Conclusion: Pharmacist review of ED antibiotic orders for patients admitted withpneumonia delays care and potentially causes harm to ED patient safety.

125 Daily Antihypertensive Therapy Results in MilderStroke and More Favorable Outcomes

Vaidyanathan L, Bellolio MF, Enduri S, Decker WW, Stead LG/Mayo ClinicCollege of Medicine. Division of Emergency Medicine Research, Rochester, MN

Study Objective: Antihypertensive therapy prior to an acute ischemic stroke havean impact on stroke severity and functional outcome.

Methods: The cohort included all patients presenting to the emergencydepartment with an acute ischemic stroke over a 43-month period (December 01 toJune 05). The daily intake of an antihypertensive and specific drug class wasabstracted. The outcome variables of stroke severity and functional outcome weredetermined using the NIHSS and the modified Rankin score (mRs) respectively. Thestroke severity was calculated for each patient on admission while the functionaloutcome was calculated on discharge from the hospital stroke service. The etiology ofthe event was estimated using the TOAST classification system.

Results: Of a total of 1038 patients enrolled, median age was found to be 75.9years with an SD of 14.7, and 47.2% of the selected cohort were female. 69%(n�702) were on an antihypertensive medication on admission.

Following adjustment for stroke subtype and age, regular intake of anantihypertensive was found to be significantly associated with a lower stroke severityon presentation (p�0.001) and better functional outcome at hospital discharge(p�0.001).

Analysis of individual groups of antihypertensives did not show any significantdifference. This finding is likely explained by the fact that 63.1% of the patients whowere taking an antihypertensive, were taking more than one agent (table 1).

Table 1

Conclusion: Antihypertensive therapy seems to be associated with a lower strokeseverity on admission as well as better functional outcome on discharge.

126 Safety and Effectiveness of Intravenous Low-DoseProchlorperazine for Nausea and Vomiting in theEmergency Department

Flannigan M, Clements E, Zeigler A, Jones JS/Grand Rapids MERC/ MichiganState University, Grand Rapids, MI

Study Objectives: Prochlorperazine (PCZ) has been accepted as an effectiveantiemetic for more than 50 years, although its therapeutic success has been limitedby the akathisia that occurs frequently with intravenous (IV) use. Slow infusion ofPCZ does not decrease the incidence of these adverse effects. However, no studieshave been done to determine whether the incidence of akathisia is reduced bydecreasing the dose of PCZ. The purpose of this pilot study was to determine ifreducing the IV dose of CPZ reduces the incidence of akathisia while maintaining itstherapeutic effectiveness as an antiemetic.

Methods: The design was a prospective, descriptive study set in an academic,tertiary-care medical center over a one-week study period. All adult patients (� 18years) who received IV CPZ for treatment of nausea/vomiting were enrolled in thestudy. The initial dosage of PCZ (2.5-10 mg) was chosen at the discretion of thetreating clinician and infused by slow intravenous injection at a rate not exceeding 5mg/minute. Primary endpoints were akathisia (defined as a strong subjective feelingof restlessness that manifests itself with an inability to sit still or remain motionless)which occurred during the patient’s stay in the ED and the need for furtherantiemetic medication. Data were analyzed using descriptive statistics and 95%confidence intervals.

Results: A total of 93 patients were enrolled, representing 8% of the adultspresenting to the ED during the study period. Sixty-seven patients (72%) wereinitially treated with 2.5 mg PCZ, eleven (12%) received 5mg PCZ, and 15 (16%)received a 10 mg dose. Nine patients (13%) given low-dose PCZ required a seconddose to control nausea. Six patients (6%) required another antiemetic and were

considered treatment failures. Only two patients (2%) experienced akathisia in theED, both had received a 10 mg initial dose of PCZ.

Conclusion: This is the first clinical study to demonstrate that low-dose (2.5 mg)prochlorperazine is an effective antiemetic. Despite the small sample size, datasuggests that this dose is results in a much smaller incidence of akathisia.

