Gabrielle Jacquet | Johns Hopkins University (original) (raw)

Papers by Gabrielle Jacquet

Oxford Medicine Online

Odontogenic infections often arise from dental caries (usually the mandibular teeth) or from dent... more Odontogenic infections often arise from dental caries (usually the mandibular teeth) or from dental extraction. Acute necrotizing ulcerative gingivitis (ANUG) is more common in immunocompromised patients. These infections may spread into the parapharyngeal and retropharyngeal spaces, involving the airway and mediastinum. Airway management is critical as odontogenic infections can compromise airways via mass effect. Complications include the following: abscess, facial or orbital cellulitis/abscess, intracranial invasion, Ludwig’s angina, Lemierre syndrome, carotid artery erosion, descending necrotizing mediastinitis, airway compromise, hematogenous dissemination to distant organs, intraoral or dentocutaneous fistula formation, and cardiovascular disease. Antibiotics are not a substitute for definitive airway management. In addition, many cases of odontogenic infection will require surgical drainage, either at the bedside in the emergency department or in the operating room. Prior to ...

Oxford Medicine Online

Pharyngitis typically presents with sore throat, fever, and pharyngeal inflammation. More serious... more Pharyngitis typically presents with sore throat, fever, and pharyngeal inflammation. More serious cases may progress to peritonsillar abscess (PTA). Infection or inflammation of the throat that primarily affects the palantine tonsils is considered tonsillitis, whereas infections involving the posterior pharynx are considered pharyngitis. Weber glands (a group of mucous salivary glands superior to the tonsil in the soft palate) have been implicated in the formation of PTA; one must consider their proximity to the trachea and to the carotid artery when pursuing fine needle aspiration. Treatment for all cases includes supportive care with antipyretics, analgesics, and fluids. Despite the much lower prevalence of group A beta-hemolytic Streptococcus infection (for which antibiotics is indicated), a staggering 49% to 57% of children and 64% of adults evaluated for pharyngitis receive an antibiotic prescription. Up to 90% of primary infections with HIV-1 are associated with acute retrovir...

Oxford Medicine Online

Influenza is a viral syndrome caused by a highly contagious viral infection. It presents with acu... more Influenza is a viral syndrome caused by a highly contagious viral infection. It presents with acute fever, respiratory symptoms, rigors, malaise, myalgia, and/or fatigue. Substantial morbidity and mortality can result in susceptible populations, including patients who are at the extremes of age; have chronic medical conditions; or are immunocompromised, pregnant, reside in a nursing home, obese, or of Native American descent. Antiviral treatment is recommended for those requiring hospital admission, those with lower respiratory tract disease, and inpatient populations at high risk for complications. In addition to causing a viral pneumonia, influenza damages the respiratory epithelium. This increases the risk of bacterial coinfection, especially in those with severe illness, pneumonia, and otitis media. Preventive recommendations include vaccination for everyone over the age of 6 months, minimizing potential exposures, attention to respiratory and hand hygiene, adherence to standard...

BACKGROUND: Short-term experiences in global health (STEGH) are increasingly common in medical ed... more BACKGROUND: Short-term experiences in global health (STEGH) are increasingly common in medical education, as they can provide learners with opportunities for service, learning, and sharing perspectives. Academic institutions need high-quality preparatory curricula and mentorship to prepare learners for potential challenges in ethics, cultural sensitivity, and personal safety; however, availability and quality of these are variable. OBJECTIVE: The objective of this study is to create and evaluate an open-access, interactive massive open online course (MOOC) that prepares learners to safely and effectively participate in STEGH, permits flexible and asynchronous learning, is free of charge, and provides a certificate upon successful completion. METHODS: Global health experts from 8 countries, 42 institutions, and 7 specialties collaborated to create The Practitioner\u27s Guide to Global Health (PGGH): the first course of this kind on the edX platform. Demographic data, pre- and posttes...

