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The Journal of Emergency Medicine 229

tudies was eliminated. The authors concluded that havingn emergency-physician-based sedation service improvedatient care and was financially beneficial to their hospital.

[Jessica Brooks, MD,

Denver Health Medical Center, Denver, CO]

Comment: This study is narrow in its scope given that itakes into account only one emergency medicine group’s ex-erience with initiating a sedation team. However, it doesndicate that using emergency physicians to staff a hospitaledation team may be beneficial both for patients and hospitalfficiency.

RISK FOR SYMPTOMATIC INTRACEREBRAL HEM-RRHAGE AFTER THROMBOLYSIS ASSESSED BYIFFUSION-WEIGHTED MAGNETIC RESONANCE IM-GING. Singer OC, Humpich MC, Fiehler J, et al. Ann Neurol008;63:52–60.

This study analyzed patients with acute ischemic stroke andvaluated the risk of developing symptomatic intracerebralemorrhage (sICH) after the administration of thrombolyticreatment. Patients were studied using data obtained retrospec-ively from a previous multi-center prospective trial. In total,45 patients with anterior circulation strokes were studied. Allatients received intravenous or intra-arterial thrombolysisithin 6 h of symptom onset. Patients were divided into threere-treatment groups based on magnetic resonance diffusion-eighted imaging (DWI) stroke lesion size: 1) small (� 10L), 2) moderate (10–100 mL), and 3) large (� 100 mL). Of

he 645 patients studied, 44 (6.8%) developed sICH afterhrombolysis. There was a significant difference of sICH in thehree pre-treatment groups, with rates of 2.8%, 7.8%, and6.1% in patients with small, moderate, and large DWItroke lesions, respectively (p � 0.05). In addition, pre-reatment DWI lesion size was an independent risk factor forotential sICH when evaluating multiple factors with logis-ic regression analysis. The authors concluded that DWIesion size is an important risk factor for the development ofICH after thrombolysis in acute stroke and that thrombo-ytics should be used judiciously in patients with large DWIesions.

[Elijah Edwards, MD,

Denver Health Medical Center, Denver, CO]

Comment: The use of thrombolytics in acute ischemictroke continues to be a controversial topic in emergencyedicine. This study demonstrates another tool that emergency

hysicians may use to guide treatment in ischemic stroke. IfWI magnetic resonance is available acutely, it may offer more

nformation to the treating physician and help to avoid poten-ially dangerous sICH after thrombolysis.

MEDICATION USE LEADING TO EMERGENCYEPARTMENT VISITS FOR ADVERSE DRUG EVENTS

N OLDER ADULTS. Budnitz DS, Shehab N, Kegler SR, et al.

nn Intern Med 2007;147:755–65. p

This study was an analysis of data compiled from theational Electronic Injury Surveillance System-Cooperativedverse Drug Event Surveillance (NEISS-CADES), Nationalmbulatory Medical Care Survey (NAMCS), and the Nationalospital Ambulatory Medical Care Survey (NHAMCS). It

ttempted to estimate the number of Emergency DepartmentED) visits for adverse drug events involving medications thaty consensus have been deemed potentially inappropriate forse in elderly patients (Beers criteria) compared with otheredications. By searching the NAMCS and NHAMCS data-

ases, the number of outpatient prescriptions written for Beersriteria as well as other more suitable medications was deter-ined. Data from patients aged 65 years or older seeking ED or

utpatient care in 58 non-pediatric hospitals participating inEISS-CADES from January 1, 2004 to December 31, 2005ere also obtained and were used to estimate ED visits for

dverse drug events that were defined as events that the phy-ician attributed to the use of a drug or to a specific drug effect.isits related to intentional overdose for self harm, therapyithdrawal, drug abuse, adverse events that occurred as a resultf treatment in the ED, and follow-up visits for previouslyiagnosed adverse events were excluded. In 10.5% of all out-atient visits, a prescription was written for a Beers criteriaedication. In an additional 9.4% of visits, a prescription wasritten for an appropriate anticoagulant, antiplatelet, or oralypoglycemic agent. On the basis of 4492 reported events, theuthors estimated that in 2004 and 2005 there were 177,504 EDisits annually for adverse drug events nationwide. Of those,.6% were related to medications listed in the Beers criteria,hereas 47.5% of events were related to oral anticoagulants,

ntiplatelet agents, oral hypoglycemics, and narrow therapeuticndex agents not listed in the Beers criteria. Thus, the numberf visits for adverse drug events was lower than expected foreers criteria medications, but significantly higher than ex-ected for certain agents not included in those criteria.

[Maria G Frank, MD,

Denver Health Medical Center, Denver, CO]

Comment: Although it is fraught with methodologic limita-ions, this article serves as a reminder of the peril associatedith the prescription of many common medications in the

lderly. Emergency physicians need to weigh the risks andenefits of such prescriptions carefully. An important questionot addressed in this article relates to interactions betweenedications and how often adverse events are related to those.

MATERNAL CAFFEINE CONSUMPTION DURINGREGNANCY AND THE RISK OF MISCARRIAGE: AROSPECTIVE COHORT STUDY. Weng X, Odouli R, Li. Am J Obstet Gynecol 2008;198:279.E1–8.

This population-based prospective cohort study was de-igned to address the issue of maternal caffeine consumptionuring pregnancy affecting the risk of miscarriage before the0th week of gestation. The study identified 2729 English-peaking, newly pregnant patients over a 2-year period from theaiser Permanente Medical Care Program, of which 1063

atients ultimately enrolled in the study and completed the