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1.
Ozgur Tatli Nur Banu Keha Kurt Yunus Karaca Aynur Sahin Ali Aygün Elif Sahin Burak Katipoglu Umut Eryigit Suha Turkmen 《The American journal of emergency medicine》2017,35(3):425-428
Purpose
To investigate the difference in pentraxin 3 (PTX 3) levels between patients with pulmonary contusion and healthy volunteers.Materials and methods
This study was conducted with a group of 20 trauma patients diagnosed with pulmonary contusion and 30 healthy individuals enrolled as a control group in a tertiary university hospital.Results
Median PTX 3 levels were 7.05 (3.29–13.1), ng/ml in the contusion group and 1.03 (0.7–1.58) ng/ml in the control group. PTX 3 titers were significantly higher in patients with pulmonary contusion compared to those of the control group (p < 0.001). An area under the curve (AUC) value of 0.968 investigated using ROC analysis to determine the diagnostic value of the PTX-3 in pulmonary contusion patients was measured. A PTX-3 cut-off value of 2.06 produced 95.5% sensitivity and 86.7% specificity.Conclusion
PTX 3 levels in pulmonary contusion increased significantly compared to the healthy control group. If supported by wider series, PTX 3 may be expected to be capable of use as a marker in pulmonary contusion. 相似文献2.
Mauro Giordano Tiziana Ciarambino Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Luca Rinaldi Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(5):749-752
Study objective
We investigated seasonal prevalence of hyponatremia in the emergency department (ED).Design
A cross-sectional study using clinical chart review.Setting
University Hospital ED, with approximately 28 000 patient visits a year.Type of participants
We reviewed 15 049 patients, subdivided in 2 groups: the adult group consisting of 9822 patients aged between 18 and 64 years old and the elderly group consisting of 5227 patients aged over 65 years presenting to the ED between January 1st, 2014 and December 31st, 2015.Intervention
Emergency patients were evaluated for the presence of hyponatremia by clinical chart review.Measurements and main results
Hyponatremia was defined as a serum sodium level < 135 mmol/l. Mean monthly prevalence of hyponatremia was of 3.74 ± 0.5% in the adult group and it was significantly increased to 10.3 ± 0.7% in the elderly group (p < 0.05 vs adults). During the summer, hyponatremia prevalence was of 4.14 ± 0.2% in adult and markedly increased to 12.52 ± 0.7% (zenith) in elderly patients (p < 0.01 vs adult group; p < 0.05 vs other seasons in elderly group). In the elderly group, we reported a significant correlation between weather temperature and hyponatremia prevalence (r: 0.491; p < 0.05).Conclusion
We observed a major influence of climate on the prevalence of hyponatremia in the elderly in the ED. Decline in renal function, salt loss, reduced salt intake and increased water ingestion could all contribute to developing hyponatremia in elderly patients during the summer. These data could be useful for emergency physicians to prevent hot weather-induced hyponatremia in the elderly. 相似文献3.
Matthew J. Binks Rhys S. Holyoak Thomas M. Melhuish Ruan Vlok Elyse Bond Leigh D. White 《The American journal of emergency medicine》2017,35(10):1542-1546
Background
Hypoxemia increases the risk of intubation markedly. Such concerns are multiplied in the emergency department (ED) and during retrieval where patients may be unstable, preparation or preoxygenation time limited and the environment uncontrolled. Apneic oxygenation is a promising means of preventing hypoxemia in this setting.Aim
To test the hypothesis that apnoeic oxygenation reduces the incidence of hypoxemia during endotracheal intubation in the ED and during retrieval.Methods
We undertook a systematic review of six databases for all relevant studies published up to November 2016. Included studies evaluated apneic oxygenation during intubation in the ED and during retrieval. There were no exemptions based on study design. All studies were assessed for level of evidence and risk of bias. The Review Manager 5.3 software was used to perform meta-analysis of the pooled data.Results
Six trials and a total 1822 cases were included for analysis. The study found a significant reduction in the incidence of desaturation (RR = 0.76, p = 0.002) and critical desaturation (RR = 0.51, p = 0.01) when apneic oxygenation was implemented. There was also a significant improvement in first pass intubation success rate (RR = 1.09, p = 0.004).Conclusion
Apneic oxygenation may reduce patient hypoxemia during intubation performed in the ED and during retrieval. It also improves intubation first-pass success rate in this setting. 相似文献4.
