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Biomedical subjects

S G Rothrock

Publications and source records attributed to S G Rothrock.

53 records · Page 3Linked to original sources
PubMed1992

Pediatric bacterial meningitis: is prior antibiotic therapy associated with an altered clinical presentation?

STUDY HYPOTHESIS: The clinical features of children treated with oral antibiotics before the diagnosis of bacterial meningitis differ from those who receive no antibiotics. DESIGN: Retrospective case series. SETTING: University medical center. PARTICIPANTS: Two hundred fifty-eight children 24 months old or younger with bacterial meningitis hospitalized during a 12-year period. Eighty-three children were treated with oral antibiotics before the diagnosis of meningitis, and 175 children were not. INTERVENTIONS: None. METHODS: The emergency department chart and hospital records were reviewed for presenting demographic, historical, physical examination, and laboratory features. Clinical features of pretreated and untreated patients were compared. RESULTS: Pretreated children demonstrated less frequent temperature of 38.3 C or higher, altered mental status and a longer duration of symptoms before diagnosis, with more frequent vomiting; ear, nose, and throat infections; and physician visits in the week before detection of meningitis (P less than .05 for all comparisons). There was no difference in incidence of upper respiratory symptoms, seizures, nuchal rigidity, Kernig's and Brudzinski's signs, focal neurologic signs, mortality, and length of hospitalization between groups. CONCLUSION: Clinical features of children who have taken antibiotics before the detection of meningitis differ significantly from those who have not undergone antibiotic therapy. Physicians should be aware of these differences when evaluating young children on antibiotics for the possibility of meningitis.

Anti-Bacterial Agents↗
PubMed1992

Intravenous magnesium for acute asthma: failure to decrease emergency treatment duration or need for hospitalization.

STUDY OBJECTIVE: To evaluate the efficacy of routine early administration of i.v. magnesium to patients with acute asthma. DESIGN: Prospective, randomized clinical trial. SETTING: Urban teaching hospital emergency department. TYPE OF PARTICIPANTS: One hundred twenty consecutive patients aged 18 to 65 years with acute asthma unresponsive to a single albuterol treatment. INTERVENTIONS: All patients received oxygen, 125 mg i.v. methylprednisolone, and hourly albuterol inhalation therapy. The study group also received 2 g i.v. magnesium sulfate infused over 20 minutes. MEASUREMENTS AND MAIN RESULTS: Demographic and clinical characteristics were similar in both groups. Hospitalization was necessary in 13 of 58 patients who received magnesium (22%; 95% confidence intervals [CI], 13% to 32%) and 11 of 62 control patients (17%; 95% CI 10% to 26%; P = .523). Duration of ED treatment in discharged patients was 224 +/- 75 minutes in the magnesium group (95% CI, 208 to 240 minutes) and 228 +/- 90 minutes in the control group (95% CI, 209 to 247 minutes, P = .832). In addition, changes in peak expiratory flow were not statistically different. CONCLUSION: Routine early administration of IV magnesium in acute asthma does not alter treatment outcome.

Acute Disease↗
PubMed1991

Clinical features of misdiagnosed appendicitis in children.

STUDY OBJECTIVE: To compare clinical features of children with misdiagnosed appendicitis with those of children with appendicitis initially diagnosed correctly. DESIGN: Retrospective review of hospital, emergency department, and clinic records. SETTING: University medical center with annual ED census of 40,000 patients. PARTICIPANTS: Children less than 13 years old admitted between May 1, 1979, and April 30, 1989, with a discharge diagnosis of appendicitis. MEASUREMENTS: Records were reviewed for historical, physical examination, laboratory, and pathologic features for all patients on their initial presentation to a physician and on final presentation during which the correct diagnosis was made. Using chi 2 analysis and Student's test, clinical features of misdiagnosed patients and patients diagnosed correctly were compared. RESULTS: One hundred eighty-one cases were identified with 50 initially misdiagnosed. On initial presentation, misdiagnosed patients were younger and more likely to have vomiting before pain onset, constipation, diarrhea, dysuria, and signs and symptoms of upper respiratory infections. Misdiagnosed cases were less likely to have right lower quadrant tenderness and documentation of bowel sounds, peritoneal signs, and rectal examinations. On final presentation, misdiagnosed patients were more likely to have pain duration of more than two days, temperature of more than 38.3 C, and to appear lethargic and irritable (P less than .05 for all measurements). CONCLUSION: Clinical features of children with misdiagnosed appendicitis differ from those of children with appendicitis initially diagnosed correctly.

Appendicitis↗
PubMed1991

Plain abdominal radiography in the detection of acute medical and surgical disease in children: a retrospective analysis.

