Widespread chest CT use in trauma evaluation may increase the diagnosis of minor sternal fracture... more Widespread chest CT use in trauma evaluation may increase the diagnosis of minor sternal fracture (SF), making former teaching about SF obsolete. We sought to determine: (1) the frequency with which SF patients are diagnosed by CXR versus chest CT under current imaging protocols, (2) the frequency of surgical procedures related to SF diagnosis, (3) SF patient mortality and hospital length of stay comparing patients with isolated sternal fracture (ISF) and sternal fracture with other thoracic injury (SFOTI), and (4) the frequency and yield of cardiac contusion (CC) workups in SF patients. We analyzed charts and data of all SF patients enrolled from January 2009 to May 2013 in the NEXUS Chest and NEXUS Chest CT studies, two multi-centre observational cohorts of blunt trauma patients who received chest imaging for trauma evaluation. Of the 14,553 patients in the NEXUS Chest and Chest CT cohorts, 292 (2.0%) were diagnosed with SF, and 94% of SF were visible on chest CT only. Only one pa...
Study objective: The objective of this study is to determine if the peritoneal fluid culture resu... more Study objective: The objective of this study is to determine if the peritoneal fluid culture results in the ascites patient being evaluated for spontaneous bacterial peritonitis (SBP) in the Emergency Department (ED) are used by the inpatient physician to appropriately alter empiric antibiotic treatment. Methods: We performed a retrospective study of all ascitic fluid samples sent from the ED between
The Journal of Trauma: Injury, Infection, and Critical Care, 2005
A retrospective analysis of 7,854 ground ambulance and 1,075 helicopter transports was conducted.... more A retrospective analysis of 7,854 ground ambulance and 1,075 helicopter transports was conducted. The 911-hospital arrival intervals for three transport methods were compared: ground, helicopter dispatched simultaneously with ground unit, and helicopter dispatched nonsimultaneously after ground unit response. Compared with ground transports, simultaneously dispatched helicopter transports had significantly shorter 911-hospital arrival intervals at all distances greater than 10 miles from the hospital. Nonsimultaneously dispatched helicopter transport was significantly faster than ground at distances greater than 45 miles, and simultaneous helicopter dispatch was faster than nonsimultaneous at virtually all distances. Ground transport was significantly faster than either air transport modality at distances less than 10 miles from the hospital. Ground ambulance transport provided the shortest 911-hospital arrival interval at distances less than 10 miles from the hospital. At distances greater than 10 miles, simultaneously dispatched air transport was faster. Nonsimultaneous dispatched helicopter transport was faster than ground if greater than 45 miles from the hospital.
e Abstract-The objective of this study was to derive a simple equation to convert distances betwe... more e Abstract-The objective of this study was to derive a simple equation to convert distances between air miles traveled by a helicopter and ground miles traveled by an ambulance. We performed a retrospective analysis of a convenience sampling of 245 "lights and sirens" ground ambulance transports between 1993 and 1997. Ground distances were recorded from odometer miles for each transport. Air miles were calculated using the Global Positioning System (GPS), measuring the distance in a straight line from the scene to the hospital. Air and ground distances were entered into a computerized spreadsheet, and the correlation coefficient and regression equation were derived. A simple approximation equation was developed and compared against the derived regression equation. There was a strong linear correlation between ground miles and air miles at virtually all distances studied (R ؍ 0.932, R 2 ؍ 0.869). Regression analysis revealed the following relationship: Ground miles ؍ 0.94 ؉ 1.25 (air miles). This was simplified to an approximation of: Ground miles ؍ 1.3 (air miles). The approximation equation yielded an answer within 1 mile of the regression equation for distances up to 40 air miles. It is concluded that in a mixed rural and urban EMS system, one may convert air and ground mileage estimates by using the simple relationship: Ground miles ؍ 1.3 (air miles). This conversion coefficient may prove useful for EMS personnel in designing reasonable helicopter utilization policies, making accurate transport decisions and conducting research.
e Abstract-To determine the accuracy of the Esophageal Detector Bulb (EDB) in the aeromedical set... more e Abstract-To determine the accuracy of the Esophageal Detector Bulb (EDB) in the aeromedical setting, we conducted a prospective, observational study of all intubated patients transported by an aeromedical program over two years. Flight personnel recorded the results of the EDB, clinical examination, pulse oximetry, and capnography (ETCO 2 ). Endotracheal tube position was confirmed by prehospital ETCO 2 or by the receiving emergency physician. There were 104 EDB assessments in 53 patients. The EDB correctly identified four of five esophageal intubations and 96 of 99 tracheal intubations. The sensitivity and specificity of the EDB in the detection of an esophageal intubation were 80% (95% CI, 38 -96%) and 97% (95% CI, 92-99%), respectively, and the overall accuracy was 96% (95% CI, 90 -98%). The EDB augments the ability of an aeromedical crew to determine endotracheal tube position, but its results must be carefully interpreted in the context of other available means of confirmation of endotracheal tube position.
