bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Medicine Journal Clubs
Authors: Jouriles Nicholas J. , Cordell William H. , Martin Daniel R. , Wolfe Richard , Emerman Charles L. , Avery Ann 
Published: September 2008

ABSTRACTObjective: To ascertain the status of journal club within emergency medicine (EM) residency programs and to describe 3 currently used formats.Methods: The directors of U.S. Residency Review Committee for Emergency Medicine (RRC‐EM)‐approved residency programs were surveyed to determine the features of their programs' journal clubs. Responses to 3 questions assessing the degree of satisfaction (5‐item scales from very good to very poor) with the “current format,” “resident participation,” and “faculty participation” from the survey were grouped according to the program director's impressions of resident and faculty “enjoyment” (2 3‐item scales) and whether the journal club is a “success” (3‐item scale) to develop an overall satisfaction index. Three journal club formats currently in use at EM residencies are described in detail.Results: Of the 101 directors surveyed, 91 (90%) responded. The respondents' overall satisfaction index was highest when the journal club was held in the evening (p < 0.008) or at a faculty member's home (p < 0.0004). The format of the journal club (e.g., by topic, with a statistical focus, with a research design focus, or as a clinical practice update) was not associated with the overall satisfaction index.Conclusion: Journal clubs associated with EM residencies vary in format and perceived success. The 3 representative journal clubs illustrate different format options.
Thrombolytic Therapy for Cerebral Infarction
Authors: Kothari Rashmi , Pancioli Arthur , Brott Thomas , Broderick Joseph 
Published: September 2008

ABSTRACTUntil recently, no clinically effective therapy for acute ischemic stroke has been available. Recent advances in the use of thrombolytic therapy for ischemic stroke appear promising in clinical care. As the use of thrombolytic therapy in acute stroke progresses, emergency physicians (EPs) will become increasingly involved in its implementation. The EP must be cognizant of both prior and ongoing investigations in acute ischemic stroke therapy. To that end, this article reviews research in the field of thrombolytic therapy for acute ischemic stroke.
Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993
Authors: Crandall Cameron , Olson Lenora , Fullerton Lynne , Sklar David , Zumwalt Ross 
Published: September 2008

ABSTRACTObjective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.Methods: The authors retrospectively sampled in 5‐year intervals all victims of penetrating trauma who presented to either the state Level‐1 trauma center or the state medical examiner from a 16‐year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person‐years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.
A Truncated E‐code System for Injury Surveillance in the Emergency Department: Description and Clinometric Testing
Authors: Bota Gary W. , Therrien Sandra A. , Rowe Brian H. 
Published: September 2008

ABSTRACTObjectives: ED injury surveillance requires accurate information about mechanism. This study explored the clinometric properties of an E‐code system specifically designed to track ED injuries.Methods: All patients assessed in the ED had cause‐of‐injury information documented using a truncated E‐code system. Patient records were hand‐searched to determine coding compliance. A selection of 98 charts (50 injury/48 noninjury) were coded by 7 physicians, 2 nurses, and 2 nosologists. Agreements (interrater and intrarater) on the diagnosis of trauma and exact E‐codes were determined (using kappa; κ).Results: E‐coding compliance was high (overall 90%: 95% CI: 85–93%), and accuracy of injury classification was 99%. Compared with an expert's coding, agreement on injury classification was excellent for physicians (κ = 0.91; 95% CI: 0.80–1.0), nurses (κ = 0.88; 95% CI: 0.75–1.0), and nosologists (κ = 0.92; 95% CI: 0.81–1.0). Agreement was substantial for the exact E‐codes between physicians (κ = 0.77; 95% CI: 0.60‐ 0.94) and nurses (κ = 0.72; 95% CI: 0.54–0.90). Recode reliability was also excellent for physicians (κ = 0.88; 95% CI: 0.75–1.0) and nurses (κ = 0.96; 95% CI: 0.88–1.0).Conclusions: Injury coding using a truncated E‐code system can provide valid and reliable data from the ED. Differences between nurses, physicians, and nosologists in the ability to accurately code using this system were minimal, thus eliminating the need for additional staff and resources.
Telephone Follow‐up for Case Finding of Domestic Violence in an Emergency Department
Authors: Sixsmith Diane M. , Weissman Laurie , Constant Florence 
Published: September 2008