A retrospective review was performed to determine the utility of plain abdominal radiographs in evaluating children presenting to the emergency department. Clinical features, radiographic interpretation, and final diagnoses of 431 patients seen over one year were recorded. One hundred three (24%) patients had major diseases (ventriculoperitoneal shunt malfunction, foreign body ingestion, appendicitis, intussusception, bowel obstruction, necrotizing enterocolitis, toxic megacolon, blunt abdominal trauma, pyloric stenosis, and Hirschsprung's disease), while the remaining 328 (76%) had minor diseases. Radiographs were categorized as diagnostic, suggestive, normal, incidental, or misleading, with respect to the patient's final diagnosis. No single clinical feature was able to detect all diagnostic radiographs in patients with major diseases. Limiting radiographs to patients with prior abdominal surgery, suspected foreign body ingestion, abnormal bowel sounds, abdominal distention, or peritoneal signs identified all patients with radiographs diagnostic of a major disease while eliminating 48% of studies ordered. Our results suggest that restricting abdominal roentgenograms to patients with at least one of these features will detect most diagnostic radiographs in children with acute abdominal diseases.

Abdomen, Acute↗
PubMed1990

Radiologic diagnosis of epiglottitis: objective criteria for all ages.

A retrospective study was undertaken to define objective radiologic parameters in diagnosing epiglottitis on soft-tissue lateral neck radiographic studies. Ratios of soft-tissue structures in 31 patients aged 7 months to 61 years with epiglottitis were compared with those of age- and sex-matched controls with croup, pharyngitis, and dysphagia. The ratios of epiglottic width to third cervical vertebral body width (EW/C3W) of more than 0.5, of aryepiglottic width to third cervical vertebral body width (AEW/C3W) of more than 0.35, and of epiglottic width to epiglottic height (EW/EH) of 0.6 or more were all found to be 100% sensitive and specific in differentiating between adult patients with and without epiglottitis. In children, EW/C3W, AEW/C3W, and EW/EH ratios of more than 0.5, of more than 0.35, and of 0.6 or more, respectively, were found to be 100% sensitive in detecting epiglottitis with specificities of 87%, 96%, and 87% respectively. These preliminary results suggest that EW/C3W, EW/EH, and AEW/C3W ratios of more than 0.5, of 0.6 or more, and of more than 0.35, respectively, may be useful in the radiologic diagnosis of epiglottitis in patients of all ages.

Adolescent↗
PubMed1990

Delayed brachial artery occlusion owing to a dog bite of the upper extremity.

We report a case of delayed presentation of vascular injury from a superficial dog bite of the upper extremity in a five-year-old male. This example of a significant arterial injury, in the setting of seemingly minor trauma, is the first known report of blunt arterial trauma owing to a dog bite in any age group. Blunt arterial trauma in children is rare unless associated with fractures, dislocations, or massive crush injuries. Additionally, persistent pulses following arterial occlusion are rare and can potentially lead to misdiagnosis of a serious arterial injury. A brief review of pediatric blunt vascular injuries is presented with implications for diagnosis and management of such cases.

Animals↗
PubMedDate not supplied

Efficacy of plain abdominal radiography in patients with biliary tract disease.

A retrospective review was performed to determine the usefulness of plain abdominal radiographs in patients presenting to the emergency department with gallbladder disease. Patients with the clinical diagnosis of biliary tract disease were divided into two groups: those with confirmed biliary tract disease and those who did not have gall bladder disease. There were no major radiologic findings (pneumoperitoneum, pneumobilia, or bowel obstruction) in any patient with biliary tract disease. No significant difference was noted in the incidence of minor radiologic findings (right upper quadrant calcification, mild ileus and right basilar atelectasis) in patients with biliary colic and acute cholecystitis. Additionally, there was no significant difference in minor findings between patients with biliary tract and nonbiliary tract disease. Plain abdominal radiographic findings were found to be nonspecific in patients with gallbladder disease and not useful in differentiating between patients with biliary colic and acute cholecystitis. Our results also suggest that plain abdominal radiographic findings are not useful in differentiating between patients with and without biliary tract disease, although the selection of patients without biliary tract disease may have biased this finding.

Acute Disease↗
PubMedDate not supplied

Misdiagnosis of appendicitis in nonpregnant women of childbearing age.

A retrospective case series was conducted at a teaching hospital with an emergency department (ED) census of 100,000 patients per year to identify the incidence of, and factors associated with, the misdiagnosis of appendicitis in nonpregnant women aged 15 to 45 years. There were 174 nonpregnant women identified with a pathologic diagnosis of appendicitis. Clinical features were then compared between patients misdiagnosed (seen in prior 10 days and given an incorrect diagnosis) and those who were initially diagnosed correctly. The results showed that 33% of the women with appendicitis were initially misdiagnosed. The most common misdiagnoses included pelvic inflammatory disease, gastroenteritis, and urinary infections. Misdiagnosed women more frequently exhibited diffuse and bilateral lower abdominal pain and tenderness, cervical motion, and right adnexal tenderness. Misdiagnosed women also had a lower incidence of right lower quadrant pain and tenderness, and peritoneal signs. In addition, misdiagnosis was associated with an increased incidence of perforation, abscess formation, and an increase in the total length of hospitalization. In conclusion, the incidence of misdiagnosis of appendicitis in women of childbearing age is high. Women who are misdiagnosed have less typical symptoms and physical findings and more frequent abnormal pelvic findings than those who are diagnosed correctly. Emergency physicians should be aware that atypical signs and symptoms are associated with misdiagnosed appendicitis in nonpregnant women of childbearing age.

