CAEP/ACMU 2000 Scientific Abstracts: 29-32

CAEP Abstracts

CJEM 2001;2(3):169-187

029 The Incidence and Prevalence of Domestic Violence in a Northern Emergency Department.
Rowe BH, Cox JE, Carter MH, Sahai VS, Bretzlaff-Michaud JA, Bota GW. University of Alberta, Edmonton, Alta.

OBJECTIVE: Domestic violence against women is an important cause of health-related morbidity and mortality and consumes enormous resources. Little is known about this problem in the ED, especially in semi-rural, northern regions. This study examines the incidence, prevalence and risk factors of physical domestic violence (DV) in women in a northern Canadian ED.
METHODS: A prospective cross-sectional study was performed at an Ontario ED between 2/99 and 6/99. A random sample of women, age >16, presenting to the ED consented to interview in private during their ED stay. A valid and reliable 52-question survey was administered by trained female research nurses; it documented health status and exposure to physical DV. RESULTS: 983 (80%) of 1,223 eligible patients consented; 192 (16%) refused and 48 (4%) were "missed." Mean age was 41 years, 546 (56%) were married or in common-law relationships. Overall, 725 (75%) reported having a current partner; 9% had been threatened or injured by that partner. Seventy (9%) patients reported being injured by a partner during pregnancy; exposure to firearms was high (18%). The lifetime prevalence of physical DV was 51% (95% CI: 49, 55) and injurious events were high. The incidence of physical DV resulting at the index ED presentation was 1% (95% CI: 0, 2). CONCLUSIONS: The incidence of physical DV in this sample was lower than reported elsewhere. However, lifetime DV prevalence was high, injurious events were serious, and access to weapons such as firearms was a concern in this setting. Further research should focus on universal screening and appropriate ED interventions to protect women against further DV.
Key words: domestic violence

030 Plain Gut vs. Non-Absorbable Nylon Sutures in Traumatic Pediatric Lacerations: Short-Term Outcomes.
Karounis H, Gouin S, Eisman H, Chalut D, Pusic M, Williams B. McGill and Montreal Universities, Montreal, Que.

OBJECTIVES: To compare short-term cosmetic outcome and rates of dehiscence and infection in pediatric lacerations repaired with absorbable plain gut versus non-absorbable nylon suture. DESIGN: Randomized clinical trial. SETTING: Montreal Children's Hospital Emergency Department (ED). PARTICIPANTS: Patients 1­18 years of age who presented to the ED with lacerations less than 12 hours old between January 1999 and February 2000. Exclusions criteria were the following: wounds that could be approximated by tissue adhesives, animal/human bites, gross contamination, puncture/crush wounds, wounds crossing joints, lacerations of tendon, nerve or cartilage, collagen vascular disease, immune deficiency, diabetes mellitus, bleeding disorder and scalp lacerations. Patients were randomized into one of two groups: absorbable pain gut sutures (group A) and non-absorbable nylon sutures (group NA). Board eligible/certified pediatric emergency physicians or clinical fellows performed laceration repair in a standardized approach. All wounds were re-evaluated within 10 days by a single research nurse who assessed the wounds using a previously validated wound evaluation score (WES) composed of 6 items (presence of step-off, contour irregularities, margin separation, edge inversion, extensive distortion and overall cosmetic appearance). A score of 6/6 is considered optimal. The presence or absence of dehiscence and infection was also noted. RESULTS: Forty-three patients were eligible of which 10 patients declined to participate. Of the 33 patients enrolled, 19 were randomized to group A and 14 to group NA. Both groups had similar demographics (sex, age), wound size (length, width), wound location and mechanism of injury. No differences were found in the proportion of optimal WES between group A and group NA (68% vs. 62%, RR ±95% CI = 1.11, 0.66,1.88). No differences were found between group A and group NA for the rates of dehiscence (0% vs. 7%) and of infection (0% in both groups). CONCLUSIONS: The use of absorbable sutures in the repair of traumatic lacerations in children appears to be an acceptable alternative to non-absorbable sutures as short-term cosmetic outcomes and complication rates are similar. Future prospective studies are required to analyze the long-term cosmesis outcome of traumatic lacerations repaired with absorbable sutures.
Key words: wound management, cosmetic, pediatric