Venkatesh R. Bellamkonda Thomas C. Wright Christine M. Lohse Virginia R. Keaveny Eric C. Funk Michael D. Olson Torrey A. Laack 《The American journal of emergency medicine》2017,35(5):769-772
Objective
A wide variety of spinal needles are used in clinical practice. Little is currently known regarding the impact of needle length, gauge, and tip type on the needle's ability to measure spinal canal opening pressure. This study aimed to investigate the relationship between these factors and the opening-pressure measurement or time to obtain an opening pressure.Methods
Thirteen distinct spinal needles, chosen to isolate the effects of length, gauge, and needle-point type, were prospectively tested on a lumbar puncture simulator. The key outcomes were the opening-pressure measurement and the time required to obtain that measure. Pressures were recorded at 10-s intervals until 3 consecutive, identical readings were observed.Results
Time to measure opening pressure increased with increasing spinal needle length, increasing gauge, and the Quincke-type (cutting) point (P < 0.001 for all). The time to measurement ranged from 30 s to 530 s, yet all needle types were able to obtain a consistent opening pressure measure.Conclusion
Although opening pressure estimates are unlikely to vary markedly by needle type, the time required to obtain the measurement increased with increasing needle length and gauge and with Quincke-type needles. 相似文献5.
Sarah D. Meskill Paula A. Revell Lakshmi Chandramohan Andrea T. Cruz 《The American journal of emergency medicine》2017,35(3):495-498
Background
Respiratory syncytial virus (RSV) and influenza have varying degree of seasonal overlap.Objective
To determine the prevalence of co-infection of RSV and influenza compared to the prevalence of those infections independently when both are in season.Methods
This was a retrospective cross-sectional study of children evaluated between July 2010 and June 2013 for viral respiratory infection using multiplex PCR. Seasonality was defined retrospectively as weeks when > 2% of the total annual positive tests were obtained and was calculated for influenza A, influenza B, and RSV independently. Periods of overlapping seasonality of RSV and influenza A and RSV and influenza B were identified. The expected incidences of co-infection were modeled as the product of the incidences of the individual viruses.Results
13,664 specimens were sent for PCR during the study period. Over all 3 seasons, RSV overlapped with influenza A and B for 22 and 18 weeks, respectively; in 2011–12, RSV overlapped with neither influenza A nor B. Based on modeling, there were 6–7 fold fewer cases of RSV/influenza co-infection observed than expected: RSV/influenza A 77 vs. 12, (p ≤ 0.001; RSV/influenza B 76 vs. 11 (p ≤ 0.001).Conclusions
The observed incidence of co-infectivity of RSV and influenza was significantly less than the expected incidence even when both were co-circulating. In light of these data, it may be reasonable to forgo rapid influenza testing or empiric antiviral treatment for children whom rapid RSV testing is positive and who are at low risk of influenza-related complications, especially in times of antiviral therapy shortages. 相似文献6.
