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A L Kellermann

Publications and source records attributed to A L Kellermann.

72 records · Page 4Linked to original sources
PubMed1990

Firearm regulations and rates of suicide. A comparison of two metropolitan areas.

To investigate a possible association between firearm regulations and suicide, we compared the incidence of suicide from 1985 through 1987 in King County, Washington, with that in the Vancouver metropolitan area, British Columbia, where firearm regulations are more restrictive. The risk of death from suicide was not found to differ significantly between King County and the Vancouver area (relative risk, 0.97; 95 percent confidence interval, 0.87 to 1.09). The rate of suicide by firearms, however, was higher in King County (relative risk, 2.34; 95 percent confidence interval, 1.90 to 2.88), because the rate of suicide by handguns was 5.7 times higher there. The difference in the rates of suicide by firearms was offset by a 1.5-fold higher rate of suicide by other means in the Vancouver area. Persons 15 to 24 years old had a higher suicide rate in King County than in the Vancouver area (relative risk, 1.38; 95 percent confidence interval, 1.02 to 1.86). Virtually all the difference was due to an almost 10-fold higher rate of suicide by handguns in King County. We conclude that restricting access to handguns might be expected to reduce the suicide rate in persons 15 to 24 years old, but that it probably would not reduce the overall suicide rate.

Adolescent↗
PubMed1990

Validating survey responses to questions about gun ownership among owners of registered handguns.

While survey-based data on firearm ownership are essential for epidemiologic studies of the relation between gun ownership and injuries, the validity of respondent answers to questions about gun ownership has not been confirmed. In order to assess the accuracy of interview data about firearms, in June to August 1987, the authors attempted to contact residents of 75 homes in the cities of Memphis, Tennessee and Seattle, Washington listed as the address of the owner of a recently registered handgun. Despite problems with inaccurate registration data, contact was ultimately made with 55 households, 35 of which consented to a general interview that included a series of questions about gun ownership. Respondents in 31 of these 35 households (88.6%) readily acknowledged that one or more guns were kept in their home. Respondents in three of the remaining four households (8.6%) stated that guns were recently kept in their homes but were no longer kept there. Only one respondent (2.9%) denied categorically that guns of any kind were kept in her home. The authors conclude that, at least among registered gun owners, respondent answers to questions about gun ownership are generally valid and that survey data of this type can be utilized with confidence.

Adult↗
PubMed1990

Inhaled albuterol and oral prednisone therapy in hospitalized adult asthmatics. Does aminophylline add any benefit?

STUDY OBJECTIVE: To determine the efficacy of intravenous aminophylline in the treatment of adult patients hospitalized for exacerbation of asthma. DESIGN: Randomized, double-blind, placebo-controlled trial throughout the study. SETTING: University Hospital Clinical Research Center. PATIENTS: Forty-four patients admitted from the emergency room with a primary diagnosis asthma; 39 patients completed the study. INTERVENTIONS: Patients received either intravenous aminophylline or placebo in addition to frequent nebulized albuterol; prednisone 0.5 mg/kg body weight every 6 h orally; and supplemental oxygen. Aminophylline infusion rates were adjusted to achieve serum theophylline concentrations of 10 to 20 micrograms/ml. Changes were made in placebo infusion rates to maintain the double blind design. MEASUREMENTS AND RESULTS: Forced expiratory volume in 1 s (FEV1) and other spirometric measurements every 8 h by a blinded investigator or trained respiratory therapist. Subjective patient response and duration of hospitalization were compared. No difference in spirometric measurements was observed between the two groups at any time point. On admission to the study, FEV1 in the placebo group was 41.5 (+/- 2.9) percent predicted and in the aminophylline group 34.7 (+/- 2.3) percent predicted (p = 0.08). At discharge, FEV1 was 70.4 (+/- 2.9) percent predicted in the placebo group and 63.7 (+/- 2.8) percent predicted in the theophylline group (p = 0.10). There was no difference in subjective patient rating or duration of hospitalization between the two groups (placebo 1.95 days and aminophylline 1.78 days, p = 0.51). CONCLUSIONS: Our results suggest that aminophylline therapy does not add significant benefit to other standard therapies in hospitalized adult asthmatic patients. Because of the risks and cost of aminophylline treatment in the hospital setting, further research is needed to determine if there are subgroups of adult asthmatics who may benefit from the addition of aminophylline to other standard optimal therapies.

