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Rosanne Naunheim

Publications and source records attributed to Rosanne Naunheim.

9 recordsLinked to original sources
PubMed2006

Point-of-care urine trypsinogen testing for the diagnosis of pancreatitis.

OBJECTIVES: To assess a point-of-care (POC) urine trypsinogen (UT) test for the diagnosis of pancreatitis in the emergency department (ED). METHODS: This was a prospective cohort study of a convenience sample of patients presenting to the ED with abdominal pain or symptoms suggestive of pancreatitis. A 3-minute POC UT test (Actim Pancreatitis; Medix Biochemica, Kauniainen, Finland) was compared with plasma lipase and amylase measurements, imaging results when performed, and final discharge diagnoses. The criterion standard was a final discharge diagnosis of acute pancreatitis. RESULTS: Of 191 patients included in this study, 17 patients were diagnosed with either acute or acute-on-chronic pancreatitis. The sensitivity and specificity of UT for acute pancreatitis were, respectively, 100% (95% confidence interval [CI] = 77% to 100%) and 96% (95% CI = 92% to 98%). Seven of the 17 patients with pancreatitis (41%) had diagnostic findings on CT and positive UT tests but had nondiagnostic plasma lipase and amylase levels. CONCLUSIONS: A POC UT screening test for pancreatitis in the ED compared favorably with plasma lipase and amylase levels. Future studies should be performed to explore whether this test in the ED setting has better clinical utility than plasma lipase or amylase.

Abdominal Pain↗
PubMed2006

Point-of-care test identifies diabetic ketoacidosis at triage.

BACKGROUND: Diabetic ketoacidosis (DKA) is a common, life-threatening complication of diabetes. The diagnosis of DKA relies on signs and symptoms, plus laboratory findings of blood glucose (BG) of > 250 mg/dL, an anion gap (AG) of > or = 15 mmol/L, and carbon dioxide (CO2) of < or = 18 mmol/L when other causes of acidosis are excluded. OBJECTIVES: To compare the results of a point-of-care test for the ketone beta-hydroxybutyrate (beta-OHB) with standard measures for accuracy in predicting DKA. METHODS: After providing informed consent, 160 patients who presented with BG of > 250 mg/dL underwent testing for beta-OHB with the Precision Xtra meter (Abbott Laboratories, North Chicago, IL) at triage in a large urban hospital emergency department. The diagnosis of DKA was made by clinicians by using standard clinical criteria without knowledge of the beta-OHB test. RESULTS: A diagnosis of DKA was made in 57 of 160 subjects. The beta-OHB values correlated strongly with AG (r = 0.66, p < 0.001) and with CO2 (r = -0.69, p < 0.001), as well as with glucose (r = 0.31, p < 0.001). Cross-classification of DKA vs. beta-OHB yielded sensitivity of 98% (95% CI = 91% to 100%), specificity of 85% (95% CI = 78% to 91%), with a positive likelihood ratio of 6.7 (95% CI = 4.22 to 10.78), and negative likelihood ratio of 0.021 (95% CI = 0.003 to 0.144) at the manufacturer-suggested beta-OHB level of 1.5. CONCLUSIONS: The point-of-care test for beta-OHB was as sensitive as more established indicators of DKA. It is more useful than glucose alone for the diagnosis of DKA and offers immediate diagnosis of patients at triage.

3-Hydroxybutyric Acid↗
PubMed2004

Minimum training for right upper quadrant ultrasonography.

The objective of this study was to assess if 10 right upper quadrant (RUQ) ultrasound (US) examinations could be used as a minimum standard for training. This was a retrospective review of patients with suspected gallbladder pathology who underwent resident-performed RUQ US before operative or department of radiology evaluation. Two hundred twenty-four patients were examined using resident-performed RUQ US followed by gold standard evaluations. One hundred seventy-eight patients were evaluated by 13 residents who met the "minimum training" standard of 10 prior examinations. The results of resident-performed RUQ US for gallstones and/or cholecystitis are shown subsequently. Previous suggestions that 10 examinations could be used as a minimum standard for training in focused abdominal sonography for trauma examinations cannot be used for RUQ US. The ACEP 2001 guidelines for 25 examinations are more consistent with the learning curve suggested by our data.

Cholecystitis↗
PubMed2004

Ultrasonography of the internal jugular vein in patients with dyspnea without jugular venous distention on physical examination.