Yuji Shono Tomohiko Akahoshi Satomi Mezuki Kenta Momii Noriyuki Kaku Jun Maki Kentaro Tokuda Tetsuro Ago Takanari Kitazono Yoshihiko Maehara 《The American journal of emergency medicine》2017,35(12):1836-1838
Background and purpose
Accurate diagnosis of acute aortic dissection (AAD) is sometimes difficult because of accompanying central nervous system (CNS) symptoms. The purpose of this study was to investigate the clinical characteristics of Type A AAD (TAAAD) with CNS symptoms.Methods
We retrospectively reviewed the medical records of 8403 patients ambulanced to our emergency and critical care center between April 2009 and May 2014.Results
We identified 59 TAAAD patients for the analysis (mean age, 67.3 ± 10.5 years; 37 (62.0%) male). Eleven patients (18.6%) presented CNS symptoms at the onset of TAAAD, and these patients complained less frequently of typical chest and back pain than those without CNS symptoms (p < 0.0001). Initial systolic and diastolic blood pressure were lower (p = 0.003, and p = 0.049, respectively) and involvement of the supra-aortic artery was more frequent in patients with CNS symptoms (p < 0.0001).Conclusion
Because CNS symptom can mask chest and back pain caused by TAAAD, physicians should always consider the possibility of TAAAD in patients with CNS symptoms in emergency medicine settings. 相似文献7.
Payman Moharamzadeh Seyedhossein Ojaghihaghighi Mohsen Amjadi Farzad Rahmani Arezoo Farjamnia 《The American journal of emergency medicine》2017,35(12):1922-1925
Objective
Local forms of the tranexamic acid have been effective in treating many haemorrhagic cases. So that the aim of the current study is to assess the effectiveness of local tranexamic acid in controlling painless hematuria in patients referred to the emergency department.Methods
This is a randomized, double-blind clinical trial study, which was conducted on 50 patients with complaints of painless lower urinary tract bleeding during June 2014 and August 2015. The patients were randomly divided into two groups of 25 people each, one group receiving tranexamic acid and the other given a placebo. During bladder irrigation, local tranexamic acid and the placebo were injected into the bladder via Foley catheter. Patients were examined over 24 h in terms of the amount of normal saline serum used for irrigation, level of hemoglobin, and blood in urine.Results
In this study it was observed that consumption of tranexamic acid significantly decreased the volume of used serum for bladder irrigation (P = 0.041) and the microscopic status of urine decreased significantly in terms of the hematuria after 24 h (P = 0.026). However, the rate of packed cell transfusion and drop in hemoglobin levels showed no significant difference in both groups of patients (P ? 0.05).Conclusion
The results of this study showed that tranexamic acid could significantly reduce the volume of required serum for bladder irrigation to clear urine, but it had no significant effect on the drop in serum hemoglobin levels. 相似文献8.
Nooraldeen Al-Dury Araz Rawshani Johan Israelsson Anneli Strömsöe Solveig Aune Jens Agerström Thomas Karlsson Annica Ravn-Fischer Johan Herlitz 《The American journal of emergency medicine》2017,35(12):1839-1844
Aim
To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age.Methods
Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18–49 years), middle-aged (50–64 years) and older (65 years and above). Comparisons between men and women were age adjusted.Results
The mean age was 72.7 years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30 days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors.Conclusion
When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30 days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors. 相似文献9.
James R. Miner Brian E. Driver Johanna C. Moore Erik Faegerstrom Lauren Klein Matthew Prekker Jon B. Cole 《The American journal of emergency medicine》2017,35(10):1451-1456
Study objective
To compare the frequency of airway and respiratory adverse events leading to an intervention between moderate sedation using alfentanil or propofol.Methods
We performed a randomized clinical trial in which adults undergoing moderate sedation in the ED received either alfentanil or propofol. Our primary outcome was the frequency of airway and respiratory adverse events leading to an intervention. Other outcomes included sedation depth, efficacy, sedation time, patient satisfaction, pain, and satisfaction.Results
108 subjects completed the trial: 52 receiving alfentanil and 56 receiving propofol. Airway or respiratory adverse events leading to an intervention were similar between the two groups: 23% for alfentanil and 20% for propofol (p = 0.657). There were no serious adverse events in any group. Secondary outcomes were notably different in the rate of reported pain (48% for alfentanil, 13% for propofol) and recall (75% for alfentanil, 23% for propofol) and similar in the rate of satisfaction with the procedure (87% for alfentanil, 84% for propofol).Conclusion
We found a similar frequency of airway and respiratory adverse events leading to intervention between alfentanil and propofol used for moderate procedural sedation. Both agents appear safe for moderate procedural sedation. 相似文献10.
