292 Intussusception Incidence Does Not Correlate WithGastrointestinal Disease

Shah S, Ekanayake R, Fiesseler F, Kairam N, Cochrane D/Morristown MemorialHospital, Morristown, NJ

Introduction: Intussusception is a pervasive disease with significant morbidity ifleft untreated. It has long been speculated that intussusception incidence maycorrelate with gastrointestinal illness, specifically gastroenteritis, which has a seasonalpeak occurring in March/April.

Study Objective: To determine if intussusception has a seasonal variation thatcorrelates with pediatric gastrointestinal illness.

Methods: Design: A multi-center retrospective cohort study. Setting: 29urban, suburban, and rural emergency departments (EDs) in the New York/New Jersey area. Participants: Consecutive patients with the final ICD9diagnosis of intussusception from April 1999 to November 2010. We “a priori”subdivided patients into: � 5 years (yrs), � 18 yrs and � 18 yrs for analysis.Statistics: Chi-square and Mann-Whitney for analysis with a significant P-value� 0.05.

Results: A total of 8,340,594 patients were seen during the study period. Atotal of 418 (.005%) patients were diagnosed with intussusception. Patients � 5yrs comprised 51% (N� 214), � 18 yrs 63% (N�265) and those 18 yrs or older37% (N�153). Overall median age was 4.6 yrs (IQR 1.4-34.7yrs). Female sexcomprised 43% (N�181) of patients. 73% (N�305) were admitted, 17%(N�69) discharged and 10% (N�44) transferred. The most common month forED visits was August, comprising 12% of all cases and the least common wasOctober and February each comprising 5.3% of visits. March and April (peakgastrointestinal season) comprised 6 % of total cases per month, compared withan average monthly rate of 8% for the remaining months (p�0.14). Over the lasttwelve years the percent of patients with this disease is: 1999 (0.0018%), 2000(0.00167%), 2001 (0.00243%), 2002 (0.00442%), 2003 (0.00358%), 2004(0.00487%), 2005 (0.0057), 2006 (0.0079), 2007 (0.0080%), 2008 (0.0090%),2009 (0.0089%), 2010 (0.0097%) (p��0.001). The median age from 1999-2004 was 3.6 yrs (IQR 1.6-22yrs) and was 5.5 yrs (IQR 1.6-36 yrs) from 2005-2010 (p�0.12).

Conclusion: The percent visits for intussusception is increasing in our EDpopulation and did not mirror the March/April peaks for gastroenteritis.

293 Correlation of Inferior Vena Cava/Aorta Ratio toFluid Therapy in Clinically Dehydrated Children

Barata IA, O’Donnell B, Houdek L, Cirilli A, Haines C, Prokofieva A, Bramante R,Modayil V, Ward MF, Sama A/North Shore University Hospital, Manhasset, NY

Background: Dehydration is commonly encountered in the emergencydepartment (ED) and is a leading cause of morbidity and mortality among children.Accurate assessment is important. The standard is to use clinical signs and symptoms;however, these methods have a low sensitivity and specificity.

Study Objectives: To look at IVC/Aorta ratio as a novel way to evaluate bodyfluid status by determining the association between IVC/Aorta Ratio and the amountof fluid given over time during fluid resuscitation of clinically dehydrated childrenwith gastroenteritis in the ED.

Hypothesis: Serial measurements of IVC/Aorta Ratio will correlate with fluidresuscitation therapy.

Methods: Prospective, observational study, convenience sample of clinicallydehydrated patients �18 years old presenting to the ED with vomiting, diarrhea,poor oral intake, and decreased urine output. Emergency physician determinesseverity of dehydration based on clinical judgment. Longitudinal anteroposteriordiameter measurements of the IVC minimal (min) and maximal (max), distal to theconfluence with hepatic veins, and proximal transverse measurements of the aortawere performed. There was no compression of the abdomen and no gradedcompression to move the bowel. The IVC min and max and aorta measurementswere performed at baseline and after 1 20 cc/kg fluid bolus. Descriptive statistics werecomputed for IVC, Aorta, and IVC/aorta ratio. The Wilcoxon Signed Rank test wasused to determine whether there was a statistically significant difference betweenIVC/aorta ratio before and after 20cc/kg bolus.

Results: Enrolled 31 patients’ ages 9 months to 15 years. There was a significantdifference in the average of the min and max IVC/aortic ratio at baseline and after abolus of 20cc/kg was given (IVC/aorta ratio at baseline mean 0.75, median 0.73;IVC/aorta ratio after hydration mean 0.95, median 0.83; p�0.0155).

Conclusion: There is a significant difference in IVC/aortic ratio at baseline andafter fluid hydration in clinically dehydrated children. Looking at IVC/aortic ratio is apromising method of estimating body water status.

294 Are Patients Who Are Diagnosed With SubarachnoidHemorrhage by Lumbar Puncture More Likely to Havea Delayed Presentation?

Kasper LM, Fiesseler FW, Salo D, Riggs RL, Calello D/Morristown MemorialHospital, Morristown, NJ; Robert Wood Medical Center, New Brunswick, NJ

Introduction: Subarachnoid hemorrhage is a life-threatening disease that can beallusive to diagnose. A head CT scan (CTH) has been quoted as being most accurateduring the first 24 hrs, with a sensitivity of � 95% in diagnosing subarachnoidhemorrhage during this period. A delay in CTH imaging by 1 wk reduces thesensitivity to near 50%.

Study Objective: To determine if a delay in presentation is associated with anincreased rate of lumbar puncture diagnosed subarachnoid hemorrhage.

Methods: Design: Retrospective cohort study. Participants: All patientspresenting to the emergency department (ED) between January 2005 andDecember 2009 in 20 NJ/NY hospitals. ICD9 diagnosis of subarachnoidhemorrhage were extracted using EMARS database. The CPT code for lumbarpuncture was then cross referenced to diagnosis. A manual chart review wasconducted on all patients diagnosed with subarachnoid hemorrhage who hadlumbar puncture performed. Every tenth subarachnoid hemorrhage chart wasthen analyzed as a “control.” Patients were excluded if: traumatic etiology, chartunavailability/incomplete, or previous diagnosis of subarachnoid hemorrhage.Duration was “a priori” divided into 7 days. Statistics: Mann-Whitney Test andChi Square Test with a present alpha of 0.05.

Results: A total of 3,741,129 patients were evaluated during the study period.subarachnoid hemorrhage was diagnosed in 1508 patients. An lumbar puncturewas determined to be positive for subarachnoid hemorrhage in 1.5%(n�22/1504) of patients. Ultimately, 4 patients had a “CT re-reads” for ICHleaving 1.2% (n�18/1504) (95% CI�0.7%-1.9%) with negative CTH andpositive lumbar puncture. Of the 150 historical control charts 20 were excludedfor chart unavailability/incomplete data, 28 for being traumatic in origin, and 4had a previous diagnosis of subarachnoid hemorrhage, leaving 98 for analysis.

Research Forum Abstracts

S276 Annals of Emergency Medicine Volume , . : October