Biomedical subjects

Gregory W Hendey

Publications and source records attributed to Gregory W Hendey.

10 recordsLinked to original sources

PubMed2006

Epidemiology of blunt head injury victims undergoing ED cranial computed tomographic scanning.

STUDY OBJECTIVE: We sought to describe the epidemiology of emergency department (ED) patients with blunt head injury undergoing cranial computed tomography (CT) scanning for the evaluation of possible traumatic brain injury (TBI). METHODS: Prospective, multicenter, observational study of ED patients undergoing cranial CT after blunt head injury. Patient's date of birth, sex, and race/ethnicity were documented before CT scanning. Individual patients were considered to have "significant" TBI if the official radiographic interpretation at the end of all imaging studies associated with the trauma was consistent with any of a set of predefined diagnoses. The relative prevalence of TBI among various prespecified groups from those undergoing cranial CT scanning was also calculated. RESULTS: Of 13728 patients who were enrolled, 8988 (65%) were men and 1193 (8.7%) had a significant acute TBI. Demographic findings associated with increased risk of TBI, among patients selected for scanning, included the following: age below 10 years (relative risk [RR] = 1.44, 95% confidence interval [CI], 1.19-1.77); age above 65 years (RR = 1.59; 95% CI, 1.40-1.80), and male sex (RR = 1.27; 95% CI, 1.30-1.43). CONCLUSION: Among patients selected for cranial CT scanning after blunt head injury, men, patients younger than 10 years, and those older than 65 years have an increased likelihood of significant TBI.

Adolescent↗

PubMed2006

Selective radiography in 100 patients with suspected shoulder dislocation.

We sought to prospectively validate an algorithm for selective radiography in the Emergency Department (ED) management of patients with suspected shoulder dislocation. Physicians ordered pre- and post-reduction radiographs based on an algorithm incorporating the mechanism of injury, previous dislocations, and the physician's clinical certainty of joint position. Follow-up consisted of telephone calls and chart review. Of 100 patients, 94 had shoulder dislocation, and 59% were recurrent. Thirty percent had both pre- and post-reduction radiographs, 45% had pre- or post-reduction only, and 25% had no shoulder films, yielding an overall 46% reduction in X-ray utilization. Mean ED times were significantly shorter for patients managed without radiographs. On telephone follow-up (76%) and chart review (100%), we found no missed fractures or persistent dislocations. Use of a clinical decision rule for selective radiography reduced the number of radiographs and time spent in the ED, while missing no fractures or dislocations.

Adult↗

PubMed2005

A pilot study to derive clinical variables for selective chest radiography in blunt trauma patients.

STUDY OBJECTIVE: The goal of this pilot study was to determine whether clinical criteria can identify blunt trauma patients with significant acute intrathoracic injury on chest radiograph. METHODS: From January 2003 to May 2004, adult blunt trauma patients who received chest radiographs were prospectively enrolled at 2 urban trauma centers. Exclusion criteria were age less than 15 years, penetrating trauma, trauma more than 72 hours before presentation, isolated head trauma, and Glasgow Coma Scale score less than 14. Before chest radiograph viewing, providers recorded the following data: mechanism of injury, vital signs including oxygen saturation, patient symptoms, intoxication, distracting injuries, and the presence or finding of visible chest wall injury, chest palpation tenderness, pain on lateral chest compression, crepitus, and abnormal chest auscultation. Significant acute intrathoracic injury was defined as pneumothorax, hemothorax, aortic injury, 2 or more rib fractures, sternal fracture, or pulmonary contusion by blinded radiologist chest radiograph interpretation. RESULTS: Of the 507 enrolled patients, 15 patients were excluded because chest radiograph was not performed. Significant acute intrathoracic injury was confirmed in 31 of 492 (6.3%) patients. Palpation tenderness and chest pain had the highest sensitivity (90%) as individual criteria for significant acute intrathoracic injury, and hypoxia had the highest specificity (97%). The combination of palpation tenderness and hypoxia identified all significant acute intrathoracic injury with the following screening performance with 95% confidence intervals (CIs): sensitivity 100% (95% CI 91% to 100%); specificity 50% (95% CI 45% to 54%); positive predictive value 12% (95% CI 9% to 17%); and negative predictive value 100% (95% CI 99% to 100%). CONCLUSION: In this small sample, the combination of palpation tenderness and hypoxia identified all blunt trauma patients with significant acute intrathoracic injury while potentially eliminating the need for 46% of chest radiographs.

Adult↗

PubMed2005

Clinically significant changes in nausea as measured on a visual analog scale.