Matthew E. Rossheim Caroline J. Stephenson 《The American journal of emergency medicine》2017,35(10):1503-1505
Background
Few studies have examined injuries resulting from practicing parkour. The current study provides details on more parkour-related emergency department visits than existed in the combined research literature.Methods
Cross-sectional data from the U.S. Consumer Product Safety Commission‘s National Electronic Injury Surveillance System were used to examine parkour-related injuries presenting to U.S. emergency departments over a seven year period.Results
Most parkour injuries were reportedly caused by landing or from striking objects. Common diagnoses included fractures, sprains/strains, abrasions/contusions, and lacerations. More than half of reported injuries (57.7%) affected the patients' extremities. In this data, there appears to be a trend of increasing parkour injuries over time. Patients as young as 8 years old have presented to emergency departments with parkour-related injuries in recent years.Conclusions
Given the relatively severe injuries obtained by youth participants, more research is needed to guide injury prevention efforts. Understanding the nature of parkour-related injuries may help inform prevention efforts. However, more systematic monitoring of participation in parkour and related injuries is needed. 相似文献11.
Timothy E. Brenkert Cynthia Adams Rebecca L. Vieira Rachel G. Rempell 《The American journal of emergency medicine》2017,35(10):1497-1499
Objective
To determine the location of intraperitoneal free fluid on FAST exam in pediatric patients undergoing evaluation for trauma.Methods
Retrospective review of all FAST exams positive for intraperitoneal free fluid performed in patients sustaining trauma between August 2009 and February 2016 in an urban pediatric emergency department. Positive results were categorized into one of nine potential intraperitoneal locations; 4 each in the right and left upper quadrants, and the pelvis.Results
One hundred and three complete positive studies were reviewed. The median age of patients was 10 years (IQR 7–14) with 66% being male. Ninety-five percent had fluid present in the pelvis, 35% had fluid present in the RUQ, and 16.5% had fluid present in the LUQ. Overall, the most frequent location of fluid outside of the pelvis was found at the inferior tip of the liver, present in 83.3% of patients with fluid in the RUQ and 29% of all patients with a positive FAST.Conclusions
The majority of pediatric trauma patients with a positive FAST exam will exhibit free fluid in the pelvis. Particular attention should be directed to the inferior tip of the liver in children as this represents the most common location for fluid collection outside the pelvis. 相似文献12.
Qing-quan Lv Xiao-hua Gu Qi-hong Chen Jiang-quan Yu Rui-qiang Zheng 《The American journal of emergency medicine》2017,35(12):1810-1814
Background
Physiologic dose hydrocortisone is part of the suggested adjuvant therapies for patients with septic shock. However, the association between the corticosteroid therapy and mortality in patients with septic shock is still not clear. Some authors considered that the mortality is related to the time frame between development of septic shock and start of low dose hydrocortisone. Thus we designed a placebo-controlled, randomized clinical trial to assess the importance of early initiation of low dose hydrocortisone for the final outcome.Methods
A total of 118 patients with septic shock were recruited in the study. All eligible patients were randomized to receive hydrocortisone (n = 58) or normal saline (n = 60). The study medication (hydrocortisone and normal saline) was initiated simultaneously with vasopressors. The primary end-point was 28-day mortality. The secondary end-points were the reversal of shock, in-hospital mortality and the duration of ICU and hospital stay.Results
The proportion of patients with reversal of shock was similar in the two groups (P = 0.602); There were no significant differences in 28-day or hospital all-cause mortality; length of stay in the ICU or hospital between patients treated with hydrocortisone or normal saline.Conclusion
The early initiation of low-dose of hydrocortisone did not decrease the risk of mortality, and the length of stay in the ICU or hospital in adults with septic shock.Trial registration: www.clinicaltrials.govNCT02580240. 相似文献13.
