pregnancy test if female, and 12 lead electrocardiogram were performed on eachsubject. They were placed on cardiac monitoring and received intravenous fluids via aperipheral catheter. Subjects received either cold (4 � C, n=7) or room temperature(23 � C, n=4) normal saline at a rate of 30cc/kg over thirty minutes. Core temperaturewas recorded using an ingestible temperature monitor. Core and skin temperaturesand vital signs were recorded every two minutes. Subjects indicated their level ofdiscomfort on a 100mm visual analog scale at five minute intervals. Intravenousmeperidine (10mg increments up to 50mg) was available at patient request to relievediscomfort or shivering in both groups. After 30 minutes, the infusion was stoppedand patients were monitored for an additional thirty minutes.

Results: The total decrease in core temperature over 30minutes was 0.9G0.3 �Cand0.4G0.1 �C for the hypothermia and control groups, respectively. The majorityof cooling occurred within the first fifteen minutes and was followed by a plateau inwhich little or no further cooling occurred. The cold fluids had a smaller effect onskin temperature; this decreased by a maximum of 0.4G0.8 �C at the chest andtriceps. Subject heart rate decreased initially after initiating fluids in both groups(maximum decrease 15G11 bpm at eight minutes in the hypothermia group and16G8 bpm for controls), followed by a gradual return to baseline. Cold intravenousfluid was associated with a maximum discomfort level of 34G6 mm, while the controlgroup had a maximum discomfort level of 20G5 mm. In all subjects, this peak leveloccurred between 15 and 30 minutes into the study. Only two subjects (both in thehypothermia group) required intravenous meperidine for discomfort or shivering.

Discussion: The neurological benefits of induced hypothermia have been shownto be greatest when initiated soon after brain injury. These data suggest that infusionof cold intravenous fluids via a peripheral catheter is a fast, affordable, safe, andeffective means of lowering core body temperature with only moderate patientdiscomfort. Future studies will assess if light sedation or decreased shivering wouldenable cooling to be even more effectively achieved and tolerated.

59 Serum B-Type Natriuretic Peptide (BNP) Level in Geriatric

Heart Failure

Kim H, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea

Study Objective: B-type Natriuretic Peptide (BNP), secreted in response toincreased wall tension in the ventricles, is increased in patients with congestive heartfailure. We performed this study to evaluate the difference of serum BNP levelsbetween geriatric and non-geriatric heart failure patients.

Methods: We conducted a prospective study of 175 patients (male 84) whopresented symptom of heart failure in emergency department from September 2003to September 2004. We compare with the clinical characteristics, the serum BNPlevel, and transthoracic echocardiographic findings between two age groups: less than65 years of age (non-geriatric group, n=56), and over 65 years of age (geriatric group,n=119). We excluded renal failure.

Results: The serum BNP level by New York Heart Association (NYHAclassification) I and II were significantly differed between geriatric and non-geriatricgroup (859G815 vs 110G154 U/L, p=0.027, and 1328G1253 vs 743G562 U/L,p=0.021). The serum BNP level by NYHA III and IV were not differed betweengeriatric and non-geriatric group (819G759 vs 1193G1269 U/L, p=0.199, and2453G1805 vs 1109G742 U/L, p=0.143). The serum BNP level correlated withejection fraction negatively in geriatric group (p=0.004, R=�0.263). The serum BNPlevel and other systolic and diastolic parameters (LVED: left ventricularend-diastolic dimension, LVSD: left ventricular end-systolic dimension, FS:fractional shortening, E/A ratio: early rapid filling wave/atrial contracion ratio)did not correlated.

Conclusion: The serum BNP level of geriatric heart failure by NYHAclassification I and II (mild symptom) are higher than that of non-geriatrics. Theserum BNP level correlated with ejection fraction negatively in geriatric heart failure.

61 Emergency Department Utilization: Characterization and

Comparison of Visits by Minority Versus Non-Minority

Elderly Populations

Marquez A, Prendergast HM, Schlichting A, Figueroa-Pal EM, University of Illinois

Medical Center, Chicago, IL; Highland General Hospital, Oakland, CA

Background: The emergency department (ED) is the most common entry pointfor accessing the healthcare system for older adults. Recent statistics demonstratehigher ED utilization among minority elderly.

Objectives: To characterize ED use by elderly minority as compared to non-minority elderly. Setting: urban academic emergency department.

