Læknablaðið : fylgirit - 15.06.2002, Blaðsíða 28

POSTERS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
study was performed to determine whether lateral decubitus (LD)
or sitting (S) patient positioning yielded higher success rates.
Methods: This study randomized a convenience sample of emer-
gency department patients of all ages at an urban level one trauma
center in the Southeastern United States who required diagnostic
lumbar puncture. Each was randomized to one of two positions for
initial attempt at obtaining cerebrospinal fluid: lateral decubilus
versus sitting. A sealed research packet contained the initial posi-
tion assignment for each patient. Patient demographics, level of
physician LP experience, and procedural data including number of
attempts, need for repositioning or alternative operator, as well as
results of laboratory studies of the cerebrospinal fluid were recor-
ded. This study was approved by our Institutional Review Board
and informed consent was obtained from each patient.
Results: A total of 115 patients were enrolled over a 1 year period
beginning in April, 2000, with most lumbar punctures performed by
upper level emergency medicine residents having over 30 previous
successful LP's. Fifty-five patients were assigned to LD and sixty to
S position for initial lumbar puncture attempt. Indications for
lumbar puncture included evaluation for infection in 97 (84%) and
exclusion of subarachnoid hemorrhage in 18 (16%). 50 patients
(43%) were under 90 days old, with 39 (34%) over 18 years of age.
Age dislribution as well as procedure indications were very similar
between groups. In the LD assignment group, cerebrospinal fluid
(CSF) was successfully obtained in 48 (87%) versus 52 (87%) in the
S assignment group. Of the 7 initial lailures in the LD group, 5 were
successful when repositioned to S with failure to obtain CSF in 2.
For the 8 initial failures in the S position, 6 had CSF obtained on
conversion to the LD position with 2 failures to obtain CSF. CSF
was obtained from the first needle passage in 35 of 55 (64%) for the
LD group and 33 of the 60 (55%) for the S group (p=NS). For the
successful procedures, CSF contained <100 RBCs in 32 of 53
(60%) in the LD group and 40 of 58 (69%) in the S group (p=NS).
Of the 15 patients where obtaining CSF required reposilioning or
failed, 12 (80%) were under 3 months of age. No patient in this
study was felt to have suffered subarachnoid hemorrhage, bul 27
(23%) had meningitis (93% aseptic).
Conclusions: It is concluded thal lateral decubitus and sitting
position appear to have equal success rates in the emergency
evaluation of patients by lumbar puncture.
P 34 - Neurologic Emergencies
Evaluation of and predictors of admission among 258 spina
bifida patient visits to an emergency department
Caterino J
Allegheny General Hospital. Pittsburgh, PA, USA
Objectives: To provide a descriptive analysis of emergency depart-
ment (ED) presentation, diagnosis, and management of palients
with spina bifida (SB) and to identify factors predictive of increased
likelihood of hospital admission.
Mcthods: A retrospective observational chart review was performed
of SB patients presenting to an urban Level 1 trauma and tertiary
care center ED from 8/91 through 4/99. Inclusion criteria were pre-
sence of SB and primary evaluation by the ED. Subjects were identi-
fied through computerized billing records. Data describing chief
complaint(s), history of present illness, physical findings, lab results,
28 Læknablaðið/Fylgirit 45 2002/88
imaging studies, final diagnosis, and disposition were collected.
Certain variables were analyzed in both univariate and multivariate
analyses to determine their relationship to hospital admission.
Results: One hundred thirty-five patients met entrance criteria.
Records were available for 125 with a total of 258 ED visits. Mean
age at visit was 22.45 years (range 7 weeks to 56 years old). There
were 407 presenting complaints of which fever (n=55), vomiting
(36), headache (32), abdominal pain (23), and urinary tract symp-
toms (20) were most common. There were 335 final diagnoses of
which urinary tract infection (n=55), cellulitis (26), seizure (17),
headache (17), and dehydration (12) were most common. 43% of
ED visits resulted in admission. In the univariate analysis,
predictors of increased likelihood of admission included: presence
of fever (odds ratio [OR], 3.05; 95% confidence interval [CI], 1.71
to 5.36); abnormal vital signs (OR, 3.03; 95% CI, 1.83 to 5.02); and
headache or mental status changes (OR, 2.71; 95% CI, 1.54 to 4.71).
Abnormal leukocyte count (OR, 1.73; 95% CI, 0.73 to 4.09),
abnormal urinalysis (OR, 1.62; 95% CI, 0.77 to 3.39), and abnormal
chest x-ray (OR. 7.00; 95% CI, 0.85 to 56.80)) were not predictive of
admission. Presence of abdominal pain (OR, 0.40; 95% CI, 0.16 to
0.98) was associated with decreased likelihood of admission. In the
multivariate analysis, predictors of increased Iikelihood of admis-
sion were: presence of fever (OR, 2.27; 95% CI 1.20 to 4.32), abnor-
mal vital signs (OR, 2.24; 95% CI 1.27 to 3.97), or headache/mental
status changes (OR, 2.46; 95% CI, 1.35 to 4.47). A diagnosis of
genitourinary disease (OR, 1.03; 95% CI, 0.57 to 1.84) and presence
of abdominal pain (OR, 0.47; 95% CI, 0.97 to 1.30) were not
predictive of admission.
Conclusions: A large percentage of this population has serious
illnesses requiring admission. Increased likelihood of admission is
predicted by presence of fever, headache or mental status changes,
abnormal urinalysis, and abnormal chest radiograph. Abnormal
leukocyte count and presence of abdominal pain are not predictive
of increased likelihood of admission.
P 35 - Neurologic Emergencies
A case of severe hypothermia with cerebral hemorrhage
Chung SM
South Korea
Objective: Hypothermia is not an uncommon condition that
emergency physicians encounter in their emergency department
services. Most cases involve mild hypothermia and are rewarmed
well without any complication or sequelae. Hypothermia is well
known to be correlated with drug intoxication, such as with alcohol.
Since alcohol adds to the suppressive effect on the central nervous
system due to hypothermia, most intoxicated patients are so deeply
drunk that they look comatose. We present the case of a hypo-
thermic coma patient whose course was complicated by a neuro-
logic incident.
Case Report: A 41-year old male, drunk and semi-comatose, had
been left in his car for more than 12 hours on a freezing cold night.
He arrived at our emergency department with a body temperature
of 27.3°C. The patient was warmed with active rewarming, and
during the procedure, the patient appeared markedly hypertensive,
instead of showing rewarming shock. After initial stabilization the
patient was taken for a cerebral CT scan and was found to have a
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