Per Kristian Hyldmo MaryBeth Horodyski Bryan P. Conrad Sindre Aslaksen Jo Røislien Mark Prasarn Glenn R. Rechtine Eldar Søreide 《The American journal of emergency medicine》2017,35(11):1630-1635
Objective
Prehospital personnel who lack advanced airway management training must rely on basic techniques when transporting unconscious trauma patients. The supine position is associated with a loss of airway patency when compared to lateral recumbent positions. Thus, an inherent conflict exists between securing an open airway using the recovery position and maintaining spinal immobilization in the supine position. The lateral trauma position is a novel technique that aims to combine airway management with spinal precautions. The objective of this study was to compare the spinal motion allowed by the novel lateral trauma position and the well-established log-roll maneuver.Methods
Using a full-body cadaver model with an induced globally unstable cervical spine (C5-C6) lesion, we investigated the mean range of motion (ROM) produced at the site of the injury in six dimensions by performing the two maneuvers using an electromagnetic tracking device.Results
Compared to the log-roll maneuver, the lateral trauma position caused similar mean ROM in five of the six dimensions. Only medial/lateral linear motion was significantly greater in the lateral trauma position (1.4 mm (95% confidence interval [CI] 0.4, 2.4 mm)).Conclusions
In this cadaver study, the novel lateral trauma position and the well-established log-roll maneuver resulted in comparable amounts of motion in an unstable cervical spine injury model. We suggest that the lateral trauma position may be considered for unconscious non-intubated trauma patients. 相似文献14.
Serhad Omercikoglu Erhan Altunbas Haldun Akoglu Ozge Onur Arzu Denizbasi 《The American journal of emergency medicine》2017,35(3):383-390
Introduction
Atlantodental interval (ADI), basion-dental interval (BDI) and the thickness of prevertebral soft tissue (TOPST) measured in lateral cervical radiographs were reported to be useful indicators and indirect signs of underlying cervical spine injuries. However, cervical computed tomography (MDCT) is the first method of imaging used in all trauma patients and upper normal limits (UNLs) of cervical distances according to age and sex are undetermined. Therefore, we aimed to calculate these metrics.Methods
500 adult trauma patients with cervical MDCT at the time of admission were retrospectively selected. ADI, BDI, and TOPSTs were measured by two blinded researchers.Results
488 cervical spine CT scans were reported to be normal and 12 has pathological findings. Mean ADI, BDI and TOPST of C1, C2, C6 and C7 were statistically significantly wider in males. In females, ADI and BDI were significantly narrower with the increase in age. In males, only ADI was significantly narrower, and TOPST of C6 and C7 vertebra were significantly wider with the increase in age. We found the optimal UNLs as follows: ADI 2.5 mm, BDI 8.5 mm, C1 6.5 mm, C2 5.7 mm, C3 6.3 mm (6 mm for C1–3 for practical purposes), C4 11.7 and C5–7 17 mm.Discussion
We believe that the increase in distances with age may be affected by the height losses of discs and vertebral bodies, formation of anterior osteophytes and regional kyphosis by age. Those results were compatible with the previous reports. 相似文献15.
