Intimate Partner Violence Among Men Presenting to a University Emergency Department

Objective: We sought to investigate the one-year point prevalence for male intimate partner violence (IPV) in men presenting to a university emergency department, to identify types of violence, to examine differences in male IPV rates based on patient demographics, and to identify any differences in prevalence based on types of partnership. Methods: This survey study was conducted from September 2001 until January 2002 at a tertiary, academic, Level I Trauma Center with an emergency department (ED) that has 40,000 visits per year. The anonymous written survey consisted of 16 questions previously validated in the Colorado Partner Violence Study, Index of Spouse Abuse and the Conflict Tactics Scale. This survey was administered to all consenting adult men who presented to the ED. Odds ratios (OR) with 95% CI were calculated when appropriate and a p-value of 0.05 was set for significance. Results: The oneyear point prevalence rate of male IPV was 24% in our study population (82/346). Among the men who experienced some form of abuse specified as either physical, emotional, or sexual, the prevalence was calculated to be 15.6% (54/346), 13.6% (47/346), and 2.6% (9/346), respectively. Education, income, age, and race did not demonstrate an association for any one variable to be associated with intimate partner abuse (p>0.05) with the exception of increased risk of IPV among unemployed men in the relationship (p<0.04, OR 0.592). IPV towards men was found to affect both heterosexual as well as homosexual relationships. Overall, 2% (8/346) of the men surveyed had received medical treatment as a result of IPV by their intimate partner within the past year. Three percent (11/344) of those men reporting abuse were abusers themselves. Conclusion: The point prevalence of IPV among our study population was 24%. In our study of 346 men, male IPV crossed all socioeconomic boundaries, racial differences, and educational levels regardless of the sex of the partner

Intimate Partner Violence Among Women Presenting to a University Emergency Department

Objective: To establish point and one-year prevalence data regarding partner violence (PV) for women presenting to a university teaching hospital, University of California, Irvine Medical Center (UCIMC), one of 15 emergency departments in Orange County, and to determine differences in partner violence rates when comparing descriptive variables such as race, income and education. Methods: An anonymous, written survey was administered to a convenience sample of 370 women presenting to University of California Irvine Emergency Department over a 12 month period. Results: Partner violence has a point prevalence of 6.7% and a one-year prevalence of 37.0%. Women who have experienced previous abuse are more likely to present with complaints related to PV acutely. Lower income levels correlate with a higher incidence of physical, emotional, and sexual abuse. We found no correlation between race and likelihood of PV. Conclusion: PV in Orange County, California occurs quite frequently. The oneyear prevalence compares to that of the entire state of California, but is at the higher limit when other areas are compared. Detection rates among EPs should be improved, and services to women who have suffered PV will need to be enhanced within Orange County

Analgesia and Addiction in Emergency Department Patients with Acute Pain Exacerbations

Introduction: There is ongoing controversy regarding the appropriate use of narcotic analgesia for patients presenting frequently to the emergency department (ED) with subjective acute exacerbations of pain. "Are we treating pain or enabling addiction?”Objectives: To determine whether the presence o f specific factors could be used to identify adults complaining of acute exacerbations of pain for suspected drug addiction, to estimate the percentage of drug addicted patients, to assess the physicians’ ability to detect drug addiction and to evaluate interrater reliability.Methods: A Drug Abuse Screening Test (DAST-20) was administered to 76 ED patients who presented with acute exacerbations of pain and either multiple ED visits for similar pain complaints, specific narcotic requests, or “allergies to non-narcotics. The DAST-20 was also administered to 74 age-matched controls. Treating ED physicians rated their suspicion for drug addiction using a visual analog scale (VAS). Results: The overall estimation of drug addiction based on the DAST-20 survey was 17.3% (26/150). Twenty-one percent (16/76) of the analgesia subjects and 13.5% (10/74) of the control subjects scored positive for drug addiction as measured by the DAST-20. Of the analgesia subjects with positive DAST-20 scores for drug addiction, 43.8% (7/16) had multiple ED visits, 43. 8% (7/16) requested specific narcotics and 6.3% (1/16) reported “allergies” to non-narcotics. There was no correlation between the VAS scores and the DAST-20 scores. There was a significant correlation between resident and attending VAS scores for their suspicion for drug addiction

