bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Potential of Using Billing Data for Emergency Department Injury Surveillance
Authors: Weiss Harold B. , Dill Susan M. , Garrison Herbert G. , Coben Jeffrey H. 
Published: September 2008

ABSTRACTObjective: To determine the availability of and sample statewide ED injury information obtained from hospital billing data for the purpose of demonstrating the feasibility of information acquisition for subsequent data linkage.Methods: A retrospective, database investigation was conducted to obtain data describing a statewide stratified sample of ED patients. The aim was to collect a computerized billing summary record for each injured ED patient seen at each sampled hospital over a 1‐year period. All 215 Pennsylvania acute care hospitals in 1991 were eligible for sample selection. Data collection for the project was conducted in 1993. Participants included directors of hospital medical records and billing departments.Results: Twenty‐four hospitals contributed data sets from the original target goal of 31 strata. The final combined data set contained 187,404 records with injury diagnoses from approximately 616,000 ED patient visits, representing a 12% sample of all annual statewide ED visits. Age, sex, date of visit, and primary diagnosis fields were completed from the retrieved data >99% of the time. More than two‐thirds of the sampled records had a social security number, and total charges were recorded >90% of the time. Other variables such as name and address were contained in <50% of the records submitted. E‐codes were usually not available.Conclusions: Retrospective compilation of multihospital ED billing data to create a statewide ED data sample—with the potential for injury research and probabilistic database linkage—can be accomplished; there are, however, important limitations.
Is Closed Diagnostic Peritoneal Lavage Contraindicated in Patients with Previous Abdominal Surgery?
Authors: Moore Gregory P. , Alden Andrew W. , Rodman George H. 
Published: September 2008

ABSTRACTObjective: To compare the accuracies and complication rates of diagnostic peritoneal lavage (DPL) in trauma patients with and without previous abdominal surgery.Methods: A retrospective review of DPL accuracy and complication rate was performed using all ED trauma patients who underwent DPL during 1993 as identified by the trauma registry. Care was provided at a Level‐1 trauma center, a 1,100‐bed, central‐city teaching hospital with an annual ED census of 84,000. Records were reviewed for a history of previous surgery, DPL results, complications, mechanism of injury, and location of abdominal scars. DPL was performed using the Seldinger technique with a standard Arrow Diagnostic Peritoneal Lavage Kit using an 8‐Fr catheter. Rates for patient groups with and without previous abdominal surgery were compared using Fisher's exact test. A “misclassified” DPL was defined as either a positive DPL with negative laparotomy or a negative DPL with subsequent need for laparotomy. “Complications” were defined as iatrogenic injury during the procedure or inability to obtain return of fluid during the lavage.Results: A total of 372 DPLs were performed; 42 in patients with previous surgery and 330 in patients without prior surgery. The groups were similar with respect to proportion with blunt trauma (95% vs 97%), positive DPL (19% vs 19%), misclassified rate (2.4% vs 1.8%), and complication rate (2.4% vs 0.9%); no significant difference was found between groups. The previous abdominal surgeries were appendectomy (n = 20), tubal ligation (n = 5), abdominal hysterectomy (n = 4), cholecystectomy (nonlaparoscopic) (n = 4), pyloric stenosis (n = 1), uterine prolapse (n = 1), undescended testis (n = 1), partial gastrectomy (n = 1), and unknown (n = 5). The analysis had a 90% power of detecting a 10% difference between the 2 groups.Conclusion: The complication rate and accuracy of closed DPL in patients with previous abdominal surgery were similar to those for DPL performed in patients without previous abdominal surgery.
Violence against Women: Provider Barriers to Intervention in Emergency Departments
Authors: McGrath Meghan E. , Bettacchi Andrea , Duffy Susan J. , Peipert Jeffrey F. , Becker Bruce M. , Angelo Linda St. 
Published: September 2008

