- Email: [email protected]
Simple rule for calculating normal erythrocyte sedimentation rate
ABSTRACTS
a large metropolitan teaching hospital. Of 1,140 patients dedared "medically clear" in the emergency department prior to referral to the PES, 38 were later found to have OBS. The authors discovered these 38 patients using four screening criteria associated with OBS: 1) disorientation, 2) clouding of consciousness, 3) older than 40 years with no previous psychiatric history, or 4) abnormal vital signs. Among patients meeting at least one of these criteria, only one of 39 patients did not have OBS. The investigators conclude that these screening criteria are valid and useful in differentiating OBS from functional psychosis. [Editor's note: There is no substitute for a thorough formal mental status examination in the evaluation of all "psych" patients presenting to an ED. The burden of proof is on the emergency physician to rule out organicity prior to psychiatric referral.] Michael H. Forman, MD
ESR, NORMALVALUES, CALCULATING OF
Simple rule for calculating normal erythrocyte sedimentation rate Miller A, Green M, Robinson D Br Med J 286:66 Jan 1983
Measurement of the serum ESR is a frequently performed laboratory test, but considerable confusion as to normal values continues to exist. The authors measured the ESR by the Westergren method in 27,912 adults (26,836 men and 1,076 non-pregnant women) between the ages of 20 and 65 years and plotted the 98 percentile curve for ESR against age. The results showed that the upper limit of normal for this laboratory parameter is age dependent, and further that the 98% curve can be approximated by the following formulae: for men, upper limit of normal for ESR = age in years divided in two; for women, upper limit of normal for ESR = age in years plus ten divided by two. The authors demonstrate these formulae to be both accurate for age over 20 years and easy to remember. [Editor's note: Serum ESR can be a helpful "'negative" El) test, ie, if normal, it helps to rule out many serious disease states.] Ron M. Walls, MD
CAMPYLOBACTER ENTERITIS, PEDIATRIC
Age.specific presentation of Campylobacter enteritis in children Naqvi SH, Dunkle LM, Clapper MA Clin Pediatr 22:98-i00 Feb 1983
Campylobacter fetus is a frequent cause of diarrheal illness in children. Twenty-seven patients ranging in age from three weeks to 15 years were reviewed to define the presen82/459
tation and severity of this disease. Twenty-five patients presented with diarrhea, and two with severe abdominal pain. Fourteen of the diarrhea patients had blood in their stool. Age-specific findings were as follows: one of six infants under six months of age had fever over 38.3 C, while 12 of 21 older children had fever over 38.3 C and n i n e of these reached 38.9 C. Three of four infants under three months of age had prominent abdominal distension with dilation and ileus on roentgenography. Four of six infants under six months of age required hospitalization for dehydration, while none of the older children was dehydrated. All three neonates under one month of age had an absolute monocytosis with counts over 1,092/mm 3, while all the 13 older children who had blood counts had monocyte counts under 900/mm 3. Fever is unusual in children under six months of age. Fever and abdominal pain may be prominent in children over 12 years. Absolute monocytosis on CBC in the absence of granulocytopenia in neonates and the marked abdominal distension in small infants may be helpful in the clinical diagnosis of Campylobacter enteritis in this age group. Campylobacter enteritis caused diarrhea for 7 to 12 days in untreated patients. Erythromycin is known to eradicate Campylobacter from the stools, but has not been proven to shorten the clinical course. Ron M. Walls, MD
ANTIBIOTICS, SIMPLE LACERATIONS; LACERATIONS, ANTIBIOTICS
The value of prophylactic antibiotics for simple lacerations Thirlby RC, Blair JA Ill, Thai ER Surg Gynecol Obstet 156:212-216 Feb 1983
Four hundred ninety-nine patients with minor lacerations were prospectively randomized into two treatment groups. In the first group adults were given cephalexin, 250 mg orally four times a day for three days and children were given 25 mg/kg/day in four divided doses for three days, while the second group served as controls and received no antibiotics. Patients excluded from the study were those with lacerations occurring more than eight hours prior to treatment, those with human or animal bites, those with diabetes, those taking steroids or receiving chemotherapy, those allergic to cephalosporins, those with lesions within the mouth, and those with lacerations requiring wound closure in the operating room. Local wound care was standardized using iodinated cleaning solution, sharp debridement when indicated, and normal saline irrigation after anesthesia with plain lidocaine. Wounds were evaluated at the time of suture removal or earlier if they returned for infection. The overall infection rate was 6.6% and no statistical difference was seen between the two groups. The incidence of infection was highest in contaminated wounds and wounds in the extremities regardless of whether antibiotics were used. A statistically significant increase in the infection rate was
