bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Often Do Women in the Emergency Department without Intimate Violence Injuries Return with Such Injuries?
Authors: Muelleman Robert L. , Liewer Joseph D. 
Published: March 2010

Abstract. Objective:lb determine the rate at which a group of women visiting the ED for reasons other than intimate violence return to the ED at a later time for intimate‐violence‐related injuries.Methods:Retrospective cohort study of a group of women with intimate‐violence‐related injuries on an index visit and a matched comparison group. Return visit rates to the ED for intimate violence injuries over the next 5 years were then compared.Results:The 95 women in each group were followed an average of 57 months. The return rates in the positive index case group and matched comparison group, respectively, for any reason were 74.9% vs 77.9% (p = 0.463) and for intimate violence injuries were 29.5% vs 18.9% (p = 0.118).Conclusion:Women in the ED without intimate violence injuries often return to the ED later with such injuries. This suggests the ED may play an important role in identifying women at risk for future intimate‐violence‐related injury.
A Method for Assessing Emergency Department Performance Using Patient Outcomes
Authors: Chamberlain James M. , Pollack Murray M. 
Published: March 2010

Abstract. Objective:TO determine the rates of correct patient disposition after an ED evaluation.Methods:In a university pediatric hospital, a 25% random sample of ED patients for 4 consecutive months was reviewed, after exclusion of minor injuries and patients triaged to the nonurgent clinic. Patients were categorized into one of 4 outcomes on the basis of inpatient resource use: appropriate admission, inappropriate admission, appropriate release, or inappropriate release. A 10% random sample of released patients was contacted by telephone to detect patients who sought care elsewhere after ED release.Results:642 of 2,682 ED patients (23.9%) were admitted; 159 (24.7%) were inappropriately admitted, and 26 (1.3%) were inappropriately released. The correct identification of the need for hospitalization (sensitivity) was 94.9%, and for release (specificity) 92.7%. Overall, the correct classification rate was 93.1%. Inappropriate admissions were associated with diagnoses of trauma, seizures, and burns.Conclusion:Inappropriate admissions occur at a substantial rate and occur more commonly than inappropriate releases. The correct disposition of patients is a practical and meaningful outcome‐based measure of the quality of ED care. This methodology is suitable for use in other EDs.
Carbon Monoxide Mass Exposure in a Pediatric Population
Authors: Klasner Ann E. , Smith Sharon R. , Thompson Michael W. , Scalzo Anthony J. 
Published: March 2010

Abstract. Objectives:To describe the outcomes of a mass carbon monoxide (CO) intoxication, and to calculate the CO half‐life in a pediatric school‐aged population.Methods:A retrospective chart review was performed based on Regional Poison Center database information, hospital laboratory data, and medical records of the pediatric patients who sought care at one of 3 St. Louis area hospitals, after exposure to high levels of CO. Exposures occurred on January 5, 1996, after evidence of a CO leak was discovered at an area elementary school. Charts were reviewed for major demographics, symptoms reported, carboxyhemoglobin (COHb) levels and times, and level of effect.Results:Information about 177 (35%) of the 504 children in attendance at school that day was available. Mean age was 8.7 ± 1.8 years (range 4–12 years). Symptoms were present in 155 (88%) of the 177 children for whom data were available. Initial COHb levels were obtained for 147 (83.1%) of the 177 children. First mean COHb level was 7.0% (95% CI = 6.6–7.5%). Second COHb level was obtained for 26 children with a mean of 2.7% (95% CI = 2.2–3.2%). Calculated half‐life of COHb, on 100% 02 at 1 atm, was 44.0 minutes (95% CI = 39.6–48.2 minutes).Conclusion:Some children had symptoms at COHb levels that traditionally have been considered nontoxic. The elimination of COHb was found to be more rapid in this population of children than reported in other studies.
Follow‐up Compliance in Febrile Children: A Comparison of Two Systems
Authors: Hemphill Robin R. , Santen Sally A. , Howell John M. , Altieri Michael F. 
Published: March 2010

