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Biomedical subjects

David S Greenes

Publications and source records attributed to David S Greenes.

7 recordsLinked to original sources
PubMed2005

Hyponatremia among runners in the Boston Marathon.

BACKGROUND: Hyponatremia has emerged as an important cause of race-related death and life-threatening illness among marathon runners. We studied a cohort of marathon runners to estimate the incidence of hyponatremia and to identify the principal risk factors. METHODS: Participants in the 2002 Boston Marathon were recruited one or two days before the race. Subjects completed a survey describing demographic information and training history. After the race, runners provided a blood sample and completed a questionnaire detailing their fluid consumption and urine output during the race. Prerace and postrace weights were recorded. Multivariate regression analyses were performed to identify risk factors associated with hyponatremia. RESULTS: Of 766 runners enrolled, 488 runners (64 percent) provided a usable blood sample at the finish line. Thirteen percent had hyponatremia (a serum sodium concentration of 135 mmol per liter or less); 0.6 percent had critical hyponatremia (120 mmol per liter or less). On univariate analyses, hyponatremia was associated with substantial weight gain, consumption of more than 3 liters of fluids during the race, consumption of fluids every mile, a racing time of >4:00 hours, female sex, and low body-mass index. On multivariate analysis, hyponatremia was associated with weight gain (odds ratio, 4.2; 95 percent confidence interval, 2.2 to 8.2), a racing time of >4:00 hours (odds ratio for the comparison with a time of <3:30 hours, 7.4; 95 percent confidence interval, 2.9 to 23.1), and body-mass-index extremes. CONCLUSIONS: Hyponatremia occurs in a substantial fraction of nonelite marathon runners and can be severe. Considerable weight gain while running, a long racing time, and body-mass-index extremes were associated with hyponatremia, whereas female sex, composition of fluids ingested, and use of nonsteroidal antiinflammatory drugs were not.

Analysis of Variance↗
PubMed2004

Effect of recent antipyretic use on measured fever in the pediatric emergency department.

OBJECTIVES: To determine the prevalence of recent antipyretic use among febrile infants at a pediatric emergency department (ED) and to test the hypothesis that recent antipyretic use is associated with lower measured temperatures in the ED. METHODS: We prospectively enrolled infants younger than 366 days at a pediatric ED. Eligible subjects had a history of fever prior to arrival at the ED or had a measured temperature of 38 degrees C or higher at the ED. Research assistants collected detailed information about recent use of antipyretic drugs. Peak measured temperature prior to arrival at the ED (temperature maximum [Tmax]), measured temperature at the ED, defervescence from Tmax to measured ED temperature, and rates of diagnostic testing were compared between subjects who had or had not been treated with antipyretic medication within the past 6 hours. RESULTS: We enrolled 474 infants. Infants treated with an antipyretic medication (n = 187) had a significantly higher Tmax and a significantly higher measured ED temperature than untreated subjects (n = 287) (P<.001). Treated and untreated subjects did not differ in the amount of defervescence from Tmax to measured ED temperature (P = .41) unless treated subjects included only those who reportedly received therapeutic doses of antipyretic medication within 1 to 5 hours prior to arrival at the ED (P = .02). CONCLUSIONS: Although many febrile infants seen in the pediatric ED have recently received antipyretics, only a few have received a therapeutic dose between 1 and 5 hours prior to arrival. Among febrile infants seen in the ED, recent antipyretic use is associated both with a higher reported Tmax and with higher measured temperatures at the ED. Patients treated with a therapeutic antipyretic dose 1 to 5 hours prior to arrival experience more defervescence from their Tmax than untreated subjects.

Age Factors↗
PubMed2004

How much tachycardia in infants can be attributed to fever?

