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Biomedical subjects

T Beattie

Publications and source records attributed to T Beattie.

At least 19 recordsLinked to original sources
PubMed2005

Can we abolish skull x rays for head injury?

OBJECTIVES: To assess the effect of a change in skull x ray policy on the rate of admission, use of computed tomography (CT), radiation dose per head injury, and detection of intracranial injuries; and to compare the characteristics of patients with normal and abnormal head CT. DESIGN: Retrospective cohort study. SETTING: UK paediatric teaching hospital emergency department. PATIENTS: 1535 patients aged between 1 and 14 years with a head injury presenting to the emergency department between 1 August 1998 and 31 July 1999 (control period), and 1867 presenting between 1 August 2002 and 31 July 2003 (first year of new skull x ray policy). INTERVENTION: Hospital notes and computer systems were analysed and data were collected on all patients presenting with a head injury. RESULTS: The abolition of skull x rays in children aged over 1 year prevented about 400 normal skull x rays being undertaken in period 2. The percentage of children undergoing CT rose from 1.0% to 2.1% with no change in the positive CT pick up rate (25.6% v 25.0%). There was no significant change in admission rate (10.9% v 10.1%), and a slight decrease in the radiation dose per head injury (0.042 mSv compared to 0.045 mSv). CONCLUSIONS: Skull x rays can be abandoned in children aged 1 to 14 without a significant increase in admission rate, radiation dose per head injury, or missed intracranial injury. The mechanism and history of the injury and a reduced Glasgow coma scale are probably the most important indicators of significant head injury in children.

Accidents↗
PubMed2005

Imaging infants with head injury: effect of a change in policy.

OBJECTIVE: Head injury is one of the commoner injuries presenting to the emergency department (ED). Infants are hard to assess clinically and emphasis has been placed on radiological examination. Skull radiographs, however, are not a reliable indicator of intracranial injury. As a result of this the policy in this ED was revised so that skull radiographs were only to be performed in those infants less than 1 year with visible evidence of head injury or a suspicious history for non-accidental injury. METHODS: Retrospective cohort study of all infants less than 1 year who presented with head trauma to the ED of a paediatric teaching hospital between 1 August 1998 and 31 July 1999, and between 1 August 2002 and 31 July 2003. Hospital notes and radiology computer systems were examined and data were collected and analysed. RESULTS: 181 infants aged less than 1 year presenting to the ED in 1998/9 and 190 infants in 2002/3. Altogether 140 (77.3%) infants had a skull radiograph in 1998/9, five (3.6%) identified skull fractures. During 2002/3, 56 (29.5%) infants had a radiograph, a reduction of 47.5%, of which three (5.4%) had skull fractures. All fractures had reported haematomas to their scalp. The change in policy decreased the total radiation dose to the population by 9.4 mSv. No significant injuries were missed as a result of the change in policy. INTERPRETATION: In infants under 1 year, unless non-accidental injury is suspected, it is suggested that skull radiographs should only be performed when there are visible signs of a head injury.

Clinical Protocols↗
PubMed2002

A randomised, controlled trial comparing a tissue adhesive (2-octylcyanoacrylate) with adhesive strips (Steristrips) for paediatric laceration repair.

OBJECTIVE: To compare the tissue adhesive 2-octylcyanoacrylate (Dermabond) with adhesive strips, Steristrips in paediatric laceration repair. METHOD: Children with suitable lacerations were randomly allocated for wound closure with either a tissue adhesive or adhesive strips. Thirty children were treated in each group. Linear Visual Analogue Scores were used to judge parents' and nurses' opinions of the application of each treatment. A similar scoring system was used to judge the cosmetic outcome as viewed by parents and a plastic surgeon. Complications and trial failures were noted. RESULTS: Complete data were available for 44 of the children. Parents viewed the treatments as equally acceptable. In contrast those performing the procedure judged the tissue adhesive more difficult to apply. Scores of cosmetic outcome by both parents and the plastic surgeon showed no significant difference in the treatment method used. There were four children in the tissue adhesive group and one from the adhesive strip group in whom the wounds were unable to be closed. CONCLUSION: Both tissue adhesives and adhesive strips are excellent "no needle" alternatives for the closure of suitable paediatric lacerations. This study suggests that the techniques are similar in efficacy, parental acceptability, and cosmetic outcome. The choice as to which is used may come down to economics and operator preference.

