Applying the Boston syncope criteria to near syncope.

Background: We recently demonstrated that near-syncope patients are as likely as syncope patients to experience adverse outcomes. The Boston Syncope Criteria (BSC) identify patients with syncope unlikely to have adverse outcomes and reduce hospitalizations. It is unclear whether these guidelines could reduce hospitalization in near syncope as well.

Sustained effectiveness of a primary-team-based rapid response system.

Objective: Laws and regulations require many hospitals to implement rapid-response systems. However, the optimal resource intensity for such systems is unknown. We sought to determine whether a rapid-response system that relied on a patient's usual care providers, not a critical-care-trained rapid-response team, would improve patient outcomes.

Emergency department abnormal vital sign "triggers" program improves time to therapy.

Background: Implementation of rapid response systems to identify deteriorating patients in the inpatient setting has demonstrated improved patient outcomes. A "trigger" system using vital sign abnormalities to initiate evaluation by physician was recently described as an effective rapid response method.

Objectives: The objective was to evaluate the effect of a triage-based trigger system on the primary outcome of time to physician evaluation and the secondary outcomes of therapeutic intervention, antibiotics, and disposition in emergency department (ED) patients.

Reducing admissions utilizing the Boston Syncope Criteria.

Background: We previously developed criteria to identify patients with syncope at risk for adverse events. Although we proposed a theoretical substantial reduction in admission, these criteria were untested in actual practice.

Objective: To perform a prospective effectiveness study testing the hypothesis that using the Boston Syncope Criteria as a clinical guideline will safely reduce the proportion of patients admitted with syncope.

Do outcomes of near syncope parallel syncope?

Background: Limited information on the evaluation of emergency department (ED) patients complaining of "near syncope" exists. Multiple studies of syncope exclude near syncope claiming near syncope is poorly defined and its definition is nonuniform.

Objective: The aim of this study was to determine the incidence of critical interventions or adverse outcomes associated with near syncope and compare these outcomes with syncope.

Can benign etiologies predict benign outcomes in high-risk syncope patients?

Background: We previously studied and validated risk factors for adverse outcomes or need for critical intervention in syncope.

Objective: To determine whether high-risk patients, diagnosed with benign etiologies of syncope after a normal emergency department (ED) work-up, sustain favorable outcomes.

Methods: Prospective, observational cohort of consecutive ED patients aged ≥ 18 years with syncope.

Predicting adverse outcomes in syncope.

Syncope is a common presentation to the Emergency Department (ED); however, appropriate management and indications for hospitalization remain an ongoing challenge. The objective of this study was to determine if a predefined decision rule could accurately identify patients with syncope likely to have an adverse outcome or critical intervention. A prospective, observational, cohort study was conducted of consecutive ED patients aged 18 years or older presenting with syncope.

The yield of head CT in syncope: a pilot study.

Unlabelled: Although head CT is often routinely performed in emergency department (ED) patients with syncope, few studies have assessed its value.

Objectives: To determine the yield of routine head CT in ED patients with syncope and analyse the factors associated with a positive CT.

Methods: Prospective, observational, cohort study of consecutive patients presenting with syncope to an urban tertiary-care ED (48,000 annual visits).

Motor vehicle crashes in New York State: importance of accounting for emergency department deaths when assessing differences in in-hospital mortality by level of care.

Background: Motor vehicle crashes (MVCs) are one of the leading causes of death in the nation and in New York State, particularly among younger adult males. It is important to study how to reduce mortality from MVCs.

Methods: Hospitalized victims of motor vehicle crashes in the 1994-1995 New York State Trauma Registry were identified for the study.

Pediatric pre-hospital advanced life support care in an urban setting.

Objective: To describe pediatric advanced life support (PALS) in a single urban environment and clarify educational priorities for ALS pre-hospital providers and pediatric medical control physicians.

Methods: Retrospective observational review of all pediatric pre-hospital PALS transport and medical control records of the two-tiered, unified, municipal emergency medical service of the City of Boston (catchment area 590,000) over a 1-year period.

