The Journal of Emergency Medicine via MedWorm.com

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

Partial Contents of Volume 42, Number 2

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

Issue Highlights

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

Calendar of Events

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

Heart Disease May be a Risk Factor for Pulmonary Embolism without Peripheral Deep Venous Thrombosis: Sørensen HT, Horvath-Puho E, Lash TL, et al. Circulation 2011;124:1435–41.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This study from Denmark sought to evaluate whether common heart diseases that increase the risk of left-sided arterial embolism (such as heart failure, myocardial infarction, atrial fibrillation, atrial flutter) are also associated with an increased incidence of isolated pulmonary embolism (embolism without an apparent peripheral venous source). This was a case-control study with data gathered over 27 years from 1980 to 2007 from the Danish National Patient Registry, totaling 109,752 patients with a first recorded incident of pulmonary embolism (PE) or deep vein thrombosis (DVT), or both, in the lower limb both as primary or secondary discharge diagnosis. For each case, a risk-set sampling was utilized to select five population controls matched to index patient's age, sex, and date of diag...

Development of a Screening Tool for Pediatric Sexual Assault May Reduce Emergency Department Visits: Floyed RL, Hirsh DA, Greenbaum VJ, Simon HK. Pediatrics 2011;128:221–6.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This study retrospectively analyzed 163 cases of alleged sexual assault in children (Source: The Journal of Emergency Medicine)

Role of Conservative Management in Traumatic Aortic Injury: Comparison of Long-term Results of Conservative, Surgical, and Endovascular Treatment: Mosquera VX, Marini M, Lopez-Perez JM, et al. J Thorac Cardiovasc Surg 2011;142:614–21.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This study out of Spain is one of a few large single-center retrospective studies comparing the early and long-term outcomes of patients with acute traumatic aortic injury (ATAI) who were conservatively managed vs. those who underwent open surgical or endovascular repair. The 30-year study identified 66 patients with both minor ATAI (intramural hematoma without intimal tear or intimal tear10mm or aneurysm/pseudoaneurysm) and divided them into three groups depending on treatment intention at the time of admission: conservative (n=37), surgical (n=22), and endovascular (n=7). The primary outcomes were in hospital mortality, late mortality (at 1, 5, and 10 years), and long-term survival free from aorta-related complications. The study found that overall in-hospital mortality was 18.2% and the...

Outcomes of Hospitalized Patients with Non-acute Coronary Syndrome and Elevated Cardiac Troponin Level: McFalls EO, Larson G, Johnson GR, et al. Am J Med 2011;124:630–5.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This study examined the outcomes of patients with elevated troponin levels but with non-acute coronary syndrome with data from 2006 from the Veterans Affairs (VA) centralized database. All patients seen during this year who had an elevated troponin during their index hospitalization were included and categorized as acute coronary syndrome (ACS) or non-acute coronary syndrome (non-ACS). Data for patients who died or who had a low expectation of survival based on discharges to hospice, skilled nursing/community nursing, or an inpatient stay>30 days were excluded, as they might not have been deemed eligible for cardiac imaging. Troponin results exceeding the 99th percentile of the upper reference limit for each hospitalization, medical center, and each quarter of the fiscal year were utilized...

Predictors of Early and Late Case-fatality in a Nationwide Danish Study of 26,818 Patients with First-ever Ischemic Stroke: Andersen KK, Andersen ZJ, Olsen TS. Stroke 2011;42:2806–12.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This study used data from the Danish National Indicator Project to retrospectively identify predictors of early case-fatality (3-day, 7-day, and 30-day) as well as late case-fatality (90-day and 1-year) in patients with first-ever ischemic stroke. It included 26,818 patients, all of whom were hospitalized for a first-ever ischemic stroke in Denmark between 2000 and 2007. Multiple logistic regression identified stroke severity (as defined by the Scandinavian Stroke Scale) and age as significant predictors of 3-day, 7-day, and 30-day case fatality. Interestingly, 3-day and 7-day case-fatality rates stabilized at ages>70 years, and the 3-day case fatality rates even declined at ages>85 years. The authors postulated that this may have been secondary to a “survival of the fittest” phenom...

Comparative Effectiveness of Antibiotic Treatment Strategies for Pediatric Skin and Soft-tissue Infections: Williams DJ, Cooper WO, Kaltenbach LA, et al. Pediatrics 2011;128:479–87.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This was a retrospective cohort study of 47,501 children aged 0–17 years comparing the effectiveness of treatment with trimethoprim-sulfamethoxazole (TMP-SMX) or a β-lactam vs. clindamycin in drained and undrained skin and soft-tissue infections (SSTI). Children with an SSTI and prescription for either clindamycin (reference treatment), trimethoprim-sulfamethoxazole, or a β-lactam (penicillin or cephalosporin) filled within 2 days of the SSTI were included in the study and grouped based on drainage status. Exclusion criteria included: SSTI within the last 365 days, treatment with multiple agents, treatment with topical antibiotics, SSTI requiring hospital admission, burns, foreign bodies, or surgical-site infections. Effectiveness of each antibiotic therapy was defined with respect to ...

Patients with Traumatic Brain Injury. Population-Based Study Suggests Increased Risk of Stroke: Chen YH, Kang JH, Lin, HC. Stroke 2011;42:2733–9.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This study had limitations in that it could evaluate only those cases where patients sought treatment for TBI or stroke. In addition, this study did not have access to data on mechanism of TBI, and risk factors such as body mass index, diet, activity level, smoking, and alcohol consumption that may have altered the findings. (Source: The Journal of Emergency Medicine)

Health Insurance Status, Medical Debt, and Their Impact on Access to Care in Arizona: Herman PM, Rissi JJ, Walsh ME. Am J Public Health 2011;101:1437–43.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This study used data from the 2008 Arizona Health Survey to create logistic regression models examining how health insurance status affected medical debt and access to care among 2368 Arizona residents aged 18–64 years. Medical debt was defined as individuals who were having problems paying or were currently paying medical bills. Access to care was defined by delayed or missed medical care or medications due to cost or lack of insurance. The authors found that an individual's current insurance status was not an independent predictor of their medical debt. Importantly, however, individuals who had insurance at the time of the survey but were uninsured at some time during the preceding year (inconsistent coverage) had the highest measures of medical debt. These individuals had an adjusted ...