031 Clinical Diagnosis of Clavicle Fractures.
Landine JK, McGraw RC, Pickett W. Queen's University, Kingston, Ont.

Clavicle fractures are a common problem in the ED. Complications are rare and generally restricted to fractures in the medial or lateral third of the clavicle. We set out to determine whether ED physicians can accurately predict clavicle fracture location prior to obtaining x-rays.
METHODS: We conducted a prospective analysis with an inception cohort of ED patients. Eligible patients had an injury deemed to be consistent with acute clavicle fracture. Prior to obtaining radiographs, ED physicians or residents completed a questionnaire predicting the location of the fracture. They selected medial third, middle third, lateral third, or unsure. This prediction was later compared to the radiologist's report of the fracture location. RESULTS: Between April 1999 and January 2000, 109 patients with clavicle fractures were seen, and 72 (66%) were enrolled in the study. Of these fractures, 57 (79%) were middle third, 11 (15%) were lateral third, 2 (3%) involved both middle and lateral third, and 2 (3%) were medial third. The physicians correctly predicted the fracture location in 62 patients (86%). The physicians predicted a fracture to be middle third 47 times and in every case (100% accuracy, 95% CI 92%­100%) this prediction was correct when compared to the radiograph. We felt that an important miss would be for the ED physician to predict a middle third fracture when it was in fact medial or lateral. In no cases did this happen. None of the 72 patients had pneumothorax or neurovascular injury. CONCLUSION: These results suggest that ED physicians can accurately predict middle third clavicle fractures on clinical examination. These results support the development of a prospective study to investigate the need for diagnostic radiography in uncomplicated middle third clavicle fractures.
Key words:clavicle fracture, radiography, utilization

032 Clinically Meaningful Values of the Visual Analog Scale of Pain Severity.
Lee J, Stiell I, Hobden E, Wells G. Clinical Epidemiology Unit, University of Ottawa, Ottawa.

OBJECTIVES: Previous studies of the clinically significance of the Visual Analog Scale (VAS) have correlated VAS scores with descriptive categories (e.g., "a little less pain"). The objective of this study was to determine what values of the VAS correspond to the patients' perception of analgesic need, and the values and change in VAS associated with perception of adequate pain control.
METHODS: A prospective, observational cohort design was used. Patients presenting with acute pain during study hours were approached for informed consent. Eligible consenting patients were asked to rate their pain severity on a 100-mm horizontal VAS, and stated whether or not they would accept oral and/or parenteral analgesia. The VAS was repeated at discharge, and patients were asked whether they had received adequate treatment for their pain. The unpaired t-test was used to compare change in pain scores between groups.
RESULTS: Of 124 patients enrolled, 66 were female (53%), with an overall mean age of 36 years: 98 stated they would accept oral analgesics (79%). Their mean VAS was 63 mm (95% CI 58­68), vs. 48 mm (95% CI 37­58) for the 26/124 patients who reported no analgesic need. Parenteral analgesics were required by 62/124 patients (50%). Their mean VAS was 72 mm (95% CI 66­78), vs. 48 mm (95% CI 41­54) for those who did not want an injection. The mean VAS for the 98 patients who reported adequate pain control at discharge was 31 mm (95% CI 25­36) vs. 53 mm (95% CI 25­36) for those with inadequate pain control. The mean change in VAS was ­29 (95% CI ­36 to ­22) for patients with adequate analgesia vs. ­4 (95% CI ­9 to 1, T = 5.7, p < 0.01) for those with inadequate pain control. CONCLUSION: A mean reduction in VAS of 29 mm may represent a minimum clinically significant difference corresponding to patients perception of adequate analgesic control. Further studies of the clinical utility of the VAS are needed.
Key words: pain, analgesia, visual analog scale