoracostomy Placement: A Novel Technique
Gottlieb M, Nakitende D, Kimball D, Christian E, Bailitz J/Cook County (Stroger) Hospital, Chicago, IL
Study Objectives: Tube thoracostomies (TT) are performed for a variety of indications including pneumothorax, hemothorax, and empyema. The most commonly technique involves insertion of a finger into the chest cavity with advancement of a Kelly clamped chest tube alongside the finger. Studies have demonstrated complication rates ranging from as 1.19.5% depending upon the provider level of experience. There have been a few online discussions mentioning the use of a bougie to facilitate thoracostomy tube passage, but to the best of our knowledge, there are no studies assessing its feasibility. The purpose of this pilot study was to assess the feasibility of this approach as an adjunct to the standard TT placement. Methods: We conducted a pilot, feasibility study of this technique using a fresh human cadaver model. Two experts who have placed more than 50 TT and two senior residents who had placed more than 10 TT clinically prior to the study each performed one standard TT insertion and one bougie-guided TT. The insertions were with a 36 French chest tube and there were eight total placements. The providers alternated which approach was performed first, serving as their own case and control. The bougieassisted approach involved preloading the chest tube onto the bougie (Figure), advancing the bougie alongside the finger after entering the chest cavity, and then advancing the chest tube forward in a Seldinger technique. Two separate physicians confirmed intrathoracic placement by dissection and with ultrasound. The primary outcome was procedural time, which was measured from the first incision to the time when the provider was ready to suture. Secondary outcomes included incision length, percentage correct intrathoracic placement, and complications. Results: We performed eight total insertions with 100% intrathoracic placement with both approaches. Average procedure time was 48 seconds (95% CI 15-81 seconds) for the standard technique and 40 seconds (95% CI 16-65 seconds) for the bougie-guided technique without significant differences between expert and senior resident subgroups. Of note, the mean incision length was 4.9 cm (95% CI 3.2-6.5 cm) for the standard approach and 3.0 cm (95% CI 2.3-3.6 cm) for the bougie-guided approach. There were no significant complications identified in this sample.
Annals of Emergency Medicine S125
Research Forum Abstracts Conclusion: The bougie-guided TT is a novel approach to chest tube insertion and demonstrated excellent feasibility in this pilot study. Further studies should address the use of this technique in larger samples, as well as with more novice providers and obese patients.
349
High Risk Potential in Stable Pelvic Fractures Among Patients of Sub-Geriatric Age
Gray C, Wang H, Chukwama J, Martin J, Jennings A, Phillip J, Buca S, Robinson R/JPS, Fort Worth, TX
Study Objectives: Pelvic fractures are one of the common fractures seen in trauma. The risk of associated morbidity and mortality varies especially in patients initially presenting to the emergency department in stable condition. The injury mechanisms and patterns among patients in the sub-geriatric age overlap those seen in both the geriatric and young ages. As a result sub-geriatric pelvic trauma patients initially presenting in stable condition may be considered at lower risk in terms of potential morbidity and mortality. Therefore, in order to properly evaluate and manage stable pelvic fracture patients of the sub-geriatric age, it is important to identify those patients with relatively high risk for poor outcomes. The aim of this study is analysis of data from the national trauma data bank to identify potential high risk(s) among patients of the sub-geriatric ages. Methods: All trauma patients older than 18 years with any type of pelvic fracture (including acetabulum fractures) from January 2003 to December 2010 were included. Over 150 variables including demographics, injury mechanism and severity, injury location and associated injuries, initial vital signs, blood product use, length of stay, intensive care unit admission, mechanical ventilation, hospital complications, and mortality were reviewed and analyzed. The study intended to compare different variables in three different age groups including patients less than 50 years old (young), patients 50 to 65 years old (sub-geriatric), and patients greater than 65 years old (geriatric). Analysis of Variance with Bonferroni correction was used for group comparisons. Results: Of the total 29,705 stable pelvic fracture patients due to blunt trauma, 18.66% were of the sub-geriatric. Ilium fractures had higher mortality (3.77%), injury severity scores (13.508.66), blood transfusion rate (4.47%), and hospital complication rates (29.97%) than any other type of pelvic fractures. These results were similar when compared with patients of the geriatric group. Pubis fractures were associated with higher internal injuries (22.86%), findings similar in the young age group. Among all stable pelvic fracture patients, patients of the sub-geriatric tended to have the highest ICU admission rate (72.94%), length of hospitalization (9.3510.48 days), and in-hospital complication rate (27.69%) regardless as to whether the patient was ultimately discharged to home or transferred to another facility. Conclusions: Different pelvic injury patterns are seen in patients of different age groups. Sub-geriatric aged patients with pelvic fractures had the highest rate of ICU admissions resulting in prolonged hospitalizations and higher in-hospital complications. Special attention needs to be paid to these patients who are diagnosed with ilium and pubis fractures as they tend to have higher rates of internal injuries, morbidity, and mortality.