127 Targeted Feedback Through BMI to InfluenceEmergency Physicians Prescribing Patterns forAppropriate Treatment of Uncomplicated Bronchitisand Upper Respiratory Infection

Milzma DP, Dubin J, Grebreyes K, Ameha M/Washington HospitalCenter/Georgetown EM Residency, Washington, DC

Study Objective: Physicians too often prescribe antibiotics for patients withuncomplicated bronchitis and upper respiratory infections despite evidence-basedpractice success without antibiotic administration (ABX). Targeted feedback (BriefMotivational Intervention) has been used in other venues to change deepseated habitssuch as smoking. The objective of this study is to use such methods to changeprescriber patterns in a group of proven overusers of ABX for uncomplicated URI/bronchitis patients.

Methods: An electronic emergency department database Azyxxia (Smith,Feied, Microsoft; Redmond, WA) was used to identify emergency physicianperscriber patterns of discharge diagnoses of: bronchitis, upper respiratoryinfection, and cough, based on ICD 9 coding. All attendings at 4 hospitalsunderwent evaluation for presence or absence of the following prescriptions:azithromycin, doxycycline, moxifloxacin, ciprofloxicin, levefloxacin,trimethoprim/sulfamethoxazole, erythromycin, amoxicillin. In addition,comorbid conditions of COPD, asthma (age � 40), and HIV were noted forsubanalysis. Retrospective analysis of baseline prescribing patterns was performedfor a period of up to 24 months. Each physician (number) completed a surveytool regarding practice of prescribing antibiotics for bronchitis and URI. BMIincluded time reviewing EVM literature and the historical prescribing resultswere then provided to individual physicians with comparisons to peer group. Forthe next 3 months individual to peer prescribing data was given to each physiciantwice each month and repeat BMI was performed monthly. At the conclusion ofthe study period, the survey tool was completed again, prospectively and theperscriber pattern was followed, and re-evaluated.

Results: The baseline retrospective data revealed that the 60% of ED patientsdischarged with a diagnosis of bronchitis were prescribed antibiotics in a consecutivereview of 4,890 patients. After BMI, CXR rates of 58% and additional testing with8% CT chest and 27% EKG wre also reduced. Initial finding found no increasedrates of patient returns for hospital admission at 1 week; however, the ED recidivismincreased 30% at 30 days for non-ABX treated patients. ABX use by emergencyphysicians decreased following BMI. Actual provider reduction and is available intable fomat. The most commonly prescribed antibiotic was azythromycin.

After the intervention of targeted prescribing feedback, there was a reduction inprescribing antibiotics for bronchitis and upper respiratory infections in patientswithout comorbid conditions of COPD, asthma �40 years age, and HIV.

Conclusion: Targeted feedback through BMI to physicians of prescribingpatterns can help change clinical practice and reduce the number of unnecessaryprescriptions written for viral conditions. Feedback needs to be given frequently andshould compare individual peer group.

128 Health Care and Posttraumatic Stress DisorderFollowing a Major Natural Disaster

Macht M, Mills LD, Levitan R, DeWulf A, Afonso N, Avegno J, Mills TJ/TulaneUniversity, New Orleans, LA; Louisiana State University at New Orleans, TulaneUniversity, New Orleans, LA

Study Objectives: Hurricane Katrina and the subsequent flooding resulted in lossof home, livelihood, loved ones and property for most residents of the greater NewOrleans metropolitan area (NO). We explore personal loss, healthcare, and therelationship to posttraumatic stress disorder (PTSD) among residents of NO whosurvived Hurricane Katrina.

Methods: This IRB approved, prospective study was conducted over 6 weeksin randomly assigned 6 hour blocks in a public Emergency Department (ED)waiting room. The study was conducted 10 months after the hurricane. Allpeople 18 years of age and older who lived in NO during the hurricane wereenrolled. Researchers conducted a verbal interview using standardized questions.

Research Forum Abstracts

Volume , . : September Annals of Emergency Medicine S41