Biomedical subjects

M C Henry

Publications and source records attributed to M C Henry.

At least 37 records · Page 2Linked to original sources

PubMed1997

Thermal effects of neutralization therapy and water dilution for acute alkali exposure in canines.

OBJECTIVE: To evaluate the change in temperature of the gastric mucosa and lumen contents when a weak acid or water is used to manage acute alkali exposure. METHODS: A prospective in-vivo canine model was used in a university-based animal laboratory setting. Eighteen adult canines weighing 20-25 kg were placed under a surgical plane of anesthesia and a laparotomy was performed. A gastrotomy was then made later ligation of the distal esophagus and proximal duodenum. Separate mucosa and lumen temperature probes were placed. Then 25 mL of room-temperature (24-26 degrees C) 50% sodium hydroxide (NaOH) was instilled in the gastric lumen. After 5 minutes, each canine was given treatment. Group 1 (n = 10) was treated with 75 mL of room-temperature orange juice. Group 2 (n = 8) was treated with 75 mL of room-temperature water. Continuous mucosa and lumen temperatures were observed and recorded at baseline and at specified intervals for 35 minutes after the alkali insult. Repeated-measures analysis of variance was used to evaluate the overall temperature profile. Signed-rank tests were used to compare the changes in temperature immediately following neutralization treatment. RESULTS: Significant temperature decreases of 1.1 degrees C and 2.1 degrees C were observed for both mucosa (p = 0.002) and lumen (p < 0.001) temperature, respectively, following neutralization therapy with room-temperature orange juice. In the group treated with room-temperature water, significant temperature decreases of 2.1 degrees C for mucosa (p = 0.01) and 2.4 degrees C for lumen (p = 0.01) were observed. Posttreatment temperatures did not exceed baseline for the entire observation period. CONCLUSION: Neutralization therapy with room-temperature orange juice or water dilution for acute gastric injuries by liquid alkali does not cause a rise in mucosal or intraluminal temperatures in an in-vivo canine model.

Acids↗

PubMed1996

Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis.

STUDY OBJECTIVE: To assess the ability of various clinical and laboratory parameters to predict the results of hepatobiliary scintigraphy (HBS) in patients with suspected acute cholecystitis. METHODS: This was a retrospective chart review of all patients referred from the emergency department for an HBS in 1993 to exclude acute cholecystitis. The setting was a university-affiliated tertiary care hospital with an annual census of approximately 42,000. The participants were 100 consecutive patients who were seen in the ED and had an HBS and obtainable medical records. Medical records of all patients referred from the ED for an urgent HBS in 1993 were retrospectively reviewed for the following information: demographics, historical information, physical findings, laboratory findings, biliary scintigraphic findings, and surgical pathologic findings. Comparisons were made between patients with a positive or negative HBS. Sensitivities, specificities, and positive and negative predictive values were calculated for dichotomous variables with a positive HBS as a control standard. A separate analysis was performed for patients with pathologically confirmed acute cholecystitis. RESULTS: Fifty-three patients had a positive HBS, and 47 had a negative HBS. A history of fever had a positive predictive value of 100% and a sensitivity of 14.6%. The presence of Murphy's sign was both sensitive (97.2%) and highly predictive (93.3%) of a positive HBS yet was not documented in 35 cases. All other variables were not found to be helpful in predicting the results of HBS. Pathologic diagnoses were available in 44 patients. Of 40 patients with pathologically confirmed acute cholecystitis, fever and leukocytosis were absent at the time of presentation in 36 (90%) and 16 (40%) of the cases, respectively. Murphy's sign was absent in 3 (10%) of 29 of these patients. A stepwise analysis failed to identify any combination of clinical variables that was associated with a higher probability of a positive HBS. CONCLUSION: No single or combination of clinical or laboratory findings at the time of ED presentation identified all patients with a positive HBS. Murphy's sign had the highest sensitivity and positive predictive value yet was poorly documented. Liberal use of biliary scintigraphy or ultrasound is encouraged to avoid underdiagnosis of acute cholecystitis.

Acute Disease↗

PubMed1996

Prospective countywide evaluation of the effects of motor vehicle safety device use on hospital resource use and injury severity.

