Annals Update 12/3/2012

Direct Link:
http://www.mdconsult.com/das/journallist/issue/352414047-2/32244?issn=0196-0644
PubMed Results

Items 1 – 25 of 25

1. Ann Emerg Med. 2012 Oct;60(4):17A-19A.
Concussion research being carried out.
Cearnal L.
PMID: 23180502 [PubMed – in process]
Related citations


2. Ann Emerg Med. 2012 Oct;60(4):17A-21A.
Chronic traumatic encephalopathy: emergency physicians fielding more questions in the absence of evidence.
Cearnal L.
PMID: 23180501 [PubMed – in process]
Related citations


3. Ann Emerg Med. 2012 Oct;60(4):15A-16A.
Annals Q&A with Dr. Eric Topol. Interviewed by Truman J Milling Jr.
Topol E.
PMID: 23180500 [PubMed – in process]
Related citations


4. Ann Emerg Med. 2012 Dec;60(6):e11-2. doi: 10.1016/j.annemergmed.2012.07.108.
A Four-year-old Male With Abdominal Pain.
Day L, Thimann D, Smith A.

Department of Pediatrics, Division of General Pediatrics, Children’s Medical Center, Dallas TX.

PMID: 23178029 [PubMed – in process]
Related citations



5. Ann Emerg Med. 2012 Dec;60(6):820. doi: 10.1016/j.annemergmed.2012.07.006.
Misuse of the pulmonary embolism rule-out criteria.
Bossart PJ.

Salt Lake City, UT.

PMID: 23178028 [PubMed – in process]
Related citations



6. Ann Emerg Med. 2012 Dec;60(6):820. doi: 10.1016/j.annemergmed.2012.07.008.
In reply.
Green SM, Yealy DM.

Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, CA.

PMID: 23178027 [PubMed – in process]
Related citations



7. Ann Emerg Med. 2012 Dec;60(6):819-20. doi: 10.1016/j.annemergmed.2012.06.020.
Recurrent seizure activity in a child after acute vilazodone ingestion.
Carstairs SD, Griffith EA, Alayin T, Ejike JC, Cantrell FL.

Department of Emergency Medicine, Naval Medical Center, San Diego, CA.

PMID: 23178026 [PubMed – in process]
Related citations



8. Ann Emerg Med. 2012 Dec;60(6):818-9. doi: 10.1016/j.annemergmed.2012.06.010.
In reply.
Sakles JC.

Department of Emergency Medicine, University of Arizona, Tucson, AZ.

PMID: 23178025 [PubMed – in process]
Related citations



9. Ann Emerg Med. 2012 Dec;60(6):817-8. doi: 10.1016/j.annemergmed.2012.05.044.
Comparative Performance of C-MAC Video Laryngoscope and Macintosh Direct Laryngoscope for Emergency Intubation.
Xue FS, Liao X, Cheng Y.

Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China.

PMID: 23178024 [PubMed – in process]
Related citations



10. Ann Emerg Med. 2012 Dec;60(6):817. doi: 10.1016/j.annemergmed.2012.06.009.
In reply.
Sonkar SK, Soni D, Soni DK, Sonkar GK.

Department of Medicine, C.S.M. Medical University (Formerly King George Medical University), UP Lucknow, India.

PMID: 23178023 [PubMed – in process]
Related citations



11. Ann Emerg Med. 2012 Dec;60(6):816-7. doi: 10.1016/j.annemergmed.2012.05.043.
Recommendations regarding management of methanol toxicity.
Skolnik AB, O’Connor A, Ruha AM, Curry S.

Banner Good Samaritan Medical Center, Department of Medical Toxicology, Phoenix, AZ.

PMID: 23178022 [PubMed – in process]
Related citations



12. Ann Emerg Med. 2012 Dec;60(6):815-22. doi: 10.1016/j.annemergmed.2012.05.010.
Woman with white patches on tongue.
Jin X, Zeng X.

State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China.

PMID: 23178021 [PubMed – in process]
Related citations



13. Ann Emerg Med. 2012 Dec;60(6):803-14. doi: 10.1016/j.annemergmed.2012.07.121.
Is “PERC Negative” Adequate to Rule Out Pulmonary Embolism in the Emergency Department? Evaluating Meta-analysis for Studies of Clinical Prediction Models: Answers to the July 2012 Journal Club Questions.
Self WH, Barrett TW.

