Parental report of child restraint device use in an emergency department population.

To survey parents regarding use of child restraint devices (CRD) and knowledge of CRD recommendations, parents of children < or = 14 years of age presenting to an emergency department (ED) provided demographic data and answered questions regarding the family's restraint use and their understanding of CRD recommendations. Three hundred thirteen adults completed surveys, providing data on 541 children. Decreasing restraint use was reported with advancing child age. Parental restraint use remained constant. Demographics were similar. Optimal infant CRD position was not identified by 27%. Incorrect answers were associated with single parents, lower income, less education, and older child age. Only 41% identified the age for mandatory car seat use. Most identified the safest vehicle position for any child. No variables were associated with correct answers. In conclusion, CRD use decreases with increasing child age. In this study, many parents were unaware of CRD recommendations.

Prevalence of traumatic brain injury in an ED population.

The objective of this study was to determine prevalence of traumatic brain injury (TBI) in an emergency department (ED) population. Questionnaires were administered to patients in an urban, university, trauma center ED. All respondents provided demographics; patients reporting TBI were asked age at injury, if they experienced loss of consciousness (LOC), mechanism, or if medical attention was sought. Five hundred one patients completed the survey. Forty-one percent reported TBI; 23% had TBI with LOC. Mean age at injury was 21.5 years. Mechanism was evenly distributed among sports, assaults, falls, and motor vehicle crashes (MVC). Medical attention was sought for 61% of injuries. Men were more likely to report TBI (P <.001). Medical attention was more likely if MVC or LOC and less likely in sports-injured patients (all P <.01). Twenty-five percent of patients with TBI sustained repeat injury by the same mechanism. Prevalence of TBI in this population is high. Many occur by mechanisms that potentially are preventable.

Socioeconomic and health status differences between depressed and nondepressed ED elders.

The objective of the study was to describe differences in demographics, medical conditions, and social situation between depressed and nondepressed elderly emergency department (ED) patients. We studied a prospective convenience sample of English-speaking ED patients greater-than-or-equal 65 years, without altered mental status, obvious dementia or delirium, participating in a depression screening study during an ED visit for a nonpsychiatric complaint. Demographics were collected. Research personnel administered the Geriatric Depression Scale (GDS), the Folstein Mini-Mental State Examination and a health questionnaire. A total of 103 subjects were enrolled. GDS identified 33 patients (32%) with DEP. DEP patients were more likely to report the following: lower income, lower education level, more medical conditions, less independence, assisted living, and poorer overall health than ND patients. A third of these elderly ED patients report symptoms consistent with depression. There are significant differences in socioeconomic characteristics, health status, and functional ability. Future depression studies should focus on elders with these characteristics.

Validation of a brief screening tool to detect depression in elderly ED patients.

Although depression is the most common psychiatric disorder in the elderly, it is often unrecognized by physicians. The objective of the study was to assess the utility of a 3-question screening instrument (ED-DSI) to detect depression among elderly emergency department (ED) patients. We used a prospective convenience sample of English-speaking ED patients >or=65yr. Patients were excluded for being too ill to participate, having obvious dementia, or acute changes in mentation. A physician administered the ED-DSI. Trained research personnel blinded to ED-DSI answers then administered the 30 question Geriatric Depression Scale (GDS). The ED-DSI was considered positive if the patient answered yes to one or more questions and subjects were considered depressed when the GDS score was >or=10. ED-DSI was compared to GDS using contingency tables. A total of 103 subjects were enrolled. Average age was 75 years and subjects were predominately female (66%) and white (85%). GDS identified 33 patients (32%) as depressed. Of these, 26 were correctly identified by ED-DSI giving an ED-DSI sensitivity of 79% (95%CI (65%, 93%)) specificity of 66% (95%CI (54%, 78%)) and a negative predictive value of 87% (95%CI (79%, 95%)). The 3-question ED-DSI is a useful tool to detect depression in this population of ED patients.

Physician and patient factors influencing the treatment of low back pain.

Previous retrospective studies have suggested that patient demographics may influence analgesic administration. These studies have not taken physicians' impression of patient pain into account. This prospective study investigates the influence of (i) physician impression of the degree of pain and (ii) patient demographics on the use of analgesic. A convenience sample of adults with non-traumatic lower back pain was studied. Possible predictors of analgesic administration included physician pain scores (assessed by visual analogue scale), patient ethnicity, gender, age, and insurance. These variables were tested individually and then using logistic regression. For the total of 91 patients enrolled, only physician pain scale was found to be associated with analgesic use. Median scores were 68 mm (interquartile range = 62-80 mm) for those receiving treatment versus 48 mm (interquartile range = 30-58 mm) for those who did not (P < 0.001). This study therefore suggests that physician impression of patient pain rather than patient demographics influences analgesic use.