J Emerg Med
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There have been conflicting reports regarding the applicability of Trauma Injury Severity Score (TRISS) methodology to evaluate trauma care in a developing country setting. The objective of this study was to apply TRISS methodology to evaluate trauma care in the public hospitals of a Caribbean developing country. A prospective, observational study was conducted in the three major general hospitals in Trinidad. ⋯ The M statistic was 0.98 and the overall Z statistic was 5.81. The ROC curve analysis showed TRISS to be a fair discriminator in the study case-mix with an area under the curve of 0.82 (95% confidence interval 0.69-0.96). There is a considerable disparity between predicted and observed outcomes when trauma patients are evaluated by the TRISS methodology in a developing country setting.
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Review Case Reports
Fever, abdominal pain, and leukopenia in a 13-year-old: a case-based review of meningococcemia.
The presenting symptoms of meningococcemia are protean, and the illness is rapidly progressive and often fatal, making it simultaneously one of the most dangerous and most important illnesses the Emergency Physician can encounter. It attacks the young and it is highly contagious. This report uses one of the many unusual presentations of meningococcemia as a framework for discussing the epidemiology, presentation, diagnosis, and treatment of meningococcal disease.
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Topical anesthetics are found in a variety of prescription and non-prescription preparations, from teething gels to hemorrhoid creams. In 2003, there were 8576 exposures to local/topical anesthetics reported to the American Association of Poison Control Centers, with 67% of cases in the age group younger than 6 years old. This report reviews the available literature involving topical anesthetic exposures in children younger than 6 years old, including the National Library of Medicine's Pub Med database (limited to English language) and data from POISINDEX. ⋯ Toxicity may result from topical absorption, ingestion, or aspiration. Additionally, toxicity can result from unintentional as well as therapeutic mishaps. Although the number of cases is limited, these medications can be toxic at low doses-which, in children younger than 6 years of age, may amount to as little as a teaspoon.
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Existing guidelines for the number of ultrasounds required before clinical competency are based not on scientific study but on consensus opinion. The objective of this study was to describe the learning curve of limited right upper quadrant ultrasound. This was a prospective descriptive study. ⋯ Inclusion of all required images increased after 25 ultrasounds. Sonographers who had performed over 25 ultrasounds showed excellent agreement with the expert over-read, with only two disagreements, both from a single individual. It was concluded that clinicians are clinically competent after performing 25 ultrasounds of the gallbladder.
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Multicenter Study
Prehospital transport time intervals for acute stroke patients.
Recognizing factors that cause prehospital stroke delays may improve time of presentation to the Emergency Department (ED) and allow earlier treatment of acute stroke patients. ⋯ Prehospital scene time and run times for acute strokes are less when there is diagnostic concordance between dispatchers and paramedics. Time intervals did not differ between missed and recognized strokes.