Annals of emergency medicine
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Inferential and descriptive statistics continue to be used incorrectly when analyzing biomedical data. Glasgow Coma Score (GCS) and Revised Trauma Score (RTS) data have recently been described and analyzed using parametric statistical methods in several studies despite the ordinal nature of these data scales. The objective of this study was to determine whether GCS and RTS data are normally distributed, despite their ordinal nature. ⋯ Parametric statistical descriptors and inferential methods are inappropriate for use with GCS and RTS data. Ordinal data should be tested for normality before statistical analysis with parametric statistical methods.
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Randomized Controlled Trial Comparative Study Clinical Trial
Neuromuscular blockade-assisted oral intubation versus nasotracheal intubation in the prehospital care of injured patients.
To compare nasotracheal intubation (NTI) to neuromuscular blockade-assisted oral intubation (NMB-assisted oral intubation) in the prehospital care of injured patients. ⋯ In the prehospital management of severely injured patients, there is no significant difference between NMB-assisted oral intubation and NTI in the rate at which endotracheal intubation is achieved. However, practitioners may prefer NTI because it requires significantly less time to perform than NMB-assisted oral intubation.
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To determine retrospectively the diagnostic accuracy of various ECG ST segment elevation criteria for the prehospital ECG diagnosis of acute myocardial infarction. ⋯ Fifty-one percent of patients whose prehospital 12-lead ECG met 1 mm or more ST segment elevation criteria had non-myocardial infarction diagnoses. ST segment elevation alone lacks the positive predictive value necessary for reliable prehospital myocardial infarction diagnosis. Inclusion of reciprocal changes in prehospital ECG myocardial infarction criteria improved the positive predictive value to more than 90% and included a significant majority (62% to 86%) of acute myocardial infarction patients with ST segment elevation who received thrombolytic therapy within five hours after hospital arrival. ST segment elevation criteria that include reciprocal changes identify patients who stand to benefit most from early interventional strategies.
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Case Reports
Pneumocephalus following an epidural blood patch procedure: an unusual cause of severe headache.
Pneumocephalus is a rare complication of anesthetic procedures involving the epidural space. We report the case of a 36-year-old woman who developed a severe headache due to pneumocephalus that occurred during an epidural blood patching procedure. This report reviews the blood patch procedure and its attendant complications. Emergency physicians should be aware of the potential complications of this commonly performed procedure and include iatrogenic pneumocephalus in the differential diagnosis of severe headache in the proper clinical scenario.