ABSTRACTObjective: To determine: 1) provider behavior in screening for domestic violence (DV) and sexual assault (SA); 2) provider training in DV and SA; 3) provider knowledge of available protocols for DV and SA; and 4) provider perception of barriers to intervention.Methods: Anonymous, structured surveys were distributed to physicians, nurses, and social workers at an adult ED trauma center, an affiliated pediatric ED, and a women's urgent care center between July and September 1995.Results: Of 207 staff members (59%) responding, 54% and 68% indicated that they never/rarely screen for DV or SA, respectively. Thirty‐five percent had received no DV training and 27% had received no SA training. Thirty‐one percent of the staff had knowledge of existing protocols for DV and 63% had knowledge of existing protocols for SA. Providers trained in DV were more likely to screen for DV (RR 1.5, 95% CI 1.27–1.92, p ≤ 0.001) and SA (RR 1.49, 95% CI 1.24–1.79, p ≤ 0.0018), and providers trained in SA were more likely to screen for SA (RR 1.32, 95% CI 1.13–1.54, p = 0.0019) and DV (RR 1.35, 95% CI 1.13–1.60, p = 0.0007). Barriers that the majority of staff experienced in the care of DV/SA victims included: frustration that the victim would return to an abusive partner, concerns about misdiagnosis, lack of time, personal discomfort, reluctance to intrude into familial privacy, and lack of 24‐hour social service support.Conclusion: Providers surveyed had received little training in and rarely screen for violence, and there are a range of personal and institutional barriers impeding intervention with victims of SA and DV. Institutional changes to enhance training and support providers working in the front line of this epidemic may improve services for victims of violence.
Injury Prevention: Is There a Role for Out‐of‐hospital Emergency Medical Services?
Authors: Kinnane Janet M. , Garrison Herbert G. , Coben Jeffrey H. , Alonso‐Serra Hector M. 
Published: September 2008

ABSTRACTObjective: To review the literature for options for integrating injury prevention into the role of out‐of‐hospital emergency medical services (EMS).Data Sources: Computerized searches of the English‐language literature from 1966 through 1994 were conducted using the MEDLINE and National Association of EMS Physicians (NAEMSP) databases. These were supplemented by hand searches of pertinent journals not indexed on MEDLINE or by NAEMSP and the reference lists of retrieved articles. Key words searched included emergency medical services, accident, injury, prevention, and safety.Article Selection: The review included all articles that described the experience of EMS organizations or individuals providing primary injury prevention (PIP) services or that proposed EMS PIP activities. Synthesis: PIP EMS experiences and PIP activities proposed for EMS included: preventing injuries in EMS providers, serving as role models, identifying persons at risk for injury, providing prevention counseling, collecting injury data, surveying residences and institutions for injury risks and hazards, conducting educational programs and media campaigns, and advocating legislative changes that promote injury prevention. Few studies have evaluated the effectiveness of EMS PIP activities.Conclusion: As changes in the market compel health care systems to focus more on prevention, EMS organizations and individual providers may be assuming new injury prevention roles. Some EMS systems in many parts of the country have incorporated PIP into their work. It is necessary, however, to determine which PIP roles are effective and how they will be supported.
The Effect of Hypertonic Sodium and Dantrolene on Propranolol Cardiotoxicity
Authors: Kerns William , Ransom Mary , Tomaszewski Christian , Raymond Richard 
Published: September 2008

ABSTRACTObjective:To evaluate whether measures that lower cytosolic calcium (Ca) can reverse propranolol (prop) toxicity in the isolated, perfused rat heart.Methods:Isolated rat hearts were perfused on a Langendorff apparatus with Krebs‐Henseleit‐bicarbonate (KHB) buffer solution. Toxicity was produced by perfusing the hearts with prop (5 (μg/mL) for 30 minutes. Subsequently, the hearts were treated for 30 minutes with buffer containing prop plus experimental treatment. Three treatments were chosen: hypertonic sodium (Na) (160 mmol), to stimulate Na‐Ca exchange, dantrolene (dan) (10 μmol), to inhibit Ca release from sarcoplasmic reticulum, and combined hypertonic Na and dan. The hearts were paced after 20 minutes of treatment. Heart rate (HR), left ventricular peak systolic pressure (LVP), the first derivative of LVP (dP/dt), and coronary flow were measured.Results:prop decreased HR and rendered the hearts refractory to pacing, prop did not alter dP/dt. prop increased LVP consistent with increased cytosolic Ca. Combined hypertonic Na and dan treatment restored the ability to pace PROP‐toxic hearts to the basal HR. Individually, hypertonic Na or dan treatment partially restored the ability to pace toxic hearts. As experimental treatments increased HR, dP/dt and LVP decreased, consistent with decreased cytosolic Ca availability.Conclusion:These data are consistent with the hypothesis that bradycardia during β‐blocker cardiotoxicity is mediated by altered Ca homeostasis.
Out‐of‐hospital Experience with the Syringe Esophageal Detector Device
Authors: Pelucio Maria , Halligan Luanne , Dhindsa Harinder 
Published: September 2008

