Emergency department management of XXXX : need for standardization and improved risk stratification.

@entity1 @entity548 @entity341 @entity1163 @entity1151 @entity299 @entity583 @entity943
Variations in @entity341 ( @entity341 ) @entity1163 management have not been well studied. The goals of this study were to assess variations in management, and emergency physicians' risk perception and disposition decision making. We conducted a prospective study of adults with @entity1163 in six EDs in four cities over 32 months. We collected @entity1 characteristics, @entity341 management, disposition, physicians' prediction probabilities at index presentation and followed @entity1 for 30 days for serious outcomes: death, @entity583 ( @entity583 ), @entity943 , structural @entity299 , @entity1151 , significant @entity548 , or procedural interventions. We used descriptive statistics, ROC curves, and regression analyses. We enrolled 3662 @entity1 : mean age 54.3 years, and 12.9 % were hospitalized. Follow-up data were available for 3365 @entity1 (91.9 %) and 345 @entity1 (10.3 %) suffered serious outcomes: 120 (3.6 %) after @entity341 disposition including 48 @entity1 outside the hospital. After accounting for differences in @entity1 case mix, the rates of @entity341 investigations and disposition were significantly different (p < 0.0001) across the four study cities; as were the rates of 30-day serious outcomes (p < 0.0001) and serious outcomes after @entity341 disposition (p = 0.0227). There was poor agreement between physician risk perception and both observed event rates and referral patterns (p < 0.0001). Only 76.7 % (95 % CI 68.1-83.6) of @entity1 with serious outcomes were appropriately referred. There are large and unexplained differences in @entity1163 . Moreover, there is poor agreement between physician risk perception, disposition decision making, and serious outcomes after @entity341 disposition. A valid risk-stratification tool might help standardize @entity341 management and improve disposition decision making.
