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Biomedical subjects

H C Thode

Publications and source records attributed to H C Thode.

69 records · Page 4Linked to original sources
PubMed1990

Age, sex, and road-use patterns of motor vehicular trauma in Rhode Island: A population-based hospital emergency department study.

Population-based hospital emergency department data on motor vehicle traffic trauma in Rhode Island, 1984-85, are analyzed by age, sex, and road-use status. Annualized rates of overall and severe trauma were 1,195 cases (95% confidence interval [CI] = 1,164, 1,225) and 102 cases (95% CI = 94, 111) per 100,000 population, respectively. Overall and severe rates peaked at ages 15-24 years. Male rate excesses were most pronounced for motor-cycle and pedal cycle trauma.

Accidents, Traffic↗
PubMed1988

Simulated percentage points for the null distribution of the likelihood ratio test for a mixture of two normals.

We find the percentage points of the likelihood ratio test of the null hypothesis that a sample of n observations is from a normal distribution with unknown mean and variance against the alternative that the sample is from a mixture of two distinct normal distributions, each with unknown mean and unknown (but equal) variance. The mixing proportion pi is also unknown under the alternative hypothesis. For 2,500 samples of sizes n = 15, 20, 25, 40, 50, 70, 75, 80, 100, 150, 250, 500, and 1,000, we calculated the likelihood ratio statistic, and from these values estimated the percentage points of the null distributions. Our algorithm for the calculation of the maximum likelihood estimates of the unknown parameters included precautions against convergence of the maximization algorithm to a local rather than global maximum. Investigations for convergence to an asymptotic distribution indicated that convergence was very slow and that stability was not apparent for samples as large as 1,000. Comparisons of the percentage points to the commonly assumed chi-squared distribution with 2 degrees of freedom indicated that this assumption is too liberal; i.e., one's P-value is greater than that indicated by chi 2(2). We conclude then that one would need what is usually an unfeasibly large sample size (n greater than 1,000) for the use of large-sample approximations to be justified.

Biometry↗
PubMed1986

Motor vehicle trauma in northeastern Ohio. I: Incidence and outcome by age, sex, and road-use category.

Hospital emergency department visits for motor vehicle trauma occurring in a midwestern metropolitan region (Cleveland and Lorain-Elyria, Ohio Standard Metropolitan Statistical Areas; 2.2 million population) were analyzed to determine the incidence and outcome by age, sex, and road-use category. A 50% incidence sample (n = 20,752) of motor vehicle trauma events to residents of this region was identified from the emergency department records of 41 participating hospitals for a one-year period, 1977. These hospitals accounted for 98% of all emergency department cases in the region. The annual motor vehicle trauma incidence rate per 100,000 population was 1,871. The highest annual incidence rate (4,462) was for ages 20-24; the lowest rates were for infants under one year (837) and for the elderly over 74 years (667). Incidence rate rank-ordered road-use categories were as follows: passenger car occupant, motorized cycle rider, other enclosed vehicle occupant, pedestrian, and pedal cyclist. Above age 4, age-specific male incidence rates significantly exceeded female incidence rates for most road-use categories. There were 80 admissions and 7 fatalities per 1,000 motor vehicle trauma incidence cases. Case-admission ratios were highest for pedestrians (266), riders of motorized cycles (184), and pedal cyclists (115); they were lowest for occupants of partially or fully enclosed vehicles (65). Case-fatality ratios per 1,000 cases were also highest for pedestrians (43) and riders of motorized cycles (11). Male case-fatality ratios exceeded female ratios for each road-use category in nearly all age groups, and male case-admission ratios exceeded those for females ages 10-54. For ages 75 and over, the admission ratios and fatality ratios were nearly twice as high as in any other age group.

Accidents, Traffic↗
PubMed1985

Synthetic-fuel plants: potential tumor risks to public health.

This article quantifies potential public health risks from tumor-producing pollutants emitted from two synthetic-fuel plants (direct liquefaction--Exxon Donor Solvent: and indirect liquefaction--Lurgi Fischer-Tropsch) located at a representative site in the eastern United States. In these analyses gaseous and aqueous waste streams were characterized; exposures via inhalation, terrestrial and aquatic food chains, and drinking water supplies were modeled. Analysis suggested that emissions of "polycyclic aromatic hydrocarbons," "aromatic amines," "neutral N, O, S heterocyclics," "nitriles," and "other trace elements" pose the largest quantifiable risks to public health. Data and analysis for these pollutant categories should be refined to more accurately match compound-specific estimated exposure levels with tumorigenic potency estimates. Before these results are used for regulatory purposes, more detailed analysis for selected pollutant classes are needed, and more sophisticated aquatic exposure models must be developed. Also, differences in geographic scales among the environmental transport models used need to be rectified.

