Abstract. Objective: To compare betamethasone with placebo as an adjuvant to antibiotic therapy in the treatment of acute exudative pharyngitis. Methods: The study was a randomized, doubled-blind, placebo-controlled, single-center, parallel, outpatient clinical trial. After consent was obtained, each patient was asked to rate his or her pain on a 10-cm numbered visual analog scale (VAS; 0-10). All of the patients received injectable benzathine penicillin. If allergic to penicillin, they were started on a 10-day course of polyenteric-coated erythromycin (PCE). Each patient was randomized to receive either IM betamethasone or IM placebo. All patients were contacted by telephone at 24 and 48 hours by one of the study investigators and asked to rate their pain based on another VAS. If their pain was not resolved by 48 hours, they were called again daily between the third and seventh days after the initial visit to determine the time of pain resolution. Results: A total of 92 patients were enrolled in the study, with 46 randomized to receive placebo and 46 to receive betamethasone. Eight patients were excluded from the statistical analysis because of inability to obtain follow-up. Demographic comparison showed that gender distributions, ages, mean initial pain scores, mean times to the first and second follow-up calls, and treatment regimens were similar in the 2 groups. There were significantly better pain scores for the betamethasone group a t first follow-up ( p = 0.0005), at second followup ( p = 0.004), and in number of hours until relief of pain ( p = 0.004). When only those patients with a positive culture for a streptococcus species were analyzed, there also were significant reductions in pain score a t the first ( p = 0.006) and second ( p = 0.02) follow-up visits. Conclusion: Pain relief was greater and more rapid in patients treated with betamethasone as a n adjuvant therapy in acute exudative pharyngitis.

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The results of this clinical trial suggest that oral steroid and IM steroid provide similar levels of pain relief in acute exudative pharyngitis.

Abstract.Previous study has shown that the use of intramuscular (IM) steroid leads to improved symptoms in patients with group A beta-hemolytic streptococcus (GABHS). Objective: To compare oral with IM steroids as an adjunct to antibiotic therapy in the treatment of acute exudative pharyngitis. The null hypothesis was that there would be no difference in effectiveness of oral versus IM steroids. Methods: The study was a randomized, double-blind outpatient clinical trial. After consent was obtained, each patient was asked to rate his or her pain on a 10-cm numbered visual analog scale (VAS; 0-10). All of the patients received injectable benzathine penicillin or, if allergic to penicillin, a ten-day course of polyentericcoated erythromycin. Each patient was randomized to receive either injectable steroid plus oral placebo or injectable placebo plus oral steroid. All medications were given in the emergency department. All patients were contacted by telephone at 24 hours (first followup) and 48 hours (second follow-up) by one of the study investigators and asked to rate their pain based on another VAS. If their pain was not resolved by 48 hours, they were called again daily for the third to seventh day after the initial visit. The time to total resolution of the sore throat was documented. The main outcome measures were time to complete relief of pain and VAS scores. Pain medication was not controlled; however, use of pain medications and amounts were recorded. Results: A total of 78 patients were initially enrolled in the study. Eight patients were excluded from the statistical analysis because of inability to follow up. A total of 70 were entered, with 35 randomized to IM steroid plus oral placebo and 35 to IM placebo plus oral steroid. There was no difference in pain scores for the oral versus IM group at first follow-up (p = 0.13) and second follow-up (p = 0.82), and in number of hours to relief of pain (p = 0.06). Using repeated-measures analysis of variance, no difference in the effects of the two medications over time was detected (p = 0.83). Conclusions: The results of this clinical trial suggest that oral steroid and IM steroid provide similar levels of pain relief in acute exudative pharyngitis.

Objectives: To determine whether adults who witnessed intimate partner violence (IPV) as children would have an increased rate of being victims of ongoing IPV, as measured by the Ongoing Violence Assessment Tool (OVAT), compared with adult controls who did not witness IPV as children. The authors also sought to determine whether there were differences in demographics in these two groups.Methods: This was a cross sectional cohort study of patients presenting to a high-volume academic emergency department. Emergency department patients presenting from November 16, 2005, to January 5, 2006, during 46 randomized four-hour shifts were included. A confidential computer touch-screen data entry program was used for collecting demographic data, including witnessing IPV as a child and the OVAT. Main outcome measures were witnessing IPV as a child, ongoing IPV, and associated demographics. Assuming a prevalence of IPV of 20% and a clinically significant difference of 20% between adults who witnessed IPV as children and adult controls who did not witness IPV as children, the study was powered at 80%, with 215 subjects included.Results: A total of 280 subjects were entered; 256 had complete data sets. Forty-nine percent of subjects were male, 45% were Hispanic, 72 (28%) were adults who witnessed IPV as children, and 184 (72%) were adult controls who did not witness IPV as children. Sixty-three (23.5%) were positive for ongoing IPV. There was no correlation of adults who witnessed IPV as children with the presence of ongoing IPV, as determined by univariate and bivariate analysis. Twenty-three of 72 (32%) of the adults who witnessed IPV as children, and 39 of 184 (21%) of the adult controls who did not witness IPV as children, were positive for IPV (difference, 11%; 95% confidence interval [CI] = À2% to 23%). Significant correlations with having witnessed IPV as a child included age younger than 40 years (odds ratio [OR], 4.2; 95% CI = 1.7 to 9.1), income less than $20,000/year (OR, 5.1; 95% CI = 1.6 to 12.5), and abuse as a child (OR, 9.1; 95% CI = 4.2 to 19.6). Other demographics were not significantly correlated with having witnessed IPV as a child.Conclusions: Adults who witnessed IPV as children were more likely to have a lower income, be younger, and have been abused as a child, but not more likely to be positive for ongoing IPV, when compared with patients who had not witnessed IPV. ACADEMIC EMERGENCY MEDICINE 2007; 14:411-418 ª 2007 by the Society for Academic Emergency MedicineKeywords: intimate partner violence, child witness of intimate partner violence, adult child witness I ntimate partner violence (IPV) is defined as persistent physical abuse by one adult on another, both of whom are involved in an intimate relationship with the other as a spouse or a partner.1 Studies suggest that 8%-12% of all women experience some form of IPV in any given year, and approximately 20%-50% of