STUDY OBJECTIVE: We evaluated the efficacy of safety devices (seat belts and air bags) on hospital resource use and injury severity while controlling for variables known to affect outcome of motor vehicle crashes. METHODS: We conducted a prospective observational study of motor vehicle crash victims who were transported to the hospital in a suburban-rural county with a population of 1.4 million. Out-of-hospital providers recorded patient demographic characteristics, mechanism of injury (based on American College of Surgeons criteria), and use of seat belts or air bags. Hospital charts were reviewed for hospital admission, length of hospital stay, ICU stay, surgery, major nonorthopedic surgery or death, and severe injury (Injury Severity Score > 15). RESULTS: The study group comprised 1,446 motor vehicle crash victims. Median age was 30 years, 47% were male, and 69% used safety devices. The use of safety devices reduced the likelihood of hospital admission (adjusted odds ratio [OR], .67; 95% confidence interval [CI], .46 to .98) surgery (adjusted OR, .52; 95% CI, .27 to 1.01), major surgery or death (adjusted OR, .14; 95% CI, .04 to .52), and severe injuries (adjusted OR of injury Severity Score > 15, .39; 95% CI, .19 to .83). CONCLUSION: The use of safety devices is associated with decreased hospital resource use and less severe injuries for victims of motor vehicle crashes who are transported to the hospital by emergency medical services providers, even after adjustment for many other variables known to affect the outcome of motor vehicle crashes. Continued efforts to promote safety device use are warranted.

Accidents, Traffic↗

PubMed1996

Outcome of patients who refused out-of-hospital medical assistance.

Activation of the emergency medical services (EMS) system does not always result in transport of a patient to the hospital. This study assessed the outcomes of patients who refused medical assistance in the field, to determine if refusal of medical assistance (RMA) is associated with poor outcomes. Four high-volume suburban volunteer ambulance corps participated in the study. Consecutive patients who refused medical assistance were prospectively enrolled. Medical and identifying data were collected for each patient. Telephone follow-up was conducted to determine the patient's condition and if the patient sought further care after RMA. Primary endpoints were whether the patient sought further care, was admitted to a hospital, or died subsequent to RMA. Follow-up was successfully obtained for 199 of 321 patients enrolled (62%). Of these 199 patients, 95 (48%) sought further medical care within 1 week for the same complaint, with 13 being admitted to the hospital. Six of the 13 admitted patients had chief complaints of a cardiac or respiratory nature. One patient died during hospital admission. Even if none of the patients lost to follow-up had sought further care, a substantial number of patients who refuse out-of-hospital medical assistance seek further care. Some of these patients require hospital admission, especially those with cardiac or respiratory complaints. Efforts to minimize RMA should be especially focused on patients with such complaints.

Adolescent↗

PubMed1996

Evaluation of American College of Surgeons trauma triage criteria in a suburban and rural setting.

In suburban and rural counties, patient transport to specialized facilities such as trauma centers may result in prolonged transport times with the resultant loss of ambulance coverage in the primary service area. We evaluated the American College of Surgeons trauma triage criteria as modified by New York State to determine the ability of these criteria to predict the need for trauma center care in victims of blunt traumatic injury. Blunt trauma patients were retrospectively identified through review of patient care reports for the presence either of mechanism or of physiological criteria for transport to a trauma center. Controls were randomly selected from patients with blunt trauma not meeting any of the criteria. Main outcome parameters were the emergency department (ED) disposition, length of hospital stay, need for intensive care unit (ICU) care, and major nonorthopedic operative interventions. There were 857 patients enrolled. The presence either of mechanism or of physiological criteria increased the likelihood of hospital admission (control, 11%; mechanism, 35%; and physiological, 33%). Relative to patients without any criteria, the presence of mechanism criteria alone did not identify patients who required a prolonged length of stay (67% vs 71%), intensive care unit services (13% vs 19%) or major nonorthopedic operative interventions (0.2% vs 1.6%). The presence of physiological criteria increased the likelihood of requiring all of these services. These comparisons held true for victims of motor vehicle accidents, pedestrians struck by motor vehicles, and people who fell from heights above ground level. Patients with physiologic criteria may benefit from transport directly to a trauma center. Because of the low need for operative intervention and ICU services, patients with no criteria or mechanism criteria at long distances from a trauma center may be initially evaluated at the closest hospital and transferred to a trauma center if hospitalization or ICU care is necessary. Further study to determine the predictive value of certain individual mechanism criteria is warranted.