Child↗
PubMed2002

Management of febrile children in a paediatric emergency department.

OBJECTIVES: To study the determinants and appropriateness of hospitalisation of febrile children in a paediatric emergency department. DESIGN: An observational prospective study. SETTING AND SUBJECTS: Patients presenting to the emergency department of the Edinburgh Royal Hospital for Sick Children over nine consecutive weeks. METHODS: Clinical and laboratory data were collected from patients presenting with an infectious illness. A three point scale was used to assess both the degree of severity of illness and the probability of bacteraemic illness. Patients who received the following therapies in hospital were identified: intravenous antibiotics, intravenous fluids, oxygen therapy, upper airway suctioning or nasogastric feeding. The clinical and laboratory characteristics of patients admitted to the hospital were studied. RESULTS: A third of the five thousand and twenty one patients seen presented with an infectious illness. Of these, 42% were febrile, while 22% had a high temperature (> 38.5 degrees C). Forty one per cent were hospitalised and of these only 44% received one or more of the treatments mentioned above. Only the illness-severity--score predicted the requirement for such treatment. This clinical scoring was also a powerful predictor of bacterial infection. The positive predictive value of a high temperature (> 38.5 degrees C) in predicting bacterial infection was 40%. The negative and positive predictive values for neutrophilia (> 10 x 10(9)/1) were 47% and 77% respectively. Forty three per cent of the admitted patients were investigated with blood culture and 2.5% of blood cultures were positive for a pathogenic organism. There were no Hib isolates. The positive and negative predictive values of a high temperature for bacteraemic illness were 5% and 99% respectively. CONCLUSION: A large proportion of paediatric patients is perhaps unnecessarily hospitalised. Inappropriate hospitalisation may be prevented by the development and implementation of guidelines based on objective criteria. Enhancement of the role of ambulatory paediatrics in the care of febrile children may be more cost-effective than anticipatory hospitalisation.

Adolescent↗
PubMed1999

Systemic hormonal, electrolyte, and substrate changes after non-thermal limb injury in children.

Relatively little is known regarding the hormonal changes after injury in children. Adult protocols are often applied to children, although the latter often have different physiological responses to trauma. Twenty children with an angulated displaced fracture of the radius and/or ulna (injury severity score 9) were studied prospectively for changes in adrenaline, noradrenaline, cortisol, angiotensin II, arginine vasopressin, urea, electrolytes, and glucose. Two blood samples were taken: one an arrival at the accident and emergency department and one preoperatively several hours later. There were marked increases in adrenaline, noradrenaline, cortisol, and arginine vasopressin above the normal range. Five (25%) cases demonstrated greater early increases in adrenaline than those reported for adult injuries of similar severity. Early hypokalaemia in four cases had corrected towards normal within a few hours, without potassium supplementation.

Adolescent↗
PubMed1999

Seven year follow up of children presenting to the accident and emergency department with irritable hip.

OBJECTIVE: To assess an established protocol for managing children with irritable hip in the accident and emergency department. METHODS: Retrospective seven year follow up of all children managed under an established hip pain protocol. The main outcome measure was of failure of the protocol to identify serious pathology. RESULTS: A total of 103 children met the criteria for assessment using the protocol. Sixty were allowed home, and outpatient follow up arranged. All of these children except one were diagnosed as having transient synovitis. This child had Perthes' disease and was diagnosed at first presentation. Forty three children were admitted, with eight subsequently having a diagnosis other than transient synovitis of the hip. It was possible to review 80 children seven years later. Of these children no long term problems were encountered. CONCLUSION: The protocol used in the department for children with irritable hip is successful in identifying those children with transient synovitis of the hip, or other benign causes, and therefore not requiring hospital admission. Long term follow up showed that no serious pathology was missed.

