Prehospital dispatch assessment of stroke.

This study is to determine the assessment accuracy for the diagnosis of stroke by EMS dispatchers and paramedics compared to emergency physicians (EPs). Of the 191 patients who met inclusion criteria, dispatchers assessed 133 as having a stroke; EPs agreed in 67 (50%) cases. Paramedics assessed 100 patients as having stroke; EPs agreed in 70 (70%) cases. Dispatcher and paramedic sensitivity for diagnosing stroke was 61% and 64%, respectively; specificity was 20% and 63% respectively. Sensitivity for the detection of acute stroke was nearly identical between EMS dispatchers and on-scene paramedics; overall agreement with emergency physician diagnosis was moderate.

Cervical infections in emergency department patients with vaginal bleeding.

UNLABELLED: To the best of the authors' knowledge, no previous study has compared the prevalences of Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (NG) cervical infection among pregnant and non-pregnant patients presenting to the emergency department (ED) with vaginal bleeding. OBJECTIVES: To determine the prevalence of these infections in a simultaneously assembled cohort, and to determine whether pregnancy is associated with altered rates of CT or NG cervical infection among patients with vaginal bleeding. METHODS: This was a prospective, seven-month, cross-sectional study of a convenience sample of patients (aged > or = 15 years) who presented to an urban, teaching ED with the chief complaint of vaginal bleeding. A urine pregnancy test was administered to each patient. Cervical swab specimens were analyzed for CT or NG via polymerase chain reaction technology (DNA probe). The hospital laboratory's baseline 18% rate of positive tests was used for sample size planning. Chisquare analysis and Fisher's exact test, where appropriate, were used to compare pregnant and non-pregnant patient groups. RESULTS: Cervical infection rates did not differ between pregnant and non-pregnant patients. Testing for CT showed that 13 of 114 (11%) of the pregnant patients were positive, while 11 of 147 (8%) non-pregnant patients tested positive (chi(2) = 0.759, p = 0.384). Testing for NG revealed that seven of 114 (6%) pregnant patients tested positive, while 16 of 147 (11%) non-pregnant patients tested positive (chi(2) = 1.256, p = 0.262). Combined testing showed that 18 of 114 (16%) of the pregnant patients and 25 of 147 (17%) of the non-pregnant patients harbored a cervical infection with one or both pathogens (chi(2) = 0.009, p = 0.925). CONCLUSIONS: The prevalence of CT or NG cervical infection in pregnant patients presenting to the ED with vaginal bleeding is 16%. Pregnant and non-pregnant patients with vaginal bleeding are at similar risks for having CT or NG cervical infection. Cervical swab specimens should be obtained in all patients with vaginal bleeding.

Does payment improve follow-up of pelvic inflammatory disease?

In order to determine whether a monetary incentive would increase clinic follow-up rates in patients treated for pelvic inflammatory disease (PID) in the emergency department (ED), a randomized, prospective study was undertaken. Comparison was made between groups offered $5.00 plus transportation costs and groups offered transportation costs only. Follow-up rates were low in the experimental and control groups, and not statistically different. We conclude that a $5.00 incentive does not increase follow-up rates after ED treatment of PID.

Can elbow extension be used as a test of clinically significant injury?

BACKGROUND: The objective of this study was to evaluate whether a simple test of full elbow extension was a reliable indicator of bone/joint injury at the elbow joint. METHODS: In this prospective study, patients with acute elbow injuries were asked to fully extend the injured elbow. Radiologists blinded to the results of the extension test interpreted the radiographs. RESULTS: Of 114 patients with acute elbow injury entered into the study, 110 underwent adiographic evaluation. Inability to extend the elbow was found in 37 of 38 patients with bone injury. Only 1 of 54 patients who were able to fully extend the elbow was found to have bone/joint injury. The sensitivity and specificity of the elbow-extension test for identification of bone/joint injury was 97% and 69%, respectively. CONCLUSIONS: The elbow-extension test can be used as a sensitive clinical screening test for patients with acute elbow injuries.

EMS medical coverage at PGA tour events.

OBJECTIVE: To analyze the availability and level of medical services for fans at Professional Golfer Association (PGA) Tour events. METHODS: A questionnaire, written in cooperation with PGA Tour headquarters, was sent to the tournament director of each PGA Tour event that hosted same-site events in 1998 and 1999. The survey addressed five areas of fan medical services: 1) health care provider availability; 2) advanced cardiac life support (ACLS) capabilities, including equipment; 3) presence of on-site ambulance(s); 4) fan fatalities; and 5) alcohol consumption limitations. RESULTS: Survey response was 92% (36/39). Health care providers were on site at all PGA Tour events: physicians (97%), emergency medical technicians [EMTs (78%)], nurses (75%), and paramedics (64%). A combination of health care providers was used at 94% of PGA Tour events. Ninety-seven percent of PGA Tour events had at least one ACLS-certified provider present along with ACLS equipment. Ambulances were on site at 89% of PGA Tour events and a hospital was located within 5-10 miles at 92% of events. Three of the PGA Tour events reported having one fan fatality through the 1998 and 1999 seasons. Seventy-eight percent of the PGA Tour events imposed regulations to limit alcohol consumption and sales. Methods included: restricted sale locations (56%); limits on alcohol sale (50%); advertisement for responsible alcohol consumption (33%); crowd conduct (28%). CONCLUSIONS: All PGA Tour events provided medical services for fans and 97% had ACLS capabilities. To promote fan safety and viewing etiquette, responsible alcohol consumption was a recognized priority at 78% of PGA Tour events.