Risk of Radiation Exposure to Emergency Department Personnel From Portable Radiographs.

Background: There are concerns that emergency health care workers are exposed to ionizing radiation as the result of frequent portable radiographs obtained in the emergency department (ED) during active patient care.

Objective: Our aim was to investigate whether ED staff are exposed to significant radiation due to scatter from portable radiography at a busy trauma center and whether exposure was related to factors such as location or distance.

Methods: This was a prospective cohort study performed during 3 consecutive months in the ED at a large, academic trauma center.

Overutilization of Helicopter Emergency Medical Services in Central Gulf Coast Region Results in Unnecessary Expenditure.

Introduction: When appropriately used, helicopter emergency medical services (HEMSs) allow for timely delivery of severely injured patients to definitive care. Inappropriate utilization of HEMSs results in increased cost to the patient and trauma system. The purpose of this study was to review current HEMS criteria in the central Gulf Coast region and evaluate for potential areas of triage refinement and cost savings.

Care Transitions After Acute Myocardial Infarction for Transferred-In Versus Direct-Arrival Patients.

Background: Many patients in the United States require transfer from one hospital to another for acute myocardial infarction (MI) care. How well these transferred-in patients are transitioned back to their local community is unknown.

Methods And Results: We used linked Medicare claims data to examine postdischarge outcomes of 39 136 patients with acute MI aged ≥65 years discharged alive from 451 US hospitals in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines.

Performance of the 4-way range of motion test for radiographic injuries after blunt elbow trauma.

Objectives: Acute elbow injuries are common in the acute care setting. A previous study observed that limited active range of motion (ROM) was highly sensitive for radiographic injuries after blunt trauma. Our aim was to validate these findings in patients ≥5 years old with an acute (<24 hours) nonpenetrating elbow injury.

Overdiagnosis of Clostridium difficile Infection in the Molecular Test Era.

Importance: Clostridium difficile is a major cause of health care-associated infection, but disagreement between diagnostic tests is an ongoing barrier to clinical decision making and public health reporting. Molecular tests are increasingly used to diagnose C difficile infection (CDI), but many molecular test-positive patients lack toxins that historically defined disease, making it unclear if they need treatment.

Objective: To determine the natural history and need for treatment of patients who are toxin immunoassay negative and polymerase chain reaction (PCR) positive (Tox-/PCR+) for CDI.

Recovery of salivary DNA from the skin after showering.

Purpose: After sexual assault there is a limited amount of time before the DNA evidence on the surface of the victim's body is not recoverable. During an assault, the offender may leave saliva on the victim's skin. Traditional examination methods use a swabbing technique to collect saliva for DNA testing.

Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the emergency department.

Introduction: Consensus guidelines recommend sepsis screening for adults with systemic inflammatory response syndrome (SIRS), but the epidemiology of SIRS among adult emergency department (ED) patients is poorly understood. Recent emphasis on cost-effective, outcomes-based healthcare prompts the evaluation of the performance of large-scale efforts such as sepsis screening. We studied a nationally representative sample to clarify the epidemiology of SIRS in the ED and subsequent category of illness.

Shock index and early recognition of sepsis in the emergency department: pilot study.

Introduction: Screening for severe sepsis in adult emergency department (ED) patients may involve potential delays while waiting for laboratory testing, leading to postponed identification or over-utilization of resources. The systemic inflammatory response syndrome (SIRS) criteria are inaccurate at predicting clinical outcomes in sepsis. Shock index (SI), defined as heart rate / systolic blood pressure, has previously been shown to identify high risk septic patients.

Examination of histological samples from submerged carrion to aid in the determination of postmortem submersion interval.

The use of histology in the as a tool for estimating postmortem intervals has rarely been explored but it has the potential for offering medical examiners an additional means for estimating the postmortem submersion interval (PMSI) during a death investigation. This study used perinatal piglets as human analogs which were submerged in freshwater for various time intervals. Each piglet was extracted from the water and underwent a necropsy examination during which histological samples were collected.

Comparison of protocols for measuring and calculating postmortem submersion intervals for human analogs in fresh water.

Protocols for determining postmortem submersion interval (PMSI) have long been problematic for forensic investigators due to the wide variety of factors affecting the rate of decomposition of submerged carrion. Likewise, it has been equally problematic for researchers to develop standardized experimental protocols to monitor underwater decomposition without artificially affecting the decomposition rate. This study compares two experimental protocols: (i) underwater in situ evaluation with photographic documentation utilizing the Heaton et al.

Hyperlactatemia affects the association of hyperglycemia with mortality in nondiabetic adults with sepsis.

Background: Admission hyperglycemia has been reported as a mortality risk factor for septic nondiabetic patients; however, hyperglycemia's known association with hyperlactatemia was not addressed in these analyses.

Objectives: The objective was to determine whether the association of hyperglycemia with mortality remains significant when adjusted for concurrent hyperlactatemia.

Methods: This was a post hoc, nested analysis of a retrospective cohort study performed at a single center.