Risk of Constrictive Pericarditis after Acute Pericarditis: Imazio M, Brucato A, Maestroni S, et al. Circulation 2011;124:1270–5.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This was a prospective cohort study out of Italy that aimed to evaluate the risk of developing constrictive pericarditis (CP) after acute pericarditis (AP) with a risk assessment according to the etiology. Five hundred cases of first-episode AP were clinically diagnosed by two of the following criteria: pericardial chest pain, pericardial friction rub, new diffuse ST-segment elevation or PR depressions, or new or worsening pericardial effusion. Cases were grouped based on the following etiologies: viral/idiopathic (n=416), connective tissue disease/pericardial injury syndromes (n=36), neoplastic (n=25), tuberculosis (n=20), and purulent (n=3); then prospectively followed for a median of 72 months to evaluate for progression to constrictive pericarditis. The study found that CP was a rare c...

Early Stroke Risk and ABCD2 Score Performance in Tissue- vs Time-defined TIA: A Multicenter Study: Giles MF, Albers GW, Amarenco P, et al. Neurology 2011;77:1222–8.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This study investigated the performance of the ABDC2 prognostic tools in TIA sub-classified by imaging as tissue-positive (TP; stroke with rapid and complete recovery) or tissue-negative (TN; classic TIA) based on diffusion-weighted imaging (DWI) or computed tomography (CT) imaging according to newly proposed criteria. It involved 12 independent research centers at international locations that submitted data on cohorts of patients with a diagnosis of TIA (time based), which were categorized by ABCD2 scores, brain infarction, and outcomes of recurrent stroke at 7 and 90 days. Recurrent stroke was defined as a new neurologic deficit of vascular origin lasting more than 24h or leading to death and occurring after resolution of TIA. Those with minor strokes, a non-neurovascular diagnosis, and ...

Association of ICU or Hospital Admission with Unintentional Discontinuation of Medications for Chronic Diseases: Bell CM, Brener SS, Gunraj N, et al. JAMA 2011;306:840–7.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

In this population-based cohort study, Bell et al. examined the association between intensive care unit (ICU) or hospital admission with unintentional discontinuation of medications for chronic diseases. The study population included all hospitalized patients in Ontario, Canada from 1997 to 2009 who were 66 years of age or older and had at least 1 year of continuous medication use before hospitalization in at least one of the following five medication groups (n=187,912): 1) statins; 2) antiplatelet or anticoagulant agents; 3) levothyroxine; 4) respiratory inhalers; 5) gastric acid-suppressing medications. The control group consisted of non-hospitalized patients (n=208,468). The primary outcome was unintentional medication discontinuation, defined by failure to renew the prescription with...

American Academy of Emergency Medicine

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

Editorial Board

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

Partial Contents of Volume 42, Number 1

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

Issue Highlights

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

Calendar of Events

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

List of Reviewers for Volumes 40 and 41, 2011

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

Neal Abarbanell, md Fort Pierce, Florida (Source: The Journal of Emergency Medicine)

Intramuscular Dexmedetomidine Sedation for Pediatric MRI and CT: Mason KP, Lubisch NB, Robinson F, et al. AJR Am J Roentgenol 2011;197:720–5.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

Sedation in pediatrics continues to be an area of great interest among researchers, as clinicians try to balance adequate sedation, side-effect profiles, and less painful administration of pharmacologic agents. In this retrospective chart review, researchers examined the efficacy of intramuscular (IM) dexmedetomidine for sedation in children undergoing diagnostic imaging, as well as assessing the safety of the agent in the same population. Sixty-five children from age 1 month to 10 years, with the majority being 2–3 years of age, undergoing magnetic resonance imaging or computed tomography scans for non-traumatic indications received dexmedetomidine for sedation. Patients were not eligible for dexmedetomidine for a variety of pre-existing conditions, such as obesity, intracranial bleedin...

The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) Trial: Goldstein JA, Raff GL, Chinnaiyan KM, et al. J Am Coll Cardiol 2011;58:1414–22.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

This study evaluated coronary computed tomographic angiography (CCTA) as a potential alternative to the current standard of care. The study was conducted as a multicenter comparative effectiveness trial comparing CCTA to rest-stress myocardial perfusion imaging (MPI). Patients with acute chest pain and low risk for MI (defined as Thrombolysis in Myocardial Infarction [TIMI] risk score < 4) with no ECG changes concerning for acute ischemia and no elevated serum biomarkers were randomized to receive CCTA vs. MPI. Patients with CCTA showing < 25% coronary arterial stenoses were eligible for discharge home; patients with 25–70% stenoses were recommended for cross-over for rest-stress MPI, and patients with > 70% stenoses were referred for invasive coronary angiography. Importantly, this stud...

Clinical Examination is Highly Sensitive for Detecting Clinically Significant Spinal Injuries after Gunshot Wounds: Inaba K, Barmparas G, Ibrahim D, et al. J Trauma 2011;71:523–7.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

Rapid assessment of spinal injury in penetrating trauma patients is an important step in the management of these potentially seriously injured patients. In an urban, academic medical center, 282 adult patients with penetrating injury were enrolled over a 6-month period. These patients had a standardized physical examination of their spine using a checklist in an attempt to prospectively determine the sensitivity and specificity of a structured clinical examination to evaluate for spinal injury after penetrating trauma. Of the 282 patients, 139 sustained a stab wound and none of these patients had a spinal injury. Of the remaining 143 gunshot wound (GSW) patients, 112 were deemed evaluable (Glasgow Coma Scale score of 15, not intoxicated, with no distracting injury) and underwent a standard...

Female Breast, Lung, and Pelvic Organ Radiation from Dose-reduced 64-MDCT Thoracic Examination Protocols: A Phantom Study: Litmanovich D, Tack D, Lin PJ, Boiselle PM, Raptopoulos V, Bankier AA. AJR Am J Roentgenol 2011;197:929–34.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

This study compared the phantom organ radiation dose to the breast, lungs, and pelvis from five CT-PE protocols using an anthropomorphic phantom model on a standard 64-detector CT scanner. The five protocols were chosen to represent current scanning practice patterns used to reduce overall radiation in CT-PE protocols with variation in scan length, section thickness, tube potential, pitch, tube current, noise index, and whether dose modulation was used. The outcomes measured included the total dose in milligrays to each organ as well as the volume CT dose index (vCTDI: the average dose delivered to the scan volume). When comparing the protocols used during the contrast injection phase of a CT-PE scan, protocol 3, which has been reported to decrease overall radiation dose to the breast in p...

Development and Validation of Risk Prediction Algorithm (QThrombosis) to Estimate Future Risk of Venous Thromboembolism: Prospective Cohort Study: Hippisley-Cox J, Coupland C. BMJ 2011;343:d4656.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

This article, in contrast, is targeted at primary care providers and aimed to predict absolute risk of VTE at 1 and 5 years in asymptomatic patients. The authors used a large research database of data routinely collected from general practices in the United Kingdom to create a prospective cohort of patients aged 25–84 years with no history of VTE, not on oral anticoagulants, and without pregnancy in the preceding year. They randomly assigned patients to either a derivation cohort or a validation cohort. They then identified a broad group of risk factors for VTE based on previously published studies including age, body mass index, tobacco use, congestive heart failure, chronic renal failure, use of hormone replacement therapy, cancer, and others. The clinical outcome was diagnosis of VTE,...