Acute Disease↗
PubMed1990

Patient 'dumping' post-COBRA.

To gauge the impact of the new federal patient transfer provisions following the federal Combined Budget Reconciliation Act of 1985 (COBRA), we monitored all emergency interhospital transfers to a public hospital emergency department in the Memphis, Tennessee area during three identical time periods: June 1 to August 31 of 1986, 1987, and 1988. A high number of transfers in the summer of 1986 diminished only slightly in summer 1987 (following implementation of COBRA). Far greater reductions occurred in summer 1988, when overcrowding forced our hospital to refuse most transfers. In contrast to changes in hospital policy, COBRA alone had little effect in this area.

Emergency Service, Hospital↗
PubMed1989

Dispatcher-assisted cardiopulmonary resuscitation. Validation of efficacy.

Dispatcher-delivered telephone instruction in cardiopulmonary resuscitation (CPR) has been proposed to increase rates of bystander CPR in cases of out-of-hospital cardiac arrest. We tested the efficacy of a previously developed CPR message using a recording mannikin in a high stress, simulated cardiac arrest scenario. Community volunteers were unaware they would perform CPR until immediately before each trial. Performance of volunteers without prior CPR training (group A, n = 65) who received telephone instruction was compared with that of previously trained volunteers (group B, n = 43) who received the same message. Performances of both groups were also compared with a third group (group C, n = 43) composed of previously trained volunteers who did not receive the message. Quality of CPR was graded by three CPR instructors using explicit criteria. Printout strips from the recording mannikins were also analyzed. Evaluators were unaware of the training status of volunteers. The three groups were of comparable sex, race, and educational level, but group C was significantly younger than groups A and B (31.7 vs. 37.7 years, p less than 0.001). Because of the time required for telephone instruction, groups A and B started chest compressions a mean of 4.0 minutes after collapse compared with 1.2 minutes for group C (p less than 0.0001). We found that the previously untrained volunteers of group A performed CPR of an overall quality comparable to that performed by previously trained members of group C. Group A performed chest compressions significantly better than group C (p less than 0.02) but had greater problems performing effective ventilations.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed1988

Handgun regulations, crime, assaults, and homicide. A tale of two cities.

To investigate the associations among handgun regulations, assault and other crimes, and homicide, we studied robberies, burglaries, assaults, and homicides in Seattle, Washington, and Vancouver, British Columbia, from 1980 through 1986. Although similar to Seattle in many ways, Vancouver has adopted a more restrictive approach to the regulation of handguns. During the study period, both cities had similar rates of burglary and robbery. In Seattle, the annual rate of assault was modestly higher than that in Vancouver (simple assault: relative risk, 1.18; 95 percent confidence interval, 1.15 to 1.20; aggravated assault: relative risk, 1.16; 95 percent confidence interval, 1.12 to 1.19). However, the rate of assaults involving firearms was seven times higher in Seattle than in Vancouver. Despite similar overall rates of criminal activity and assault, the relative risk of death from homicide, adjusted for age and sex, was significantly higher in Seattle than in Vancouver (relative risk, 1.63; 95 percent confidence interval, 1.28 to 2.08). Virtually all of this excess risk was explained by a 4.8-fold higher risk of being murdered with a handgun in Seattle as compared with Vancouver. Rates of homicide by means other than guns were not substantially different in the two study communities. We conclude that restricting access to handguns may reduce the rate of homicide in a community.

British Columbia↗
PubMed1988

Utilization and yield of drug screening in the emergency department.

