bluuebunny/crossref_metadata_2025_split huggingface dataset:
HIV Seroprevalence in Emergency Department Patients: Portland, Oregon, 1988–1991
Authors: Jui Jon , Stevens Penny , Hedberg Katrina , Modesitt Steve 
Published: September 2008

ABSTRACTObjectives: In Portland, OR: 1) to determine the changes in HIV seroprevalence for ED patients from 1988 to 1991, 2) to define the characteristics of the HIV‐positive ED patient. 3) to determine the hepatitis B seroprevalence of HIV‐seropositive ED patients, and 4) to demonstrate the feasibility of an ED population‐based surveillance investigation.Methods: A prospective, multiyear observational, cross‐sectional, multicenter, population‐based seroprevalence study was performed using seven urban hospital EDs. Serologic testing for HIV and hepatitis B was performed on excess blood obtained from ED patients. Four sampling periods were used at each hospital at 14‐month inlervals starting June 1988 and ending December 1991. The blood specimens were obtained concurrently at all the participating hospitals.Results: Of 1,681 patients, 17 (1.0%) were HIV‐positive. The HIV seroprevalence rate was relatively stable over time: 0.5% (2/444) in 1988, 1.7% (7/396) in 1989, 1% (3/296) in 1990, and 0.9% (51545) in 1991. Most (94%) HIV patients were men, 100% were white, 81% were≥230 years old. Most (59%) of the HIV‐positive patients also were positive for hepatitis B core antibody. Many (76%) of the HIV‐positive patients were known to be positive by the emergency health care worker.Conclusion: HIV seroprevalence among the ED patients in Portland, OR, was generally stable from 1988 to 1991. Many HIV‐positive patients also were hepatitis‐B‐positive, thus representing a double occupational infectious disease risk to ED personnel. A significant minority (24%) of the HIV‐positive patients were not known to be HIV‐positive by the ED personnel. Universal precautions and hepatitis B immunization are paramount for reducing the risk of infectious disease due to exposure to body fluids.
Alcohol Use among Subcritically Injured Emergency Department Patients
Authors: Becker Bruce , Woolard Robert , Nirenberg Ted D. , Minugh P. Allison , Longabaugh Richard , Clifford Patrick R. 
Published: September 2008

ABSTRACTObjectives: To determine the incidence of alcohol use in subcritically injured patients presenting to the ED, by using a saliva alcohol test (SAT) at ED triage during the ED initial assessment; to compare the incidence of alcohol use revealed by the SAT with documentation of alcohol use by ED nurses and emergency physicians (EPs) blinded to the SAT results; and to describe the demographics of the SAT‐positive, subcritically injured population.Methods:A blinded, prospective, observational evaluation of ED patients presenting with subcritical injuries was performed. The patients were tested for alcohol use with an SAT, and a subsequent record review was conducted for extraction of demographic data and evidence of documentation of alcohol use by ED nurses and EPs blinded to the SAT results.Results:During the study. 791 subcritically injured patients had SATs performed. Twenty‐one percent of these patients were found to be alcohol‐positive by SAT. Either the ED nurse or the EP documented a clinical impression of alcohol use for 52% of the SAT‐positive patients. There were higher SAT‐positive rates among men (24%), victims of assault (47%), and patients arriving at night (41%).Conclusions:While the SAT identified 21% of the subcritically injured patient population as alcohol‐positive, ED nurse and EP documentation did not identify half of these alcohol‐positive patients. Many of these patients may be at risk for additional injuries related to their drinking behavior.
The Dextromethorphan Defense: Dextromethorphan and the Opioid Screen
Authors: Storrow Alan B. , Magoon Michael Raynard , Norton John 
Published: September 2008

ABSTRACTObjective: To determine whether a single oral dose of dextromethorphan produces a falsely positive qualitative urine opioid screen.Methods:A prospective, randomized, triple‐blind, placebo‐controlled, crossover exposure study design was used. Twenty adult volunteers participated. All were without routine medications, not pregnant or lactating, without known sensitivity to dextromethorphan, and negative for urine toxicologic screening immediately prior to testing. These volunteers underwent three separate urine Enzyme‐Multiplied Immunoassay Technique (EMIT) opioid screens. Each screen was performed six hours after the subject had ingested a single liquid medication, either dextromethorphan, codeine, or placebo. Each volunteer took all three medications randomly, at least 72 hours apart. Half of the volunteers took the standard adult dose of dextromethorphan (20 mg). while the other half ingested twice this amount (40 mg). The amounts of codeine (30 mg) and sucrose placebo (10 mL) remained constant.Results:For these young adults (mean age & SD = 30.7 ±2.8 years), all urine EMIT assays six hours after ingestion of dextromethorphan, at both dosage levels, were negative for opioids and all other drugs. All assays after codeine and placebo ingestion were positive and negative for opioids, respectively.Conclusion:Although dextromethorphan is structurally similar to opioid drugs, the ingestion of a single normal (or even twice normal) dose of dextromethorphan is not likely to produce a falsely positive six‐hour urine opioid EMIT screen.
Hematologic Safety of Intraosseous Blood Transfusion in a Swine Model of Pediatric Hemorrhagic Hypovolemia
Authors: Plewa Michael C. , King Randall W. , Fenn‐Buderer Nancy , Gretzinger Karl , Renuart Donald , Cruz Rafael 
Published: September 2008

