bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rate of Patient Workups by Non–Emergency Medicine Residents in an Academic Emergency Department
Authors: Stone C. Keith , Stapczynski J. Stephan , Thomas Stephen H. , Koury Shaheed I. 
Published: September 2008

ABSTRACTObjective: To quantify the number of patients seen per hour by non–emergency medicine (non–EM) residents in a university hospital ED.Methods: This retrospective observational study was performed in a university hospital ED and level I trauma center. The facility had no EM residency, but was staffed with 24–hour EM faculty coverage. A computerized tracking system was searched for the number of patients seen by each of 93 non–EM residents for 12 nonconsecutive months. The ED schedule for each month was used to calculate the number of hours worked by each resident. From these figures, the number of patients seen per hour by each resident was calculated.Results: The postgraduate years of training of the residents were as follows: 78 (84%) were PGY1, ten (11%) were PGY2, and five (5%) were PGY3. All the residents combined saw a mean 0. 95 ± 0. 20 patients/ hour, with a range from 0. 58 to 1. 75 patients/hour. There was no significant difference between the numbers of patients seen when compared by specialty using the Tukey–Kramer test (α = 0. 05).Conclusion: The rate at which non–EM residents work up patients is consistent with previously reported rates for EM residents.
Communicating Information to Patients: The Use of Cartoon Illustrations to Improve Comprehension of Instructions
Authors: Delp Chris , Jones Jeffrey 
Published: September 2008

ABSTRACTObjective: To evaluate the effect of cartoon illustrations on patient comprehension of and compliance with ED release instructions.Methods: A prospective, randomized, controlled study of consecutive patients who presented to the ED of a community teaching hospital with lacerations necessitating wound repair during a three‐month study period. At ED release, the patients were randomly assigned to receive wound care instructions with or without cartoon illustrations. Three days later, the patients were followed up by telephone. A blinded investigator asked a series of questions designed to test the patient's recall of, understanding of, and compliance with wound care instructions.Results: A total of 234 patients were successfully contacted by telephone; 105 (45%) had been given ED release instructions with cartoons, 129 (55%), without cartoons. There was no significant difference in age, gender, level of education, or satisfaction with the ED visit between the two groups. The patients given cartoon instructions were more likely to have read the instructions (98% vs 79%, p < 0. 001), were more likely to answer all wound care questions correctly (46% vs 6%, p < 0. 001), and were more compliant with daily wound care (77% vs 54%, p < 0. 01). Subset analysis of those patients who had less than a high school education (n = 57) demonstrated even larger differences between the two treatment groups in terms of comprehension of and compliance with ED release instructions.Conclusion: Cartoon illustrations are an effective strategy for conveying information and may improve patient compliance with ED release instructions.
Community–wide Emergency Department Visits by Patients Suspected of Drug–seeking Behavior
Authors: Zechnich Andrew D. , Hedges Jerris R. 
Published: September 2008

ABSTRACTObjective: To measure community–wide ED use by patients at high risk for drug–seeking behavior.Methods: A retrospective, observational study was performed to analyze a cohort of university hospital ED patients seen January 1 to June 30, 1990, for specific pain–related diagnoses (i.e., ureteral colic, toothache, back pain, abdominal pain, or headache) and either independently identified on at least one other local hospital's “patient alert” list or having a drug–related death during 1990. Patients with terminal illnesses were excluded. The frequency of ED (and affiliated urgent care clinic) visits and hospital admissions were determined for January 1 to December 31, 1990, at seven local hospitals. Detailed, supplemental chart review was performed for visits to three of these hospitals from 1990 to 1992.Results: Thirty patients were identified as being at risk for drug–seeking behavior (mean age: 34.3 years; range: 21–55 years; 50% males). We identified 379 visits for this cohort (86% ED visits, 9.8% urgent care visits, 4.7% hospital admissions), for an average of 12.6 visits (range: 2–33) per patient per year. On average, each patient visited 4.1 (range: 1–7) different hospitals and used 2.2 (range: 1–6) different aliases. Two patients died of drug overdose. Supplemental chart review revealed 28 episodes (among 17 different patients) in which a patient was told that he or she “would receive no further ‘narcotics’” from that facility; these patients subsequently received controlled substances from another hospital in 93% of these instances and from the same facility in 71%.Conclusions: Patients identified as being at high risk for drug–seeking behavior have high community–wide ED visit rates. Improving communication between and within hospitals may help identify patients who could benefit from more consistent community–wide care and appropriate treatment for addiction.
Variance Cardiography for Emergency Department Evaluation of Chest Pain Patients
Authors: Spadafore Joseph C. , Lieber James G. , Vasilenko Peter 
Published: September 2008

