The use of ultrasound is now widespread within the field of Emergency Medicine. The availability of lightweight and relatively cheap ultrasound devices has enabled clinicians to obtain more detailed information about the condition of acutely ill and injured patients than can be done with a clinical exam only. This paper discusses the standardized E-FAST exam for trauma; the technical details of the exam and the reliability of the information gained by each of it's components. Other advanced use of ultrasound for evaluation of trauma patients is introduced. Investing in the equipment and physician training to provide emergency ultrasound evaluation of injured and acutely ill patients in Iceland may be a relatively inexpensive way to improve patient care.
OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy (sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)) of 64-slice multidetector computed tomography (MDCT) compared with quantitative coronary angiography (QCA) for detection of coronary artery disease (CAD). MATERIAL AND METHODS: Sixty-nine patients participating in a study of coronary in-stent restenosis were investigated. After a 64-slice MDCT scan patients were evaluated by QCA. The coronary arteries were divided into 15 segments and stenosis was graded for each segment by both methods. The diagnostic accuracy of 64-slice MDCT was evaluated using the QCA as the gold standard. RESULTS: Among the 69 patients included in the study 13 (19%) were female and 56 male. The mean age was 63 (SD 10) years. The following risk factors were present: high blood pressure 67%, elevated blood cholesterol 54%, diabetes 12% and family history of CAD 71%. Current smokers were 22% and previous smokers were 48%. Altogether 663 segments were examined. Of those 221 (33%) segments were excluded; 103 because of stents, 48 because of heavy calcification, 41 because of motion artifacts and 29 because the segments were less than 1.5 mm in diameter. The mean time between MDCT and QCA was 6.3 (SD 12.1) days. The sensitivity of 64-slice MDCT for diagnosing significant stenosis (>or= 50% according to QCA) was 20%, the specificity was 94%, PPV was 16%, NPV was 95% and the accuracy was 89%. CONCLUSION: High NPV and specificity indicates that MDCT is useful for accurately excluding significant CAD but the low sensitivity and low PPV indicate that the method is not accurate in diagnosing coronary artery stenosis of 50% or more according to QCA.
An abnormal electrocardiogram (ECG) is common among young athletes but the underlying cause is unclear. Therefore it is hard to predict how accurate ECG is when screening for sudden cardiac death (SCD) in elite athletes.
1) to determine the prevalence of abnormal ECG patterns, among soccer players, especially in relation to age and 2) to link ECG patterns with echocardiographic findings in order to find out whether the ECG can predict disease and/or physiological changes.
A total of 159 male soccer players (16-45 years, mean age 25.5 years) that participated in the UEFA cup competition 2008-2010 were studied. They underwent both an ECG and echocardiography along with routine history and cardiologic examination, according to UEFA protocol. RESULTS were classified and grouped according to standards set by The European Society of Cardiology and The American Society of Echocardiography.
84 (53%) had abnormal ECG patterns. The prevalence of abnormal ECG patterns decreased with age. Echocardiographic findings showed that left ventricular wall thickness, mass and diameter increased with age, along with left atrial diameter. Left ventricular wall thickness, diameter and mass were similar among those with an abnormal ECG and those with a normal ECG.
The prevalence of abnormal ECGÂ´s is high in Icelandic soccer players, a finding that usually does not indicate underlying heart disease. There was no relationship between ECG changes and echocardiographic findings. High prevalance of abnormal ECG patterns in young athletes reduces the usefulness of ECG in screening for SCD.
OBJECTIVE: The psychometric properties of the Icelandic version of the Bulimia Test-Revised (BULIT-R) were investigated. The BULIT-R is a self-report instrument designed to assess a broad range of eating-disordered behaviour, particularly bulimic symptomatology. MATERIAL AND METHODS: The BULIT-R was administered to 66 female patients receiving outpatient psychiatric treatment. Almost half of the patients (n=32) sought treatment for disturbed eating behaviours and 34 women were in treatment for depression or anxiety. In addition, three other self-report measures were administered to the women, the Eating Disorder Diagnostic Scale (EDDS), the Beck Depression Inventory-II (BDI-II) and the Obsessive-Compulsive Inventory-Revised (OCI-R), in order to assess convergent and divergent validity. RESULTS: The study estimated the reliability and construct validity of the BULIT-R. The internal reliability was high (Cronbach's coefficient alpha = 0,96). The BULIT-R correlated highly with EDDS, a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa and binge eating disorder, and it correlated lower with BDI-II and OCI-R. The BULIT-R differentiated between patients with and without eating-disordered symptomatology. CONCLUSIONS: These results indicate that the Icelandic version of the BULIT-R is a reliable and valid measure to assess eating disordered behaviour, particularly bulimic behaviour among female outpatients.
