Biomedical subjects

Amy A Ernst

Publications and source records attributed to Amy A Ernst.

27 records · Page 2Linked to original sources

PubMed2002

Comparison of three instruments for assessing ongoing intimate partner violence.

BACKGROUND: Active injury surveillance programs need to address 'ongoing' intimate partner violence (IPV). While the Abuse Assessment Screen (AAS) has been validated for 'present'(within a year) IPV it is not clear that it is valid for 'present' (ongoing) IPV. We have created an OAS (Ongoing Abuse Screen, OAS) by changing the AAS to specifically request information related to 'ongoing' IPV. The hypothesis of this study was that the OAS represents a construct that is different from either the original AAS or a single question asking about ongoing IPV. MATERIAL/METHODS: All patients presenting to the ED during a convenience sampling of shifts completed the survey. The survey included the OAS, the AAS, and the question 'Are you presently a victim of IPV?' Comparisons were made between these 3 using the kappa statistic for agreement. RESULTS: A total of 488 surveys were completed. The AAS was positive in 288/488 (59%, 95%CI= 55-63%), the OAS was positive in 78/488 (16%, 95%CI=13-19%), and the single question for DV was positive in 14/488 (3%, 95%CI=2-5%). Kappa was 0.28 for the AAS and the OAS. When compared to the single question about present DV, kappa was 0.05 for the AAS and 0.27 for the OAS. CONCLUSIONS: The OAS may be a useful tool for evaluating ongoing IPV. The OAS resulted in rates different from that of the AAS and may be more specific to ongoing IPV than the AAS and more sensitive than a single question about DV.

Adult↗

PubMed2002

Protocol for rapid sequence intubation in pediatric patients -- a four-year study.

BACKGROUND: To evaluate a protocol for rapid sequence intubation (RSI) for pediatric patients in a Level 1 trauma center. MATERIAL/METHODS: Retrospective review of prospectively gathered Continuing Quality Improvement (CQI) data at an inner city Level 1 trauma center with an emergency medicine residency program. Protocols for RSI were established prior to initiating the study. All pediatric intubations at the center from February 1996 to February 2000 were included. Statistical analysis included descriptive statistics for categorical data and Chi-square for comparisons between groups. RESULTS: Over the 4-year study period there were 83 pediatric intubations ranging in age from 18 months to 17 years; mean age 8.6. All had data collected at the time of intubation. There were 20 (24%) females and 62 (76%) males (p<0.001). Reasons for intubation were related to trauma in 71 (86%) and medical reasons in 12 (14%) (p<0.001). Of the trauma intubations 7 (10%) were for gunshot wounds, 39 (55%) were secondary to MVCs, and the remainder (25; 35%) were from assaults, falls, and closed head injuries. The non-trauma intubations were for smoke inhalation, overdose, seizure, HIV related complications, eclampsia, and near drowning. Intubations were successful with one attempt in 65 (78%) cases. No surgical airways were necessary. Rocuronium was used in 4 cases. Protocol deviations did not lead to complications. CONCLUSIONS: This protocol based pediatric rapid sequence intubation method worked well in an EM residency program. More intubations were in males and more were necessary due to trauma in this group.

Adolescent↗

PubMed2002

Residents with disabilities: a national survey of directors of emergency medicine residency programs.

BACKGROUND: The Americans With Disabilities Act (ADA) has been in effect since 1990. The present study shows response to this act for emergency medicine (EM) residents nationwide. METHODS: A total of 121 surveys were mailed to the directors of American College of Graduate Medical Education (ACGME)-approved residency programs. A definition of disability was provided, and a second mailing was sent to those not replying. RESULTS: Ninety-two program directors (76%) responded, representing 4,644 residents. Of these, 62 residents (1.3%) were reported as having a documented disability. Programs with a known disabled resident were significantly more likely to have available resources for assistance. Forty-seven (52%) of the program directors suspected a resident might have an undiagnosed disability, and 40 (85%) of these recommended testing or referral. CONCLUSIONS: There is a wide array of disabilities among EM residents. Available assistance varies. This may apply to other residencies as well.

Cross-Sectional Studies↗

PubMed2002

Awareness and use of over-the-counter pain medications: a survey of emergency department patients.

BACKGROUND: A survey study was done to determine basic knowledge about and use of over-the-counter (OTC) pain medications among patients seen in our emergency department (ED). The hypothesis was that knowledge about OTC pain medications would be correlated with demographic characteristics. METHODS: The study was a prospective 21-question survey during randomized 4-hour shifts over a 6-week study period. RESULTS: Of the 213 subjects who participated, 143 (67%) reported having used some form of nonsteroidal anti-inflammatory drug (NSAID), and 127 (60%) had used acetaminophen products recently. Women were more aware of toxic interactions and gastrointestinal (GI) irritation related to these medications. Ibuprofen use correlated with age (younger individuals used more) and having no primary physician (those without a physician used less). Knowledge about GI effects correlated with age, sex, and education. Knowledge about renal and hepatic problems correlated with age and education. CONCLUSION: Many patients use OTC pain medications. Many are ill informed about their use and side effects. More education is needed.

