316: Toxoplasma gondii Antibodies and Associated Oxidative Stress Among Asymptomatic Blood Donors

Research Forum Abstracts abdominal pain were reviewed for the final ED diagnosis of PE. Additionally, all ED charts with the final diagnosis of PE were reviewed for presenting complaint of abdominal pain. Diagnosis of PE was determined by computed tomographic angiography (CTA) in the ED and confirmed with the final hospital discharge diagnosis. Exclusion criteria were hypoxia, tachypnea, and complaint of shortness of breath or chest pain on presentation to the ED. Results: Four out of 42 (9.5%) patients diagnosed with PE in the ED were initially evaluated for intra-abdominal pathology. All had a chief complaint of abdominal pain with normal vital signs on presentation and did not complain of shortness of breath or chest pain. Two patients had recent surgery while the other two had no risk factors for PE. Three of the four patients presented with right upper quadrant abdominal pain and were initially evaluated for biliary disease with a right upper quadrant ultrasound. The gallbladder was normal in all cases. The fourth patient had both right upper and lower abdominal pain. CT of the abdomen was unremarkable except for a right lower lobe pulmonary infiltrate. Three of the patients were diagnosed by the attending radiologist as having pneumonia due to a right lower lobe infiltrate on chest X-ray or CT. Since symptoms of pneumonia were absent, further ED workup proceeded to CTA. All four patients had filling defects on CTA in the right lower lobe segmental pulmonary artery, possibly explaining their right upper quadrant abdominal pain. None had tachycardia, tachypnea or were hypoxic on presentation. Conclusion: PE is a difficult diagnosis to make on clinical grounds alone. It is well documented that PEs can present with various complaints and can mimic other disease processes. Without the classic tachypnea, hypoxia, or chest pain, clinicians may be less likely to suspect PE. This small case series demonstrates that PE should be considered in cases of significant upper abdominal pain in which an abdominal source cannot be identified.

316

Toxoplasma gondii Antibodies and Associated Oxidative Stress Among Asymptomatic Blood Donors

Abousamra Sr NK/University Hospital, Mansoura, Egypt

Background: Since existing therapies are not fully effective, and no Toxoplasma gondii vaccine is available, efforts to reduce toxoplasmosis transmission are crucial to reducing the impact of this disease. Study Objectives: We evaluate the presence of T. gondii antibodies and oxidative stress associated in asymptomatic blood donors in northeastern Egypt in a crosssectional study. Methods: From March to September 2007 we recruited 230 blood donors (169 men and 61women) with age ranges from 20 to 50 who attended to blood banks, Mansoura University Hospital, Egypt. We interviewed blood donors about sociodemographic characteristics and potential risk factors for T. gondii infection using a structured questionnaire. A venous blood sample was taken to document their T. gondii antibody status using enzyme-linked immunosorbent assay (ELISA). Also, serum level of malondialdehyde (MDA) and activity of glutathione peroxidase (GSHPx) and tocopherol fractions (␣, ␥, ␦) was assessed. Results: Overall, 155 (67.4%) of 230 blood donors were positive for anti-T. gondii IgG antibodies and 24 (15.5%) of them were of low IgG avidity, which is high percentage compared to many countries. Univariate logistic regression analysis showed an association between T. gondii seropositivity and area of residence, blood type, older ages, level of education, history of immune weakness, contact with cats, professional contact with farm animals, agricultural activities, washing hands before meals, eating unwashed vegetables, drinking raw milk, eating cheese made from raw milk, eating luncheon or shawerma. In a multivariate logistic regression analysis, eating luncheon or shawerma (adjusted odds ratio [OR] 80.82 [95% CI 18.62350.81], P ⬍0.0001) and being non-educated (adjusted OR 32.25 [95% CI 7.46139.44], P ⬍0.0001) showed a strong significant association with T. gondii antibodies. T. gondii-seropositive blood donors had significantly (P ⬍ 0.001) higher MDA level paralleled with significant decrease in the level of GSH-Px (P ⬍0.0188) and tocopherol fractions (P ⬍ 0.001) compared with T. gondii negative blood donors. Conclusion: This study highlights that T. gondii is prevalent among healthy blood donors in northeastern Egypt, and that there is a need for T. gondii screening tests to be included in the blood donation scheme to insure safe blood transfusion.