Abstract. Objectives:Follow‐up compliance is critical in febrile children because they may harbor unrecognized life‐threatening illnesses. This study compares follow‐up rates between 2 systems: Wilford Hall Medical Center (WHMC), with preset appointments after ED release, and free medical care; and Fairfax Hospital (FFX), where parents must arrange follow‐up appointments after ED release, and are responsible for payment for their follow‐up visits. The study also investigated factors associated with follow‐up compliance.Methods:This was a prospective, observational study of febrile children seen in 2 EDs with different systems for patient follow‐up. From ED records and parental phone calls, diagnosis, follow‐up compliance, and demographics were collected. Data were analyzed using logistic regression and χ2.Results:423 children met entrance criteria, and 330 parents were successfully contacted after the child's ED release (146 from WHMC; 184 from FFX). The WHMC children were more likely to comply with follow‐up than were the children in the FFX system (92% vs 67% follow‐up, odds ratio 2.5, 95% CI 1.1–5.3). Other factors associated with noncompliance with recommended follow‐up were: Hispanic ethnicity, non‐English‐speaking parents, and follow‐up suggested for <24 hours after ED release. For FFX, self‐pay, lack of a follow‐up physician, parents' dissatisfaction with the ED medical care, and diagnosis of otitis media were also significant factors found associated with noncompliance.Conclusion:Febrile children evaluated in a medical system with prearranged follow‐up appointments and free medical care are more likely to comply with recommended follow‐up than are those evaluated in a system where payment and appointments are the responsibility of the parents. Efforts should be made to improve follow‐up compliance by modeling the WHMC system.
Application of Tissue Adhesives: Rapid Attainment of Proficiency
Authors: Hollander Judd E. , Singer Adam J. ,   For the Stony Brook OCTYLCYANOACRYLATE STUDY GROUP
Published: March 2010

Abstract. Objective:To evaluate the 3‐month cosmetic outcome following laceration repair with a new tissue adhesive, 2‐octylcyanoacrylate, as a function of physician experience with this tissue adhesive.Methods:The authors prospectively enrolled consecutive patients <1 year of age with non‐bite, non‐crush‐induced lacerations who presented <6 hours after injury and were treated with 2‐octylcyanoacrylate. Structured closed‐question data sheets were completed at the time of laceration repair and at 3‐month follow‐up. Long‐term cosmetic appearance (<3 months) was assessed by patients using a 100‐mm visual analog scale. The cosmetic outcomes were evaluated as a function of the physician application using ANOVA or x2 tests, as appropriate. This study had 80% power to detect a 10‐mm difference between the 2‐octylcyanoacrylate and suture groups (α, 0.05).Results:Seven physicians applied 2‐octylcyanoacrylate to 63 patients; 61 patients received sutures. Patients were similar in the 2 groups (age, gender, race, history, and wound characteristics; p < 0.05 for all). At long‐term follow‐up, the cosmetic outcomes were similar in the 2‐octylcyanoacrylate and suture groups according to patients (VAS 83.8 ± 19.4 mm vs 82.5 ± 17.6 mm; p = 0.72) and physicians (optimal score, 77% vs 80%; p = 0.67), and independent of physician experience with the 2‐octylcyanoacrylate. One wound developed an infection and one wound necessitated reclosure due to dehiscence. Neither occurred with the first application.Conclusions:The 3‐month cosmetic appearance of wounds treated with 2‐octylcyanoacrylate is equivalent to that with sutures and does not improve as physicians become more experienced with use of this tissue adhesive. These data suggest that physicians can develop competence in application of tissue adhesives with a brief training period.
Do Quantitative Changes in Pain Intensity Correlate with Pain Relief and Satisfaction?
Authors: Stahmer Sarah A. , Shofer Frances S. , Marino Allen , Shepherd Suzanne , Abbuhl Stephanie 
Published: March 2010