ABSTRACTObjective: To determine the accuracy of a syringe esophageal detector device (EDD) for detecting esophageal intubations in an out‐of‐hospital setting.Methods: Prospective, observational study of adult (age ≥18 years) patients intubated by paramedics from October 1993 through May 1994 in an urban emergency medical services (EMS) system. Paramedics were instructed to record the EDD reading after endotracheal tube placement. However, paramedics were instructed not to modify their tube locations based on the EDD reading. Tube placement was evaluated by a physician upon patient arrival at a local ED.Results: Paramedics performed 374 intubations during the study period, and in 213, the EDD was used. Of these 213 patients, 45 were excluded from analysis (32—tube placement not confirmed, 11—paramedic uncertain of EDD reading, 2—too young). In the remaining 168 intubations, the EDD correctly identified 5 of 10 esophageal intubations (sensitivity 50%; 95% CI: 19%, 81%). The EDD correctly identified 156 of 158 tracheal intubations (specificity 99%; 95% CI: 96%, 100%).Conclusions: In this paramedic field study, the EDD demonstrated poor sensitivity for esophageal intubations. Further EMS studies of the EDD are needed to clarify the value of the device in out‐of‐hospital emergent clinical intubations.
Bioimpedance Cardiac Output Measurements in Patients with Presumed Congestive Heart Failure
Authors: Weiss Steven J. , Kulik James P. , Calloway Edward 
Published: September 2008

ABSTRACTObjective: To describe preliminary ED experience with thoracic electrical bioimpedance (TEB) for evaluation of patients with complaints suggestive of congestive heart failure (CHF).Methods: A 6‐month, prospective, observational study was performed using a convenience sample of patients with signs and symptoms consistent with CHF. Patients were excluded if they had received medication prior to arrival in the ED, if they were obese, and if they had unstable vital signs. They also were excluded if they were combative, refused to sign consent, or had invasive lines that did not allow for TEB lead placement. Patients also were excluded if the study could not be completed because the patient was taken from the department for a diagnostic test, or if there were no good follow‐up records available 6–12 months after the patient's visit. The patient's physician was blinded to the output of the TEB monitor. Cardiac output (CO), stroke volume (SV), end‐diastolic volume (EDV), thoracic fluid index (TFI), and acceleration index (ACI) were recorded at 5‐minute intervals. Results were evaluated for the time intervals 0–5 minutes, 30–35 minutes, and 60–65 minutes.Results: Seven patients were included in the study. The echocardiographic diagnoses were hypertrophic car‐diomyopathy (2 cases), dilated cardiomyopathy (2 cases), ischemic cardiomyopathy (1 case), right ventricular hypertrophy (1 case), and pericardial effusion (1 case). Significant changes were seen in all cardiac parameters, with variance from individual to individual.Conclusions: Significant differences in TEB variables exist between patients who appear similar on initial examination in the ED. Changes noted on TEB may help to further elucidate physiologic differences. The clinical use of TEB‐based hemodynamic measurements to guide presumed CHF patient management remains speculative.
Predictors of Repeat Emergency Department Visits by Elders
Authors: McCusker Jane , Healey Elizabeth , Bellavance François , Connolly Brian 
Published: September 2008

ABSTRACTObjective: To determine which characteristics of older patients who use a hospital ED are associated with repeat visits during the 90 days following the index visit.Methods: The study was conducted in the ED of a 400‐bed university‐affiliated acute care community hospital in Montreal. Patients aged ≥75 years who visited the ED between 08:00 and and 16:00 on a convenience sample of days over an 8‐week period (July and August 1994) were assessed using a questionnaire, physical and cognitive status instruments, and a functional problem checklist. The hospital's administrative database was used to identify repeat visits during the 90 days following the ED visit. The representativeness of the sample was assessed by analyses of ED visits made by 4,466 persons aged ≥65 years during a 12‐month period (September 1993 to August 1994) using the hospital's administrative database.Results: 256 patients aged ≥75 years visited the ED during the study period and 167 were assessed. Of these, 54 (32%) were admitted to the hospital. Among the 113 patients released from the ED, 27 (24%) made repeat visits during the next 90 days. In univariate analyses, repeat visits were significantly associated with the number of functional problems, cognitive impairment, and previous ED visits. In multiple logistic regression, male gender, living alone, and number of functional problems were independent predictors of repeat visits. In the administrative data analyses, nighttime arrival to the ED for the index visit was significantly associated with repeat visits.Conclusions: Self‐reported risk factors can help to identify a group of elders likely to make repeated ED visits; the development of a screening instrument incorporating questions on these problems and implementation of appropriate interventions might improve these patients' quality of life and reduce the demand for further ED care in this age group.
Early Diagnostic Efficiency of Cardiac Troponin I and Troponin T for Acute Myocardial Infarction
Authors: Tucker John F. , Collins Richard A. , Anderson Alfred J. , Hauser Jacqueline , Kalas John , Apple Fred S. 
Published: September 2008