350
Study Objective: To evaluate the clinical diagnostic impact of contrast enhanced ultrasound (CEUS) compared to traditional abdominal computed tomography (CT) and standard ultrasound (US) in a Bayesian clinical decision scheme integrating the emergency trauma score (EMTRAS). Methods: The EMTRAS is comprised of 4 parameters: patient age, Glasgow Coma Scale, base excess, and prothrombin time (PT). For the purposes of our model the EMTRAS was used as pretest probability and stratified as: low risk (0-3 points¼10%), moderate risk (4-6 points¼42%) and high risk (7-12 points¼80%) based on mortality risk. Sensitivity (Se) and specificity (Sp) for US, CT and CEUS was obtained from pooled data and used to calculate negative (-) and positive (+) likelihood ratios (LRs). EMTRAS percentage risk used as pretest probability and likelihood ratios were charted into a Bayesian nomogram to obtain posttest probabilities. Absolute (ADG) and relative diagnostic gains (RDG) were then calculated. ANOVA was used to evaluate strength of association with a p-value set at 0.05. Results: Data for Se, Sp, LR+ and LR- were obtained (Table) for ultrasound (Se¼45.7%, Sp¼91.8%, LR+¼ 5.57, LR-¼0.59), contrast enhanced ultrasound (Se¼91.4%, Sp¼100%, LR+¼91, LR-¼ 0.09), and CT (Se¼94.8 %, Sp¼98.7%, LR+¼73, LR-¼0.05). Ultrasound LR+ model results showed low risk posttest probability of 38%, RDG of 28% and ADG of 280%, moderate risk posttest of 80%, RDG of 38%, and ADG of 90.5%, and high risk posttest of 96%, RDG of 16% and ADG of 20%. CEUS model results for LR+, yielded low risk posttest probability of 91%, ADG of 81.0% and RDG of 810.0%, moderate risk posttest probability of 99.0% ADG of 57.0% and RDG of 135.7%, and high risk posttest probability of 100.0%, RDG of 20.0%, and RDG of 25.0%. CT LR+ results were low risk posttest of 89%, RDG of 79% and ADG of 790%, moderate risk posttest of 98%, RDG of 56%, and ADG of 133.3%, and high risk posttest of 100%, RDG of 20% and ADG of 25%. Comparison of CT vs CEUS (Table) did not yield statistically significant differences for LR+ (P ¼ .9811). Conclusion: This study found that CEUS performed statistically similar to traditional abdominal CT in an EMTRAS Bayesian clinical decision scheme. The greatest incremental gain was obtained for low pre-test positive likelihood ratio groups. Further validation of this model is needed as well as cost-benefit analysis. Limitations include the retrospective nature of the data and the limited universe of subjects it offers.
The Acute Care Diagnostics Collaboration: Performance Assessment of Contrast-Enhanced Ultrasound Compared to Abdominal Computed Tomography and Conventional Ultrasound in an Emergency Trauma Score Bayesian Clinical Decision Scheme
Baez AA, Cochon LR, Supino M/Jackson Memorial Hospital, Miami, FL; University of Barcelona, Barcelona, Spain
Background: The ACDC is a multinational effort that integrates Bayesian theory and statistical modeling in clinical decision rules, combining assessments of diagnostic quality and cost effectiveness in various patient populations.