Adolescent↗

PubMed1996

Response of childhood malaria to chloroquine and Fansidar in an area of intermediate chloroquine resistance in Côte d'Ivoire.

The parasitological, clinical and haematological responses to chloroquine treatment were studied in children during a 28-day follow-up in an area of Côte d'Ivoire with intermediate chloroquine resistance. The parasitological, clinical and haematological responses to Fansidar were also investigated in patients who returned to the health centre within 28 days with symptoms of malaria. Of 82 children aged 0-9 years who completed the study, only 67% were parasite-negative on thick blood film on day 7, which decreased to 21% by day 28. While chloroquine treatment still produced clinical remission at day 7 in 95% of the children, 35% had recurrent fever with concomitant parasitaemia before day 28. All fever cases subsequently treated with Fansidar remained parasite-negative over a period of 28 days. On day 28 the haematocrit levels were higher in those children who responded successfully to treatment with either chloroquine or Fansidar than in the children who were still parasite-positive but without fever (two-tailed t-test, P = 0.02). The rate of resistance to chloroquine was most pronounced among the younger children (< 5 years), 18% of whom showed clinical failure by day 14. This study underlines the importance of monitoring the durability of response to chloroquine treatment for at least 14 days in young children in Côte d'Ivoire.

Animals↗

PubMed1996

Incremental benefit of individual American College of Surgeons trauma triage criteria.

OBJECTIVE: To determine the incremental benefit of individual American College of Surgeons (ACS) trauma triage criteria for prediction of severe injuries after consideration of concurrent physiologic, anatomic, mechanism, or "other" criteria. METHODS: A prospective cross-sectional study of motor vehicle crash victims transported to any of the 12 hospitals in a suburban/rural county by local ambulance services was performed. Demographic and individual ACS criteria were collected using structured data instruments. EDs provided patient disposition within 24 hours of patient arrival. Medical records were reviewed. Major outcomes were admission, operative interventions (OR), major nonorthopedic operative interventions or death (Maj-OR), and injury severity score (ISS). To optimize sensitivity and specificity of out-of-hospital triage decision rules, receiver operating characteristic (ROC) curves were derived. RESULTS: Of 1,545 patients, 13% were admitted; 6% had OR; 1% had Maj-OR; and 3% had ISSs > or = 16. For all outcomes, the most useful criteria were physiologic and anatomic. Some additional criteria (crash speed > 20 mph, > or = 30-inch vehicle deformity, axle displacement) substantially worsened specificity, with minimal or no improvement in sensitivity. For example, the optimal ROC curve for Maj-OR was determined by a systolic blood pressure < 90 mm Hg, Glasgow Coma Scale (GCS) score < 13, respiratory rate (RR) < 10 or > 29, death of a same-car occupant, penetrating injury, and/or > or = 24-inch opposite-side compartment intrusion (sensitivity, 85%; specificity, 87%). An ISS > or = 16 was predicted by GCS score < 13, RR < 10 or > 29, penetrating injury, 2 proximal long bone fractures, flail chest, > or = 24-inch opposite-side compartment intrusion, patient ejection, rollover, and/or age < 5 or > 55 years (sensitivity, 86%; specificity, 70%). CONCLUSION: Physiologic and anatomic trauma triage criteria predicted increased hospital resource utilization and severe injury. On the other hand, when used concurrently with physiologic, anatomic, and "other" criteria, some mechanism criteria worsen specificity with negligible improvement in sensitivity. In particular, crash speed > 20 mph and > or = 30-inch vehicle deformity had little predictive value for all outcomes.

Accidents, Traffic↗

PubMed1996

Renal gluconeogenesis and blood flow during endotoxic shock.