Prehospital Emergency Care - PREHOSP EMERG CARE, 2008
To compare the outcomes of out-of hospital cardiac arrest (OHCA) victims treated with monophasic ... more To compare the outcomes of out-of hospital cardiac arrest (OHCA) victims treated with monophasic truncated exponential (MTE) versus biphasic truncated exponential (BTE) defibrillation in an urban EMS system. We conducted a retrospective review of electronic prehospital and hospital records for victims of OHCA between August 2000 and July 2004, including two years before and after implementation of biphasic defibrillators by the Fresno County EMS agency. Main outcome measures included: return of spontaneous circulation (ROSC), number of defibrillations required for ROSC, survival to hospital discharge, and discharge to home versus an extended care facility. There were 485 cases of cardiac arrest included. Baseline characteristics between the monophasic and biphasic groups were similar. ROSC was achieved in 77 (30.6%, 95% CI 25.2-36.5%) of 252 patients in the monophasic group, and in 70 (30.0% 95% CI 24.5-36.2%) of 233 in the biphasic group (p= .92). Survival to hospital discharge was 12.3% (95% CI 8.8-17%) for monophasic and 10.3% (95% CI 7.0-14.9%) for biphasic (p= .57). Discharge to home was accomplished in 20 (7.9%, 95% CI 5.1-12.0%) of the monophasic, and in 15 (6.4%, 95% CI 3.9-10.4%) of the biphasic group (p= .60). More defibrillations were required to achieve ROSC (3.5 vs. 2.6, p= .015) in the monophasic group. We found no difference in ROSC or survival to hospital discharge between MTE and BTE defibrillation in the treatment of OHCA, although fewer defibrillations were required to achieve ROSC in those treated with biphasic defibrillation.
To derive a decision instrument (DI) that identifies patients who have virtually no risk of signi... more To derive a decision instrument (DI) that identifies patients who have virtually no risk of significant intrathoracic injury (SITI) visible on chest radiography and, therefore, no need for chest imaging. Methods: This is a prospective observational study. At three Level 1 trauma centers, physicians caring for blunt trauma patients aged Ͼ14 years were asked to record the presence or absence of 12 clinical criteria before viewing chest imaging results. SITI was defined as pneumothorax, hemothorax, aortic/great vessel injury, two or more rib fractures, ruptured diaphragm, sternal fracture, and pulmonary contusion on official radiograph readings. The (interrater reliability) and screening performance of individual criteria were determined. By using recursive partitioning, the most highly sensitive combination of criteria for SITI was derived. Results: Of the 2,628 subjects enrolled, 271 (10.3%) were diagnosed with a total of 462 SITIs, with rib fractures (73%), pneumothorax (38%), and pulmonary contusion (29%) as the most common injuries. Chest pain and chest wall tenderness had the highest sensitivity for SITI (65%). The DI of chest pain, distracting injury, chest wall tenderness, intoxication, age Ͼ60 years, rapid deceleration, and altered alertness/mental status had the following screening performance: sensitivity 99.3% (95% confidence interval [CI], 97.4 -99.8), specificity 14.0% (95% CI, 12.6 -15.4), negative predictive value 99.4% (95% CI, 97.8 -99.8), and positive predictive value 11.7% (95% CI, 10.5-13.1). All seven criteria in the DI met the predetermined cut off for acceptable (range, 0.51-0.81). Conclusions: We derived a DI consisting of seven clinical criteria that can identify SITI in blunt trauma patients with extremely high sensitivity. If validated, this instrument will allow for safe, selective chest imaging with potential resource savings.
Study Objectives: Using chest computed tomography (CT) as the gold standard, we sought to determi... more Study Objectives: Using chest computed tomography (CT) as the gold standard, we sought to determine the frequency of missed significant intrathoracic injuries (SITI) of ED chest radiography (CXR) in blunt trauma patients.