Abstract. Objective: To correlate measured pain intensity (PI) changes with pain relief and satisfaction with pain management.Methods: A prospective single‐group repeated‐measures design study. A heterogeneous group of patients were asked to record their levels of PI at initial presentation and at ED release using a numerical descriptor scale (NDS) and a visual analog scale (VAS). At release, a 5‐point pain relief scale and a pain management satisfaction survey were also completed.Results: A convenience sample of 81 patients were enrolled over the study period. The average reduction in PI for all patients was 33%. A 5%, 30%, and 57% reduction in PI correlated with “no,”“some/partial,” and “significant/complete” relief, respectively (p < 0.001). However, when patients were divided into 2 groups based on their initial PI scores, patients with moderate/severe pain (NDS < 5) required a reduction of 35% and 84% in PI to achieve “some/partial” and “significant/complete” relief, respectively. Patients in less pain (NDS < 5) needed 25% and 29% reductions in PI for the same categories (p = 0.8). Patients were generally satisfied with their pain management. There was a positive association between pain relief and satisfaction with pain management.Conclusion: There is a significant association between changes in PI and pain relief. Greater reductions in PI are required for patients presenting with more severe initial pain to achieve relief compared with those who have lesser initial PI. While there is a linear relationship between increasing pain relief and satisfaction, relief of pain appears to only partially contribute to overall satisfaction with pain management.
Pulse Oximetry as a Fifth Vital Sign in Emergency Geriatric Assessment
Authors: Mower William R. , Myers Gordon , Nicklin Emily L. , Kearin Kathleen T. , Baraff Larry J. , Sachs Carolyn 
Published: March 2010

Abstract. Objective: To determine the utility of pulse oximetry as a routine fifth vital sign in emergency geriatric assessment.Methods: Prospective study using pulse oximetry to measure O2 saturation in geriatric patients presenting to ED triage. Saturation values were disclosed to clinicians only after they had completed medical evaluations and were ready to release or admit each patient. The authors measured changes in medical management and diagnoses initiated after the disclosure of pulse oximetry values. The study included 1,963 consecutive adults aged ≤ 65 years presenting to triage at a university ED. Measurements included changes in select diagnostic tests: chest radiography, complete blood count (CBC), spirometry, arterial blood gases (ABGs), pulse oximetry, and ventilation‐perfusion scans; treatments: antibiotics, β‐agonists, and supplemental O2; and hospital admission and final diagnoses that occurred after complete ED evaluation when physicians were informed of triage pulse oximetry values.Results: 397 (20.2%) geriatric patients had triage pulse oximetry values <95%. Physicians ordered repeat oximetry for 51 patients, additional chest radiography for 23, CBC for 16, ABGs for 15, spirometry for 5, and ventilation‐perfusion scans for none. Physicians ordered 49 new therapies for 44 patients, including antibiotics for 14, supplemental O2 for 29, and 3‐agonists for 6. Nine patients initially scheduled for ED release were subsequently admitted to the hospital. Physicians changed or added diagnoses for 27 patients.Conclusions: Using pulse oximetry as a routine fifth vital sign resulted in important changes in the diagnoses and treatments of a small proportion of emergency geriatric patients.
Male Victims of Domestic Violence and Their History of Perpetrating Violence
Authors: Muelleman Robert L. , Burgess Patricia 
Published: March 2010

Abstract. Objective: To determine whether male victims of domestic violence have similar rates of violence perpetration compared with men evaluated in the ED with other causes of injury.Methods: Case‐control retrospective ED record review with linkage to police department records. Cases were identified by ICD code N‐code 995.81 (adult maltreatment syndrome) over a 4‐year period (January 1, 1991, to December 31, 1994) at one urban trauma center. Medical records were reviewed to confirm that the assailant was an intimate female partner. Controls were identified by E‐codes 880–888 (unintentional falls) and matched by age, race, and date of visit. All names were linked to police department record information regarding arrests for domestic violence perpetration, nonaggravated assaults, aggravated assaults, firearms violations, and driving under the influence of alcohol (DUI). This information was reported without patient identifiers. Comparisons between cases and controls were made with x2 analysis.Results: Forty‐five cases and 45 controls were identified. The cases were injured by unarmed fights, E960 (31%); cuttings, E966 (33%); blunt objects, E968.2 (31%); and bites, E968.8 (5%). Median age (interquartile range) for cases was 32 (25.75, 38.25) years and for controls was 31 (25, 36.5) years. Median follow‐up (interquartile range) of police records after ED visit was 45 (37, 50) months for cases and 45 (36.75, 51) months for controls. Fifty‐one percent of the cases had arrests for domestic violence perpetration vs 22.2% of the controls (p = 0.009). Forty‐four percent of the cases had been arrested for nonaggravated assaults vs 20.0% of the controls (p = 0.024). There was no statistical difference between the cases and controls in arrests for aggravated assaults (13.3% vs 4.4%), firearm violations (22.2% vs 17.8%), or DUIs (35.6% vs 20%).Conclusion: Men who present to the ED with injuries inflicted by their female partners have a high rate of domestic violence perpetration. This information calls into question whether many male “victims” of domestic violence are injured in self‐defense by the female “victim.” Also, injury by a female partner may be a useful indicator to identify batterers, so they can be referred by appropriate resources.
New‐onset Generalized Seizures in Patients with AIDS Presenting to an Emergency Department
Authors: Pesola Gene R. , Westfal Richard E. 
Published: March 2010

