bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Community Intervention by Firefighters to Increase 911 Calls and Aspirin Use for Chest Pain
Authors: Meischke Hendrika , Diehr Paula , Rowe Sharon , Cagle Anthony , Eisenberg Mickey 
Published: March 2006

Abstract Objectives: To test the effectiveness of an intervention, delivered face‐to‐face by local firefighters, designed to increase utilization of 911 and self‐administration of aspirin for seniors experiencing chest pain. Methods: King County, Washington was divided into 126 geographically distinct areas that were randomized to intervention and control areas. A mailing list identified households of seniors within these areas. More than 20,000 homes in the intervention areas were contacted by local firefighters. Data on all 911 calls for chest pain and self‐administration of aspirin were collected from the medical incident report form (MIRF). The unit of analysis was the area. Firefighters delivered a heart attack survival kit (that included an aspirin) and counseled participants on the importance of aspirin and 911 use for chest pain. Main outcome measures were 911 calls for chest pain and aspirin ingestion for a chest pain event, obtained from the MIRFs that are collected by emergency medical services personnel for 2 years after the intervention. Results: There were significantly more calls (16%) among seniors on the mailing list in the intervention than control areas in the first year after the intervention. Among the seniors who were not on the mailing list, there was little difference in the intervention and control areas. The results were somewhat sensitive to the analytical model used and to an outlier in the treatment group. Conclusions: A community‐based firefighter intervention can be effective in increasing appropriate response to symptoms of a heart attack among elders.
How Many Attempts Are Required to Accomplish Out‐of‐hospital Endotracheal Intubation?
Authors: Wang Henry E. , Yealy Donald M. 
Published: March 2006

Abstract Background: An important goal of emergency airway management is to complete endotracheal intubation (ETI) correctly, safely, and quickly, and repeated ETI attempts can increase patient morbidity and mortality. Clinical protocols limiting the number of ETI attempts may minimize harm, but this strategy also may reduce the frequency of successful ETI. Objectives: To characterize the relationship between the number of out‐of‐hospital ETI attempts and ETI success. Methods: This study used prospective, multicenter data from 42 emergency medical services agencies from an 18‐month period. Out‐of‐hospital rescuers (paramedics, out‐of‐hospital nurses, and physicians) completed structured, closed‐response data forms describing clinical methods, course, and outcomes for all ETIs. An ETI attempt was defined as an insertion of the laryngoscope blade. Rescuers identified ETI outcome (success or failure) for each attempt. The authors defined overall success as ETI outcome (success or failure) on the last attempt, examining cardiac arrest, conventional nonarrest, sedation‐facilitated, and rapid‐sequence ETI separately. Univariate odds ratios (ORs) were used to identify the number of ETI attempts in which the cumulative ETI success rate approached the overall ETI success rate. Results: Complete data were available for 1,941 cases. More than 30% of patients received more than one ETI attempt. For 1,272 cardiac arrest ETIs, cumulative success for the first three attempts were 69.9%, 84.9%, and 89.9%; cumulative success approached overall success (91.8%) after three attempts (OR, 0.79; 95% confidence interval [CI] = 0.61 to 1.04). For 463 conventional non‐arrest ETIs, cumulative success for the first three attempts were 57.6%, 69.2%, and 72.7%; cumulative success approached overall success (73.7%) after two attempts (OR, 0.95; 95% CI = 0.71 to 1.28). For 126 sedation‐facilitated ETIs, cumulative success for the first three attempts were 44.4%, 62.7%, and 75.4%; cumulative success approached overall success (77.0%) after three attempts (OR, 0.92; 95% CI = 0.51 to 1.64). For 80 rapid‐sequence ETI, cumulative ETI success for the first three attempts were 56.3%, 81.3%, and 91.3%; cumulative success approached overall success (96.3%) after three attempts (OR, 0.41; 95% CI = 0.10 to 1.65). Conclusions: Out‐of‐hospital rescuers often require multiple attempts to accomplish ETI. A protocol limit of three attempts offers reasonable opportunity for accomplishing ETI within the constraints of the out‐of‐hospital environment.
An Emergency Department Intervention to Increase Booster Seat Use for Lower Socioeconomic Families
Authors: Gittelman Michael A. , Pomerantz Wendy J. , Laurence Susan 
Published: March 2006