Angiographic Characteristics of Coronary Disease and Postresuscitation Electrocardiograms in Patients with Aborted Cardiac Arrest Outside a Hospital: Radsel P, Knafelj R, Kocjancic S, Noc M. Am J Cardiol 2011;108:634–8.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

After cardiac arrest, post-resuscitation electrocardiogram (ECG) may demonstrate ST- elevation myocardial infarction (STEMI), ST changes, or other findings concerning for coronary artery occlusion. In this retrospective study, researchers at an academic medical center in Slovenia examined the ECGs of 212 consecutive patients who underwent percutaneous coronary angiography (PCA) after out-of-hospital cardiac arrest, seeking to relate the ECG to a culprit lesion. Three hundred thirty-five patients with out-of-hospital cardiac arrest over a 5-year period were initially examined in the study, with 123 being excluded from PCA due to death before angiography, patients being post-coronary artery bypass grafting, non-ischemic cause of arrest, prolonged down time, physician decision, or other exclu...

Platelet Transfusion: An Unnecessary Risk for Mild Traumatic Brain Injury Patients on Antiplatelet Therapy: Washington CW, Schuerer DJ, Grubb RL. J Trauma 2011;71:358–63.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

The growing percentage of Americans on anti-platelet therapy has lead to an increased incidence of anticoagulated patients within the emergency department with minor traumatic brain injury. There has been a considerable amount of literature attempting to determine the proper management of these patients. In this retrospective chart review of 108 patients on antiplatelet therapy with isolated minor traumatic brain injury (MTBI = Glasgow Coma Scale [GCS] score ≥ 13 plus intracranial hemorrhage [ICH] found on head computed tomography [CT]) admitted to a Level 1 trauma center, the authors attempted to determine whether platelet transfusions led to improved neurological outcomes. Patients were excluded from the study if they were on other forms of anticoagulation, if their intracranial hemorr...

Weekend and Night Outcomes in a Statewide Trauma System: Carr BG, Wiebe DJ, Reilly PM, et al. Arch Surg 2011;146:810–7.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

The differential quality of “off-hours” care for critical conditions has been cited repeatedly in the literature across a spectrum of diseases and specialties. In this article, the authors sought to evaluate whether trauma patients in a well-established regional trauma system were also subject to the so-called “weekend effect.” Retrospective data were collected on all adult trauma patients admitted to an accredited trauma center in Pennsylvania over a 5-year period, looking at in-house mortality, length of stay (LOS), and delay over 2 h to laparotomy or craniotomy. The data were subdivided by patient arrival time as weekday, weeknight, or weekend admissions. In unadjusted analyses of the data, the authors found that patients presenting on weeknights had a higher in-hospital mortali...

Clinical Predictors of Admission in Infants with Acute Bronchiolitis: Marlais M, Evans J, Abrahamson E. Arch Dis Child 2011;96:648–52.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

Bronchiolitis is common in infants, and deciding whether or not to admit these patients can be difficult in the emergency department (ED). Researchers at a large, urban academic center in the United Kingdom sought to identify clinical predictors of hospital admission in infants presenting with bronchiolitis and to devise a clinical risk scoring system in this population. The authors retrospectively examined the clinical records of 449 infants that presented with acute bronchitis over a 1-year period. Of these patients, 163 (36%) were admitted to the hospital. A total of 29 potential risk predictors were evaluated, and the most accurate predictors of hospital admission were age, duration of symptoms, heart rate, respiratory rate, and oxygen saturation. Predictors with incomplete data sets o...

Comparison of Gender-specific Mortality in Patients < 70 Years versus ≥ 70 Years Old with Acute Myocardial Infarction: Ishihara M, Inoue I, Kawagoe T, et al. Am J Cardiol 2011;108:772–5.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

This study assessed age-stratified mortality rates among men and women undergoing coronary angiography for AMI to determine whether gender discrepancies are age specific. The retrospective observational study included 2677 consecutive patients at a single tertiary care center who presented with chest pain, and subsequently were found to have electrocardiographic changes and biomarker changes consistent with an MI, and underwent angiography before revascularization therapy. Patients were divided by gender and by age; > or 70 years old age group: women 77.1 ± 5.5 years vs. men 75.4 ± 4.6 years old; p < 0.001, < 70 years old age group: women 60.4 ± 8.2 years old vs. men 56.4 ± 8.5 years old; p < 0.001). In both age groups, women had a statistically significant increased number of medical...

Blunt Cervical Spine Trauma and Distracting Injuries: Konstantinidis A, Demetriades D, Plurad D, et al. J Trauma 2011;71:528–32.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

This study aimed to clarify the role of distracting injuries in the evaluation of cervical spine injuries. The authors collected prospective data on over 9000 blunt trauma patients admitted to the trauma surgery service at an academic medical center. Of these patients, 119 (1.3%) had a cervical spine injury, either bony or ligamentous, found on imaging, but 15% of these patients were excluded from the study because their physical examination was limited by intoxication or altered mental status. Of the 101 evaluable patients with confirmed c-spine injury, 96% (all but 4 patients) had midline neck pain or tenderness during their initial physical examination. These included 88 patients with injuries that have previously been described as “distracting,” including pelvic fractures and long ...

American Academy of Emergency Medicine

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

Editorial Board

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

(Source: The Journal of Emergency Medicine)

Partial Contents of Volume 41, Number 6

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Issue Highlights

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Calendar of Events

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Early Blood Product and Crystalloid Volume Resuscitation: Risk Associated With Multiple Organ Dysfunction After Severe Blunt Traumatic Injury: Brakenridge SC, Phelan HA, Henley SS, et al. J Trauma 2011;71:299–305.

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

This study was a secondary retrospective analysis of 1366 patients with blunt trauma and hemorrhagic shock, with an abbreviated injury score ≥ 2 outside the head region, age ≥ 13 years, base deficit ≥ 6 mmol/L, systolic blood pressure < 90 mm Hg prehospital or within 60 min of arrival, and blood product transfusion within 12 h. Exclusion criteria were mortality risk from head injury (abbreviated injury score head > 4), cervical spinal cord injury, thermal burn > 20% total body surface area, death < 48 h from time of injury, and > 6 h before evaluation at a level I trauma center. The primary outcome of interest was at least one episode of multiple organ dysfunction (MOD) within 28 days. The predictors of interest were total units of packed red blood cells (PRBC), total units fresh fro...