Study objective: We determine the sensitivity, specificity, and clinical utility of the Gram's st... more Study objective: We determine the sensitivity, specificity, and clinical utility of the Gram's stain of peritoneal fluid in patients undergoing paracentesis.
Objectives: The first-attempt success rate of intubation was compared using GlideScope video lary... more Objectives: The first-attempt success rate of intubation was compared using GlideScope video laryngoscopy and direct laryngoscopy in an emergency department (ED).
Study Objectives: Hematuria by urine dipstick with absent red blood cells (RBCs) on microscopy is... more Study Objectives: Hematuria by urine dipstick with absent red blood cells (RBCs) on microscopy is indicative of rhabdomyolysis. We determined the sensitivity of this classic urinalysis (UA) finding in the diagnosis of rhabdomyolysis. Methods: We conducted a retrospective electronic medical record review of patients with a primary or secondary diagnosis of rhabdomyolysis with a creatine phosphokinase (CPK) greater than 1000 IU/L and a UA within the first 24 hours. Data were collected using a standardized data form, and a blinded panel of 3 emergency medicine physicians reviewed selected cases. Sensitivity and 95% confidence intervals (CIs) were calculated for detection of rhabdomyolysis by UA. Results: During the study period, 1796 patients were diagnosed with rhabdomyolysis, of whom 228 met inclusion criteria. The mean peak CPK was 27 509 IU/L. One hundred ninety-five (86%) had a urine dippositive for blood. However, only 94 patients (41%) had a positive urine dip and negative microscopic hematuria, resulting in a sensitivity of 41% (95% CI, 35%-47%). In a subset of 66 patients (29%) with more severe rhabdomyolysis (initial CPK, ≥ 10 000 IU/L; mean CPK, 53 365 IU/L), UA had a sensitivity of 55% (95% CI, 43%-67%). Broadening the definition of negative microscopy from 0 to 3 RBCs to less than 10 RBCs only increased the sensitivity to 79% (95% CI, 73%-83%). Conclusions: The combination of a positive urine dip for blood and negative microscopy is an insensitive test for rhabdomyolysis, and the absence of this finding should not be used to exclude the diagnosis.
Objective: The aim of this study was to compare phenobarbital (PB) versus lorazepam (LZ) in the t... more Objective: The aim of this study was to compare phenobarbital (PB) versus lorazepam (LZ) in the treatment of alcohol withdrawal in the emergency department (ED) and at 48 hours. Methods: Prospectively, randomized, consenting patients were assessed using a modified Clinical Institute Withdrawal Assessment (CIWA) score and given intravenous PB (mean, 509 mg) or LZ (mean, 4.2 mg). At discharge, LZ patients received chlordiazepoxide (Librium), and PB patients received placebo. Results: Of 44 patients, 25 received PB, and 19 LZ. Both PB and LZ reduced CIWA scores from baseline to discharge (15.0-5.4 and 16.8-4.2, P b .0001). There were no differences between PB and LZ in baseline CIWA scores (P = .3), discharge scores (P = .4), ED length of stay (267 versus 256 minutes, P = .8), admissions (12% versus 16%, P = .8), or 48-hour follow-up CIWA scores (5.8 versus 7.2, P = .6). Conclusion: Phenobarbital and LZ were similarly effective in the treatment of mild/moderate alcohol withdrawal in the ED and at 48 hours.
Objective: The objective of the study was to determine the sensitivity and specificity of abnorma... more Objective: The objective of the study was to determine the sensitivity and specificity of abnormal ascitic fluid appearance in the detection of spontaneous bacterial peritonitis (SBP), as a sensitivity approaching 100% could exclude SBP if the fluid is clear. Methods: We performed a retrospective review of all ascitic fluid samples sent for cell count over a 4-year period. Spontaneous bacterial peritonitis was defined as an absolute neutrophil count of more than 250 cells/mm 3 or a positive culture. Abnormal fluid appearance was defined as hazy, cloudy, or bloody. Results: There were 916 ascitic fluid samples analyzed during the study period. Eighteen percent of samples had a clear appearance, whereas 82% were abnormal. Abnormal ascitic fluid appearance had a sensitivity of 98.1% (95% confidence interval, 95.3%-99.5%) and a specificity of 22.7% (95% confidence interval, 19.4%-26.3%) in the detection of SBP.
