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Biomedical subjects

David F M Brown

Publications and source records attributed to David F M Brown.

At least 19 recordsLinked to original sources
PubMed2004

Renal ultrasound.

Renal US is one of several imaging modalities available to the EP in the evaluation of patients with acute urologic disorders. It offers excellent anatomic detail without exposure to radiation or contrast agents but is limited in its assessment of renal function. It is an important alternative to helical CT scanning for evaluating renal colic, especially in children and pregnant women. It has an important role in excluding bilateral renal obstruction as the cause of acute renal failure. It is likely that Doppler renal US also will take on a prominent role in the evaluation of renal vascular disorders. It already has become the standard of care in the management of renal transplant patients. Bedside emergency renal US performed and interpreted by EPs with limited training and experience is increasing in use and gaining acceptance. At present, the primary role of renal US is to identify hydronephrosis in patients with renal colic or acute renal failure but, in the future, its role likely will expand as technology advances and its use increases. In many patients, bedside renal US may obviate the need for further diagnostic workup and speed the diagnosis and treatment of an emergency patient.

Colic↗
PubMed2004

Chest pain.

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Cardiac Catheterization↗
PubMed2004

Duration of symptoms and follow-up patterns of patients discharged from the emergency department after presenting with abdominal or flank pain.

BACKGROUND: Little is known about the duration of symptoms and follow-up patterns of patients seen in emergency departments for abdominal or flank pain. OBJECTIVE: We aimed to measure the duration of symptoms and follow-up rate of patients discharged home from the emergency department after presenting with non-traumatic abdominal or flank pain. METHODS: We conducted a single-centre, prospective descriptive study of adult patients who presented to our emergency department with non-traumatic abdominal or flank pain and were discharged from the emergency department. We gathered clinical data during the index emergency department visit and conducted telephone interviews of subjects 2-5 weeks later. RESULTS: We reached 63 of 90 subjects (70%). The median duration of pain was 3 days after the emergency department visit. During the follow-up period, only 41% had followed-up with their family physician or primary care provider, although an additional 21% had planned to. Persistence of symptoms was common in the 37% of subjects who did not follow-up. CONCLUSION: Of subjects discharged from the emergency department after visits for non-traumatic abdominal or flank pain, most improve within several days. Fewer than half follow-up with a family practitioner or a primary care provider. Emergency department revisits are uncommon and often for unrelated problems.

Abdominal Pain↗
PubMed2003

Predictors of delay in presentation to the ED in patients with suspected acute coronary syndromes.

Delays in seeking medical attention for patients with acute coronary syndromes (ACS) preclude early application of life-saving treatment and diminish efficacy. Previous studies suggest 3-hour delays between onset of symptoms and ED arrival in patients with typical presentations of acute myocardial infarction (AMI). A prospective observational study was conducted in an urban ED measuring lag time (LT) among adults presenting within 48 hours of onset of symptoms suggestive of ACS. Univariate and multiple regression analyses were performed on 5 predictors: age, sex, symptoms at presentation, and 2 different outcomes (AMI and ACS). Three hundred seventy-four patients were enrolled. Mean age was 63 years with 38% 70 years or older. Seventy-three percent of all patients with suspected ACS presented with chest pain, 27% with atypical symptoms. Overall mean LT was 8.7 hours (standard deviation 11). In subgroup analysis, patients aged >/=70 years were more likely to have LTs >12 hours (29% vs. 19% P =.043) and patients without chest pain had longer mean LTs (11.6 vs. 7.6 hours, P =.01). Delay in ED presentation is group specific. Advanced age and patients with atypical symptoms are predictive of longer LTs. Contrary to previously published data, patients with symptoms suspicious for ACS can delay an average of 9 hours, which might alter current thinking in the prevention and care of these patients.

Adult↗
PubMed2003

Fever and rash.

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Adult↗
PubMed2003

Use of diagnostic testing in the emergency department for patients presenting with non-traumatic abdominal pain.

The objective of the study was to measure the utilization and diagnostic value of tests used in the Emergency Department (ED) on patients with undifferentiated non-traumatic abdominal or flank pain. Specific goals were to measure how often these tests led to changes in diagnosis or disposition, which tests were most commonly used, and which tests providers considered most helpful. We conducted a pilot single-center, prospective descriptive study, enrolling all eligible adult patients who presented to our ED with non-traumatic abdominal or flank pain during defined hours of our intake period. Based on serial provider interviews pre- and post-testing, we measured the frequency of change of most likely diagnosis and disposition, which tests were performed, and the provider-perceived value of tests. We enrolled 124 subjects with a mean age of 44 years; 27% were admitted. Testing led to a change in most likely diagnosis in 37% of subjects, and in disposition in 41%. Frequency of diagnostic test use varied from a high of 93% for CBC to 6% for a blood or urine culture. Overall, 65% of patients had at least one imaging study performed, and 39% had an abdominal/pelvic computed tomography (CT) scan. Over all subjects, providers identified the most useful tests as the CT scan (31%) and urinalysis (17%). In conclusion, among ED patients who presented with non-traumatic abdominal or flank pain to one academic center, the pre-test most likely diagnosis and disposition were changed based on the ED evaluation in over one-third of subjects. Almost all received blood tests and two-thirds received one or more imaging studies. Based on providers' subjective opinions, the most valuable tests were the abdomino/pelvic CT scan and the urinalysis.

Abdomen↗
PubMed2002

Comparison of two different methods of quantitative coronary angiography in patients with acute coronary syndromes.

The minimal cost algorithm (MCA) commonly used for quantitative coronary arteriography has limitations in definition of complex lesion morphology. A gradient field transform (GFT) algorithm has been designed for the better analysis of complex lesions. We compared MCA with GFT in angiograms of 125 patients in the Myocardial Infarction with Novastan and t-PA (MINT) trial. Lesion border definition was rated as one (poor), two (good), or three (very good). While MCA- and GFT-derived reference diameters (RDs) were similar, GFT yielded smaller minimal lumen diameter (MLD) than MCA by 0.22 +/- 0.31 mm (P < 0.01), and the difference between GFT- and MCA-derived MLDs increased with decreasing MLD. Mean percent diameter stenosis (% DS) was 9.1% +/- 11.1% greater by GFT (P < 0.001). Lesion border definition in simple lesions was similar (not significantly different). However, in complex lesions GFT performed better (2.49 +/- 0.61 vs. 2.11 +/- 0.74; P < 0.05). Thus, GFT appears to improve analysis of complex lesions compared to MCA. GFTs role in angiographic trials and clinical practice deserves further study.

Algorithms↗