Carcinogens, Environmental↗
PubMedDate not supplied

"Abnormal" electrocardiograms in patients with cocaine-associated chest pain are due to "normal" variants.

"Abnormal" electrocardiograms are found in 56% to 84% of patients with cocaine-associated chest pain. This study was designed to assess whether these findings can be explained by "normal" variations in young patients' electrocardiograms. This cross-sectional study was conducted in a municipal hospital emergency department and walk-in clinic. History and results of an electrocardiogram for consecutive patients with cocaine-associated chest pain, aged 18 to 35 years, were compared to normal controls matched for age, race, and gender. Electrocardiograms underwent detailed analysis by two physicians blinded to both the study protocol and the hypothesis. Interphysician concordance for electrocardiographic diagnosis was substantial. There were 112 patients enrolled, 56 in each group. There was no significant difference found in the mean frequency of electrocardiographic diagnoses between the cocaine-associated chest pain patients and controls. The early repolarization variant was common. In conclusion, "normal" variations (J point and ST segment elevations) account for many of the "abnormal" electrocardiograms observed in young patients with cocaine-associated chest pain. Further study is needed to define the prevalence of these "normal" variations, and to determine if standard electrocardiographic criteria for thrombolysis apply to young patients.

Adolescent↗
PubMedDate not supplied

A clinical decision rule in the evaluation of acute knee injuries.

We constructed a clinical decision rule to optimize the use of radiography in patients with acute knee injuries. A prospective observational study at a university hospital ED was conducted over 10 months. Patients 15 years of age and older with acute knee injuries who underwent radiography were included. Patients were excluded if they were intoxicated, had distracting injuries, previous knee surgery, or open wounds. A standardized closed question data collection instrument that recorded 12 historical and 26 physical examination criteria was used. Radiographs were interpreted by two radiologists blinded to each other's diagnosis. The main outcome parameter was the presence or absence of a fracture. We identified 18 fractures in 213 patients (8%). Patients with fractures were more likely to have severe joint line tenderness, severe localized swelling, an effusion, ecchymosis, flexion < 90 degrees, and an inability to bear weight. A clinical algorithm for the use of radiography that requires the presence of either an inability to bear weight, an effusion, or an ecchymosis was 100% sensitive for the detection of a fracture. All 76 patients without any of these criteria did not have a fracture. Limiting knee radiography to patients with these criteria would have reduced radiography by 39% without missing a fracture. In conclusion, a clinical decision rule for knee radiography that requires the presence of either an inability to bear weight, an effusion, or an ecchymosis was shown to reduce the need for radiography by 39% while still identifying all fractures. Prospective validation of this model is required.

Adolescent↗
PubMedDate not supplied

Evaluation of CK-MB isoform analysis for early diagnosis of myocardial infarction.

Measurement of CK-MB and its isoforms by high-voltage electrophoresis has been proposed as a sensitive test for early detection of myocardial infarction (MI). We performed a prospective study of this test in 231 patients presenting to the Emergency Department with symptoms consistent with ischemic chest pain. Blood specimens were obtained at 0, 1, and 3 h following presentation, and plasma was immediately frozen and analyzed within 1 week by high-voltage electrophoresis for total CK-MB and isoforms. The test was considered positive whenever total CK-MB was elevated (>6 U/L) or the cardiac isoform MB2 was relatively increased (MB2 > 2 U/L and MB2/MB1 > 1.7). This test had a sensitivity of 68% overall and 55% for specimens collected within 3 h of symptom onset. It was positive within 3 h of presentation in 36/39 (92%) of patients with confirmed MI. Specificity was 92% overall and did not vary with time after symptoms. The CK-MB alone, at the cutoff of 6 U/L, had lower sensitivity overall (56%; p = 0.01) and within 3 h of onset (39%; p = 0.03), and higher specificity overall (98%; p < 0.001). Lowering the cutoff for CK-MB alone to match the sensitivity of the isoform test caused a greater loss of specificity. It is concluded that analysis of CK-MB by high-voltage electrophoresis is an effective method for rapid diagnosis of MI, with the isoform analysis enhancing early sensitivity.

Adolescent↗
PubMedDate not supplied

Effects of prehospital nitroglycerin on hemodynamics and chest pain intensity.