Articles Selected for Inclusion and Demographics of Drowning Deaths. (XLSX 20 kb)

World Journal of Emergency Medicine, 2018

BACKGROUND: As the field of Emergency Medicine grows worldwide, the importance of an Emergency De... more BACKGROUND: As the field of Emergency Medicine grows worldwide, the importance of an Emergency Department Crash Cart (EDCC) has long been recognized. Yet, there is paucity of relevant peer-reviewed literature specifi cally discussing EDCCs or proposing detailed features for an EDCC suitable for both adult and pediatric patients. METHODS: The authors performed a systematic review of EDCC-specifi c literature indexed in Pubmed and Embase on December 20, 2016. In addition, the authors reviewed the 2015 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, the 2015 European Resuscitation Council (ERC) guidelines for resuscitation, and the 2013 American College of Surgeons (ACS) Advanced Trauma Life Support (ATLS) 9th edition. RESULTS: There were a total of 277 results, with 192 unique results and 85 duplicates. After careful review by two independent reviewers, all but four references were excluded. None of the four included articles described comprehensive contents of equipment and medications for both the adult and pediatric populations. This article describes in detail the fi nal four articles specifi c to EDCC, and proposes a set of suggested contents for the EDCC. CONCLUSION: Our systematic review shows the striking paucity of such a high impact indispensable item in the ED. We hope that our EDCC content suggestions help enhance the level of response of EDs in the resuscitation of adult and pediatric populations, and encourage the implementation of and adherence to the latest evidence-based resuscitation guidelines.

Journal of Travel Medicine, 2018

International journal of medical education, Jan 21, 2017

Medical Research Archives

International journal of critical illness and injury science

According to the World Health Organization, the three leading causes of mortality in lower-middle... more According to the World Health Organization, the three leading causes of mortality in lower-middle-income countries (LMIC) are ischemic heart disease (IHD), stroke, and lower respiratory infections (LRIs), causing 111.8, 68.8, and 51.5 annual deaths per 100,000, respectively. Due to barriers to healthcare, patients frequently present in critical stages of these diseases. Measured implementations in critical care in LMIC have been published; however, the literature has not been formally reviewed. We performed a systematic review of the literature indexed in PubMed as of October 2017. Abstracts were limited to human studies in English, French, and Spanish, conducted in LMIC, and containing quantitative data on acute care of IHD, stroke, and LRI. The search resulted in 4994 unique abstracts. Through multiple rounds of screening using criteria determined , 161 manuscripts were identified: 38 for IHD, 20 for stroke, 26 for adult LRI, and 78 for pediatric LRI. These studies, predominantly ...

Medical Education Online

Background: Short-term experiences in global health (STEGH) are increasingly common in medical ed... more Background: Short-term experiences in global health (STEGH) are increasingly common in medical education, as they can provide learners with opportunities for service, learning, and sharing perspectives. Academic institutions need high-quality preparatory curricula and mentorship to prepare learners for potential challenges in ethics, cultural sensitivity, and personal safety; however, availability and quality of these are variable. Objective: The objective of this study is to create and evaluate an open-access, interactive massive open online course (MOOC) that prepares learners to safely and effectively participate in STEGH, permits flexible and asynchronous learning, is free of charge, and provides a certificate upon successful completion. Methods: Global health experts from 8 countries, 42 institutions, and 7 specialties collaborated to create The Practitioner's Guide to Global Health (PGGH): the first course of this kind on the edX platform. Demographic data, pre-and posttests, and course evaluations were collected and analyzed. Results: Within its first year, PGGH enrolled 5935 learners from 163 countries. In a limited sample of 109 learners, mean posttest scores were significantly improved (p < 0.01). In the course's second year, 213 sampled learners had significant improvement (p < 0.001). Conclusion: We created and evaluated the first interactive, asynchronous, free-of-charge global health preparation MOOC. The course has had significant interest from US-based and international learners, and posttest scores have shown significant improvement.

Pediatrics, Nov 1, 2017

Trainees and clinicians from high-income countries are increasingly engaging in global health (GH... more Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships.