ABSTRACTObjective: To assess the risk of hemolysis, disseminated intravascular coagulation (DIC), or fat embolism syndrome (FES) with pressurized intraosseous (10) blood transfusion following hemorrhage.Methods: A controlled, repeated‐measures, randomized animal study with blinded pathologic evaluations was conducted. Sixteen pento‐barbital‐anesthetized, instrumented immature swine underwent a 20‐mL/kg hemorrhage into citrate‐phosphate‐dextrose bags, then received autologous blood transfusion via a 16‐ga IV catheter (eight), or via a 15‐ga 10 needle in the proximal tibia (eight) under maximal manual pressure using a 30‐mL syringe. At baseline and at one hour and 48 hours posttransfusion, blood samples were assayed for hemoglobin (Hb), schistocytes, free Hb in plasma, bilirubin, lactate de‐hydrogenase, platelets, fibrinogen, and alveolar‐arteriolar O2 gradient. Lung sections were examined for inflammation after hematoxylid eosin stain, and for fat emboli after oil red‐O‐stain. Kidney sections were examined for inflammation using hematoxylin/eosin stain.Results: Though the 10 transfusion rate of 21 ± 6 mumin was slower than the IV rate of 35 ± 5 mL/min (p = 0.0012), all the animals returned to baseline blood pressure within 15 minutes and survived. The presence of schistocytes and mildly elevated free Hb in plasma was noted in both groups at baseline and each time period, and was presumed to be due to sampling from the arterial catheter. All other laboratory values remained within normal limits and without inter‐group differences at any time period. No fat embolus was noted, and all lung and kidney specimens were free of inflammation.Conclusions: In this model, pressurized 10 blood transfusion appears to be hematologically safe, i.e., without risk of appreciable hemolysis, DIC, or FES.
Injury as a Motivator to Reduce Drinking
Authors: Longabaugh Richard , Minugh P. Allison , Nirenberg Ted D. , Clifford Patrick R. , Becker Bruce , Woolard Robert 
Published: September 2008

ABSTRACTObjectives: To identify predictors of readiness to change drinking behavior by minor‐injury patients who had positive saliva alcohol tests (SATs) in the ED. To develop and test a model intended to be prognostic of readiness to change, which included predispositional and injury‐event‐related variables.Methods: An on‐site survey was conducted of minor‐injury ED patients sampled consecutively during predesignated periods. Patients were identified as SAT‐positive during their screening evaluations. After giving their consent, they were administered a self‐report battery that assessed predispositional and injury‐event‐related variables as well as readiness to change their drinking. Predictors of readiness to change drinking were tested with regression analyses.Results: Twenty‐four SAT‐positive patients participated; there were 18 men and six women (average age 34 years). Preinjury predispositional variables were by themselves unrelated to the patient's readiness to change while in the ED. Aversiveness of the injury and perception of degree of alcohol involvement were injury‐event‐related variables predictive of readiness to change (p <0.008). Negative consequences attributed to drinking prior to the injury event strengthened the association of injury aversiveness and alcohol involvement with readiness to change (p <0.0075).Conclusion: Interventions to decrease drinking in this population should focus on increasing patient awareness of the association between drinking, injuries, and other alcohol‐related negative consequences.
Agreement in the Interpretation of Extremity Radiographs of Injured Children and Adolescents
Authors: Minnes Bruce G. , Sutcliffe Terry , Klassen Terry P. 
Published: September 2008