Access to Firearms among Orange County Youth: A School-Based Study

Objective: School-associated firearm violence among children and adolescents is a national public concern. The objective of this study was to determine the accessibility of firearms, methods of firearm access and firearm safety knowledge among middle and high school students in Orange County, California. Methods: After permission from school officials and parents was obtained, a 24-question survey was distributed to 176 students in grades 6 through 12 at four schools in Orange County. Data was collected over a 12-month period beginning in February 2003. Data analysis was presented in proportions. In addition, cross tabulations were performed to determine which factors were associated with access to guns, having fired a gun, and firearm possession at school. Results: The mean age of participants was 16.1 years. Seventy-seven (45%) were male, 121 (69%) Hispanic, and 171 (94%) were of middle income. Four participants (2.3%) admitted to gang involvement, 47 (26.7%) had fired a gun. Those more likely to have fired a gun appeared to be non-Hispanic males (p= 0.001). Seventy-five (43%) reported access to a gun. Older students and those in grades 9 to 12 were more likely to have access to a gun (p= 0.01), which they stated could be obtained from their homes, friends or relatives (4.5% to 22%). No students admitted to bringing a gun to school. Two (1.1%) students stated that they had thought of using a gun at school. One hundred one students (62%) were taught firearm safety by their parent(s). Conclusion: Almost half of the students in this study acknowledged that they could gain access to a gun and two students had thought about using a gun at school. Firearm education, safety and counseling are of paramount importance to ensure safety among school youths

Complications of MRSA Treatment: Linezolid-induced Myelosuppression Presenting with Pancytopenia

Methicillin-resistant Staphylococcus aureus (MRSA) infections have grown to epidemic proportions in the United States. With the development of increasing drug resistance of MRSA to traditional antimicrobials, there has been a search for a more effective antibiotic treatment. Linezolid is one of the most effective oral medications used for outpatient treatment of MRSA infections. We present a case of pancytopenia after outpatient treatment with linezolid. Myelosuppression is a rare but serious side effect of linezolid of which emergency physicians need to be aware in order to provide early intervention

Acute Ischemic Stroke in a Pediatric Patient

Acute ischemic stroke in a pediatric patient is a complex disease with a variety of etiologies that differ from adults. Though rare, they are a real phenomenon with potentially devastating consequences. Some treating institutions are using anti-thrombotic drug therapy with unclear benefits. Available literature, which is limited to case reports and retrospective reviews of databases, clouds this topic with both positive and negative outcomes. Emergency department management should focus on stabilization and resuscitation with immediate involvement of a pediatric neurologist and intensivist. The decision to use anti-thrombotic drug therapy, including anti-platelet drugs and thrombolytics, should be in consult with the specialists involved until randomized controlled trials determine their safety and efficacy in the pediatric population

Under Utilization of local anesthetics in infant lumbar punctures

Background: Lumbar Puncture (LP) is an invasive procedure frequently used to diagnose meningitis among the pediatric population. Neonates and infants have not routinely received local anesthesia prior to LP. Study Objective: To determine whether emergency medicine physicians and pediatricians use local analgesics on neonates and infants prior to performing an LP and to identify which local anesthetics, if any, were used. Methods: Prospective, cohort study of all infants, six months of age or less, that received an LP in the emergency department (ED) or inpatient pediatric units for suspected meningitis during a period of year at a university tertiary care hospital. Results: A total sample population of 111 infants that received an LP within the study period. A control population of 42 adults received an LP. Only 40.4% (45/111) of the infants received local analgesia prior to LP: either 1% lidocaine, EMLA or a combination of the two. Infants were less likely to receive lidocaine or EMLA prior to LP compared to adult subjects (OR= 0.27; 95% CI0.12 to 0.62). No neonates that were less than one month of age received local procedural anesthesia by emergency medicine or pediatric physicians. ED physicians’ use of local anesthesia prior to LP increased with increasing age of the infant. The pediatricians in this study used local anesthesia prior to LP when the infant was at least five months of age. Discussion: The data objectively support recent literature regarding the under use or lack of use of analgesia prior to LP among neonates and infants. Local anesthetics should be used routinely without exception prior to performing an LP in the pediatric population