Emergency qualitative tests for drugs are commonly ordered during evaluation of cases of suspected drug overdose. We prospectively compared the utilization and yield of drug screens based on urine and of identical tests of gastric contents under actual clinical conditions in a busy metropolitan emergency department. During the 4.5-month study period, physicians ordered drug screening in 405 of 582 (70%) study cases. Screens of both types of body fluid were ordered in only 95 cases (16%), suggesting study physicians regarded these tests to be functionally equivalent. Drug screens of gastric fluid were favored in cases involving acute ingestion and in medically complicated cases requiring gastric lavage. Urine drug screens were favored in clinically stable cases with primarily thought or behavior disorders. In the 95 cases for which both drug screens were ordered, gastric screens in 18 cases detected 20 drugs not detected by urine drug screening. Urine screening, on the other hand, identified 74 drugs not found on gastric screening in 48 cases. Gastric drug screening also performed poorly in comparison to quantitative serum drug levels. Seventeen false-positive urine or gastric screens were noted as well. Despite significant technical limitations, physicians frequently order drug screens in our emergency department. Qualitative drug screening of gastric fluid may prove useful in cases involving acute ingestion, but samples of urine and serum must also be submitted for analysis if optimal test performance is to be achieved.

Acute Disease↗
PubMed1988

In-hospital resuscitation following unsuccessful prehospital advanced cardiac life support: 'heroic efforts' or an exercise in futility?

From our emergency department logbook we identified 281 consecutive patients transported to the Regional Medical Center at Memphis following failed prehospital advanced cardiac life support (ACLS). Medical records were obtained for 240 cases (85.4%). Initial cardiac rhythms in the ED included ventricular fibrillation or pulseless ventricular tachycardia (29%), electromechanical dissociation (18%), and asystole (51%). Thirty-two patients (13.3%) were successfully resuscitated in the ED, but only four (1.7%) survived to hospital discharge. Two patients had good neurologic outcomes; both degenerated to cardiac arrest shortly prior to arrival in the ED. The remaining two survivors were discharged to nursing homes with severe neurologic deficits. Of the 41 cases for whom no medical records could be found, 39 were noted in our logbook to have died in the ED. No record of subsequent hospital admission could be found for the other two. Both are presumed to have died. Failure to respond to prehospital ACLS predicts nonsurvival and may warrant cessation of efforts in the field. Future programs and research efforts in the management of out-of-hospital cardiac arrest should be focused on optimal provision of prehospital care prior to the onset of irreversible deterioration.

Emergencies↗
PubMed1988

Emergency department patient 'dumping': an analysis of interhospital transfers to the Regional Medical Center at Memphis, Tennessee.

To study the extent and nature of transfers of emergency department (ED) patients because of inability to pay, we audited all telephone requests and actual patient transfers from private hospital EDs and their affiliated free-standing emergency centers to the ED of the Regional Medical Center at Memphis (the Med), a publicly subsidized hospital, between June 1 and August 31, 1986. Transfers to the Med's "special care" centers were assumed to represent tertiary care referrals and were excluded. During the 92-day study interval, ED physicians at the Med handled 190 telephone requests for transfer. Requesting physicians explicitly identified "no money" or "no insurance" as the primary reason for transfer in 89 per cent of 164 cases in which these data were recorded. Thirty-seven per cent of requests were refused; half were too unstable or required an intensive care unit (ICU) bed when none were available. One hundred forty-six transfers (55 per cent) arrived without prior telephone authorization, most by private automobile. Almost all transferred patients (91 per cent) were sent for primarily economic reasons. One out of four was found to be unstable on arrival by explicit clinical criteria. Eighty-two patients transferred for economic reasons (34 per cent) required emergency hospitalization and accounted for 564 bed days during a period of extreme inpatient crowding. Three patients died prior to discharge. Two had been transferred for primarily economic reasons.

Emergency Service, Hospital↗
PubMed1987

Impact of drug screening in suspected overdose.

