Using routine accident and emergency department data to describe local injury epidemiology.

All 17330 Accident and Emergency Department (A and E) attendances following injury (67% of all A and E attendances by residents of the EH54 postcode (the town of Livingston) at St John's Hospital during 1995 and 1996 were examined to study local accident epidemiology. The overall annual injury attendance rate for males (245.7/1000) and females (148.0/1000) and sex and age group analyses show recognised patterns reflecting occupation and domestic circumstances. Higher attendance rates were associated with greater deprivation and living close to the hospital. The unique injury coding system used by the hospital offers the potential to highlight particular injury types occurring within population sub-groups. When linked with primary care and out-of-hours centre data, this could be useful in targeting preventive activities; this will be facilitated in this hospital, which will become part of a 'combined' acute and primary care trust from April 1999.

Prognosis of elderly patients with non-specific abdominal pain.

OBJECTIVE: To examine the long term outcome of patients over 65 years presenting with acute non-specific abdominal pain. SETTING: District general hospital. DESIGN: Retrospective cohort survey. SUBJECTS: 43 patients with non-specific abdominal pain, median age 75.5 years, presenting in 1985. METHODS: Case notes were reviewed and a questionnaire sent to the patients' general practitioners to assess long term outcome. RESULTS: There was little evidence that these patients subsequently developed or died from a disease requiring surgery. However, this patient group did have a significantly poorer five year survival than a representative control group because of cardiorespiratory disorders. CONCLUSIONS: Non-specific abdominal pain in elderly patients should not be regarded as harmless but may have medical rather than surgical implications.

Use of Autosuture Surgiport for pleural drain insertion.

The insertion of pleural drains (tube thoracostomy) is associated with serious complications in up to 10 per cent of cases. A safe and efficient technique of tube thoracostomy using the Autosuture Surgiport is described.

Should nurses be allowed to request X-rays in an accident & emergency department?

A prospective study was carried out during the month of November, 1990 in the A&E Department, St John's Hospital, Livingston in order to assess the extended role of the A&E nurse and their ability to request X-rays prior to patients being seen by a doctor. A total of 579 randomly selected patients were triaged by A&E Department nurses. Almost 3/4 of these patients were X-rayed at the request of the triage nurse. Less than 7% of these X-rays were considered to have been unnecessary by the doctor who subsequently managed the patient. Of those patients who had an X-ray after seeing a doctor, more than 90% fell within the X-ray triage criteria but had not had an X-ray requested by the triage nurse. Overall, nurses were shown to request X-rays correctly and efficiently with the result that patients had to spend less time in the A&E Department.

Inability to fully extend the injured elbow: an indicator of significant injury.

Elbow injuries are commonly seen in accident departments. Patients with possible bony injuries to the elbow were assessed to see if inability to fully extend the elbow was a good indicator of bony injury and hence the need for X-ray. The sensitivity of this test was 90.7% (95% confidence limits 80.7-100.7) and the specificity 69.5% (95% confidence limits 60.3-78.7). Use of this simple test would reduce both radiography costs and unnecessary exposure to radiation.

Scaphoid tubercle tenderness: a better indicator of scaphoid fractures?

Tenderness in the anatomical snuff box (ASB) has long been accepted as an indicator of a possible scaphoid fracture. The longitudinal axis of the scaphoid lies in an anteroposterior plane, perpendicular to the remainder of the carpal bones, in the radially deviated wrist. The scaphoid tubercle can therefore be easily and accurately palpated on the palmar aspect of the radially deviated wrist. This study was devised to determine if tenderness over the scaphoid tubercle (ST) was superior to ASB tenderness in identifying definite fractures. Over a 10-month period 246 patients were seen who were suspected of having a scaphoid injury. Thirty (12%) were eventually proven to have definite fracture. Tenderness in the ASB had a sensitivity rate of 90% (95% confidence limits 80-100%) and specificity of 40% (33-47%) as an indicator of a definite fracture. ST tenderness had a sensitivity of 87% (75-99%) and specificity of 57% (50-64%). There is therefore no significant difference in the sensitivity between ASB and ST tenderness but ST tenderness is significantly more specific. However, the presence of either ASB or ST tenderness should be used in order to identify all fractures. Patients with neither ASB nor ST tenderness require symptomatic treatment only.

Embolotherapy of a mycotic pseudoaneurysm of the internal mammary artery in chronic granulomatous disease.

We report a case demonstrating an unusual and previously unpublished complication of chronic granulomatous disease (CGD), that is massive hemorrhage from a mycotic pseudoaneurysm of the left internal mammary due to invasive Aspergillus fumigatus of the anterior chest wall. This brief report further illustrates the angiographic diagnosis and embolotherapeutic control of a mycotic pseudoaneurysm of the internal mammary artery.

Rare-earth oxides of manganese and cobalt rival platinum for the treatment of carbon monoxide in auto exhaust.

The perovskite-like compounds RE(1-X)Pb(5)MnO(3) and RECoO(3), where RE (rare earth) is lanthanum, praseodymium, or neodymium, are active catalysts for the oxidation of carbon monoxide. Crushed single crystals of these compounds compare favorably with commercial platinum catalysts in initial activity and lifetime. Therefore, these compounds are promising substitutes for platinum in devices for the catalytic treatment of auto exhaust.