ABSTRACTObjective: To determine whether telephone follow‐up of selected female patients seen in an urban ED would improve domestic violence (DV) case finding.Methods: A prospective, cross‐sectional study was conducted on consecutive female patients between the ages of 16 and 65 years treated in an urban trauma center during July and August 1995. Record review identified those patients with conditions suggesting increased risk for DV: injury; substance abuse; complaints or diagnoses related to stress, anxiety, depression, or panic attack; or complaints of headache, nonspecific abdominal pain, generalized fatigue, or numbness lasting >] week. Attempts were made to telephone all patients who had high‐risk presentations within 3 days of their emergency visits. Patients were contacted by a trained interviewer regarding the circumstances of their visits.Results: There were 142 (9%) high‐risk presentations out of 1,500 ED visits by women. Of these high‐risk visits, 68 patients denied DV, 19 patients did not speak English, 16 patients gave an incorrect telephone number, 18 patients could not be reached after 3 telephone calls, and 6 patients did not give a telephone number. Of the remaining 15 patients, 5 were diagnosed at the initial visit as having experienced DV, and 10 admitted on the follow‐up call that the visit had been related to DV or emotional stress at home.Conclusion: A structured interview, conducted via telephone in follow‐up of released ED patients, identified an additional 10 victims out of 142 high‐risk presentations and 1,500 total ED presentations. This approach is labor‐intensive, with a relatively low yield. Nonetheless, prospective identification of selective high‐risk cases by physicians, coupled with subsequent social service telephone contact, may be a complement in department case finding.
Who Gets Bystander Cardiopulmonary Resuscitation in a Witnessed Arrest?
Authors: Jackson Raymond E. , Swor Robert A. 
Published: September 2008

ABSTRACTObjective: To identify characteristics associated with provision of bystander CPR in witnessed out‐of‐hospital cardiac arrest cases.Methods: An observational, prospective, cohort study was performed using cardiac arrest cases as identified by emergency medical services (EMS) agencies in Oakland County, MI, from July 1, 1989, to December 31, 1993. All patients who sustained a witnessed arrest prior to arrival of EMS personnel were reviewed.Results: Of the 927 patients meeting entry criteria, the 229 patients receiving bystander CPR were younger: 60.9 ± 14.7 vs 67.9 ± 14.7 years (p < 0.01). Most (76.6%) cardiac arrests occurred in the home. In a multivariate logistic model, only the location of arrest outside the home was a significant predictor of receiving bystander CPR [odds ratio (OR) 3.8; 99% CI 2.5, 5.9]. Arrests outside the home were associated with significantly improved outcome, with 18.2% of out‐of‐home and 8.2% of in‐home victims discharged from the hospital alive (OR 2.5; 99% CI 1.4, 4.4).Conclusion: Patients who have had witnessed cardiac arrests outside the home are nearly 4 times more likely to receive bystander CPR, and are twice as likely to survive. This observation emphasizes the need for CPR training of family members in the authors' locale. This phenomenon may also represent a significant con‐founder in studies of out‐of‐hospital cardiac arrest and resuscitation.
Population Density, Automated External Defibrillator Use, and Survival in Rural Cardiac Arrest
Authors: Stapczynski J. Stephan , Svenson James E. , Stone C. Keith 
Published: September 2008