OBJECTIVES: To determine whether endotoxic shock decreases the renal gluconeogenic capacity and the renal artery blood flow. METHODS: An in-vivo, murine, nonrecirculating kidney perfusion model was studied in a trauma research laboratory. Each of 12 fasted, male Holtzman rats (shock n = 6, control n = 6) was injected with 1 mL of normal saline or endotoxin (20 mg/kg). Five hours after the injection, all the rats were anesthetized and blood samples were obtained for the determination of the plasma glucose. Right renal artery blood flow was measured by an ultrasonic small-animal flow meter. The kidney was then perfused via the renal artery with 37 degrees C, oxygenated, glucose-free Krebs-Henseleit solution in the presence of 100 mumol of phloridzin to inhibit the cellular uptake of glucose. Renal glucose production was determined by measuring glucose in both renal vein effluent and urine. After 30 minutes of equilibration, 5 mmol of lactate and 0.5 mmol of pyruvate were added to the perfusate as a gluconeogenic substrate. Renal vein and ureteral effluent samples were collected after 5, 10, and 15 minutes. RESULTS: The endotoxic shock group showed hypoglycemia (p < 0.05) as well as a decrease in renal artery blood flow (p < 0.05). Gluconeogenic stimulation was demonstrable in both the control and the endotoxic shock groups after 15 minutes of perfusion with substrate (p < 0.05). However, renal gluconeogenesis was significantly attenuated in the endotoxic shock group compared with the control. CONCLUSIONS: Renal glucose production in response to a gluconeogenic substrate is significantly attenuated during the hypoglycemic phase of endotoxic shock. Endotoxic shock also causes a significant decrease of renal artery blood flow.

Animals↗

PubMed1996

Evidence for and impact of selective reporting of trauma triage mechanism criteria.

OBJECTIVE: To determine whether out-of-hospital care charts selectively report trauma triage criteria, and the impact of such documentation on triage guideline development. METHODS: A special structured data instrument that requested the presence or absence of the American College of Surgeons (ACS) trauma triage criteria was completed by emergency medical services (EMS) personnel transporting victims of motor vehicle crashes. The standard written EMS report forms for a subset of 199 patients with at least 1 ACS trauma triage mechanism criterion were reviewed by the investigators. Outcome data were obtained from medical record review. The structured data instrument and the standard EMS report were compared for concordance. The impact of method of data collection on the ability of the ACS criteria to predict patient outcome was determined. RESULTS: EMS reports and structured data instruments similarly noted the presence of anatomic, physiologic, and "other" trauma triage criteria (p > 0.07 for all individual comparisons). Most mechanism-of-injury criteria noted on the data instrument (pedestrian struck > 20 mph; crash speed > 20 mph; vehicle deformity; compartment intrusion; rollover; and ejection) were infrequently documented on the standard EMS report (median 28.5% noted, range 0-100%). Patients who had mechanism criteria noted on the EMS report were more likely to be admitted to the hospital (44% vs 13%; p = 0.006), to require major operative procedures (10% vs 0%; p = 0.005), and to have prolonged lengths of stay (26% vs 9%; p = 0.02) and injury severity scores > or = 16 (15% vs 3%; p = 0.03) than were patients who had mechanism criteria documented only on the structured data instrument. CONCLUSIONS: In the authors' EMS system, standard EMS report documentation underreports ACS trauma triage mechanism criteria. This underreporting appears to bias outcome analysis in the direction of a worse outcome and more resource utilization. Reporting of mechanism-of-injury criteria improves with use of a structured data instrument.

Accidents, Traffic↗

PubMed1996

Association of training level and short-term cosmetic appearance of repaired lacerations.

OBJECTIVE: To determine the association between emergency practitioner level of training and cosmetic appearance of primarily closed wounds as evaluated at the time of suture removal. METHODS: A retrospective analysis of wound registry data was performed. At the time of wound closure, standard data were collected including details of patient demographics, wound characteristics, preparation, closure, and postoperative care, for consecutive patients sutured in the ED. Follow-up data were obtained at the time of the return visit using a previously described cosmetic scale. With the scale, all lacerations were assigned 0 or 1 point each for the presence or absence of six items: a step-off of borders; contour irregularities; margin separation; edge inversion; excessive distortion; and overall appearance. For analysis, the proportion of wounds with a score of 6 (optimal cosmetic appearance in all categories) was associated with practitioner level of training. RESULTS: Five hundred fifty-two patients' wounds were evaluated. The percentages of various practitioners' achieving an optimal cosmetic score were: medical students (MSs), 50%; first-year residents (EM1s), 54%; second-year residents (EM2s), 66%; third-year residents (EM3s), 68%; physician assistants (PAs), 70%; and attending physicians (APs), 66%. The senior practitioners (EM2s, EM3s, PAs, APs) were significantly more likely to obtain a maximal cosmetic score than were the junior practitioners (MSs, EM1s) (68% vs 52%, p = 0.016). CONCLUSION: Significant improvement in short-term cosmetic results following wound repair is associated with a training level beyond PGY1. These data reinforce the need for careful patient selection and close supervision of wound repair by trainees, especially of wound repair by medical students and interns.

