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Scott Compton

Publications and source records attributed to Scott Compton.

At least 19 recordsLinked to original sources
PubMed2006

Outcomes from out-of-hospital cardiac arrest in Detroit.

OBJECTIVE: To determine the out-of-hospital cardiac arrest survival rate, and prevalence of modifiable factors associated with survival, in Detroit, Michigan, over a 6-month period of time in 2002. METHODS: A retrospective review of all out-of-hospital cardiac arrests responded to by the Detroit Fire Department, Division of Emergency Medical Services. All elements of the EMS runsheet were transcribed to a database for analysis. Patient hospital records were reviewed to determine survival to hospital admission. All survivors to hospital admission were surveyed later in the Michigan Department of Vital Records death registry search. RESULTS: During this study timeframe, there were 538 confirmed out-of-hospital cardiac arrests within the City of Detroit, of which 67 were excluded for being dead on scene [51 (12.5%)] or having no available hospital records [16 (3.0%)]. Of the remaining 471 patients, 443 (94.1%) died before hospital admission. Only 44 (9.9%) of the 471 patients had a first recorded rhythm of ventricular fibrillation (VF), and 339 (76.5%) were asystolic. Of the 28 patients who survived to hospital admission, only 2 (7.1%) were noted to have a first rhythm of VF, and 15 (53.6%) were asystolic. Only one patient survived to hospital discharge. CONCLUSIONS: In this urban setting, out-of-hospital cardiac arrest is an almost uniformly fatal event.

Adolescent↗
PubMed2006

Emergency medical service providers' experience with family presence during cardiopulmonary resuscitation.

OBJECTIVE: To describe emergency medical service providers' experiences with family member presence during resuscitation, and to determine whether those experiences are similar within urban and suburban settings. METHODS: We conducted a personally distributed survey of a convenience sample of urban and suburban emergency medical service (EMS) providers presenting to two Midwestern Emergency Departments. Providers were questioned as to their experiences with resuscitating patients in the presence of family members. RESULTS: There were 128 respondents to the survey (59 urban and 69 suburban), of which 70.1% were EMT-Paramedics. No provider who was approached refused participation. Nearly all (122) had performed CPR in the presence of family members, with most (77%) performing greater than 20. Subjects averaged 12.3 years of experience. The majority of urban and suburban providers felt it was inappropriate for family to witness resuscitations (75.9% versus 60.3%, respectively; p=0.068). Many providers reported feeling uncomfortable with family presence (31.5% urban versus 44.8% suburban; p=0.136), and few preferred that family witness the resuscitation (13.2% urban versus 15.4 suburban; p=0.738). A minority of providers believed that family were better prepared to accept the death of the patient (37.0% urban versus 37.6% suburban; p=0.939). Approximately half felt comfortable providing emotional support (66.0% urban versus 53.7% suburban; p=0.173). Many felt that family caused a negative impact during resuscitation (53.7% urban and 36.8% suburban; p=0.061). Urban providers more often reported feeling threatened by family members during resuscitation (66.7% versus 39.7%; p=0.003), and felt that family often interfered with their ability to perform resuscitations (35.6% versus 16.4%, p=0.014). CONCLUSIONS: EMS providers have substantial experience with family witnessed resuscitations, are uncomfortable about their presence, and often must provide support for families. While urban providers tended to report more negative experiences and perceptions, there were minimal differences between the two groups.

Adult↗
PubMed2006

The relationship between the hospital setting and perceptions of family-witnessed resuscitation in the emergency department.