ABSTRACTObjective: To determine whether population density is an independent predictor of survival from out‐of‐hospital cardiac arrest managed by basic life support (BLS) services using automated external defibrillators (AEDs).Methods: A retrospective, observational study in Kentucky of 34 BLS services covering 22 counties during the years 1992 to 1994 who used AEDs to treat patients who had out‐of‐hospital cardiac arrests.Results: Of 311 patients who had out‐of‐hospital cardiac arrests, 110 (35%) were defibrillated, 46 (15%) were resuscitated to hospital admission, and 19 (6%) survived to hospital discharge. Univariate predictors for survival to hospital discharge were emergency medical services response interval (from call receipt to ambulance arrival) <8 minutes, defibrillation by the AED, initial rhythm of ventricular fibrillation or ventricular tachycardia (VF/VT), and population density >100/square mile (sq mi) for the BLS service area (p < 0.001). A forced logistic regression model of survival to hospital discharge, using these 4 factors plus the presence of a witnessed arrest or bystander CPR, demonstrated that population density >100/sq mi was highly significant (OR 9.4, 95% CI: 1.7 to 51.4, p < 0.01). Stepwise logistic regression models with combinations of these 6 factors found that survival to hospital discharge was best predicted by an initial rhythm of VF/VT (p = 0.004) and population density >100/sq mi (p = 0.011).Conclusions: Population density is strongly associated with survival from out‐of‐hospital cardiac arrest. BLS services within areas with population densities ≤100/sq mi sustained little benefit from the addition of AEDs to their treatment of patients who had out‐of‐hospital cardiac arrests.
Frequent Users of the Emergency Department: Can We Intervene?
Authors: Spillane Linda L , Lumb Eileen W. , Cobaugh Daniel J. , Wilcox Susan Riley , Clark John S. , Schneider Sandra M. 
Published: September 2008

ABSTRACTObjective: To determine whether the use of individualized patient care plans and multidisciplinary case management would decrease ED utilization by frequent ED users.Methods: The authors performed a prospective, randomized clinical trial of the impact of a care plan on ED use by adults with frequent ED visits. Patients with >10 ED visits to a university hospital in 1993 were identified. Patients were matched for age, sex, and number of visits and then randomized into 2 groups. The control group received standard emergency care. The treatment group was managed by a multidisciplinary team and treated in the ED according to individualized care plans. ED use was tracked at the university hospital and at the other 5 community hospitals in the city.Results: Of the 70 enrolled patients, 25 of 37 control patients and 27 of 33 treatment patients made visits to the university hospital during the 1‐year study period. Only those patients with follow‐up visits were included in the data analysis. Patients remaining in the control group made 247 total visits (range 1–65) to the university hospital and 179 total visits (range 0–38) to the community hospitals during the study period. Patients in the treatment group made 320 total visits (range 1–72) to the university hospital and 254 total visits (range 0–135) to the community hospitals during the study period. There was no significant difference in the median number of visits made to either the university hospital or the community hospitals by the patients in the control group and those in the treatment group.Conclusions: The use of individualized care plans and case management did not significantly decrease ED utilization by frequent ED users. However, the impact of individualized care plans and case management on other quality‐of‐care measures (e.g., patient satisfaction, ED length of stay, hospitalizations, primary care visits, and health care costs) remains to be determined.
Evaluation of a New Assay for Cardiac Troponin I vs Creatine Kinase‐MB for the Diagnosis of Acute Myocardial Infarction
Authors: Brogan Gerard X. , Hollander Judd E. , McCuskey Charles F. , Thode Henry C. , Snow Jeffrey , Sama Andrew , Bock Jay L. ,   Biochemical Markers for Acute Myocardial Ischemia (BAMI) Study Group
Published: September 2008

ABSTRACTObjective: To compare a new assay for cardiac troponin I (cTn‐I) with an assay for creatine kinase‐MB (CK‐MB) for the diagnosis of acute myocardial infarction (AMI).Methods: A prospective cross‐sectional study of patients presenting with symptoms consistent with cardiac ischemia was performed at a university teaching hospital. Serum sampling for cTn‐I and CK‐MB was performed at 0, 1, 3, 8, and 16 hours after presentation. Normal values were defined as CK‐MB ≤ 7 ng/mL and a relative index ≤ 2%, cTn‐I ≤ 1.4 ng/mL. Final diagnosis was made using World Health Organization criteria, including standard enzyme sampling. Consecutive patients with AMI were compared with a randomly selected subset of patients without AMI to determine the sensitivity and specificity of the cTn‐I and CK‐MB assays for AMI, stratified by time from symptom onset. The ability of the biochemical cardiac markers obtained within 6 hours of symptom onset to predict later complications or need for interventions was assessed using odds ratios (ORs).Results: Thirty‐five patients who had AMI were compared with 136 patients who did not have AMI. The sensitivities and specificities of the cTn‐I and CK‐MB assays, stratified by time from symptom onset, were: Patients who had elevations in either CK‐MB or cTn‐I within 6 hours of symptom onset were at increased risk for cardiovascular complications and/or interventions (CK‐MB, OR 5.8; cTn‐I, OR 6.3).Conclusion: cTn‐I was as sensitive and specific for AMI as was CK‐MB in ED patients who presented within 24 hours of symptom onset. However, cTn‐I was more sensitive in patients who presented ≥ 24 hours after symptom onset. Elevations of either marker within 6 hours of symptom onset predict an increased risk of complications and/or need for interventions.
Evaluation of Ketorolac in Children with Forearm Fractures
Authors: Pierce Mary Clyde , Fuchs Susan 
Published: September 2008