AEM Education and Training

Objectives: In medical education and training, increasing numbers of institutions and learners ar... more Objectives: In medical education and training, increasing numbers of institutions and learners are participating in global health experiences. Within the context of competency-based education and assessment methodologies, a standardized assessment tool may prove valuable to all of the aforementioned stakeholders. Milestones are now used as the standard for trainee assessment in graduate medical education. Thus, the development of a similar, milestone-based tool was undertaken, with learners in emergency medicine (EM) and global health in mind. Methods: The Global Emergency Medicine Think Tank Education Working Group convened at the 2016 Society for Academic Medicine Annual Meeting in New Orleans, Louisiana. Using the Interprofessional Global Health Competencies published by the Consortium of Universities for Global Health's Education Committee as a foundation, the working group developed individual milestones based on the 11 stated domains. An iterative review process was implemented by teams focused on each domain to develop a final product. Results: Milestones were developed in each of the 11 domains, with five competency levels for each domain. Specific learning resources were identified for each competency level and assessment methodologies were aligned with the milestones framework. The Global Health Milestones Tool for learners in EM is designed for continuous usage by learners and mentors across a career. Conclusions: This Global Health Milestones Tool for learners in EM may prove valuable to numerous stakeholders. The next steps include a formalized pilot program for testing the tool's validity and usability across training programs, as well as an assessment of perceived utility and applicability by collaborating colleagues working in training sites abroad.

Journal of graduate medical education, 2017

The western journal of emergency medicine, 2017

BMC public health, May 8, 2017

According to the World Health Organization, drowning is the 3rd leading cause of unintentional in... more According to the World Health Organization, drowning is the 3rd leading cause of unintentional injury-related deaths worldwide, accounting for 370,000 annual deaths and 7% of all injury-related deaths. Low- and middle-income countries are the most affected, accounting for 91% of unintentional drowning deaths. The authors performed a systematic review of literature indexed in EMBASE, PubMed, Web of Science, Cochrane Library, and Traumatology journals formerly indexed in PubMed in January 2014 and again in September 2016. Abstracts were limited to human studies in English, conducted in low- and middle-income countries, and containing quantitative data on drowning epidemiology. A total of 62 articles met inclusion criteria. The majority of articles originate from Asia (56%) and Africa (26%). Risk factors for drowning included young age (<17-20 years old), male gender (75% vs. 25% female), rural environment (84% vs. 16% urban), occurring in the daytime (95% vs. 5% night time), lack o...

Annals of emergency medicine, Jan 30, 2016

Researchers from low- and middle-income countries have limited access to publishing and editing r... more Researchers from low- and middle-income countries have limited access to publishing and editing resources. This study describes a journal-initiated platform to improve publication quantity and quality in Sub-Saharan Africa emergency care research: Author Assist. This is a descriptive report of a quality improvement project of referrals to the African Journal of Emergency Medicine's (AfJEM's) Author Assist program between January 2011 and December 2015. After either pre- or post-peer review rejection, authors are matched to an experienced volunteer assistant to revise and resubmit their article in a process that blinds handling editors and reviewers, but not the editor in chief, to participation. Participant data were collected from an Author Assist coordination database and linked to Scopus (Elsevier, Amsterdam, The Netherlands) and the journal's online submission platform. Of the 47 articles referred for Author Assist, 12 (26%) were originally rejected in the pre-peer r...

World journal of emergency medicine, 2016

Emergencies such as road traffic accidents (RTAs), acute myocardial infarction (AMI) and cerebrov... more Emergencies such as road traffic accidents (RTAs), acute myocardial infarction (AMI) and cerebrovascular accident (CVA) are the most common causes of death and disability in India. Robust emergency medicine (EM) services and proper education on acute care are necessary. In order to inform curriculum design for training programs, and to improve the quality of EM care in India, a better understanding of patient epidemiology and case burden presenting to the emergency department (ED) is needed. This study is a retrospective chart review of cases presenting to the ED at Kerala Institute of Medical Sciences (KIMS), a private hospital in Trivandrum, Kerala, India, from November 1, 2011 to April 21, 2012 and from July 1, 2013 to December 21, 2013. De-identified charts were systematically sampled and reviewed. A total of 1 196 ED patient charts were analyzed. Of these patients, 55.35% (n=662) were male and 44.7% (n=534) were female. The majority (67.14%, n=803) were adults, while only 3.85%...