STUDY OBJECTIVE: Our objective is to determine the minimum clinically significant change in nausea as measured on a visual analog scale. METHODS: This was a prospective, descriptive, convenience sample study of consenting adults presenting to the emergency department with nausea, excluding intoxicated patients and those with mild nausea (measuring <30 mm on a visual analog scale). Patients rated their nausea severity on a 100-mm visual analog scale and reported whether their nausea was "a lot less," "a little less," "unchanged," "a little more," or "a lot more" compared with previous assessments. We defined the minimum clinically significant change as the mean difference in visual analog scale in patients reporting "a little less" or "a little more" nausea. RESULTS: Eighty-three paired visual analog scale measurements were collected from 50 patients. Fifty-eight percent of patients were women, and the mean age was 41 years. Mean changes in visual analog scale with corresponding qualitative descriptors were "a lot less" in 16 paired measurements (-42.2 mm; 95% confidence interval [CI] -54.9 to -29.5); "a little less" in 34 paired measurements (-15.4 mm; 95% CI -20.0 to -10.8); "no change" in 28 paired measurements (-0.4 mm; 95% CI -5.6 to 4.8); "a little more" in 2 paired measurements (16 mm; 95% CI -86 to 118); and "a lot more" in 3 paired measurements (23.7 mm; 95% CI -5.4 to 52.8). Patients reported "a little more" or "a little less" nausea in 36 paired measurements, with a mean change in visual analog scale of 15.4 mm (95% CI 11.0 to 19.8). CONCLUSION: The minimum clinically significant visual analog scale change in nausea was 15 mm, which is similar to previous studies of other symptoms, and helps in the interpretation of clinical studies reporting changes in nausea.

Adolescent↗

PubMed2005

When is the helicopter faster? A comparison of helicopter and ground ambulance transport times.

BACKGROUND: A retrospective analysis of 7,854 ground ambulance and 1,075 helicopter transports was conducted. METHODS: The 911-hospital arrival intervals for three transport methods were compared: ground, helicopter dispatched simultaneously with ground unit, and helicopter dispatched nonsimultaneously after ground unit response. RESULTS: Compared with ground transports, simultaneously dispatched helicopter transports had significantly shorter 911-hospital arrival intervals at all distances greater than 10 miles from the hospital. Nonsimultaneously dispatched helicopter transport was significantly faster than ground at distances greater than 45 miles, and simultaneous helicopter dispatch was faster than nonsimultaneous at virtually all distances. Ground transport was significantly faster than either air transport modality at distances less than 10 miles from the hospital. CONCLUSION: Ground ambulance transport provided the shortest 911-hospital arrival interval at distances less than 10 miles from the hospital. At distances greater than 10 miles, simultaneously dispatched air transport was faster. Nonsimultaneous dispatched helicopter transport was faster than ground if greater than 45 miles from the hospital.

Air Ambulances↗

PubMed2005

Overnight and postcall errors in medication orders.

OBJECTIVE: To compare the error rates in medication orders by physicians who were off call, on overnight call, and postcall. METHODS: This was a retrospective review of inpatient medication orders, pharmacy records, and resident physician work schedules in a university-affiliated community teaching hospital with residency programs in emergency medicine, family practice, internal medicine, obstetrics, pediatrics, and surgery. The authors calculated error rates, odds ratios (ORs), and 95% confidence intervals (95% CIs) for physicians during April 2000. RESULTS: In 8,195 medication orders, there were 177 errors (2.16% overall error rate). There was an increased error rate for overnight and postcall orders (2.71%, OR 1.44, 95% CI = 1.06 to 1.95) in comparison to orders written by off-call physicians (1.90%). Error rates were significantly higher on the medical/surgical wards during the overnight (3.91%, OR 1.89, 95% CI = 1.22 to 2.92) and postcall (3.41%, OR 1.64, 95% CI = 1.10 to 2.43) periods compared with the off-call (2.11%) period, and postgraduate year 1 (PGY1) physicians had a higher overnight error rate (4.23%, OR 2.28, 95% CI = 1.44 to 3.61). Error rates were also higher on the medical/surgical wards compared with critical care units (2.62% vs. 1.22%, OR 2.17, 95% CI = 1.48 to 3.18). The PGY1 physicians had error rates similar to those of the PGY2-5 physicians when off call, but were significantly higher on overnight call (4.23% vs. 0.52%, OR 8.47, 95% CI = 2.00 to 35.82). CONCLUSIONS: Medication-ordering error rates were higher for overnight and postcall physicians, particularly on the general medical/surgical wards, and in PGY1 physicians during the overnight period.

California↗

PubMed2003

How far is that by air? The derivation of an air: ground coefficient.