Abstract Objectives: To evaluate the effectiveness of booster seat education within an emergency department (ED) setting for families residing in lower socioeconomic neighborhoods. Methods: This was a prospective, randomized study of families with children aged 4 to 7 years and weighing 40 to 80 lb who presented to a pediatric ED without a booster seat and resided in lower socioeconomic communities. Subjects were randomly assigned to one of three groups: 1) received standard discharge instructions, 2) received five‐minute booster seat training, and 3) received five‐minute booster seat training and free booster seat with installation. Automobile restraint practices were obtained initially and by telephone at one month. Results: A total of 225 children were enrolled. Before randomization in the study, 79.6% of parents reported that their child was usually positioned in the car with a lap/shoulder belt and 13.3% with a lap belt alone. Some parents (16.4%) had never heard of a booster seat, and 44.9% believed a lap belt was sufficient restraint. A total of 147 parents (65.3%) were contacted for follow‐up at one month. Only one parent (1.3%) in the control group and four parents (5.3%) in the education group purchased and used a booster seat after their ED visit, while 55 parents (98.2%) in the education and installation group reported using the booster seat; 42 (75.0%) of these parents reported using the seat 100% of the time. Conclusions: Education in a pediatric ED did not convince parents to purchase and use booster seats; however, the combination of education with installation significantly increased booster seat use in this population.
A Comprehensive Statewide Analysis of Seatbelt Non‐use with Injury and Hospital Admissions: New Data, Old Problem
Authors: Allen Shane , Zhu Shankuan , Sauter Carley , Layde Peter , Hargarten Stephen 
Published: March 2006

Abstract
Objectives:
To investigate the association of seatbelt nonuse with injury patterns, injury severity, and in‐patient hospital admission among adults presenting to emergency departments (EDs) in a statewide, population‐based, sample of motor vehicle crashes.
Methods:
Using data from the 2002 Crash Outcome Data Evaluation System (CODES) for Wisconsin, 23,920 occupants of motor vehicle crashes, aged 16 years or older, who were treated in an ED, were analyzed. Logistic regression was used to compare the odds ratio of having sustained an injury to specific body regions and of being admitted to an inpatient unit in unbelted individuals compared with those who were belted.
Results:
Compared with belted occupants presenting to an ED, their unbelted counterparts were more likely to be male (56% vs. 40%) and to have used alcohol (17% vs. 4%). Unbelted occupants were younger (31 years vs. 38 years) and incurred higher ED charges ($681 vs. $509) than belted occupants. Additionally, unbelted occupants have a higher proportion of single‐vehicle crashes, such as rollovers (44% vs. 22%), and rural crashes (56% vs. 44%). Unbelted occupants comprised 20% of study patients treated in the ED and discharged, 44% of patients treated in the ED and admitted, and 68% of patients dying in the ED. Unbelted occupants were more likely to be admitted (odds ratio [OR] = 2.6) than belted individuals and were more likely to suffer severe injuries to the head, face, thorax, abdomen, spine, upper and lower extremities (OR ranging from 1.6 to 3.9).
Conclusions:
Among patients presenting to an ED after a motor vehicle crash, unbelted occupants are more likely to require inpatient admission and to have sustained a severe injury to numerous body regions than are belted occupants.
Medical Error Identification, Disclosure, and Reporting: Do Emergency Medicine Provider Groups Differ?
Authors: Hobgood Cherri , Weiner Bryan , Tamayo‐Sarver Joshua H. 
Published: March 2006