Annals of Emergency Medicine
12:7 July 1983
a large metropolitan teaching hospital. Of 1,140 patients dedared "medically clear" in the emergency department prior to referral to the PES, 38 were later found to have OBS. The authors discovered these 38 patients using four screening criteria associated with OBS: 1) disorientation, 2) clouding of consciousness, 3) older than 40 years with no previous psychiatric history, or 4) abnormal vital signs. Among patients meeting at least one of these criteria, only one of 39 patients did not have OBS. The investigators conclude that these screening criteria are valid and useful in differentiating OBS from functional psychosis. [Editor's note: There is no substitute for a thorough formal mental status examination in the evaluation of all "psych" patients presenting to an ED. The burden of proof is on the emergency physician to rule out organicity prior to psychiatric referral.] Michael H. Forman, MD
ESR, NORMALVALUES, CALCULATING OF
Simple rule for calculating normal erythrocyte sedimentation rate Miller A, Green M, Robinson D Br Med J 286:66 Jan 1983
Measurement of the serum ESR is a frequently performed laboratory test, but considerable confusion as to normal values continues to exist. The authors measured the ESR by the Westergren method in 27,912 adults (26,836 men and 1,076 non-pregnant women) between the ages of 20 and 65 years and plotted the 98 percentile curve for ESR against age. The results showed that the upper limit of normal for this laboratory parameter is age dependent, and further that the 98% curve can be approximated by the following formulae: for men, upper limit of normal for ESR = age in years divided in two; for women, upper limit of normal for ESR = age in years plus ten divided by two. The authors demonstrate these formulae to be both accurate for age over 20 years and easy to remember. [Editor's note: Serum ESR can be a helpful "'negative" El) test, ie, if normal, it helps to rule out many serious disease states.] Ron M. Walls, MD
CAMPYLOBACTER ENTERITIS, PEDIATRIC
Age.specific presentation of Campylobacter enteritis in children Naqvi SH, Dunkle LM, Clapper MA Clin Pediatr 22:98-i00 Feb 1983
Campylobacter fetus is a frequent cause of diarrheal illness in children. Twenty-seven patients ranging in age from three weeks to 15 years were reviewed to define the presen82/459
tation and severity of this disease. Twenty-five patients presented with diarrhea, and two with severe abdominal pain. Fourteen of the diarrhea patients had blood in their stool. Age-specific findings were as follows: one of six infants under six months of age had fever over 38.3 C, while 12 of 21 older children had fever over 38.3 C and n i n e of these reached 38.9 C. Three of four infants under three months of age had prominent abdominal distension with dilation and ileus on roentgenography. Four of six infants under six months of age required hospitalization for dehydration, while none of the older children was dehydrated. All three neonates under one month of age had an absolute monocytosis with counts over 1,092/mm 3, while all the 13 older children who had blood counts had monocyte counts under 900/mm 3. Fever is unusual in children under six months of age. Fever and abdominal pain may be prominent in children over 12 years. Absolute monocytosis on CBC in the absence of granulocytopenia in neonates and the marked abdominal distension in small infants may be helpful in the clinical diagnosis of Campylobacter enteritis in this age group. Campylobacter enteritis caused diarrhea for 7 to 12 days in untreated patients. Erythromycin is known to eradicate Campylobacter from the stools, but has not been proven to shorten the clinical course. Ron M. Walls, MD
ANTIBIOTICS, SIMPLE LACERATIONS; LACERATIONS, ANTIBIOTICS
The value of prophylactic antibiotics for simple lacerations Thirlby RC, Blair JA Ill, Thai ER Surg Gynecol Obstet 156:212-216 Feb 1983
Four hundred ninety-nine patients with minor lacerations were prospectively randomized into two treatment groups. In the first group adults were given cephalexin, 250 mg orally four times a day for three days and children were given 25 mg/kg/day in four divided doses for three days, while the second group served as controls and received no antibiotics. Patients excluded from the study were those with lacerations occurring more than eight hours prior to treatment, those with human or animal bites, those with diabetes, those taking steroids or receiving chemotherapy, those allergic to cephalosporins, those with lesions within the mouth, and those with lacerations requiring wound closure in the operating room. Local wound care was standardized using iodinated cleaning solution, sharp debridement when indicated, and normal saline irrigation after anesthesia with plain lidocaine. Wounds were evaluated at the time of suture removal or earlier if they returned for infection. The overall infection rate was 6.6% and no statistical difference was seen between the two groups. The incidence of infection was highest in contaminated wounds and wounds in the extremities regardless of whether antibiotics were used. A statistically significant increase in the infection rate was
Annals of Emergency Medicine
12:7 July 1983