physicians with a $21.04 reimbursement. If sutures are removed at the same facilitywhere placed, Medicare cannot be billed for additional costs incurred.

In our institution, approximately 2,200 lacerations are repaired per year. Weestimate that eliminating routine follow-up visits with primary care physicians wouldsave Medicare $43,000 annually at our hospital alone. If this were to be extrapolatedout for the estimated 11 million lacerations repaired annually in the United States,this method could save Medicare upwards of $215,000,000 per year.

Conclusion: The routine use of absorbable plain gut sutures for laceration repairleads to a greater cost savings overall by eliminating obligatory follow-up visits thatrequire materials and professional time, but do not generate significant revenue. Thepotential cost savings to Medicare would be great, and this data acts as a proxy forinsurance companies and self-payers alike. Patients benefit by having fewer missedwork and school days, lower bills from primary physicians, and the elimination ofpsychologically traumatic suture removal for pediatric patients and their parents.

171 High Rate of Positive Urinalysis in Syncope PatientsScott S, Mahmood K, Patel D, Nagurka R, McCormick M, Fang

C, Bushi S, Butt A, Altschuler E/University of Medicine and Dentistry of NewJersey, Newark, NJ; The University of Medicine and Dentistry of New Jersey,Newark, NJ; The Brooklyn Hospital Center, Brooklyn, NY

Study Objectives: To determine if there is a high prevalence of UTIs in patientswith syncope.

Methods: We prospectively enrolled patients for twenty-one months aged 50-89with a hospital admission diagnosis of syncope or pneumonia, as a control, from oururban, Level I trauma center. Urinalysis was requested for study analysis if notroutinely ordered for patient care. Positive urinalyses were defined as positiveleukocyte esterase or nitrate, 3 or more white blood cells were present, or if rarebacteria were observed. A 7-item questionnaire was orally administered to assess forthe classic symptoms of UTI.

Results: We enrolled 289 participants (syncope n�158, pneumonia n�131;results displayed in Table 1). Patients were well matched in terms of sex and age.We assessed the comparison of rate of positive urinalyses in syncope versuspneumonia patients using a Bernoulli trial/z-test model with the expectedprobability of positive urinalyses in syncope patients taken as the rate inpneumonia patients: 39.7% (52/131). We would then have expected 62.7 (0.397x 158) positive urinalyses in syncope patients (�6.1). There were 72 positiveurinalyses in the syncope, indicating a strong trend (p�0.1) for a greater numberof positive urinalyses in syncope versus pneumonia patients. UTIsymptomatology did not differ significantly between the syncope and pneumoniaparticipants, or between those with a positive or negative urinalysis. Thesefindings demonstrate that patients with syncope and a positive urinalysis did notexhibit classic symptoms of a UTI.

Conclusion: Though correlation is not causation, perhaps bacterial factors orhost cytokine release in response to infection acting peripherally or centrallycould lead to dehydration, loss of vascular or muscle tone, or centrally drivendecreased oral intake. Our finding of a high rate of positive urinalysis in syncopepatients may aid in the prevention, evaluation, and treatment of syncope patients.

172 Endotracheal Tube Placement Varification byUltrasonography: A Comparison of Three MethodsUsing a Porcine Model

Murman DH, Budhram G, Sullivan A, Lufty L/Baystate Medical Center,Springfield, MA

Study Objectives: Timely and accurate confirmation of correct endotracheal tube(ETT) placement is critical in clinical practice. Several methods to confirm ETTplacement using ultrasonography (US) – diaphragmatic movement, lung sliding, andtrans-tracheal ETT visualization – have recently been described. The aims of thisstudy were to define the accuracy of each confirmation method, to determine the timeto verification, and assess operator confidence in predicting ETT location.

Methods: This was a prospective, randomized, blinded study including twenty-five recently euthanized animals that were intubated either in the esophagus ortrachea (total of 50 intubations). Sonographers were research assistants, residents, andattending physicians. Each sonographer was given a brief teaching session on the 3US methods. Each animal was intubated by the investigators twice in a random order,either in the trachea or the esophagus, and underwent all 3 US examinations for eachintubation (150 US exams). The same person performed all 3 US examinations foreach intubation. US interpretation, time to US interpretation, and confidence withUS interpretation were recorded. Logistic regression models were used to assess fordifferences in dichotomized performer confidence and time variables, and theKruskal-Wallis test was used to determine differences in median times between USmethods.

Results: All 3 methods had similar accuracy for detecting the correct ETTlocation (trans-tracheal 88%, thoracic lung sliding 92%, diaphragmatic 92%). Theoperators were able to rapidly assess the location of the ETT (figure 1, median times,12.5, 14.0, 21.0, p�0.01, trans-tracheal, thoracic lung sliding, diaphragmaticmovement respectively). Trans-tracheal scans were more likely than the other 2methods to be performed rapidly (� 15 seconds, figure 2, p�0.01). Whensonographers were confident in their findings (confidence �70%) the overallaccuracy was 95%, compared to 69% when sonographers lacked confidence (�70%,p�0.01). After adjusting for multiple variables, method of US and performerconfidence were the only significant predictors of time to completion of USassessment.

Conclusions: Using this model, all 3 methods for determining ETT placementwere found to be accurate. Trans-tracheal and thoracic ultrasonographys were notedto be faster than diaphragmatic movement. Trans-tracheal was the most likely to beperformed in a clinically useful time of 15 seconds or less. High confidence in USfindings was the only variable to be associated with accuracy for the correct answer.Further research should be performed to determine if these findings are replicated inthe clinical setting.

Research Forum Abstracts

S62 Annals of Emergency Medicine Volume , . : October