bluuebunny/crossref_metadata_2025_split huggingface dataset:
An introduction to sensitivity, specificity, predictive values and likelihood ratios
Authors: Chu Kevin 
Published: March 2003

Objective: To assist clinicians and other health‐care providers to understand the terms used to describe the accuracy of diagnostic tests. Methodology: This paper reviews the calculation and interpretation of sensitivity, specificity, predictive values, receiver operating characteristic curves and likelihood ratios. Results: Sensitivity and specificity are measures of the accuracy of a diagnostic test. There is a trade‐off between sensitivity and specificity that is dependent on the cut‐off level chosen for a positive diagnosis. Predictive values are measures of the usefulness of a test once the test results are known. Predictive values depend on the prevalence of the disease, as well as on the sensitivity and specificity of the test. Sensitivity, specificity and predictive values are easily calculated by the construction of a two‐by‐two table. Multiple testing, either in parallel or in series, can alter the sensitivity, specificity and predictive values. Receiver operating characteristic curves plot the relationship between sensitivity and specificity at various cut‐offs, facilitating the comparison of accuracy among tests. Likelihood ratios are an alternative measure of accuracy and have the advantage of being able to assess multiple test outcomes, rather than simply assessing dichotomized positive or negative results. Conclusion: An understanding of how the measurements that are used to describe the accuracy of diagnostic tests are calculated is essential to the interpretation of test results.
Continuity of care in the transition from emergency department to general practitioner: Is it adequate?
Authors: Taylor David McD , Cameron Peter A 
Published: March 2003

Abstract Objective: To assess the adequacy of continuity of care for patients who are discharged to home or admitted to hospital from the emergency department. Methods: Questionnaire survey of emergency department communication practices. Results: Seventy‐five of 86 emergency departments (87.2%) participated. Emergency departments failed to communicate with general practitioners upon disposition of many patients. For patients discharged to home, significantly more private emergency departments contacted general practitioners directly by telephone (P < 0.01) or by letter (P < 0.001). Significantly more public emergency departments gave patients a letter to take to their general practitioners (P < 0.01). Overall, emergency departments gave the patient a general practitioner letter some (33.3% of emergency department) or most (40.0%) of the time. Few letters were posted or faxed and little use of Email was made. Pre‐formatted letters were used less than was expected. On patient admission, the telephone was used most frequently to advise general practitioners. Conclusions: Continuity of patient care may be inadequate in many emergency departments. Emergency departments should establish a check system to ensure that a communication is made with the general practitioners of all patients. Telephone or facsimile communication is recommended on patient admission. Other modes may be more appropriate on patient discharge to home. Structured, pre‐formatted letters/facsimiles are recommended. Emergency department–general practitioner communications should be used as a performance indicator of emergency department practice.
Controversies in the prehospital management of major trauma
Authors: Pepe Paul E 
Published: March 2003

AbstractMany traditional therapies in the prehospital management of major trauma may be of little value or may be even harmful. Little scientific evidence exists to support the use of the pneumatic antishock garment, and some studies have shown it to worsen outcome. The traditional role of intravenous fluid resuscitation also has been questioned and, in situations such as penetrating truncal trauma, it may be associated with comparatively worse outcomes. Although some infusion may be appropriate in severe haemorrhage, the clear priority in such patients is evacuation to definitive surgical intervention. Airway control and establishment of intravenous access are recommended en route. Endotracheal intubation may be capable of prolonging the ability to tolerate circulatory arrest, but overzealous ventilation may further compromise cardiac output where there is severe haemodynamic instability. If these procedures delay patient transport, any benefit they may offer could be outweighed by delaying definitive care. Many of the paradigms of prehospital trauma care should be reconsidered and carefully evaluated in future randomized controlled trials.
Snakebite in tropical Australia, Papua New Guinea and Irian Jaya
Authors: Currie Bart J 
Published: March 2003

