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Objectives: This study evaluated the incidence of subarachnoid hemorrhage (SAH) and the use of computed tomography (CT) and lumbar puncture (LP) in a cohort of emergency department (ED) patients with acute headache. Methods: Health records from a tertiary care ED were used to identify all patients over 15 years of age who presented with headache over a 10-month period. Patients were excluded if they had been referred with confirmed SAH or if they had recurrent headache, head trauma, decreased level of consciousness or new neurologic deficits. Outcome measures included ED diagnosis, use of CT or LP, and ED length of stay. Analysis included descriptive statistics, 95% confidence intervals (CIs) and analysis of variance for length of stay. Results: The mean age of the 891 patients was 41.9 years. Ten (1.1%) of the patients had SAH, 313 (35.1%) underwent CT, and 85 (9.5%) underwent LP. Only 9 (2.9%) of the CT scans and 2 (2.4%) of the LPs were positive for SAH. Of the 296 patients with normal CT results, 232 (78.4%) did not undergo subsequent LP. The mean length of stay was 4.0 hours (95% CI, 3.8-4.1) if no diagnostic testing was performed, 5.0 hours (95% CI, 4.7-5.4) if CT was performed and 7.1 hours (95% CI, 6.3-7.9) if LP was performed (p = 0.001). Conclusions: Diagnostic testing was associated with substantially prolonged lengths of stay. CT and LP had low diagnostic yields, which suggests the need for a clinical decision rule to rule out SAH in ED patients with acute headache. RÉSUMÉ Objectifs : La présente étude a évalué l'incidence des hémorragies sous-arachnoïdiennes (HSA) et le recours à la tomodensitométrie et à la ponction lombaire auprès d'une cohorte de patients reçus à l'urgence pour un mal de tête sévère. Méthodes : Les dossiers de santé provenant d'un département d'urgence (DU) de soins tertiaires furent utilisés pour identifier tous les patients âgés de plus de 15 ans ayant consulté pour un mal de tête sur une période de dix mois. Les patients furent exclus s'ils avaient été envoyés à l'urgence avec un diagnostic confirmé de HSA ou si leurs maux de tête étaient récurrents, s'ils étaient atteints d'un traumatisme crânien, d'une diminution de leur état de conscience ou de nouveaux dé-ficits neurologiques. Les mesures du résultat comprenaient le diagnostic au DU, le recours à la tomodensitométrie ou à la ponction lombaire et la durée du séjour au DU. L'analyse comprenait des statistiques descriptives, des intervalles de confiance (IC) à 95 % et l'analyse de la variance pour la durée du séjour.

Background: Despite increasing use of the flipped classroom (FC) technique in undergraduate medical education, the benefit in learning outcomes over lectures is inconsistent. Best practices in preclass video design principles are rarely used, and it is unclear if videos can replace lectures in contemporary medical education. Methods:We conducted a prospective quasi-experimental controlled educational study comparing theorybased videos to traditional lectures in a medical student curriculum. Medical students enrolled in an emergency medicine clerkship were randomly assigned to either a lecture group (LG) or a video group (VG). The slide content was identical, and the videos aligned with cognitive load theory-based multimedia design principles. Students underwent baseline (pretest), week 1 (posttest), and end-of-rotation (retention) written knowledge tests and an observed structured clinical examination (OSCE) assessment. We compared scores between both groups and surveyed student attitudes and satisfaction with respect to the two learning methods.Results: There were 104 students who participated in OSCE assessments (49 LG, 55 VG) and 101 students who participated in knowledge tests (48 LG, 53 VG). The difference in OSCE scores was statistically significant 1.29 (95% confidence interval = 0.23 to 2.35, t(102) = 2.43, p = 0.017), but the actual score difference was small from an educational standpoint (12.61 for LG, 11.32 for VG). All three knowledge test scores for both groups were not significantly different.Conclusions: Videos based on cognitive load theory produced similar results and could replace traditional lectures for medical students. Educators contemplating a FC approach should devote their valuable classroom time to active learning methods. M edical educators have increasingly proposed using a flipped classroom (FC) for medical student education. 1,2 In this model, the traditional lecture is a student's preclass homework, while in-class time is spent on active, inquiry-based learning facilitated by an instructor. 1,3-5 Most preclass lectures were recorded in the forms of podcasts, screencasts, and videos. 6 Despite the promise of FC to promote active learning, outcomes are inconsistent. 6-8 By dissecting how each element (preclass and in-class) contributes to learning,