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Scaphoid fracture: A new method of assessment
Abstracts
Abstracts in this issue were prepared by residents in the University of Arizona Emergency Medicine Residency Program. Samuel M Keim, MD Co-Editor Section of Emergency Medicine University of Arizona College of Medicine Tucson, Arizona Laurie Vande Krol, MD Co-Editor Emergency Medical Services Denver General Hospital Denver, Colorado William A Robinson, MD, FACEP Co-Editor Department of Emergency Medicine University of Missouri-Kansas City School of Medicine Kansas City, Missouri
Reprint no. 47/3/55099 Copyright 9 by the American Collegeof Emergency Physicians
MAY 1994
Scaphoid fracture: A new method of assessment Hodgkinson DVV,Nicholson OA, Stewart G, et al Clio Radiol 48.398-401 Dec 1993 The early management of suspected carpal scaphoid fractures that are not initially confirmed by plain radiographs remains unclear. Historically, these patients have been managed conservatively and treated with scaphoid plaster for at least ten days and reevaluated at that time. This prospective study of 78 patients was designed to assess the value of color flow Doppler ultrasound scanning in patients with suspected acute carpal scaphoid fracture. Both wrists of all patients were scanned within 12 to 72 hours after injury. The scaphoid outer cortex and the radial artery as it traverses the anatomic snuff box are readily visible with this imaging technique, and the distance between these two structures was recorded. The authors calculated a scaphoid index based on this distance. Patients were managed without the knowledge of ultrasound results using plain radiographs and clinical examinations and were followed until resolution of symptoms. All 12 patients subsequently considered to have scaphoid fracture were identified and noted to have a significantly increased scaphoid index. The authors conclude that proper early identification of scaphoid injury with this technique could minimize the
23:5 ANNALS OF EMER6ENCYMEDICINE
number of patients improperly immobilized.
TammyYKastre, MO
Ventricular arrhythmias in trials of thrombolytic therapy for acute myocardial infarction SolomonSO, RidkerPM, AntmanEM Circulation 88:2575-2581 Dec 1993 The authors performed a meta-analysis of 15 randomized controlled trials to estimate the risk of developing ventricular tachycardia (VT)or ventricular fibrillation (VF) in patients after [eceiving thrombolytic therapy for an acute myocardial infarction and to determine if these arrhythmias can account for the increased death rate that occurs during the first post-thrombolytic hospital day. The 15 trials (which included the GISSI-1, ISIS pilot, AIMS, and ISIS-2 studies) were performed between 1985 and 1990 and included a total of 39,613 patients. The thrombolytic agent was streptokinase in seven studies, tissue plasminogen activator in four studies, and anistreplase in four studies. The authors subdivided the studies into three groups based on the time the tachyrhythmia developed after thrombolysis: the first six hours, the first hospital day,
and the entire hospitalization. The VF rate was 3.15% for 1,018 patients in the thrombolytic group versus 3.23% for 1,024 patients in the placebo group during the first six hours (summary odds ratio = 0.98%), 2.99% for 10,040 patients in the thrombolytic group versus 2.99% for 10,012 patients in the placebo group during the first hospital day (summary odds ratio = 1.0%), and 5.04% for 19,956 patients in the placebo group during the entire hospitalization (summary odds ratio = 0.83%). The authors conclude that thrombolysis is not associated with an increased risk of VF during the first hospital day and is associated with a decreased risk of VF during the entire hospitalization. Eight of the 15 studies, with 9,363 total randomized patients, reported the incidence of VT during the entire hospitalization. The VT rate was 10.8% in the thrombolytic group versus 7.5% in the placebo group (summary odds ratio = 1.34%). Developing VT was not associated with a higher mortality during the first hospital day. The authors conclude that thrombolysis may be associated with an increased risk of VT but that this may reflect ascertainment bias because of increased survival during the entire hospitalization in the thrombolytic group and/or a greater propensity to nonlethal reperfusion ventricular tachyarrhythmias. The authors also conclude that the concurrent prophylactic administration of antiarrhythmic drugs during and after thrombolytic therapy, as is currently
