Injury prevention...who, me?
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Emergency Medicine↗
Biomedical subjects
N C Mann
Publications and source records attributed to N C Mann.
Influenza vaccination and acute otitis media in children.
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Acute Disease↗
Bucket-related drownings in the United States, 1984 through 1990.
The purpose of the study is to document the incidence of bucket-related drowning in the United States and to identify factors associated with this type of submersion injury. Analysis of Consumer Product Safety Commission data revealed 160 bucket-related drownings for the years 1984 through 1989, representing a mortality rate of 0.367 per 100,000 persons (younger than 2 years old) per year in the United States. Eighty-eight percent of bucket drownings occurred in toddlers aged 7 to 15 months old. Black children were six times more likely to drown in a bucket than white children of similar age (P less than .0001). Male toddlers were at significantly greater risk than females (P less than .01). A seasonal trend present in the data indicated that infants are more likely to drown in warmer than in colder months (P less than .01). States with the highest rates of bucket drowning were Vermont (2.1/100,000), Arizona (1.5/100,000), and Illinois (1.0/100,000). Through passive and active educational strategies, perhaps this fatal home injury can be prevented.
Black or African American↗
Hospital follow-up of patients categorized as not needing an ambulance using a set of emergency medical technician protocols.
OBJECTIVE: Using hospital outcomes, this study evaluated emergency medical technicians' (EMTs') ability to safely apply protocols to assign transport options. METHODS: Protocols were developed that categorized patients as: 1) needs ambulance; 2) may go to emergency department (ED) by alternative means; 3) contact primary care provider (PCP); or 4) treat and release. After education on application of the protocols, EMTs categorized patients at the scene prior to transport but did not change current practice. Hospital charts were reviewed to determine outcome of patients whom EMTs categorized as not needing an ambulance. Category 2 patients were assumed to need the ambulance if they were admitted to a monitored bed or intensive care unit. Category 3 and 4 patients were assumed to need the ED if they were admitted. RESULTS: The EMTs categorized 1,300 study patients: 1,023 (79%) ambulance transport, 200 (15%) alternative means, 63 (5%) contact PCP, and 14 (1%) treat and release. Hospital data were obtained for 140 (51%) patients categorized as not needing ambulance transport. Thirteen of 140 (9%) patients who transporting EMTs determined did not need the ambulance were considered to be undertriaged: five in category 2, six in category 3, and one in category 4. Six of 13 (46%) undertriaged patients had dementia or a psychiatric disorder as one of their presenting complaints. CONCLUSION: These protocols led to a 9% undertriage rate. Patients with psychiatric complaints and dementia were at high risk for undertriage.
Adult↗
Use of resuscitation skills by paramedics caring for critically injured children in Oregon.
OBJECTIVES: 1) To perform a statewide analysis of the frequency of major pediatric trauma cases and the use of resuscitation skills by paramedics (EMT-Ps). 2) To determine whether EMT-Ps use resuscitation skills less frequently for injured children than for older patients. METHODS STUDY DESIGN: Retrospective, database analysis of major trauma cases. SETTING AND POPULATION: 1995 statewide trauma registry data for patients with EMT-P scene care. OBSERVATIONS: The database included patient demographics, field vital signs, field procedures [e.g., intravenous (i.v.) line placement, chest compressions, needle thoracostomy, endotracheal intubation], field medication, and vital signs at ED presentation. DATA ANALYSIS: Patients aged < or = 12 years ("pediatric") were compared with those aged > 12 years ("older"). Analyses of patients with tachycardia, hypotension, and obtundation were performed using chi 2 analysis (alpha = 0.05). RESULTS: Of 3,502 trauma patients managed by an EMT-P, only 297 (8%) were aged < or = 12 years. Fewer pediatric patients (18%) than adults (27%) had an injury severity scale score > or = 16, p < 0.005. The frequency of most resuscitation skills and the administration of medications were not statistically different between patient groups. However, i.v.s were four times more likely to be placed in adults (76%) than in pediatric patients (42%), p < 0.001. Subanalyses indicated fewer pediatric patients with tachycardia (p = 0.02) or hypotension (p = 0.02) received an i.v., compared with adults who had similar physiologic parameters. Obtunded patients were equally likely to receive endotracheal intubation, although the procedure was rarely used (20%). CONCLUSIONS: EMT-Ps infrequently manage seriously injured children. i.v.s are less frequently placed in pediatric trauma patients, even in the setting of physiologic abnormalities. The contributions of these field procedures to patient outcomes should be evaluated further.
Adolescent↗
Assessing rater performance without a "gold standard" using consensus theory.
This study illustrates the use of consensus theory to assess the diagnostic performances of raters and to estimate case diagnoses in the absence of a criterion or "gold" standard. A description is provided of how consensus theory "pools" information provided by raters, estimating rater competencies and differentially weighting their responses. Although the model assumes that raters respond without bias (i.e., sensitivity = specificity), a Monte Carlo simulation with 1,200 data sets shows that model estimates appear to be robust even with bias. The model is illustrated on a set of elbow radiographs, and consensus-model estimates are compared with those obtained from follow-up data. Results indicate that with high rater competencies, the model retrieves accurate estimates of competency and case diagnoses even when raters' responses are biased.
Adult↗