OBJECTIVE: To compare the support for, and perceptions of, family-witnessed resuscitation (FWR) in urban and suburban emergency departments (ED). METHODS: A convenience sample of ED personnel from two urban and two suburban midwestern hospitals in the United States were surveyed. Survey questions assessed respondents' opinions and experiences regarding the presence of family members during a resuscitation attempt. Data analysis was conducted using descriptive statistics, 95% confidence intervals (CI), and chi2 tests. RESULTS: There were 218 respondents to the survey (108 urban, 110 suburban) of which the majority (63.3%) were female, and a mean (S.D.) age of 36.9 (10.2). The majority [131 (60.1%)] were health care providers (i.e. physicians, nurses, and physician assistants) while the remainder included support staff (i.e. security, pastoral care, and social workers). Half (50.9%; 95% CI: 44.3-57.6) of all ED personnel felt it was appropriate for an escorted family member to be allowed to be present during a resuscitation attempt. However, ED personnel of urban settings were less likely to support FWR (38.9% urban versus 62.7% suburban; p < 0.001). Likewise, fewer urban than suburban personnel thought that the psychological impact of witnessing a failed resuscitation attempt would be beneficial for a family member (37.6% versus 61.7%; respectively, p = 0.001). Of note, a minority, yet substantial percentage of all ED personnel believed that the practice would increase the potential for malpractice litigation (28.7% urban versus 21.8% suburban; p = 0.242). CONCLUSION: Overall, there is divided support among ED personnel for FWR. The hospital setting appears to influence this support strongly, as well as the perceived benefit of FWR.

Adult↗
PubMed2006

CPR training and CPR performance: do CPR-trained bystanders perform CPR?

OBJECTIVES: To determine factors associated with cardiopulmonary resuscitation (CPR) provision by CPR-trained bystanders and to determine factors associated with CPR performance by trained bystanders. METHODS: The authors performed a prospective, observational study (January 1997 to May 2003) of individuals who called 911 (bystanders) at the time of an out-of-hospital cardiac arrest. A structured telephone interview of adult cardiac-arrest bystanders was performed beginning two weeks after the incident. Elements gathered during interviews included bystander and patient demographics, identifying whether the bystander was CPR trained, when and by whom the CPR was performed, and describing the circumstances of the event. If CPR was not performed, we asked the bystanders why CPR was not performed. Logistic regression was used to calculate odds ratios and 95% confidence intervals (95% CI) for factors associated with CPR performance. RESULTS: Of 868 cardiac arrests, 684 (78.1%) bystander interviews were completed. Of all bystanders interviewed, 69.6% were family members of the victims, 36.8% of the bystanders had more than a high-school education, and 54.1% had been taught CPR at some time. In 21.2% of patients, the bystander immediately started CPR, and in 33.6% of cases, someone started CPR before the arrival of emergency medical services (EMS). Important overall predictors of CPR performance were the following: witnessed arrest (OR = 2.3; 95% CI = 1.4 to 3.8); bystander was CPR trained (OR = 6.6; 95% CI = 3.5 to 12.5); bystander had more than a high-school education (OR = 2.0; 95% CI = 1.2 to 3.1), or arrest occurred in a public location (OR = 3.1; 95% CI = 1.7 to 5.8). These variables were significant predictors of CPR performance among CPR-trained bystanders, as was CPR training within five years (OR = 4.5; 95% CI = 2.8 to 7.3). Common reasons that the CPR-trained bystanders cited for not performing CPR were the following: 37.5% stated that they panicked, 9.1% perceived that they would not be able to do CPR correctly, and 1.1% thought that they would hurt the patient. Surprisingly, only 1.1% objected to performing mouth-to-mouth resuscitation. CONCLUSIONS: A minority of CPR-trained bystanders performed CPR. CPR provision was more common in CPR-trained bystanders with more than a high-school education and when CPR training had been within five years. Previously espoused reasons for not doing CPR (mouth-to-mouth, infectious-disease risk) were not the reasons that bystanders cited for not doing CPR. Further work is needed to maximize CPR provision after CPR training.

Adult↗
PubMed2006

The knowledge and perceptions of medical personnel relating to outcome after cardiac arrest.