ABSTRACTObjective: To compare the early diagnostic efficiency of the cardiac troponin I (cTn‐I) level with that of the cardiac troponin T (cTn‐T) level, as well as the creatine kinase (CK), CK‐MB, and myoglobin levels, for acute myocardial infarction (AMI) in patients without an initially diagnostic ECG presenting to the ED within 24 hours of the onset of their symptoms.Methods: A prospective, observational, cohort study was performed involving chest pain patients admitted to a large urban community hospital. Participants were consecutive consenting ED chest pain patients ≥30 years of age. Exclusions included duration of symptoms >24 hours, inability to complete data collection, receipt of CPR, and ST‐segment elevation on the initial ECG. Measurements included levels of cTn‐I, cTn‐T, CK, CK‐MB, and myoglobin at the time of presentation and 1, 2, 6, and 12–24 hours after presentation as well as presenting ECG and clinical follow‐up. Confirmation of the diagnosis of AMI was based on World Health Organization criteria.Results: Of the 177 patients included in the study, 27 (15%) were diagnosed as having AMIs. The sensitivities of all 5 biochemical markers for AMI were poor at the time of ED presentation (3.7–33.3%) but rose significantly over the study period. The sensitivity of cTn‐T was significantly better than that of cTn‐I over the initial 2 hours, but both markers' sensitivities were low (<60%) during this time frame. The cTn‐I was significantly more specific for AMI than was the cTn‐T, but not significantly better than CK‐MB or myoglobin. Likelihood ratio analysis showed that the biochemical markers with the highest positive likelihood ratios for AMI during the first 2 hours following ED presentation were myoglobin and CK‐MB. From 6 through 24 hours, the positive likelihood ratios for cTn‐I, CK‐MB, and myoglobin were superior to those of CK and cTn‐T.Conclusions: cTn‐I, CK‐MB, and myoglobin are significantly more specific for AMI than are CK and cTn‐T. Myoglobin is the biochemical marker having the highest combination of sensitivity, specificity, and negative predictive value for AMI within 2 hours of ED presentation. Neither cTn‐I nor cTn‐T offers significant advantages over myoglobin and CK‐MB in the early (≤2 hours) initial screening for AMI. The cardiac troponins are of benefit in identifying AMI ≤6 hours after presentation.
Thermal Effects of Neutralization Therapy and Water Dilution for Acute Alkali Exposure in Canines
Authors: Homan Clark S. , Singer Adam J. , Henry Mark C. , Thode Henry C. 
Published: September 2008

ABSTRACTObjective: To evaluate the change in temperature of the gastric mucosa and lumen contents when a weak acid or water is used to manage acute alkali exposure.Methods: A prospective in‐vivo canine model was used in a university‐based animal laboratory setting. Eighteen adult canines weighing 20–25 kg were placed under a surgical plane of anesthesia and a laparotomy was performed. A gastrotomy was then made after ligation of the distal esophagus and proximal duodenum. Separate mucosa and lumen temperature probes were placed. Then 25 mL of room‐temperature (24–26°C) 50% sodium hydroxide (NaOH) was instilled in the gastric lumen. After 5 minutes, each canine was given treatment. Group 1 (n = 10) was treated with 75 mL of room‐temperature orange juice. Group 2 (n = 8) was treated with 75 mL of room‐temperature water. Continuous mucosa and lumen temperatures were observed and recorded at baseline and at specified intervals for 35 minutes after the alkali insult. Repeated‐measures analysis of variance was used to evaluate the overall temperature profile. Signed‐rank tests were used to compare the changes in temperature immediately following neutralization treatment.Results: Significant temperature decreases of 1.1°C and 2.1°C were observed for both mucosa (p = 0.002) and lumen (p < 0.001) temperatures, respectively, following neutralization therapy with room‐temperature orange juice. In the group treated with room‐temperature water, significant temperature decreases of 2.1°C for mucosa (p = 0.01) and 2.4°C for lumen (p = 0.01) were observed. Posttreatment temperatures did not exceed baseline for the entire observation period.Conclusion: Neutralization therapy with room‐temperature orange juice or water dilution for acute gastric injuries by liquid alkali does not cause a rise in mucosal or intraluminal temperatures in an in‐vivo canine model.
Effect of Hypothermia, Dichloroacetate, and Deferoxamine in the Treatment for Cortical Edema and Functional Recovery after Experimental Cortical Impact in the Rat
Authors: Heegaard William , Biros Michelle , Zink Julie 
Published: September 2008

