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PubMed1995

Effect of CBC results on ED management of women with lower abdominal pain.

Recent studies have suggested that the results of complete blood counts (CBCs) are neither sensitive nor specific in diagnosing abdominal pain, but no study has attempted to determine whether CBC results actually influence the management of ED patients. This study attempted to determine whether CBC results in women with lower abdominal pain affect ED disposition or diagnosis. One hundred women between the ages of 15 and 45 with lower abdominal pain presenting to a community hospital ED with an annual census of 45,000 were enrolled in this prospective study. Before review of the CBC results but after review of all other studies, the ED physician recorded a presumptive diagnosis and indicated whether consultation and/or admission were warranted. After the results of the CBC were reviewed, these factors were reassessed. Patient management or ED diagnosis was affected in two cases (2%; 95% confidence interval 0% to 7%), one resulting in appropriate discharge and one resulting in unnecessary admission. It was concluded that in young women with abdominal pain CBC results rarely affect clinical decision-making.

Abdominal Pain↗

PubMed1991

Cat scratch encephalopathy.

Cat scratch disease is usually benign, self-limited and without sequelae. Margileth has established four clinical criteria, three of which must be satisfied to make the diagnosis: 1) a history of animal exposure, usually kitten, with primary skin or ocular lesions; 2) regional chronic adenopathy without other apparent cause; 3) a positive cat scratch disease antigen skin test; and 4) lymph node biopsy demonstrating noncaseating granulomas and germinal center hyperplasia. Central nervous system involvement in cat scratch disease has been previously reported, although it is extremely uncommon. In a several-month period, we encountered two cases of cat scratch disease complicated by encephalopathy. The intents of this paper are twofold: 1) to briefly review the current literature on cat scratch disease, 2) to demonstrate that cat scratch disease complicated by encephalopathy presents acutely with seizures, posturing and coma and resolves rapidly with supportive care.

Cat-Scratch Disease↗