- Email: [email protected]
393
Research Forum Abstracts active patient in the ED and 2 minutes for each hallway admission. Time to discharge from the ED averaged about 4 hours plus the census effects, which were 5 minutes per active patient and 2 minutes per hallway admission. For admitted patients the median time until they left the ED was 456 minutes (IQR 321-672); with an average of over 7 hours plus the census effects, 3 minutes for each active patient and 14 minutes for each admitted patient ahead of them. Conclusion: Both the number of active patients and the boarding of admitted patients in the ED have a direct impact on time to both first order, and overall length of stay in the ED for both admitted and non-admitted patients. This appears to increase linearly for both factors. Also, as the number of boarded admissions increases, the process for moving a given patient to the inpatient unit is significantly delayed. Every effort to minimize the number of admitted patients being boarded in the ED should be utilized.
391
Physician Preferences and Relative Costs for Different Outcomes in Acute Appendicitis
Birkhahn RH, Khan T, Datillo PA, Melville L, Van Deusen SK, Gaeta TJ/New York Methodist Hospital, Brooklyn, NY
Background: Acute appendicitis is a complex clinical problem where the goal of the physician in decisionmaking is to maximize the number of patients with appendicitis going straight to surgery and minimize the number of delayed appendectomies, non-therapuetic laparotomies, and imaging studies. Study objectives: To establish a weighting system based on relative cost for different outcomes in patients presenting to an ED with acute appendicitis from the perspective of the ED and Surgical faculty. Methods: Academic faculty from the Departments of Surgery and EM were surveyed using a modified standard gamble technique to elucidate relative costs for 6 different outcomes in acute appendicitis. Faculty were presented with a scenario of a patient with RLQ pain presenting for evaluation and either being sent directly to the operating room, sent for abdominal CT scan, or sent for serial observation (inpatient or outpatient) given either of two disease states (present or absent). The exercise was presented by a trained interviewer with the following provisions, CT was always accurate, patients observed always returned for serial evaluation, and the cost scale was 0 to 100 (with 100 being greatest relative cost and 0 being no relative cost). The physician was asked to provide an estimate of a relative cost for each of 6 possible outcomes with relation to death (100) and perfect health (0). Results: A total of 14 EM faculty and 12 Surgical faculty participated in the exercise. The relative weighting for each outcome is shown below. Conclusion: Surgical and EM faculty had fairly consistent estimation of relative cost. One notable difference was that surgeons weighted the marginal cost of a CT scan less than an immediate operation for true appendicitis and similar to observation for patients without appendicitis. A modified standard gamble technique can be applied in a local practice environment to establish weighting for outcomes in appendicitis for a decision analysis of the process of care in patients with suspected appendicitis.
392
The Effect of Emergncy Department Crowding Factors on Pain Management
Hwang U, Harris B, Morrison RS, Richardson LD/Mount Sinai School of Medicine, New York, NY
Background: Emergency departments (ED) serve to provide care to the acutely ill and injured, and safety net care to disenfranchised and vulnerable populations. These missions are threatened by the phenomenon of ED crowding. Pain management is a useful model to explore the effects of ED crowding factors on timely patient care. Study Objectives: To determine the effect of patient-related and ED crowding factors on pain management. Methods: Observational cohort of patients ⱖ18 y.o. with painful conditions seen in an academic, urban, ED July 2005. Study eligibility is based on both chief complaint and final ED diagnosis of extremity conditions (ankle, elbow, fall, hip,
Volume , . : October
neck, shoulder, wrist) warranting analgesic management. Patient-related variables include: age, gender, ethnicity, severity index, Charlson comorbidity score, number of prior medications. ED crowding factors include: ED census, % age of admitted patients (boarders), and physician (MD) and nursing (RN) staffing levels. Nonparametric data logarithmically transformed. Outcomes studied are: times of pain assessment, analgesia ordering, and administration. Results: During this period 160 patients were enrolled: 62% were female, 59% were black or Hispanic; mean (⫾SD) age was 53 (20) years, Emergency Severity Index (ESI) was 3.5 (0.7), comorbidity score was 0.5 (1.0), number of prior medications was 2.3 (3.1). For pain assessment: 89% had pain assessed at triage and 38% reported severe pain [⬎ 5 on scale of 0-10]. For pain treatment: 51% received no analgesia. The mean time in minutes to first pain assessment was 131 (118), to analgesic ordering was 124 (122), to analgesic administration was 147 (125). The mean census during this time was 54 (16), % age of boarders was 31 (8), number of attending MDs 3 (1), number of resident MDs 4 (4), and number of RNs 15 (3). When ED census was ⬎ 100% bed capacity [31 beds] there were delays to pain assessment (⫹80 mins, p ⬍ 0.0001), and pain treatment (⫹92 mins, p ⬍ 0.0001). There were also delays for women to pain assessment (⫹57 mins, p ⬍ 0.01), but no delays in treatment. Spearman’s correlation coefficient for ED census vs. time to pain assessment (ttPA) was r⫽0.30 (p ⬍ 0.01), and time to analgesic administration (ttPRx) was r⫽0.24 (p⫽0.05). The direction of these associations remained true for % age of boarders vs. ttPA (r⫽0.19, p⫽0.03) and ttPRx (r⫽0.27, p⫽0.02). There were no differences in pain management secondary to age, ESI and comorbidity scores, number of prior medications, and ED staffing levels. Gender, census ⬎ 120% bed capacity, and % age of boarders remained statistically significant in multivariate models. Conclusion: In this study, there were delays in pain management associated with gender, ED census levels, and number of boarders. Patients presenting with extremity injuries considered painful had no differences in pain management attributable to age, ethnicity, severity, or clinical staffing levels.