Vanderbilt University Medical Center, Nashville, TN.

PMID: 23178020 [PubMed – in process]
Related citations



14. Ann Emerg Med. 2012 Dec;60(6):800-2. doi: 10.1016/j.annemergmed.2012.10.016.
Commentary: If We Shoot Ourselves in the Foot, Will EMS Be There to Respond?
Kahn C.

Department of Emergency Medicine, University of California, San Diego, San Diego, CA.

PMID: 23178019 [PubMed – in process]
Related citations



15. Ann Emerg Med. 2012 Dec;60(6):722-5. doi: 10.1016/j.annemergmed.2012.10.013.
NHAMCS: Does It Hold Up to Scrutiny?
Cooper RJ.

UCLA Emergency Medicine Center, Los Angeles, CA. Electronic address: [email protected].

PMID: 23178018 [PubMed – in process]
Related citations



16. Ann Emerg Med. 2012 Dec;60(6):692-798. doi: 10.1016/j.annemergmed.2012.05.011.
Young woman with vomiting, dyspnea, and chest pain.
Rosales-Zabal JM, Romero-Ordoñez MA, Palma-Carazo F, Martinez-Santos MC, Sanchez-Yagüe A, Suarez-Aleman G, Perez-Aisa A, Sanchez-Cantos AM.

Emergency Department, Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain; Gastrointestinal Unit, Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain.

PMID: 23178017 [PubMed – in process]
Related citations



17. Ann Emerg Med. 2012 Dec;60(6):687-91. doi: 10.1016/j.annemergmed.2012.09.017.
Emergency department crowding 2.0: coping with a dysfunctional system.
Kocher KE, Asplin BR.

Department of Emergency Medicine and the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI. Electronic address: [email protected].

PMID: 23178016 [PubMed – in process]
Related citations



18. Ann Emerg Med. 2012 Nov 9. pii: S0196-0644(12)01616-2. doi: 10.1016/j.annemergmed.2012.10.009. [Epub ahead of print]
Hospital Collaboration With Emergency Medical Services in the Care of Patients With Acute Myocardial Infarction: Perspectives From Key Hospital Staff.
Landman AB, Spatz ES, Cherlin EJ, Krumholz HM, Bradley EH, Curry LA.

Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA. Electronic address: [email protected].

Abstract
STUDY OBJECTIVE:

Evidence suggests that active collaboration between hospitals and emergency medical services (EMS) is significantly associated with lower acute myocardial infarction mortality rates; however, the nature of such collaborations is not well understood. We seek to characterize views of key hospital staff about collaboration with EMS in the care of patients hospitalized with acute myocardial infarction.

METHODS:

We performed an exploratory analysis of qualitative data previously collected from site visits and detailed interviews with 11 US hospitals that ranked in the top or bottom 5% of performance on 30-day risk-standardized acute myocardial infarction mortality rates, using Centers for Medicare & Medicaid Services data from 2005 to 2007. We selected all codes from the previous analysis in which EMS was most likely to have been discussed. A multidisciplinary team analyzed the data with the constant comparative method to generate recurrent themes.

RESULTS:

Both higher- and lower-performing hospitals reported that EMS is critical to the provision of timely care for patients with acute myocardial infarction. However, close collaborative relationships with EMS were more apparent in the higher-performing hospitals, which demonstrated specific investment in and attention to EMS through respect for EMS as valued professionals and colleagues, strong communication and coordination with EMS and active engagement of EMS in hospital acute myocardial infarction quality improvement efforts.

CONCLUSION:

Hospital staff from higher-performing hospitals described broad, multifaceted strategies to support collaboration with EMS in providing acute myocardial infarction care. The association of these strategies with hospital performance should be tested quantitatively in a larger representative study.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23146627 [PubMed – as supplied by publisher]
Related citations



19. Ann Emerg Med. 2012 Nov 9. pii: S0196-0644(12)01297-8. doi: 10.1016/j.annemergmed.2012.07.112. [Epub ahead of print]
Accuracy of Point-of-Care Ultrasonography for Diagnosis of Elbow Fractures in Children.
Rabiner JE, Khine H, Avner JR, Friedman LM, Tsung JW.

Department of Pediatrics, Division of Pediatric Emergency Medicine, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY. Electronic address: [email protected].

