Research Forum Abstracts

abdominal pain were reviewed for the final ED diagnosis of PE. Additionally, all EDcharts with the final diagnosis of PE were reviewed for presenting complaint ofabdominal pain. Diagnosis of PE was determined by computed tomographicangiography (CTA) in the ED and confirmed with the final hospital dischargediagnosis. Exclusion criteria were hypoxia, tachypnea, and complaint of shortness ofbreath or chest pain on presentation to the ED.

Results: Four out of 42 (9.5%) patients diagnosed with PE in the ED wereinitially evaluated for intra-abdominal pathology. All had a chief complaint ofabdominal pain with normal vital signs on presentation and did not complain ofshortness of breath or chest pain. Two patients had recent surgery while the other twohad no risk factors for PE. Three of the four patients presented with right upperquadrant abdominal pain and were initially evaluated for biliary disease with a rightupper quadrant ultrasound. The gallbladder was normal in all cases. The fourthpatient had both right upper and lower abdominal pain. CT of the abdomen wasunremarkable except for a right lower lobe pulmonary infiltrate. Three of the patientswere diagnosed by the attending radiologist as having pneumonia due to a right lowerlobe infiltrate on chest X-ray or CT. Since symptoms of pneumonia were absent,further ED workup proceeded to CTA. All four patients had filling defects on CTAin the right lower lobe segmental pulmonary artery, possibly explaining their rightupper quadrant abdominal pain. None had tachycardia, tachypnea or were hypoxicon presentation.

Conclusion: PE is a difficult diagnosis to make on clinical grounds alone. It iswell documented that PEs can present with various complaints and can mimic otherdisease processes. Without the classic tachypnea, hypoxia, or chest pain, cliniciansmay be less likely to suspect PE. This small case series demonstrates that PE should beconsidered in cases of significant upper abdominal pain in which an abdominal sourcecannot be identified.

316 Toxoplasma gondii Antibodies and AssociatedOxidative Stress Among Asymptomatic BloodDonors

Abousamra Sr NK/University Hospital, Mansoura, Egypt

Background: Since existing therapies are not fully effective, and no Toxoplasmagondii vaccine is available, efforts to reduce toxoplasmosis transmission are crucial toreducing the impact of this disease.

Study Objectives: We evaluate the presence of T. gondii antibodies and oxidativestress associated in asymptomatic blood donors in northeastern Egypt in a cross-sectional study.

Methods: From March to September 2007 we recruited 230 blood donors (169men and 61women) with age ranges from 20 to 50 who attended to blood banks,Mansoura University Hospital, Egypt. We interviewed blood donors aboutsociodemographic characteristics and potential risk factors for T. gondii infectionusing a structured questionnaire. A venous blood sample was taken to document theirT. gondii antibody status using enzyme-linked immunosorbent assay (ELISA). Also,serum level of malondialdehyde (MDA) and activity of glutathione peroxidase (GSH-Px) and tocopherol fractions (�, �, �) was assessed.

Results: Overall, 155 (67.4%) of 230 blood donors were positive for anti-T.gondii IgG antibodies and 24 (15.5%) of them were of low IgG avidity, which is highpercentage compared to many countries. Univariate logistic regression analysisshowed an association between T. gondii seropositivity and area of residence, bloodtype, older ages, level of education, history of immune weakness, contact with cats,professional contact with farm animals, agricultural activities, washing hands beforemeals, eating unwashed vegetables, drinking raw milk, eating cheese made from rawmilk, eating luncheon or shawerma. In a multivariate logistic regression analysis,eating luncheon or shawerma (adjusted odds ratio [OR] 80.82 [95% CI 18.62-350.81], P �0.0001) and being non-educated (adjusted OR 32.25 [95% CI 7.46-139.44], P �0.0001) showed a strong significant association with T. gondiiantibodies. T. gondii-seropositive blood donors had significantly (P � 0.001) higherMDA level paralleled with significant decrease in the level of GSH-Px (P �0.0188)and tocopherol fractions (P � 0.001) compared with T. gondii negative blooddonors.