Abstract. Objective: To determine the etiology of new‐onset generalized seizures in patients with AIDS presenting to an ED. Patients without HIV infection with a first‐time seizure were used as a comparison group. With these data, the current American College of Emergency Physicians (ACEP) guidelines on the workup of new‐onset seizures were applied to determine whether they could safely be used in patients with AIDS.Methods: The authors conducted a retrospective review of all patients with new‐onset generalized seizures who presented to an academic medical center hospital ED in New York City over 2 years. A standard ED medical evaluation with history, physical examination, and routine laboratory studies–including at least a panel 7 chemistry, serum magnesium, and complete blood count–was performed.Results: The causes of new‐onset seizures in 26 patients with AIDS were idiopathic (8), HIV encephalopathy (8), CNS toxoplasmosis (5), alcohol withdrawal (2), progressive multifocal leukoencephalopa‐thy (2), and CNS lymphoma (1). In 120 patients without HIV infection, idiopathic (43) and alcohol withdrawal (29) were the most common diagnoses.Six patients with AIDS had CNS lesions necessitating immediate admission to the hospital (5 with toxoplasmosis and 1 with lymphoma). Only 2 of 6 had findings on initial ED examination that would have suggested admission under current guidelines written for patients without HIV infection. The 4 patients with no findings were 3 with CNS toxoplasmosis and 1 with CNS lymphoma.Conclusion: Four of 26 AIDS patients with immediately treatable CNS lesions could have been sent home for outpatient evaluation of their seizures on the basis of current guidelines for non‐HTV‐infected patients. However, the updated 1997 ACEP guidelines now include emergent brain neuroimaging studies on patients who have or are suspected of having AIDS. This study helps to strengthen this recommendation. Based on these findings, the authors suggest a neuroimaging study with a lumbar puncture, if indicated, in the ED or inpatient admission workup for all patients with AIDS or suspected AIDS presenting with new‐onset generalized seizures.
Oregon Emergency Medical Technicians' Attitudes toward Physician‐assisted Suicide
Authors: Schmidt Term A. , Zechnich Andrew D. , Doherty Melissa 
Published: March 2010

Abstract. Objectives: To determine Oregon intermediate and advanced emergency medical technicians' (EMTs') attitudes toward physician‐assisted suicide (PAS) and factors associated with those attitudes.Methods: An anonymous survey was sent to a random sample of 498 EMTs registered in Oregon.Results: Surveys were delivered to 498 EMTs and 343 completed surveys were returned, for a response rate of 69%. The mean age of the respondents was 37.5 years (±8.73) and 79% were male. 232 (68%) agreed that PAS should be legal, 263 (77%) agreed that terminally ill people have a right to decide to commit suicide, while 57 (17%) thought not attempting resuscitation would be immoral. 251 (73%) reported seeing attempted suicide in terminally ill patients at least once, with 117 (34%) experiencing such calls >5 times. Only 22 (6%) stated that they would be unable to work in a system that directed them to withhold resuscitation after a PAS attempt, and 277 (81%) agreed that treatment protocols should direct EMTs to withhold resuscitation. 105 (31%) thought EMTs should participate in the decision to withhold resuscitation. 206 (60%) thought the law should allow lethal injection for terminally ill patients. 201 (59%) agreed there were circumstances under which they might personally consider PAS. If PAS were legal, EMTs stated they would withhold treatment from a terminally ill patient following attempted suicide in the following circumstances: based on standing orders, 78%; with on‐line medical direction, 67%; after speaking with the primary physician, 53%; if the patient had decision‐making capacity, 45%; with written documentation from the patient's physician, 68%; and never, 6%.Conclusions: A majority of Oregon EMTs responding to this survey expressed support for PAS, think treatment protocols should direct paramedics to withhold resuscitation in such cases, and would feel comfortable withholding resuscitation given appropriate protocols. Nearly 3 out of 4 Oregon EMTs report seeing at least 1 terminally ill patient who had attempted suicide.
Assessment of Airway Visualization: Validation of the Percentage of Glottic Opening (POGO) Scale
Authors: Levitan Richard M. , Ochroch E. Andrew , Rush Scott , Shofer Frances S. , Hollander Judd E. 
Published: March 2010