ABSTRACTObjective: To determine the test performance of 24–lead variance cardiography (VC), an ECG technique that measures QRS morphologic variability, for ED evaluation of chest pain associated with coronary artery disease (CAD).Methods: A prospective, single–blind study of VC was performed in a community teaching hospital ED. All chest pain patients (>30 years of age) who, after initial emergency physician evaluation, were believed to have pain of potential cardiac etiology and were admitted to the hospital were eligible. Exclusion criteria included obvious noncardiac etiology for discomfort, bundle–branch block, atrial fibrillation, and incomplete subsequent cardiac evaluation. After initial evaluation and stabilization, VC was obtained. The numerical output of VC was a CAD index (CADI). Serum myoglobin and creatine kinase (CK)–MB levels were obtained at the time of presentation and after one, two, and six hours. Hospital records were reviewed to determine final diagnosis and in–hospital evaluation results.Results: Fifty–two of 75 eligible patients had complete data. Final diagnoses were as follows: 27/52 (52%), noncardiac; 13/52 (25%), acute myocardial infarction (AMI); and 12/52 (23%), unstable angina due to CAD. Twenty–three percent (12/52) of the patients had CADIs < 75. Eleven of these were found to have noncardiac origins for their chest pain. The twelfth patient had a 12–lead ECG revealing AMI and had been given thrombolytic therapy with subsequent reperfusion prior to VC. Using a CADI < 75 as the cutoff for a negative study, VC alone had a negative predictive value of 92%, a sensitivity of 96%, a positive predictive value of 60%, and a specificity of 41%.Conclusion: A CADI < 75, in addition to clinical impression and initial ECG, may identify chest pain patients who do not have significant CAD. Further prospective assessment of VC is warranted.
Serial Myoglobin Levels for Patients with Possible Myocardial Infarction
Authors: Davis Charles P. , Barrett Kevin , Torre Paul , Wacasey Kevin 
Published: September 2008

ABSTRACTObjectives: To determine the sensitivity and specificity of a new myoglobin assay for acute myocardial infarction (AMI), considering both the total amount of serum myoglobin and its percentage change over 2 hours.Methods: A prospective, observational test performance study for the recognition of AMI was done using serial myoglobin assays of 42 admitted chest pain patients at a large, urban teaching hospital ED. Myoglobin testing was performed at presentation (time 0) and at 1 and 2 hours after arrival. A myoglobin level >100 g/L (ng/mL) or a change >50% from baseline (increase or decrease) any time during the 2–hour period was considered positive. Patients and their physicians were blinded to the myoglobin results. The managing clinician's final diagnosis of the presenting event was used as the diagnostic criterion standard.Results: The sensitivity of the myoglobin technique for detection of AMI in the first hours in the ED was 13/14 (93%; 95% CI: 66–100%). The 1 patient who had a false‐negative test had evidence of AMI on the ECG and an initially abnormal creatine kinase‐MB (CK‐MB) assay. The specificity was 22/28 (79%; 59–92%). However, of the 6 patients who had “false‐positive” myoglobin tests, all had serious illness: significant cardiac disease (n = 4), in‐hospital death (n = 1), or deep venous thrombosis (n = 1).Conclusion: Myoglobin level determinations are sensitive tests to detect AMI during the first 2 hours of a patient's stay in the ED and may complement current clinical tools.
An Emergency Medicine Approach to Violence throughout the Life Cycle
Authors: Muelleman Robert L. , Reuwer John , Sanson Tracy G. , Gerson Lowell , Woolard Bert , II Arthur H. Yancy , Bernstein Edward ,   for the SAEM Public Health and Education Committee
Published: September 2008

ABSTRACTThis document by the SAEM Public Health and Education Committee outlines the public health impact of interpersonal violence as it pertains to acute emergency care. This paper provides an overview of violence through the life cycle (i.e., child abuse, youth violence, intimate violence, and elderly abuse). It also makes specific recommendations regarding the role emergency physicians can play in reducing violence through medical education, research, surveillance, public education, advocacy, and clinical practice.
Blood Cultures in Adult Patients Released from an Urban Emergency Department: A 15‐month Experience
Authors: Sturmann Kai M. , Bopp James , Molinari Diane , Akhtac Saadia , Murphy Jane 
Published: September 2008