EMF-6
Declining Reimbursements for ED Visits Across Payor Groups from 1996-2003
Hsia R, MacIsaac D, Tsai AC, Baker LC/Stanford University Hospital, Palo Alto, CA
Background: The past decade has seen enormous changes in the field of health care policy regarding the delivery of health services, which inevitably has financial ramifications for providers. Previous studies show that expenditures for health care services have been increasing for patients in all insurance categories, both private and public. However, while the widespread belief among emergency providers that expenditures compared to charges are decreasing, the authors know of only one recent study that has actually examined the rate of overall payments. Study Objective: The goal of this research is to quantify the rate of payments to charges for ED visits over the years of 1996 to 2003 and document these trends. Methods: We used 1996-2003 data from the Medical Expenditure Panel Survey (MEPS), a national probability sample of the US civilian noninstitutionalized population. We used the ED visit as the unit of analysis, analyzing a total of 37,617 visits over the 8-year period. We excluded visits that were charged under flat-fee arrangements or had zero charges, as well as ED visits resulting in hospital admission since distinction of these charges is imprecise. We also excluded visits covered under the Uniformed Services, the Department of Veterans Affairs, or non-Medicare/nonMedicaid public hospital/physician insurance programs. Our outcome variables were charges and payments. Results: Our results show that charges and expenditures per ED visit have been increasing significantly over time, but that gap between the two has also been increasing. In other words, the payment rate has been consistently decreasing over 1996-2003 in all categories. Payment rates for privately insured patients, for example, declined from 76% in 1996 to 56% in 2003; for Medicaid visits, rates declined from 42% to 30%; for Medicare visits, 50% to 37%; and 42% to 35% for uninsured visits.
393
Real Time Documentation of Reasons for Delay to ED Presentation After Acute Ischemic Stroke
Vaidyanathan L, Kashyap R, Bhagra A, Gilmore RM, Decker WW, Stead LG, Bellolio M/Mayo Clinic, Rochester, MN
Study Objective: To catalog the reasons why a significant number of patients still present late to medical attention after an acute ischemic stroke. Methods: All patients presenting to our ED with symptoms of acute brain
Annals of Emergency Medicine S117
Research Forum Abstracts ischemia were prospectively enrolled. A standard questionnaire was administered by a trained study coordinator uninvolved in the clinical care of the patient. Time of onset of symptoms and time to ED presentation were recorded and patients were specifically asked to describe what they did between onset of symptoms and making the decision to get care and arriving to medical attention. The questionnaire specifically solicited the reasons in the patient’s own words, and was administered as promptly as possible after patient arrival. Reasons were also classified according to a multiple choice scale. Results: 240 patients have been enrolled to date. More than one half (57%) had a delayed presentation and 45% did not feel time was of essence (figs 1 and 2). Category of reason for delayed presentation were as follows: 22% thought their symptoms would go away (most common reason); 3% had to wait for a ride to the ED; 11% tried to get a hold of or saw their primary care provider. 16% were transferred from another hospital or ED. Figure 3 lists the patients’ personal reasons in their or their family’s own words. Conclusion: Despite great efforts at community education and improving access to care, there still exists a significant delay to ED presentation after an acute cerebrovascular event. Ongoing patient education is vital to decrease this time delay.