ABSTRACTObjectives: To evaluate ketorolac for pain relief and an opioid‐sparing effect in children with forearm fractures necessitating reduction.Methods: A prospective, randomized, double‐blind study was conducted at an urban children's hospital ED. A convenience sample of children aged 3–18 years with isolated forearm fractures was studied. None received prior pain medication. A 10‐point visual analog scale (VAS) was used to assess pain at the time of study entry and prior to sedation/analgesia. The Children's Hospital of Eastern Ontario's Pain Score (CHEOPS), a 13‐point behavioral score, was used to assess pain during sedation. Patients received either IV ketorolac (K), 1 mg/kg, or saline (S) after entry into the study. After a minimum of 20 minutes, pain was reassessed and supplemental analgesia/sedation administered. A standard dose of midazolam, 0.1 mg/kg to a maximum of 6 mg, was given to all patients, and fentanyl was titrated at 1‐μg/kg increments based on patient need. Once the patient was comfortable, reduction was performed and a reduction CHEOPS score assigned.Results: For the 34 study children (17 K, 17 S), there was no difference in sex or mean age between the groups. Mean total doses of fentanyl were 2.26 μg/kg in the K group and 2.85 μg/kg in the S group (p = 0.07). The median changes in VAS score before and after receiving the study drug were —1.13 K and ‐0.18 S (p = 0.06). The median CHEOPS score was 10 for both groups. Seven of the 17 patients in the S group required the maximum fentanyl dose (4 μg/kg), compared with 2 of 17 in the K group (p = 0.06).Conclusions: Although ketorolac seems to add to patient comfort in children with forearm fractures, it does not have a significant opioid‐sparing effect. Ketorolac showed a trend toward pain relief, but statistical significance was not reached.
Alcohol Use among Injured Patients Aged 12 to 18 Years
Authors: Mannenbach Mark S. , Hargarten Stephen W. , Phelan Mary Beth 
Published: September 2008

ABSTRACTObjective: To examine the scope of alcohol use among a population of injured adolescents.Methods: A convenience sample of injured patients aged 12–18 years seen at a pediatric ED was tested for the presence of alcohol. Injured patients seen within 6 hours of their injuries were asked to submit urine samples for testing using reagent strips. Data were collected from the patient, out‐of‐hospital emergency care personnel, and parents regarding the circumstances of the injury.Results: Of the 243 injured patients who were tested during an 8‐month period, 231 were included in the final analysis. Ninety patients (39%) were alcohol‐positive. The mean age of the alcohol‐positive group was 16.0 ± 1.64 years, compared with 15.3 ± 1.8 years for the alcohol‐negative group (p < 0.003). There was no significant difference between the 2 groups based on race, gender, or injury characteristics. A positive urine alcohol test was found for 18 (33%) of the motor vehicle crash victims, 9 (38%) of the motor vehicle drivers, 10 (37%) of the patients who attempted suicide, and 49 (44%) of the assault victims.Conclusions: A substantial percentage of injured adolescent patients were alcohol‐positive. The authors recommend the use of alcohol screening when treating injured adolescents.
Rotating Shiftwork Schedules: Can We Enhance Physician Adaptation to Night Shifts?
Authors: Smith‐Coggins Rebecca , Rosekind Mark R. , Buccino Kenneth R. , Dinges David F. , Moser Richard P. 
Published: September 2008