Abstract
STUDY OBJECTIVE:

We determine the test performance characteristics for point-of-care ultrasonography performed by pediatric emergency physicians compared with radiographic diagnosis of elbow fractures and compare interobserver agreement between enrolling physicians and an experienced pediatric emergency medicine sonologist.

METHODS:

This was a prospective study of children aged up to 21 years and presenting to the emergency department (ED) with elbow injuries requiring radiographs. Before obtaining radiographs, pediatric emergency physicians performed focused elbow ultrasonography. An ultrasonographic result positive for fracture at the elbow was defined as the pediatric emergency physician’s determination of an elevated posterior fat pad or lipohemarthrosis of the posterior fat pad. All patients received an elbow radiograph in the ED and clinical follow-up. The criterion standard for fracture was fracture on initial or follow-up radiographs.

RESULTS:

One hundred thirty patients with a mean age of 7.5 years were enrolled by 26 sonologists. Forty-three (33%) patients had a radiograph result positive for fracture. A positive elbow ultrasonographic result had a sensitivity of 98% (95% confidence interval [CI] 88% to 100%), specificity of 70% (95% CI 60% to 79%), positive likelihood ratio of 3.3 (95% CI 2.4 to 4.5), and negative likelihood ratio of 0.03 (95% CI 0.01 to 0.23) for fracture. The interobserver agreement (κ) was 0.77. The use of elbow ultrasonography would reduce radiographs in 48% of patients but would miss 1 fracture.

CONCLUSION:

Point-of-care ultrasonography is highly sensitive for elbow fractures, and a negative ultrasonographic result may reduce the need for radiographs in children with elbow injuries. Elbow ultrasonography may be useful in settings in which radiography is not readily accessible or is time consuming to obtain.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23142008 [PubMed – as supplied by publisher]
Related citations



20. Ann Emerg Med. 2012 Nov 9. pii: S0196-0644(12)01425-4. doi: 10.1016/j.annemergmed.2012.08.026. [Epub ahead of print]
Emergency Medical Services Out-of-Hospital Scene and Transport Times and Their Association With Mortality in Trauma Patients Presenting to an Urban Level I Trauma Center.
McCoy CE, Menchine M, Sampson S, Anderson C, Kahn C.

Department of Emergency Medicine, UC Irvine School of Medicine, Orange, CA. Electronic address: [email protected].

Abstract
STUDY OBJECTIVE:

We determine the association between emergency medical services (EMS) out-of-hospital times and mortality in trauma patients presenting to an urban Level I trauma center.

METHODS:

We conducted a secondary analysis of a prospective cohort registry of trauma patients presenting to a Level I trauma center during a 14-year period (1996 to 2009). Inclusion criteria were patients sustaining traumatic injury who presented to an urban Level I trauma center. Exclusion criteria were extrication, missing or erroneous out-of-hospital times, and intervals exceeding 5 hours. The primary outcome was inhospital mortality. EMS out-of-hospital intervals (scene time and transport time) were evaluated with multivariate logistic regression.

RESULTS:

There were 19,167 trauma patients available for analysis, with 865 (4.5%) deaths; 16,170 (84%) injuries were blunt, with 596 (3.7%) deaths, and 2,997 (16%) were penetrating, with 269 (9%) deaths. Mean age and sex for blunt and penetrating trauma were 34.5 years (68% men) and 28.1 years (90% men), respectively. Of those with Injury Severity Score less than or equal to 15, 0.4% died, and 26.1% of those with a score greater than 15 died. We analyzed the relationship of scene time and transport time with mortality among patients with Injury Severity Score greater than 15, controlling for age, sex, Injury Severity Score, and Revised Trauma Score. On multivariate regression of patients with penetrating trauma, we observed that a scene time greater than 20 minutes was associated with higher odds of mortality than scene time less than 10 minutes (odds ratio [OR] 2.90; 95% confidence interval [CI] 1.09 to 7.74). Scene time of 10 to 19 minutes was not significantly associated with mortality (OR 1.19; 95% CI 0.66 to 2.16). Longer transport times were likewise not associated with increased odds of mortality in penetrating trauma cases; OR for transport time greater than or equal to 20 minutes was 0.40 (95% CI 0.14 to 1.19), and OR for transport time 10 to 19 minutes was 0.64 (95% CI 0.35 to 1.15). For patients with blunt trauma, we did not observe any association between scene or transport times and increased odds of mortality.