Study Objective: To validate the 5 Johnston criteria in emergency department (ED) patients presenting with transient stroke symptoms. Methods: We prospectively enrolled ED TIA patients into this study. We specifically documented the 5 Johnston criteria for all TIA patients. All patients had cardiac monitoring, cardiac ultrasound, carotid artery imaging, and serial clinical evaluations including a neurology consultation. Patients admitted initially to observation who had positive testing were admitted in hospital for further management. Primary outcome was stroke at 90 days. Results: 149 patients were enrolled with a mean age of (67.7 ⫾ 15.4), % male (32%), and the average number of TIA risk factors was (2.5 ⫾ 1.3). Sixteen patients, 10.7%, had a stroke identified, 11 patients on the index visit and 5 more identified at 90 days. There were no deaths. Of the high risk TIA features, 98 or 66% were over 60, 96 or 64% had TIA duration ⬎ 10 mins, 83 or 56% had weakness, 59 or 40% had speech impairment, 32 or 21% had diabetes and 17 or 11% had previous stroke. Conclusion: The Johnston high risk TIA criteria identified the majority of patients who went on to suffer a stroke at 90 days.
395
Admission Serum Glucose Level in Known Diabetics: No Impact Stroke Severity or Functional Outcome
Gilmore RM, Stead LG/Mayo Clinic, Rochester, MN
Figure 3: Patient statements for delayed presentation to the ED: • “I did not want anyone to find out.” • “Ambulance did not run in the daytime in our town and I had to call neighboring community’s ambulance”. • “It happened while we were sleeping and I did not know it was happening”. • [Patient] on the streets; no one noticed a difference in his speech or demeanor. • “Did not want to come in on Saturday because I thought the ER would be too busy”. • “I wanted to watch the play-offs”. • [Patient] was alone and passed out. • [Patient] was found unresponsive the next morning. • “Ambulance people stated it wasn’t my symptoms were not concerning. They had sent the other EMT down to the ambulance for a break. In the meantime [Patient] became unresponsive and the EMT in the apartment had to try and get the other EMT back to the apartment. He wouldn’t answer his radio so they had to go through the dispatcher to get him back to the apartment”. • [Patient] was obese and had a size issue. • “Ambulance could not find my address”. • “I fell and couldn’t get to the phone so I waited for someone to come”. • [Patient] in denial about having a stroke, refused EMS transport even though wife had called promptly. • “I didn’t want to come without a friend in case I would die in the hospital alone.” • “I didn’t see the point of coming; last time I had a stroke they kept me for 4 days and sent me home on an aspirin.” • “I have had a bum left arm for months, I figured it was just that.”
394
Study Objective: It is well known that hyperglycemia at ED presentation predicts poor prognosis following acute ischemic stroke, in unselected patients. We sought to determine if initial blood glucose level influenced outcomes following acute ischemic stroke in patients with known Type 2 diabetes mellitus (DM). Methods: The study was conducted at an academic medical center with an annual ED census of 77,000 visits, of which 500 are for acute ischemic stroke (AIS). All consecutive patients presenting to the emergency department (ED) during a 2-year period with AIS were enrolled (n⫽681). Patients who denied research authorization (19) or presented more than 24 hours after symptom onset (182) were excluded. There were 115 patients with Type 2 DM eligible for inclusion in the study. The effect of initial blood glucose level on stroke severity (NIHSS), functional impairment (Rankin), and 90 day mortality was analyzed for this population. Hyperglycemia was defined as ⬎ 130 mg/dl. A poor Rankin score was defined as ⬎ 2. Results: Of 115 patients, 67 (58.2%) were male with a mean age of 73.2 years. Hyperglycemia on presentation was found in 75 patients (65.2%). The degree of functional impairment was similar among patients with hyperglycemia and those with normal blood glucose (poor Rankin scores in 55% and 65% respectively, p⫽0.32). Stroke severity was not significantly different between the two groups, although a trend towards greater severity in the normal glucose group was observed (median NIHSS 6.0 vs 4.0, p⫽0.086). No significant difference in 90 day mortality was observed; 13% in the normal glucose group, 19.4% in the hyperglycemia group p⫽0.66. Conclusions: Although type II diabetics are known to have worse strokes and outcomes, among this group the initial ED blood glucose level does not further risk stratify the degree of functional impairment, stroke severity, or 90 day mortality.