Severity of Bacterial Vaginosis and the Risk of Sexually Transmitted Infection: Allsworth JE, Peipert JF. Am J Obstet Gynecol 2011 Feb 27 [Epub ahead of print].

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

Bacterial vaginosis (BV) has been linked to increased sexually transmitted infections (STI) in high-risk patients. Allsworth and Peipert attempted to determine if the severity of BV in women at high risk for contracting an STI correlated with the incidence of STI. This retrospective analysis of a prospectively collected dataset followed high-risk, sexually active females between the ages of 13 and 35 years for 24 months after an initial BV severity assessment, specifically assessing infection with Chlamydia or gonorrhea. BV severity was assessed using two classification schemes. The first was Nugent's criteria, which is based off of the gram stain of the wet prep and includes: 1) the presence of large Gram-positive rods scored from 4–0, 2) the presence of small Gram-positive rods scored ...

Comparative Evaluation of the Modified CT Severity Index and CT Severity Index in Assessing Severity of Acute Pancreatitis: Bollen TL, Singh VK, Maurer R, et al. AJR Am J Roentgenol 2011;197:386–92.

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

This study compared the modified computed tomography severity index (MCTSI), the original CT severity index (CTSI), and the Acute Physiology, Age, and Chronic Health Evaluation (APACHE II) index in their correlation with acute pancreatitis severity. The CTSI is a numeric scoring system that provides a score based on the extent of pancreatic inflammation and pancreatic parenchymal necrosis as seen on CT. The MCTSI, developed in 2004, simplifies the evaluation of inflammation and parenchymal necrosis and also incorporates extrapancreatic complications in the numeric score. Retrospective analysis of a hospital database identified 397 cases of acute pancreatitis; 196 (49%) underwent contrast-enhanced CT (175 patients) or magnetic resonance imaging (21 patients) within 1 week of onset of sympto...

Treatment of Streptococcal Pharyngitis with Once-Daily Amoxicillin versus Intramuscular Benzathine Penicillin G in Low-Resource Settings: A Randomized Control Trial: Rimoin AW, Hoff NA, Fischer Walker CL, et al. Clin Pediatr 2011;50:535–42.

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

In this study, when patients were compliant with either treatment eradication, success rates were equivalent. However, in Egypt, where compliance with the 10-day oral amoxicillin treatment was a major issue, the IM BPG treatment was superior in successful treatment of GAS pharyngitis. (Source: The Journal of Emergency Medicine)

Reducing Time-to-Treatment Decreases Mortality of Trauma Patients with Acute Subdural Hematoma: Tien HC, Jung V, Pinto R, Mainprize T, Scales DC, Rizoli SB. Ann Surg 2011;253:1178–83.

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

The “golden hour” in the treatment of the trauma patient is a well-known concept suggesting that early assessment and treatment of a trauma patient will maximize the likelihood of survival. Although often cited in textbooks and widely taught within the classroom, there are few objective data demonstrating that the early treatment of the trauma patient results in improved outcomes. This retrospective cohort study from a single large urban Canadian trauma center attempted to determine if there was a survival benefit with reduced pre-hospital time and time to craniotomy in patients sustaining isolated acute subdural hematomas. Excluding patients referred from outside hospitals, those with penetrating trauma, severe torso injury, and intoxication, the final study population of patients who...

Acute Ischemic Stroke in Children versus Young Adults: Bigi S, Fischer U, Wehrli E, et al. Ann Neurol 2011;70:245–54.

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

This study from Switzerland compared 128 children (ages 1 month to 16 years) to 199 young adults (ages 16-45 years) who suffered an acute ischemic stroke from January 2000 to December 2008. Data for children were collected from the Swiss Neuro Pediatric Stroke Registry (a Swiss national registry) and data for young adults were collected from the Bernese stroke registry (a hospital-based registry). Children were more likely to be male (62% vs. 49%, p = 0.023) and had fewer risk factors such as hypertension (p = 0.001), hypercholesterolemia (p = 0.003), or a family history of stroke (p = 0.048). Stroke etiology in children was more likely to be “other determined cause” (51% vs. 29%, p < 0.001), steno-occlusive arteriopathy (18% vs. 0%, p < 0.001), and moyamoya syndrome (5% vs. 0.2%, p = ...

The Effect of Supplemental Oxygen on Hypercapnia in Subjects with Obesity-associated Hypoventilation: A Randomized, Crossover, Clinical Study: Wijesinghe M, Williams M, Perrin K, Weatherall M, Beasley R. Chest 2011;139:1018–24.

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

This study sought to determine if the same effect is seen in patients with obesity-associated hypoventilation (OAH). In this double-blind, randomized, controlled, crossover trial of 24 patients newly diagnosed with OAH, subjects inhaled either 100% oxygen or room air via full-face continuous positive airway pressure mask, without positive airway pressure, for 20 min on 2 separate days. Baseline measurements of transcutaneous carbon dioxide tension (PtCO2), minute ventilation, and volume of dead-space-to-tidal-volume ratio were compared to the same values at 20 min by mixed linear model to determine differences between the two treatments. All subjects who completed the study (23 of 24) participated in both of the treatments on separate days within 7 days. Testing was terminated early in 3 s...

Focused Assessment of Patients with Asthma in the Emergency Department: Kanis K, Lovell J, Bowan M, Titus MO. Clin Pediatr 2011;50:529–34.

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

Asthma accounts for approximately 20 million visits to emergency departments (EDs) across the country every year. Clinical asthma severity (CAS) scores have been developed in an attempt to improve and standardize asthma care during acute exacerbations. In this retrospective chart review, Kanis et al. attempted to determine whether the adoption of a CAS score for pediatric patients within their large urban ED improved identification of patients with severe asthma and increased the aggressiveness of treatment received. When comparing all asthma patients seen within their ED in the 18 months preceding the implementation of a CAS score to the first 18 months after the implementation of the CAS score, there were little differences in the percentage of patients admitted to the hospital (pre-CAS ...

Evaluation of the Total Face Mask for Noninvasive Ventilation to Treat Acute Respiratory Failure: Ozsancak A, Sidhom SS, Liesching TN, et al. Chest 2011;139:1034–41.

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

This study compared the total face mask (TFM) to the commonly used oronasal mask (ONM). The TFM covers the entire face and creates an air seal using a silicon gasket around the perimeter of the face, theoretically eliminating discomfort to the nasal bridge and simplifying mask application. Of 60 patients enrolled in the study, 31 were randomized to the ONM group and 29 to the TFM group. There was no statistically significant difference in baseline characteristics including sex, age, vital signs, arterial blood gas values, dyspnea score, and indication for NIV between groups, except for a higher heart rate in the TFM group (102.4 ± 20.8 beats/min vs. 116.0 ± 19.1 beats/min). There was no significant difference in the primary outcomes of mask discomfort (graded using a visual analog scale ...