ABSTRACTObjectives: To evaluate the effectiveness of a broad, literature‐based night shiftwork intervention for enhancement of emergency physicians' (EPs') adaptation to night rotations.Methods: A prospective, double‐blind, active placebo‐controlled study was conducted on 6 attending physicians in a university hospital ED. Three data sets were collected under the following conditions: baseline, after active placebo intervention, and after experimental intervention. In each condition, data were collected when the physicians worked both night and day shifts. Measurements included ambulatory polysomnographic recordings of the main sleep periods, objective performance tests administered several times during the subjects' shifts, and daily subjective ratings of the subjects' sleep, moods, and intervention use.Results: The subjects slept an average of 5 hr 42 min across all conditions. After night shifts, the subjects slept significantly less than they did after day shifts (5 hr 13 min vs 6 hr 20 min; p < 0.05). The physicians' vigilance reaction times and times for intubation of a mannequin were significantly slower during night shifts than they were during day shifts (p = 0.007 and p < 0.04, respectively), but performances on ECG analysis did not significantly differ between night and day shifts. Mood ratings were significantly more negative during night shifts than they were during day shifts (more sluggish p < 0.04, less motivated p < 0.03, and less clear thinking p < 0.04). The strategies in the experimental intervention were used 85% of the time according to logbook entries. The experimental and active placebo interventions did not significantly improve the physician's performance, or mood on the night shift, although the subjects slept more after both interventions.Conclusions: Although the experimental intervention was successfully implemented, it failed to significantly improve attending physicians' sleep, performance, or mood on night shifts. A decrease in speed of intubation, vigilance reaction times, and subjective alertness was evident each time the physicians rotated through the night shift. These findings plus the limited sleep across all conditions and shifts suggest that circadian‐mediated disruptions of waking neurobehavioral functions and sleep deprivation are problems in EPs.
Underrecognition of Cervical Neisseria gonorrhoeae and Chlamydia trachomatis Infections in the Emergency Department
Authors: Yealy Donald M. , Greene Thomas J. , Hobbs Gregory D. 
Published: September 2008

ABSTRACTObjectives: 1) To quantify the frequency of underrecognized Neisseria gonorrhoeae and Chlamydia trachomatis cervical infections in women tested in the ED, 2) to describe and compare the characteristics of those treated and not treated during the initial visit, and 3) to quantify the delay interval until treatment was provided.Methods: A 2‐year, retrospective consecutive case series was performed from June 1, 1992, to May 31, 1994. There were 148 women with ≥1 discrete occurrence of culture‐proven cervical N. gonorrhoeae or C. trachomatis infection studied. All the patients were evaluated in a university‐affiliated, tertiary care hospital‐based ED with a large rural referral area. The main outcome measures were the proportions of patients with positive cultures both treated and not treated in the ED, the clinical characteristics of each group, and the proportion remaining untreated or experiencing treatment delays of ≥ 2 weeks after attempted phone, mail, and public health follow‐up.Results: Of 157 occurrences of positive cultures for N. gonorrhoeae or C. trachomatis, 86 (53%) were treated with a regimen suggested by the CDC prior to ED release. The proportion of women with isolated C. trachomatis infections that were underrecognized and untreated initially was larger than the proportions with isolated N. gonorrhoeae or combined infections (79% vs 27% and 53%, respectively, p < 0.0001). Women with findings suggestive of advanced disease (history of fever or chills, or examination evidence of temperature >38°C, purulent vaginal discharge, or any uterine/salpinx/ovarian tenderness) were more often recognized and treated with appropriate antibiotics initially (p = 0.02 to <0.00001 for all). After phone, mail, and public health follow‐up, treatment could not be documented for 25% of the occurrences, in all cases due to an inability to locate the patient. An additional 20% of the women did not receive treatment for 14–60 days.Conclusions: In this population, both N. gonorrhoeae and C. trachomatis cervical infections are frequently underrecognized in the ED, with isolated C. trachomatis infections associated with significantly higher proportions of underrecognition. Many affected women remain untreated for extended intervals, creating public and individual health risks. Improved point of contact detection, follow‐up, and treatment policies are needed to limit these risks.