Validation of Johnson Criteria for Transient Ischemic Attacks
Ross MA, Compton S, Medado P, Ryder A, O’Neil BJ/William Beaumont Hosp, Royal Oak, MI
Introduction: In 2000 Johnston studied TIA patients from a retrospective database and reported five independent risk factors for stroke at 90 days - age over 60 (OR 1.8), diabetes (OR 2.0), TIA duration over 10 minutes (OR 2.3), weakness with TIA (OR 1.9), and speech impairment with TIA (OR 1.5).
S118 Annals of Emergency Medicine
Volume , . : October
391
Physician Preferences and Relative Costs for Different Outcomes in Acute Appendicitis
Birkhahn RH, Khan T, Datillo PA, Melville L, Van Deusen SK, Gaeta TJ/New York Methodist Hospital, Brooklyn, NY
Background: Acute appendicitis is a complex clinical problem where the goal of the physician in decisionmaking is to maximize the number of patients with appendicitis going straight to surgery and minimize the number of delayed appendectomies, non-therapuetic laparotomies, and imaging studies. Study objectives: To establish a weighting system based on relative cost for different outcomes in patients presenting to an ED with acute appendicitis from the perspective of the ED and Surgical faculty. Methods: Academic faculty from the Departments of Surgery and EM were surveyed using a modified standard gamble technique to elucidate relative costs for 6 different outcomes in acute appendicitis. Faculty were presented with a scenario of a patient with RLQ pain presenting for evaluation and either being sent directly to the operating room, sent for abdominal CT scan, or sent for serial observation (inpatient or outpatient) given either of two disease states (present or absent). The exercise was presented by a trained interviewer with the following provisions, CT was always accurate, patients observed always returned for serial evaluation, and the cost scale was 0 to 100 (with 100 being greatest relative cost and 0 being no relative cost). The physician was asked to provide an estimate of a relative cost for each of 6 possible outcomes with relation to death (100) and perfect health (0). Results: A total of 14 EM faculty and 12 Surgical faculty participated in the exercise. The relative weighting for each outcome is shown below. Conclusion: Surgical and EM faculty had fairly consistent estimation of relative cost. One notable difference was that surgeons weighted the marginal cost of a CT scan less than an immediate operation for true appendicitis and similar to observation for patients without appendicitis. A modified standard gamble technique can be applied in a local practice environment to establish weighting for outcomes in appendicitis for a decision analysis of the process of care in patients with suspected appendicitis.
392
The Effect of Emergncy Department Crowding Factors on Pain Management
Hwang U, Harris B, Morrison RS, Richardson LD/Mount Sinai School of Medicine, New York, NY
Background: Emergency departments (ED) serve to provide care to the acutely ill and injured, and safety net care to disenfranchised and vulnerable populations. These missions are threatened by the phenomenon of ED crowding. Pain management is a useful model to explore the effects of ED crowding factors on timely patient care. Study Objectives: To determine the effect of patient-related and ED crowding factors on pain management. Methods: Observational cohort of patients ⱖ18 y.o. with painful conditions seen in an academic, urban, ED July 2005. Study eligibility is based on both chief complaint and final ED diagnosis of extremity conditions (ankle, elbow, fall, hip,
Volume , . : October
neck, shoulder, wrist) warranting analgesic management. Patient-related variables include: age, gender, ethnicity, severity index, Charlson comorbidity score, number of prior medications. ED crowding factors include: ED census, % age of admitted patients (boarders), and physician (MD) and nursing (RN) staffing levels. Nonparametric data logarithmically transformed. Outcomes studied are: times of pain assessment, analgesia ordering, and administration. Results: During this period 160 patients were enrolled: 62% were female, 59% were black or Hispanic; mean (⫾SD) age was 53 (20) years, Emergency Severity Index (ESI) was 3.5 (0.7), comorbidity score was 0.5 (1.0), number of prior medications was 2.3 (3.1). For pain assessment: 89% had pain assessed at triage and 38% reported severe pain [⬎ 5 on scale of 0-10]. For pain treatment: 51% received no analgesia. The mean time in minutes to first pain assessment was 131 (118), to analgesic ordering was 124 (122), to analgesic administration was 147 (125). The mean census during this time was 54 (16), % age of boarders was 31 (8), number of attending MDs 3 (1), number of resident MDs 4 (4), and number of RNs 15 (3). When ED census was ⬎ 100% bed capacity [31 beds] there were delays to pain assessment (⫹80 mins, p ⬍ 0.0001), and pain treatment (⫹92 mins, p ⬍ 0.0001). There were also delays for women to pain assessment (⫹57 mins, p ⬍ 0.01), but no delays in treatment. Spearman’s correlation coefficient for ED census vs. time to pain assessment (ttPA) was r⫽0.30 (p ⬍ 0.01), and time to analgesic administration (ttPRx) was r⫽0.24 (p⫽0.05). The direction of these associations remained true for % age of boarders vs. ttPA (r⫽0.19, p⫽0.03) and ttPRx (r⫽0.27, p⫽0.02). There were no differences in pain management secondary to age, ESI and comorbidity scores, number of prior medications, and ED staffing levels. Gender, census ⬎ 120% bed capacity, and % age of boarders remained statistically significant in multivariate models. Conclusion: In this study, there were delays in pain management associated with gender, ED census levels, and number of boarders. Patients presenting with extremity injuries considered painful had no differences in pain management attributable to age, ethnicity, severity, or clinical staffing levels.