Conclusion: This study highlights that T. gondii is prevalent among healthyblood donors in northeastern Egypt, and that there is a need for T. gondii screening

tests to be included in the blood donation scheme to insure safe blood transfusion.

S138 Annals of Emergency Medicine

317 Early Predictors of Mortality and Length of Stay inEmergency Department Nursing Home-AcquiredPneumonia

Robinson D, Medado P, Anderson S, Haque N, Zervos MJ, O’Neil BJ/WilliamBeaumont Hospitals, Royal Oak, MI; Henry Ford Hospital, Detroit, MI

Background: Pneumonia is a leading cause of morbidity, hospitalization andmortality among older people living in nursing homes and a major reason fortransfers to acute care facilities. There is currently little literature regarding earlymortality predictors in ED nursing home patients admitted with pneumonia. Suchpredictors could have prognostic and therapeutic benefits.

Study Objective: Define early predictors of mortality and LOS in nursing homepatients admitted with pneumonia.

Methods: We performed a retrospective chart review per Gilbert and Lowensteinguidelines on nursing home patients admitted with pneumonia at 2 large academichospitals. ED visit data was analyzed for prediction of LOS and mortality. Categoricalvariables were examined using Pearson’s chi-square and Fisher’s exact test whereappropriate. Continuous variables were analyzed using a Wilcoxon rank test andSpearman correlation. Step-down multiple logistic regression analyses were performedto determine the strongest predictors of a death. All analyses used SAS® version9.1.3.

Results: 303 patients with complete data were available for analysis. Patients whodied had higher RR, glucose, BUN and creatinine levels; lower Glasgow Coma Scoresand Hgb and more SOB symptoms, and had a greater incidence of mental statuschanges and intubations than those discharged alive. On stepdown multi-variablelogistic regression, increased HR, Hct and BUN, decreased temperature and Hgb andpresence of a mental status change were found to be the strongest predictors of death.See Table 1. Patients who were intubated and febrile had longer LOS,19.57�/�16.8 v 9.31�/�6.6, p�0.0001 and 10.07�/�9.6 v 11.58�/�9, p �0.012 respectively. As age increases, LOS decreases (Spearman Correlation Coefficient�0.140, p�0.017); as RR and temp increase, LOS increases (Spearman Coeff.165and .146, p�0.006 and 0.015 respectively).

Conclusions: The best early ED predictors of in hospital mortality are decreasedmental status and anemia. Elevated temperature and signs of dehydration were alsopredictive of in-hospital mortality. Hospital length of stay was related to age, fever,intubation and respiratory rate.

318 Tissue Oxygenation in Soft Tissue Infections

Capraro GA, Reiser M, Jasienowski S, Blank FS/Baystate Medical Center/TuftsU. School of Medicine, Springfield, MA; Baystate Medical Center, Springfield, MA

Study Objectives: To determine the oxygenation status of non-draining,untreated soft tissue infections presenting to the emergency department (ED). Therehave been few investigations of the oxygenation status of soft tissue infections, thoughthis may be an important consideration in understanding the pathophysiology of suchinfections and guiding therapies.

Methods: Prospective, convenience sample of patients suspected to have eithercellulitis or abscess seeking care in a tertiary, urban ED. There were no cases ofnecrotizing fasciitis. Near infrared spectroscopy (NIRS) (InSpectra 325, HutchinsonTechnologies, Hutchinson, MN)-determined tissue saturation of Oxygen (StO2) wasmeasured at the center of the infected region and at the corresponding contra-lateralcontrol site when available. The Wilcoxan matched pairs sign test was applied to testfor a significant difference between infected sites and conta-lateral control sites, usingStata SE/10.0. Kruskal Wallis equality-of-populations rank tests were used for allother inferences.

Results: 38 participants with infected regions and control sites available ranged inage from 7-82 years, mean 36.0 (16.9) with 39.5% female. 86.8% white or Hispanic,

42.1% smokers, 7.9% had diabetes, and 5.3% had peripheral vascular disease. Mean

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