Widespread chest CT use in trauma evaluation may increase the diagnosis of minor sternal fracture... more Widespread chest CT use in trauma evaluation may increase the diagnosis of minor sternal fracture (SF), making former teaching about SF obsolete. We sought to determine: (1) the frequency with which SF patients are diagnosed by CXR versus chest CT under current imaging protocols, (2) the frequency of surgical procedures related to SF diagnosis, (3) SF patient mortality and hospital length of stay comparing patients with isolated sternal fracture (ISF) and sternal fracture with other thoracic injury (SFOTI), and (4) the frequency and yield of cardiac contusion (CC) workups in SF patients. We analyzed charts and data of all SF patients enrolled from January 2009 to May 2013 in the NEXUS Chest and NEXUS Chest CT studies, two multi-centre observational cohorts of blunt trauma patients who received chest imaging for trauma evaluation. Of the 14,553 patients in the NEXUS Chest and Chest CT cohorts, 292 (2.0%) were diagnosed with SF, and 94% of SF were visible on chest CT only. Only one pa...
Study objective: The objective of this study is to determine if the peritoneal fluid culture resu... more Study objective: The objective of this study is to determine if the peritoneal fluid culture results in the ascites patient being evaluated for spontaneous bacterial peritonitis (SBP) in the Emergency Department (ED) are used by the inpatient physician to appropriately alter empiric antibiotic treatment. Methods: We performed a retrospective study of all ascitic fluid samples sent from the ED between
The Journal of Trauma: Injury, Infection, and Critical Care, 2005
A retrospective analysis of 7,854 ground ambulance and 1,075 helicopter transports was conducted.... more A retrospective analysis of 7,854 ground ambulance and 1,075 helicopter transports was conducted. The 911-hospital arrival intervals for three transport methods were compared: ground, helicopter dispatched simultaneously with ground unit, and helicopter dispatched nonsimultaneously after ground unit response. Compared with ground transports, simultaneously dispatched helicopter transports had significantly shorter 911-hospital arrival intervals at all distances greater than 10 miles from the hospital. Nonsimultaneously dispatched helicopter transport was significantly faster than ground at distances greater than 45 miles, and simultaneous helicopter dispatch was faster than nonsimultaneous at virtually all distances. Ground transport was significantly faster than either air transport modality at distances less than 10 miles from the hospital. Ground ambulance transport provided the shortest 911-hospital arrival interval at distances less than 10 miles from the hospital. At distances greater than 10 miles, simultaneously dispatched air transport was faster. Nonsimultaneous dispatched helicopter transport was faster than ground if greater than 45 miles from the hospital.
e Abstract-The objective of this study was to derive a simple equation to convert distances betwe... more e Abstract-The objective of this study was to derive a simple equation to convert distances between air miles traveled by a helicopter and ground miles traveled by an ambulance. We performed a retrospective analysis of a convenience sampling of 245 "lights and sirens" ground ambulance transports between 1993 and 1997. Ground distances were recorded from odometer miles for each transport. Air miles were calculated using the Global Positioning System (GPS), measuring the distance in a straight line from the scene to the hospital. Air and ground distances were entered into a computerized spreadsheet, and the correlation coefficient and regression equation were derived. A simple approximation equation was developed and compared against the derived regression equation. There was a strong linear correlation between ground miles and air miles at virtually all distances studied (R ؍ 0.932, R 2 ؍ 0.869). Regression analysis revealed the following relationship: Ground miles ؍ 0.94 ؉ 1.25 (air miles). This was simplified to an approximation of: Ground miles ؍ 1.3 (air miles). The approximation equation yielded an answer within 1 mile of the regression equation for distances up to 40 air miles. It is concluded that in a mixed rural and urban EMS system, one may convert air and ground mileage estimates by using the simple relationship: Ground miles ؍ 1.3 (air miles). This conversion coefficient may prove useful for EMS personnel in designing reasonable helicopter utilization policies, making accurate transport decisions and conducting research.
e Abstract-To determine the accuracy of the Esophageal Detector Bulb (EDB) in the aeromedical set... more e Abstract-To determine the accuracy of the Esophageal Detector Bulb (EDB) in the aeromedical setting, we conducted a prospective, observational study of all intubated patients transported by an aeromedical program over two years. Flight personnel recorded the results of the EDB, clinical examination, pulse oximetry, and capnography (ETCO 2 ). Endotracheal tube position was confirmed by prehospital ETCO 2 or by the receiving emergency physician. There were 104 EDB assessments in 53 patients. The EDB correctly identified four of five esophageal intubations and 96 of 99 tracheal intubations. The sensitivity and specificity of the EDB in the detection of an esophageal intubation were 80% (95% CI, 38 -96%) and 97% (95% CI, 92-99%), respectively, and the overall accuracy was 96% (95% CI, 90 -98%). The EDB augments the ability of an aeromedical crew to determine endotracheal tube position, but its results must be carefully interpreted in the context of other available means of confirmation of endotracheal tube position.
