The Multiple Estimation of Risk Based on the Emergency Department Spanish Score in Patients With Acute Heart Failure (MEESSI-AHF) is a validated clinical decision tool that characterizes risk of mortality in emergency department (ED) acute heart failure patients. The objective of this study is to compare the distribution of risk categories between hospitalized and discharged ED patients with acute heart failure ..read more

We commend the work by Brown et al1 that, using the fragility index and fragility quotient, assesses the fragility of randomized controlled trials in the emergency medicine literature. Although they provide a good overview of the limitations of the 2 metrics, we would like to further question the utility of fragility measures ..read more

Trachoma is a cause of blindness that has long been neglected. We were therefore delighted to see material on the diagnosis of trachoma in a recent issue of Annals.1 However, we think the case that prompted the submission of this article is more likely to be allergic rather than infectious in origin, for 2 reasons. First, the reported tearing and itch that were prominent in the history would be atypical for trachoma,2 but are classic features of an allergic conjunctivitis. Second, the papillary hypertrophy noted by the authors in their description and clearly displayed in their excellent photo ..read more

A 58-year-old man with a history of hypertension and chronic back pain presented to the emergency department with worsening right-sided back pain radiating to his groin. His pain was worse with movement and associated with nausea and vomiting. The patient was initially hypotensive, with a blood pressure of 66/41 mm Hg, a pulse rate of 138 beats/min, and temperature of 100.8°F (38.2°C). On physical examination, the patient was pale and diaphoretic, with his legs flexed at the hips. His abdomen was soft and nontender ..read more

A 16-year-old male adolescent with no significant medical history presented to the emergency department (ED) with atraumatic left-sided scrotal pain. He denied associated symptoms, including fever, penile discharge, and urinary complaints. His vital signs, genitourinary examination results, and urinalysis results were normal. Ultrasonography was performed (Figure ..read more

A 75-year-old man with confirmed cholecystitis and a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia presented to our emergency department as a transfer from an outside hospital. On arrival, he was ill appearing, febrile, tachycardic, and slightly hypotensive. He was given broad-spectrum antibiotics, and an ECG (Figure 1) was performed for surgical planning. ECG showed normal sinus rhythm with ST-segment changes. No previous ECG was available for comparison ..read more

We read with great interest the article by Klein et al.1 The editorial by Dickert and Sugarman2 accompanying this article argues that Food and Drug Administration regulations concerning the practicability of informed consent in emergency medicine clinical trials lead to ethical ambiguity. We agree that some regulatory restrictions may be at odds with scientific rigor and commend Klein et al for their creative study design ..read more

A 45-year-old man presented with painful swelling of his right-hand long finger after experiencing a splinter puncture wound 5 days before. He had been treated at an outside emergency department the day before, where a negative radiograph result was obtained, and began receiving oral antibiotics ..read more

We thank Wheeler et al1 for their inquiry. We fully agree that the use of exception from informed consent is appropriate and necessary for performing quality agitation research. If we refrain from conducting research on agitation, we are depriving this population of advancements surrounding their care. Wheeler et al requested we elaborate on our experience with the Food and Drug Administration (FDA) and institutional review board ..read more

A 69-year-old woman presented with a 15-day history of persistent conjunctivitis, unresponsive to topical antibiotics. On physical examination, bilateral eyelid edema, mucopurulent discharge, and redness of both sclerae (Figure 1) were observed. During a site visit to the patient’s home, sick kittens with rhinitis, nasal discharge, and lethargy were observed (Figure 2). The patient often fed street cats. Four months previously, she had adopted 3 abandoned stray pregnant cats. On delivery, all kittens were born with disease and some died ..read more