Impact of metformin use on the prognostic value of lactate in sepsis.

Objective: The objective of this study is to determine if metformin use affects the prevalence and prognostic value of hyperlactatemia to predict mortality in septic adult emergency department (ED) patients.

Methods: This is a single-center retrospective cohort study. Emergency department providers identified study subjects; data were collected from the medical record.

Evaluation of the Stratus CS Acute Care D-dimer assay (DDMR) using the Stratus CS STAT Fluorometric Analyzer: a prospective multisite study for exclusion of pulmonary embolism and deep vein thrombosis.

Background: D-dimer testing is an integral part of the diagnostic algorithm in excluding patients with venous thromboembolism. In this study, we prospectively evaluated the Stratus DDMR D-dimer test in patients suspected of pulmonary embolism (PE) and deep vein thrombosis (DVT).

Methods: Patients suspected of venous thromboembolism were prospectively enrolled at four different clinical sites, with sodium citrate and lithium heparin plasma was tested using the DDMR D-dimer test on the Stratus CS analyzer.

Patients prefer boarding in inpatient hallways: correlation with the national emergency department overcrowding score.

Objective. The boarding of patients in Emergency Department (ED) hallways when no inpatient beds are available is a major cause of ED crowding. One solution is to board admitted patients in an inpatient rather than ED hallway.

S-adenosyl-L-methionine treatment for alcoholic liver disease: a double-blinded, randomized, placebo-controlled trial.

Background: S-adenosyl-L-methionine (SAM) is the methyl donor for all methylation reactions and regulates the synthesis of glutathione, the main cellular antioxidant. Previous experimental studies suggested that SAM may benefit patients with established alcoholic liver diseases (ALDs). The aim of this study was to determine the efficacy of SAM in treatment for ALD in a 24-week trial.

Using forms to develop research projects.

This article is the 16(th) in a multipart series designed to assist readers, particularly novices, in the area of clinical research. This article is focused on the process of developing a new research project. It provides tools to help those involved in beginning their own research projects.

Impaired homocysteine transsulfuration is an indicator of alcoholic liver disease.

Background & Aims: Although abnormal hepatic methionine metabolism plays a central role in the pathogenesis of experimental alcoholic liver disease (ALD), its relationship to the risk and severity of clinical ALD is not known. The aim of this clinical study was to determine the relationship between serum levels of methionine metabolites in chronic alcoholics and the risk and pathological severity of ALD.

Methods: Serum levels of liver function biochemical markers, vitamin B6, vitamin B12, folate, homocysteine, methionine, S-adenosylmethionine, S-adenosylhomocysteine, cystathionine, cysteine, alpha-aminobutyrate, glycine, serine, and dimethylglycine were measured in 40 ALD patients, of whom 24 had liver biopsies, 26 were active drinkers without liver disease, and 28 were healthy subjects.

Fracture of a GlideScope® Cobalt GVL® Stat disposable blade during an emergency intubation.

Background: Emergency airway management is a diverse discipline, often utilizing advanced equipment with video technology to enable the intubator to visualize a patient's vocal cords that would be difficult or impossible to see with routine direct laryngoscopy. The GlideScope® Cobalt (Saturn Biomedical Systems, Inc., Burnaby, BC, Canada) is one type of video laryngoscope with disposable plastic GVL® Stat blades (Saturn Biomedical Systems) that can improve glottic view over direct laryngoscopy.

Delayed complications of emergency airway management: a study of 533 emergency department intubations.

Objectives: Airway management is a critical procedure performed frequently in emergency departments (EDs). Previous studies have evaluated the complications associated with this procedure but have focused only on the immediate complications. The purpose of this study is to determine the incidence and nature of delayed complications of tracheal intubation performed in the ED at an academic center where intubations are performed by emergency physicians (EPs).

Preservation of active range of motion after acute elbow trauma predicts absence of elbow fracture.

Objective: Previous studies indicate that an inability to fully extend the elbow after elbow trauma is indicative of fracture. We hypothesized that maintenance of active range of motion (ROM) of the elbow in flexion, extension, pronation, and supination after elbow trauma is very specific for the absence of fracture or effusion, and limitation of ROM is sensitive for fracture or effusion.

Methods: This was a prospective observational study with convenience sampling of a carefully selected patient population.

Evaluation of the chest pain patient: survey of current practice patterns.

The objective of this study was to measure the prevalence of chest pain centers, and describe the associated protocols most commonly used to rapidly risk-stratify patients in these units. This study is a survey conducted from May to July 2003 via direct mail. A questionnaire was mailed to 4653 hospitals in the United States.

Reporting patterns for "lapses of consciousness" by California emergency physicians.

Physician reporting of lapses of consciousness (LOC) to the Department of Motor Vehicles is a controversial topic in medicine. The objective of this study was to describe current LOC reporting practices by emergency physicians (EPs) in a state with mandatory reporting requirements (California). A questionnaire describing 14 different clinical scenarios involving LOC was distributed to a diverse sample of California EPs.