ABSTRACTS

patients had C trachomatis reiso- lated after therapy. Twelve post- treatment isolates of C trachomatis were available for serotyping, and all showed the same serotype as the ini- tial infecting strain. It was concluded that ciprofloxacin in both regimens of as much as 2 g daily is as effective as d0xycycline for the treatment of the c l i n i c a l s y n d r o m e of non- gonococca] urethritis, but that the ciprofloxacin regimens were ineffec- tive in curing chlamydial urethritis.

James Bodenhamer, MD

seat belt syndrome; abdominal trauma, blunt

Delayed onset of intestinal obstruction in children after unrecognized seat belt injury Hardacre JM, West KW, Rescorla FR, et al J Pediatr Surg 25:967-969 Sep 1990

Safety seats and seat belts have considerably decreased the mortality of children involved in motor Vehicle accidents. However, the use of these devices has contributed to the in- creasing number of cases of a spec- trum of injuries, including intestinal perforation, mesenteric disruptions, lumbar fractures, and dislocations, termed the "seat belt syndrome." The authors present two cases of de- layed-onset intestinal obstruction at- tributed to Unrecognized abdominal trauma. In both cases, the children were restrained with adult lap belts only. Both had significant concomi- tant injuries (L-4 vertebral compres - sion fracture and splenic rupture, re- spectively) and presented three to six weeks after the accident with symp- toms of small bowel obstruction: bil- ious emesis, nausea, and abdominal pain. The children were evaluated by abdominal radiograph in one case and abdominal computed tom0gra- phy and a small bowel contrast study in the other. At exploratory laparot- omy, both were found to have vol- vulus secondary to an omental adhe- sion, Most visceral injuries are de- tected and treated promptly, often with the aid of the seat belt sign:

contusions, petechiae, and abrasions across the chest or lower abdomen. Recommendations are to maintain a high index of suspicion for these in- juries, encourage the use of shoulder harnesses, and promptly investigate the signs and symptoms of small- bowel obstructions in the post-trau- matic pediatric patient.

Anne Winiarski, MD

motor vehicle accidents, smoking

Risk of automobile accidents in c igaret te smokers Brison RJ Can ,J Pubfic Health 81:102-106 Mar 1990

Cigarette smoking has been shown to be a risk factor for accidental in- jury. Controversy remains whether smokers have an increased risk of motor vehicle crash that is indepen- dent of alcohol use. The author un- dertook a case-control study to iden- tify any increased risk of motor vehi- cle crash m cigarette smokers over nonsmokers. To minimize variability expected by age and sex with respect to known risk factors of motor vehi- cle crashes Lalcohol use, number of miles driven per year, car ownership), the sample was restricted to men from 30 to 39 years old. Cases were defined as presence of a motor vehi- cle crash over a two-year period, and crashes studied were those resulting in property damage alone. Twenty- one hundred self-administered ques- tionnaires Ii,100 control and 1,000 case) were mailed to Washington state residents asking about motor vehicle crash history, smoking sta- tus, proportion of time one smokes while driving, usual use of alcohol, usual driving speed, average annual mileage, age, income, and marital status; the response rate was 55%. Questionnaires lacking information on smoking or other informat ion were excluded, resulting in a sample of 595 cases and 548 controls. The case group included those individuals wi th documen ted motor vehicle crash on state motor vehicle records and/or those declaring themselves in-

Annals of Emergency Medicine

volved in a motor vehicle crash on the questionnaire. The Case group was then subdivided into those ad- mitt ing to at least partial respon- sibility for the accident (356) and those not at fault (239). Unadjusted relative risk estimates and logistic regression analysis found that for drivers at fault, cigarette smokers have a 50% higher risk for motor vehicle crash. Increased number of miles driven per year and younger age increased risk regardless of fault. Alcohol was not a statistically signif- icant risk factor for motor vehicle crash in this group, although a trend toward increasing risk of crash with increasing alcohol use was noted. In- creased risk for motor vehicle crash also was seen with increasing fre- quency of smoking while driving. Seat belt use, speed while driving, in- come. and marital status were not found to be statistically significant risk factors for motor vehicle crashes. It was concluded that there is an as- sociation between smoking and auto- mobile accidents that is likely to be independent of the risk of alcohol use, and the t endency to smeke while driving shows a strong associa- tion with the risk of motor vehicle crashes. Several postulates as to why a relationship between motor vehicle crash and smoking may exist include distraction from driving, behavioral differences in smokers, and possible carbon monoxide toxicity.

Jeffrey Hill. MD

emergency medical services, occuoatlona injury

Evaluation of the injury profile of personnel in a busy urban EMS system Hogya PT, Ellis L Am J Emerg Med 4:308 Jul 1990

This retrospective study of 254 in- juries, occurring over a three-to-five- year period in a busy emergency medical services system suggests an occupational injury profile among e m e r g e n c y m e d i c a l t e c h n i c i a n s (EMTs} and paramedics. The most common injury was low back strain,

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