OBJECTIVE: To assess the effects of prehospital nitroglycerin (NTG) on vital signs and chest pain intensity. METHODS: A retrospective review of advanced life support (ALS) run sheets was performed in a suburban volunteer emergency medical services (EMS) system receiving 8,000 annual ALS calls. All consecutive patients who were administered NTG by EMS were included. Standardized forms were used to collect data on patient demographics, history, and physical exam. Patients assessed their chest pain (CP) before and after NTG on a verbal numeric scale of 0-10 from least to most severe. The presence of syncope, dysrhythmias, or profound hypotension [loss of peripheral pulses, a systolic blood pressure (SBP) of <90 mm Hg after NTG, or a drop of >100 mm Hg in BP] was noted. Results. One thousand six hundred sixty-two patients received NTG over 18 months, their mean age was 66 years, and 48% were female. Indications for NTG included CP (83%), dyspnea (45%), and congestive heart failure (20%). After NTG administration, the CP score decreased from 6.9 to 4.4 (mean difference = 2.6; 95% CI = 2.4 to 2.8). The CP completely resolved in 10% of the patients. Mean decreases in SBPs and diastolic BPs were 11.8 mm Hg (95% CI = 10.7 to 13.0) and 4.0 mm Hg (95% CI = 2.9 to 5.1). The mean pulse rate increased by 2.7 beats/min (95% CI = 0.6 to 4.9). There were 12 patients with adverse events [0.7% (95% CI = 0.4% to 1.3%)], including profound bradycardia and hypotension (1), transient drop in SBP of 100 mm Hg responding to fluids (6), post-NTG SBP <90 mm Hg (4), and syncope (1). There were no deaths in the prehospital setting. CONCLUSIONS: Use of prehospital NTG appears safe. While NTG reduces CP, most patients have residual pain.

Advanced Cardiac Life Support↗
PubMedDate not supplied

Comparison of forearm and upper arm blood pressures.

OBJECTIVE: In the prehospital setting it is not always feasible to obtain blood pressure (BP) readings from the upper arm. This study was performed to compare BPs obtained from subjects' forearms and upper arms in order to assess the utility of forearm BP as a surrogate for standard BP. METHODS: The authors performed a prospective, cross-sectional, convenience study in a sample of ambulatory university ED patients, where each subject had sequential determinations of left upper arm and forearm BPs with an automated monitor at ED triage. The order of measurement was determined by the day of the week. Demographic and clinical data were also recorded. The main outcome measure was the correlation between upper arm and forearm systolic and diastolic BPs. Pearson's correlation coefficient and Student's t-test were used to analyze the data. RESULTS: 151 patients were enrolled. The mean age was 35.3+/-15.7 years; 40% were female and 78% were white. The mean forearm and upper arm systolic BPs were 129.8+/-20.7 mm Hg and 126.2+/-17.6 mm Hg (p = 0.002). The mean forearm and upper arm diastolic BPs were 80.7+/-14.5 mm Hg and 76.8+/-13.4 mm Hg (p<0.001). The correlations between forearm and upper arm systolic and diastolic BPs were 0.75 (p<0.001) and 0.72 (p<0.001). The differences between forearm and upper arm systolic and diastolic BPs were within 20 mm Hg in 86% and 94% of patients, respectively. CONCLUSION: Forearm BP is a fairly good predictor of standard upper arm BP in most patients. Forearm BP may be used when measurement of upper arm BP is not feasible.

Adult↗
PubMedDate not supplied

National analgesia prescribing patterns in emergency department patients with burns.

Previous studies suggest that many patients with burns receive inadequate analgesia. A secondary analysis of the 1992 to 1999 National Hospital Ambulatory Medical Care Survey (a national, weighted sample of emergency department [ED] encounters) was performed to estimate national analgesia prescribing patterns in ED patients with burns. In 1999, there were 21,103 patient encounters sampled from 376 EDs, resulting in an estimated 102.8 million ED visits in 1999. One hundred thirty-eight patients in the sample (0.7%) had burns for an estimated 827,000 annual burns. Patient mean age was 28 years. Forty-three percent were female, 25% were children under 18 years of age, and 81% were white. Pain assessments were performed in about half of the patients, and only half of the patients received analgesics. Analgesia administration did not differ by year, sex, age, race, ethnicity, geographic location, or insurance payment type, yet it was more likely with increased pain. We conclude that many patients with burns do not have documentation of pain assessment or analgesia administration while in the ED.