Communicating Data about the Benefits and Harms of Treatment: A Randomized Trial: Woloshin S, Schwartz LM. Ann Intern Med 2011; 155:87–96.

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

This study demonstrated that natural frequency is not the best way to communicate benefits and harms of treatments, and that the most succinct percent format resulted in the best comprehension. (Source: The Journal of Emergency Medicine)

Outpatient versus Inpatient Treatment for Patients with Acute Pulmonary Embolism: An International, Open-label, Randomised, Non-inferiority Trial: Aujesky D, Roy PM, Verschuren F, et al. Lancet 2011;378:41–8.

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

The most common practice pattern within the emergency department (ED) for the disposition of patients with pulmonary embolism (PE) is to admit the patient for initial anticoagulation while oral anticoagulation is started. An increasing number of guidelines suggest that a select, stable patient population can be discharged from the ED after starting subcutaneous anticoagulation in conjunction with oral anticoagulation. This international, multi-centered, randomized trial of 344 patients attempted to determine non-inferiority of ED-initiated enoxaparin treatment vs. inpatient-initiated enoxaparin treatment in stable, low-risk patients. Patients over the age of 18 years with either a new filling defect on spiral computed tomography scan, a high-probability V/Q scan, or a documented deep vein ...

American Academy of Emergency Medicine

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Editorial Board

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Gastrointestinal Emergencies

The Journal of Emergency Medicine — Mon, 10 Oct 2011 04:00:00 +0100

In the world of emergency medicine, the complaint of abdominal pain is frequent. Given the multitude of organs and potential culprits, the abdominal complaint can easily frustrate the clinician. Ideally, a simple but complete text comparing and contrasting the various etiologies and treatments for abdominal pain would exist. The gold standard for this is currently Cope’s Early Diagnosis of the Acute Abdomen, edited by William Silen . This is a difficult act to follow. Tham, Collins, and Soetikno sought to bring a fresh light to typical gastrointestinal issues. (Source: The Journal of Emergency Medicine)

Drowning Terminology

The Journal of Emergency Medicine — Fri, 07 Oct 2011 04:00:00 +0100

We read with interest Muth et al.’s study, “Infrared Ear Thermometry in Water-related Accidents—Not a Good Choice,” and applaud their contribution to the literature of drowning management (). (Source: The Journal of Emergency Medicine)

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Partial Contents of Volume 41, Number 4

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Issue Highlights

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Editorial Board

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Calendar of Events

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Hypertension Influences Recurrent Stone Formation in Nonobese Stone Formers: Kim YJ, Park MS, Kim WT, et al. Urology 2011;77:1059–63.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

This study from Korea looked at the relationship between hypertension and recurrent stone formation. In this case control study, the authors used a database of 1200 calcium stone formers (SF) who had undergone stone evaluation at their institution. Of these, 228 patients were included in the study and divided into two groups: hypertensive SF (those who self-reported history of hypertension and treatment with antihypertensives) and normotensive SF. A metabolic evaluation including serum and urine chemistries was performed 4–6 weeks after stone management completion. Medications that may affect chemistries were discontinued 1 week before evaluation in both groups, except for antihypertensives in the hypertensive SF, which were continued. All SF were followed with abdominal radiograph and u...

Time Trends in Pulmonary Embolism in the United States: Wiener RS, Schwartz LM, Woloshin S. Arch Intern Med 2011;171:831–7.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

As computed tomography (CT) scanners have become more sophisticated and highly sensitive, CT pulmonary angiography (CTPA) has largely become the test of choice for diagnosing pulmonary embolism (PE). In this retrospective time trend analysis, the authors question whether this increased sensitivity has led to over-diagnosis and treatment. The authors searched the Nationwide Inpatient Sample and Multiple Cause-of-Death databases and compared the age-adjusted incidence, mortality, and complications of treatment of PE among U.S. adults for the 5 years before (1993–1998) and after (1998–2006) the introduction of CTPA. For this study, treatment complications were described as in-hospital intracranial hemorrhage, gastrointestinal bleeding, or secondary thrombocytopenia. Incidence of PE incre...

Incidence of Adrenal Insufficiency and Impact of Corticosteroid Supplementation in Critically Ill Children with Systemic Inflammatory Syndrome and Vasopressor-Dependent Shock: Hebbar KB, Stockwell JA, Leong T, Fortenberry JD. Crit Care Med 2011;39:1145–50.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

This study was a retrospective review of 78 patients with a median age of 84 months, who were treated at the Atlanta Pediatric Intensive Care Unit (PICU) with a protocol for steroid supplementation in patients meeting SIRS criteria. The primary outcome was decrease in vasopressor requirements after initiation of steroid treatment. All PICU patients requiring intravenous fluids and vasopressors for treatment of shock were tested for adrenal insufficiency with a standardized corticotrophin stimulation test. Patients were then classified as having absolute adrenal insufficiency (AAI) if a basal cortisol level < 18 mg/dL was measured vs. relative adrenal insufficiency (RAI) if the corticotrophin stimulation test induced a change in measured cortisol levels. Of the initial 78 patients, 44 (56%)...

Decompressive Craniectomy in Diffuse Traumatic Brain Injury: Cooper DJ, Rosenfeld JV, Murray L, et al. N Engl J Med 2011;364:1493–502.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

Elevated intracranial pressure (ICP) has been associated with poor outcomes in patients suffering traumatic brain injury (TBI). However, the optimal treatment for ICP as a result of TBI remains unclear. In this randomized controlled prospective trial, the authors examined the effect of early decompressive craniectomy vs. standard medical therapy in patients with refractory elevated ICP after TBI. Refractory ICP was defined as ICP > 20 mm Hg for more than 15 min, persisting after first-line treatment including pharmacologic sedation, normalization of arterial carbon dioxide pressure, mannitol, hypertonic saline, neuromuscular blockade, and external ventricular drainage. Early decompressive craniectomy was defined as bilateral craniectomy within 72 h of presentation, and standard medical the...

Morbidity Related to Emergency Endotracheal Intubation—A Substudy of the KETAmine SEDation Trial: Jabre P, Avenel A, Combes X, et al. Resuscitation 2011;82:517–22.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

This retrospective study from France looked at prospectively collected data from the KETAmine SEDation (KETASED) trial to evaluate the association between intubation difficulty and the occurrence of immediate complications and 28-day mortality. In the KETASED trial, patients over the age of 18 years requiring sedation for emergency tracheal intubation in a mobile intensive care unit (ICU) or ambulance were randomized to receive either ketamine or etomidate in combination with a paralytic agent (succinylcholine). Patients were excluded if they were in cardiac arrest, had contraindications to succinylcholine, ketamine, or etomidate, or were known to be pregnant. The intubation technique was standardized between mobile ICUs. The emergency physicians performing the procedure recorded complicat...