ABSTRACTObjectives: To measure agreement beyond chance (kappa) for comparison interpretations of extremity radiographs by pediatric radiologists and emergency physicians (EPs) and to identify factors associated with disagreement.Methods: A random sample of 205 radiographs was selected from 1,016 patients having x‐rays of their extremities in the emergency and radiology departments of a tertiary care pediatric hospital. Interpretations by the “official” reporting pediatric radiologist (ORPR), the treating EP, and a pediatric radiologist blinded to all clinical information (BPR) were compared for three categories: “abnormal” (one or more of fracture, dislocation, or effusion); “possibly abnormal”; and “normal.”Results: The overall weighted kappa (K,) for the ORPRs and the EPs was 0.55. For fractures alone, the K, for the ORPRs vs the EPs was 0.77; and for effusions alone, the value was 0.34. The K, for the ORPRs vs the BPR was 0.63 (range 0.43–0.83 for individual ORPRs). The main areas of disagreement were in the identification of joint effusions and of nondisplaced fractures of the phalanges, elbow joint. tarsals, or metatarsals.Conclusions:There is good agreement between EPs and pediatric radiologists in interpreting extremity radiographs of injured children and adolescents. Disagreement occurs mainly for effusions or minor fractures and for the elbow region. Because of the importance of recognizing abnormalities in this region, an educational intervention to improve this area of deficiency is recommended.
Histopathologic Evaluation of the Therapeutic Efficacy of Water and Milk Dilution for Esophageal Acid Injury
Authors: Homan Clark S. , Maitra Subir R. , Lane Bernard P. , Thode Henry C. , Davidson Lev 
Published: September 2008

ABSTRACTObjective: To determine whether acid‐induced injury to the esophagus is decreased by early dilutional therapy with water or milk.Methods: A controlled in‐vitro animal model for acid injury to the esophagus was carried out using esophagi harvested from 70 Sprague‐Dawley rats of both sexes and weighing 250–350 g. One control and six experimental groups each containing ten esophagi were instilled with 1 mL of 0.5 normal solution of hydrogen chloride (N HCl). Dilution with water or milk was performed at 0, 5, or 30 minutes postinjury in the experimental groups. No dilution was performed with the control group. Specimens were maintained in an oxygenated saline bath for a 60‐minute experimental period and then fixed in 10% formalin for histologic evaluation. Injury severity was rated by blinded histopathologic examination using scores of 0 (no injury), 1 (minor), 2 (moderate), and 3 (severe) for the histopathologic categories: cornified epithelial cells (CEs), granular cells (GCs), granular cell nuclei (GNs), and basal cells (BCs). Red blood cells were scored as positive or negative for lysis.Results: The controls showed the most severe outcomes. Significant differences in injury occurred for all time periods and histopathologic categories, except for the GN/water and BC/milk histopathologic category/treatment groups. However, a linear trend analysis was significant for all histopathologic categories except BC. These analyses support decreased injury in the earlier treated groups. Injury severity was highest in the most superficial cell layer (CE).Conclusions: Emergency therapy with water or milk reduces acute acid injury to the esophagus. Earlier treatment is associated with decreased injury severity. This research supports the use of dilutional therapy with water or milk for acute acid injury to the esophagus.
Visualization of C7‐T1 on Portable Lateral Cervical Spine Radiographs Using a Lead‐lined Acrylic Filter
Authors: Quinn James V. , Cwinn Adam , Carr Brendan , Grahovac Steven , Stiell Ian , Pelland Pierre 
Published: September 2008

ABSTRACTObjective: To determine whether lead‐lined acrylic cervical filters can improve the quality of portable lateral cervical spine (c‐spine) radiographs for trauma patients.Methods: Twenty trauma patients who required portable c‐spine x‐rays had these taken with a lead filter attached to the collimator of the portable x‐ray machine to improve penetration and visualization of lower cervical structures without overpenetrating upper cervical structures. The radiographs of these patients were compared with the first portable c‐spine radiographs without filters for 20 controls matched for gender and injury severity. The comparison of radiographs was done by an experienced emergency physician and a neuroradiologist blinded to whether the filter was used.Results: The two groups were similar for demographic and clinical characteristics. There was a significant improvement in the ability to visualize the C7‐T1 level for the filter group compared with the control group (65% vs 30%, p < 0.05). Agreement between the physicians was excellent (kappa = 0.79, 95% CI = 0.60‐0.99).Conclusions: Lead‐lined acrylic filters improve the ability to visualize the lower c‐spine in trauma patients.
Accuracy of E‐codes Assigned to Emergency Department Records
Authors: Schwartz Robert J. , Nightingale Bonnie S. , Boisoneau David , Jacobs Lenworth M. 
Published: September 2008