AbstractWhile snakebite numbers are decreasing in temperate Australia, snakebite remains an important cause of morbidity in tropical Australia and of mortality in Papua New Guinea and Irian Jaya. The Australasian elapid snakes have complex mixtures of venom components, with distinct clinical syndromes defined for the potentially lethal species. Life‐threatening scenarios are progressive neuromuscular paralysis with taipan (Oxyuranus spp.) and death adder (Acanthophis spp.) envenoming and early hypotensive collapse and severe coagulopathy with fibrinogen depletion and major bleeding (especially intracranial haemorrhage) with brown snake (Pseudonaja spp.) bites. The ‘brown snake paradox’ is that textilotoxin is one of the most potent neurotoxins known, yet neurotoxicity is uncommon in brown snake envenoming. Prospective studies using assays of serial patient serum venom levels will provide better evidence for efficacy or otherwise of various first‐aid methods used and help define appropriate doses of antivenoms for specific clinical scenarios. Financial and distribution constraints have resulted in antivenoms being unavailable for use in most regions of Papua New Guinea and Irian Jaya.
Randomized controlled trial of midazolam premedication to reduce the subjective adverse effects of adenosine
Authors: Hourigan Craig , Safih Shameem , Rogers Ian , Jacobs Ian , Lockney Amanda 
Published: March 2003

AbstractObjective:To determine the safety and efficacy of midazolam premedication to minimize the subjective adverse effects of adenosine.Methods:Double‐blind prospective randomized controlled trial of patients presenting to an urban emergency department. Included were a convenience sample of patients who would have received adenosine by the existing department protocol. Exclusion criteria were pregnancy, benzodiazepine allergy, regular benzodiazepine medication, alcoholism, altered mental state (precluding informed consent), and age less than 18 or greater than 65 years. Subjects received either 1.5 mg of intravenous midazolam or normal saline placebo 5 min prior to the administration of adenosine. Side‐effect recall was judged by a questionnaire at 1 h and 24 h postadenosine administration.Results:A total of 34 patients were recruited into the trial, 16 in the placebo group and 18 in the midazolam group. The groups were well matched for demographics, treatment and outcome. There was a significant reduction in the midazolam group for complaint scores of palpitations (P = 0.04) and chest pain (P = 0.02) and a trend to reduction in complaint scores for most other parameters. There were no adverse outcomes in any of the patients studied.Conclusions:Co‐administration of midazolam can safely reduce the recall of the unpleasant adverse effects of adenosine. Its use may be most appropriate in patients who are particularly anxious or have had previous adverse experiences with adenosine.
Abdominal injury and the seat‐belt sign
Authors: Wotherspoon Sonya , Chu Kevin , Brown Anthony FT 
Published: March 2003

AbstractObjective:To report on: 1. Prevalence of seat‐belt sign in motor vehicle accident victims with abdominal injuries; 2. Prevalence of intestinal injuries in patients with seat‐belt sign; and 3. Spectrum of abdominal injuries in a population with high usage of three‐point restraints.Methods:A retrospective chart review was conducted in an adult tertiary‐referral hospital from January 1992 to August 1998. Patients were identified from International Classification of Disease‐9 codes for abdominal wall and intra‐abdominal injuries.Results:The seat‐belt sign was present in 60/99. The proportion of intestinal injuries in patients with and without seat‐belt sign were 9/60 and 0/39, respectively (P = 0.01). In the 25 patients with intra‐abdominal injuries, there were 10 hepatic, 8 splenic, 9 intestinal and 4 retroperitoneal injuries.Conclusion:The seat‐belt sign is indicative of an increased risk of intestinal injury, which is difficult to detect with no single test providing reliable diagnosis. Other intra‐abdominal and retroperitoneal injuries may also occur, which are more readily diagnosed on computed tomography scan or focused abdominal utlrasound when available, but are no more frequent in patients with the seat‐belt sign than those without.
Does routine use of the 15‐lead ECG improve the diagnosis of acute myocardial infarction in patients with chest pain?
Authors: Rosengarten Pamela , Kelly Anne‐Maree , Dixon Dianne 
Published: March 2003