OBJECTIVE: We sought to evaluate the knowledge of probable outcome by medical personnel for in-hospital and out-of-hospital cardiac arrests, and self-reported history of CPR training referrals for family members of cardiac patients. METHODS: One hundred people from each of three population lists were randomly selected at a large, urban school of medicine and affiliated medical center: (1) year III and IV medical students; (2) residents in family medicine, emergency medicine, internal medicine, anesthesia, and surgery; (3) attending physicians in the same departments. A questionnaire was distributed that elicited estimates of in-hospital and out-of-hospital cardiac arrest (IHCA and OHCA, respectively) survival rates, and CPR training referral history. Estimates were compared against published data for accuracy (IHCA: 5-20%; OHCA 1-10%) RESULTS: The overall response rate was 63%. Accurate in-hospital cardiac arrest estimates [% (95% CI)] of survival were provided by 51.1% (36.8-63.4%), 47.3% (35.9-58.7%), and 36.7% (23.2-50.2%) of students, residents, and attending physicians, respectively. Accurate out-of-hospital estimates of survival were provided by 51.1% (36.8-63.4%), 52.1% (40.6-63.5%), and 70.8% (57.9-83.7%), respectively. Most thought that family members of cardiac patients ought to be CPR trained (92.6%). However, few had referred any for training in the past year (16.5%). There was strong support across respondent groups for including death notification information in the ACLS training program, with 80.4% of all respondents in favor. CONCLUSIONS: This study demonstrates that medical experience is not associated with accurate estimates of cardiac arrest survival. Overwhelmingly, medical personnel believe family members should be trained to perform CPR, however, few refer family members for CPR training.

Attitude of Health Personnel↗
PubMed2005

Workplace violence: a survey of emergency physicians in the state of Michigan.

STUDY OBJECTIVE: We seek to determine the amount and type of work-related violence experienced by Michigan attending emergency physicians. METHODS: A mail survey of self-reported work-related violence exposure during the preceding 12 months was sent to randomly selected emergency physician members of the Michigan College of Emergency Physicians. Work-related violence was defined as verbal, physical, confrontation outside of the emergency department (ED), or stalking. RESULTS: Of 250 surveys sent, 177 (70.8%) were returned. Six were blank (3 were from retired emergency physicians), leaving 171 (68.4%) for analysis. Verbal threats were the most common form of work-related violence, with 74.9% (95% confidence interval [CI] 68.4% to 81.4%) of emergency physicians indicating at least 1 verbal threat in the previous 12 months. Of the emergency physicians responding, 28.1% (95% CI 21.3% to 34.8%) indicated that they were victims of a physical assault, 11.7% (95% CI 6.9% to 16.5%) indicated that they were confronted outside of the ED, and 3.5% (95% CI 0.8% to 6.3%) experienced a stalking event. Emergency physicians who were verbally threatened tended to be less experienced (11.1 versus 15.1 years in practice; mean difference -4.0 years [95% CI -6.4 to -1.6 years]), as were those who were physically assaulted (9.5 versus 13.1 years; mean difference -3.6 years [95% CI -5.9 to -1.3 years]). Urban hospital location, emergency medicine board certification, or on-site emergency medicine residency program were not significantly associated with any type of work-related violence. Female emergency physicians were more likely to have experienced physical violence (95% CI 1.4 to 5.8) but not other types of violence. Most (81.9%; 95% CI 76.1% to 87.6%) emergency physicians were occasionally fearful of workplace violence, whereas 9.4% (95% CI 5.0% to 13.7%) were frequently fearful. Forty-two percent of emergency physicians sought various forms of protection as a result of the direct or perceived violence, including obtaining a gun (18%), knife (20%), concealed weapon license (13%), mace (7%), club (4%), or a security escort (31%). CONCLUSION: Work-related violence exposure is not uncommon in EDs. Many emergency physicians are concerned about the violence and are taking measures, including personal protection, in response to the fear.

Emergency Service, Hospital↗
PubMed2005

The case for practical clinical trials in psychiatry.