Adolescent↗
PubMed1999

Subtyping of high-level plasmid-mediated tetracycline resistant Neisseria gonorrhoeae isolated in Scotland between 1992 and 1998.

Tetracycline resistant Neisseria gonorrhoeae (TRNG) contain a 25.2 MDa TetM plasmid encoding a 68 KDa cytoplasmic protein which confers high-level tetracycline resistance. The aim of this study was to subtype all TRNG isolated in Scotland between 1992 and 1998. Subtyping was performed by a polymerase chain reaction (PCR) assay which characterizes the TetM plasmid as either the Dutch variant (443 base pair product) or the American variant (777 base pair product). Of the 78 TRNG isolates, 35 were the American variant and 43 were the Dutch variant. TRNG were distributed amongst 30 serovar/auxotype classes, the most common being 1A6/NR (11.5%), 1A6/P (14.1%) and 1B4/NR (14.1%). The country where infection was acquired was known for 36 of the 46 TRNG strains isolated between 1996 and 1998. All infections acquired in Asia and South America were the Dutch variant whereas all infections acquired in Africa were the American variant. A penicillinase plasmid was present in 66% (23/35) of the American variant TRNG compared with 51% (22/43) of the Dutch variant: the 3.2 MDa penicillinase plasmid was found in 87% of the American variant TRNG whereas the 4.4 MDa penicillinase plasmid was found in 68% of the Dutch variant TRNG. We conclude that subtyping of TRNG by PCR is a useful tool in studying the epidemiology of gonococcal infection due to plasmid-mediated resistant isolates.

Bacterial Typing Techniques↗
PubMed1999

Injuries in the adolescent population in Scotland: patterns and types of injuries sustained.

OBJECTIVE: To provide information on the incidence, sex distribution, type, site and severity of injuries requiring medical attention reported in a nationally representative sample of Scottish teenagers studied longitudinally. DESIGN: Health visitors administered structured interviews with parents (usually mothers). Quantitative data were analysed using SPSS-PC, and qualitative and textual data were coded using the Abbreviated Injury Score (AIS). SETTING: Scotland. SUBJECTS: Responses were received in respect of 958 (68%) of the estimated 1,416 teenagers enrolled in the British Cohort Study (BCS 70), and resident in Scotland in 1986/7. RESULTS: 43% of subjects were reported as having experienced one or more unintentional injury events requiring medical attention between the ages of 10 and 16/17. Boys experienced significantly more injuries than girls. Neither social class nor region appeared to be a significant risk factor for reported injury. CONCLUSION: Patterns of accidents in Scottish adolescents are reported. Further areas for study are suggested.

Adolescent↗
PubMed1997

Seat restraint use, previous driving history, and non-fatal injury: quantifying the risks.

AIMS: To quantify the increased risk of non-fatal injury when children travel unrestrained in a car, and to identify other preventable risk factors. METHODS: Case-control study of 78 children presenting to an accident and emergency (A&E) department having sustained an injury while travelling in a car, and 97 children attending an A&E outpatient clinic with conditions unrelated to road traffic accidents. RESULTS: Seat restraint was associated with a 93% lower risk of child accident injury. A driver with points on the licence was over five times more likely to have had an accident resulting in child injury than a driver without points. Child accident injury was also associated with the driver's accident history. CONCLUSIONS: These data allow the effect of achieving new target levels of seat restraint use to be estimated. Strategies aimed at reducing the risk of further accident among drivers with a history of accident may have a beneficial impact on childhood accident injuries.

Accidents, Traffic↗
PubMed1996

A computer model of major haemorrhage and resuscitation.