ABSTRACTObjective: To investigate the effects of hypothermia alone or in combination with dichloroacetic acid (DCA) and/or deferoxamine (DFO) in reducing cortical edema (CE) and improving neurologic functional recovery after moderate closed head trauma with controlled cortical impact (CCI).Methods: Anesthetized rats were randomized to receive right parietal moderate CCI (impact depth 2 mm, speed 3.5 m/sec) or sham operations. Immediately after trauma, the animals underwent selective brain cooling to 30°C (temporalis muscle temperatures). Ten minutes after trauma, the randomized animals received intra‐peritoneal doses of DCA (25 mg/kg), DFO (50 mg/kg), both DCA and DFO, or equivolume normal saline. For evaluation of cortical edema, some animals (n = 42) were sacrificed 4 hours after trauma and cortical specific gravity (SpG) was determined gravimetrically. The other animals (n = 47) were evaluated for functional recovery beginning 6 days posttrauma. Neurobehavioral performance was assessed in the Morris water maze.Results: Cortical edema was significantly less in the animals treated with hypothermia (SpG = 1.041 ± 0.001, p < 0.05) compared with the untreated traumatized animals (SpG = 1.037 ± 0.001). Combination treatment with hypothermia and drug treatment did not reduce cortical edema when compared with no treatment. Hypothermia with and without drug treatment did not improve neurobehavioral performance when compared with no treatment.Conclusions: In this pilot study with a relatively small sample size, hypothermia alone significantly reduced post‐CCI cortical edema as measured by SpG. Hypothermia combined with drug treatment did not reduce posttraumatic cortical edema. Hypothermia with and without drug therapy did not improve functional neurologic recovery in the rats subjected to CCI.
A Pilot Study of the Predictive Value of Plasma Tumor Necrosis Factor α. and Interleukin 1β for Streptococcus pneumoniae Bacteremia in Febrile Children
Authors: Strait Richard T. , Ruddy Richard M. , Friedland Leonard R. , Duncan Kathy M. , Wilmott Robert W. 
Published: September 2008

ABSTRACTObjective: To determine the value of tumor necrosis factor α (TNF) and interleukin 1β (IL1) levels in predicting Streptococcus pneumoniae bacteremia in nontoxic‐appearing, febrile children who do not have a bacterial source for their fever on physical examination.Methods: A prospective, nested case‐control study was conducted in a children's hospital ED. All febrile children <3 years old who were believed to be immunocompetent and not in shock, had no obvious bacterial source for their fever on physical examination, and had a blood culture obtained were eligible. Plasma obtained at the time of the blood culture was available for analysis by enzyme‐linked immunosorbent assays for TNF and ILL Children who had positive blood cultures for Streptococcus pneumoniae were the cases. The controls were selected from children who had negative blood cultures.Results: During a 1‐year period, 12 cases and 65 controls were identified. There was no significant difference in age, height or duration of fever, or illness acuity between the groups. The following were used as threshold values for a positive test: white blood cell (WBC) count >15.0 × 109 cells/L, TNF >21.5 ng/mL, and IL1 >9.0 ng/mL. Using an estimated prior probability of bacteremia of 4%, the positive predictive value (PPV) and the negative predictive value (NPV) for bacteremia were 11.7% and 98.6% using the WBC count, 11.1% and 98.6% using the IL1 level, and 9.0% and 98.9% using the TNF level. The combination of WBC count with either TNF or IL1 gave an NPV of 100%, with PPVs of 8.5% for TNF and 9.9% for ILLConclusions: Like the WBC count, TNF and IL1 are good negative but poor positive predictors of Streptococcus pneumoniae bacteremia in nontoxic‐appearing, febrile children. At present, the addition of plasma TNF or IL1 levels would add little to emergency physicians' ability to predict Streptococcus pneumoniae bacteremia. However, as the quantification of these cytokines becomes more rapid, available, and standardized, and more knowledge of TNF and IL1 levels during various illnesses is gained, their utility in the clinical setting for ruling out bacteremia should be further assessed.