Adolescent↗
PubMedDate not supplied

Is there gender bias in the prehospital management of patients with acute chest pain?

OBJECTIVE: Prior emergency department (ED) and inpatient studies have found that women with coronary artery disease are more frequently misdiagnosed and undertreated compared with men. This study was performed to determine whether there is a gender bias in the prehospital management of patients with acute chest pain. METHODS: This study was performed in a large urban county emergency medical services (EMS) agency with approximately 40,000 patient contacts/year. The study population comprised consecutive patients > or = 45 years old with a chief complaint of atraumatic chest pain. Using chi2 analysis and the unpaired Student's t-test, male and female patient encounters were compared. This study had >80% power (alpha 0.05) to detect a 3% difference between populations. RESULTS: Data from 2,858 consecutive patient encounters were analyzed, with females comprising 1,508 (53%). Females were significantly older than males (67 +/- 13.1 vs. 62.7 +/- 12.3 years, p < 0.001). Male patients were more likely to receive aspirin (42.3% vs. 35.4%, p < 0.001) and 12-lead electrocardiograms (ECGs) (46.8% vs. 39.3%, p < 0.001) compared with female patients. The rates of transport refusal, oxygen, nitroglycerin, and narcotic administration did not differ between populations. CONCLUSION: Although females presenting to this urban EMS system with acute chest pain were older, they received significantly less aspirin and fewer 12-lead ECGs in the field. These results suggest strategies must be developed to ensure that appropriate therapy is provided to women presenting to EMS systems with acute cardiac ischemia.

Aged↗
PubMedDate not supplied

Outcome of acute otitis media with abnormal tympanometric patterns in children.

OBJECTIVE: To assess the ability of ED tympanometry to identify those children with acute otitis media who are at greater risk for treatment failure, recurrent infection, or persistent middle ear effusion. METHODS: A prospective observational study was performed in the EDs of a county hospital and a university medical center. One hundred seventeen children, aged 5 months to 5 years, with acute otitis media and abnormal tympanometric patterns were categorized into three groups--low compliance, high pressure, and low pressure--based on the initial patterns. All the children received oral amoxicillin for ten days. They had repeat tympanometry and otoscopy at 14- and 60-day follow-up visits, and were followed to determine clinical outcomes. RESULTS: Initial treatment success was equivalent for all groups: low compliance 93% (95% confidence interval 81%-97%), high pressure 91% (95% CI 71%-98%), low pressure 89% (95% CI 59%-99%). Rates of relapse, reinfection, 90-day non-recurrence, and persistent otoscopic and tympanometric middle ear effusion did not differ significantly between groups. CONCLUSION: ED tympanometry of children with acute otitis media is unable to provide prognostic information regarding treatment failure, recurrent infection, or persistent middle ear effusion.

Acoustic Impedance Tests↗
PubMedDate not supplied

Infrared tympanic thermometry in the evaluation of pediatric acute otitis media.

OBJECTIVE: The reliability of infrared tympanic thermometry (ITT) in children and the effect of acute otitis media (AOM) on ITT are unsettled. This study assessed the effect of AOM on ITT and the utility of ITT in the diagnosis of AOM. METHODS: 520 consecutive children, aged 6 months to 6 years, presenting to the ED of an urban teaching hospital were eligible for this prospective observational study. Nurses recorded oral or rectal reference temperatures (RefTs) and bilateral ITT temperatures upon presentation. Emergency physicians were blinded to the ITT temperatures. AOM was diagnosed according to published clinical criteria. RESULTS: Among 520 patients, 108 had unilateral AOM and 78 had bilateral AOM. In patients with unilateral AOM, the infected ears were warmer (I = 100.4 +/- 1.8 degrees F) than the uninfected ears (U = 100.3 +/- 1.8 degrees F, p = 0.035). However, the disparity in TM temperatures in infected and uninfected ears with unilateral AOM (I - U = 0.2 +/- 0.9 degrees F) was similar to the difference between right and left ears in those without AOM (R - L = 0.1 +/- 0.8 degrees F, p = 0.60). Compared with patients without AOM, patients with AOM demonstrated no significant elevation of ITT temperatures over RefTs (I - RefT = -0.8 +/- 1.2 degrees F in AOM; ITT - RefT = -0.8 +/- 1.2 degrees F in non-AOM; p = 0.94). This study had >99% power to detect a 1.0 degrees F difference for all groups compared. CONCLUSIONS: Infrared tympanic temperature are not helpful in diagnosing AOM in children. AOM has little direct effect on ITT temperatures.

Acute Disease↗
PubMedDate not supplied

Diagnosis of acute appendicitis: increasing accuracy, improving outcome, and decreasing liability.

When patients present with classic features, the diagnosis of appendicitis is generally straightforward. However, a large number of patients present with atypical features. Physicians must understand the limitations of the clinical examination and many other diagnostic adjuncts currently available. They also need to be aware of high-risk populations. Importantly, physicians must not be reluctant to consult surgical specialists in borderline cases. Only by consulting in such cases will physicians be able to decrease misdiagnosis, improve patient outcome, and avoid liability.

Acute Disease↗