Acetaminophen↗

PubMed2002

Development of a site sampling form for evaluation of ED overcrowding.

BACKGROUND: ED overcrowding is fast becoming a national crisis although no definition exists. The purpose of this study is to develop and pilot a sampling form that accurately reflects the concept of ED Overcrowding. MATERIAL/METHODS: A 26-question site-sampling form was designed based on input from academic physicians at 11 medical schools nationwide. The study was conducted at an inner city Academic medical center. Site-samplings were conducted at 20 times over a one-week period by an independent observer. These times ranged from very slow to severely overcrowded. Information was obtained by counting patients in the waiting room, ED rooms, ED halls and registration/triage, ancillary services, the charge nurse, and the attending physicians. The charge nurse, and ED physicians rated the degree of overcrowding and the ED physician rated the feeling of being rushed. A 'combined outcome variable' was created which consisted of the average responses of nurses and physician's opinion of ED overcrowding and physician's feeling of being rushed. All other data was compared to this outcome variable. RESULTS: Seven questions were significantly correlated with the combined outcome variable. These were the number of people in the waiting room, patients awaiting triage, patients awaiting registration, full patient rooms, hallway patient, patients awaiting beds, and total registered patients. According to this scale our ED was overcrowded 20% of the time. CONCLUSIONS: This analysis clarifies the definition of overcrowding, helps indicate the variance among responses to overcrowding questions, and provides the foundation for prospective analysis of overcrowding in multiple EDs.

Crowding↗

PubMed2000

Prochlorperazine versus promethazine for uncomplicated nausea and vomiting in the emergency department: a randomized, double-blind clinical trial.

STUDY OBJECTIVE: Nausea and vomiting related to gastritis or gastroenteritis are common complaints in the emergency department. The most effective antiemetic agent is yet undetermined. This study was conducted to compare the efficacy of prochlorperazine versus promethazine for uncomplicated nausea and vomiting in the ED. METHODS: The study was a randomized, double-blind comparison of prochlorperazine (Compazine) and promethazine (Phenergan) for acute ED treatment of gastritis or gastroenteritis. We studied patients 18 years or older with presumed uncomplicated gastritis or gastroenteritis who presented to 2 academic EDs. Patients were randomly assigned to receive either prochlorperazine, 10 mg intravenously, or promethazine, 25 mg intravenously. Visual analog scale readings of patient comfort were obtained at baseline and at 30- and 60-minute intervals. The primary endpoint was degree of relief at 30 and 60 minutes. Secondary endpoints were time to complete relief, need for further antiemetic medication (treatment failures), and side effects. Statistical analysis was performed using the Mann-Whitney U test for nonparametric analysis and repeated-measures analysis of variance (ANOVA). RESULTS: Eighty-four patients were enrolled in the study; 42 received prochlorperazine and 42 received promethazine. There were no differences in demographics in the 2 groups. At baseline (time 0), there was no difference in symptoms (P =.23). At 30 and 60 minutes after receiving medication, prochlorperazine worked significantly better than promethazine (P =.004 and P <.001 using nonparametric analysis). Using repeated-measures ANOVA, there was a significant difference in symptoms over time for both groups (P <.001) and a significant difference in prochlorperazine versus promethazine (P =.002). Time to complete relief was significantly shorter with prochlorperazine (P =.021). There were significantly fewer treatment failures with prochlorperazine (P =.03, 9.5% versus 31%; difference 21%, 95% confidence interval 5 to 38). There was no difference in incidence of extrapyramidal effects. Prochlorperazine caused significantly fewer complaints of sleepiness (P =.002, 38% versus 71%; difference 33%, 95% confidence interval 13 to 53; P =.002). CONCLUSION: Prochlorperazine works significantly better than promethazine for relieving symptoms of nausea and vomiting more quickly and completely in ED patients with uncomplicated nausea and vomiting.

Adolescent↗

PubMedDate not supplied

Repeat EMS transports among elderly emergency department patients.

