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Expanded TOC
CK-MB level significantly outperformed the ROC curve area of the delta myoglobin level for early identification of acute myocardial infarction (0.97 versus 0.81; 95% confidence interval [CI] for difference between areas 0.09 to 0.24). At the most accurate cutoff value, a 2-hour delta CK-MB more than 0.7 ng/mL had a sensitivity of 93.2% (95% CI 81.3 to 98.5), a specificity of 94.4% (95% CI 92.7 to 95.8), a positive likelihood ratio of 16.7, and a negative likelihood ratio of 0.07. 20
Electrical Cardioversion of Emergency Department Patients With Atrial Fibrillation (Original Research) JH Burton, DR Vinson, K Drummond, TD Strout, HC Thode, JJ McInturff We identify the outcomes and complications associated with emergency department (ED) electrical cardioversion of patients with atrial fibrillation. This retrospective health records survey investigated a consecutive cohort of ED atrial fibrillation patients who underwent electrical cardioversion in 4 EDs during a 42-month period. The study population consisted of 388 patients (mean age 61 years; range 20 to 93 years). Duration of atrial fibrillation was less than 48 hours in 99% of the cohort. Electrical cardioversion was successful in 332 (86%) patients. Twenty-eight complications were noted in 25 electrical cardioversion encounters: 22 attributed to procedural sedation and analgesia and 6 attributed to electrical cardioversion. Three hundred thirty-three (86%) patients were discharged to home from the ED: 301 after electrical cardioversion success and 32 with electrical cardioversion failure. Thirty-nine patients (10%) returned to the ED within 7 days, 25 of these patients (6% of successful electrical cardioversion patients) returned because of relapse of atrial fibrillation.
INFECTIOUS DISEASE 31
Current Centers for Disease Control and Prevention Guidelines for HIV Counseling, Testing, and Referral: Critical Role of and a Call to Action for Emergency Physicians (Review Article) RE Rothman In 2001, the Centers for Disease Control and Prevention issued revised guidelines for HIV counseling, testing, and referral directed toward promoting further reduction of HIV acquisition and transmission. The guidelines give explicit emphasis to the role of emergency physicians according to recognition that the emergency department (ED) represents the only source of medical care for many patients and often serves as the primary site for routine health care to communities at risk for HIV. Despite the time and practical limitations inherent in ED practice, many studies suggest that routine HIV counseling, testing, and referral in the ED may be feasible and effective. This article reviews those studies in the context of the most up-to-date Centers for Disease Control and Prevention HIV counseling, testing, and referral guidelines.
43
Murine Typhus—Hawaii, 2002 (CDC Update)
45
Commentary (CDC Update) S Takhar
TRAUMA 47
Defining “Therapeutically Inconsequential” Head Computed Tomographic Findings in Patients With Blunt Head Trauma (Original Research) C Atzema, WR Mower, JR Hoffman, JF Holmes, AJ Killian, JA Oman, AH Shen, SD Greenwood Many injuries detected by computed tomographic (CT) imaging of blunt head trauma patients are considered “therapeutically inconsequential.” We estimated the prevalence of these findings and determined how frequently affected patients had “important neurosurgical outcomes,” defined as either a directed intervention or a poor Glasgow Outcome Scale score. We prospectively enrolled all blunt head trauma patients undergoing emergency head CT imaging at 18 centers participating in the National Emergency X-radiography Utilization Study II. From these cases, we identified all patients whose official CT reading met predefined criteria for therapeutically inconsequential injuries. We obtained detailed follow-up information for all such patients at 6 sites, including the need for neurosurgical intervention and Glasgow Outcome Scale scores. Therapeutically inconsequential head CT findings were present in 155 of 8,374 subjects (1.85%; 95% confidence interval 1.57% to 2.16%). Sites participating in the follow-up study enrolled 81 of these patients, of whom 10 (12%) patients had important neurosurgical outcomes. Follow-up information was available for 9 patients, all of whom had abnormal mental status at CT scanning. Coagulopathy was also present in 5 of 7 patients for whom coagulation status was known.
1 0 A
ANNALS OF EMERGENCY MEDICINE
44:1
JULY 2004
Electrical Cardioversion of Emergency Department Patients With Atrial Fibrillation (Original Research) JH Burton, DR Vinson, K Drummond, TD Strout, HC Thode, JJ McInturff We identify the outcomes and complications associated with emergency department (ED) electrical cardioversion of patients with atrial fibrillation. This retrospective health records survey investigated a consecutive cohort of ED atrial fibrillation patients who underwent electrical cardioversion in 4 EDs during a 42-month period. The study population consisted of 388 patients (mean age 61 years; range 20 to 93 years). Duration of atrial fibrillation was less than 48 hours in 99% of the cohort. Electrical cardioversion was successful in 332 (86%) patients. Twenty-eight complications were noted in 25 electrical cardioversion encounters: 22 attributed to procedural sedation and analgesia and 6 attributed to electrical cardioversion. Three hundred thirty-three (86%) patients were discharged to home from the ED: 301 after electrical cardioversion success and 32 with electrical cardioversion failure. Thirty-nine patients (10%) returned to the ED within 7 days, 25 of these patients (6% of successful electrical cardioversion patients) returned because of relapse of atrial fibrillation.
INFECTIOUS DISEASE 31
Current Centers for Disease Control and Prevention Guidelines for HIV Counseling, Testing, and Referral: Critical Role of and a Call to Action for Emergency Physicians (Review Article) RE Rothman In 2001, the Centers for Disease Control and Prevention issued revised guidelines for HIV counseling, testing, and referral directed toward promoting further reduction of HIV acquisition and transmission. The guidelines give explicit emphasis to the role of emergency physicians according to recognition that the emergency department (ED) represents the only source of medical care for many patients and often serves as the primary site for routine health care to communities at risk for HIV. Despite the time and practical limitations inherent in ED practice, many studies suggest that routine HIV counseling, testing, and referral in the ED may be feasible and effective. This article reviews those studies in the context of the most up-to-date Centers for Disease Control and Prevention HIV counseling, testing, and referral guidelines.
43
Murine Typhus—Hawaii, 2002 (CDC Update)
45
Commentary (CDC Update) S Takhar
TRAUMA 47
Defining “Therapeutically Inconsequential” Head Computed Tomographic Findings in Patients With Blunt Head Trauma (Original Research) C Atzema, WR Mower, JR Hoffman, JF Holmes, AJ Killian, JA Oman, AH Shen, SD Greenwood Many injuries detected by computed tomographic (CT) imaging of blunt head trauma patients are considered “therapeutically inconsequential.” We estimated the prevalence of these findings and determined how frequently affected patients had “important neurosurgical outcomes,” defined as either a directed intervention or a poor Glasgow Outcome Scale score. We prospectively enrolled all blunt head trauma patients undergoing emergency head CT imaging at 18 centers participating in the National Emergency X-radiography Utilization Study II. From these cases, we identified all patients whose official CT reading met predefined criteria for therapeutically inconsequential injuries. We obtained detailed follow-up information for all such patients at 6 sites, including the need for neurosurgical intervention and Glasgow Outcome Scale scores. Therapeutically inconsequential head CT findings were present in 155 of 8,374 subjects (1.85%; 95% confidence interval 1.57% to 2.16%). Sites participating in the follow-up study enrolled 81 of these patients, of whom 10 (12%) patients had important neurosurgical outcomes. Follow-up information was available for 9 patients, all of whom had abnormal mental status at CT scanning. Coagulopathy was also present in 5 of 7 patients for whom coagulation status was known.
1 0 A
ANNALS OF EMERGENCY MEDICINE
44:1
JULY 2004