Adolescent↗

PubMed1996

Hydrogen peroxide 3% exposures.

OBJECTIVE: To present a child who developed gastric ulcers and duodenal erosions after ingestion of hydrogen peroxide 3% and delineate the epidemiology, medical outcomes, and toxicity of exposures to this agent managed by a poison control center. METHODS: A retrospective chart review of exposures to hydrogen peroxide 3% reported to the Long Island Regional Poison Control Center from January 1992 to April 1995 was conducted. Data extracted included age, route of exposure, amount of agent, symptoms, therapy, and medical outcome. RESULTS: There were 670 exposures to hydrogen peroxide 3% of 81,126 total exposures reported during the 40 months. Most exposures were by oral route (77%), occurred in children < 17 years old (67%), and were asymptomatic (85.6%). All but one exposure resulted in a benign outcome. One child, who presented with bloody emesis, developed multiple gastric ulcers and duodenal erosions after ingestion of hydrogen peroxide 2-4 oz. CONCLUSIONS: Exposure to hydrogen peroxide 3% is usually benign, however, severe gastric injury may occur following small ingestions in children. Patients who report persistent vomiting or bloody emesis require medical evaluation and consideration of endoscopy to evaluate gastrointestinal injury.

Child, Preschool↗

PubMed1995

Level of training, wound care practices, and infection rates.

This prospective, nonrandomized descriptive study compares the traumatic wound infection rates in patients based on level of training of emergency department (ED) practitioners. Wounds were evaluated in 1,163 patients. A wound registry data sheet was prospectively completed on all patients sutured in the ED. All practitioners were assigned a unique identification number. Follow-up data was obtained at the time of the return visit. Patients failing to return were contacted by telephone. Data were analyzed for patient wound infection rates by practitioner level of training. Patient wound infection rates by practitioner level of training were: medical students, 0/60 (0%); all resident physicians, 17/547 (3.1%); physician assistants, 11/305 (3.6%); and attending physicians 14/251 (5.6%), P was not significant. Comparison of junior (medical students and interns) to senior practitioners (all other practitioners) found no difference in infection rates (8/262 [3.1%] v 34/901 [3.8%], P = .58). In conclusion, carefully selected patients sutured by closely supervised medical students and junior residents have infection rates as low as those sutured by more experienced practitioners.

Adolescent↗

PubMed1995

Wound registry: development and validation.

STUDY OBJECTIVE: More than 11 million patients with traumatic wounds are seen annually in emergency departments. We developed and validated a data registry for traumatic wounds treated in the ED. DESIGN: Prospective, consecutive patient enrollment with a validation cohort of a convenience sample of 100 patients. SETTING: University-affiliated hospital ED. PARTICIPANTS: For all patients with traumatic wounds requiring sutures, wound registry data sheets were completed at the time of initial visit using a closed-question format. Data recorded included demographic characteristics, time from injury to evaluation, pertinent medical history, wound characteristics, type of anesthesia, details of wound-cleansing methods, details of wound closure, and postoperative care. We devised a follow-up tool to evaluate for the presence of infection and short-term cosmetic appearance. Interphysician reliability was assessed for wound description, presence of infection, and cosmetic appearance by use of the kappa statistic. RESULTS: A wound registry data collection instrument that takes less than 1 minute to complete and enables the collection of most wound management techniques used by emergency physicians was found to have substantial interobserver concordance for wound description (kappa range, .55 to .97), wound infection (kappa = 1.0) and overall cosmetic appearance (kappa = .61). CONCLUSION: The wound registry is a reliable data collection instrument that is easy to use. It may be useful as a continuous quality-improvement tool or for standardization of wound surveillance and treatment data to facilitate future prospective studies in wound management.