Abstract
Objectives:
To determine if the three types of emergency medicine providers—physicians, nurses, and out‐of‐hospital providers (emergency medical technicians [EMTs])—differ in their identification, disclosure, and reporting of medical error.
Methods:
A convenience sample of providers in an academic emergency department evaluated ten case vignettes that represented two error types (medication and cognitive) and three severity levels. For each vignette, providers were asked the following: 1) Is this an error? 2) Would you tell the patient? 3) Would you report this to a hospital committee? To assess differences in identification, disclosure, and reporting by provider type, error type, and error severity, the authors constructed three‐way tables with the nonparametric Somers' D clustered on participant. To assess the contribution of disclosure instruction and environmental variables, fixed‐effects regression stratified by provider type was used.
Results:
Of the 116 providers who were eligible, 103 (40 physicians, 26 nurses, and 35 EMTs) had complete data. Physicians were more likely to classify an event as an error (78%) than nurses (71%; p = 0.04) or EMTs (68%; p < 0.01). Nurses were less likely to disclose an error to the patient (59%) than physicians (71%; p = 0.04). Physicians were the least likely to report the error (54%) compared with nurses (68%; p = 0.02) or EMTs (78%; p < 0.01). For all provider and error types, identification, disclosure, and reporting increased with increasing severity.
Conclusions:
Improving patient safety hinges on the ability of health care providers to accurately identify, disclose, and report medical errors. Interventions must account for differences in error identification, disclosure, and reporting by provider type.
Subsequent Suicide Mortality among Emergency Department Patients Seen for Suicidal Behavior
Authors: Crandall Cameron , Fullerton‐Gleason Lynne , Aguero Roberto , LaValley Jonathon 
Published: March 2006

Abstract
Objectives:
To determine whether suicide mortality rates for a cohort of patients seen and subsequently discharged from the ED for a suicide‐related complaint were higher than for ED comparison groups.
Methods:
This was a nonconcurrent cohort study set at a university‐affiliated urban ED and Level 1 trauma center. All ED patients 10 years and older, with at least one ED visit between February 1994 and November 2004, were eligible. ED visit characteristics defined the cohort exposure. Patients with visits for suicide attempt or ideation, self‐harm, or overdose (exposed) were compared with patients without these visits (unexposed). Exposure classification was determined from billing diagnoses, E‐codes (E950–E959), and free‐text searching of the ED tracking system data for suicide, overdose, and spelling variants. Emergency department patient data were probabilistically linked to state mortality records. The principal outcome was suicide death. Suicide mortality rates were calculated by using person‐year (py) analyses. Relative rates (RR) and 95% confidence intervals (95% CIs) were calculated from Cox proportional hazards models.
Results:
Among the 218,304 patients, the average follow‐up was 6.0 years; there were 408 suicide deaths (incidence rate [IR]: 31.2 per 100,000 py). Males (IR: 48.3) had a higher rate than females (IR: 13.5; RR: 3.6; 95% CI = 2.8 to 4.6). A single ED visit for overdose (RR: 5.7; 95% CI = 4.5 to 7.4), suicidal ideation (RR: 6.7; 95% CI = 5.0 to 9.1), or self‐harm (RR: 5.8; 95% CI = 5.1 to 10.6) was strongly associated with increased suicide risk, relative to other patients.
Conclusions:
The suicide rate among these ED patients is higher than population‐based estimates. Rates among patients with suicidal ideation, overdose, or self‐harm are especially high, supporting policies that mandate psychiatric interventions in all cases.
The Effect of Soft‐tissue Ultrasound on the Management of Cellulitis in the Emergency Department
Authors: Tayal Vivek S. , Hasan Nael , Norton H. James , Tomaszewski Christian A. 
Published: March 2006

Abstract Objectives: To evaluate the effect of diagnostic soft‐tissue ultrasound (US) on management of emergency department (ED) patients with clinical cellulitis. Methods: This was a prospective observational study in an urban ED of adult patients with clinical soft‐tissue infection without obvious abscess. The treating physician's pretest opinions regarding the need for further drainage procedures and the probability of subcutaneous fluid collection were determined. Emergency sonologists then performed US of the infected area, and the effect on management plan was recorded. Results: Ultrasound changed the management of patients with cellulitis in 71/126 (56%) of cases. In the pretest group that was believed not to need further drainage, US changed the management in 39/82 (48%), with 33 receiving drainage and 6 receiving further diagnostics or consultation. In the pretest group in which further drainage was believed to be needed, US changed the management in 32/44 (73%), including 16 in whom drainage was eliminated and 16 who had further diagnostic interventions. US had a management effect in all pretest probabilities for fluid from 10% to 90%. Conclusions: Soft‐tissue US changes physician management in approximately half of patients in the ED with clinical cellulitis. US may guide management of cellulitis by detection of occult abscess, prevention of invasive procedures, and guidance for further imaging or consultation.
Intubating Conditions and Hemodynamic Effects of Etomidate for Rapid Sequence Intubation in the Emergency Department: An Observational Cohort Study
Authors: Zed Peter J. , Abu‐Laban Riyad B. , Harrison David W. 
Published: March 2006

