Journal Reviews

Keshavarz R, Merchant RC, McGreal, J, et al. Emergency contraception provision: A survey of emergency department practitioners. Acad Emerg Med 2002; 9:69-74.

Although most ED practitioners were willing to offer emergency contraception (EC), physicians were less willing to prescribe it for exposures other than sexual assault, says this study from the Mount Sinai School of Medicine in New York City. A survey completed by 600 ED physicians gave nine scenarios and asked whether the respondent would offer EC for each.

Here are key findings:

• Given the scenario of a patient sexually assaulted by unknown assailants, 88% of 600 respondents said they were willing to offer EC.

• More physicians said they would offer EC if the assailant was known to be HIV-infected (90%) than if the assailant had low HIV risk factors (79%).

• More physicians said they would offer EC if a patient was sexual assaulted (88%) than if the patient had consensual sex (73%)

The researchers note that a higher percentage of female respondents were willing to offer EC in all the scenarios presented. "It is likely that female practitioners are more concerned than males about unwanted pregnancies and are more cognizant of its implications," they write. They add that since practitioner offering of EC varied depending on whether the patient was sexually assaulted and HIV risk factors, the decision-making process of the physicians may be influenced by religious or ethical beliefs.

"Since the likelihood of pregnancy was the same in these scenarios, these results suggest that nonmedical influences such as the nature of the sexual contact and characteristics of the sexual partner affected the offering of EC," they conclude. "We suggest that practitioners draw from this study and re-examine the clinical indications for prescribing EC."

Mandavia DP, Hoffner RJ, Mahaney K, et al. Bedside echocardiography by emergency physicians. Ann Emerg Med 2001; 38:377-382.

According to this study from the University of Southern California Medical Center in Los Angeles, echocardiography performed at the bedside is reliable in evaluating a patient for pericardial effusions. Of the 515 patients at high risk for pericardial effusion who were enrolled in the study, 103 patients were diagnosed with pericardial effusion. ED physicians had an overall accuracy of 97.5%.

ED physicians can perform focused bedside echocardiography reliably to detect pericardial effusions for patients at high risk, conclude the researchers. "Emergency training programs and departments should incorporate this important diagnostic tool into their clinical practice," they argue.