S126 Annals of Emergency Medicine
Volume 66, no. 4s : October 2015
346
superior in determining the presence of occult shock. The main objective of this study was to determine whether shock index or serum lactate is better at detecting the presence of occult shock in trauma pateints. Methods: The electronic medical record of patients admitted to the trauma service in 2014 after being treated for Tier 1 trauma activations where reviewed for demographic data, shock index and initial serum lactate. The administration of more than 2 units of packed red blood cells was used as the gold standard for the presence of shock. Results: There were 373 patients included in this study. Of these 52 patients required the administration of greater than 2 units of packed red blood cells. The average Injury Severity Score was >15. Table demonstrates the differences between the test characteristics of the shock index and serum lactate for determining the presence of occult shock. We found that serum lactate is superior to the shock index at determining the presence of occult shock in trauma patients. Conclusion: These findings suggest that though shock index is capable of determing the presence of shock in patients who have grossly abnormal vital signs, the ratio lacks the capability to determine the presence of occult shock. Serum lactate should be used to make decisions regarding the hemodynamic/perfusion status of the patient.
Anterior Shoulder Dislocation Reduction in the Emergency Department: Is There a Best Technique?
Stoesz AE, Zwank MD, Stuck LH, Ward CM/Regions Hospital, Saint Paul, MN; HealthPartners Institute for Education & Research, Bloomington, MN
Study Objectives: Anterior shoulder dislocations occur with an estimated incidence rate of 24 per 100,000 person-years in the United States. Although more than 90% of these shoulders are successfully reduced in the emergency department (ED), practitioners do not agree on the best reduction technique. Our aim was to ascertain first attempt success rates of different reduction techniques at an academic urban trauma center. Secondarily, we looked at usage of different methods of analgesia and sedation. Methods: We retrospectively reviewed the medical records of all patients over age 15 who presented to the ED over a three-year period with an isolated anterior shoulder dislocation. We recorded the reduction technique used, type of analgesia used, and number of attempts need for successful reduction. Results: Two hundred forty patients met inclusion criteria for the study. The reduction technique could be identified in the medical record in 156 patients (65%). Providers utilized the Milch/Hennepin (abduction/external rotation) technique most often (71 patients, 30%), followed by the Stimson (prone extension/traction) technique (52 patients, 22%). Other techniques used included the traction-countertraction/ Hippocratic method (20 patients), the Kocher (external rotation) method (9 patients) and the Cunningham (shoulder massage/traction) method (4 patients). In our population, the Milch technique reduced the shoulder on the first attempt in 74.6% of patients and 32% of those patients had procedural sedation. The Stimson technique had a 60% first attempt success rate with no patients receiving procedural sedation. The traction/countertraction method had a 61.5% first attempt success rate but 75% of patients received procedural sedation. Twenty-four shoulders could not be reduced in the ED and required orthopedic consultation. Conclusion: The results of this study suggest that the Milch technique may be superior to Stimson or Hippocratic methods for reducing anterior shoulder dislocations; however, the Stimson technique never required procedural sedation. The majority of patients were reduced in the emergency department without orthopedic assistance.