Methods: Descriptive study using a standardized retrospective chart review ofED patient records. Comparison of minority versus non-minority groups usingChi-squared analysis. Elderly patients were defined as age 65 years or older. Minoritygroups were defined using U.S. Bureau of Census classifications and included AfricanAmerican, American Indian, Asian, Latino, and Pacific Islander.

Results: Three hundred and thirty-two patient charts were reviewed of which 288(86.7%) were for minority patients and 44 (13.3%) were for non-minority patients.The average patient age was 70.8G6.1years, with non-minority groups beingsignificantly older (73.3G6.8 vs. 70.5G5.8, p=0.004). A greater percentage of non-minority ED visits were triaged as urgent or emergent as compared with minoritygroups (85.4% vs. 62.8%, p=0.004) whereas minority patients had a higher incidenceof non-urgent triage classifications (34.0% vs. 13.6%, p=0.005). Patients classified asurgent or emergent upon triage were no more likely than non-urgent patients to havea medical (p=0.08), surgical (p=0.33), injury (p=0.19), psychiatric (p=1.00), or morethan one presenting complaint (p=0.28). There were no statistically significantdifferences in imaging or laboratory testing, mean number of ED diagnoses perpatient, and overall disposition between minority and non-minority patients. Therewere no significant differences between the mean number of ED visits in the last6 months between minority and non-minority patients (p=0.40).

Conclusion: Elderly minority patients tended to be younger and seek care fromEDs for less urgent conditions than non-minority patients. These data suggest thatinterventions that could provide greater access to primary care may favorable impactthe higher incidence of ED utilization among minority elderly.

62 Cefepime Versus Traditional Antibiotic Therapy in the

Treatment of Nursing Home Acquired Pneumonia:

A Pilot Study

O’Sullivan J, Miller V, Khan GM, Zervos M, O’Neil BJ, Ryder A, William Beaumont

Hospital, Royal Oak, MI

Study Objectives: Pneumonia is a leading cause of hospitalization and mortalityamong the elderly in nursing homes Pathogens causing nursing home acquiredpneumonia (NHAP) differ from those in the community, with increased incidence ofresistant gram-negative organisms. However these patients are often treated like thosewith community acquired pneumonia, (CAP). Current treatment guidelines (ATS &IDSA) do not specifically address the issue of NHAP. Cefepime is a fourth generationcephalosporin that is considered by many infectious disease physicians (ID) to be afirst line choice because of its excellent gram negative and lung pathogen coverage.We evaluated the outcome of nursing home patients treated with cefepime versustraditional antimicrobial therapy for pneumonia.

Objective: To evaluate the impact of antibiotic choice on outcomes in nursinghome patients with pneumonia.

Methods: We performed a retrospective chart review of patients residing in anursing home who were admitted through the emergency department with a

Research Forum Abstracts

60 The Clinical Characteristics of Organophosphate

Intoxication in Geriatric Patients

Kim H, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea

Study Objective: The plasma cholinesterase activity can vary with a variety ofphysiological factors. We performed this study to evaluate the clinical characteristicsof organophosphate intoxication in geriatric patients.

Methods: We conducted a prospective study of 58 patients (male 35, mean age53G17 years) who ingested organophosphate insecticides from January 2003 toDecember 2004. Patients were divided into two age groups: less than 65 years of age(non-geriatric group, n=37), and over 65 years of age (geriatric group, n=21). Weexcluded liver cirrhosis, cancer, malnutrition, low serum albumin states, and infection.

Volume 46, no. 3 : September 2005

Results: The incidence rate of aspiration pneumonia and shock were significantlydifferent between geriatric and non-geriatric group (50% vs 16.2%, p=0.012, and47.6% vs 18.9%, p=0.035). The geriatric group was higher rate of ventilator carethan non-geriatric group (90.5% vs 59.8%, p=0.016). When the rate ofcholinesterase recovers gradually in geriatric group, rapidly in non-geriatric group(15 days after ingestion: 1517 vs 2947 U/L, p=0.46, 20 days after ingestion 1160vs 4250 U/L, p=0.001). The plasma cholinesterase level was not differed admissionday (521 vs 629 U/L, p=0.68). The amount of ingestion, the mean bloodpressure, the mean pulse rate, the mean respiratory rate, and pH, PaO2, PaCO2,the lactate level, amylase level, and mortality rate were not differed.

Conclusion: The organophosphate intoxication of the geriatric group isassociated with more increased morbidities such as aspiration pneumonia, shock,ventilator care. The geriatric patients recover gradually the plasma cholinesterase levelafter organophosphate intoxication.

Annals of Emergency Medicine S19