We studied how emergency qualitative drug screens were ordered and used during the evaluation of 405 consecutive adult patients presenting to a metropolitan emergency department with suspected drug intoxication. Physicians completed a two-part questionnaire outlining diagnosis, diagnostic certainty, suspected drug(s), and management plans immediately following initial evaluation and again at the time of ED disposition. Screen results were reviewed prior to ED disposition in 361 (89%) cases. We found that qualitative drug screens were associated with substantial changes in diagnostic certainty, as measured by changes in probability estimates and changes in absolute mean log-likelihood ratios. In 196 cases for which all data were recorded prospectively, drug screens excluded a diagnosis of drug intoxication or specifically suspected drugs in 81 cases (41%), but identified previously unsuspected drugs in only 21 cases (11%, P less than .001). Management changes followed qualitative drug screen results in 16 of 361 cases overall (4.4%), but seven of these were also associated with diagnostic quantitative serum drug levels. Potentially critical interventions were begun in two cases following positive screens but delayed in another due to a falsely negative screen. Guidelines for more efficient test utilization are proposed.

Emergencies↗
PubMed1986

Protection or peril? An analysis of firearm-related deaths in the home.

To study the epidemiology of deaths involving firearms kept in the home, we reviewed all the gunshot deaths that occurred in King County, Washington (population 1,270,000), from 1978 through 1983. The medical examiner's case files were supplemented by police records or interviews with investigating officers or both, to obtain specific information about the circumstances, the scene of the incident, the type of firearm involved, and the relationship of the suspect to the victim. A total of 743 firearm-related deaths occurred during this six-year period, 398 of which (54 percent) occurred in the residence where the firearm was kept. Only 2 of these 398 deaths (0.5 percent) involved an intruder shot during attempted entry. Seven persons (1.8 percent) were killed in self-defense. For every case of self-protection homicide involving a firearm kept in the home, there were 1.3 accidental deaths, 4.6 criminal homicides, and 37 suicides involving firearms. Hand-guns were used in 70.5 percent of these deaths. The advisability of keeping firearms in the home for protection must be questioned.

Accidents, Home↗
PubMedDate not supplied

Predicting the outcome of unsuccessful prehospital advanced cardiac life support.

OBJECTIVE: To determine if failure to achieve return of spontaneous circulation following prehospital advanced cardiac life support (ACLS) warrants termination of efforts at the scene. DESIGN: Retrospective case series. SETTING: Memphis, Tenn, a city of 610337 people that is served by a fire department-based emergency medical service system. All city ambulances provide ACLS. PATIENTS: Adult victims of out-of-hospital cardiac arrest due to heart disease. INTERVENTION: All patients received prehospital ACLS according to the 1986 American Heart Association guidelines. Following prehospital ACLS, all patients were transported to the nearest hospital emergency department whether or not a pulse was restored in the field. MAIN OUTCOME MEASURES: Survival to hospital admission, survival to hospital discharge, and neurological status at discharge. RESULTS: Over the 39-month study interval, the Memphis Fire Department treated 1068 victims of out-of-hospital cardiac arrest. Three hundred ten of these (29%) had return of spontaneous circulation prior to transport for some period. The remaining 758 patients (71%) never regained a pulse and were transported with ongoing cardiopulmonary resuscitation. Patients who had return of spontaneous circulation prior to transport were more likely to be admitted (69% vs 7.0%) and far more likely to be discharged alive (26.5% vs 0.4%) than patients who failed to respond to prehospital ACLS. Three patients who survived to hospital discharge despite failure to achieve return of spontaneous circulation prior to emergency medical service transport sustained their cardiac arrest after paramedic arrival. All three were discharged with moderate to severe cerebral disability. CONCLUSION: Rapid transport of adults who fail to respond to an adequate trial of prehospital ACLS does not result in meaningful rates of survival. In such cases, on-line emergency medical service physicians should authorize paramedics to cease efforts in the field.

Aged↗