347
Detecting Occult Shock in Trauma Patients: A Comparison of Serum Lactate versus Shock Index
Arslan A, Flax L, Nunez P, Kanter M, Fraser R, Caputo N, Simon R/Lincoln Medical and Mental Health Center, Bronx, NY; Lincoln Medical Center, Bronx, NY
Study Objectives: Trauma is the leading cause of death of patients aged 1-44 in the United States. Early identification of serious injury leads to better outcomes for these patients. Vital signs have been shown to be inadequate in helpung the physician determine the presence of occult shock. The shock index is a ratio of heart rate to systolic blood pressure and has been validated to be of use in detecting the presence of shock. Serum lactate has been demonstrated to determine the presence of hypoperfusion in patients suffering trauma. Knowing that hypoperfusion does not always equate to hypotension and normotension does not always equate to normoperfusion, the question remains as to whether serum lactate or the shock index is
Volume 66, no. 4s : October 2015
348
Bougie-Assisted Tube Thoracostomy Placement: A Novel Technique
Gottlieb M, Nakitende D, Kimball D, Christian E, Bailitz J/Cook County (Stroger) Hospital, Chicago, IL
Study Objectives: Tube thoracostomies (TT) are performed for a variety of indications including pneumothorax, hemothorax, and empyema. The most commonly technique involves insertion of a finger into the chest cavity with advancement of a Kelly clamped chest tube alongside the finger. Studies have demonstrated complication rates ranging from as 1.19.5% depending upon the provider level of experience. There have been a few online discussions mentioning the use of a bougie to facilitate thoracostomy tube passage, but to the best of our knowledge, there are no studies assessing its feasibility. The purpose of this pilot study was to assess the feasibility of this approach as an adjunct to the standard TT placement. Methods: We conducted a pilot, feasibility study of this technique using a fresh human cadaver model. Two experts who have placed more than 50 TT and two senior residents who had placed more than 10 TT clinically prior to the study each performed one standard TT insertion and one bougie-guided TT. The insertions were with a 36 French chest tube and there were eight total placements. The providers alternated which approach was performed first, serving as their own case and control. The bougieassisted approach involved preloading the chest tube onto the bougie (Figure), advancing the bougie alongside the finger after entering the chest cavity, and then advancing the chest tube forward in a Seldinger technique. Two separate physicians confirmed intrathoracic placement by dissection and with ultrasound. The primary outcome was procedural time, which was measured from the first incision to the time when the provider was ready to suture. Secondary outcomes included incision length, percentage correct intrathoracic placement, and complications. Results: We performed eight total insertions with 100% intrathoracic placement with both approaches. Average procedure time was 48 seconds (95% CI 15-81 seconds) for the standard technique and 40 seconds (95% CI 16-65 seconds) for the bougie-guided technique without significant differences between expert and senior resident subgroups. Of note, the mean incision length was 4.9 cm (95% CI 3.2-6.5 cm) for the standard approach and 3.0 cm (95% CI 2.3-3.6 cm) for the bougie-guided approach. There were no significant complications identified in this sample.
Annals of Emergency Medicine S125
Research Forum Abstracts Conclusion: The bougie-guided TT is a novel approach to chest tube insertion and demonstrated excellent feasibility in this pilot study. Further studies should address the use of this technique in larger samples, as well as with more novice providers and obese patients.
349
High Risk Potential in Stable Pelvic Fractures Among Patients of Sub-Geriatric Age
Gray C, Wang H, Chukwama J, Martin J, Jennings A, Phillip J, Buca S, Robinson R/JPS, Fort Worth, TX
Study Objectives: Pelvic fractures are one of the common fractures seen in trauma. The risk of associated morbidity and mortality varies especially in patients initially presenting to the emergency department in stable condition. The injury mechanisms and patterns among patients in the sub-geriatric age overlap those seen in both the geriatric and young ages. As a result sub-geriatric pelvic trauma patients initially presenting in stable condition may be considered at lower risk in terms of potential morbidity and mortality. Therefore, in order to properly evaluate and manage stable pelvic fracture patients of the sub-geriatric age, it is important to identify those patients with relatively high risk for poor outcomes. The aim of this study is analysis of data from the national trauma data bank to identify potential high risk(s) among patients of the sub-geriatric ages. Methods: All trauma patients older than 18 years with any type of pelvic fracture (including acetabulum fractures) from January 2003 to December 2010 were included. Over 150 variables including demographics, injury mechanism and severity, injury location and associated injuries, initial vital signs, blood product use, length of stay, intensive care unit admission, mechanical ventilation, hospital complications, and mortality were reviewed and analyzed. The study intended to compare different variables in three different age groups including patients less than 50 years old (young), patients 50 to 65 years old (sub-geriatric), and patients greater than 65 years old (geriatric). Analysis of Variance with Bonferroni correction was used for group comparisons. Results: Of the total 29,705 stable pelvic fracture patients due to blunt trauma, 18.66% were of the sub-geriatric. Ilium fractures had higher mortality (3.77%), injury severity scores (13.508.66), blood transfusion rate (4.47%), and hospital complication rates (29.97%) than any other type of pelvic fractures. These results were similar when compared with patients of the geriatric group. Pubis fractures were associated with higher internal injuries (22.86%), findings similar in the young age group. Among all stable pelvic fracture patients, patients of the sub-geriatric tended to have the highest ICU admission rate (72.94%), length of hospitalization (9.3510.48 days), and in-hospital complication rate (27.69%) regardless as to whether the patient was ultimately discharged to home or transferred to another facility. Conclusions: Different pelvic injury patterns are seen in patients of different age groups. Sub-geriatric aged patients with pelvic fractures had the highest rate of ICU admissions resulting in prolonged hospitalizations and higher in-hospital complications. Special attention needs to be paid to these patients who are diagnosed with ilium and pubis fractures as they tend to have higher rates of internal injuries, morbidity, and mortality.
