Journal Reviews

Kim M, Strait RT, Sato TT, et al. A randomized clinical trial of analgesia in children with acute abdominal pain. Acad Emerg Med 2002; 9:281-287.

Giving intravenous morphine to children with acute abdominal pain does not adversely affect the examination, according to researchers from Medical College of Wisconsin in Milwaukee and Cincinnati Children’s Medical Center. The study looked at 60 children with abdominal pain who participated in the study, 29 receiving morphine and 31 receiving saline. There was no significant change in the areas of tenderness for either group, and no significant accuracy in the diagnosis. All children who required laparotomy were identified.

The study showed that tenderness to palpation or percussion remained after morphine is administered, so physicians were able to correctly evaluate the abdomen for peritoneal signs in children who required surgery. "Our findings suggest that the use of intravenous opioids in children with moderate to severe acute abdominal pain is possible without the fear of significant changes in physical findings or delay in diagnosis," the researchers conclude. 

Cooper RJ, Schriger DL, Flaherty HL. Effect of vital signs on triage decisions. Ann Emerg Med 2002; 29:223-232.

Although the vast majority of triage decisions made by emergency department (ED) nurses were not affected by knowledge of the patient’s vital signs, the vital signs did change the nurse’s assessments for 7.9% of patients, says this study from the University of California at Los Angeles School of Medicine.

The study looked at assessments made by 625 experienced triage nurses at 24 EDs for 14,285 patients, before and after vital signs were taken. The nurses chose one of five hypothetical triage destinations for the patient: calling 911, being seen in the ED in less than two hours, being seen in the physician’s office in two to eight hours, being seen in the physician’s office in eight to 24 hours, or receiving home care.

After the vital signs were known, triage destinations were downgraded in 2.4% of patients and upgraded in 5.5%. However, the researchers note that changes were more likely to occur in children 2 years old or younger, patients with communication problems, and patients 75 years or older.

The researchers say that although vital signs affect triage decisions only in a small minority of patients, the individuals often are from vulnerable populations. They warn that the actual urgency of a patient’s presentation may not be recognized if vital signs are not known. "For at least some of these patients, the upgrades may be of clinical consequence," they wrote.

Stermac LE, Stirpe TS. Efficacy of a 2-year-old sexual assault nurse examiner program in a Canadian hospital. J Emerg Nurs 2002; 28:18-23.

Sexual assault victims were assessed more quickly by sexual assault nurse examiners (SANEs) than emergency physicians, says this study from the University of Toronto and Sunnybrook and Women’s College, both in Toronto. Records of 515 women who presented at a sexual assault care center in 1996 and 1997 were examined. Victims were examined either by a physician or SANE, and similar treatment services were provided.

However, the study found that if a victim was seen by a SANE, the average assessment time was 3.25 hours, as compared with an average of four hours for victims who were seen by physicians. The researchers suggest that a possible explanation is that physicians were treating victims who had sustained more severe trauma and injuries, as the center’s protocol requires. In addition, the physicians were interrupted during the examination more often than SANEs (25.1% of the time for physicians, and 20% for the SANEs).

According to the study, SANEs were more likely than physicians to conduct partial physical examinations or evidence collection for sexual assault evidence kits. "In some cases, full examinations and kits may not be required, a SANE may delete parts of the examination, or an examination may be discontinued because of the distress of the victim," the researchers theorize, adding that partial kits still can be used as evidence in court.

The findings support the use of SANEs in the treatment of sexual abuse victims, say the researchers, since shorter treatment times and less frequent interruptions are important considerations.

"It is well understood that waiting a long time to receive emergency services is difficult and stressful for sexual assault victims," wrote the researchers.