in resolution time and hospital length of stay. Patients with ACPEand COPD may have a higher percentage of intubation rate.

These final four abstracts were poster presentations. Thesefour posters were judged by our international panel ofjudges to be the award winners, based on judging doneon-site at the Third Mediterranean Congress in Nice, inSeptember, 2005.

Determining Alcohol Elimination Rates in Chronic Alco-holics Presenting in the EDJean Readie, Oliver Hung, Steven Hochman, Richard ShihMorristown Memorial Hospital, Morristown (NJ), USA

Objective: Chronic alcoholics eliminate ethanol at higher ratesthan non-alcoholics. The exact rate of increase in elimination isunknown. Certain alcoholics may eliminate ethanol at muchgreater rates than the textbook estimated 20–25mg/dL/hr for al-cohol-tolerant individuals. A case report has suggested that firstorder elimination kinetics may occur in certain patients presentingwith extremely high ethanol levels. The purpose of the study is toevaluate ethanol elimination rates among chronic alcoholics pre-senting to the emergency department with extremely high serumethanol levels. Methods: The study design was a prospective,convenience sample of alcohol-intoxicated patients presenting tothe ED with an initial serum ethanol � 400 mg/dL. Serial serumethanol measurements were obtained over 4 hours on a predeter-mined schedule. Informed written consent was obtained during aprior ED visit when the patient’s initial blood alcohol level wasmeasured � 400 mg/dl and the patient (when sober) agreed toenroll in the study if he/she returned on a future ED visit for thesame presentation. Demographic data (ethnicity, gender, age) andserum ethanol level and time sampling was recorded. Eliminationrates were calculated for each patient. Results: 9 male patientsenrolled into the study. Mean initial serum ethanol level was471.53 mg/dL. (range: 405.1–602.7 mg/dL). Mean eliminationrate � 28 � 5 mg/dL/hr (range 21–36). Mean correlation coeffi-cient � �0.97 � 0.03. (range �0.92–0.99) No evidence offirst-order kinetic metabolism was noted for any patient. Conclu-sion: Chronic alcoholics with high serum ethanol levels greaterthan 400 mg/dL appear to eliminate alcohol using zero kinetics ata mean rate of 28 mg/dL/hr.

Injury pattern and severity of traffic accidents victims-Younever have a second chance to get a first impressionU Schmucker, J Seifert, K Reichenbach, A Ekkernkamp, GMatthes Dept. Trauma and Reconstructive Surgery, Universityof Greifswald, Germany

Background: Road traffic accidents are the main cause ofsevere and fatal injuries. The World Health Organisation(WHO) estimates 50 million victims world wide. For theemergency physician on scene an immediate perception andjudgement of relevant information is essential. The visibleinformation on the first survey of the accident scene gives

relevant and fundamental information on speed level, impactmechanism and deformation of vehicles. Numerous complexreconstructive parameters like delta-v have demonstratedtheir importance in understanding accident mechanisms andresulting injuries. However they are less significant to thepractical trauma management at the accident scene. There-fore it is the goal of this investigation to analyze basicaccident parameters visible to the emergency physician forevaluating injury pattern and severity. Methods: In thisprospective, non-interventional, in-depth investigation, alltraffic accidents between (01/2001 - 01/2005), within adetermined area in which at least one injured person had aMaximum Abbreviated Injury Scale (MAIS) of 2– 6 werereviewed. Data collection included an on-scene surveywithin 30 minutes after the accident, a detailed technicalinspection of all vehicles involved, a documentation of clin-ical records and personal interviews with patients and driv-ers. All data was processed using a customer-designed databank. Injury severity was analysed using the Injury SeverityScore (ISS) and the (Maximum) Abbreviated Injury Scale((M)AIS). All accidents were divided into subgroups torepresent special types of collisions (collision against tree,frontal and side impact), speed levels (inner city, outer cityroads) or vehicles (cars, motorcycles). Results: 287 trafficaccidents with 359 injured were reviewed: injury severity(ISS) 15.6 � 22.5, lethality 14%. Before analysis of impactmechanism, complex type of collisions (n � 147) had to beexcluded as the single injuries could not be clearly related toa single impact/force in these cases. 62% of cases were frontimpact (ISS 20.0 � 26.1, lethality 16%) and 38% were sideimpact collisions (ISS 21.6 � 26.3, lethality 18%). Classi-fication of all MAIS 3– 6 injuries shows an injury patternwith higher injury severity (MAIS) in the side impact group(except abdominal trauma): injuries of the thorax (frequency27% side impact vs. 17% front impact), head (18% vs. 15%),lower extremity (13% vs. 12%), cervical spine (9% vs. 5%),abdomen (3% vs. 7%), pelvis (3% vs. 1%), upper extremity(3% vs. 3%). Severe abdominal injuries were more frequentafter front impact (7% versus 3%). In the minor injurygroup, MAIS 1–2 injuries: front impact collisions led tosignificantly greater rates of thorax injuries (44% vs. 23%)and lower limb injuries (27% vs. 14%). In further analysismotorcycle accidents were considered separately. There wasno difference between side (frequency 22%; ISS 20.3 �25.7) and front impact (57%; ISS 21.4 � 21.6) but there wasa low injury severity in cases in which there was no collisionwith any opponent (20%; ISS 8.3�6.9). Motorcycles wereinvolved in 20% of all accidents: ISS 19.4 � 24.9, lethality16%. Classification of MAIS 2– 6 injuries showed a differentinjury pattern with higher injury severity in the motorcyclegroup compared with injuries of non-motorcycle collisions:injuries of head (frequency 51% vs 58%), lower extremity(49% vs. 30%), upper extremity (37% vs. 22%), thorax (15%vs. 35%), pelvis (14% vs. 18%), spine (10% vs. 17%),abdomen (7% vs. 23%). The majority of motorcycle acci-dents occurred in inner city areas (67%) at low speed level.However there was no significant difference between innercity and outer city crashes regarding injury severity (inner

