2014 SAEM ABSTRACTS The editors of Academic Emergency Medicine (AEM) are honored to present these abstracts accepted for presentation at the 2014 annual meeting of the Society for Academic Emergency Medicine (SAEM), May 14 to 17 in Dallas, Texas. These abstracts represent countless hours of labor, exciting intellectual discovery, and unending dedication by our specialty’s academicians. We are grateful for their consistent enthusiasm, and are privileged to publish these brief summaries of their research. This year, SAEM received 1324 abstracts for consideration, and accepted 797 (60%). Each abstract was independently reviewed by up to six dedicated topic experts blinded to the identities of the authors. Final determinations for scientific presentation were made by the SAEM Program Scientific Subcommittee cochaired by Steven B. Bird, MD and Chris A. Ghaemmaghami, MD and the SAEM Program Committee, chaired by Michael L. Hochberg, MD. Their decisions were based on the final review scores and the time and space available at the annual meeting for oral and poster presentations. There were also 159 Innovations abstracts submitted, of which 54 were accepted. The Innovations Subcommittee was co-chaired by JoAnna Leuck, MD and Laurie Thibodeau, MD. We present these abstracts as they were received, with minimal proofreading and copy editing. Any questions related to the content of the abstracts should be directed to the authors. All authors attested to appropriate IRB or animal care committee approval at the time of submission. Presentation numbers precede the abstract titles; these match the listings for the various oral and poster sessions at the annual meeting in Chicago, as well as the abstract numbers (not page numbers) shown in the key word and author indexes at the end of this supplement. On behalf of the editors of AEM, the membership of SAEM, and the leadership of our specialty, we sincerely thank our research colleagues for these contributions, and their continuing efforts to expand our knowledge base and allow us to better treat our patients. David C. Cone MD Editor-in-Chief

The following standard acronyms are used in the abstracts:

95% CI 95% confidence interval


cerebrovascular accident


American Academy of Emergency Medicine


diastolic blood pressure


American College of Emergency Physicians




emergency department


emergency medicine


emergency medical services


US Food and Drug Administration


human immunodeficiency virus


International Normalized Ratio


inter-quartile range


millimeters of mercury


magnetic resonance imaging


National Institutes of Health


post-graduate year


receiver operating characteristics

ACGME Accreditation Council for Graduate Medical Education AIDS

acquired immune deficiency syndrome




area under the curve


blood pressure


beats per minute


complete blood count


Clerkship Directors in Emergency Medicine


Council of EMS Residency Directors


cardiopulmonary resuscitation


computed tomography


chest x-ray

© 2014 by the Society for Academic Emergency Medicine doi: 10.1111/acem.12365

ISSN 1069-6563 PII ISSN 1069-6563583

S5 S5

S6 2014 SAEM abstracts


Society for Academic Emergency Medicine


tissue plasminogen activator


systolic blood pressure




standard deviation


Lorazepam Versus Diazepam For Pediatric Status Epilepticus: Results Of A Randomized Clinical Trial James M. Chamberlain1, Pamela Okada2, Maija Holsti3, Prashant Mahajan4, Jill M. Baren5, Kathleen M. Brown1, Cheryl Vance6, Victor Gonzalez7, Richard Lichenstein8, Rachel Stanley9, David C. Brousseau10, Joseph Grubenhoff11, Roger Zemek12, David W. Johnson13, and Traci E. Clemons14 1 Children’s National Medical Center, Washington, DC; 2University of Texas Southwestern, Dallas, TX; 3University of Utah, Salt Lake City, UT; 4Children’s Hospital of Michigan, Detroit, MI; 5Perelman School of Medicine, Philadelphia, PA; 6University of California Davis, Sacramento, CA; 7Baylor College of Medicine, Houston, TX; 8University of Maryland, Baltimore, MD; 9University of Michigan, Ann Arbor, MI; 10Medical College of Wisconsin, Milwaukee, WI; 11Children’s Hospital of Colorado, Denver, CO; 12Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada; 13 Alberta Children’s Hospital, Calgary, AB, Canada; 14The Emmes Corporation, Rockville, MD

Benzodiazepines are considered first-line therapy for pediatric status epilepticus. Some studies suggest that lorazepam may be superior to diazepam, but lorazepam is not FDA-approved for this indication.