Adolescent↗
PubMedDate not supplied

Evaluation of an emergency-procedure teaching laboratory for the development of proficiency in tube thoracostomy.

OBJECTIVE: Emergency-procedure laboratories are not a standardized part of the curriculum for emergency medicine residency programs. The authors evaluated the efficacy of an emergency-procedure laboratory to teach medical students and residents the performance of tube thoracostomy. METHODS: A prospective repeated-measures study of tube thoracostomy placement training was performed in an animal-laboratory setting. Participants were six first-postgraduate-year emergency medicine residents and six fourth-year medical students. Each participant was given a written pretest on tube thoracostomies followed by lectures on tube thoracostomy, venous cutdown, peritoneal lavage, and surgical airway. The procedure laboratory, using an anesthetized canine model (20-25 kg), was then conducted. Tube thoracostomies were timed from skin incision to passage of the tube into the thoracic cavity with subsequent tube fogging. Four attempts per participant were documented. Eighteen days later, an identical procedure laboratory was conducted for the same students including a written posttest identical to the pretest. RESULTS: The written test scores improved for every participant (p < 0.0001). Mean times for procedures completion improved from 121 sec to 39 sec (p = 0<.001) during the first session and improved from 58 sec to 28 sec (p = 0.005) during the second session. Retention of skills was indicated by significant shortening of the time to completion from the first attempt of the first session to that of the second session (121 sec to 58 sec, p = 0.002). CONCLUSION: This procedure laboratory, which emphasized skill repetition, led to improvement in procedural speed and retention of tube thoracostomy skills over time. This approach to teaching clinical procedures should be considered for emergency medicine residency programs and for continuing medical education courses that emphasize acquisition of clinical procedural skills.

Animals↗
PubMedDate not supplied

Variations in the electrocardiograms of young adults: are revised criteria for thrombolysis needed?

OBJECTIVE: The evaluation of chest pain in young adults has changed with the recognition of cocaine-induced myocardial ischemia. The high frequency of abnormal electrocardiograms (56-84%) in the cocaine-user population is largely due to "normal" electrocardiographic variants (early repolarization). The authors sought to determine the frequency of these "normal" variants in a young population, and whether these findings can be confused with acute ischemia. METHODS: A prospective convenience sample of subjects aged 18 to 35 without known heart disease was interviewed and had 12-lead electrocardiographic tracings performed. An emergency physician (physician 1) and a cardiologist (physician 2) read the tracings while blinded to patient history, age, and race. When the physicians disagreed, another physician adjudicated the diagnosis. RESULTS: Four hundred fourteen subjects (127 black, 175 Hispanic, and 112 Caucasian) were enrolled. Overall, 154 tracings (37%) were normal, 245 (59%) were abnormal but nondiagnostic for ischemia, and 15 (4%) were consistent with ischemia. Frequencies of repolarization "abnormalities" as determined by physicians 1 and 2, respectively, were: blacks, 32%, 51%; Hispanics, 26%, 35%; Caucasians, 17%, 27%; chi-squared, p = 0.02 and 0.0004. Patients with ischemic electrocardiograms according to physician 1 had a high frequency of repolarization "abnormalities" according to physician 2, and vice versa (100%, 61%). Electrocardiographic criteria for thrombolytic use per physician 2 were present in 31 patients (7%): blacks, 9%; Hispanics, 10%; and Caucasians, 2%; chi-squared, p = 0.03.

Adolescent↗
PubMedDate not supplied

Improving the sensitivity and specificity of the abbreviated injury scale coding system.

The Abbreviated Injury Scale with Epidemiologic Modifications (AIS 85-EM) was developed to make it possible to code information about anatomic injury types and locations that, although generally available from medical records, is not codable under the standard Abbreviated Injury Scale, published by the American Association for Automotive Medicine in 1985 (AIS 85). In a population-based sample of 3,223 motor vehicle trauma cases, 68 percent of the patients had one or more injuries that were coded to the AIS 85 body region nonspecific category external. When the same patients' injuries were coded using the AIS 85-EM coding procedure, only 15 percent of the patients had injuries that could not be coded to a specific body region. With AIS 85-EM, the proportion of codable head injury cases increased from 16 percent to 37 percent, thereby improving the potential for identifying cases with head and threshold brain injury. The data suggest that body region coding of all injuries is necessary to draw valid and reliable conclusions about changes in injury patterns and their sequelae. The increased specificity of body region coding improves assessments of the efficacy of injury intervention strategies and countermeasure programs using epidemiologic methodology.

Accidents, Traffic↗