Results: Of the 555 pediatric patients receiving ALS transport, 38% were for respiratory emergencies, 24% for nonrespiratory medical emergencies, 19% for traffic-related blunt trauma, and 10% for penetrating trauma.

Accounting for intubation status in predicting mortality for victims of motor vehicle crashes.

Background: Two of the important predictors of mortality for trauma patients are the Glasgow Coma Scale and the respiratory rate. However, for intubated patients, the verbal response component of the Glasgow Coma Scale and the respiratory rate cannot be accurately obtained. This study extends previous work that attempts to predict mortality accurately for intubated patients without using verbal response and respiratory rate.

An examination of the volume-mortality relationship for New York State trauma centers.

Objectives: New York State Trauma Registry data were analyzed to determine whether there is a significant relationship between the volume of trauma patients treated by a trauma center and its risk-adjusted inpatient mortality rate.

Methods: Stepwise logistic regression was used to identify significant independent predictors of mortality, their weights, and the probability of in-hospital mortality for each patient. These data were then used to calculate risk-adjusted mortality rates for various ranges of hospital volume.

Predictors of mortality in adult patients with blunt injuries in New York State: a comparison of the Trauma and Injury Severity Score (TRISS) and the International Classification of Disease, Ninth Revision-based Injury Severity Score (ICISS).

Background: The purpose of this study was to determine the statistical model that best predicted mortality from blunt trauma using a contemporary population-based database.

Methods: 1994-1995 New York State Trauma Registry data for patients with blunt injuries were used to predict mortality using three statistical models: (1) the original Trauma and Injury Severity Score (TRISS) model based on Major Trauma Outcome Study data, (2) a new TRISS model whose coefficients were derived using New York data, and (3) the International Classification of Disease, Ninth Revision-based Injury Severity Score (ICISS) with predicted survival values obtained from the Agency for Health Care Policy and Research's Health Care Utilization Project. The models were compared with respect to discrimination (using the C statistic) and calibration (using the Hosmer-Lemeshow [H-L] statistic).

Integration of United States emergency medicine concepts into emergency services in the New Independent States.

At this writing, a collaborative partnership has been in place for 30 months between the Boston University Medical Center, the University of Massachusetts Medical Center, the Armenian Ministry of Health, and the Emergency Hospital of Yerevan, Armenia, to improve emergency and trauma care in that city. Fifty-five individuals have traveled to and from the Emergency Hospital, the partner hospital. The collaboration has led to the creation of the Emergency Medical Services Institute (EMSI) at Emergency Hospital, an 800-bed facility that serves as a trauma center and as base for the Yerevan ambulance system.

Efficacy of pediatric trauma care: results of a population-based study.

To determine concordance between regional outcome and national norms with respect to pediatric injury diagnosis, severity, and mortality in a state lacking a well-organized trauma system, we compared summary data from all pediatric trauma-related hospital discharge abstracts compiled by the [New York State Department of Health] Statewide Planning and Research Cooperative [Mandatory Hospital Reporting] System (SPARCS), with comparable data from pediatric trauma centers participating in the National Pediatric Trauma Registry (NPTR), for similar epochs in the late 1980s. Analysis was based on 14,234 cases from SPARCS and 17,098 cases from NPTR. Data were grouped by principal anatomic diagnosis (ICD-9-CM N-code) and injury severity score (ISS), for each of which incidence and mortality were calculated, both individually and collectively, then compared item by item for sources of variance.

Epidemiology of pediatric trauma: importance of population-based statistics.

To determine the validity of using hospital-based pediatric trauma registry data to draw specific inferences with regard to regional pediatric trauma system design, we compared statistical data on the incidence and mortality of pediatric and adult injuries and burns calculated by the New York State Department of Health, based on legally mandated reports of injury deaths and hospital discharges for 1989. During this year, some 488 children, aged 0 to 14 years, died as a result of injuries, a rate of 13.8 per 100,000 annually, of whom 408 (11.