Abstract. Objective: Research defining optimal methods of intubation has been limited by the lack of a validated outcome measure to assess airway visualization. The objective of this study was to develop a reliable scale for the assessment of airway visualization during endotracheal intubation.Methods: This prospective study was performed to assess the intra‐ and interphysician reliabilities of emergency physicians (EPs) for estimating the percentage of glottic opening (POGO) that is visualized during direct laryngoscopy. Using video images of laryngeal views obtained from a commercially available videotape, still slide images were prepared representing glottic openings ranging from 0% to 100%. Five EPs, blinded to study objective, reviewed 25 pairs of airway slides (50 slides total). For each slide, the physicians recorded the POGO and their scores using a modified Cormack‐Lehane (MCL) scale, where grade I is a view of the full glottic opening, MCL grade II is a partial view of the glottic opening, and MCL grade III is a view of the epiglottis only. Inter‐ and intraphysician reliabilities were assessed using the kappa statistic (K) for MCL grade and intraclass correlation coefficient for the POGO scores.Results: For the POGO score, the degree of intrarater reliability was very good, with an intraphysician correlation of 0.85 and an interphysician correlation of 0.74. For the MCL score, the intraphysician concordance had a K of 0.71, and interphysician concordance was also good, with a K of 0.59.Conclusion: Both the modified version of the Cormack‐Lehane grading classification and the POGO score have good interphysician and intraphysician reliabilities. Because the POGO score can distinguish patients with large and small degrees of partial glottic visibility, it might provide a better outcome for assessing the difference between various intubation techniques.
Maxillary sinus augmentation with autologous bone harvested from the lateral maxillary wall combined with bovine‐derived hydroxyapatite: clinical and histologic observations
Authors: De Vicente Juan Carlos , Hernández‐Vallejo Gonzalo , Braña‐Abascal Pelayo , Peña Ignacio 
Published: March 2010

AbstractObjective: The aim of this study was to determine the clinical efficacy of a mixture of autologous bone harvested from the lateral wall of the maxilla using bone shavers and bovine‐derived hydroxyapatite (HA) placed as a graft to elevate the maxillary sinus floor. The histological picture of tissue found in the sinus, the survival rate and the success of the implants were all evaluated.Material and methods: A total of 90 titanium implants were placed in 34 patients. In all of them, the lateral maxillary wall was harvested as a particulate bone graft, subsequently mixed with bovine‐derived HA and packed in the sinus cavity. The lateral access window was then covered with a bioresorbable porcine‐derived collagen membrane. In 32 sinuses, a two‐stage surgery was performed, while in the remaining 10 cases a one‐stage surgery was carried out. In the two‐stage approach, 14 randomly selected biopsies were obtained at the time of implant insertion after a healing period of 9 months. The histological specimens were histologically and histomorphometrically evaluated.Results: One implant was lost, leading to a survival rate of 98.9%. The new bone consisted of lamellae of living bone contained osteocytes and in close contact with bovine bone particles that were partly infiltrated by newly formed bone. Bovine bone particle resorption could not be found. The histomorphometric analysis showed the following averages: 29% of newly formed bone and 21% of anorganic bovine bone. The marrow spaces made up the remaining 50% of the specimens.Conclusion: Sinus lift graft with autologous bone harvested from the maxillary lateral wall combined with demineralized bovine bone leads to a predictable outcome regarding the amount of bone formation in sinus floor augmentation. To cite this article:
de Vicente JC, Hernández‐Vallejo G, Braña‐Abascal P, Peña I. Maxillary sinus augmentation with autologous bone harvested from the lateral maxillary wall combined with bovine‐derived hydroxyapatite: clinical and histologic observations. Clin. Oral Impl. Res. 21, 2010; 430–438 doi: 10.1111/j.1600‐0501.2009.01877.x