STUDY OBJECTIVES: We evaluate the hypothesis that pulse rate increases linearly with increased body temperature in infants and determine how much tachycardia in infants can be explained by a 1 degrees C (1.8 degrees F) increase in body temperature. METHODS: Infants younger than 1 year and presenting to a pediatric emergency department were prospectively enrolled. Rectal temperature and pulse rate were measured. Research personnel rated behavioral state as sleeping, awake and quiet, fussy, or crying. Patients were excluded if they were fussy or crying or if they had any medical condition expected to cause tachycardia. The remaining patients were divided into 6 age-based groups. Linear regression analysis of pulse rate and temperature was performed for each group. RESULTS: Four hundred ninety patients were enrolled. Pulse rate increased linearly with temperature in all age groups older than 2 months (adjusted r2=0.102 to 0.376) but not in infants younger than 2 months (adjusted r2=0.004). In infants aged 2 months or older, a multivariate linear regression model adjusted for age showed that pulse rate increased an average of 9.6 beats/min (95% confidence interval 7.7 to 11.5) per 1 degrees C (1.8 degrees F) increase in temperature (adjusted r2=0.225). At any given temperature, the prediction interval for an individual's pulse rate had a span of approximately 64 beats/min. CONCLUSION: In infants 2 to 12 months of age, pulse rate increases linearly with body temperature, with a mean increase of 9.6 beats/min for each 1 degrees C (1.8 degrees F) increase in body temperature. Pulse rates of individual infants vary greatly, however, with a broad range of pulse rates observed at any given temperature.

Body Temperature↗
PubMed2004

When body temperature changes, does rectal temperature lag?

By using temporal artery and rectal thermometers, we followed temperatures in 45 febrile (>38.5 degrees C) infants given an antipyretic drug. Sixty and 90 minutes after drug administration, temporal artery temperatures had decreased significantly more than rectal temperatures. When body arterial temperature changes rapidly, changes in rectal temperature may lag.

Analgesics, Non-Narcotic↗
PubMed2003

Can the initial history predict whether a child with a head injury has been abused?

OBJECTIVE: Previous studies of child abuse have used the presenting history as part of the case definition of abuse. Thus, data from these studies cannot be used to determine the diagnostic utility of historical features for identifying cases of abuse. The objective of this study was to determine the diagnostic utility of certain historical features for identifying cases of abusive head trauma. METHODS: We retrospectively studied all children, aged 0 to 3 years, who had acute traumatic intracranial injury and were admitted to a tertiary care pediatric hospital from 1993 to 2000. Cases were categorized as either "definite abuse" or "not definite abuse" on the basis of radiologic, ophthalmologic, and physical examination findings, without regard to the presenting history. RESULTS: Forty-nine (30%) of 163 children met the criteria for definite abuse. Having no history of trauma had a high specificity (0.97) and positive predictive value (PPV; 0.92) for abuse. Among the subgroup of patients with persistent neurologic abnormality at hospital discharge (n = 34), having a history of no or low-impact trauma had a specificity of 1.0 and a PPV of 1.0 for definite abuse. Injuries were blamed on home resuscitative efforts in 12% of definite abuse cases and 0% of not definite abuse cases. The initial history of trauma was changed in 9% of definite abuse cases, as compared with 0% of not definite abuse cases. CONCLUSION: Among young children with a head injury, certain historical features have high specificity and PPV for diagnosing child abuse.

Brain Injuries↗
PubMed2002

Computerized reminders to physicians in the emergency department: a web-based system to report late-arriving abnormal laboratory results.

Inadequate follow-up for abnormal laboratory results is a frequent cause of medical errors, especially for those that arrive after the patient is discharged in an Emergency Department (ED) setting. We have developed and implemented a computerized reminder system called the Automated Late-Arriving Results Monitoring System (ALARMS) for the Emergency Department at Children's Hospital, Boston. ALARMS scans the hospital's laboratory and ED registration databases to generate an electronic daily log of all late-arriving abnormal results for ED patients, which can be obtained by authorized physicians through a web-based user interface inside the hospital's intranet. We believe, by using this automated data-driven rule-based reminder system, we can minimize the risk of errors resulting from late-arriving laboratory data without requiring substantial additional efforts from clinicians.

Boston↗