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J McKernan

Publications and source records attributed to J McKernan.

5 recordsLinked to original sources
PubMed1998

Variation among trauma centers' calculation of Glasgow Coma Scale score: results of a national survey.

BACKGROUND: Glasgow Coma Scale (GCS) scoring is enigmatic in intubated patients. To determine if there is consensus among Level I trauma centers, a national telephone survey was conducted. METHODS: Trauma registrars at state-verified or American College of Surgeons-verified Level I trauma centers were questioned about GCS scoring, recording, and reporting in patients who are intubated or intubated and pharmacologically paralyzed. RESULTS: Seventy-three centers were contacted. Seventy-one use initial GCS scores for registry recording. Intubated patients are given 1 point for verbal component plus eye and motor scores at 26% of centers and a total GCS score of 3 at 23%; GCS score is estimated with "T" given for verbal component at 16%, scored as unknown at 10%, always scored as 15 at 10%, and the method of scoring is unknown at 15%. Pharmacologically paralyzed intubated patients are given a total GCS score of 3 at 34%, GCS score is estimated with "T" given for verbal component at 18%, patients are given 1 point for verbal component plus eye and motor scores at 12%, scored as unknown at 11%, always scored as 15 at 8%, and the method of scoring is unknown at 16%. CONCLUSION: Wide variation in GCS scoring among Level I trauma centers was identified. Because GCS scores are used in treatment algorithms, trauma scoring, and outcome prediction (Trauma and Injury Severity Score), uniform scoring is essential and should be pursued. Use of state and national databases and outcome research may be adversely affected by the lack of consistent GCS scoring.

Adult↗
PubMedDate not supplied

Urinalysis of alpha-hydroxyalprazolam, alpha-hydroxytriazolam, and other benzodiazepine compounds by GC/EIMS.

This procedure was developed as an overall benzodiazepine confirmation scheme and includes the detection of the most important urinary analytes encountered by clinical toxicology laboratories in North America: alpha-hydroxyalprazolam, alpha-hydroxytriazolam, 2-hydroxyethylflurazepam, oxazepam, temazepam, and lorazepam. Desmethyldiazepam (nordiazepam) was not targeted because it is metabolized to oxazepam. This procedure takes advantage of beta-glucuronidase hydrolysis for analysis of intact benzodiazepine molecules, oxazepam-2H5 as an internal standard, a newly developed extraction solvent, and a silylating moiety that may be more sensitive than trimethylsilyl (-TMS) derivatives, the tertbutyldimethylsilyl (-TBDMS) derivative. For all compounds the extraction efficiency was greater than 90% and the limit of quantitation (LOQ at a S/N of 10) was less than 10 ng/mL. Coefficients of variation for a 200-ng/mL control were less than 5% and less than or equal to 11% for within-run and between-run trials, respectively. Of 13 human specimens screened by EMIT and most with self-reported histories, alpha-hydroxyalprazolam was found in seven (range 49-1264 ng/mL), oxazepam was found in five (72-3897 ng/mL), and lorazepam (476 ng/mL), 2-hydroxyethylflurazepam (2301 ng/mL), and alpha-hydroxytriazolam (106 ng/mL) in one each.

Alprazolam↗