EMF-6
Declining Reimbursements for ED Visits Across Payor Groups from 1996-2003
Hsia R, MacIsaac D, Tsai AC, Baker LC/Stanford University Hospital, Palo Alto, CA
Background: The past decade has seen enormous changes in the field of health care policy regarding the delivery of health services, which inevitably has financial ramifications for providers. Previous studies show that expenditures for health care services have been increasing for patients in all insurance categories, both private and public. However, while the widespread belief among emergency providers that expenditures compared to charges are decreasing, the authors know of only one recent study that has actually examined the rate of overall payments. Study Objective: The goal of this research is to quantify the rate of payments to charges for ED visits over the years of 1996 to 2003 and document these trends. Methods: We used 1996-2003 data from the Medical Expenditure Panel Survey (MEPS), a national probability sample of the US civilian noninstitutionalized population. We used the ED visit as the unit of analysis, analyzing a total of 37,617 visits over the 8-year period. We excluded visits that were charged under flat-fee arrangements or had zero charges, as well as ED visits resulting in hospital admission since distinction of these charges is imprecise. We also excluded visits covered under the Uniformed Services, the Department of Veterans Affairs, or non-Medicare/nonMedicaid public hospital/physician insurance programs. Our outcome variables were charges and payments. Results: Our results show that charges and expenditures per ED visit have been increasing significantly over time, but that gap between the two has also been increasing. In other words, the payment rate has been consistently decreasing over 1996-2003 in all categories. Payment rates for privately insured patients, for example, declined from 76% in 1996 to 56% in 2003; for Medicaid visits, rates declined from 42% to 30%; for Medicare visits, 50% to 37%; and 42% to 35% for uninsured visits.
393
Real Time Documentation of Reasons for Delay to ED Presentation After Acute Ischemic Stroke
Vaidyanathan L, Kashyap R, Bhagra A, Gilmore RM, Decker WW, Stead LG, Bellolio M/Mayo Clinic, Rochester, MN
Study Objective: To catalog the reasons why a significant number of patients still present late to medical attention after an acute ischemic stroke. Methods: All patients presenting to our ED with symptoms of acute brain
Annals of Emergency Medicine S117
Research Forum Abstracts ischemia were prospectively enrolled. A standard questionnaire was administered by a trained study coordinator uninvolved in the clinical care of the patient. Time of onset of symptoms and time to ED presentation were recorded and patients were specifically asked to describe what they did between onset of symptoms and making the decision to get care and arriving to medical attention. The questionnaire specifically solicited the reasons in the patient’s own words, and was administered as promptly as possible after patient arrival. Reasons were also classified according to a multiple choice scale. Results: 240 patients have been enrolled to date. More than one half (57%) had a delayed presentation and 45% did not feel time was of essence (figs 1 and 2). Category of reason for delayed presentation were as follows: 22% thought their symptoms would go away (most common reason); 3% had to wait for a ride to the ED; 11% tried to get a hold of or saw their primary care provider. 16% were transferred from another hospital or ED. Figure 3 lists the patients’ personal reasons in their or their family’s own words. Conclusion: Despite great efforts at community education and improving access to care, there still exists a significant delay to ED presentation after an acute cerebrovascular event. Ongoing patient education is vital to decrease this time delay.