Oxford Medicine Online

Odontogenic infections often arise from dental caries (usually the mandibular teeth) or from dent... more Odontogenic infections often arise from dental caries (usually the mandibular teeth) or from dental extraction. Acute necrotizing ulcerative gingivitis (ANUG) is more common in immunocompromised patients. These infections may spread into the parapharyngeal and retropharyngeal spaces, involving the airway and mediastinum. Airway management is critical as odontogenic infections can compromise airways via mass effect. Complications include the following: abscess, facial or orbital cellulitis/abscess, intracranial invasion, Ludwig’s angina, Lemierre syndrome, carotid artery erosion, descending necrotizing mediastinitis, airway compromise, hematogenous dissemination to distant organs, intraoral or dentocutaneous fistula formation, and cardiovascular disease. Antibiotics are not a substitute for definitive airway management. In addition, many cases of odontogenic infection will require surgical drainage, either at the bedside in the emergency department or in the operating room. Prior to ...

Oxford Medicine Online

Pharyngitis typically presents with sore throat, fever, and pharyngeal inflammation. More serious... more Pharyngitis typically presents with sore throat, fever, and pharyngeal inflammation. More serious cases may progress to peritonsillar abscess (PTA). Infection or inflammation of the throat that primarily affects the palantine tonsils is considered tonsillitis, whereas infections involving the posterior pharynx are considered pharyngitis. Weber glands (a group of mucous salivary glands superior to the tonsil in the soft palate) have been implicated in the formation of PTA; one must consider their proximity to the trachea and to the carotid artery when pursuing fine needle aspiration. Treatment for all cases includes supportive care with antipyretics, analgesics, and fluids. Despite the much lower prevalence of group A beta-hemolytic Streptococcus infection (for which antibiotics is indicated), a staggering 49% to 57% of children and 64% of adults evaluated for pharyngitis receive an antibiotic prescription. Up to 90% of primary infections with HIV-1 are associated with acute retrovir...

Oxford Medicine Online

Influenza is a viral syndrome caused by a highly contagious viral infection. It presents with acu... more Influenza is a viral syndrome caused by a highly contagious viral infection. It presents with acute fever, respiratory symptoms, rigors, malaise, myalgia, and/or fatigue. Substantial morbidity and mortality can result in susceptible populations, including patients who are at the extremes of age; have chronic medical conditions; or are immunocompromised, pregnant, reside in a nursing home, obese, or of Native American descent. Antiviral treatment is recommended for those requiring hospital admission, those with lower respiratory tract disease, and inpatient populations at high risk for complications. In addition to causing a viral pneumonia, influenza damages the respiratory epithelium. This increases the risk of bacterial coinfection, especially in those with severe illness, pneumonia, and otitis media. Preventive recommendations include vaccination for everyone over the age of 6 months, minimizing potential exposures, attention to respiratory and hand hygiene, adherence to standard...

BACKGROUND: Short-term experiences in global health (STEGH) are increasingly common in medical ed... more BACKGROUND: Short-term experiences in global health (STEGH) are increasingly common in medical education, as they can provide learners with opportunities for service, learning, and sharing perspectives. Academic institutions need high-quality preparatory curricula and mentorship to prepare learners for potential challenges in ethics, cultural sensitivity, and personal safety; however, availability and quality of these are variable. OBJECTIVE: The objective of this study is to create and evaluate an open-access, interactive massive open online course (MOOC) that prepares learners to safely and effectively participate in STEGH, permits flexible and asynchronous learning, is free of charge, and provides a certificate upon successful completion. METHODS: Global health experts from 8 countries, 42 institutions, and 7 specialties collaborated to create The Practitioner\u27s Guide to Global Health (PGGH): the first course of this kind on the edX platform. Demographic data, pre- and posttes...