Fangyan Wang Zengyou Jin Kaiyi Shen Tingting Weng Zhisong Chen Jiahui Feng Zhengzheng Zhang Jiaming Liu Xiaolong Zhang Maoping Chu 《The American journal of emergency medicine》2017,35(3):402-409
Objectives
The depressed heart function is the main complication to cause death of septic patients in clinic. It is urgent to find effective interventions for this intractable disease. In this study, we investigated whether butyrate could be protective for heart against sepsis and the underlying mechanism.Methods
Mice were randomly divided into three groups. Model group challenged with LPS (30 mg/kg, i.p.) only. Butyrate group received butyrate (200 mg/kg·d) for 3 days prior to LPS administration (30 mg/kg). Normal group received saline only. 6 h and 12 h after LPS administration were chosen for detection the parameters to estimate the effects or mechanism of butyrate pretreatment on heart of sepsis.Results
The data showed that septic heart depression was attenuated by butyrate pretreatment through improvement of heart function depression (P < 0.01) and reduction of morphological changes of myocardium. The overexpression of proinflammatory factors, TNF-α, IL-6 and LTB4, in heart tissues induced by sepsis was significantly alleviated by butyrate pretreatment (P < 0.01). As oxidative stress indicators, SOD and CAT activity, and MDA content in heart were deteriorated by LPS challenge, which was noticeably ameliorated by butyrate pretreatment (P < 0.01 or P < 0.05).Conclusions
In conclusion, pretreatment with butyrate attenuated septic heart depression via anti-inflammation and anti-oxidation. 相似文献16.
Rohit P. Shenoi Elizabeth A. Camp Daniel M. Rubalcava Andrea T. Cruz 《The American journal of emergency medicine》2017,35(12):1791-1797
Introduction
Blunt trauma is a leading cause of pediatric morbidity. We compared injuries, interventions and outcomes of acute pediatric blunt torso trauma based on intent.Methods
We analyzed de-identified data from a prospective, multi-center emergency department (ED)-based observational cohort of children under age eighteen. Injuries were classified based on intent (unintentional/inflicted). We compared demographic, physical and laboratory findings, ED disposition, hospitalization, need for surgery, 30-day mortality, and cause of death between groups using Chi-squared or Fisher's test for categorical variables, and Mann-Whitney test for non-normal continuous factors comparing median values and interquartile ranges (IQR).Results
There were 12,044 children who sustained blunt torso trauma: Inflicted = 720 (6%); Unintentional = 9563 (79.4%); Indeterminate = 148 (1.2%); Missing = 1613 (13.4%). Patients with unintentional torso injuries significantly differed from those with inflicted injuries in median age in years (IQR) [10 (5, 15) vs. 14 (8, 16); p-value < 0.001], race, presence of pelvic fractures, hospitalization and need for non-abdominal surgery. Mortality rates did not differ based on intent. Further adjustment using binary, logistic regression revealed that the risk of pelvic fractures in the inflicted group was 96% less than the unintentional group (OR: 0.04; 95%CI: 0.01–0.26; p-value = 0.001).Conclusions
Children who sustain acute blunt torso trauma due to unintentional causes have a significantly higher risk of pelvic fractures and are more likely to be hospitalized compared to those with inflicted injuries. 相似文献17.
Orli Megged 《The American journal of emergency medicine》2017,35(1):36-38
Aim
Bacteremia is an uncommon complication of urinary tract infection (UTI). The aim of this study was to identify risk factors for bacteremic UTI in pediatric patients.Methods
The medical records of all pediatric patients with UTI between 2013 and 2014 were retrospectively reviewed. Pediatric patients with accompanying bacteremia were compared with pediatric patients with no bacteremia.Results
Five hundred twenty-seven cases of UTI were identified. Blood cultures were taken in 464, 26 (5.6%) of which also were bacteremic. Pediatric patients with bacteremia were more likely to be male (58% vs 28%, P < .01), to be younger than 3 months (54% vs 31%, P = .02), and to have higher creatinine (average 0.77 ± 0.97 vs 0.34 ± 0.24, P < .01). Pediatric patients with bacteremia had higher rate of underlying urologic conditions. The following variables were included in multivariate analysis: age < 3 months, sex, ethnicity, method of urine collection, creatinine, and underlying urologic conditions. Only creatinine (odds ratio, 3.67; 95% confidence interval, 1.69-8.11) was found as an independent risk factor for bacteremia.Conclusions
High creatinine at presentation is a risk factor that might aid in early identification of pediatric patients with high risk for bacteremia and its complications. 相似文献18.
