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Unacceptable selection bias (Thomas Hughes, 22 September 2011)

While reduction in primary care availability is certainly a factor in increasing ED attendance, the assumption that patients who are triaged 4 and 5 who are not admitted and not injured are all potential primary care patients is unacceptable selection bias.

The very fact that a patient arrives at an ED rather than attending primary care means their pre-test probability of having a significant medical problem is much higher than those seen in primary care. The populations are different.

To conclude from the modelling that adding more primary care would reduce ED attendance assumes that primary care would be sited where less healthy and poorer patients would have good access, and then that these patients would use the service instead of, rather than in... read full comment

Comment on: Moineddin et al. BMC Emergency Medicine, 11:13

further issues with wound care (John Benitez, 13 September 2011)

The authors are to be commended for putting together a good diverse group of experts on managing snakebites (Crotalid) in the US. It puts together an organized approach to evaluating the victim of a snake bite.

I would encourage, and I hope there was no disagreement in the panelists, that antibiotics not be routinely used, unless there are clear indications for doing so. Also missing from the article was any statement of need for appropriate range of motion (ROM) exercises that a patient should be encouraged to do or taught to do to avoid further complications post discharge such as contractures and loss of function of digits. We routinely encourage AROM (and where necessary PROM) exercises for the patient during hospitalization and post-hospitalization. If followed up in... read full comment

Comment on: Lavonas et al. BMC Emergency Medicine, 11:2

Comments Welcome (Aaron Bernard, 09 September 2011)

Greetings BMC Readers,

We hope to hear from you regarding our recent publication. Thoughts? Comments? Questions? Personal Experiences.

I think this research may appeal to educators and researchers who have an interest in professionalism education and the hidden curriculum of medical education. We also feel the average clinician will enjoy reading some of the student professionalism narratives in the Supplemental Document. These can be quite eye opening to read.


Aaron W. Bernard, MD read full comment

Comment on: Bernard et al. BMC Emergency Medicine, 11:11

4 day delay in fracture diagnosis raises concern (Dustin Paz, 03 August 2006)

I'm interested to know why the 'Correct diagnosis was delayed 3.9 days on average (s.d. 0.5; median 1 day)' I wonder what policy was in place to rectify the discrepancy, and if so what it was. 4 days seems like an extended amount of time to correctly interpret the study. read full comment

Comment on: Hallas et al. BMC Emergency Medicine, 6:4

Authors' reply (Peter Hallas, 03 August 2006)

We thank Dr. Hopkins for the comments. There are indications in our study that many of the fractures simply were difficult to diagnose even for experienced doctors: a resident had been called by the intern to see the x-rays in 24 of the 61 cases of error (p<0.05) thus indicating that the intern on call was aware that interpretation the particular x-rays might be difficult. In addition several mistakes were made even when pictures had been reviewed by a consultant in orthopaedics. We excluded scaphoid and rib fractures from the study because in some cases these fractures should be diagnosed on the basis of clinical examination alone even in the absence of a positive finding on the x-rays; thus based solely on the x-rays findings it would be misleading to claim that a diagnosis of one... read full comment

Comment on: Hallas et al. BMC Emergency Medicine, 6:4

Sclerosed and potentially sclerosed vessels (Dave Hopkins, 15 June 2006)

The intention of your experiment is quite commendable. I respect your observance of the scenarios in real emergency departments when it comes to an injury of this nature. However, I believe that your experiment, while credible, lacks many details about the effects that a procedure such as this may entail to the patient on which it is being performed. First, the location and nature of the injury needs to be more clearly defined. Many would say that this is unnecessary. However, if a person has been stabbed in the abdomen or chest, a procedure like this could cause many different, and potentially worse, consequences. Some common examples are: mesenteric rupture, ventricular overexpansion followed by cardiac collapse, etc. Also, this technique should come with a comprehensible use policy.... read full comment

Comment on: Chami et al. BMC Emergency Medicine, 5:11

Experience and Cause (Dave Hopkins, 31 May 2006)

This study is truly comprehensive and I commend you on your efforts. However, I do believe that a lack of EXPERIENCED doctors, as you mentioned once in the manuscript, are really the cause of misdiagnosed fractures. Also, you failed to include rib fractures and scaphoid fractures in your study. I feel that these two types of fractures should be included in your manuscript due to the fact that they are two of the most common types of fractures typically seen in a common Emergency Department. Also, I do believe that the cause of said fracture should be included in your data. Some fractures caused by difficult to diagnose pathologies can be easily overseen. For example, if a leg is broken due to an osteosarcoma, the fracture may be difficult to diagnose along with the condition itself. This... read full comment

Comment on: Hallas et al. BMC Emergency Medicine, 6:4