Abstract Objectives: To describe and analyze the intubating conditions and hemodynamic effects of etomidate in patients undergoing rapid sequence intubation (RSI) in the emergency department. Methods: The authors conducted a prospective observational study of all patients who received etomidate for induction of RSI over a 42‐month period in a large tertiary care teaching hospital. Intubating conditions were determined by the emergency physician for both sedation and paralysis and for technical difficulty using a five‐point Likert scale. Hemodynamic effects were evaluated before, after, and every five minutes for 15 minutes following administration of etomidate. Results: Etomidate was used for induction of RSI in 522 patients, all of whom were included in the final efficacy analysis, while 491 were included in the analysis of hemodynamics. Lidocaine and fentanyl were used as pretreatment in 65.1% and 26.1% of patients, respectively, while succinylcholine was the paralytic in 94.3% of intubations. Sedation and paralysis were rated as excellent or good in 88.1% and 8.8% of patients, respectively, while technical difficulty was very easy or easy in 60.7% and 19.0% of patients, respectively. Mean (± SD) baseline systolic blood pressure (sBP), diastolic blood pressure (dBP), and heart rate were found to be 132.7 (± 35.4) mm Hg, 69.5 (± 21.2) mm Hg, and 96.1 (± 26.2) bpm, respectively. Overall, there was a clinically insignificant elevation in sBP (p < 0.0001), dBP (p = 0.0002), and heart rate (p < 0.0001) immediately postintubation. Elevations in sBP persisted at five minutes (p = 0.0230) and ten minutes (p = 0.0254) postintubation. Diastolic blood pressure and heart rate returned to baseline at five minutes after intubation and remained stable throughout the 15‐minute postintubation assessment period. In the subgroup of 80 patients with a preintubation sBP < 100 mm Hg, there was a 12.1–mm Hg elevation in sBP (p < 0.0001) and a 7.3–mm Hg elevation in dBP (p = 0.0001) immediately postintubation. This elevation persisted throughout the 15‐minute postintubation assessment period. Conclusions: Etomidate appears to provide appropriate intubating conditions in a heterogeneous group of patients undergoing RSI in the emergency department. Hemodynamic stability appears to be present following administration of this agent, even in patients with low pre‐RSI blood pressure. This attribute must be weighed against potential adverse effects of this agent, including adrenal suppression.
The Probability of Pulmonary Embolism Is a Function of the Diagnoses Considered Most Likely Before Testing
Authors: Kabrhel Christopher , McAfee Andrew T. , Goldhaber Samuel Z. 
Published: March 2006

Abstract
Objectives:
To determine the frequency of pulmonary embolism (PE) diagnosis when different alternative diagnoses were considered most likely before testing, because the relationship between specific alternative diagnoses and the diagnosis of PE has not been explored.
Methods:
This study was a preplanned secondary analysis of a prospective study of the diagnosis of pulmonary embolism conducted in the emergency department (ED) of an urban university hospital. Physicians were queried as to their most likely pretest diagnosis when they ordered any of the following tests to evaluate possible PE: D‐dimer, contrast‐enhanced computed tomography of the chest, ventilation–perfusion lung scan, or pulmonary angiogram. To compare the frequency of PE diagnosis across alternative diagnoses, risk ratios, 95% confidence intervals (CI), and p‐values using Fisher's exact test were calculated.
Results:
Six hundred seven patients were enrolled, and 61 had PE. Physicians thought PE was the most likely pretest diagnosis in 162 (26.7%) patients, and 20.4% (95% CI = 14.4% to 27.4%) of these patients had PE. For four alternative diagnoses, PE was diagnosed less frequently than when PE was considered most likely: musculoskeletal pain (2.2%, 95% CI = 0.4% to 6.2%), anxiety (1.7%, 95% CI = 0.0 to 9.2%), asthma or chronic obstructive pulmonary disease (0, 95% CI = 0.0 to 10.9%), and viral syndrome (0, 95% CI = 0.0 to 14.3%).
Conclusions:
The frequency of PE is related to the most likely pretest alternative diagnosis. PE is diagnosed infrequently when anxiety, asthma or chronic obstructive pulmonary disease, musculoskeletal pain, or viral syndrome is the most likely alternative diagnosis.
Impact of Impedance Cardiography on Diagnosis and Therapy of Emergent Dyspnea: The ED‐IMPACT Trial
Authors: Peacock W. Frank , Summers Richard L. , Vogel Jody , Emerman Charles E. 
Published: March 2006

