ABSTRACTS
sential to use a valid scale that requires no extra tasks beyond stabilization and transport. A s"oiirrg-system'suited for'pi._ *as sgucf using a microcompute, to deuelop'rni l:-T:::'-^t:l: p_r_"f ve,srmplii:f ications. Data elemenrs were uniform Iy ::lltl andig.rr graoed lrmited to objectifiableobservationsroutinely -ade ai trauma scenes;impossible or redundantelement varue combinatlonswererdentifredand excluded.This processproduced a scale,
nearlv.identical {JSJ, to;;;;;;;s l.l,:J':^trywrrn perrormancecompa_rahle
oi uit"r silnr,
to the CTS. BecauseJS contiins only 4 routinely assessiddata elements tr..pri*ory rate, blood pressure,pulse, and neurological),it represents a significant im_ in ppli cability f or prehospital scoring.'High_degree l::l:T::_, -a corretatronbetween the 2 systems was confirmedby impritergeneratedcomparisonso^feachof the 1g,000p.".rbl" bia-J;;; combinationswith its JS counteroart.
trent questronnairewas administered.Of the 54 patients studied, I ll7%),(GroupA), deniedhaving receiveJ *riri.n insrrucions aesprtedocumentation to the contrary in the medical record.Of y.,.r,.,"::, 6,167v")received "o t o-e oUr.rultio" and only I Lh,::: lrrTo/ could recall even I of the g items enumeratedin the mana€ementplan. Of the remaining patients, 17 (GroupB),had the instructions.given directly"to ,t. p.r*"ii"l3l%) be convevedbv rne parrentto the individual responsiblefor the observation.rn 159"/o) received .,o-obseiuatio",' *f,if . 4 di;i :*3r"^tof ]9 i ;;_ cerveoobservatronin concert with the instructions; none, how_ ever,could recall more than 3 of the managemeit rtems. In the remaining 2l cases{39%)]Group C),_the initructions were grven directly to the individr"i ,-.rpL.,.iii. l.i p-"iir"s th;f"_; management.Of these, 167%)were observedas reqiriredin the lBmanagementplan. In addition, g i3g%)recalled 4 or more man_ agement items at follow-up. Of the 54 casesstudied, ;;; ;;_ plication occurredduring h'ome -obr"rurti*, r.qriiring admission to the hospital for intracianial bleeding ""J fr..ii-p"r.us. We con_ clude that home observationoi patien-t,a*.fr"#a from the ED following closed-head infury may b; ;;;il;%, particularly when the after-caremanagementinstructions are not given di_ rectly to the individual reslonsible f". p;;;"d];;;ire observation.
","351i?,-" ", LOg iTi.iffi'.;',iJ:H::;:l
B. Eisner,D Howes,T TurnbuilI fmerge;t M;diJne Residency, Universityof liltnois,Chicago; lrtercyFospltai liJ weoicat Center, Chicago . In many institutions it is the standardof care to obtain serum chemistriesas well as serum anticonvulsantlevels part of the as '.ifi"*y ED evaluation.of seizure patients. To determine tfr" "i such a.workup in the ED,.67 seizure ;;il;;-;r.r"nting to an y_l.j,.hing,hospital were studteJ-i" " riandardi,Ja, :::^.:;:l mann€r.AII patients n-: specuve studied had historical and physical examination data obtained, and serum CnC, eiettroly,;, iUN; ql"cose, calcium, magnesium,dilantin, and'phenobarl illiltlll.: perform".d.a"y patienr presentingwith l) ,1::1.::,:.1Tl"atrons nrsr-nme serzure{more than.6 years of age);2} recent h"istory oi significant head trauma; 3) focal .r""rot8ji" i.ii"rt, or 4) focal nature of seizure activiiy underwent CT "scanning of the head. Beforereceiving laboratoiy.r.."tt,,"a "ft.r'"tn"i"i"S historical and physical eximination'd.at", ir,. i'*"riiiriJii .riorogies were
rr,-!" l':::11n.t.',+ed,probability' oecame. avarlabte, the 5 most
eii.r'iir? r"uor".orya"t,
likely etiologies again were listed p€rcentagesof likelihood. CT"scanZf the head was 11,{lssiEea on 4 patients 15.97%1. There were no significant abnor_ l-.1191-.9 rnalues ln serum chemistries noted; there were no seizuresdue nfjmadfl to derangementsin serum.ch.-i.,ry-"oi -"s there any ellect of lab results on diagnosisor dispositioril ioi serum ailantin ,or phenobarbitallevelJ were the piesumeJ'."*., of seizures
alcoholirittJi"*"iin 146.ss%li ll, ifutr,.'.,lls reDrrleselzuresin. patients tzL.rr-/ol;
ls patients
4 15.64%lispace_oicupying lesion in 2 pa-tientsl2.BZ%),and.CVA i" Z pjlt.i,t, (2.82,i"i-i; more than 9O"/ooI patients in this study, ,frJ airg"ori, and dis_ position could have beenpredicted basedon hrst ana plysical examrnation alone. Identifying high_yield it.ms t'., hi.i*y-;;; physical examination -rv heli air"eci Uforatoiy t"rtirrg by identifying those patients ,, ii.t 16rit ";; ;;;;ilimalities, thus obviatingthe need for a standardseizure ;;.h;;; the ED.