Prehospital Emergency Care - PREHOSP EMERG CARE, 2008
To compare the outcomes of out-of hospital cardiac arrest (OHCA) victims treated with monophasic ... more To compare the outcomes of out-of hospital cardiac arrest (OHCA) victims treated with monophasic truncated exponential (MTE) versus biphasic truncated exponential (BTE) defibrillation in an urban EMS system. We conducted a retrospective review of electronic prehospital and hospital records for victims of OHCA between August 2000 and July 2004, including two years before and after implementation of biphasic defibrillators by the Fresno County EMS agency. Main outcome measures included: return of spontaneous circulation (ROSC), number of defibrillations required for ROSC, survival to hospital discharge, and discharge to home versus an extended care facility. There were 485 cases of cardiac arrest included. Baseline characteristics between the monophasic and biphasic groups were similar. ROSC was achieved in 77 (30.6%, 95% CI 25.2-36.5%) of 252 patients in the monophasic group, and in 70 (30.0% 95% CI 24.5-36.2%) of 233 in the biphasic group (p= .92). Survival to hospital discharge was 12.3% (95% CI 8.8-17%) for monophasic and 10.3% (95% CI 7.0-14.9%) for biphasic (p= .57). Discharge to home was accomplished in 20 (7.9%, 95% CI 5.1-12.0%) of the monophasic, and in 15 (6.4%, 95% CI 3.9-10.4%) of the biphasic group (p= .60). More defibrillations were required to achieve ROSC (3.5 vs. 2.6, p= .015) in the monophasic group. We found no difference in ROSC or survival to hospital discharge between MTE and BTE defibrillation in the treatment of OHCA, although fewer defibrillations were required to achieve ROSC in those treated with biphasic defibrillation.
To derive a decision instrument (DI) that identifies patients who have virtually no risk of signi... more To derive a decision instrument (DI) that identifies patients who have virtually no risk of significant intrathoracic injury (SITI) visible on chest radiography and, therefore, no need for chest imaging. Methods: This is a prospective observational study. At three Level 1 trauma centers, physicians caring for blunt trauma patients aged Ͼ14 years were asked to record the presence or absence of 12 clinical criteria before viewing chest imaging results. SITI was defined as pneumothorax, hemothorax, aortic/great vessel injury, two or more rib fractures, ruptured diaphragm, sternal fracture, and pulmonary contusion on official radiograph readings. The (interrater reliability) and screening performance of individual criteria were determined. By using recursive partitioning, the most highly sensitive combination of criteria for SITI was derived. Results: Of the 2,628 subjects enrolled, 271 (10.3%) were diagnosed with a total of 462 SITIs, with rib fractures (73%), pneumothorax (38%), and pulmonary contusion (29%) as the most common injuries. Chest pain and chest wall tenderness had the highest sensitivity for SITI (65%). The DI of chest pain, distracting injury, chest wall tenderness, intoxication, age Ͼ60 years, rapid deceleration, and altered alertness/mental status had the following screening performance: sensitivity 99.3% (95% confidence interval [CI], 97.4 -99.8), specificity 14.0% (95% CI, 12.6 -15.4), negative predictive value 99.4% (95% CI, 97.8 -99.8), and positive predictive value 11.7% (95% CI, 10.5-13.1). All seven criteria in the DI met the predetermined cut off for acceptable (range, 0.51-0.81). Conclusions: We derived a DI consisting of seven clinical criteria that can identify SITI in blunt trauma patients with extremely high sensitivity. If validated, this instrument will allow for safe, selective chest imaging with potential resource savings.
Study Objectives: Using chest computed tomography (CT) as the gold standard, we sought to determi... more Study Objectives: Using chest computed tomography (CT) as the gold standard, we sought to determine the frequency of missed significant intrathoracic injuries (SITI) of ED chest radiography (CXR) in blunt trauma patients.