ABSTRACTObjective: To determine the frequency of positive blood cultures obtained from adult patients with potential occult bacteremia released from an urban ED and how often these positive cultures alter the subsequent patient course or management.Methods: This retrospective case series study was conducted at the ED of a large, urban teaching hospital. The study population consisted of a convenience sample of adult patients who presented to the ED with evidence of fever or other clinical conditions suggesting the possibility of bacteremia. The records of all patients who had blood cultures done and who were not admitted to an inpatient service were reviewed. Follow‐up was obtained for all patients for whom culture results were positive. A substantial influence on the medical management or clinical course by a (noncontaminant) positive blood culture result was defined as a positive result that directly led to: further diagnostic testing, hospital admission, initiation or alteration of antibiotic therapy, or a different diagnosis. Culture‐positive patients who were noncompliant with requested ED follow‐up were included in this estimate. An estimate of the laboratory charges per diagnosis of bacteremia also was derived.Results: Only 24 of 1,350 patients (1.8% of the study population; 95% CI 1.1–2.5%) had true‐positive blood cultures. Only 7 patients (0.52% of the population; 95% CI 0.14–0.90%) potentially had their medical management affected by the positive blood culture results. Based on the laboratory charges associated with all blood cultures for this patient group, the cost per clinically significant positive blood culture result was $11,570.Conclusions: The prevalence of bacteremia was 1.8% among the released patients who had blood cultures obtained in the ED. Furthermore, only 0.52% of the patients had positive blood cultures that potentially affected their medical management. Further study is warranted to identify specific criteria for selecting ambulatory patients for whom the use of blood cultures may be cost‐effective.
Subarachnoid Hemorrhage Diagnosis: Lumbar Puncture Is Still Needed When the Computed Tomography Scan Is Normal
Authors: Sidman Robert , Connolly Emily , Lemke Thomas 
Published: September 2008

ABSTRACTObjectives: To determine the sensitivity of third‐generation CT scanners for diagnosed nontraumatic subarachnoid hemorrhage (SAH) and to assess the impact of symptom duration on sensitivity.Methods: A retrospective chart review was performed in a university‐affiliated tertiary care hospital with an annual ED volume of >100,000 patients. The target population was all patients who presented to the ED from January 1991 to September 1994 with symptoms suggestive of SAH and who had a final diagnosis of nontraumatic SAH based on either a positive CT scan or positive spinal fluid analysis. Patients referred from outside facilities were included if they had a CT done at the study site. All CT scans were done using third‐generation scanners. Official CT scan reports were used to categorize scans as positive or negative.Results: There were 140 patients identified with SAH, with a mean age of 56 years (range 10–88). The sensitivity of CT in the diagnosis of nontraumatic SAH when performed at or before 12 hours of symptom duration was 100% (80/80), and 81.7% (49/60) after 12 hours of symptom duration (95% CI 95–100% and 69.5–90.4%, respectively; p < 0.0001). Eleven of the 140 patients had a negative CT and positive spinal fluid analysis, yielding an overall sensitivity of 92.1% (129/140).Conclusion: The sensitivity of third‐generation CT scans for SAH decreases with time from the onset of symptoms. In this sample population, CT was able to detect all patients scanned ^12 hours after symptom onset. Although the study demonstrated good sensitivity of CT scan reports for SAH when the scan was performed after S12 hours of symptom onset, additional real‐time experience is needed to better define the potential risk of a missed SAH should this population not receive the customary lumbar puncture examination in the setting of a negative CT scan.
The Frequency of Unsuspected Minor Illness or Injury in Intoxicated Patients
Authors: Biros Michelle H. 
Published: September 2008

