ACEP Journal Begins New Series Exploring Evidence-Based Medicine and Announces Results of Innovative Studies on Telemedicine and Alcohol-Related Emergency Visits

For Immediate Release
October 30, 1997

CONTACT:
Laura Gorem, (202) 728-0610, ext. 3006

ACEP Journal Begins New Series Exploring Evidence-Based Medicine and Announces Results of Innovative Studies on Telemedicine and Alcohol-Related Emergency Visits

Washington, D.C.óA new series explores how evidence-based emergency medicine can close the gap between research and practice in the November issue of Annals of Emergency Medicine. New studies also are released on how telemedicine technology can be used to improve health care in underserved areas and how emergency departments can be used to identify alcohol-related problems.

Evidence-Based Emergency Medicine

Several articles in this issue begin a new journal series on evidence-based medicine (EBM), a relatively recent movement in the field of medicine that seeks to more efficiently transfer research into clinical practice. In the introductory article ("Evidence-Based Emergency Medicine: Integrating Research Into Practice"), EBM is defined as the ability to track down, critically appraise, and incorporate the rapidly growing body of research into front-line patient care; the history of thrombolytic therapy for treating acute myocardial infarction is cited as an example of the gap in knowledge-transfer. The articles also addresses objections to EBM.

"Evidence-based practitioners must know how to search the literature to obtain the best evidence for answering questions, evaluate the strengths of study methods, extract relevant clinical messages, and apply them in patient care,"said Dr. Gordon Guyatt, of McMaster University in Ontario and one of the founders of the EBM movement. "Traditionally, these skills have not been taught in either medical school or postgraduate training, but this is changing."

Another article applies the concepts of evidence-based medicine to a specific questionó "Recombinant Tissue Plasminogen Activator: In My Community Hospital ED, Will Early Administration of rt-PA to Patients With the Initial Diagnosis of Acute Ischemic Stroke Reduce Mortality and Disability?"

Telemedicine

A 1-year study of 190 clinical teleconsultations between rural primary care providers and various specialists concludes that invaluable relationships are established between emergency physicians and primary care providers in rural sites that improve health care delivery and that emergency physicians should consider participating in these consultations and using them in their practices. In the studyóperhaps the first to analyze the roles of emergency physicians in a clinical telemedicine networkóthe largest percentage of consultations requested by primary care providers were for emergency medicine physicians (24 percent), mostly for trauma or orthopedic care (73 percent). The average consultation time was 4 minutes.

In a clinical telemedicine system, the technology available through telemedicine (e.g., T-1 telephone lines, videoconferencing, and peripheral devicesósuch as high-resolution cameras, stethoscopes, and otoscopes), allows emergency physicians to deliver specialty health care in areas where specialty services are not available.

"It is possible that telemedicine technology in the future will enhance the delivery of health care to underserved areas while simultaneously reducing health care costs," said Dr. Craig J. Lambrecht of Medcenter One Health Systems in Bismarck, North Dakota. "Applying telemedicine technology can reduce isolation among practitioners and improve both access to health care by patients and the quality of health care delivered in underserved areas. Helping patients stay in their communities to receive health care will improve economic viability of health care organizations in rural areas, as well as entire communities."

The article describes how telemedicine is in its infant stages in the United States and is expanding to all parts of the country (i.e., 40 states). In a survey of physician satisfaction with the system during the study, emergency physicians ranked all emergency medicine consultations as excellent with respect to equipment resolution and the quality of telemedicine technology in helping them render clinical options and management recommendations. ("Emergency Physicians's Roles in a Clinical Telemedicine Network")

Intoxicated ED Patients: A 5-Year Follow-Up of Morbidity and Mortality

The study concludes that a single alcohol-related emergency department visit is an important predictor of continued problem drinking, alcohol-impaired driving, and possibly, premature death; the morbidity and mortality rates of intoxicated emergency department patients was 2.4 times higher than the nonintoxicated comparison group, 5 years after presentation. The 5-year death rate among intoxicated patients aged 40 to 69 years was especially high (19 percent). Intoxicated patients also were more likely to revisit emergency departments because of suicidal behavior or domestic violence. In addition, only 13 percent of intoxicated patients in the study received a referral to a psychiatrist, substance abuse counselor, mental health worker, or alcohol rehabilitation facility.

"Alcohol abuse is one of society's most serious health problems, a fact that is self-evident in urban emergency departments," said Dr. Paul Davidson of the Colorado Emergency Medicine Research Center at the University of Colorado Health Sciences Center. "The implication is clear: greater effort should be taken to diagnose, counsel, and refer intoxicated emergency patients for therapy, because without referral, their 5-year outcome may be poor."

Restraint Position and Positional Asphyxia

Another study shows that restricting a person's body position (e.g., the police restraint "hobble" or the "hogtie" positions) can restrict pulmonary function, although clinically relevant changes in oxygenation or ventilation were not found in the healthy volunteers who participated in the study. The study sought to determine whether the breathing is adversely affected of individuals placed in prone positions (e.g., with wrists handcuffed or tied together behind backs and ankles bound together and secured to wrists) and whether sudden, unexpected deaths in persons restrained in these manners can be attributed to respiratory failure because of the body position or "positional aspyxia." The article also states that a combination of factors, including underlying medical conditions, intoxication, agitation, delirium, and struggle, as well as body position, may result in respiratory compromise which might not be detected by the study.

Other Articles

"Abbreviated Educational Session Improves Cranial Computed Tomography Scan Interpretations by Emergency Physicians."óThe study concludes that emergency physicians' interpretation skills of cranial CT scans can be improved using a 1-hour educational session.

"Prevention of Gastrointestinal Iron Absorption by Cheation From an Orally Administered Premixed Deferoxamine/Charcoal Slurry."óThe study shows that adding DFO [deferoxamine] to AC [activated charcoal] (creating a slurry) reduced gastrointestinal iron absorption of ferrous sulfate. Iron ingestion is one of the most common forms of overdose and a source of morbidity and mortality in both children and adults. The study is clinically important because activated charcoal absorbs iron poorly, and therefore therapeutic recommendations have been limited to invasive procedures (e.g., whole bowel irrigation).

Attached is a copy of the table of contents for the November issue of Annals of Emergency Medicine. Copies of articles can be obtained from the American College of Emergency Physicians.

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Annals of Emergency Medicine is the peer-reviewed journal of the American College of Emergency Physicians, a national medical society representing more than 19,500 physicians who specialize in emergency medicine. ACEP is committed to improving the quality of emergency care through continuing education, research, and public education.