Antelope Valley Hospital

About: Antelope Valley Hospital is a healthcare organization based out in Lancaster, California, United States. It is known for research contribution in the topics: Head injury & Emergency department. The organization has 14 authors who have published 17 publications receiving 233 citations.

Validation of the Pediatric NEXUS II Head Computed Tomography Decision Instrument for Selective Imaging of Pediatric Patients with Blunt Head Trauma.

Abstract: Background Data suggest that clinicians, when evaluating pediatric patients with blunt head trauma, may be overordering head computed tomography (CT). Prior decision instruments (DIs) aimed at aiding clinicians in safely forgoing CTs may be paradoxically increasing CT utilization. This study evaluated a novel DI that aims for high sensitivity while also improving specificity over prior instruments. Methods We conducted a planned secondary analysis of the NEXUS Head CT DI among patients less than 18 years old. The rule required patients satisfy seven criteria to achieve "low-risk" classification. Patients were assigned "high-risk" status if they fail to meet one or more criteria. Our primary outcome was the ability of the rule to identify all patients requiring neurosurgical intervention. Results The study enrolled 1,018 blunt head injury pediatric patients. The DI assigned high-risk status to 27 of 27 patients requiring neurosurgical intervention (sensitivity = 100.0%, 95% confidence interval [CI] = 87.2%-100%]). The instrument assigned low-risk status to 330 of 991 patients who did not require neurosurgical intervention (specificity = 33.3%, 95% CI = 30.3%-36.3%). None of the 991 low-risk patients required neurosurgical intervention (negative predictive value [NPV] = 100%, 95% CI = 99.6%-100%). The DI correctly assigned high-risk status to 48 of the 49 patients with significant intracranial injuries, yielding a sensitivity of 98.0% (95% CI = 89.1%-99.9%). The instrument assigned low-risk status to 329 of 969 patients who did not have significant injuries to yield a specificity of 34.0% (95% CI = 31.0%-37.0%). Significant injuries were absent in 329 of the 330 patients assigned low-risk status to yield a NPV of 99.7% (95% CI = 98.3%-100%). Conclusions The Pediatric NEXUS Head CT DI reliably identifies blunt trauma patients who require head CT imaging and could significantly reduce the use of CT imaging.

Potential Influence of Antisecretory Therapy on the Development of Candida-Associated Intraabdominal Infection

Abstract: Background:Concerns surrounding the potential extra gut complication of gastric acid suppression are becoming increasingly realized.Objective:To determine whether chronic antisecretory treatment with a proton pump inhibitor (PPI) or histamine2-receptor antagonist (H2RA) is associated with the presence of Candida spp. in cases of complicated intraabdominal infection.Methods:We conducted a case-controlled study of adult surgical intensive care unit patients with complicated intraabdominal infection during a 5-year period. Exclusion criteria consisted at primary peritonitis, diagnosis of intraabdominal infection more than 72 hours before hospital admission, or a stay in the intensive care unit of less than 72 hours. Patients were categorized into either the antisecretory group (H2RA or PPI therapy prior to admission) or control group (no prior antisecretory therapy).Results:One hundred eighteen patients met inclusion criteria. Chronic antisecretory (n = 41) and control (n = 77) patients were similar except i...

Symptomatic Pneumorrhachis After an Epidural Blood Patch

Abstract: Background Pneumorrhachis (PR), the presence of air within the spinal canal, is a rare, radiologic epiphenomenon arising from traumatic, nontraumatic, and iatrogenic causes. Often asymptomatic, PR is usually managed conservatively. However, PR can be associated with underlying serious pathology and can become symptomatic, requiring more aggressive diagnostic and treatment modalities from the treating physician. Although well known in the anesthesia literature, this case report is the first in the emergency medicine literature to describe iatrogenic, symptomatic PR presenting in the emergency department (ED). Case Report A 34-year-old woman presented to the ED with a postural puncture headache after epidural anesthesia for a vaginal delivery. An epidural blood patch was administered, after which the patient acutely developed cervical radicular pain. Computed tomography angiography of the head and neck revealed epidural PR. Conservative treatment with analgesia, intravenous fluids, and bed rest was administered. Her pain improved significantly, and at 5-month follow-up, she remained symptom-free. Why Should an Emergency Physician Be Aware of This? PR is a rare and usually benign disease, especially in the setting of an iatrogenic cause such as lumbar puncture. However, in traumatic settings, PR in the intradural space should alert the emergency physician to search for underlying serious pathology if it has not already been found. Finally, PR can become symptomatic, and treatment will depend on the severity of symptoms.