Study objective: We determine the sensitivity, specificity, and clinical utility of the Gram's st... more Study objective: We determine the sensitivity, specificity, and clinical utility of the Gram's stain of peritoneal fluid in patients undergoing paracentesis.
Objectives: The first-attempt success rate of intubation was compared using GlideScope video lary... more Objectives: The first-attempt success rate of intubation was compared using GlideScope video laryngoscopy and direct laryngoscopy in an emergency department (ED).
Study Objectives: Hematuria by urine dipstick with absent red blood cells (RBCs) on microscopy is... more Study Objectives: Hematuria by urine dipstick with absent red blood cells (RBCs) on microscopy is indicative of rhabdomyolysis. We determined the sensitivity of this classic urinalysis (UA) finding in the diagnosis of rhabdomyolysis. Methods: We conducted a retrospective electronic medical record review of patients with a primary or secondary diagnosis of rhabdomyolysis with a creatine phosphokinase (CPK) greater than 1000 IU/L and a UA within the first 24 hours. Data were collected using a standardized data form, and a blinded panel of 3 emergency medicine physicians reviewed selected cases. Sensitivity and 95% confidence intervals (CIs) were calculated for detection of rhabdomyolysis by UA. Results: During the study period, 1796 patients were diagnosed with rhabdomyolysis, of whom 228 met inclusion criteria. The mean peak CPK was 27 509 IU/L. One hundred ninety-five (86%) had a urine dippositive for blood. However, only 94 patients (41%) had a positive urine dip and negative microscopic hematuria, resulting in a sensitivity of 41% (95% CI, 35%-47%). In a subset of 66 patients (29%) with more severe rhabdomyolysis (initial CPK, ≥ 10 000 IU/L; mean CPK, 53 365 IU/L), UA had a sensitivity of 55% (95% CI, 43%-67%). Broadening the definition of negative microscopy from 0 to 3 RBCs to less than 10 RBCs only increased the sensitivity to 79% (95% CI, 73%-83%). Conclusions: The combination of a positive urine dip for blood and negative microscopy is an insensitive test for rhabdomyolysis, and the absence of this finding should not be used to exclude the diagnosis.
Objective: The aim of this study was to compare phenobarbital (PB) versus lorazepam (LZ) in the t... more Objective: The aim of this study was to compare phenobarbital (PB) versus lorazepam (LZ) in the treatment of alcohol withdrawal in the emergency department (ED) and at 48 hours. Methods: Prospectively, randomized, consenting patients were assessed using a modified Clinical Institute Withdrawal Assessment (CIWA) score and given intravenous PB (mean, 509 mg) or LZ (mean, 4.2 mg). At discharge, LZ patients received chlordiazepoxide (Librium), and PB patients received placebo. Results: Of 44 patients, 25 received PB, and 19 LZ. Both PB and LZ reduced CIWA scores from baseline to discharge (15.0-5.4 and 16.8-4.2, P b .0001). There were no differences between PB and LZ in baseline CIWA scores (P = .3), discharge scores (P = .4), ED length of stay (267 versus 256 minutes, P = .8), admissions (12% versus 16%, P = .8), or 48-hour follow-up CIWA scores (5.8 versus 7.2, P = .6). Conclusion: Phenobarbital and LZ were similarly effective in the treatment of mild/moderate alcohol withdrawal in the ED and at 48 hours.
Objective: The objective of the study was to determine the sensitivity and specificity of abnorma... more Objective: The objective of the study was to determine the sensitivity and specificity of abnormal ascitic fluid appearance in the detection of spontaneous bacterial peritonitis (SBP), as a sensitivity approaching 100% could exclude SBP if the fluid is clear. Methods: We performed a retrospective review of all ascitic fluid samples sent for cell count over a 4-year period. Spontaneous bacterial peritonitis was defined as an absolute neutrophil count of more than 250 cells/mm 3 or a positive culture. Abnormal fluid appearance was defined as hazy, cloudy, or bloody. Results: There were 916 ascitic fluid samples analyzed during the study period. Eighteen percent of samples had a clear appearance, whereas 82% were abnormal. Abnormal ascitic fluid appearance had a sensitivity of 98.1% (95% confidence interval, 95.3%-99.5%) and a specificity of 22.7% (95% confidence interval, 19.4%-26.3%) in the detection of SBP.
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Papers by Gregory Hendey