ABSTRACTObjective: To determine the frequency of unsuspected minor illness or injury in a group of patients frequently seen in the ED for acute intoxication.Methods: The medical records of the 20 patients seen most frequently in the ED for acute intoxication in 1993 were reviewed for the number of ED visits for intoxication, the number of associated documented episodes of minor trauma or illness, the extent of ED workup of discovered illness or injury, and patient disposition from the ED.Results: The 20 study patients were evaluated in the ED 1,858 times in 1993 for acute intoxication, a mean of 92.5 visits/patient (±26.6). The most frequent injury was minor trauma above the neck, occurring a mean of 9 times (±3.6) in each of the study patients during 1993. Evaluation included repeated neurologic examinations and frequent radiography of the cervical spine (n = 80), skull (n = 5), facial bones (n = 6), and mandible (n = 5). A limited number of head CT scans also were done (n = 8). The most frequent minor illnesses were gastritis (n = 7), managed with hydration, and mild hypothermia (n = 6), managed with passive rewarming.Conclusions: The incidence of unsuspected minor illness or injury in this patient group was substantial. While most unsuspected medical problems had little clinical significance, some were potentially dangerous, and some necessitated hospitalization (e.g., hypothermia, hematemesis, and respiratory depression).
Flunitrazepam and Its Involvement in Date or Acquaintance Rape
Authors: Anglin Deirdre , Spears Kelvin L. , Hutson H. Range 
Published: September 2008

ABSTRACTAn estimated 1 in 4 women in the United States will be raped in their lifetimes. Approximately 75% of all rapes are date or acquaintance rapes. Recently the illegal use of flunitrazepam (Rohypnol), a benzodiazepine, as a prelude to the assault has been reported. Flunitrazepam readily dissolves, and once in solution, is colorless, odorless, and tasteless. The predominant clinical manifestations are drowsiness, impaired motor skills, and anterograde amnesia. Due to the amnestic effects of flunitrazepam, historical clues of the rape event are difficult to obtain. Patients with a complaint of sexual assault who appear intoxicated or have anterograde amnesia should be suspected of unknowingly ingesting flunitrazepam. In addition to adhering to standard rape protocols, a urine specimen should be analyzed for flunitrazepam metabolites using gas chromatography/mass spectrometry. If the hospital, local, or forensic laboratory is unable to analyze for flunitrazepam, Hoffmann‐La Roche Inc., the manufacturer of Rohypnol, should be contacted. Hoffmann—La Roche has a mechanism for definitive testing for flunitrazepam, at no cost, for health care providers, rape treatment centers, and law enforcement agencies. A network of organizations is attempting to reduce the abuse of flunitrazepam in association with date rape.
Role of Pilot Instrument Proficiency in the Safety of Helicopter Emergency Medical Services
Authors: Wuerz Richard C. , O'Neal Rick 
Published: September 2008

ABSTRACTObjectives: To determine whether instrument‐proficient pilots would more safely manage a flight into unplanned instrument meteorologic conditions (IMC) than would nonproficient pilots.Methods: A controlled experimental study was performed using a full‐motion helicopter simulator. Participants were emergency medical services (EMS) pilots with commercial licenses and previous simulator experience who were blinded to the study design and hypothesis. During a simulated EMS mission, cloud ceiling and visibility were decreased until IMC prevailed, and pilot actions were recorded. Data included the altitude at which the aircraft entered IMC, and whether the pilots maintained control of the aircraft, flew within aviation standards (i.e., bank angle, airspeed), and safely landed.Results: Twenty‐eight pilots (13 instrument‐proficient, 15 nonproficient) participated; they had a median of 6,300 hours of helicopter experience. Two pilots crashed, both from the nonproficient group. The instrument‐proficient pilots lost control less often (15% vs 67%, p < 0.05), maintained instrument standards more often (77% vs 40%, p < 0.05), and entered IMC at a higher altitude (689 feet vs 517 feet, p < 0.05) compared with the nonproficient pilots. Instructor comments indicated that the nonproficient pilots made more errors than did the instrument‐proficient pilots.Conclusions: Instrument‐proficient pilots more safely manage an unexpected encounter with IMC. Helicopter EMS programs should strongly consider maintaining instrument proficiency to enhance safety.
Early Stroke Recognition: Developing an Out‐of‐hospital NIH Stroke Scale
Authors: Kothari Rashmi , Hall Kent , Brott Thomas , Broderick Joseph 
Published: September 2008