Abstract Background: Dyspnea is one of the most common emergency department (ED) symptoms, but early diagnosis and treatment are challenging because of multiple potential causes. Impedance cardiography (ICG) is a noninvasive method to measure hemodynamics that may assist in early ED decision making. Objectives: To determine the rate of change in working diagnosis and initial treatment plan by adding ICG data during the course of ED clinical evaluation of elder patients presenting with dyspnea. Methods: The authors studied a convenience sample of dyspneic patients 65 years and older who were presenting to the EDs of two urban academic centers. The attending emergency physician was initially blinded to the ICG data, which was collected by research staff not involved in patient care. At initial ED presentation, after history and physical but before central lab or radiograph data were returned, the attending ED physician completed a case report form documenting diagnosis and treatment plan. The physician then was shown the ICG data and the same information was again recorded. Pre‐ and post‐ICG differences were analyzed. Results: Eighty‐nine patients were enrolled, with a mean age of 74.8 ± 7.0 years; 52 (58%) were African American, 42 (47%) were male. Congestive heart failure and chronic obstructive pulmonary disease were the most common final diagnoses, occurring in 43 (48%), and 20 (22%), respectively. ICG data changed the working diagnosis in 12 (13%; 95% CI = 7% to 22%) and medications administered in 35 (39%; 95% CI = 29% to 50%). Conclusions: Impedance cardiography data result in significant changes in ED physician diagnosis and therapeutic plan during the evaluation of dyspneic patients 65 years and older.
Reasons Why Patients Choose an Ambulance and Willingness to Consider Alternatives
Authors: Yarris Lalena M. , Moreno Raymond , Schmidt Terri A. , Adams Annette L. , Brooks Heather S. 
Published: March 2006

Abstract Objectives: To test a hypothesis that patients would accept alternatives to transport to an emergency department (ED) by ambulance and to evaluate factors related to patient willingness to consider alternatives. Concerns about resource utilization have prompted emergency medical services (EMS) systems to explore alternatives to ambulance transport to an ED, but studies have evaluated the safety of alternatives, not patient preferences. Methods: Trained research assistants surveyed patients transported by ambulance to a university ED. Interfacility transfers, trauma patients, and critically ill patients were excluded. The primary outcome was willingness to accept one of several presented alternatives to ambulance transport to the ED for that visit. Demographic and clinical factors were evaluated for association with willingness to consider alternatives. Relative risks (RR) and 95% confidence intervals (95% CI) were determined by using Mantel‐Haenszel stratified methods. Results: Three hundred fifteen subjects completed the survey. Two hundred forty‐seven (78.4%) were willing to consider at least one alternative. One hundred ninety‐four (61.6%) were willing to consider transportation by car, and 177 (56.2%) were willing to consider transportation by taxi. Factors associated with willingness to consider alternatives included the following: age 18–65 years (RR, 1.25; 95% CI = 1.03 to 1.49), being unemployed (RR, 1.08; 95% CI = 1.08 to 1.33), use of the ED for routine care (RR, 1.25; 95% CI = 1.17 to 1.35), and not being admitted to the hospital (RR, 1.19; 95% CI = 1.04 to 1.40). Race, gender, health insurance status, and EMS interventions en route were not associated with willingness to consider transportation alternatives. Conclusions: Many patients transported by ambulance to an ED would have considered an alternative, if one were offered.