350
Study Objective: To evaluate the clinical diagnostic impact of contrast enhanced ultrasound (CEUS) compared to traditional abdominal computed tomography (CT) and standard ultrasound (US) in a Bayesian clinical decision scheme integrating the emergency trauma score (EMTRAS). Methods: The EMTRAS is comprised of 4 parameters: patient age, Glasgow Coma Scale, base excess, and prothrombin time (PT). For the purposes of our model the EMTRAS was used as pretest probability and stratified as: low risk (0-3 points¼10%), moderate risk (4-6 points¼42%) and high risk (7-12 points¼80%) based on mortality risk. Sensitivity (Se) and specificity (Sp) for US, CT and CEUS was obtained from pooled data and used to calculate negative (-) and positive (+) likelihood ratios (LRs). EMTRAS percentage risk used as pretest probability and likelihood ratios were charted into a Bayesian nomogram to obtain posttest probabilities. Absolute (ADG) and relative diagnostic gains (RDG) were then calculated. ANOVA was used to evaluate strength of association with a p-value set at 0.05. Results: Data for Se, Sp, LR+ and LR- were obtained (Table) for ultrasound (Se¼45.7%, Sp¼91.8%, LR+¼ 5.57, LR-¼0.59), contrast enhanced ultrasound (Se¼91.4%, Sp¼100%, LR+¼91, LR-¼ 0.09), and CT (Se¼94.8 %, Sp¼98.7%, LR+¼73, LR-¼0.05). Ultrasound LR+ model results showed low risk posttest probability of 38%, RDG of 28% and ADG of 280%, moderate risk posttest of 80%, RDG of 38%, and ADG of 90.5%, and high risk posttest of 96%, RDG of 16% and ADG of 20%. CEUS model results for LR+, yielded low risk posttest probability of 91%, ADG of 81.0% and RDG of 810.0%, moderate risk posttest probability of 99.0% ADG of 57.0% and RDG of 135.7%, and high risk posttest probability of 100.0%, RDG of 20.0%, and RDG of 25.0%. CT LR+ results were low risk posttest of 89%, RDG of 79% and ADG of 790%, moderate risk posttest of 98%, RDG of 56%, and ADG of 133.3%, and high risk posttest of 100%, RDG of 20% and ADG of 25%. Comparison of CT vs CEUS (Table) did not yield statistically significant differences for LR+ (P ¼ .9811). Conclusion: This study found that CEUS performed statistically similar to traditional abdominal CT in an EMTRAS Bayesian clinical decision scheme. The greatest incremental gain was obtained for low pre-test positive likelihood ratio groups. Further validation of this model is needed as well as cost-benefit analysis. Limitations include the retrospective nature of the data and the limited universe of subjects it offers.
The Acute Care Diagnostics Collaboration: Performance Assessment of Contrast-Enhanced Ultrasound Compared to Abdominal Computed Tomography and Conventional Ultrasound in an Emergency Trauma Score Bayesian Clinical Decision Scheme
Baez AA, Cochon LR, Supino M/Jackson Memorial Hospital, Miami, FL; University of Barcelona, Barcelona, Spain
Background: The ACDC is a multinational effort that integrates Bayesian theory and statistical modeling in clinical decision rules, combining assessments of diagnostic quality and cost effectiveness in various patient populations.
S126 Annals of Emergency Medicine
Volume 66, no. 4s : October 2015