OBJECTIVE: Clinical trials in psychiatry frequently fail to maximize clinical utility for practicing clinicians, or, stated differently, available evidence is not perceived by clinicians (and other decision makers) as sufficiently relevant to clinical practice, thereby diluting its impact. To attain maximum clinical relevance and acceptability, researchers must conduct clinical trials designed to meet the needs of clinicians and others who are making decisions about patients' care. The authors present the case for psychiatry's adoption of the practical clinical trials model, which is widely used in research in other areas of medicine. METHOD: The authors outline the characteristics and scope of practical clinical trials, give examples of practical clinical trials, and discuss the challenges of using the practical clinical trials model in psychiatry, including issues of funding. RESULTS: Practical clinical trials, which are intended to provide generalizable answers to important clinical questions without bias, are characterized by eight key features: a straightforward clinically relevant question, a representative sample of patients and practice settings, sufficient power to identify modest clinically relevant effects, randomization to protect against bias, clinical uncertainty regarding the outcome of treatment at the patient level, assessment and treatment protocols that enact best clinical practices, simple and clinically relevant outcomes, and limited subject and investigator burden. CONCLUSIONS: To implement the practical clinical trials model in psychiatry will require stable funding for network construction and maintenance plus methodological innovation in governance and trial selection, assessment, treatment, data management, site management, and data analytic procedures.

Adolescent↗
PubMed2005

Potential impact of a targeted cardiopulmonary resuscitation program for older adults on survival from private-residence cardiac arrest.

OBJECTIVE: Traditional cardiopulmonary resuscitation (CPR) training programs do not target older adults who are most likely to witness private-residence cardiac arrests and do not reliably result in a bystander who is likely to perform CPR in the event of an arrest. This study was performed to compare targeted CPR training programs for older adults (older than 50 years) that 1) increase numbers of CPR-trained bystanders of private-residence cardiac arrest or 2) increase the percentage of trained bystanders of private-residence cardiac arrest who perform CPR. A simultaneous outcome was to estimate the minimal significant survival benefit associated with each of the training programs. METHODS: A probabilistic simulation model was developed in Fortran95 that incorporated key out-of-hospital cardiac arrest elements, including witnessed arrests, CPR-trained witness, CPR provision, and impact of CPR on ventricular fibrillation. Input data were derived from published or publicly available data, including a large prospective cohort study of outcomes in Oakland County, MI. Monte Carlo simulation (n = 10,000) and sensitivity analyses (n = 40) were used to assess median and the empiric 95% confidence intervals [CIs] for incremental survival with either intervention. RESULTS: The baseline model, calibrated to the characteristics of the input-data community, established that, for private-residence cardiac arrests, 40.8% of cardiac arrest bystanders were trained in CPR; however, only 25.7% performed CPR. This yielded 4.81% survival (95% CI = 4.72 to 4.89). Modeling the impact on the baseline training level with increased CPR performance among trainees indicated that 75% of private-residence trained bystanders would need to perform CPR in order to reach a minimally significant improvement in survival (5.02%; 95% CI = 4.94 to 5.15). Similarly, targeted CPR training that would result in a significant survival benefit (to 5.01%; 95% CI = 4.93 to 5.09) would require that 70.8% of bystanders be trained. CONCLUSIONS: CPR training programs that focus on yielding 75% of trainees who perform CPR in the event of witnessing an arrest would have equivalent results to mass CPR training programs that result in 70% of bystanders being trained in CPR. However, the minimal survival benefit associated with these programs (around 0.2%) may prove either method costly with minimal effect.

Aged↗
PubMed2004

The Child and Adolescent Psychiatry Trials Network (CAPTN).

OBJECTIVE: The current generation of clinical trials in pediatric psychiatry often fails to maximize clinical utility for practicing clinicians, thereby diluting its impact. METHOD: To attain maximum clinical relevance and acceptability, the Child and Adolescent Psychiatry Trials Network (CAPTN) will transport to pediatric psychiatry the practical clinical trials model widely used in other areas of medicine. RESULTS: CAPTN, a collaborative effort of the Duke Clinical Research Institute and the American Academy of Child and Adolescent Psychiatry, will conduct large, simple "practical" trials that provide generalizable answers to important clinical questions without bias. "Large" in this case means the random allocation of thousands of patients in hundreds of clinical centers to different treatments as they are delivered in community settings. "Simple" means that the number and type of data elements (and, hence, subject and investigator burden) is small and straightforward so as not to discourage provider or patient participation and to maximize the number of subjects per dollar spent. CONCLUSION: With 200 to 400 child and adolescent psychiatrists each participating in two or three practical clinical trials over 4 years, CAPTN promises to advance both the evidence base and research capacity in child and adolescent psychiatry.