ABSTRACTObjective: To determine the accuracy of ICD‐9‐CM external‐cause‐of‐injury codes (e‐codes) assigned to the medical records of injured patients treated in an ED and released.Methods: A comparison was made of routine coding and expert recoding of medical records generated in the ED for a convenience sample of patients treated for injuries within 24 hours of injury occurrence and subsequently released from the ED. The medical record was handwritten and subsequently coded by three medical records coders (MRCs). The e‐coded charts were sent to an external medical record consultant (expert), who was blinded to the codes previously assigned. The expert reading was used as the criterion standard. Accuracy was measured using a kappa statistic, and errors were described.Results: Of 126 available patient charts, 108 (85.7%) were assigned e‐codes by MRCs. The expert assigned two codes to (double‐coded) 67 patients, while the MRCs double‐coded only one patient. The additional code was usually a “place of occurrence code.” In 60 cases (55.6%), the expert code exactly matched the MRC code; kappa = 0.462. Of the 48 mismatches (44.4%), 20 (41.7%) were e‐coded in the wrong category, 20 (41.7%) were e‐coded in the correct category but with incorrect specificity of information, either too specific or not specific enough, and eight (16.6%) had combined coding errors.Conclusion: The accuracy of e‐codes assigned to ED records was moderate in this single institution analysis. Errors were predominantly related to the specificity of the code, but some e‐codes were in the wrong category. There are implications for injury surveillance and research. E‐code assignment must be standardized and applied uniformly to obtain accurate codes. Automation of e‐coding could improve accuracy and consistency of codes. National and international epidemiologic studies of cause of injury among ED patients will be severely hampered until e‐code assignment can be better standardized.
Emergency Procedures Important to the Training of Emergency Medicine Residents: Who Performs Them in the Emergency Department?
Authors: Gallagher E. John , Coffey John , Lombardi Gary , Saef Steven 
Published: September 2008

ABSTRACTObjective: To quantify one aspect of emergency medicine (EM) training by determining the proportion of emergency procedures performed by emergency physicians (EPs) in EDs with EM residency programs (EMRPs).Methods: Cross‐sectional descriptive survey of all allopathic EMRPs accredited by the EM Residency Review Committee (RRC‐EM) as of July 1, 1993. Using a modified visual analog scale, program directors indicated the proportion of ten index procedures performed in the ED by EPs vs all other physicians.Results: All 98 EMRPs meeting entry criteria responded to the survey. The medians for the percentage of times index procedures were performed in the ED by an EP were as follows (parentheses following percentages enclose 95% CIs): endotracheal intubation, 97% (95%, 100%); reduction of anterior shoulder dislocation, 93% (88%, 97%); thoracostomy, 63% (50%, 75%); transvenous pacer insertion, 60% (50%, 75%); cricothyrotomy, 50% (50%, 75%); thoracotomy, 50% (25%, 50%); diagnostic peritoneal lavage, 50% (25%, 50%); fiberoptic laryngoscopy, 22% (6%, 25%); sigmoidoscopy, 0% (0%, 6%); and pelvic sonography, 0% (0%, 0%).Conclusion: EPs in EDs of institutions that have EMRPs perform, on average, 50% of all index procedures (95% CI 47%, 52%). This information may assist EM programs experiencing difficulty in ensuring that their residents receive an equitable share of those procedures that are critical to their training.
Efficacy of Ipratropium Bromide in Acute Childhood Asthma: A Meta‐analysis
Authors: Osmond Martin H. , Klassen Terry P. 
Published: September 2008

ABSTRACTPurpose: To determine whether inhaled ipratropium bromide provides an additive, clinically important improvement in children with acute asthma who are being treated with β2‐agonists.Methods: An English‐language literature search was conducted employing MEDLINE (1966 to 1992), Science Citation Index (1986 to 1992) using key citations, bibliographic reviews of primary research and review articles, and correspondence with authors of recent articles. After independent review by two observers, six studies were selected on the basis of prespecified selection criteria. Two observers independently assessed the selected papers by using explicit methodologic criteria for evaluating the quality of studies dealing with therapeutic intervention.Results: None of the six studies found a significant difference in clinical rating score, admission rate, or length of stay in hospital between the ipratropium bromide and the control groups. The three studies with the highest methodologic validity measured the change in percentage predicted forced expiratory volume in 1 second (FEV1) from baseline to 60 minutes. The pooled effect size (95% CI) for these studies was 0.88 (0.42–1.34), which translates to an improvement in percentage predicted FEV1 over the control group of 12.5% (95% CI, 6.6–18.4). In a subset of 23 children who had severe airway obstruction, peak expiratory flow rate (PEFR) responded better to a β2‐agonist alone (p = 0.007).Conclusion: The existing evidence reveals that the addition of ipratropium bromide to a β2‐agonist offers a statistically significant improvement in percentage predicted FEV1 but no clinical improvement. As it may cause deterioration in PEFR in severely asthmatic children, ipratropium bromide should not be used universally for acute childhood asthma until further research determines the clinical significance of these spirometric changes.
Biochemical Markers of Cerebral Injury in Patients with Minor Head Trauma and Ethanol Intoxication
Authors: Levitt M. Andrew , Cook Laura Ann Staffeld , Simon Barry C. , Williams Virgil 
Published: September 2008