Murat Yesilaras Turgay Yilmaz Kilic Suveyda Yesilaras Ozge Duman Atilla Dilek Öncel Mahmut Çamlar 《The American journal of emergency medicine》2017,35(10):1408-1413
Introduction
The aim of this study was to investigate the relationship between the optic nerve sheath diameter (ONSD) measured on non-contrast head computed tomography (CT) and the diagnosis and prognosis of spontaneous subarachnoid hemorrhage (SAH) on emergency department (ED) patients.Method
We used a matched control group of patients with the same age and gender who were diagnosed in the ED with spontaneous SAH and who admitted to the ED with headache. Four emergency medicine attending physicians made the ONSD measurements. For measurements, the 3-mm posterior location where the optic nerve enters the eyeball was used.Results
This study was done with 61 spontaneous SAHs with an equal number of control patients. The median ONSD for control and spontaneous SAH groups was 5.76 [interquartile range (IQR): 0.96] mm and 6.72 (IQR: 1.42) mm, respectively (p < 0.001). The area under the receiver operating characteristic curve was determined as 0.791 (confidence interval 95% 0.710–0.872). At an ONSD threshold value of 6.1 mm, the sensitivity and specificity of SAH was 72%. There was no significant relationship between ONSD and in-hospital mortality in spontaneous SAH patients (p > 0.05). The intra-class correlation coefficients for inter and intra-rater reliability were 0.84 and 0.95, respectively.Conclusion
In patients with spontaneous SAH, the ONSD measured in the orbital sections of a head CT is strongly correlated with a SAH diagnosis. Assessment of ONSD in head CTs taken with spontaneous SAH suspicion may contribute to the diagnoses of spontaneous SAH. 相似文献19.
Sun Hwa Lee Seong Jong Yun Dong Hyeon Kim Hyeon Hwan Jo Seokyong Ryu 《The American journal of emergency medicine》2017,35(10):1519-1524
Objectives
To retrospectively evaluate the diagnostic performance of qualitative and quantitative radiographic parameters for diagnosing adult acute epiglottitis, and identify the prevalence and risk factors of false-negative neck radiography-based diagnosis of acute epiglottitis.Methods
An emergency physician and a radiologist independently reviewed neck radiographs of 91 patients with laryngoscopy-confirmed acute epiglottitis and 91 control subjects between March 2010 and June 2016 for qualitative and quantitative radiographic parameters of acute epiglottitis, and concluded a diagnosis. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic performance of radiographic parameters, while independent risk factors of false-negative diagnosis were determined by multivariate logistic regression analysis. Inter-observer agreement was also calculated.Results
All radiographic parameters showed good diagnostic performance with sensitivities and specificities of 33.0–80.2% and 64.8–100%, respectively. Epiglottis width (EW) > 6.3 mm showed the highest diagnostic performance (area under the ROC curve [AUC]: 0.867, sensitivity: 75.8%, specificity: 97.8%). Interobserver agreement for all radiographic parameters was excellent (range: 0.893–0.991). The lateral neck radiography-based false-negative diagnosis rate was 31.9%, and previous oral antibiotic usage was an independent risk factor of false-negative results.Conclusion
EW > 6.3 mm showed the best diagnostic accuracy, facilitating a neck radiograph-based diagnosis of acute epiglottitis. However, false-negative results on neck radiograph are quite common and previous oral antibiotic usage is a risk factor. Based on the knowledge of the usefulness and risk factors of false-negative results of neck radiography, diagnostic process for acute epiglottitis using neck radiography need to be changed. 相似文献20.
Kristin Berona Amin Abdi Michael Menchine Tom Mailhot Tarina Kang Dina Seif Mikaela Chilstrom 《The American journal of emergency medicine》2017,35(2):240-244