Objectives: To compare the efficacy and safety of lorazepam to that of diazepam for pediatric status epilepticus. Methods: We performed a multicenter, double-blind, randomized controlled trial of children aged 3 months to 17 years with convulsive status epilepticus. Patients received either 0.2 mg/kg of diazepam or 0.1 mg/kg of lorazepam intravenously, with half this dose repeated at 5 minutes if necessary. The primary efficacy outcome was cessation of status epilepticus by 10 minutes without recurrence at 30 minutes. The primary safety outcome was the performance of assisted ventilation within 4 hours. Secondary outcomes included rates of recurrence and sedation, and times to cessation of status epilepticus and return to baseline mental status. This trial was conducted under the exception from informed consent regulations for emergency research. Results: There were 273 patients; 140 diazepam, 133 lorazepam. Baseline characteristics and etiology of seizures were similar between treatment groups. Efficacy rates were 72.1% diazepam and 72.9% lorazepam (absolute efficacy difference 0.8%, 95% CI -11.4 to 9.8). Twenty-six subjects in each group required assisted ventilation (16.0% diazepam, 17.6% lorazepam, absolute risk difference 1.6%, 95% CI -9.9 to 6.8). There were no statistically significant differences in secondary outcomes except that lorazepam patients were more likely to be sedated (66.9% versus 50%, respectively, absolute risk difference 16.9%, 95% CI 6.1 to 27.7). Conclusion: Diazepam and lorazepam have similar efficacy and safety for treating pediatric status epilepticus. Logistic considerations, such as need for refrigeration and medication availability, rather than concerns about efficacy or safety, should influence the choice of benzodiazepine for emergency therapy.


Decrease In The Prescription Of Opioids In A Large Public Hospital System: Effect Of Prescribing Guidelines Eric Legome1,2, Ruth Cadet2, Christopher McStay2,3, Emergency Medicine Council of Health, Hospitals Corporation2, and Ross Wilson2 1 Kings County Hospital, Brooklyn, NY; 2Health and Hospitals Corporation, New York, NY; 3 Bellevue Hospital Center, New York, NY

Background: Due to mortality and morbidity from prescription opioids,the New York City Department of Health, in concert with local physicians, developed guidelines for prescription of opioids in NYC EDs. The largest adopter, Health and Hospitals Corporations (HHC), reviewed it’s changes in prescribing after introduction of the guidelines. Objectives:

To review if voluntary guidelines change opioid prescribing by ED providers in a public hospital system. Methods: A computerized database was retrospectively reviewed for all adults presenting to an ED in the corporation’s acute care hospitals. (~1.1 million ED visits/year) Data were abstracted from 9 of 11 hospitals. Two were excluded for IT issues. All adults discharged from one of the EDs with prescriptions containing oxycodone, hydrocodone, methadone, or codeine were included. We compared differences in opioid prescriptions of ED providers (attending physicians, mid-level providers, and EM residents) for a 6 month time frame pre and post guidelines in 2012 vs 2013. Variables: 1) Opioid prescriptions per 1000 ED visits, 2) total prescriptions, 3) percent of prescriptions with 20 pills or less, 4) total pills prescribed, 5) and 30-day patient return rate (percent of visits where patients received an opioid prescription AND returned (in multiple defined time frames) and received another prescription).


The rate of prescriptions given by ED providers per 1000 ED visits fell 18.8% (62.6 to 50.8). The percent of prescriptions with

Abstracts of the SAEM 2014 Annual Meeting, May 13-17, 2014, Dallas, Texas.

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