Adolescent↗
PubMed2003

A randomized controlled trial of chest compression only CPR for older adults-a pilot study.

UNLABELLED: Older people are trained infrequently in cardiopulmonary resuscitation (CPR), yet are more likely to witness a cardiac arrest. Older people who are CPR trained perform CPR when witnessing a cardiac arrest. OBJECTIVE: To assess whether elderly adults (>55 years) who receive chest-compression only cardiopulmonary resuscitation (CC-CPR) training display equivalent skill retention rates compared with those who receive traditional CPR instruction. We also identified factors associated with 3 months skill retention at 3 months in both groups. METHODS: Older adults in a suburban hospital Older Adult Services program were invited to participate in an experimental CPR course. The 2 h course was modelled after the AHA Friends and Family course, and used one of two standardized video scenarios. Seventy four subjects were randomized to CC-CPR (n=36) or traditional CPR (n=38) training. Participation consisted of initial training, followed by a 3 months return videotaped assessment. Three months skill competence was assessed either by consensus between two video evaluators, or the on-site evaluator. Chi square and Kappa tests were used for analysis, and unadjusted odds ratios and 95% confidence intervals are reported. RESULTS: Skill retention assessments were completed on 29 (81%) CC-CPR and 26 (68%) CPR trainees. Subjects were elderly (71.5+/-6.69 years), and had a high rate of previous CPR training (58.0%). Groups were similar in demographic characteristics. After training, participants exhibited high rates of perceived competence (86.4%), although the overall 3 months skill retention was low (43.6%). CC-CPR training resulted in equivalent skill retention rates as compared with traditional CPR training (51.7 vs. 44.4%; P=0.586). No participant factors were associated with skill retention, including age, previous CPR training, education level, medical history, or perceived physical ability to perform. CONCLUSION: We identified low rates of CPR skill retention in this elderly population. CC-CPR instruction was associated with equivalent skill retention rates compared with traditional CPR instruction. No demographic factors were associated with successful skill retention.

Aged↗
PubMed2003

The use and effectiveness of an emergency department observation unit for elderly patients.

STUDY OBJECTIVE: Emergency department observation units are cost-effective alternatives to hospital admission for selected patients. However, the use and effectiveness of these units in the elderly population is unclear. We sought to describe the use of an ED observation unit by elderly patients (>or=65 years), to determine whether the ED observation unit is effective for them in terms of ED observation unit length of stay and hospital admission rates, and to compare efficacy and return visit rates between younger and older patients. METHODS: This is a retrospective observational cohort study of consecutive adult patients sent to an ED observation unit from 1996 to 2000 at a high-volume tertiary care suburban teaching hospital. ED observation unit length of stay of less than 18 hours and admittance rates of less than 30% were used as indicators of efficacy. Diagnosis, length of stay, hospital admission rates, and 30-day return visit rates were compared between younger and older patients. RESULTS: Twenty-two thousand five hundred and thirty adult patients were observed, with 37.2% older than 65 years of age. The most common diagnoses in elderly patients were chest pain (24.0%), dehydration (11.7%), syncope (6.5%), back pain (4.6%), and chronic obstructive pulmonary disease (3.8%). Length of stay in the ED observation unit was longer for the elderly than younger patients but still averaged less than 18 hours (15.8 hours [95% confidence interval (CI) 15.7 to 16.0] versus 14.4 hours [95% CI 14.3 to 14.5], respectively). Elderly patients were more likely to be admitted from the ED observation unit than younger patients (26.1% versus 18.5%); however, their overall admission rate remained less than 30%. Compared with younger patients, the odds ratios for inpatient admission of elderly patients was highest for back pain (2.10; 95% CI 1.62 to 2.73), pyelonephritis (1.78; 95% CI 1.16 to 2.71), and chest pain (1.65; 95% CI 1.44 to 1.89). Thirty-day related return visit rates between age groups were similar (9.4% versus 7.6%). CONCLUSION: Elderly ED observation unit patients had ED observation unit lengths of stay and hospital admission rates that were effective for an ED observation unit setting and ED return visits rates that were comparable with those of younger patients.

