79: Alcohol and Head Injury

ICEM 2008 Scientific Abstract Program require specialist consultation when compared to knife injuries and all sharp injuries (p⬍0.05). Wounds resulting from known knife injuries were more likely to involve the torso (p ⬍ 0.0001) requiring radiology (p⫽0.0002) and intercostal drain insertion (p⬍0.05). Weapon type did not significantly affect admission or operation rates. Conclusion: Patterns of wound distribution and severity can be correlated to weapon type used. Although penetrating knife wounds are more immediately severe in the emergency department, there is a quiet epidemic of significant injuries affecting the face and hands. These bottle-inflicted wounds, often multiple, to the face and hands resulted in more specialist consultations and the resulting injuries, particularly to the hand require very intensive follow-up and rehabilitation. This is a hidden cost to the health care system, and is compounded by the considerable consequences for the patient: physically, psychologically (particularly disfiguring lacerations to the face) and economically where extended specialist rehabilitation or long-term disability affects possible employment and requires financial support. Violence-related injuries are known to increase in the presence of alcohol consumption and opportune weapons such as beer bottles are shown here to cause economically and socially significant injuries. As South Africa prepares to host the FIFA World Cup in 2010 long-term preventative measures to decrease the injury and morbidity potential of convenient weapons must be considered should include consultation between health care providers and the brewing industry.

compared to MidAge of 4.7% and YOUNG of 3.9%, p⬍.01. Alcohol presence was reported in 9.2% OLD, 31% MidAge, and 37% YOUNG, p⬍.01. Table below reveals mortality with and without alcohol presence, along with ISS and LOS information. Conclusion: Alcohol presence in trauma patients decreases with age, but when present, is associated with increased ISS, LOS. For MidAge and OLD patients, alcohol presence is associated with increased mortality. It may be beneficial to evaluate patients alcohol consumption when initiating traumatic injury prevention interventions, especially for older patients.

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Alcohol and Head Injury

Johnston Sr JJ, McGovern Sr SJ/North Tyneside General Hospital, NewcastleUpon-Tyne, United Kingdom; Ulster Hospital Dundonald, Belfast, United Kingdom

Study Objective: To determine whether there is a significant difference in the pattern and severity of injury sustained during falls in patients who have consumed alcohol and those who have not. To determine how pattern and severity of injury correlates with blood alcohol level [BAL]. Method: A prospective quasi-randomised controlled study between November 2001 and July 2002. All healthy adults between 16 and 60 years who had fallen from standing height were included. A systematic history and examination allowed calculation of injury severity scores as per abbreviated injury scale update 1998. BALs were obtained from intoxicated patients with consent. Results: 351 healthy adult patients were included in the study, there were 238 in the no alcohol group,113 had consumed alcohol and blood alcohol levels were obtained for 47. The alcohol group had a higher incidence of head injuries{46(48%)v22(9%)) with a lower incidence of limb injuries {39(39%)v183(76%)} than the no alcohol group. There was a significant difference in the pattern of injury between the alcohol and no alcohol groups (X2, P⬍0.001) and there was a significant difference in the injury severity scores (P⬍0.001, Z ⫺2.5). In the alcohol group severity and pattern correlated with alcohol level at the time of injury. Patients with an alcohol level⬍200mg/dL had mostly soft tissue limb injuries (58%), 200-250 mostly significant limb fractures (55%) and ⬎250 mostly significant head injuries (90%). Conclusions: Alcohol-related falls are more often associated with severe craniofacial injury. The severity of both limb and head injury is greater and correlates directly with BAL.

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Effects of Alcohol on Outcomes in Middle Age and Older Adults Suffering Trauma

Irvin CB, Tucker C, Abuel V, Gray S/St. John Hospital and Medical Center, Detroit, MI

Background: Seniors suffering trauma have a worse prognosis than younger victims. Seniors may already be challenged (with slower response times, visual challenges, etc). and the compounding effect of alcohol may contribute to increased mortality. The effects of alcohol on outcome of seniors suffering trauma is unknown. Study Objective: To determine the proportion of elderly trauma victims with alcohol present, compared to younger victims, and evaluate if alcohol presence affects outcome. Methods: Using the NTDB (version 6.1), the following variables were extracted: Age (⬎ 64 (OLD), 40-64 (MidAge), and 18-39 (YOUNG), Injury Severity Score (ISS), Alcohol present, Length of Stay (LOS), Discharge status (alive vs dead), and ICU days. Cases with missing data were excluded. Results: Of the 404,559 cases evaluated, 16% were OLD, 35% were MidAge, and 50% were YOUNG. OLD were more likely to die with a mortality rate of 9.3%,

Volume , .  : April 

An Electronic Decision Support System for Asthma Management in Emergency Departments: A Sustainable Alternative for Evidence-Based Guideline Implementation

Kwok R, Dinh M, Chu M, Dinh D, Taylor B/Royal Prince Alfred Hospital, Newtown, Australia; Royal Prince Alfred Hospital, Sydney, Australia; Canterbury Hospital, Sydney, Australia; Os Technology, Sydney, Australia; St Thomas Hospital, London, United Kingdom

Study Objectives: To compare clinical documentation, discharge information and test ordering for emergency department patients with asthma before and after implementation of an integrated electronic decision support system (EDSS). Methods: Design: A post implementation cohort interface was compared with historical cohort. Setting: The emergency department of an Australian inner city metropolitan hospital with an annual census of 30,000 patients per year and an overall admission rate of 30%. Study participants: Consecutive patients 16 years and over presenting with acute asthma to the emergency department were enrolled over a six month period after EDSS implementation. Control cohort consisted patients with acute asthma identified over the previous 6 months prior to EDSS implementation. Intervention: Patients enrolled during post implementation period were assessed and managed with the aid of an online integrated and dynamic EDSS for asthma management in emergency departments. Clinical documentation, decision supports, order entry and discharge documentation were integrated into a single seamless interface. Decision supports were based on current National Asthma Council of Australia guidelines. Outcomes: Primary outcome was quality of clinical documentation measured by presence or absence of specific variables in medical records. This was based on reviews of asthma management guidelines which included documentation of asthma severity and provision of asthma management plan. Secondary outcome was admission rate, representation rate and test ordering. Data Collection and Analysis: Systematic data abstraction was performed on all records using trained independent reviewers. Study groups were stratified according to patient age, sex and treating doctor seniority. Categorical variables were compared using Chi square test and continuous variables compared using Mann Whitney U tests. Based on previous pilot studies, an overall improvement in primary outcome from 50% to 80% after EDSS implementation was predicted. Assuming power of 90% and alpha value of 0.05, a balanced sample of 100 participants was required. Ethics: Human research ethics committee approval was obtained prior to commencement of the study. Results: Post EDSS implementation group was associated with higher rates of documentation in 7 out of the 10 outcomes compared to control group. This included documentation of asthma severity (100% vs 22% p⬍0.001). Based on preliminary results, patients in post implementation group had higher rates of asthma management plan provision (11% vs 38% p⬍0.001), corticosteroid prescription and lower rates of test ordering. Conclusion: In this observational study, preliminary results show that implementation of EDSS at a single emergency department was associated with

Annals of Emergency Medicine 495