S138 Annals of Emergency Medicine

317

Early Predictors of Mortality and Length of Stay in Emergency Department Nursing Home-Acquired Pneumonia

Robinson D, Medado P, Anderson S, Haque N, Zervos MJ, O’Neil BJ/William Beaumont Hospitals, Royal Oak, MI; Henry Ford Hospital, Detroit, MI

Background: Pneumonia is a leading cause of morbidity, hospitalization and mortality among older people living in nursing homes and a major reason for transfers to acute care facilities. There is currently little literature regarding early mortality predictors in ED nursing home patients admitted with pneumonia. Such predictors could have prognostic and therapeutic benefits. Study Objective: Define early predictors of mortality and LOS in nursing home patients admitted with pneumonia. Methods: We performed a retrospective chart review per Gilbert and Lowenstein guidelines on nursing home patients admitted with pneumonia at 2 large academic hospitals. ED visit data was analyzed for prediction of LOS and mortality. Categorical variables were examined using Pearson’s chi-square and Fisher’s exact test where appropriate. Continuous variables were analyzed using a Wilcoxon rank test and Spearman correlation. Step-down multiple logistic regression analyses were performed to determine the strongest predictors of a death. All analyses used SAS® version 9.1.3. Results: 303 patients with complete data were available for analysis. Patients who died had higher RR, glucose, BUN and creatinine levels; lower Glasgow Coma Scores and Hgb and more SOB symptoms, and had a greater incidence of mental status changes and intubations than those discharged alive. On stepdown multi-variable logistic regression, increased HR, Hct and BUN, decreased temperature and Hgb and presence of a mental status change were found to be the strongest predictors of death. See Table 1. Patients who were intubated and febrile had longer LOS, 19.57⫹/⫺16.8 v 9.31⫹/⫺6.6, p⬍0.0001 and 10.07⫹/⫺9.6 v 11.58⫹/⫺9, p ⬍ 0.012 respectively. As age increases, LOS decreases (Spearman Correlation Coefficient ⫺0.140, p⫽0.017); as RR and temp increase, LOS increases (Spearman Coeff.165 and .146, p⫽0.006 and 0.015 respectively). Conclusions: The best early ED predictors of in hospital mortality are decreased mental status and anemia. Elevated temperature and signs of dehydration were also predictive of in-hospital mortality. Hospital length of stay was related to age, fever, intubation and respiratory rate.

318

Tissue Oxygenation in Soft Tissue Infections

Capraro GA, Reiser M, Jasienowski S, Blank FS/Baystate Medical Center/Tufts U. School of Medicine, Springfield, MA; Baystate Medical Center, Springfield, MA

Study Objectives: To determine the oxygenation status of non-draining, untreated soft tissue infections presenting to the emergency department (ED). There have been few investigations of the oxygenation status of soft tissue infections, though this may be an important consideration in understanding the pathophysiology of such infections and guiding therapies. Methods: Prospective, convenience sample of patients suspected to have either cellulitis or abscess seeking care in a tertiary, urban ED. There were no cases of necrotizing fasciitis. Near infrared spectroscopy (NIRS) (InSpectra 325, Hutchinson Technologies, Hutchinson, MN)-determined tissue saturation of Oxygen (StO2) was measured at the center of the infected region and at the corresponding contra-lateral control site when available. The Wilcoxan matched pairs sign test was applied to test for a significant difference between infected sites and conta-lateral control sites, using Stata SE/10.0. Kruskal Wallis equality-of-populations rank tests were used for all other inferences. Results: 38 participants with infected regions and control sites available ranged in age from 7-82 years, mean 36.0 (16.9) with 39.5% female. 86.8% white or Hispanic, 42.1% smokers, 7.9% had diabetes, and 5.3% had peripheral vascular disease. Mean

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