Adult↗
PubMed2003

Searching for moderators and mediators of pharmacological treatment effects in children and adolescents with anxiety disorders.

OBJECTIVE: To examine whether age, gender, ethnicity, type of anxiety disorder, severity of illness, comorbidity, intellectual level, family income, or parental education may function as moderators and whether treatment adherence, medication dose, adverse events, or blinded rater's guess of treatment assignment may function as mediators of pharmacological treatment effect in children and adolescents with anxiety disorders. METHOD: The database of a recently reported double-blind placebo-controlled trial of fluvoxamine in 128 youths was analyzed. With a mixed-model random-effects regression analysis of the Pediatric Anxiety Rating Scale total score, moderators and mediators were searched by testing for a three-way interaction (strata by treatment by time). A two-way interaction (strata by time) identified predictors of treatment outcome. RESULTS: No significant moderators of efficacy were identified, except for lower baseline depression scores, based on parent's (but not child's) report, being associated with greater improvement (p < .001). Patients with social phobia (p < .05) and greater severity of illness (p < .001) were less likely to improve, independently of treatment assignment. Blinded rater's guess of treatment assignment acted as a possible mediator (p < .001), but improvement was attributed to fluvoxamine, regardless of actual treatment assignment. Treatment adherence tended to be associated (p = .05) with improvement. CONCLUSIONS: In this exploratory study, patient demographics, illness characteristics, family income, and parental education did not function as moderators of treatment effect. Social phobia and severity of illness predicted less favorable outcome. Attribution analyses indicated that study blindness remained intact. The presence of concomitant depressive symptoms deserves attention in future treatment studies of anxious children.

Adolescent↗
PubMed2003

Perceived self-efficacy in performing and willingness to learn cardiopulmonary resuscitation in an elderly population in a suburban community.

BACKGROUND: Older persons are the group most likely to respond to cardiac arrests in private residences. OBJECTIVE: To characterize the knowledge about, attitudes toward, and perceived self-efficacy of older persons in learning and providing cardiopulmonary resuscitation. METHODS: A total of 2743 surveys were mailed to adults 55 years and older who resided in a single Michigan suburb. Data were collected on demographics, medical history, training in and willingness to provide cardiopulmonary resuscitation, and concerns about providing this intervention. RESULTS: The 631 persons (24.6%) who responded were elderly (mean age, 73.5 years) and had a mean of 1.7 occupants per household. More than one third lived alone. Of all respondents, 275 (43.6%) had received training in cardiopulmonary resuscitation, 370 (58.6%) indicated a willingness to learn cardiopulmonary resuscitation, and 412 (65.3%) thought that they had the ability to perform this intervention. Respondents 80 years or younger were significantly more likely than respondents more than 80 years old to be willing to learn cardiopulmonary resuscitation (65.7% vs 19.0%, P < .001) and perceived themselves as able to perform it (73.0% vs 34.0%, P < .001). The absence of mouth-to-mouth ventilation as part of training had minimal impact on the willingness of either age group to receive training (61.2% vs 58.6%, P = .19). Perceived ability to learn and perform cardiopulmonary resuscitation did not vary with the medical history of the respondent or the respondent's spouse. CONCLUSION: Adults 56 to 80 years old perceive themselves as able to perform cardiopulmonary resuscitation and are interested in receiving training.

Aged↗
PubMed2002

Estimated cost effectiveness of a police automated external defibrillator program in a suburban community: 7 years experience.