AbstractObjective:It has been suggested that the use of additional electrocardiogram leads might improve the diagnostic sensitivity of this test, thus potentially expanding eligibility for thrombolysis for patients suffering myocardial infarction. The aims of this study were to evaluate the role of the 15‐lead electrocardiogram in the emergency department chest pain population and to determine whether the routine use of the extra leads expands the group of patients eligible to receive thrombolysis.Methods:Blinded, individual and independent analysis by two emergency physicians of paired 12‐ and 15‐lead electrocardiograms from adult patients with a primary complaint of chest pain. The main outcome measure was the diagnosis of myocardial infarction eligible for thrombolysis. Data were analysed using descriptive statistics and kappa statistics for agreement between raters.Results:540 electrocardiograms (270 sets) were analysed. Myocardial infarction qualifying for thrombolysis was identified (by consensus) in 21 cases. In no case did the 15‐lead electrocardiograph identify a myocardial infarction qualifying for thrombolysis that was not identified on the 12‐lead electrocardiogram.Conclusion:In this study, the 15‐lead electrocardiogram did not increase the number of thrombolysis‐eligible myocardial infarctions identified when compared with the 12‐lead electrocardiogram. This study is limited by the small patient sample size, and a large multicentre trial is recommended to compare the 12‐ and 15‐lead electrocardiograms in the emergency department population where the incidence of posterior and right‐sided myocardial infarction is ultimately known.
Improvement in decision‐making for thrombolysis following introduction of angioplasty referral guidelines
Authors: Dilley Stuart 
Published: March 2003

AbstractObjective:To determine whether the introduction of acute angioplasty referral guidelines would lead to an improvement in decision‐making times with respect to thrombolysis for patients with acute myocardial infarction.Methods:Retrospective and prospective collection of ‘time from diagnostic electrocardiogram to treatment’ for all patients who received thrombolytic treatment for acute myocardial infarction in the emergency department.Results:Median time from ‘diagnostic electrocardiogram to thrombolysis’ fell from 38 to 26 min (P < 0.0001) following introduction of acute angioplasty referral guidelines. This was primarily due to an improvement in median decision‐making times for patients with anterior infarcts from 65 to 27 min (P = 0.0009).Conclusion:Significant improvements were seen in thrombolysis decision‐making times for patients with acute myocardial infarction following the introduction of acute angioplasty referral guidelines.
Plasma alkalinization for tricyclic antidepressant toxicity: A systematic review
Authors: Blackman Konrad , Brown Simon G A , Wilkes Garry J 
Published: March 2003

AbstractObjective:To review the evidence that plasma alkalinization improves the outcome in tricyclic antidepressant toxicity.Methods:Medline search from 1966 to October 2000 (articles in all languages were included) and examination of bibliographies. Published papers including animal studies, in vitro studies, human case reports, case series and retrospective studies were reviewed.Results:Our search identified 115 publications, all of which were retrieved. Human studies included eight case reports, four case series, one controlled study and two retrospective chart reviews. No randomized controlled human trials were found. Twelve animal studies were identified that investigated pH manipulation or saline load and their effects on physiological parameters in tricyclic antidepressant toxicity.Conclusions:The practice of alkalinization for tricyclic antidepressant toxicity is based on animal studies, case reports and opinion. The mechanism of action appears to be multifaceted and may vary between different tricyclic antidepressants. Significant interspecies variation makes extrapolation from animal studies to humans difficult. Alkalinization therapy appears reasonable in patients with compromising dysrhythmias and shock when supportive interventions have been ineffective; however, the available evidence does not support prophylactic alkalinization in the absence of life‐threatening cardiovascular toxicity.
Outcome of emergency department patients with delayed admission to an intensive care unit
Authors: Parkhe Meera , Myles Paul S , Leach Deborah S , Maclean Andrew V 
Published: March 2003