AIM OF STUDY: To compare the utility and reliability of coronary angiography with multislice computed tomography (MSCT) and by cardiac catheterisation in assessing atherosclerotic lesions and stenosis. MATERIAL AND METHODS: Data were assessed from 44 subjects (25 men, 19 women) (mean age 63 years; range 34-80 years) referred to MSCT who also had undergone invasive coronary angiography within a time frame of one year. Coronary angiograms from both studies were assessed by segmental analysis and the atherosclerotic severity graded. The frequency of coronary calcification on MSCT was separately assessed in 150 subjects. RESULTS: By retrospective evaluation, 29 segments were found to have significant stenosis (> or = 50%) on the invasive coronary angiogram. Of these 17 had a diameter over 2.0 mm and 14 (83%) thereof were correctly diagnosed by MSCT. On the other hand, MSCT assessed four stenosis to be significant that were not judged so on the invasive angiogram. On MSCT, the frequency of coronary calcifications increased with age and in those 60 years and older it was 96% in males and 71% in females (p=0.025). CONCLUSION: Good agreement was found between MSCT and invasive coronary angiography in assessing significant stenosis in vessel segments over 2.0 mm. In older subjects coronary calcification on MSCT is frequent and diminishes its accuracy. MSCT seems most useful in relatively young subjects in whom the coronary arteries need to be evaluated to avoid unnecessary cardiac catheterisation.
The KOOS self-report questionnaire (Knee injury and Osteoarthritis Outcome Score) has 5 sub-scales, assessing knee symptoms and function, and quality of life. It is widely used as it has been found to be a valid and reliable measure. The purpose of this study was to investigate the validity, reliability and responsiveness of the Icelandic translation of KOOS.
A total of 145 were recruited for the study and in addition to answering KOOS, knee pain was rated on a visual analog scale (VAS), perception of knee function during activities of daily living on a numerical rating scale, and some were tested with the timed up-and-go test (TUG). Reliability was assessed by observing ICC-values, internal consistency with Cronbach's alpha, and associations between KOOS subscales and other outcome measures with Pearson's correlation coefficient. A one-way ANOVA was used to assess differences between groups of participants with different levels of knee dysfunction.
A significant change in all KOOS subscales was found in a group of individuals seeking treatment for their knee dysfunction (p
OBJECTIVE: The records of the emergency room of Landspitali University Hospital in Iceland provide important information on the prevalence and incidence of various problems. The objective of this research is to evaluate the reliability of data concerning the visits of adolescents under the influence of alcohol. Data AND METHODS: Records of visits to the Emergency Room of Landspitali University Hospital by 14-16 year old capital region adolescents are compared with the results of a survey in early 2003. The correspondence between hospital records and adolescent self-reports is compared to the correspondence between records and self-reports of the presence of alcohol in visits. RESULTS: In all cases students report more emergency room visits than are recorded by Landspitali University Hospital. The difference is 4.2% (+/- 0.6%) in accident visits and 2.2% (+/- 0.2%) in violence visits. In the case of the presence of alcohol in visits the difference is 9.3% (+/- 0.4%) between hospital records (0.2%) and adolescent self-reports (9.5%). CONCLUSION: The records of Landspitali University Hospital are not a valid source of information on alcohol-related problems among adolescents. About one in ten adolescents in the capital region of Iceland claim to have visited an emergency room because of their own alcohol consumption but hospital records of the presence of alcohol only include about 1/60 of that number.
Nutritional support of ICU patients is usually guided by estimations of their caloric needs. However, recent studies have shown that energy expenditure (EE) of critically ill patients is not as high as previously thought. The goal of this study was to measure EE in ICU patients, compare it with estimated EE and evaluate nutritional support.
Energy expenditure was measured with indirect calorimetry in a broad group of ICU patients requiring mechanical ventilation >48 hours. In comparison EE was estimated with the Harris-Benedict equation. Nutritional support during ICU stay was registered.
Mean measured EE of 56 patients was 1820 +/- 419 kcal/day or 22 kcal/kg/day. The Harris- Benedict equation underestimated EE by 11%, but adding a stress factor resulted in 15% overestimation. Mean nutritional support was 1175 +/- 442 kcal/day or 67% of EE. The energy deficit was greatest during the first week of ICU stay. Mean protein administration was 0,44 g/kg/day.
Measured EE of ICU patients was less than nutritional support recommended by international guidelines. These results are in accordance with recent studies. Nutritional support was only 67% of measured energy expenditure and protein content less than recommended. Further studies are needed as it has not be shown how this might influence outcome.