CONCLUSION:

In this analysis of patients presenting to an urban Level I trauma center during a 14-year period, we observed increased odds of mortality among patients with penetrating trauma if scene time was greater than 20 minutes. We did not observe associations between increased odds of mortality and out-of-hospital times in blunt trauma victims. These findings should be validated in an external data set.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23142007 [PubMed – as supplied by publisher]
Related citations



21. Ann Emerg Med. 2012 Nov 6. pii: S0196-0644(12)01549-1. doi: 10.1016/j.annemergmed.2012.09.016. [Epub ahead of print]
Ultrasound-Guided Peripheral Intravenous Access Program Is Associated With a Marked Reduction in Central Venous Catheter Use in Noncritically Ill Emergency Department Patients.
Shokoohi H, Boniface K, McCarthy M, Khedir Al-Tiae T, Sattarian M, Ding R, Liu YT, Pourmand A, Schoenfeld E, Scott J, Shesser R, Yadav K.

Department of Emergency Medicine, George Washington University, Washington, DC. Electronic address: [email protected].

Abstract
STUDY OBJECTIVE:

We examine the central venous catheter placement rate during the implementation of an ultrasound-guided peripheral intravenous access program.

METHODS:

We conducted a time-series analysis of the monthly central venous catheter rate among adult emergency department (ED) patients in an academic urban ED between 2006 and 2011. During this period, emergency medicine residents and ED technicians were trained in ultrasound-guided peripheral intravenous access. We calculated the monthly central venous catheter placement rate overall and compared the central venous catheter reduction rate associated with the ultrasound-guided peripheral intravenous access program between noncritically ill patients and patients admitted to critical care. Patients receiving central venous catheters were classified as noncritically ill if admitted to telemetry or medical/surgical floor or discharged home from the ED.

RESULTS:

During the study period, the ED treated a total of 401,532 patients, of whom 1,583 (0.39%) received a central venous catheter. The central venous catheter rate decreased by 80% between 2006 (0.81%) and 2011 (0.16%). The decrease in the rate was significantly greater among noncritically ill patients (mean for telemetry patients 4.4% per month [95% confidence interval {CI} 3.6% to 5.1%], floor patients 4.8% [95% CI 4.2% to 5.3%], and discharged patients 7.6% [95% CI 6.2% to 9.1%]) than critically ill patients (0.9%; 95% CI 0.6% to 1.2%). The proportion of central venous catheters that were placed in critically ill patients increased from 34% in 2006 to 81% in 2011 because fewer central venous catheterizations were performed in noncritically ill patients.

CONCLUSION:

The ultrasound-guided peripheral intravenous access program was associated with reductions in central venous catheter placement, particularly in noncritically ill patients. Further research is needed to determine the extent to which such access can replace central venous catheter placement in ED patients with difficult vascular access.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23141920 [PubMed – as supplied by publisher]
Related citations



22. Ann Emerg Med. 2012 Nov 6. pii: S0196-0644(12)01606-X. doi: 10.1016/j.annemergmed.2012.10.002. [Epub ahead of print]
Which Central Line Insertion Site Is the Least Prone to Infection?
Akhter M, Runde D, Lee J.

Department of Emergency Medicine, Emory University.

PMID: 23141919 [PubMed – as supplied by publisher]
Related citations



23. Ann Emerg Med. 2012 Nov 6. pii: S0196-0644(12)01509-0. doi: 10.1016/j.annemergmed.2012.09.004. [Epub ahead of print]
EMS Triage and Transport of Intoxicated Individuals to a Detoxification Facility Instead of an Emergency Department.
Ross DW, Schullek JR, Homan MB.

American Medical Response Inc, Colorado Springs, CO; Penrose-St. Francis Health Services and Front Range Emergency Specialists PC, Colorado Springs, CO. Electronic address: [email protected].

Abstract
STUDY OBJECTIVE:

We evaluate the effectiveness and safety of emergency medical services (EMS) provider use of a checklist to triage alcohol-inebriated patients directly to a detoxification facility, rather than an emergency department (ED).

METHODS:

A retrospective cohort study was conducted of all patients evaluated during a 2-year period, from 2003 to 2005, by EMS providers who used a detoxification evaluation checklist to aid in triage decisionmaking. Patients who did not meet detoxification evaluation checklist criteria were transported to an ED. Twelve-hour follow-up was solicited for patients taken to the detoxification center. Hospital records of inebriated patients transported to an ED were reviewed to assess ultimate need for ED care.