OBJECTIVES: Previous studies of repeat care of the elderly have focused on trauma cases only. The purposes of this study were to identify repeat transports of elderly patients to the authors' emergency department (ED) by emergency medical services (EMS), to identify demographics, and to compare chief complaints. METHODS: A population-based, retrospective cohort study was conducted. Data for this study were obtained from computerized registration files in an urban, university-affiliated ED with an annual census of approximately 60,000 visits. Patients were included if they were 65 years of age or older and they were transported by EMS in 1997. The repeater group included patients who had one or more EMS transports within the following 12 months. The comparison group was composed of all patients with no further EMS transport within the 12 months after the index visit. Demographics extracted from the database were gender, chief complaint, total number of visits, and time since previous visits. Repeats were characterized by frequency (number of visits in 12 months after the index visit), type (visit for same vs different complaint), and rate (time to the first return visit). Repeaters were defined as more than one visit within a 12-month period. Repeaters were subdivided as follows: "immediate" (within 72 hours), "short-term" (within 2 months), and "long-term" (within 12 months). Chi-square and 95% confidence intervals (95% CIs) were used. A p-value < 0.05 was considered statistically significant. RESULTS: There were 365 (23%) repeaters and 1,212 (77%) nonrepeaters. Repeaters accounted for 811 (40%) of the total of 2,023 elderly patients transported by EMS. Fifty-seven percent of all elderly patients transported by EMS were female, with no significant difference between the repeaters and nonrepeaters. There were significantly fewer transports for a chief complaint of trauma among the repeaters than among the nonrepeaters (14% vs 26%, diff = 12, 95% CI = 9-15%). Among the 365 repeaters, 186 (51%) had two transports, 92 (15%) had three transports, 36 (10%) had four transports, and 51 (14%) had five or more transports. Of the return transports by repeaters, 40 (12%) were "immediate," 191 (52%) were "short-term," and 134 (36%) were "long-term." CONCLUSION: Repeaters accounted for 18% of elderly ED patients transported by EMS and 40% of elderly transports to the authors' ED. There were significantly fewer trauma transports in the repeater group. One-half of the repeaters returned only once in a 12-month period and a third of these occurred more than three months apart. It is important to understand the characteristics of elderly EMS repeaters in order to use this opportunity for intervention.

Age Factors↗

PubMedDate not supplied

Emergency medical services screening of elderly falls in the home.

OBJECTIVES: Previous studies of injury prevention among the elderly have focused on care by community-based services for the elderly. The plan for this study was to determine whether emergency medical services (EMS) could be a valuable partner in an injury prevention program for the elderly. The purposes of the study were: 1) to determine whether it is feasible to gather injury prevention data prospectively, 2) to determine whether these data suggest the need for further intervention to aid the elderly, and 3) to determine whether retrospective chart data are comparable to prospectively gathered data for evaluating the elderly home environment. METHODS: Trained fire/EMS chiefs gathered prospective data from the homes of all elderly falls. Patients were included if they were 65 years of age or older. Demographics extracted from the chart were gender, age, and average income based on zip code information from the city office. A 29-question survey was developed based on a literature review. Results were obtained representing information in six categories: environment, appearance, health, violence, access to help, and repeat medical care utilization. Retrospective data were obtained from run reports and from a computerized EMS database. Proportions and 95% confidence intervals were used. A p-value < 0.05 was considered statistically significant. RESULTS: There were 70 prospective elderly fall cases evaluated and 74 retrospective charts reviewed, each representing a two-to-four-month period. Prospectively, significant problems were found with the patient's environment in up to 53% of cases, appearance in up to 29%, health in up to 77%, abuse in up to 3%, access in up to 57%, and repeat use in 33-68%. Although there were no differences in the age, income, or percentage transported between the prospective and retrospectively obtained groups, a significantly higher percentage of females were entered prospectively. Retrospective chart review obtained reasonable amounts of data for only four of 29 questions. CONCLUSION: Prospective analysis is easily gathered and identifies elderly injuries and patterns. A significant number of elderly patients whose homes were visited by EMS need help. Retrospective analysis gleans little injury prevention information.

Accidental Falls↗

PubMedDate not supplied

Relationship of restraint use, patient injury, and assaults on EMS personnel.

OBJECTIVE: We hypothesized that the assaults on EMS personnel by patients requiring restraints can be correlated with demographic information, patient condition, and other scene information such as presence the of law enforcement. METHODS: The study was a one-year cross-sectional study of paramedic restraint use and assault on EMS personnel in an urban area. A data collection form was completed by EMS for each patient placed in restraints. Study outcome variable was "Assault on EMS personnel." Predictor variables included demographic and EMS call information, patient condition, law-enforcement related variables, and the paramedic's perception of the need for chemical restraints. To compare predictor and outcome variables, a multivariable model with odds ratios and 95% confidence intervals was used. RESULTS: The study included 271 restrained patients over a 12-month period from April 2002 to April 2003. Seventy-seven (28%) cases were positive for assaults on EMS personnel. Multivariable analysis including 8 variables, indicated the following 6 variables were associated with assault on EMS personnel: time of day between midnight and 6 am (OR = 4.4, 95% CI = 1.6-12.7); female patient (OR for males 0.6, 95% CI = 0.3-1.0); violent patient (OR = 10.1, 95%CI = 2.3-48.2); patient injured under supervision (OR = 3.9, 95% CI = 1.1-13.8); arrested patient (OR = 4.4, 95% CI = 1.1-18.5); and perceived need for chemical restraint (OR = 2.1, 95% CI = 1.2-3.9). CONCLUSION: Multiple factors are correlated with assaults on EMS personnel by patients requiring restraints. By specifically targeting patients exhibiting these factors, EMS providers can help prevent injury to themselves. Patients not exhibiting these factors may be less dangerous.

Adolescent↗