AbstractObjective: To compare 30 day mortality, length of stay and cost for adult emergency department patients with a delay in intensive care unit admission of up to 24 h with a group of patients admitted directly from the emergency department to the intensive care unit.Methods: Retrospective cohort study in a 300‐bed university affiliated teaching hospital. One hundred and twenty‐two adult emergency department patients admitted to the intensive care unit either directly from the emergency department (direct group) or within 24 h of ward admission (delayed group) were identified. The main outcome measures investigated were 30 day mortality, length of stay and cost.Results: Thirty day mortality in the delayed group was significantly higher, the risk ratio being 2.46 (95% confidence interval 1.2–5.2). The length of stay and cost were similar in the direct and delayed groups. Baseline estimate of risk of death derived from the mortality probability model calculated from the emergency department data was similar for the two groups (P = 0.10). Emergency department triage categorization and emergency department staff seniority was significantly different (χ2 for trends, P = 0.002 and 0.023, respectively), with patients in the delayed group more likely to be triaged as less urgent and to be initially assessed by junior staff.Conclusions: Our study shows that patients transferred to the intensive care unit within 24 h of ward admission from the emergency department had a significant increase in 30 day mortality compared with patients admitted to the intensive care unit directly from the emergency department, but no difference was found in terms of length of stay and cost.
Most head injury related motorcycle crash deaths are related to poor riding practices
Authors: Stella Julian , Cooke Clive , Sprivulis Peter 
Published: March 2003

AbstractObjective: To report the characteristics of head injury related motorcycle crash deaths.Methods: Motorcycle crash deaths with head injury (Abbreviated Injury Severity score ≥ 2) between 1 January 1998 and 31 December 1999 were identified from the Western Australia State Coronial Database. Demographics, incident and death locations, type of incident and role of unsafe riding behaviour were examined.Results: There were 39 deaths analysed (35 motorcycle riders and four pillion passengers). The median age was 29 years (range 9–64 years), with 22 deaths (56.4%) in the range 15–29 years and 92.3% of those killed being male. Twenty‐one motorcycle crashes were single‐vehicle crashes (53.8%). There were 25 deaths at scene (64.1%). Ethanol was implicated in 12 cases (30.8%) and other drugs were implicated in 11 cases (28.2%). Speeding was implicated in 12 cases (30.8%) and a lack of appropriate safety equipment was implicated in five cases (12.8%). One or more of the unsafe practices above was identified in 23 cases (59%). Overall, there was no difference in the rate of unsafe practices in single‐vehicle incidents compared with incidents involving another vehicle (P = 0.342). Ethanol was associated with 10 single motorcycle incidents (47.6%) compared with two (11.1%) involving another vehicle (P = 0.018). Unsafe practices were involved in 76% of at‐scene deaths, compared with 28.6% in those surviving to hospital (P = 0.007).Conclusion: A large proportion of head injury related motorcycle crash deaths are related to the unsafe behaviour of motorcyclists. A preventative campaign focusing on young male motorcycle riders and unsafe driving behaviour may reduce this death toll.
Is there a role for the use of pressure immobilization bandages in the treatment of jellyfish envenomation in Australia?
Authors: Little Mark 
Published: March 2003

AbstractBackground: The aim of this paper was to review the literature relating to the use of pressure immobilization bandages in the first aid management of jellyfish sting in Australia and to attempt to make a recommendation about their use based on the current literature.Methods: A descriptive review of all published cases of jellyfish envenomation in Australia was performed, with specific focus on the discussion of pressure immobilization bandages in the management of such cases. A Medline search was performed using the key words listed for this article. Selected articles were reviewed and further publications were identified from the published reference lists given in the selected articles.Results: The published articles were grouped into three groups: in vitro evidence, case reports and editorial comment (either in journals or book). Fifteen references were identified that discussed the use of pressure immobilization bandages in the management of jellyfish envenomation. Other articles were identified that had significant management issues discussion.Conclusion: Most of the ‘jellyfish’ literature is in relation to envenomation by Chironex fleckeri. This jellyfish is usually found in tropical Australia and has resulted in the deaths of 67 people in Australia. The last death was near Cairns in 2000. Unfortunately, there are few good data on marine envenomations, with most of the literature being Chironex envenomation case reports. There are minimal data on the effect of pressure immobilization bandages on other jellyfish envenomations. There is no good evidence to support the use of pressure immobilization bandages in the management of jellyfish sting in Australia.
Patients with a longer duration of symptoms of acute asthma are more likely to require admission to hospital
Authors: Kelly Anne‐Maree , Powell Colin , Kerr Debra 
Published: March 2003