Rising Use of CT in Child Visits to the Emergency Department in the United States, 1995–2008: Larson DB, Johnson LW, Schnell BM, et al. Radiology 2011;259:793–801.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

This study sampled data from the National Hospital Ambulatory Medical Care Survey from 1995–2008 in an attempt to examine the use of CT in the pediatric population in emergency departments in the United States. Each year, between 5072 and 9725 pediatric visits were sampled, with a mean of 7375 visits. The number of visits associated with CT increased from 1.2% to 5.9%, a 4.8-fold increase. The compound annual growth rate was 12.8%. This effect was less pronounced at pediatric-specific facilities, but there was still a substantial increase. Additionally, the percent visits with CT increased across all age groups, from infant to adolescent, but was most prominent in the adolescent group. The most common chief complaint that resulted in CT scan was head injury (34% in 2008), whereas the gre...

Coronary Artery Calcium Scoring Does Not Add Prognostic Value to Standard 64-Section CT Angiography Protocol in Low-Risk Patients Suspected of Having Coronary Artery Disease: Kwon SW, Young JK, Jaemin S, et al. Radiology 2011;259:92–9.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

This study found that patients with clinical CAD tended to have risk factors of increased age, male gender, history of hypertension, diabetes, and dyslipidemia, with a significantly higher CACS and a higher amount of CAD seen on CCTA. A total of 3% of patients developed an outcome event. The authors noted that CACS was not an independent predictor of any cardiac outcome, but the presence of CAD on CCTA was. Additionally, both a CACS of > 400 or two- to three-vessel CAD on CTTA had an 80% or less event-free survival rate. Overall, CAC scores were more predictive than patient history-based risk factors for predicting adverse events, but there was no difference in combining CACS with CCTA in predicting adverse outcomes than CCTA alone, which was higher than CACS alone. The authors concluded t...

Blood Cultures in the Emergency Department Evaluation of Childhood Pneumonia: Shah SS, Dugan MH, Bell LM, et al. Pediatr Infect Dis J 2011;30:475–9.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

This study from Philadelphia examined the prevalence of bacteremia in children presenting to the emergency department (ED) with community-acquired pneumonia (CAP), as well as the impact of positive blood cultures on clinical management. A case control study out of The Children's Hospital of Philadelphia (CHOP) Pediatric Research Consortium, it included children from three states including urban, suburban, and semirural locations. Patients were younger than 18 years old, seen in a CHOP ED, and diagnosed with CAP. Exclusion criteria included hospitalization in the last 14 days or presence of an immunocompromising or chronic medical condition predisposing them to severe disease. The included patients were then divided into three groups: those with documented bacteremia (positive blood culture...

The Influence of Race on the Development of Acute Lung Injury in Trauma Patients: Brown LM, Kallet RH, Matthay MA, et al. Am J Surg 2011;201:486–91.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

Outcomes and incidence for certain chronic diseases, such as hypertension, vary among different racial and ethnic groups, but it is unclear if there is a similar effect in acute illnesses. This retrospective cohort study investigated the effect of race on mortality due to acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The authors reviewed the charts of 4397 adult trauma patients, including 1831 Caucasians, 871 African-Americans, 886 Hispanics, and 809 Asian/Pacific Islanders requiring intensive care unit admission at an urban teaching hospital in San Francisco, California. There were 219 patients identified who developed ALI/ARDS within 72 h of admission. The overall incidence of ALI/ARDS in the study was 5% and was similar across all racial cohorts. The incidence ...

Vital Signs and Estimated Blood Loss in Patients with Major Trauma: Testing the Validity of the ATLS Classification of Hypovolemic Shock: Guly HR, Bouamra O, Spiers M, et al. Resuscitation 2011;82:556–9.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

The Advanced Trauma Life Support (ATLS) classification of shock is a widely accepted and utilized tool to assess the severity of trauma, direct treatment, and predict morbidity and mortality. This retrospective case review from England and Wales sought to validate the classification of shock based on physiological parameters taught in ATLS. The authors reviewed all blunt and penetrating traumas included in the Trauma Audit and Research Network database between 1989 and 2007. Patients were included if they were older than 16 years and admitted to the hospital for more than 3 days, admitted to an intensive care unit, or died within 93 days of injury. Patients were excluded if they were over 65 years of age with isolated orthopedic injuries, or of any age with isolated limb injuries. Included...

Norepinephrine Increases Cardiac Preload and Reduces Preload Dependency Assessed By Passive Leg Raising in Septic Shock Patients: Monnet X, Jabot J, Maizel J, et al. Crit Care Med 2011;39:689–94.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

This prospective interventional study from France aimed to further characterize the hemodynamic effects of norepinephrine (NE). The authors hypothesized that in addition to its powerful vasoconstrictive arterial effects, NE also exerts an effect on the venous side, increasing venous return, cardiac preload, and cardiac output. This non-blinded single-arm study was conducted in a university hospital in a 15-bed medical intensive care unit and included patients who had a diagnosis of sepsis and circulatory shock (defined as systolic blood pressure < 90 mm Hg plus decreased urine output or heart rate > 100 beats/min or skin mottling), an NE infusion already in place, a diastolic blood pressure < 40 mm Hg, and a positive passive leg raise (PLR). The investigators first recorded baseline hemody...

American Academy of Emergency Medicine

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Quantifying Drug-seeking Behavior: A Case Control Study

The Journal of Emergency Medicine — Wed, 28 Sep 2011 04:00:00 +0100

Conclusions: Requesting parenteral medication and reporting greater than ten out of ten pain were most predictive of drug-seeking, while reporting a non-narcotic allergy was less predictive of drug-seeking than other behaviors. (Source: The Journal of Emergency Medicine)

Risk Factors Associated with Delayed Diagnosis of Acute Pulmonary Embolism

The Journal of Emergency Medicine — Wed, 28 Sep 2011 04:00:00 +0100

Abstract: Background: Prompt diagnosis and treatment of acute pulmonary embolism (PE) is essential to reduce mortality. Risk factors for PE are well known, but factors associated with delayed diagnosis are less clear.Objective: Our objective was to identify clinical factors associated with delayed diagnosis of patients with acute PE presenting to a tertiary-care emergency department (ED).Methods: We studied 400 consecutive adults who presented to our ED with acute, symptomatic PE. All patients were diagnosed by computed tomography (CT) angiography. Early diagnosis was defined as CT diagnosis12h. Univariate and multiple logistic regression models were used to identify factors associated with delayed diagnosis. Odds ratios with 95% confidence intervals are reported.Results: The median time f...