Adolescent↗

PubMed1995

Association of out-of-hospital criteria with need for hospital admission.

OBJECTIVE: To validate high-risk historical and physiologic out-of-hospital criteria as predictors of the need for hospitalization following ED evaluation. METHODS: Consecutive patients entered into the Suffolk County advanced life support system were enrolled. Previously proposed historical and physiologic "high-risk" criteria for hospitalization were prospectively collected. Criteria were associated with the need for hospital admission following ED evaluation. RESULTS: 1,238 patients were enrolled; 391 were released from an ED after transport. Most patients (843/1,238; 68%) were admitted to a hospital; and four died in the ED. Factors associated with an increased likelihood of admission or death among the transported patients were: bradycardia (90% admitted, p < 0.02); hypotension (80%, p < 0.03); hypertension (89%, p < 0.03); and age > 55 years (81%, p < 0.0001). Unresponsiveness and other abnormal vital signs were not associated with admission on univariate analysis. Logistic regression analysis identified two other factors associated with admission or death: tachycardia (72% admitted, p < 0.01) and head injury (78% admitted, p < 0.001). CONCLUSIONS: Abnormal pulse or blood pressure, head injury, and age > 55 years are associated with patients' requiring hospital admission after accessing the emergency medical services system. These criteria may aid the design of out-of-hospital refusal-of-care policies.

Adolescent↗

PubMed1995

Poor correlation of short- and long-term cosmetic appearance of repaired lacerations.

OBJECTIVE: To describe the consistency of a cosmetic scale for repaired lacerations and to determine whether the appearance of lacerations at the time of suture removal correlates with the appearance six to nine months later. METHODS: A convenience sample of patients who had lacerations repaired in a university teaching hospital were evaluated at the time of suture removal and six to nine months following repair. All lacerations were assigned 0 or 1 point each for the presence or absence of a step-off borders, contour irregularities, margin separation, edge inversion, excessive distortion, and overall appearance. A total cosmetic score (0-6) was calculated by adding the scores for the categories above. The consistency of the cosmetic scale was assessed by comparison of scores given by two different practitioners evaluating each patient at suture removal and long-term follow-up. The 38 evaluating practitioners were assigned based on availability and did not necessarily perform serial evaluations of the same patient. RESULTS: The 41 participating patients had a median age of 19 years (range, 2-82 years). Wounds were located predominantly on the head (73%) and upper extremity (22%). Long-term follow-up was performed at a median of 219 days (range, 155-280 days) after suture removal. Interpractitioner concordance regarding optimal appearance (score of 6 vs < or = 5) was moderate (kappa = 0.52) at the time of suture removal and substantial at the time of long-term follow-up (kappa = 0.68). However, the correlation of actual scores at the time of suture removal vs at long-term follow-up was poor (r = 0.17, p = 0.29). CONCLUSION: For our clinicians, the six-item categorical scale appears consistent as a tool for the assessment of the cosmetic appearance of wounds. However, correlation between laceration appearance at the time of suture removal and six to nine months later is poor.

Adult↗

PubMed1995

On-line telemetry: prospective assessment of accuracy in an all-volunteer emergency medical service system.

OBJECTIVE: To evaluate the need for on-line telemetry control in an all-volunteer, predominantly advanced emergency medical technician (A-EMT) ambulance system. METHODS: Emergency medical service (EMS) advanced life support (ALS) providers were asked to transmit the ECG rhythms of monitored patients over a six-month period in 1993. The ECG rhythm interpretations of volunteer EMS personnel were compared with those of the on-line medical control physician. All discordant readings were reviewed by a panel of physicians to decide whether the misdiagnosis would have resulted in treatment aberrations had transmission been unavailable. RESULTS: Patients were monitored and rhythms were transmitted in 1,825 cases. 1,642 of 1,825 rhythms were correctly interpreted by the EMS providers (90%; 95% CI 89-91%). The accuracy of the EMS providers was dependent on the patient's rhythm (chi-square, p < 0.00001), the chief complaint (chi-square, p = 0.0001), and the provider's level of training (chi-square, p = 0.02). Correct ECG rhythm interpretations were more common when the out-of-hospital interpretation was sinus rhythm (95%), ventricular fibrillation (87%), paced rhythm (94%), or agonal rhythm (96%). The EMS providers were frequently incorrect when the out-of-hospital rhythm interpretation was atrial fibrillation/flutter (71%), supraventricular tachycardia (46%), ventricular tachycardia (59%), or atrioventricular block (50%). Of the 183 discordant cases, 124 (68%) involved missing a diagnosis of, or incorrectly diagnosing, atrial fibrillation/flutter. Review of the discordant readings identified 11 cases that could have resulted in treatment errors had the rhythms not been transmitted, one of which might have resulted in an adverse outcome. CONCLUSIONS: In this all-volunteer, predominantly A-EMT ALS system, patients with a field interpretation of a sinus rhythm do not require ECG rhythm transmission. Field interpretations of atrial fibrillation/flutter, supraventricular tachycardia, ventricular tachycardia, and atrioventricular blocks are frequently incorrect and should continue to be transmitted.