Articles Selected for Inclusion and Demographics of Drowning Deaths. (XLSX 20 kb)

World Journal of Emergency Medicine, 2018

BACKGROUND: As the field of Emergency Medicine grows worldwide, the importance of an Emergency De... more BACKGROUND: As the field of Emergency Medicine grows worldwide, the importance of an Emergency Department Crash Cart (EDCC) has long been recognized. Yet, there is paucity of relevant peer-reviewed literature specifi cally discussing EDCCs or proposing detailed features for an EDCC suitable for both adult and pediatric patients. METHODS: The authors performed a systematic review of EDCC-specifi c literature indexed in Pubmed and Embase on December 20, 2016. In addition, the authors reviewed the 2015 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, the 2015 European Resuscitation Council (ERC) guidelines for resuscitation, and the 2013 American College of Surgeons (ACS) Advanced Trauma Life Support (ATLS) 9th edition. RESULTS: There were a total of 277 results, with 192 unique results and 85 duplicates. After careful review by two independent reviewers, all but four references were excluded. None of the four included articles described comprehensive contents of equipment and medications for both the adult and pediatric populations. This article describes in detail the fi nal four articles specifi c to EDCC, and proposes a set of suggested contents for the EDCC. CONCLUSION: Our systematic review shows the striking paucity of such a high impact indispensable item in the ED. We hope that our EDCC content suggestions help enhance the level of response of EDs in the resuscitation of adult and pediatric populations, and encourage the implementation of and adherence to the latest evidence-based resuscitation guidelines.

Journal of Travel Medicine, 2018

International journal of medical education, Jan 21, 2017

Medical Research Archives

International journal of critical illness and injury science

According to the World Health Organization, the three leading causes of mortality in lower-middle... more According to the World Health Organization, the three leading causes of mortality in lower-middle-income countries (LMIC) are ischemic heart disease (IHD), stroke, and lower respiratory infections (LRIs), causing 111.8, 68.8, and 51.5 annual deaths per 100,000, respectively. Due to barriers to healthcare, patients frequently present in critical stages of these diseases. Measured implementations in critical care in LMIC have been published; however, the literature has not been formally reviewed. We performed a systematic review of the literature indexed in PubMed as of October 2017. Abstracts were limited to human studies in English, French, and Spanish, conducted in LMIC, and containing quantitative data on acute care of IHD, stroke, and LRI. The search resulted in 4994 unique abstracts. Through multiple rounds of screening using criteria determined , 161 manuscripts were identified: 38 for IHD, 20 for stroke, 26 for adult LRI, and 78 for pediatric LRI. These studies, predominantly ...

Medical Education Online

Background: Short-term experiences in global health (STEGH) are increasingly common in medical ed... more Background: Short-term experiences in global health (STEGH) are increasingly common in medical education, as they can provide learners with opportunities for service, learning, and sharing perspectives. Academic institutions need high-quality preparatory curricula and mentorship to prepare learners for potential challenges in ethics, cultural sensitivity, and personal safety; however, availability and quality of these are variable. Objective: The objective of this study is to create and evaluate an open-access, interactive massive open online course (MOOC) that prepares learners to safely and effectively participate in STEGH, permits flexible and asynchronous learning, is free of charge, and provides a certificate upon successful completion. Methods: Global health experts from 8 countries, 42 institutions, and 7 specialties collaborated to create The Practitioner's Guide to Global Health (PGGH): the first course of this kind on the edX platform. Demographic data, pre-and posttests, and course evaluations were collected and analyzed. Results: Within its first year, PGGH enrolled 5935 learners from 163 countries. In a limited sample of 109 learners, mean posttest scores were significantly improved (p < 0.01). In the course's second year, 213 sampled learners had significant improvement (p < 0.001). Conclusion: We created and evaluated the first interactive, asynchronous, free-of-charge global health preparation MOOC. The course has had significant interest from US-based and international learners, and posttest scores have shown significant improvement.

Pediatrics, Nov 1, 2017

Trainees and clinicians from high-income countries are increasingly engaging in global health (GH... more Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships.

