 |
From: Keith Wesley <drwes...@charter.net>
Date: Tue, 21 Sep 2010 12:02:22 -0500
Local: Tues, Sep 21 2010 1:02 pm
Subject: Re: [NAEMSP Dialog] Re: Prehospital Pain Management
I found the study.
Prehosp Emerg Care. 1998 Oct-Dec;2(4):304-7. Emergency medical services transport of patients with headache: mode of arrival may indicate serious etiology. Nemer JA, Tallick SA, O'Connor RE, Reese CL. Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA. Abstract OBJECTIVE: To determine whether mode of arrival is associated with seriousness of etiology and use of diagnostic testing in patients treated in the emergency department for headache. METHODS: This observational, retrospective study was conducted by consecutive review of the records of patients presenting to the emergency department with a chief complaint of headache from December 1994 through May 1995. Patients with altered mental status or seizures were excluded. Mode of arrival was classified as either by EMS or other (e.g., private vehicle). Patients with a final diagnosis of meningitis, intracranial hemorrhage, or central nervous system tumor were classified as having serious causes, whereas those with headache due to migraine, tension headache, or headache that was otherwise unspecified were classified as nonserious. The use of diagnostic studies, such as lumbar puncture or CT scan, and their results, was recorded. Patients were included in the category of patients having serious intracranial pathology even if the diagnosis was delayed. Statistical analysis was performed using the Yates-corrected chi-square test, and by determining odds ratios (ORs) with 95% confidence intervals. RESULTS: For 967 patients presenting with a chief complaint of headache, 837 charts were included in the analysis. A total of 102 patients arrived by EMS, and 735 arrived by other means. Patients arriving by EMS had a higher rate of serious cause of headache than did those arriving by other means (OR = 18.5, p < 0.0001). EMS patients tended to undergo additional diagnostic testing (OR = 4.4, p < 0.0001), and those tests were more likely to be abnormal than for those arriving by other means (OR = 9.4, p < 0.0001). Males had a somewhat higher rate of serious diagnosis (OR = 2.6, p < 0.05). CONCLUSIONS: In this EMS system, patients with headache who arrive by EMS are more likely to have serious causes. Mode of arrival may be of use to the clinician in assessing risk of serious illness among patients with headache. Whether this observation represents an element of self-triage or a combination of other factors remains to be determined. With that said. I'd like to see the numbers from our colleague in Alaska. If there are that many "frequent flyers" causing problems then perhaps something needs to be addressed locally as Tarrant County did. http://www.wfaa.com/news/local/Tarrant-ambulance-service-reaches-out-... Keith Wesley, MD On Sep 20, 2010, at 7:52 PM, ADAM THOMPSON, EMT-P wrote: > Dr. Wesley, Keith Wesley, MD > Presuming that article was based on evidence, do you remember the > As for the sub-standard state guidelines for prehospital pain > Adam Thompson, EMT-P > On Sep 20, 5:06 pm, Keith Wesley <drwes...@charter.net> wrote: >> Interestingly, the current edition of the Carolyn AAOS Paramedic text devoted 2 pages to identifying drug seekers. This is not appropriate. No more than blowing someone off with a complaint of chest pain because you just don't believe them. >> Keith Wesley,MD >> On Sep 20, 2010, at 2:59 PM, Erik Davis wrote: >>> Hello! >>> My name is Erik and I am new to the discussion group. I have been in the Pennsylania Emergency Medical Services for twenty-three years with the last seventeen years as a Nationally Registered Paramedic. I am very interested in learning about the constant changes that are occuring in pre-hospital medicine. >>> I am happy that pain management has become a priority in the pre-hospital management of a patient even though it was way overdue. However, I think the biggest issue that faces pre-hospital providers are the "drug-seekers" and the concern of an Emergency Room physician/nurse saying "oh this guy is a drug-seeker how did you fall for that?" >>> Erik Davis AS, NREMT-P >>> On Sep 15, 4:18 pm, Mic Gunderson <mic.gunder...@gmail.com> wrote: >>> Great question Art. Frankly, pain management should not alter a >>> -- >>> -- >> Keith Wesley, MD > -- drwes...@charter.net You must Sign in before you can post messages.
To post a message you must first join this group.
Please update your nickname on the subscription settings page before posting.
You do not have the permission required to post.
| |||||||||||||