ABSTRACTObjective: To develop an abbreviated and practical neurologic scale that could assist emergency medical services or triage personnel in identifying patients with stroke.Methods: A prospective, observational, cohort study was performed at university‐based EDs. Participants were 74 patients treated in a thrombolytic stroke trial and 225 consecutive non‐stroke patients evaluated during 4 random 12‐hour shifts in the ED. Scores on the NIH Stroke Scale were obtained for all patients by physicians. Items of this scale were modified and recoded to a binomial (normal or abnormal) scale. Serial univariate analyses using χ2 were performed to rank items. Recursive partitioning was then performed to develop the decision rule for predicting the presence of stroke.Results: Three items identified 100% of patients with stroke: facial palsy, motor arm, and dysarthria. An Abbreviated NIH Stroke Scale based on these items had a sensitivity of 100% and a specificity of 92%. A proposed Out‐of‐hospital NIH Stroke Scale consisting of facial palsy, motor arm, and a combination of dysarthria and best language items (abnormal speech) had a sensitivity of 100% and a specificity of 88%.Conclusion: Using the derivation data set, a proposed Out‐of‐hospital NIH Stroke Scale had a high sensitivity and specificity for identifying patients with stroke when performed by physicians in this group of 299 ED patients. Prospective studies of other health care professionals using the scale in the out‐of‐hospital arena are needed.
The Effect of Injection Speed on the Pain of Lidocaine Infiltration
Authors: Krause Richard S. , Moscati Ronald , Filice Michael , Lerner E. Brooke , Hughes David 
Published: September 2008

ABSTRACTObjective: To determine whether reducing the speed of injection is effective in reducing injection pain for buffered and unbuffered lidocaine solutions.Methods: A prospective, single‐blind, randomized, crossover, laboratory study was performed. Adult volunteers were recruited from ED staff at an urban teaching hospital to serve as subjects. Twenty‐nine subjects each received 4 1‐mL injections into the dorsum of the hands. Each subject received fast and slow injections of buffered and unbuffered lidocaine. Subjects rated the pain of each injection on a 100‐mm visual analog scale (VAS). Mean pain scores for each intervention were compared using analysis of variance.Results: The mean pain VAS score for fast injection of buffered lidocaine was 14.1 mm. For slow buffered injection, the mean pain score was 11.4 mm (p = 0.98). For unbuffered lidocaine, the means were 28.7 mm for fast injection and 22.2 mm for slow injection (p = 0.40).Conclusions: Reducing injection speed did not produce a statistically significant change in injection pain for either buffered or unbuffered solutions.
Victimization from Physical Violence in Pennsylvania: Prevalence and Health Care Use
Authors: Forjuoh Samuel N. , Kinnane Janet M. , Coben Jeffrey H. , Deanvater Stephen R. , Songer Thomas J. 
Published: September 2008

ABSTRACTObjectives: To determine the prevalence of interpersonal physical violence (IPV) among Pennsylvania adults, to identify the personal characteristics of the victims, and to determine their health care use for resulting injuries.Methods: Population‐based data describing physical violence were obtained through a statewide telephone survey of 3,620 Pennsylvania adults selected from households by random‐digit dialing in 1994. The prevalence and 95% confidence interval (95% CI) of victimization from IPV along with ED or other medical care facility use for IPV‐related injuries were computed by several personal characteristics. Logistic regression was used to compare victims of IPV and their levels of health care use.Results: The prevalence of reported victimization from IPV was 5.6% (95% CI = 4.9, 6.3). Significantly more victimization was reported by males, persons aged 18–29 years, those employed, and unmarried persons. The proportion of victims who reported to have gone to an ED or other medical care facility for IPV‐related injury treatment was 12.9%. Significantly more persons with annual household incomes <$20,000 reported health care use for injuries resulting from IPV than did those with incomes of ≥$20,000 (OR = 3.98; 95% CI = 1. 27, 12.48). Health care use for injuries was not found to be related to gender, age. race, employment, or marital status.Conclusions: This population‐based study of health care use for IPV‐related injuries found that victims of physical violence in Pennsylvania were not only young and unmarried men, but also employed. Health care use for resulting injuries was greater among persons with lower incomes.
Faculty Development in Emergency Medicine
Authors: Jouriles Nicholas J. , Kuhn Gloria J. , Moorhead John C. , Ray V. Gail , Rund Douglas A. 
Published: September 2008

ABSTRACTFaculty development is an important, multifaceted topic in academic medicine. In this article, academic emergency physicians discuss aspects of faculty development, including: 1) a department chair's method for developing individual faculty members, 2) the traditional university approach to promotion and tenure, 3) faculty development in a new department, and 4) personal development.