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IMPORTANT AREAS FOR EMERGENCY CARE RESEARCH A key characteristic of emergency care is the rapid assessment and treatment of potentially life-threatening illness and injury, often before a definitive diagnosis is possible. Thus, there is a need to rapidly characterize, or phenotype, emergency patients on the basis of the severity and acuity of their disease state (2, 8). Thus, an overarching priority in emergency care research is the development and testing of modalities and strategies for the efficient and rapid identification of serious injury and illness, often in a setting in which the clinical manifestations of the disease may be subtle or nonspecific; the disease prevalence is quite low, but the potential impact of a missed diagnosis or delay in definitive therapy is quite large (e.g., meningitis; myocardial ischemia). The development of such diagnostic strategies will require new and substantive research into underlying mechanisms of disease and injury, including the sequence and timing of events after insult and injury. In addition, the development of cost-effective, rapid, and accurate diagnostic strategies to be used in the setting of potentially serious but nonspecific patient presentations (e.g., fever in infants, shock, altered mental status, abdominal pain, chest pain, respiratory distress) will improve health care in two distinct ways: • Patients with serious illness will be more quickly and unambiguously identified, leading to more rapid initiation of effective treatment. •
Patients without serious illness will be more rapidly identified, minimize the need for additional testing, reduce unnecessary and potentially harmful empiric treatment, reduce lengths of stay in the ED, and decrease unnecessary hospitalization. These latter effects will reduce ED and hospital crowding, that currently impact the quality of and access to emergency care. Beyond patient characterization, there is an imperative to develop effective initial therapeutic strategies for broad classes of patients with emergency conditions (e.g., those with shock, altered mental status, and respiratory distress). Furthermore, the process of therapeutic decision making in the emergency setting of diagnostic uncertainty needs to be studied. Equally important is the development of early therapeutic strategies for patients with specific time-sensitive illnesses and injuries (e.g., closed head injury; myocardial, cerebral, or mesenteric ischemia; hemorrhagic shock; cardiopulmonary arrest).