T":il, I ! O ;itn:'"?:-i,if&;'itff::f
CE Saunders,CA Barton.n cota lbiviiio, JEilJ,gLn.y Services,Universityof ColoradoH"ilin S"""n."-r'6Jnt"r, Medical o"nu",. Victims of mild closed-headiniury who_do not require hospifrequently are observeda, io-. ly , ,"ro"".iUle fami_ l-lli1"rro," ly member or other individual guided by a'set oi'written after_ carernstructions. The efficacy ofhome observation for such cases and the extent to which afier_c"..;;;;;;;;ii pr".r, are executed.inthis setting are unknown. To aniwer these issues,we studied_54 .otts.crrti,. victims oJ mild-closed_t.li irr;,rry aircharged.from the ED for home "Ur.*"ri"" ""a.iih. responsibleindividual who had written "f-_"*"1""*ctions "r." of " for managementthat were reinforced verbally bV the EO staff. Fol_ tow-up was performed within 24 hours by t.t"ptio"., and a pa-
4l
| 11
Ifl.J"Ty
Grireria forEmersency
M.LMills / Departmentof EmergencyMedicine, UniversityHospital of Jacksonville, Jacksonville, Fiorida of this study is to establishhigh_yieldcriteria ,-Il:r LJ putPore ror emerqencvcranial CT. scansin patienti *ho present ln to the ED with aiute neurological disordcr's.i-hi.-i, "r, on_go,.rg, prospective, clinical study. Anticipated Hyc were pubrishe? an'd distributed by,the Depari-"nt oi f-.rg.*y'MJdi.i.,. and the ueparrment ot Neurology to all emergency medicine residents and {aculty.At rhe time 6i each.-.r;;;;t;;r,,-1"t, ,t ".t. .on_ taining detailed clinical findings *.i. "o-pi.i.J-U -data, ,fr" pf,V.i_ cian ordering_the scan. These Ao"g ;itil tlre final inter_ pretation of the CT scan by a neuroiadiologist, were enteredinto a data base_management system (dBASi [t?-'""rivri. and inter_ pretation. Resultswere then correlated*iit tt. pi,iposedcriteria to determine expectedyield for "r"t ".it.ilo". ir.il-r""iv from the first 200 cases,eveal tfrrt "UL"i-Sb%'oi!_".g.rr.y ari" pr_ tients requiring_anemergencyscan fell i"to -"..o"" ^rrrir_"ri""a, of o major areas. Some findings from the preliminary a"t, Presenting Complaints Trauma AlteredMS Seizures Hemiparesis Headache Coma Other
Acute AbnormalCT
CT Scans Indications Urgent Intervention
217" Trauma 197" AlteredMS '17% Seizures
41"/" frauma 24% AlteredMS 38% Seizures
11% l-leadache 9% Coma 11% Other
'13%
'127. Hemiparesis
42% Hemrparesis
Headache 47"/" Coma 27o/o Othel
27"/. 8% 187. 2a;i 9"/"
Nineteen percent of all scans indicated the need for urgent rntervention. This study elucidatesthe clinical conditions iirrt.orr.late with HYC in each category,as well as the overall indications for urgent cranial CT scans.
Sutured Wounds in an Urban I a q, Emergency Depadment .) ! D Smirh,M Vortiere,R Sn".s"r,jNaradzay, ItS_Sm/rh, p.Dundas,T Turbiak, R Rosenthat R Au;; F ririn!)-bupartment -u Jr/edicine, The Georgewasninston niversity :j^ll"^ln:::y Mreorcat uenter,Washington, DC largeserialstudiesof woundsand their complications , -Y-or, have examinedinfections in surgicalwounds.No generally