Chi-Square Distribution↗

PubMed1995

Impact of interventions for patients refusing emergency medical services transport.

OBJECTIVE: To evaluate the effect of a documentation checklist and on-line medical control contact on ambulance transport of out-of-hospital patients refusing medical assistance. METHODS: Consecutive patients served by four suburban ambulance services who initially refused emergency medical services (EMS) transport to the hospital were prospectively enrolled. In phase 1 (control phase), all patients who initially refused medical attention or transport had an identifying data card completed. In phase 2 (documentation phase), out-of-hospital providers completed a similar data card that contained a checklist of high-risk criteria for a poor outcome if not transported. In phase 3 (intervention phase), a data card similar to that used in phase 2 was completed, and on-line medical control was contacted for all patients with high-risk criteria who refused transport. The primary endpoint was the percentage of patients transported to the hospital. RESULTS: A total of 361 patients were enrolled. Transport rate varied by phase: control, 17 of 144 (12%); documentation, 11 of 150 (7%); and intervention, 12 of 67 (18%) (chi-square, p = 0.023). Transport of high-risk patients improved with each intervention: control, two of 60 (3%); documentation, seven of 70 (10%); and intervention, 12 of 34 (35%) (chi-square, p = 0.00003). Transport of patients without high-risk criteria decreased with each intervention: control, 15 of 84 (18%); documentation, four of 80 (5%); and intervention, 0 of 33 (0%) (p = 0.0025). Of the 28 patients for whom medical control was contacted, 12 (43%) were transported to the hospital, and only three of these 12 patients (25%) were released from the ED. CONCLUSION: Contact with on-line medical control increased the likelihood of transport of high-risk patients who initially refused medical assistance. The appropriateness of the decreased transport rate of patients not meeting high-risk criteria needs further evaluation.

Adolescent↗

PubMed1995

Community survey of diarrhoea in children under 5 years in Kinshasa, Zaire.

This community based survey was undertaken to assess the prevalence, characteristics and risk factors of diarrhoea in children < 5 years of age in an urban zone, at Kinshasa, Zaire. 155 community cases selected by cluster sampling, 155 age-matched controls, and 18 children with diarrhoea seen at a health centre (HC) were examined. The diarrhoea prevalence rate was 6.5%. The highest risk of persistent diarrhoea was in children of 2 to 3 years, non breast-fed, with more than one enteric agent in their stools and living in households without electricity. The rates of detection of Strongyloides stercoralis, Entamoeba histolytica and Salmonella, and heavy infections of Trichuris trichiura and Trichomonas hominis were significantly higher in cases (p < 0.05). The rate of detection of Cryptosporidium was rather high, specially in HC cases (22.2%). It was also found in both diarrhoeal (14.8%) and non-diarrhoeal specimens (12.9%). There was a lack of association between the presence of faecal white blood cells and enteric bacteria, and also between the presence of faecal red blood cells and E. histolytica, which might be due to the frequent practice of rectal injections and suppositories. A mother's perception of fever and stool aspect was fairly in agreement (respectively 70% and 53%) with that of the investigators. The high rate of dehydrated children (50.9%) may be due to the dehydration definition applied at the HC. The survey's results were used to improve the local case management flow chart and to adjust educational activities directed at mothers.

Animals↗