Biomedical subjects

Scott Compton

Publications and source records attributed to Scott Compton.

21 records · Page 2Linked to original sources

PubMed2002

Untreated hypercholesterolemia in an emergency department chest pain observation unit population.

OBJECTIVES: To describe the prevalence of hypercholesterolemia in a predominantly African American, innercity chest pain observation unit (CPOU) patient population, and to estimate the percentage of patients eligible for cholesterol-lowering therapy as indicated by the 2001 National Cholesterol Education Program guidelines. METHODS: A cross-sectional study design utilizing a convenience sample of patients from a high-volume urban hospital CPOU. Patients with chest pain suspicious of cardiac etiology who had negative initial electrocardiograms and cardiac markers were assigned to the chest pain protocol. Consenting subjects were screened for hypercholesterolemia through capillary blood point-of-care testing with a cutoff of 190 mg/dL. Those who tested positive had four-hour fasting complete lipid profiles performed by the central laboratory. RESULTS: There were 112 patients enrolled in this study (mean age = 51 years; 57% male; and 83% African American). Elevated values on the screening test were obtained on 28 [25%; 95% confidence interval (95% CI) = 16.9 to 33.0] of these patients. These patients were found to have a mean four-hour fasting total cholesterol level of 224 mg/dL, a low-density lipoprotein (LDL) level of 138 mg/dL, a high-density lipoprotein (HDL) level of 52 mg/dL, and a triglyceride level of 168 mg/dL. Of the patients identified through the screening test, 54% proved eligible for cholesterol-lowering medications and 91.7% of these patients reported an interest in initiating therapy. CONCLUSIONS: In this study, approximately 25% of inner-city CPOU patients are possible candidates for cholesterol-lowering interventions. Benefits of initiating therapy during this potential "teachable moment" in a CPOU should be investigated in a subsequent multicenter randomized trial.

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PubMedDate not supplied

Estimating cost-effectiveness of mass cardiopulmonary resuscitation training strategies to improve survival from cardiac arrest in private locations.

INTRODUCTION: Most cardiopulmonary resuscitation (CPR) trainees are young, and most cardiac arrests occur in private residences witnessed by older individuals. OBJECTIVE: To estimate the cost-effectiveness of a CPR training program targeted at citizens over the age of 50 years compared with that of current nontargeted public CPR training. METHODS: A model was developed using cardiac arrest and known demographic data from a single suburban zip code (population 36,325) including: local data (1997-1999) regarding cardiac arrest locations (public vs. private); incremental survival with CPR (historical survival rate 7.8%, adjusted odds ratio for CPR 2.0); arrest bystander demographics obtained from bystander telephone interviews; zip code demographics regarding population age and distribution; and 12.50 dollars per student for the cost of CPR training. Published rates of CPR training programs by age were used to estimate the numbers typically trained. Several assumptions were made: 1) there would be one bystander per. arrest; 2) the bystander would always perform CPR if trained; 3) cardiac arrest would be evenly distributed in the population; and 4) CPR training for a proportion of the population would proportionally increase CPR provision. Rates of arrest, bystanders by age, number of CPR trainees needed to result in increased arrest survival, and training cost per life saved for a one-year study period were calculated. RESULTS: There were 24.3 cardiac arrests per year, with 21.9 (90%) occurring in homes. In 66.5% of the home arrests, the bystander was more than 50 years old. To yield one additional survivor using the current CPR training strategy, 12,306 people needed to be trained (3,510 bystanders aged < or = 50 years and 8,796 bystanders aged > 50 years), which resulted in CPR provision to 7.14 additional patients. The training cost per life saved for a bystander aged < or = 50 years was 313,214 dollars, and that for a bystander aged > 50 years was 785,040 dollars. Using a strategy of training only those < or = 50 years, 583 elders per cardiac arrest would need to be trained, with a cost of 53,383 dollars per life saved. CONCLUSION: Using these assumptions, current CPR training strategy is not a cost-effective intervention for home cardiac arrests. The high rate of elders witnessing CPR mandates focused CPR interventions for this population.

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PubMedDate not supplied

Prehospital on-site triaging.

OBJECTIVE: To estimate the proportion of patients transported by emergency medical services (EMS) who do not need immediate emergency medical care. Secondary objectives were: 1) to evaluate the ability of paramedics to determine hich patients need immediate ambulance transport, and 2) to evaluate on-scene patient characteristics that may aid in developing an EMS transport protocol. METHODS: A prospective cross-sectional study design was utilized to estimate the percentage of low-risk patients eligible for non-ambulance transport among 277 patients transported to an emergency department via ambulance. The EMS personnel prospectively rated each patient as to need for immediate ambulance transport. Physician raters, using predefined criteria, determined eligibility for non-ambulance transport. RESULTS: There were 116 patients (59.2%, 95% CI = 53.4%-65.0%) who were not in need of immediate emergency medical care. Comparison of the EMS personnel's rating with the criterion-standard need for emergency treatment transport yielded a sensitivity of 22.1% (95% CI = 13.9%-30.2%) and a specificity of 80.5% (95%) CI = 72.5%-88.3%). Chief complaints of abdominal pain (OR = 2.94, 95% CI = 1.31-6.60) and administration of oxygen (OR = 2.13, 95% CI = 1.06-4.29) were independently associated with the need for ambulance transport, while young age (OR = 0.28, 95% CI = 0.09-0.90) was negatively associated. CONCLUSIONS: The majority of patients triaged as low-risk were not in need of immediate ambulance transport for emergency medical care. However, EMS personnel, unaided by triage protocols or specific training, could not reliably identify those patients in need of emergency medical treatment, and few factors were identified to assist that decision.

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