Partial Contents of Volume 41, Number 4

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Issue Highlights

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Calendar of Events

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Trauma in the Neighborhood: A Geospatial Analysis and Assessment of Social Determinants of Major Injury in North America: Newgard CD, Schmicker RH, Sopko G, et al. Am J Public Health 2011;101:669–77.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

Traumatic injuries are a major cause of morbidity and mortality worldwide. Although it has been shown that disparities exist among various racial, ethnic, and socioeconomic groups, it is unclear whether trends exist among geographic areas and neighborhood communities. In an attempt to further define the sociocultural framework and determinants for bodily injury, this multi-center observational study analyzed data from nine study sites across the United States and Canada. Through participation of 163 emergency medical services (EMS) systems, a sample of 7326 major trauma patients was evaluated between December 1, 2005 and April 30, 2007. Both children and adults were included (1137 were younger than 18 years old). Inclusion criteria were broadly defined, and included individuals who had sus...

Equimolar Nitrous Oxide/Oxygen versus Placebo for Procedural Pain in Children: A Randomized Trial: Reinoso-Barbero F, Pascual-Pascual SI, de Lucal R, et al. Pediatrics 2011;127:e1464–70.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

This Spanish randomized, placebo-controlled, double-blinded study evaluated the effectiveness of oxygen and nitrous oxide inhalation (EMONO) when used for short procedures including nevus excision, laceration repair, skin biopsy, venous cannulation, lumbar puncture, joint aspiration, or bone marrow aspiration. The study enrolled 100 children and randomized them to treatment with EMONO or placebo. For large cutaneous procedures, eutectic mixture of local anesthetic cream was applied. Two scales were used to evaluate the quality of sedation and pain control. Children 6 years of age and older used the faces pain scale-revised (rFPS). Those 6 years of age and younger used the Spanish version of an observational pain scale (LLANTO) based on five behavioral items (crying, psychological attitude,...

Impact of Business Cycles on US Suicide Rates, 1928–2007: Luo F, Florence CS, Quispe-Agnoli M, Ouyang L, Crosby AE. Am J Public Health 2011;101:1139–46.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

This study broadened the scope of the hypothesis to look at the relationship between suicide rates and business cycles, which include both economic expansions and recessions. The authors extracted data on suicide deaths from 1928–2007 from multiple sources. Business-cycle data were drawn from the National Bureau of Economic Research using 1-year time intervals. The overall suicide rate (per 100,000 people) peaked during the Great Depression at 22.1, and reached a nadir of 10.4 in 2000, during the longest period of economic expansion in the years studied. The suicide rate increased in 11 of the 13 recessions and decreased in 10 of the 13 expansions. Examining the data by age bracket showed statistically significant (p (Source: The Journal of Emergency Medicine)

The Effects of Sex on Out-of-hospital Cardiac Arrest Outcomes: Akahane M, Ogawa T, Soike S, et al. Am J Med 2011;124:325–33.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

Cardiac arrest is a leading cause of morbidity and mortality for both men and women. Women are considered to have improved survival after cardiac arrest compared to men, but it has not been elucidated whether this was due to differences in age or sex-based biologic variation. To evaluate this, the authors developed a descriptive observational study based in Japan, which assembled a population of patients from a national out-of-hospital cardiac arrest database between January 2005 and December 2007. A total of 276,590 patients were selected from a broader sample (women comprised 37.8%), with ages ranging from 20 to 89 years. The broad age range was selected to evaluate the role of estrogen on outcomes for women from reproductive age through menopause. Patients suffering out-of-hospital card...

Circulating Influenza Virus, Climatic Factors, and Acute Myocardial Infarction: A Time Series Study in England and Wales and Hong Kong: Warren-Gash C, Bhaskaran K, Hayward A, et al. J Infect Dis 2011;203:1710–8.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

This study compared acute myocardial infarction hospitalizations and deaths with influenza data from two separate climatic regions. England/Wales, with its temperate climate, has its influenza peak during the winter, with a clear seasonal pattern. Hong Kong, on the other hand, with its subtropical climate, has winters that are less severe, with two subsequent peaks in influenza, during the winter and summer months. Influenza data in England and Wales were collected primarily by evaluating the rates of general practitioner consultations for influenza-like illness (ILI). In Hong Kong, both ILI consultations and swab testing were used to establish influenza rates. These data were then compared with data for MI admissions and deaths in both regions. The study also used admissions for colon can...

Risk of Death and Cardiovascular Events in Initially Healthy Women with New-onset Atrial Fibrillation: Conen D, Albert CM, Chae CU, et al. JAMA 2011;305:2080–7.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

This study sought to determine the risk of adverse events among healthy middle-aged women with new-onset AF. The study utilized data from the Women's Health Study, an ongoing prospective study of 39,876 female health care professionals with a median age of 53 years (interquartile range [IQR] 49–59), examining the effects of low-dose aspirin and vitamin E in primary prevention of cardiovascular disease. Of the total cohort, 87.1% were included in this study, excluding those with a history of AF or cardiovascular event, or lost to follow-up. Over a median 15.4 years of follow-up (IQR 14.8–15.8), 2.9% were diagnosed with new-onset AF, of whom 64.9% were classified as having paroxysmal AF (PAF; spontaneously resolved in (Source: The Journal of Emergency Medicine)

Outcomes after Ischemic Stroke for Hospitals with and without Joint Commission-certified Primary Stroke Centers: Lichtman JH, Jones SB, Wang Y, et al. Neurology 2011;76:1976–82.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

Primary stroke centers (PSC) have been certified by the Joint Commission (JC) in the United States since 2003. Whether this formal certification has led to better patient outcomes or has merely identified hospitals with better performance standards is not entirely clear. To assess this question, the authors surveyed both JC-certified (n=315) and noncertified (n=4197) hospitals for 30-day risk-standardized mortality (RSMR) and readmission after hospital discharge (RSRR) rates. The population in question was comprised of Medicare fee-for-service beneficiaries 65 years or older with a primary discharge diagnosis of ischemic stroke. The mean RSMR was 10.7% ± 1.7% for JC-certified PSC vs. 11.0% ± 1.7% for non-certified hospitals. The average RSRR was 12.5% ± 1.3% for JC-certified PSC vs. 12....

