Objectives: To determine the prevalence of hip and pelvic fractures in emergency department (ED) patients with hip pain and negative standard initial radiographs. Methods: This was a retrospective, cohort study at an academic, community-based ED. ED patients presenting during a oneyear period with hip pain for whom a plain-film radiograph was obtained were included. Eligible patients were identified by query of electronic records. Plain radiographs and magnetic resonance images (MRIs) were ordered at the discretion of the treating physician. Initial plain radiographs were read at the point of care by board-certified radiologists. MRI images were reviewed by radiologists with fellowship training in musculoskeletal imaging. Structured follow-up at more than one month postvisit was conducted to rule out a subsequent diagnosis of hip fracture. Ninety-five-percent confidence intervals (95% CIs) and kappa (k) were calculated as appropriate. Results: Seven hundred sixty-four of 895 patients (85.3%) had follow-up completed (study group). Within the study group, 219 patients (29%) had

Abstract. Objective: To assess the effect of physician counseling and referral on smoking cessation rates and attendance at a smoking cessation program. Methods: This was a prospective, randomized clinical trial set in a suburban, community teaching hospital emergency department (ED). During study hours, dedicated research associates enrolled consecutive, stable, oriented patients who were smokers. Eligible, consenting patients were randomized to one of two intervention groups. The control group received a two-page ''Stop Smoking'' pamphlet from the American Heart Association (AHA). Patients in the intervention group were given the AHA pamphlet along with pharmacologic information and standardized counseling by the attending emergency physician, including written and oral referral to a smoking cessation program. The primary outcome measures were telephone contact/attendance at the smoking cessation program by the intervention group and the rate of smoking cessation in both study groups at three months post-ED visit. Categorical data were analyzed by chi-square and Fisher's exact tests. Rank data were analyzed by Mann-Whitney tests and continuous data by t-tests. All tests were two-tailed with alpha set at 0.05. Results: One hundred fifty-two patients were enrolled; 78 were randomized to the intervention group. Nearly 70% of patients (103) were available for telephone follow-up. The study groups were statistically similar with regard to baseline demographic characteristics and the prevalence of moderate or severe nicotine addiction. None of the patients (0%) in the intervention group contacted or attended the smoking cessation program during the study period (95% CI = 0-4%). The percentages of patients who stopped smoking after three months were similar in the two groups [10.4% (5/48) control vs 10.9% (6/55) intervention; p = 1]. Conclusion: The authors found no difference in the smoking cessation rates between ED patients who received written material and those who were counseled by emergency physicians. Referral of patients who smoked to a cessation program was unsuccessful.

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Abstract. Objective: To determine interobserver agreement between triage registered nurses (RNs) and emergency physicians (EPs) regarding indication for knee radiographs by applying the Ottawa knee rule (OKR) and individual components of the rule. Methods: This was a prospective, observational study in a suburban, teaching emergency department. The study enrolled a convenience sample of patients aged >17 years with traumatic knee injuries less than one week old. Patients with prior knee surgery or distracting conditions were excluded. Before study initiation, the RNs and EPs were in-serviced in the OKR. Nurses and EPs independently examined each patient for OKR criteria, blinded to the other's assessment. Knee radiographs were ordered at the discretion of the EP and were interpreted by board-certified radiologists. All patients received follow-up with a structured telephone interview to identify any undetected fractures. Kappa was calculated for each component and the overall application of the OKR to assess interobserver agreement. Results: Ninety-six patients were enrolled. The mean age was 39.6 Ϯ 18.7 years; 50% were male. Eight patients (8%) had knee fractures. Interobserver agreements between the RNs and EPs for individual components of the OKR were: age Ն55 years ( = 0.97); inability to weight bear ( = 0.51); inability to bend knee to 90 degrees ( = 0.52); fibular head tenderness ( = 0.45); and isolated patellar tenderness ( = 0.40). The EPs and RNs agreed with OKR criteria for x-ray 71% of the time ( = 0.41). Conclusions:The only criterion that resulted in almost perfect agreement between the RNs and EPs was patient age; agreement for the other four criteria and the overall decision to order x-rays was moderate.