AEM Education and Training

Objectives: In medical education and training, increasing numbers of institutions and learners ar... more Objectives: In medical education and training, increasing numbers of institutions and learners are participating in global health experiences. Within the context of competency-based education and assessment methodologies, a standardized assessment tool may prove valuable to all of the aforementioned stakeholders. Milestones are now used as the standard for trainee assessment in graduate medical education. Thus, the development of a similar, milestone-based tool was undertaken, with learners in emergency medicine (EM) and global health in mind. Methods: The Global Emergency Medicine Think Tank Education Working Group convened at the 2016 Society for Academic Medicine Annual Meeting in New Orleans, Louisiana. Using the Interprofessional Global Health Competencies published by the Consortium of Universities for Global Health's Education Committee as a foundation, the working group developed individual milestones based on the 11 stated domains. An iterative review process was implemented by teams focused on each domain to develop a final product. Results: Milestones were developed in each of the 11 domains, with five competency levels for each domain. Specific learning resources were identified for each competency level and assessment methodologies were aligned with the milestones framework. The Global Health Milestones Tool for learners in EM is designed for continuous usage by learners and mentors across a career. Conclusions: This Global Health Milestones Tool for learners in EM may prove valuable to numerous stakeholders. The next steps include a formalized pilot program for testing the tool's validity and usability across training programs, as well as an assessment of perceived utility and applicability by collaborating colleagues working in training sites abroad.

Journal of graduate medical education, 2017

The western journal of emergency medicine, 2017

BMC public health, May 8, 2017

According to the World Health Organization, drowning is the 3rd leading cause of unintentional in... more According to the World Health Organization, drowning is the 3rd leading cause of unintentional injury-related deaths worldwide, accounting for 370,000 annual deaths and 7% of all injury-related deaths. Low- and middle-income countries are the most affected, accounting for 91% of unintentional drowning deaths. The authors performed a systematic review of literature indexed in EMBASE, PubMed, Web of Science, Cochrane Library, and Traumatology journals formerly indexed in PubMed in January 2014 and again in September 2016. Abstracts were limited to human studies in English, conducted in low- and middle-income countries, and containing quantitative data on drowning epidemiology. A total of 62 articles met inclusion criteria. The majority of articles originate from Asia (56%) and Africa (26%). Risk factors for drowning included young age (<17-20 years old), male gender (75% vs. 25% female), rural environment (84% vs. 16% urban), occurring in the daytime (95% vs. 5% night time), lack o...

Annals of emergency medicine, Jan 30, 2016

Researchers from low- and middle-income countries have limited access to publishing and editing r... more Researchers from low- and middle-income countries have limited access to publishing and editing resources. This study describes a journal-initiated platform to improve publication quantity and quality in Sub-Saharan Africa emergency care research: Author Assist. This is a descriptive report of a quality improvement project of referrals to the African Journal of Emergency Medicine's (AfJEM's) Author Assist program between January 2011 and December 2015. After either pre- or post-peer review rejection, authors are matched to an experienced volunteer assistant to revise and resubmit their article in a process that blinds handling editors and reviewers, but not the editor in chief, to participation. Participant data were collected from an Author Assist coordination database and linked to Scopus (Elsevier, Amsterdam, The Netherlands) and the journal's online submission platform. Of the 47 articles referred for Author Assist, 12 (26%) were originally rejected in the pre-peer r...

World journal of emergency medicine, 2016

Emergencies such as road traffic accidents (RTAs), acute myocardial infarction (AMI) and cerebrov... more Emergencies such as road traffic accidents (RTAs), acute myocardial infarction (AMI) and cerebrovascular accident (CVA) are the most common causes of death and disability in India. Robust emergency medicine (EM) services and proper education on acute care are necessary. In order to inform curriculum design for training programs, and to improve the quality of EM care in India, a better understanding of patient epidemiology and case burden presenting to the emergency department (ED) is needed. This study is a retrospective chart review of cases presenting to the ED at Kerala Institute of Medical Sciences (KIMS), a private hospital in Trivandrum, Kerala, India, from November 1, 2011 to April 21, 2012 and from July 1, 2013 to December 21, 2013. De-identified charts were systematically sampled and reviewed. A total of 1 196 ED patient charts were analyzed. Of these patients, 55.35% (n=662) were male and 44.7% (n=534) were female. The majority (67.14%, n=803) were adults, while only 3.85%...