AbstractObjective: To determine whether, for patients with moderate or severe asthma presenting to emergency departments, there is a difference in need for hospitalization between those with a duration of symptoms less than 6 h and those with a longer duration of symptoms.Methods: This prospective, observational study investigated a sample of patients presenting with acute asthma between 21 August and the 3 September 2000, attending study emergency departments and classified as having moderate or severe asthma according to the National Asthma Guidelines. Data collected included duration of symptoms (less than 6 h or greater than 6 h) and disposition following emergency department treatment (home, ward, intensive care unit, high dependency unit, transfer). Data analysis was by Chi square analysis.Results: Of 381 eligible patients, 348 had sufficient data for entry into this study (33 had missing data). Patients with duration of symptoms more than 6 h were more likely to require hospital admission (P < 0.0001). The relative risk for hospital admission or transfer as opposed to discharge from the emergency department for the group with a duration of symptoms of more than 6 h was 2.2.Conclusion: Patients presenting with moderate or severe asthma and a duration of symptoms of more than 6 h are more likely to require hospital admission or transfer for further treatment than patients with a shorter duration of symptoms. This has implications for decision making regarding asthma management and disposition in the emergency department.
How healthy are our emergency departments?
Authors: Joe Keith , Kennedy Marcus , Bensberg Monica 
Published: March 2003

AbstractObjective: To demonstrate a comprehensive workplace health survey is able to identify indicators that contribute to staff workplace welfare.Methods: Analysis of a VicHealth workplace health survey distributed to seven suburban emergency departments. Respondents rated multiple workplace health indicators in terms of perceived importance and perceived performance. A satisfaction rating and performance gap for each indicator was calculated.Results: There was a 64% response rate to 500 surveys. Staff rated a safe environment, professional standards, and staff morale the most important factors for workplace health. They were most satisfied with the flexibility of work arrangements (85.6%) and leadership (79.9%), and were least satisfied with the performance management of staff (68.5%) and job satisfaction and morale (67.2%). The largest gaps between perceived importance and performance were in the provision of safe well‐lit parking, staff morale, and the use of reward and recognition systems.Conclusion: The VicHealth survey was an effective tool in identifying indicators that contribute to staff workplace health. Quantifiable findings allowed interdepartmental comparison and may be useful in focusing on improvements in organizational structure.
What you need to know about diving medicine but won’t find in a textbook
Authors: Emerson Gregory M 
Published: March 2003

AbstractThe old adage that ‘if a patient in your emergency department (ED) is wearing a wetsuit, fins and a mask, then he/she probably has a diving related illness’ is one that should be remembered. This is an obvious statement that should not need stating; however, simple clues can be missed or disregarded. This article will address issues that may confront emergency physicians and for which there are few resources to find the answers. It aims to explain the reasons behind some of the advice given during consultation with a hyperbaric physician. The second aim is to bring emergency physicians up to date with new diving practices and how these may impact upon traditional diving injuries. To achieve these aims, this article is a compilation of answers to frequently asked or pertinent questions related to diving medicine.
Intracerebral haemorrhage presenting as olfactory hallucinations
Authors: Nye Elizabeth , Arendts Glenn 
Published: March 2003

AbstractIsolated olfactory hallucinations are a rare event and have been associated with a number of aetiologies including seizures, migraines and psychiatric illnesses. This case report describes a 58‐year‐old woman with an unusual haemorrhagic lesion as the cause of her olfactory symptoms. A review of the literature concerning the causes and management recommendations for olfactory hallucinations is presented.