Julio C. Silva

The use of head computed tomography in elderly patients sustaining minor head trauma.

The study objectives were to ascertain historical and clinical criteria differentiating intracranial injury (ICI) in elderly patients with minor head trauma (MHT), and determine applicability of current head computed tomography (CT) scan indications in this population. A 12-month retrospective chart review was performed at a community teaching hospital with 34,000 annual Emergency Department (ED) visits. Included were patients > or = 65 years old sustaining MHT with a Glasgow Coma Scale (GCS) score of 13-15 who had a CT scan performed during their hospital stay. Data included: injury mechanism, symptoms, signs, GCS, anticoagulation use or studies, presence of alcohol or drug, CT scan result, diagnosis, and outcome and intervention(s). There were 133 patients, with 19 (14.3%) suffering ICI. Four ICI patients required neurosurgical intervention. The mean age was 80.4 years and 66% were female. Four of 19 ICI patients (21%) had a GCS of 15, no neurologic symptoms, alcohol use or anticoagulation. Only 1 of 13 signs and symptoms correlated with ICI. In this study, no useful clinical predictors of intracranial injury in elderly patients with MHT were found. Current protocols based on clinical findings may miss 30% of elderly ICI patients. Head CT scan is recommended on all elderly patients with MHT.

The Rate and Risk of Heat-Related Illness in Hospital Emergency Departments During the 1995 Chicago Heat Disaster

Objectives:To conduct an Emergency Department (ED)-based treated prevalence study of heat morbidity and to estimate the rate and risk of heat morbid events for all Chicago MSA EDs (N = 95; 2.7 million visits per year).Methods:ED patient log data were compiled from 13 randomly selected hospitals located throughout the Chicago MSA during the 2 weeks of the 1995 heat disaster and from the same 2-week period in 1994 (controls). Measurements included: age, sex, date, and time of ED service, up to three ICD-9 diagnoses, and disposition.Results:Heat morbidity for Chicago MSA hospital EDs was calculated at 4,224 (95%CI = 2964−5488) cases. ED heat morbidity increased significantly 5 days prior to the first heat-related death. In 1995, there was an increase in the estimated relative risk for the city = 3.85 and suburbs = 1.89 over the control year of 1994.Conclusions:Real time ED-based computer automated databanks should be constructed to improve public health response to infectious or noninfectious outbreaks. Rapid area-wide M&M tabulations can be used for advancing the effectiveness of community-based prevention programs, and anticipating hospital ED resource allocation.

Comparing the accuracy of syndrome surveillance systems in detecting influenza-like illness: GUARDIAN vs. RODS vs. electronic medical record reports

BACKGROUND A highly sensitive real-time syndrome surveillance system is critical to detect, monitor, and control infectious disease outbreaks, such as influenza. Direct comparisons of diagnostic accuracy of various surveillance systems are scarce. OBJECTIVE To statistically compare sensitivity and specificity of multiple proprietary and open source syndrome surveillance systems to detect influenza-like illness (ILI). METHODS A retrospective, cross-sectional study was conducted utilizing data from 1122 patients seen during November 1–7, 2009 in the emergency department of a single urban academic medical center. The study compared the Geographic Utilization of Artificial Intelligence in Real-time for Disease Identification and Alert Notification (GUARDIAN) system to the Complaint Coder (CoCo) of the Real-time Outbreak Detection System (RODS), the Symptom Coder (SyCo) of RODS, and to a standardized report generated via a proprietary electronic medical record (EMR) system. Sensitivity, specificity, and accuracy of each classifiers ability to identify ILI cases were calculated and compared to a manual review by a board-certified emergency physician. Chi-square and McNemars tests were used to evaluate the statistical difference between the various surveillance systems.ResultsThe performance of GUARDIAN in detecting ILI in terms of sensitivity, specificity, and accuracy, as compared to a physician chart review, was 95.5%, 97.6%, and 97.1%, respectively. The EMR-generated reports were the next best system at identifying disease activity with a sensitivity, specificity, and accuracy of 36.7%, 99.3%, and 83.2%, respectively. RODS (CoCo and SyCo) had similar sensitivity (35.3%) but slightly different specificity (CoCo = 98.9%; SyCo = 99.3%). The GUARDIAN surveillance system with its multiple data sources performed significantly better compared to CoCo (χ2 = 130.6, p < 0.05), SyCo (χ2 = 125.2, p < 0.05), and EMR-based reports (χ2 = 121.3, p < 0.05). In addition, similar significant improvements in the accuracy (>12%) and sensitivity (>47%) were observed for GUARDIAN with only chief complaint data as compared to RODS (CoCo and SyCo) and EMR-based reports. CONCLUSION In our study population, the GUARDIAN surveillance system, with its ability to utilize multiple data sources from patient encounters and real-time automaticity, demonstrated a more robust performance when compared to standard EMR-based reports and the RODS systems in detecting ILI. More large-scale studies are needed to validate the study findings, and to compare the performance of GUARDIAN in detecting other infectious diseases.

The use of head computed tomography in elderly patients sustaining minor head trauma

The study objectives were to ascertain historical and clinical criteria differentiating intracranial injury (ICI) in elderly patients with minor head trauma (MHT), and determine applicability of current head computed tomography (CT) scan indications in this population. A 12-month retrospective chart review was performed at a community teaching hospital with 34,000 annual Emergency Department (ED) visits. Included were patients > or = 65 years old sustaining MHT with a Glasgow Coma Scale (GCS) score of 13-15 who had a CT scan performed during their hospital stay. Data included: injury mechanism, symptoms, signs, GCS, anticoagulation use or studies, presence of alcohol or drug, CT scan result, diagnosis, and outcome and intervention(s). There were 133 patients, with 19 (14.3%) suffering ICI. Four ICI patients required neurosurgical intervention. The mean age was 80.4 years and 66% were female. Four of 19 ICI patients (21%) had a GCS of 15, no neurologic symptoms, alcohol use or anticoagulation. Only 1 of 13 signs and symptoms correlated with ICI. In this study, no useful clinical predictors of intracranial injury in elderly patients with MHT were found. Current protocols based on clinical findings may miss 30% of elderly ICI patients. Head CT scan is recommended on all elderly patients with MHT.