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Abstracts in this issue were prepared by residents in the University of Arizona Emergency Medicine Residency Program. Samuel M Keim, MD Co-Editor Section of Emergency Medicine University of Arizona College of Medicine Tucson, Arizona Laurie Vande Krol, MD Co-Editor Emergency Medical Services Denver General Hospital Denver, Colorado William A Robinson, MD, FACEP Co-Editor Department of Emergency Medicine University of Missouri-Kansas City School of Medicine Kansas City, Missouri
Reprint no. 47/3/55099 Copyright 9 by the American Collegeof Emergency Physicians
MAY 1994
Scaphoid fracture: A new method of assessment Hodgkinson DVV,Nicholson OA, Stewart G, et al Clio Radiol 48.398-401 Dec 1993 The early management of suspected carpal scaphoid fractures that are not initially confirmed by plain radiographs remains unclear. Historically, these patients have been managed conservatively and treated with scaphoid plaster for at least ten days and reevaluated at that time. This prospective study of 78 patients was designed to assess the value of color flow Doppler ultrasound scanning in patients with suspected acute carpal scaphoid fracture. Both wrists of all patients were scanned within 12 to 72 hours after injury. The scaphoid outer cortex and the radial artery as it traverses the anatomic snuff box are readily visible with this imaging technique, and the distance between these two structures was recorded. The authors calculated a scaphoid index based on this distance. Patients were managed without the knowledge of ultrasound results using plain radiographs and clinical examinations and were followed until resolution of symptoms. All 12 patients subsequently considered to have scaphoid fracture were identified and noted to have a significantly increased scaphoid index. The authors conclude that proper early identification of scaphoid injury with this technique could minimize the
23:5 ANNALS OF EMER6ENCYMEDICINE
number of patients improperly immobilized.
TammyYKastre, MO
Ventricular arrhythmias in trials of thrombolytic therapy for acute myocardial infarction SolomonSO, RidkerPM, AntmanEM Circulation 88:2575-2581 Dec 1993 The authors performed a meta-analysis of 15 randomized controlled trials to estimate the risk of developing ventricular tachycardia (VT)or ventricular fibrillation (VF) in patients after [eceiving thrombolytic therapy for an acute myocardial infarction and to determine if these arrhythmias can account for the increased death rate that occurs during the first post-thrombolytic hospital day. The 15 trials (which included the GISSI-1, ISIS pilot, AIMS, and ISIS-2 studies) were performed between 1985 and 1990 and included a total of 39,613 patients. The thrombolytic agent was streptokinase in seven studies, tissue plasminogen activator in four studies, and anistreplase in four studies. The authors subdivided the studies into three groups based on the time the tachyrhythmia developed after thrombolysis: the first six hours, the first hospital day,
and the entire hospitalization. The VF rate was 3.15% for 1,018 patients in the thrombolytic group versus 3.23% for 1,024 patients in the placebo group during the first six hours (summary odds ratio = 0.98%), 2.99% for 10,040 patients in the thrombolytic group versus 2.99% for 10,012 patients in the placebo group during the first hospital day (summary odds ratio = 1.0%), and 5.04% for 19,956 patients in the placebo group during the entire hospitalization (summary odds ratio = 0.83%). The authors conclude that thrombolysis is not associated with an increased risk of VF during the first hospital day and is associated with a decreased risk of VF during the entire hospitalization. Eight of the 15 studies, with 9,363 total randomized patients, reported the incidence of VT during the entire hospitalization. The VT rate was 10.8% in the thrombolytic group versus 7.5% in the placebo group (summary odds ratio = 1.34%). Developing VT was not associated with a higher mortality during the first hospital day. The authors conclude that thrombolysis may be associated with an increased risk of VT but that this may reflect ascertainment bias because of increased survival during the entire hospitalization in the thrombolytic group and/or a greater propensity to nonlethal reperfusion ventricular tachyarrhythmias. The authors also conclude that the concurrent prophylactic administration of antiarrhythmic drugs during and after thrombolytic therapy, as is currently
1163