An interactive computer model is described which uses 'blood volume deficit' and 'bleeding duration' together with rates of infusion to simulate the first two hours of haemorrhage. It allows multiple infusions of various fluids to be specified and includes an estimation of the volumes added by the transcapillary refill mechanism. The output is expressed graphically in terms of blood pressure and haematocrit at intervals of one minute. This computer model has proved useful for assessing the effects of a range of variables in hypovolaemic shock. It has considerable potential for investigating the relative efficacy of various clinical protocols and could provide an alternative to animal experimentation which has so far been the primary method of obtaining data on acute haemorrhage. It is also a useful teaching aid.

Animals↗
PubMed1996

Incidence and distribution of injury among schoolchildren aged 11-15.

OBJECTIVES: To measure the incidence and age and sex distribution of self reported experience of injuries in the preceding 12 month period among a representative national sample of Scottish schoolchildren and to validate the findings against other data sources. DESIGN: Self completed questionnaire administered in schools, April-June 1994. SUBJECTS: 4710 pupils aged 11, 13, and 15 years drawn from a representative sample of 270 classes with returns from 224 classes (83.2% completion rate). OUTCOME MEASURES: Number, type, site, and severity of injuries reported. RESULTS: 41.9% of pupils reported a medically attended injury, with injury incidence significantly higher in boys than in girls. Using the abbreviated injury scale (maximum abbreviated injury score) one third of injuries were either moderate or severe. CONCLUSION: The incidence and distribution of self reported injury is consistent with estimates based on other data sources thus confirming the utility of this method of injury surveillance in this age group.

Accidents↗
PubMed1996

Left-handedness increases injury risk in adolescent girls.

In a self-report survey of a representative national sample of 4081 Scottish schoolchildren, injuries requiring medical assistance were more common in left-handers; these were also more severe and likely to involve an overnight stay in hospital. Particularly at risk were adolescent girls with a 32% greater chance of being injured if they were left-handed compared with their right-handed peers. The corresponding relative risk for boys was not significant.

Adolescent↗
PubMed1994

Factor VIIIa A2 subunit residues 558-565 represent a factor IXa interactive site.

Factor VIIIa is a non-covalent heterotrimer of A1, A2, and A3-C1-C2 subunits. Previously, we speculated that the central portion of the A2 subunit, in and around the activated protein C-sensitive bond at Arg562-Gly (Fay, P. J., Smudzin, T.M., and Walker, F.J. (1991) J. Biol. Chem. 266, 20139-20145), is important for macromolecular interactions within the factor Xase enzyme complex. A peptide corresponding to factor VIII residues 558-565, SVDQRGNQ and designated FVIII558-565, was chemically synthesized and inhibited factor Xa generation in a purified system with an apparent KI of 105 microM. Tryptic cleavage of FVIII558-565 eliminated its inhibitory activity, whereas a scrambled sequence version of the peptide possessed < 30% the inhibitory activity of the native version. Overlapping peptides FVIII556-564 and FVIII561-569 were also inhibitory and confirmed the importance of residues in and around the scissile bond for functional factor Xase. Kinetic analysis revealed that peptide-mediated inhibition was non-competitive with respect to factor X. However, increasing factor IXa concentration overcame the observed inhibition. Furthermore, the peptide inhibited the factor IXa-dependent enhancement of factor VIIIa reconstituted from isolated A1/A3-C1-C2 dimer plus A2 subunit. Isolated factor VIII heavy chain (contiguous A1-A2 domains) was cleaved at Arg336 by an equimolar concentration of factor IXa in a reaction that was phospholipid-independent. No proteolysis of the isolated A1 subunit was observed in a similar reaction. These results indicate that the A2 subunit sequence delineated by residues 558-565 contributes to the interaction of cofactor with protease and that this interaction is essential for intrinsic factor Xase activity. Furthermore, that this peptide blocks both factor Xase activity and the capacity of factor IXa to stabilize the labile factor VIIIa heterotrimer suggest that this latter property is of physiologic significance.

Amino Acid Sequence↗