Biomedical subjects

Jennifer A Oman

Publications and source records attributed to Jennifer A Oman.

4 recordsLinked to original sources

PubMed2006

Performance of a decision rule to predict need for computed tomography among children with blunt head trauma.

OBJECTIVE: To assess the ability of the NEXUS II head trauma decision instrument to identify patients with clinically important intracranial injury (ICI) from among children with blunt head trauma. METHODS: An analysis was conducted of the pediatric cohort involved in the derivation set of National Emergency X-Radiography Utilization Study II (NEXUS II), a prospective, observational, multicenter study of all patients who had blunt head trauma and underwent cranial computed tomography (CT) imaging at 1 of 21 emergency departments. We determined the test performance characteristics of the 8-variable NEXUS II decision instrument, derived from the entire NEXUS II cohort, in the pediatric cohort (0-18 years of age), as well as in the very young children (<3 years). Clinically important ICI was defined as ICI that required neurosurgical intervention (craniotomy, intracranial pressure monitoring, or mechanical ventilation) or was likely to be associated with significant long-term neurologic impairment. RESULTS: NEXUS II enrolled 1666 children, 138 (8.3%) of whom had clinically important ICI. The decision instrument correctly identified 136 of the 138 cases and classified 230 as low risk. A total of 309 children were younger than 3 years, among whom 25 had ICI. The decision instrument identified all 25 cases of clinically important ICI in this subgroup. CONCLUSIONS: The decision instrument derived in the large NEXUS II cohort performed with similarly high sensitivity among the subgroup of children who were included in this study. Clinically important ICI were rare in children who did not exhibit at least 1 of the NEXUS II risk criteria.

Adolescent↗

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

Personal digital assistants change management more often than paper texts and foster patient confidence.

INTRODUCTION: Rapid retrieval of information, including drug treatment options, is critical to emergency department practice. OBJECTIVES: To assess feasibility and patient acceptance of personal digital assistants and to determine the scope of management changes. METHODS: Emergency medicine residents (EMRs, n = 18) and emergency medicine attending (EMAs, n = 12) used personal digital assistants with drug database and clinical references. Text versions were also available in the emergency department. We did a prospective, random, cross-over time-motion study, recording retrieval time, source, and changes to patient care for 16 and 8 h for EMRs and EMAs, respectively. We surveyed patients for confidence in EMRs and EMAs with personal digital assistants, and perceived efficiency. RESULTS: EMRs accessed paper (n = 131) or personal digital assistant (n = 181) information on 92.3% of patients (n = 17, both). They accessed personal digital assistant on 61.4% of patients vs. 44.5% with texts (odds ratio 1.99, 95% confidence interval 1.4-2.80). Mean access times were 9.3 and 9.4 s, respectively, +1.4 for both. Personal digital assistant access was 75%/25% between pharmacopeia and clinical resource. Personal digital assistants changed drug choice in 39/181 patients (21.5%), and other management (diagnosis, treatment or disposition) in 15/181 patients (8.3%). Odds ratio for change in management for personal digital assistant vs. paper was 2.00 (95% confidence interval 1.11-3.60). We surveyed patient perception for 198 of 295 patients (67.1%). Fifty percent reported more confidence in their EMRs and EMAs with a personal digital assistant, while 5% reported less confidence. Sixty percent agreed strongly that there is too much medical information to remember. CONCLUSIONS: Personal digital assistants are feasible in an academic emergency department and change management more often than texts. EMRs accessed personal digital assistants more often than paper texts. Patient perceptions of physicians who use personal digital assistants are neutral or favorable.

Attitude of Health Personnel↗

PubMed2004

Defining "therapeutically inconsequential" head computed tomographic findings in patients with blunt head trauma.

STUDY OBJECTIVE: Many injuries detected by computed tomographic (CT) imaging of blunt head trauma patients are considered "therapeutically inconsequential." We estimate the prevalence of these findings and determine how frequently affected patients had "important neurosurgical outcomes," defined as either a directed intervention or a poor Glasgow Outcome Scale score. METHODS: We prospectively enrolled all blunt head trauma patients undergoing emergency head CT imaging at 18 centers participating in the National Emergency X-radiography Utilization Study II (NEXUS). From these cases, we identified all patients whose official CT reading met predefined criteria for "therapeutically inconsequential" injuries. We obtained detailed follow-up information on all such patients at 6 sites, including the need for neurosurgical intervention and Glasgow Outcome Scale scores. Among patients having "important neurosurgical outcomes," we assessed the frequency of 2 potential clinical identifiers: altered mental status and coagulopathy. RESULTS: "Therapeutically inconsequential" head CT findings were present in 155 of 8,374 subjects (1.85%; 95% confidence interval 1.57% to 2.16%). Sites participating in the follow-up study enrolled 81 of these patients, of whom 10 (12%) had "important neurosurgical outcomes." Follow-up information was available for 9 patients, all of whom had abnormal mental status at CT scanning. Coagulopathy was also present in 5 of 7 patients for whom coagulation status was known. CONCLUSION: "Therapeutically inconsequential" findings are identified in less than 2% of blunt head trauma patients who undergo CT scanning. A small proportion of these patients have an "important neurosurgical outcome," but it appears that such patients may be identified clinically by the presence of abnormal mental status or coagulopathy.

Adolescent↗