RESEARCH FORUM ABSTRACTS

compressions. Based on the popular theory of CPR, one would expect less effective chest compressions with the lateral compression technique.

117 Pattern of injuries in Helmeted Motorcyclists in Singapore

Tham K-Y, Seow E, Wong HP/'i-an Tack Seng Hospital, Singapore

The law in Singapore mandates that motorcyclists must wear helmets when riding their vehicles. This is strictly enforced and compliance by locals and foreigners is close to 100%.

Study objective: To determine the injuries sustained by helmeted motorcyclists seen in the emergency deparmrent.

Methods: Data of motorcyclists with vehicular accident injuries were extracted from a database of all consecutive patients older than 15 years who presented to the ED of an urban public hospital in Singapore with trauma-related complaints. Imerviews were conducted with a closed-ended questionnaire from December 1, 1998, to March 31, 1999. Data collected were those of demographic, nature of injury, ambulance care, ED care, and disposal.

Results: There were 768 motorcyclists, contributing to 50.5% of all motor vehicle accident (MVA) victims, 9.5% of all trauma patients and 2.2% of total ED attendance. An overwhelming majority was men (97%). The mean age of motorcyclists was 32.4 years (95% confidence interval [CI] 31.5 to 33.3), which was significantly different (P<.0001) from the mean age of 362 years (95% C135.1 to 37.4) of other MVA victims. Only 0.8% (95% CI 0.3% to 1.7%) of motorcyclists had clinical signs of recent alcohol consumption, which was not significantly different from the 0.5% (95% CI 0.1% to 1.3%) of other MVA victims. The mean interval between injury and presentation to the ED was 0.33 day (95% CI 0.24 to 0.42). Motorcyclists skidding and sustaining injuries were 46.9%, whereas col- lision with a car was 35.4%, collision with a hea W vehicle 6.8%, collision with another motorcycle 4.3%, collision with a stationery object 2%, and collision with a pedestrian or cyclist 1.7%. There was 1 death among motorcyclists and 1 death among other MVA vie- rims. The proportion of motorcyclists with serious head injury was 4.6% (95% C1 2% to 8.9%), which was not significantly different from the 2.4% (95% C107% to 6%) of other MVA victims. Motorcyclists requiring admissions were 22.6% (95% CI 19.6% to 25.6%), which was not significantly different from the 21.9% (95% CI 19% to 24.8%) of admissions among other MVA victims. Of the motorcyclists discharged from the ED after treatment, 47.5% sustained only abrasions, 27.1% had contusions, 15.5% had fractures and/or dislo- cations of the limbs, 7% had open wounds, and 1% minor head injury. The proportion of motorcyclists sustaining fractures and/or dislocations of the limbs was 15.5% (95% CI 12.6% to 18.5%), which was significantly higher (P<.0001) than the 5.9% (95% CI 4.2% to 8.1%) of other MVA victims.

Conclusion: Hdmets protect motorcyclists from serious head injuries. Motorcyclists are at higher risks of sustaining serious limb injuries compared with other MVA victims. Education of motorcyclists to prevent skidding and to protect their limbs is needed.

118 Confirmation of Endotracheal Tube Placement: Analysis of 2.392 Emergency Department Intubations

Walls RM, Barton ED, on behalf of the NEAR 97 Investigators/Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Study objective: Physical examination methods of endotracheal tube placement con- firmation have been proved to be less reliable than newer methods, such as end-tidal CO 2 detection and aspiration. This study sought to determine whether newer objective meth- ods to confirm tracheal placement of endotracheal tubes placed in the ED are used to sufficient extent to be considered a standard of care.

Methods: This was a prospective, observational study of 2,392 ED intubations in 16 US teaching hospitals during the second phase (August 1997 to November 1998) of the ongoing National Emergency Airway Registry (NEAR 97).

Results: A total of 2,392 intubarions were registered over this period; 1,756 were in adults, 174 in children <18 years, 462 age unknown. Rapid sequence intubation (RSI), oral intubation with sedation only (SED), oral intubation without medications (NOM), and nasal intubation (Nil) were the first method in 7i%, 5%, 14%, and 9%. By method, detected esophageal intubatious were reported in RSI 3.6%, NOM 2.3%, NTI 1.8%, and other 5.6%. Most common methods used for tube placement confirmation included auscultation (84%), end-tidal CO 2 determination (66%), chest radiography (38%), and tube condensation (39%).