RESULTS:

Seven hundred eighteen patient encounters were reviewed. One hundred thirty-eight of these patients (19.2%) were transported to the detoxification facility, whereas 580 (80.8%) were transported to an ED; 339 patients transported to an ED were ultimately deemed to have required ED care. The criteria that most commonly excluded transport to the detoxification center were an inability to ambulate with minimal assistance (N=334) and an unwillingness to cooperate with the physical examination (N=195). Low-acuity adverse events were observed in 4 subjects (0.6%) initially transported to the detoxification center who then required subsequent transport to an ED. No high-acuity clinical complications were identified at any time. The use of the detoxification evaluation checklist resulted in high sensitivity (99%; 95% confidence interval 97% to 100%) and low specificity (42%; 95% confidence interval 37% to 48%) in predicting need for ED care.

CONCLUSION:

Our analysis suggests that field triage criteria can be used effectively to safely divert inebriated patients to a detoxification facility rather than an ED, with minimal adverse events. Use of the detoxification evaluation checklist resulted in substantial ED overtriage, and further refinement of the detoxification evaluation checklist criteria is needed to reduce it.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23141299 [PubMed – as supplied by publisher]
Related citations



24. Ann Emerg Med. 2012 Nov 2. pii: S0196-0644(12)01506-5. doi: 10.1016/j.annemergmed.2012.09.002. [Epub ahead of print]
A Call to Action for Antimicrobial Stewardship in the Emergency Department: Approaches and Strategies.
May L, Cosgrove S, L’archeveque M, Talan DA, Payne P, Jordan J, Rothman RE.

Department of Emergency Medicine, George Washington University, Washington, DC. Electronic address: [email protected].

PMID: 23122955 [PubMed – as supplied by publisher]
Related citations



25. Ann Emerg Med. 2012 Nov 2. pii: S0196-0644(12)01497-7. doi: 10.1016/j.annemergmed.2012.08.030. [Epub ahead of print]
The Prevalence of Traumatic Brain Injuries After Minor Blunt Head Trauma in Children With Ventricular Shunts.
Nigrovic LE, Lillis K, Atabaki SM, Dayan PS, Hoyle J, Tunik MG, Jacobs ES, Monroe D, Wootton-Gorges SW, Miskin M, Holmes JF, Kuppermann N; for the Traumatic Brain Injury (TBI) Working Group of the Pediatric Emergency Care Applied Research Network (PECARN).

Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA.

Abstract
STUDY OBJECTIVE:

We compare the prevalence of clinically important traumatic brain injuries and the use of cranial computed tomography (CT) in children with minor blunt head trauma with and without ventricular shunts.

METHODS:

We performed a secondary analysis of a prospective observational cohort study of children with blunt head trauma presenting to a participating Pediatric Emergency Care Applied Research Network emergency department. For children with Glasgow Coma Scale (GCS) scores greater than or equal to 14, we compared the rates of clinically important traumatic brain injuries (defined as a traumatic brain injury resulting in death, neurosurgical intervention, intubation for more than 24 hours, or hospital admission for at least 2 nights for management of traumatic brain injury in association with positive CT scan) and use of cranial CT for children with and without ventricular shunts.

RESULTS:

Of the 39,732 children with blunt head trauma and GCS scores greater than or equal to 14, we identified 98 (0.2%) children with ventricular shunts. Children with ventricular shunts had more frequent CT use: (45/98 [46%] with shunts versus 13,858/39,634 [35%] without; difference 11%; 95% confidence interval 1% to 21%) but a similar rate of clinically important traumatic brain injuries (1/98 [1%] with shunts versus 346/39,619 [0.9%] without; difference 0.1%; 95% confidence interval -0.3% to 5%). The one child with a ventricular shunt who had a clinically important traumatic brain injury had a known chronic subdural hematoma that was larger after the head trauma compared with previous CT; the child underwent hematoma evacuation.

CONCLUSION:

Children with ventricular shunts had higher CT use with similar rates of clinically important traumatic brain injuries after minor blunt head trauma compared with children without ventricular shunts.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23122954 [PubMed – as supplied by publisher]
Related citations


Posted in SDMEDED Blog Posts