STUDY OBJECTIVE: Accurate physical examination of patients with dyspnea is important. Jugular venous distention, however, can be difficult to assess in patients. The purpose of this case series is to serve as a pilot study of how ultrasonographic examination of the internal jugular vein compares with other measures of dyspnea. METHODS: This was a case series of 8 patients presenting with dyspnea without jugular venous distention on physical examination. Each patient underwent ultrasonographic examination of the internal jugular vein and inferior vena cava by an emergency physician sonographer blinded to all other clinical information after initial evaluation by another emergency physician for dyspnea. Results of ultrasonographic examination of the internal jugular vein and inferior vena cava were subsequently compared with initial emergency physician physical examination findings, initial chest radiography interpreted by radiologists, initial B-type natriuretic peptide levels, and final hospital discharge diagnosis. RESULTS: Ultrasonographic examination of the internal jugular vein compared more favorably with B-type natriuretic peptide levels and chest radiographic findings than ultrasonographic examination of the inferior vena cava in these patients with dyspnea but not jugular venous distention on physical examination. It was able to identify every patient diagnosed with cardiogenic pulmonary edema on hospital discharge. CONCLUSION: Ultrasonographic examination of the internal jugular vein appears to be helpful in patients who present with dyspnea but do not have evidence of jugular venous distention on physical examination.

Adult↗
PubMed2004

A comparison of artificial turf.

BACKGROUND: In an attempt to decrease injuries, newer forms of artificial turf have been marketed. The purpose of this study was to determine whether a new shredded rubber-based turf improves impact attenuation. METHODS: An instrumented computerized impact recording device (IRD, Techmark, Lansing, MI) was dropped 20 times from a height of 48 inches onto five types of turf used by a professional football team. RESULTS: Duncan's multiple range test shows that the new rubber-based field and the older foam field are not significantly different. There were significant differences, however, between sites on the shredded rubber-based field. CONCLUSION: The change from a foam-based system to a shredded rubber-based system had no effect on impact attenuation overall. However, areas in the shredded rubber-based field were significantly compacted, causing some sites to be much harder than the foam-based surface it replaced.

Acceleration↗
PubMed2004

Residents should not independently perform focused abdominal sonography for trauma after 10 training examinations.

OBJECTIVES: To assess whether 10 focused abdominal sonography for trauma (FAST) examinations could be used as a minimum standard for training, as suggested previously. METHODS: This was a retrospective review of patients with abdominal trauma who underwent resident-performed FAST examinations before surgical or Department of Radiology evaluation. RESULTS: Six hundred ninety-eight patients were examined by resident-performed FAST followed by reference standard evaluations. Four hundred twelve patients were evaluated by residents who previously performed 10 FAST examinations; 154 were evaluated by 29 residents performing their 11th through 30th examinations; and 258 were evaluated by 10 residents performing their 31st and subsequent examinations. The results of resident-performed FAST for intraperitoneal free fluid were as follows: 11 to 20 examinations--sensitivity, 73.9% (95% confidence interval, 51.3%-88.9%); specificity, 98.8% (92.5%-99.9%); true-positive findings, 17; true-negative, 81; false-positive, 1; false-negative, 6; total patients, 105; 21 to 30 examinations--sensitivity, 100% (73.2%-100%); specificity, 97.1% (83.3%-99.9%); true-positive, 14; true-negative, 34; false-positive, 1; false-negative, 0; total patients, 49; 31 and more examinations--sensitivity, 94.8% (88.6%-97.9%); specificity, 98.6% (94.5%-99.8%); true-positive, 110; true-negative, 140; false-positive, 2; false-negative, 6; total patients, 258. CONCLUSIONS: The suggestion that 10 examinations could be used as a minimum standard for training in FAST examinations was not validated.

Abdominal Injuries↗
PubMed2002

Does the use of artificial turf contribute to head injuries?

BACKGROUND: A number of high-profile professional football players have suffered career-ending concussions. The purpose of this article is to test the surfaces used by a professional team to determine their impact-attenuating properties. METHODS: An accelerometer was dropped from a height of 48 inches onto three different playing fields in the St. Louis area: an indoor artificial turf practice field, a grass outdoor practice field, and the artificial turf field at a domed stadium. The accelerometer was dropped 20 times from a height of 48 inches onto each surface. RESULTS: Statistical analysis of the peak Gs for impacts onto each surface indicate all three are statistically different. The artificial surface of the domed stadium was the hardest surface, with an average peak acceleration of 261 Gs compared with 183 Gs for the indoor artificial turf practice field and 246 Gs for the outdoor grass field. CONCLUSION: The surface used to play league games has the least impact attenuation of any field tested and may contribute to the high incidence of concussion in football players.

Acceleration↗