Pulsed Ultrasounds Accelerate Healing of Rib Fractures in an Experimental Animal Model: An Effective New Thoracic Therapy? Santana-Rodriguez N, Clavo B, Fernandez-Perez L, et al. J Thorac Cardiovasc Surg 2011;141:1253–8.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

In this study, 136 rats were randomized into two study groups, those who underwent radiographic and histologic evaluation and those who underwent polymerase chain reaction to evaluate gene expression. Within each of these groups, rats were then randomized into a control group and three other groups receiving doses of 50, 100, and 250 mW/cm2. Those in the radiographic/histologic study group were evaluated at 2, 10, 20, and 28 days. Those who underwent genomic evaluation were evaluated at 10 and 28 days. The rat model involved a left thoracotomy and a 0.5-cm fragment of bone removed from two adjacent ribs under anesthesia. Histologic evaluation showed that those rats that underwent PUS had an odds ratio of 5.4 for callus formation (95% confidence interval [CI], 2.1–13.9) when compared to c...

Antibiotic Prescribing During Pediatric Ambulatory Care Visits for Asthma: Paul IM, Maselli JH, Hersh AL, et al. Pediatrics 2011;127:1014–21.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

Treatment guidelines published by the National Asthma Education and Prevention Program specify that antibiotics should not be used in the treatment of asthma without evidence of concurrent bacterial infection. Based on these guidelines, the authors of this study sought to evaluate the extent of inappropriate antibiotic use in asthmatic children. Data were collected from large public-use databases of surveys conducted by the National Center for Health Statistics (NCHS) that included physician office visits as well as emergency department (ED) visits in the United States (US). The authors identified all visits by children (age (Source: The Journal of Emergency Medicine)

Factors Associated with Closures of Emergency Departments in the United States: Hsia RY, Kellerman AL, Shen Y. JAMA 2011;305:1978–85.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

Emergency departments (EDs) serve a pivotal role in providing medical care to the ever-increasing proportion of the population who are under- or uninsured. Despite the increase in utilization of EDs nationwide, each month several EDs close across the country. To assess the possible reasons for closure, namely the role of the overall economic climate, this observational study looked at the total number of metropolitan (non-rural) operational EDs between 1990 and 2009. Rural EDs were excluded due to the differences in government mandate and funding to these institutions. Variables in this study included ownership status (for-profit, non-profit, and government), teaching status, profit margin, membership, annual visit size, and case-mix index (grouped into healthier than average, average, and...

Sensitivity of the Aortic Dissection Detection Risk Score, a Novel Guideline-based Tool for Identification of Acute Aortic Dissection at Initial Presentation. Results from the International Registry of Acute Aortic Dissection: Rogers AM, Hermann LK, Booher AM, et al. Circulation 2011;123:2213–8.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

This study evaluated the sensitivity of an aortic dissection detection (ADD) risk score when applied to 2538 patients with confirmed aortic dissection from the international registry of acute aortic dissection (IRAD). The ADD risk score was derived from risk markers established in 2010 by the American Heart Association and American College of Cardiology guidelines for the diagnosis and management of thoracic aortic disease. The ADD risk score was composed of three categories (high-risk predisposing conditions, high-risk chest, abdomen, or back pain features, and high-risk examination features) consisting of 12 clinical risk markers including: history of Marfan syndrome, family history of aortic disease, history of known aortic valve disease, history of recent aortic manipulation, history o...

Cardiovascular Screening with Electrocardiography and Echocardiography in Collegiate Athletes: Magalski A, McCoy M, Zabel M, et al. Am J Med 2011;124:511–8.

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

In this study of collegiate varsity athletes, 964 consecutive participants at a single institution were screened with a comprehensive history, physical examination, 12-lead electrocardiogram (ECG), and transthoracic echocardiogram. Nine athletes were found to have an important cardiovascular condition. Seven athletes were newly diagnosed with Wolff-Parkinson-White syndrome, all of whom were eventually cleared, but four of whom underwent radiofrequency ablation. Two athletes were ultimately restricted from participation: one for long QT syndrome with a history of syncope, and one for aortic root dilatation with mild abnormalities on ECG, but no symptoms. Using AHA guidelines, 22.8% of the athletes would have met criteria for further testing, including ECG. However, of the athletes found to ...

American Academy of Emergency Medicine

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

Editorial Board

The Journal of Emergency Medicine — Thu, 01 Sep 2011 04:00:00 +0100

(Source: The Journal of Emergency Medicine)

First Aid for the Emergency Medicine Oral Boards

The Journal of Emergency Medicine — Wed, 24 Aug 2011 04:00:00 +0100

The Oral Board Examination in Emergency Medicine is usually a onetime career experience. Whether you are preparing for the examination, or you are a Board Certified Emergency Physician with colleagues looking to you for study recommendations, keeping abreast of current resources is beneficial. An ideal guide for Oral Boards would include a concise topic review, a handful of cases that are easy to study and practice, and a structured information-gathering system to approach patient simulations. The First Aid series text meets the grade in some of these respects, but also has significant pitfalls that will be reviewed below. (Source: The Journal of Emergency Medicine)

Simulation-based Emergency Medicine Resident Self-Assessment

The Journal of Emergency Medicine — Thu, 11 Aug 2011 04:00:00 +0100

Abstract: Background: Videotaped recordings of simulation-based performance may allow learners the opportunity to review, evaluate, and reflect upon their own performance. Objectives: To determine the accuracy of resident performance self-assessment after a simulation-based encounter; compare low- and high-scoring residents’ abilities to evaluate their performance; and determine if video-assisted performance review improves self-assessment accuracy. Methods: Emergency Medicine residents participated in a videotaped simulation-based assessment. Residents evaluated their performance immediately after completing simulated cases, and after reviewing the session’s video. Self-ratings were compared to the faculty observers, and scores were divided based on the median. Results: Sevent...

Emergency Department Focused Bedside Echocardiography in Massive Pulmonary Embolism

The Journal of Emergency Medicine — Fri, 05 Aug 2011 04:00:00 +0100

Conclusion: In the hands of an experienced emergency physician ultrasonographer, ED focused bedside echocardiography provides a safe, rapid, and non-invasive diagnostic adjunct for evaluation of the patient suspected of having massive PE. (Source: The Journal of Emergency Medicine)

Cervical Ectopic Pregnancy Diagnosed by Point-of-Care Emergency Department Ultrasound

The Journal of Emergency Medicine — Fri, 05 Aug 2011 04:00:00 +0100

Conclusion: Familiarity with cervical EP and its sonographic appearance is essential for emergency physicians because it can be easily mistaken for an intrauterine pregnancy or other obstetric/gynecologic pathology, such as an incomplete abortion or nabothian cyst. The management of each of these differs substantially, making accurate diagnosis crucial. (Source: The Journal of Emergency Medicine)

Partial Contents of Volume 41, Number 3