The objective of this study was to derive a simple equation to convert distances between air miles traveled by a helicopter and ground miles traveled by an ambulance. We performed a retrospective analysis of a convenience sampling of 245 "lights and sirens" ground ambulance transports between 1993 and 1997. Ground distances were recorded from odometer miles for each transport. Air miles were calculated using the Global Positioning System (GPS), measuring the distance in a straight line from the scene to the hospital. Air and ground distances were entered into a computerized spreadsheet, and the correlation coefficient and regression equation were derived. A simple approximation equation was developed and compared against the derived regression equation. There was a strong linear correlation between ground miles and air miles at virtually all distances studied (R = 0.932, R(2) = 0.869). Regression analysis revealed the following relationship: Ground miles = 0.94 + 1.25 (air miles). This was simplified to an approximation of: Ground miles = 1.3 (air miles). The approximation equation yielded an answer within 1 mile of the regression equation for distances up to 40 air miles. It is concluded that in a mixed rural and urban EMS system, one may convert air and ground mileage estimates by using the simple relationship: Ground miles = 1.3 (air miles). This conversion coefficient may prove useful for EMS personnel in designing reasonable helicopter utilization policies, making accurate transport decisions and conducting research.

Air Ambulances↗

PubMed2002

The esophageal detector bulb in the aeromedical setting.

To determine the accuracy of the Esophageal Detector Bulb (EDB) in the aeromedical setting, we conducted a prospective, observational study of all intubated patients transported by an aeromedical program over two years. Flight personnel recorded the results of the EDB, clinical examination, pulse oximetry, and capnography (ETCO(2)). Endotracheal tube position was confirmed by prehospital ETCO(2) or by the receiving emergency physician. There were 104 EDB assessments in 53 patients. The EDB correctly identified four of five esophageal intubations and 96 of 99 tracheal intubations. The sensitivity and specificity of the EDB in the detection of an esophageal intubation were 80% (95% CI, 38-96%) and 97% (95% CI, 92-99%), respectively, and the overall accuracy was 96% (95% CI, 90-98%). The EDB augments the ability of an aeromedical crew to determine endotracheal tube position, but its results must be carefully interpreted in the context of other available means of confirmation of endotracheal tube position.

Adolescent↗

PubMed2002

Spinal cord injury without radiographic abnormality: results of the National Emergency X-Radiography Utilization Study in blunt cervical trauma.

BACKGROUND: The purpose of this study was to better define the incidence and characteristics of patients with spinal cord injury without radiographic abnormality (SCIWORA), using the database of the National Emergency X-Radiography Utilization Study (NEXUS). METHODS: This was a prospective, observational study of blunt trauma patients in 21 U.S. medical centers undergoing plain cervical radiography. SCIWORA was defined as spinal cord injury demonstrated by magnetic resonance imaging, when a complete, technically adequate plain radiographic series revealed no injury. RESULTS: Of the 34,069 patients entered, there were 818 (2.4%) with cervical spine injury, including 27 (0.08%) patients with SCIWORA. Over 3,000 children were enrolled, including 30 with cervical spine injury, but none had SCIWORA. The most common magnetic resonance imaging findings among SCIWORA patients were central disc herniation, spinal stenosis, and cord edema or contusion. Central cord syndrome was described in 10 cases. CONCLUSION: In the large NEXUS cohort, SCIWORA was an uncommon disorder, and occurred only in adults.

Adult↗

PubMed2000

Necessity of radiographs in the emergency department management of shoulder dislocations.

STUDY OBJECTIVE: To determine the necessity of radiographs in the emergency department management of patients with suspected shoulder dislocation. METHODS: A prospective, observational study was conducted at a university-affiliated, Level I trauma center ED with an emergency medicine residency program. Physicians entered all patients with a suspected shoulder dislocation and reported whether they were certain that the patient's shoulder was dislocated or reduced, before obtaining radiographs. Outcome measures were the assessments of joint position and the radiology reports of prereduction and postreduction films. RESULTS: One hundred four patients were enrolled in the study, including 98 with shoulder dislocations, and 191 physician assessments were performed (96 prereduction, 95 postreduction). Twenty-eight patients had recurrent dislocations with an atraumatic mechanism (group 1), and 76 had no prior dislocation or a blunt mechanism of injury (group 2). There were no fractures in group 1 patients; the accuracy of confident assessments was 100% (95% confidence interval 92% to 100%). In group 2, the accuracy of confident assessments was 98% (95% confidence interval 94% to 100%). Incorrect assessments occurred only in patients with fractures. A derived algorithm would have reduced radiographs by 51%. CONCLUSION: Physicians are highly accurate in the clinical determination of shoulder dislocation and relocation. Radiographs should be obtained when the physician is uncertain of dislocation or reduction. Prereduction films should be obtained for patients with a blunt traumatic mechanism of injury, and postreduction for those found to have a fracture-dislocation. However, postreduction films add little in patients without fractures, and neither prereduction nor postreduction films are likely to affect the ED management of patients with recurrent dislocation by an atraumatic mechanism. Prospective validation of the derived algorithm is suggested.

California↗