ABSTRACTObjective: To determine whether biochemical markers can selectively identify those intoxicated patients with presumed minor head injuries who are likely to have CT evidence of intracranial injury.Methods: Patients presenting to the ED with simultaneous presumed minor head trauma and ethanol intoxication were prospectively entered into this cross‐sectional study. Following phlebotomy, all patients received cranial CT. Associations between the presence of an abnormal CT scan for injury and serum levels of the following biochemical markers were sought: serum catecholamines, creatine kinase‐brain band (CK‐BB), and serum amylase. Serum levels are reported as mean ± SEM.Results: Nine of the 107 patients (8.4%; 95% CI 3.9–15.4%) had evidence of intracranial injury on CT. Mean serum CK‐BB (16.1 ± 3.7 vs 13.2 ± 9.6 ng/mL), serum norepinephrine (913 ± 117 vs 1,089 ± 76 pg/mL), and serum amylase (64.9 ± 14.8 vs 84 ± 4.7 U/L) levels were not significantly different in patients with and without CT evidence of intracranial injury, respectively. Mean serum epinephrine (298 ± 54 vs 167 ± 18 pg/mL; p = 0.03) and serum dopamine (218 ± 50 vs 130 ± 9 pg/mL; p = 0.014) levels were significantly elevated in the group with intracranial injury on CT. A threshold level of serum dopamine ±140 pg/mL yields a sensitivity of 89% (95% CI 52–100%) and a specificity of 80% (95% CI 70–87%) for CT‐evident injury. A threshold level of serum epinephrine ±218 pg/mL yields a sensitivity of 89% (95% CI 52–100%) and a specificity of 80% (95% CI 70–87%) for CT‐evident injury.Conclusion: Elevated serum epinephrine and dopamine levels are associated with intracranial CT‐evident injury for ethanol‐intoxicated patients with presumed minor head injuries. The potential use of these biochemical markers to guide a more selective approach to cranial CT scanning warrants further evaluation.
Dehydration and Orthostatic Vital Signs in Women with Hyperemesis Gravidarum
Authors: Johnson David R. , Douglas Daniel , Hauswald Mark , Tandberg Dan 
Published: September 2008

ABSTRACTObjectives: To assess the hydration status of women presenting to an ED with hyperemesis gravidarum and to determine whether clinically relevant changes in orthostatic vital signs occur.Methods: A convenience sample of 23 pregnant women who had hyperemesis gravidarum, with each patient serving as her own control. The study took place in the ED observation unit of an urban teaching hospital. Women who had pregnancies of ≤16 weeks' gestation who had been vomiting for at least 24 hours were included. Supine and standing pulse rates and blood pressures (BPs) were measured sequentially after 5 minutes in each position. Patient weight and urine specific gravity (SG) also were recorded. After 6 L of lactated Ringer's solution was infused over a 12‐hour period, the same measurements were repeated. Pre‐ and posthydration changes were analyzed using the paired t‐test.Results: The mean treatment weight gain as a percentage of the total body weight was 5.6% ± 2.2% (mean ± SD). The urine SG decreased from 1.027 ± 0.004 to 1.008 ± 0.003 (p < 0.001). The mean change in systolic BP upon assuming the standing position was ‐8.3 ± 12.7 mm Hg before hydration vs 2.9 ± 7.8 mm Hg after hydration (p < 0.001). The corresponding change in mean diastolic BP was 3.7 ± 10.9 mm Hg before hydration vs 8.6 ± 10.9 mm Hg after hydration (p = 0.12). The mean change in pulse rate upon standing was 26.8 ± 14.5 beats/min before hydration vs 14.5 ± 10.1 beats/min after hydration (p = 0.002).Conclusions: Women who present to the ED with hyperemesis gravidarum are significantly dehydrated and experience measurable improvement in postural pulse rate and systolic BP changes with rehydration. However, the presenting orthostatic changes lack sufficient sensitivity to be effectively used as quantitative screening tests for dehydration.