Study Objective: To validate the 5 Johnston criteria in emergency department (ED) patients presenting with transient stroke symptoms. Methods: We prospectively enrolled ED TIA patients into this study. We specifically documented the 5 Johnston criteria for all TIA patients. All patients had cardiac monitoring, cardiac ultrasound, carotid artery imaging, and serial clinical evaluations including a neurology consultation. Patients admitted initially to observation who had positive testing were admitted in hospital for further management. Primary outcome was stroke at 90 days. Results: 149 patients were enrolled with a mean age of (67.7 ⫾ 15.4), % male (32%), and the average number of TIA risk factors was (2.5 ⫾ 1.3). Sixteen patients, 10.7%, had a stroke identified, 11 patients on the index visit and 5 more identified at 90 days. There were no deaths. Of the high risk TIA features, 98 or 66% were over 60, 96 or 64% had TIA duration ⬎ 10 mins, 83 or 56% had weakness, 59 or 40% had speech impairment, 32 or 21% had diabetes and 17 or 11% had previous stroke. Conclusion: The Johnston high risk TIA criteria identified the majority of patients who went on to suffer a stroke at 90 days.
395
Admission Serum Glucose Level in Known Diabetics: No Impact Stroke Severity or Functional Outcome
Gilmore RM, Stead LG/Mayo Clinic, Rochester, MN
Figure 3: Patient statements for delayed presentation to the ED: • “I did not want anyone to find out.” • “Ambulance did not run in the daytime in our town and I had to call neighboring community’s ambulance”. • “It happened while we were sleeping and I did not know it was happening”. • [Patient] on the streets; no one noticed a difference in his speech or demeanor. • “Did not want to come in on Saturday because I thought the ER would be too busy”. • “I wanted to watch the play-offs”. • [Patient] was alone and passed out. • [Patient] was found unresponsive the next morning. • “Ambulance people stated it wasn’t my symptoms were not concerning. They had sent the other EMT down to the ambulance for a break. In the meantime [Patient] became unresponsive and the EMT in the apartment had to try and get the other EMT back to the apartment. He wouldn’t answer his radio so they had to go through the dispatcher to get him back to the apartment”. • [Patient] was obese and had a size issue. • “Ambulance could not find my address”. • “I fell and couldn’t get to the phone so I waited for someone to come”. • [Patient] in denial about having a stroke, refused EMS transport even though wife had called promptly. • “I didn’t want to come without a friend in case I would die in the hospital alone.” • “I didn’t see the point of coming; last time I had a stroke they kept me for 4 days and sent me home on an aspirin.” • “I have had a bum left arm for months, I figured it was just that.”
394
Study Objective: It is well known that hyperglycemia at ED presentation predicts poor prognosis following acute ischemic stroke, in unselected patients. We sought to determine if initial blood glucose level influenced outcomes following acute ischemic stroke in patients with known Type 2 diabetes mellitus (DM). Methods: The study was conducted at an academic medical center with an annual ED census of 77,000 visits, of which 500 are for acute ischemic stroke (AIS). All consecutive patients presenting to the emergency department (ED) during a 2-year period with AIS were enrolled (n⫽681). Patients who denied research authorization (19) or presented more than 24 hours after symptom onset (182) were excluded. There were 115 patients with Type 2 DM eligible for inclusion in the study. The effect of initial blood glucose level on stroke severity (NIHSS), functional impairment (Rankin), and 90 day mortality was analyzed for this population. Hyperglycemia was defined as ⬎ 130 mg/dl. A poor Rankin score was defined as ⬎ 2. Results: Of 115 patients, 67 (58.2%) were male with a mean age of 73.2 years. Hyperglycemia on presentation was found in 75 patients (65.2%). The degree of functional impairment was similar among patients with hyperglycemia and those with normal blood glucose (poor Rankin scores in 55% and 65% respectively, p⫽0.32). Stroke severity was not significantly different between the two groups, although a trend towards greater severity in the normal glucose group was observed (median NIHSS 6.0 vs 4.0, p⫽0.086). No significant difference in 90 day mortality was observed; 13% in the normal glucose group, 19.4% in the hyperglycemia group p⫽0.66. Conclusions: Although type II diabetics are known to have worse strokes and outcomes, among this group the initial ED blood glucose level does not further risk stratify the degree of functional impairment, stroke severity, or 90 day mortality.
Validation of Johnson Criteria for Transient Ischemic Attacks
Ross MA, Compton S, Medado P, Ryder A, O’Neil BJ/William Beaumont Hosp, Royal Oak, MI
Introduction: In 2000 Johnston studied TIA patients from a retrospective database and reported five independent risk factors for stroke at 90 days - age over 60 (OR 1.8), diabetes (OR 2.0), TIA duration over 10 minutes (OR 2.3), weakness with TIA (OR 1.9), and speech impairment with TIA (OR 1.5).
S118 Annals of Emergency Medicine
Volume , . : October