Conclusion: In these 16 centers, physical examination is supplemented by end-tidal CO 2 detection in 66% of the cases to confirm tube placement. Aspiration and direct visualization methods are infrequemly used (6% and 3% of cases), respectively. Ready availability and widespread use of end-tidal CO 2 indicates that it is becoming a stan- dard of care for ED intubations, as it is in the operating room.

i

10 The Use of Analgesia by Physicians and Physician Assistants: Who Will Get Me Relief?

Kozlowski M J, Jackson RE, Wiater JG, Swor RA, Pascual RG/William Beaumont Hospital, Royal Oak, MI

Study objectives: Our objective was to compare the use of analgesia by physicians versus physician assistants (PAs) in patients with an isolated lower extremity injury.

Methods: Included in the study were all adult patients who presented to a busy suburban teaching hospital with an isolated lower extremity injury and had a radio- graph of the ankle or foot over a 9-week period. Patients without trauma, those with multiple trauma, patients admitted to the hospital, and patients seen by a study investigator were excluded. Practitioners were blinded to study objectives. A single investigator contacted patients using a standardized questionnaire. She inquired about their perceived level of pain on emergency department arrival using a 0 to 10 verbal analog scale, about the analgesia they took before arrival, and analgesics they received both in the ED and in prescription form at discharge. Z 2 and Mann-Whitney U tests were used for analysis.

Results: Of 516 consecutive patients who had radiographs of the ankle or foot, 111 met exclusion criteria and 3 had incomplete data. Of the remaining 403, we con- tacted 382 (95%) an average of 2.95• days after injury. Of these, 128 (34%) had a fracture and the remaining were nonfracture injuries. Initial mean pain scores were not statistically different for patients with (6.6• and without fractures (6.8_+2.1), or for whether they were treated by a physician (7.1_+2.3) or a PA (6.4_+2.1). Fractures were present in 36% of the patients seen by PAs and 29% of those seen by physicians (P=NS). Physicians and PAs gave ED analgesia to 29% and 10% of patients, respective]y (P<.001). Physicians provided a prescription to 44% of patients versus 21% of patients seen by PAs (P<.001). Of patients seen by a physician, 53% received a medication or a prescription, whereas this was reported in 24% of patients seen by PAs (P<.001).

Conclusion: Most patients who have radiographs of the foot or ankle after trau- matic injuries receive no pain medication in the ED. Physicians prescribe analgesics more frequently both in the ED and on discharge than PAs.

120 Documentation of Pelvic Examination Findings in Adult Women With History of Consensual Sexual Intercourse and Without History of Nonconsensual Sexual Intercourse

Jackson MC, Groleau G, Kimmel C, Teague H, Tso E/University of Maryland School of Medicine, Mercy Hospital, Baltimore, MD

Study objective: This was a pilot study to collect information on the pelvic exam- ination findings of adult women who have had consensual sexual intercourse within the last 3 days to document the difference in findings from the adult women victims of sexual assault. This is important in the defense of female victims who have been sexually assaulted, as frequently defense attorneys will try to say that the trauma that is documented from a sexual assault occurred with consensual intercourse.

Methods: This study was a prospective study conducted in an urban teaching hospital, community emergency departments, and outpatient settings. Any women age 18 years and older presenting to the ED or a primary care provider with a his- tory of abdominal pare and requiring a pelvic examination as part of their general evaluation was eligible for the study. Unnecessary pelvic examinations were not per- formed. The care provider asked the patient questions regarding recent history of surgery, trauma, and/or sexual assault. Patients were also screened for a history of other pelvic examinations, use of tampons, and sexual activity within 72 hours. The care provider documented findings on the gross pelvic examination (noting presence or absence of ecchymosis, petechiat hemorrhages, hematoma, tears, or other evi- dence of trauma). A diagram was provided to document the location of positive findings.

Results: Of 102 patients evaluated, 55 patients admitted to consensual sexual intercourse within 72 hours. None of the 55 patients had a history of noneonsensnal sexual intercourse. Of the 55 patients, only 1 patient had evidence of trauma noted on the gross pelvic examination. This patient denied instrumentation and noted she had on tight pants as a cause. She could not relate the finding to her consensual intercourse.

Conclusion: Patients presenting within 72 hours of consensual intercourse rarely have evidence of genital trauma noted by gross visualization.

S 32 ANNALS OF EMER6ENCY MEDICINE 34:4 OCTOBER 1999, PART 2