Here is a quick look at three articles published in the March issue of Annals of Emergency Medicine. Visit www.annemergmed.com to read the full text.

The Time Dependence of Antithrombin Initiation in Patients With Non–ST-segment Elevation Acute Coronary Syndromes: Subgroup Analysis From the ACUITY Trial

By D.B. Diercks, et al.

Editor’s Capsule Summary

• What is already known on this topic: Antithrombotic therapy is indicated to reduce ischemic coronary events for patients with acute coronary syndrome with ST segment changes and NSTEMI, though the optimal timing of therapy is unknown.
• What question this study addressed: This retrospective analysis of 2,632 emergency department patients with ACS or NSTEMI enrolled in the ACUITY trial determined the association between time to administration of antithrombotic therapy after emergency department presentation and subsequent development of a major ischemic event or bleeding within 30 days of presentation.
• What this study adds to our knowledge: The time to antithrombotic treatment was not associated with a subsequent ischemic event, but increased time to antithrombotic treatment was associated with subsequent major bleeding.
• How this is relevant to clinical practice: This study should not change practice. The observed association between early administration and decreased bleeding complications may be confounded and must be assessed in a prospective randomized trial.

Reperfusion is Delayed Beyond Guideline Recommendations in Patients Requiring Interhospital Helicopter Transfer for Treatment of ST-Segment Elevation Myocardial Infarction

By J.T. McMullan, et al.

Editor’s Capsule Summary

• What is already known on this topic: Timely reperfusion improves outcome in STEMI patients.
• What question this study addressed: This multicenter review evaluated whether STEMI patients presenting to a nonpercutaneous coronary intervention hospital who received helicopter transfer for primary percutaneous coronary intervention met the 90-minute door to balloon time benchmark.
• What this study adds to our knowledge: Only 3% of STEMI patients transferred for reperfusion met the 90-minute goal.
• How this is relevant to clinical practice: Recognition that hospitals without percutaneous coronary intervention capabilities seldom meet the reperfusion benchmark, even with helicopter transfer, should increase use of fibrinolysis at nonpercutaneous coronary intervention hospitals.

Emergency Department Crowding is Associated With Decreased Quality of Care for Children With Acute Asthma

By M.R. Sills, et al.

Editor’s Capsule Summary

• What is already known on this topic: Crowding can decrease the quality of care provided to adults in the emergency department. Less is known about its effect on children.
• What question this study addressed: This retrospective cross-sectional study of 921 children seen in the emergency department for asthma examined the relationship of crowding to quality indicators.
• What this study adds to our knowledge: ED crowding reduced timeliness and performance on quality indicators but not equity of care. Specifically, fewer children received indicated steroids and there was a delay in providing them to those who did, regardless of the patient’s economic status.
• How this is relevant to clinical practice: This report confirms practitioners’ fears that emergency department crowding affects not only timeliness, but also quality of care in children.