OBJECTIVE: To estimate the cost effectiveness of a 7-year police automatic external defibrillator (AED) program in four suburban communities. METHOD: 10-year retrospective study (7/89-7/99) of patients of four suburban communities during two study periods: (1) police first response and advanced life support (ALS) care (No-AED) and; (2) AED equipped police first response (P-AED) with subsequent ALS care. Using the perspective of the communities, we obtained costs of AED program from police agencies. We estimated cost/life saved and cost/year lives saved using decreased time to VF shock by EMS. We performed a sensitivity analysis for estimates of potential benefit using estimated improved survival as a result of decreased EMS response interval and obtained survival data. We used literature-based estimates of life expectancy after cardiac arrest survival to estimate cost/year life saved. We used student's t-test and chi(2) to estimate differences between groups. RESULTS: During the 10-year study period 208 patients met study criteria; (81 No-AED, 128 P-AED). The two groups were not different by patient age, ALS response interval, percent in VF, percent witnessed (WIT), or arrest location. Interval to first defibrillator equipped EMS vehicle arrival was less in the P-AED group (2.0 vs. 5.4 min, P<0.001) as was the interval from the emergency (911) call to first VF shock (6.6 vs. 8.4 min, P=0.02). Survival to DC was not statistically different with P-AED (11.9 vs. 9.9%, P=0.66) but this study was not powered to detect a difference. Estimated cost per life saved with P-AED varied from $23542 to $70342 and cost per year life saved ranged from $1582 to $16060. CONCLUSION: Police AED appears to be a cost-effective intervention in these suburban communities which have relatively rapid EMS response intervals.

Aged↗
PubMed2002

Painful discrimination: the differential use of analgesia in isolated lower limb injuries.

Our primary objective was to compare use of analgesia for patients with and without fracture as a result of isolated lower extremity trauma, in the emergency department (ED). Our secondary objective was to compare the analgesic practices of emergency physicians (EPs) with that of physician assistants (PAs). We performed a prospective, blinded cohort study with the presence of fracture as the risk factor and provision of any pain medication while in the ED as the primary outcome. Included in the study were all patients who presented to a 90,000 visit suburban teaching hospital with an isolated lower extremity injury who received a radiograph of the foot or ankle over a 9-week period. We excluded patients without trauma, with multiple trauma, admitted, or seen by one of the investigators. Patients admitted and those with multiple trauma were excluded because these patients had contacts with multiple physicians and it is unlikely they would be able to differentiate which physician prescribed medication and if they were emergency personnel. We defined analgesia as any pain medication at any dose. One investigator preformed follow-up interviews using a standardized questionnaire 3 days after the visit. Patients expressed their recollection of their degree of pain using a verbal analog scale of 1 to 10. We report crude and adjusted odds ratios (OR). Of 516 consecutive patients, 111 met exclusion criteria and 3 had incomplete data. Of the remaining 405, we contacted 384 (95%) in an average of 3 +/- 1 days. Patients with and without fractures recalled their initial degree of pain similarly, with the mean initial pain scores on the verbal analog scale of 6.6 +/- 2.5 versus 6.8 +/- 2.1 respectively. Patients with a fracture were more likely to receive pain medication while in the ED (23% v 15% P =.047, OR 1.75 (CI 95% 1.02, 2.99). EPs gave some form of ED analgesia to 29% of patients, as compared with 10% of patients seen by PAs (OR = 3.58 CI 95% 2.05, 6.24). EPs provided a prescription to 44% of patients versus 21% of patients seen by PAs (OR = 2.91 CI 95% 1.85, 4.57). Our estimated adjusted ORs for providing analgesia in the ED were: fracture = 2.0 (CI 95% 1.13, 3.58); EP: 3.52 (CI 95% 1.98, 2.99); and for every additional point on the verbal pain scale: 1.28 (CI 95% 1.11, 1.48). Patients with fracture were more likely to receive pain, despite reporting identical degree of pain. EPs were more likely to provide analgesia than PAs.

Adolescent↗