Abstracts 247

city ISS 15.2 � 16.9 vs. ISS 23.1 � 26.7). For analysis oftree accidents only single collisions against a tree wereincluded (no multiple collisions). These crashes were seen in19% of cases: ISS 31.3 � 29.8, (all other cases ISS 15.6 �22.5), with a 30% lethality rate, accounting for 43% of allfatal accidents of our investigation. In the severe injuriessubset (MAIS 3– 6), thorax trauma was found in 35% (allother cases 15%), injuries of the head in 23% (vs. 12%), andlower extremities 17% (vs. 0%). 90% of the patients sufferedfrom multiple injuries (vs. 71%). Severe multiple injuries(ISS � 15, at least two MAIS 2– 6 injuries) were morefrequent after collision against trees (43% vs. 24%). Con-clusions: Understanding fundamental traffic accident mech-anisms is essential for emergency physicians. Knowledge onhow certain visible basic parameters affect injury patternand severity gives important information for decision-mak-ing during preclinical trauma management. All parametersanalysed in this study can be easily classified by the emer-gency physician: speed level, impact mechanism, collisionagainst tree. Injured motorcyclists showed a different injurypattern than injured car passengers. Thorax injuries werefound less often in motorcyclists, but motorcycle crasheswere the leading cause for severe trauma to the upper andlower extremities. In both inner city and outer city accidentssevere injuries must be expected. After collision against atree severe multiple injuries must be expected. Severe tho-racic and head injuries were most frequent. Side collisionsare leading cause of severe injuries to head and thorax.

Prospective validation of a current algorithm includingbedside US performed by emergency physicians for pa-tients with acute flank pain suspected renal colicKartal M (1), Eray O (1), Culbant AB (1), Erengin H (2), ErdogruT(3), Eken C (1) 1- Emergency Department 2-Biostatistics Depart-ment 3-Urology Department Akdeniz University, Burdur, Turkey

Objective: The purpose of this study is to validate an algorithmrecommended in the current literature for patients with acute flankpain and evaluate the validity of bedside ultrasound (BsUS) per-formed by emergency physicians (EP’s) as a part of this algorithm.Methods: This prospective validation study was carried out in atertiary care hospital adult emergency department with annualcensus of 55,000 in a five month period. All, consecutive adultpatients presenting to the ED with complaints of unilateral acuteflank pain during the study period were enrolled. Verbal consentwas obtained after the protocol was briefly explained to the patientand before the administration of analgesia. A protocol form wasrecorded for each patient enrolled into the study and patients were

followed by the guidance of a previously designated algorithm inthe ED. According to this algorithm, only the patients who had nomicroscopic hematuria and no signs of stone on BsUS wereinvestigated further in the ED. Results: Of the 227 patients en-rolled, 176 patients had proven urinary tract stones by spiral CT,IVP or clinical follow up and 51 patients had no stone detected andtheir pain subsided. Following the algorithm, 122 patients who didnot have microscopic hematuria and signs of stone on BsUS weredischarged from the ED without further investigation, all patientsreceived follow up. 99 of 122 directly discharged patients hadurinary stones documented at follow up, and the others did nothave any life threatening disorder. On logistic regression analysis,having a previous history of kidney stone, radiation of pain to thegroin, accompanying nausea and detection of pelvicalyceal dila-tation on BsUS performed by the EP’s were significant variablespredicting urinary stones. Sensitivity and specificity of these vari-ables were as follows, respectively: previous stone history 59%and 66%, radiating pain to the groin 68% and 49%, nausea 71%and 51% and detection of pelvicalyceal dilatation in BsUS 81%and 37%. Conclusion: BsUS performed by EP’s can be used inthe evaluation of patients with acute flank pain as a part of aclinical algorithm safely. Previous urinary stone history, radiationof pain to the groin, accompanying nausea and detection of pel-vicalyceal dilatation are major parameters and symptoms of uri-nary stone disease, and could be safely used in the algorithms.

Recording of domestic violence by the police and emer-gency departmentsDr. Adrian Boyle, Mr. James Kirkbride, Professor Peter JonesAddenbrooke’s Hospital, Cambridge, United Kingdom

Objective: To identify what proportion of adult victims ofdomestic assault presenting to an emergency department havetheir assault recorded by the police. Methods: Comparison oftwo confidential lists from the police and the emergency de-partment over a 12 month period. Results: 263 adults had adomestic assault recorded by the police and 158 victims ofdomestic assault presented to the emergency department fol-lowing domestic assault. 14 cases appeared on both lists. Usingnovel epidemiologic techniques (capture/recapture) we esti-mate that only 13% of all domestic assaults are reported toeither agency. Severity of injury (measured by admission,outpatient follow-up or discharge) age or index of multipledeprivation at the emergency department did not seem to in-fluence reporting to the police. Conclusions: Most domesticassaults are not reported to either agency. Combining theseresults with other research suggests that less than 1% of do-mestic assaults requiring treatment in an emergency departmentresult in criminal conviction.

248 The Journal of Emergency Medicine