Læknablaðið : fylgirit - 15.06.2002, Blaðsíða 9

ABSTRACTS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
ORAL PRESENTATIONS
0 01 - Wounds and other common emergencies
ls non-specific abdominal pain really non-specific?
Akköse S', Atar N’, Özgurer A*, Öcgtigh", Tokyay R"
Uludag University Medical School, Department of Emergency Medicine* and
Department of General Surgery**, Bursa, Turkey
Objective: Abdominal pain with unknown aetiology and which
does not last more than 4 to 6 hours without any specific treatment
is called non-specific abdominal pain. We investigated the fate of
patients who were diagnosed as non-specific abdominal pain in our
emergency department.
Methods: One hundred and eleven patients who were admitted to
our emergency department with abdominal pain between Novem-
ber 20,2001 and January 20,2002 were included in the study. After
having a routine history and physical exam and the necessary
laboratory or radiological tests, patients were diagnosed as having
non-specific abdominal pain if no aetiology was found. Non-specific
abdominal pain patients did not receive any specific treatment
except, occasionally, metamizol, an analgesic. All patients were re-
examined after 24 hours and then at the 8th, 15th, and 30th days
phone calls were made to find out if they still have abdominal pain
or whether they have received any other medical or surgical
treatment since their visit to the Emergency Department.
Results: Eighty three (75%) of the 111 patients with abdominal
pain received a specific diagnosis and 28 (25%) were diagnosed as
non-specific abdominal pain. Twelve of these 28 patients were
female and 16 male and their mean age was 40. At the end of the
one month follow-up period, 23 (82%) of the 28 patients were
found to have no abdominal pain and had not received any other
treatment. The remaining 5 patients (%18) had the following
diagnosis: One had a urinary stone, one had pancreatic carcinoma,
one had familial Mediterranean fever and two had acute appendi-
citis. Our non-specific abdominal pain diagnosis rate was 25% and
our confirmed non-specific abdominal pain diagnosis rate was 21%.
Conclusíon: In the literature, the rate of non-specific abdominal
pain diagnosis in the Emergency Department is 20-40%. Although
our non-specific abdominal pain diagnosis rate is similar to that
cited in the literature, the 18 per cent difference between the
presumed and confirmed diagnosis of non-specific abdominal pain
dictates to us that the patients diagnosed as having non-specific
abdominal pain must be followed up closely to avoid misdiagnosis.
O 02 - Wounds and other common emergencies
Mortality in Emergency Department sepsis
Shapiro N
Belh Israel Deaconess Medical Center. United States
Introduction: As new therapies become available for ED patients
with sepsis syndromes, the ability to accurately predict mortality
risk may help in treatment and triage decisions.
Objectives: 1) To identify independent predictors of death in
patients wilh suspected infection. 2) To derive and validate a
prediction rule for mortality risk.
Methods: Prospective observational, cohort study of ED patients
seen at an urban university hospital between 2/1/00-2/1/01. Conse-
cutive patients, 18 years or older, were included if the ED physician
ordered a blood culture. Patients were randomly assigned to a
derivation or validation set. A multivariate regression model was
created. A clinical prediction rule was developed and tested on
both data sets. ROC areas were calculated.
Rcsults: Of 3,926 eligible patient visits, 3,804 (97%) were enrolled.
There were 2,707 visits in the derivation set with 110 deaths (5.3%)
and 1,109 in the validation set with 63 deaths (5.7%). Independent
multivariate predictors of death were: terminal illness (OR=6.3,
95%CI=3.7-10.4), tachypnea or hypoxia (2.6,1.6-4.2), platelets <
150,000 (2.6,1.6-4.4), bands > 5% (2.3,1.4-3.5), age > 65 (2.3,1.4-3.7),
lower respiratory infection (2.0,1.3-3.2), nursing home residence
(1.9,1.2-3.1), anion gap > 16 (1.8,1.0-3.3), and altered mental status
(1.7,1.1-2.7). The prediction rule stratified patients into mortality
risk groups of very low 0.6% (95% CI, .08-1.2%), low 2.3% (1.0-
3.5%), moderate 8.0% (5.8-10%), high 18% (11-24%), and very
high 51% (37-66%) in the derivation set. Application of the predic-
tion rule to the validation set yielded mortalities of 0.7%, 5%, 9%,
16%, and 38%, respectively. The ROC areas were 0.83 in the
derivation set and 0.79 in the validation set.
Conclusions: In patients with suspected infection, this model identi-
fies significant predictors of death and allows stratification of
patients according to mortality risk. Such rules may help in selec-
ting patients for specific therapies.
O 03 - Ultrasound in the ED
Initial review of clinical investigations by the Sonography
Outcomes Assessment Program
Melniker LA
New York Methodist Hospital, SOAP Consortium, New York, United States
Objectives: Demonstrate whether point-of-care, limited ultrasono-
graphy (PLUS) improves the outcomes of patients. Specifically, to
assess whether obtaining answers to highly focused clinical ques-
tions with the use of PLUS decreases the morbidity, mortality and
cost of caring for patients. To estimate the effect on population
health of PLUS and, if possible, establish the economic justification
for expanding PLUS capabilities to all emergency care facilities.
Methods: The Sonography Outcomes Assessment Program
(SOAP), a consortium of over 30 centers from around the United
States, was formed from 1997-1999. The SOAP Consortium has
developed a series of multicenter clinical trials to assess the
effectiveness of PLUS in improving the outcomes of various patient
populations. SOAP-1 is evaluating trauma patients; SOAP-2 is
evaluating pulseless patients; SOAP-3 will evaluate patients with
complications of early pregnancy; and SOAP-4 will evaluate
patients with non-traumatic abdominal pain. Pilot studies were
completed for the first 3 SOAP clinical trials. SOAP Consortium
members, Drs. Blaivas and Lambert completed a study that was the
model for the design of SOAP-4.
Results: The SOAP-1 pilot revealed trends toward decreased
mortality (6.3 + 4.8 95% CI in PLUS vs. 8.1 + 5.9 95% CI in NON-
PLUS) and ICU-length of stay (2.1d + 1.9 95% CI in PLUS vs. 3.2d
+ 2.2 95%CI in NON-PLUS); and asignificant reduction in the (%)
use of CT &/or DPL (26.6 + 8.9 95%CI in PLUS vs. 57.4 + 17.1
95%CI in NON-PLUS). The SOAP-2 pilot revealed that patients
with sonographically identified organized myocardial activity
Læknablaðið/Fylgirit 45 2002/88 9