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100 Abstracts

njury who are more likely to improve with TH. Second, theyuggest use of TH regardless of the presence of post-resusci-ation shock.

[John E. Houghland, MD,

Denver Health Medical Center, Denver, CO]

Comment: This prospective study adds to the growing body ofvidence that time from collapse to ROSC is associated withutcomes, regardless of the presence of post-resuscitation shock.he study is limited by its modest population size, and further

nvestigation into the role of TH in non-ventricular fibrillation CAs necessary. Use of historical controls is a significant limitation ofhe authors’ further analysis, and the conclusions made based onhese data are more problematic because no information is pre-ented regarding the population characteristics or the resuscitativend other medical therapy these patients received.

NOCTURIA IN MEN LESS THAN 50 YEARS OF AGEAY BE ASSOCIATED WITH OBSTRUCTIVE SLEEPPNEA SYNDROME. Moriyama Y, Miwa K, Tanaka H,ujihiro S, Nishino Y, Deguchi T. Urology 2008;71:1096–8.

This study assessed the prevalence of nocturia in patients withbstructive sleep apnea syndrome and evaluates additional voidingisorder symptoms. The authors analyzed data from 73 patients toompare the Apnea-Hypopnea index score (AHI), voiding score,umber of voids per night, and age. The prevalence of nocturia inhis study was 41.1%. The AHI score was higher in patients withocturia, especially among patients � 50 years of age, whereasatients aged � 50 years had no significant difference. In patientsver 50, the voiding symptom score was significantly higher inatients with nocturia compared to those without nocturia. Theuthors note that their study suggests that in older patients, noc-uria is primarily associated with voiding symptoms, whereas inounger patients there may be more association with obstructiveleep apnea symptoms.

[Michael Prendergast, MD,

Denver Health Medical Center, Denver, CO]

Comments: This small study points out an important asso-iation between obstructive sleep apnea syndrome and urologicisease. Although less germane to the emergency setting, itay offer the emergency physician additional insight into

rimary disease processes in patients with complaints of noc-uria or voiding abnormalities. Additional studies may beeeded to explain the difference in associated symptoms be-ween older and younger patients.

EVALUATION OF A “TRIPLE RULE-OUT” CORO-ARY COMPUTED TOMOGRAPHY (CT) ANGIOGRA-HY PROTOCOL: USE OF 64-SECTION CT IN LOW-O-MODERATE RISK EMERGENCY DEPARTMENTATIENTS SUSPECTED OF HAVING ACUTE CORO-ARY SYNDROME. Takakuwa KM, Halpern EJ. Radiology008;248:438–46.

Chest pain is a common yet complex diagnostic challenge

or the emergency physician. An estimated 6–8 billion dollars r

s spent each year on negative inpatient cardiac evaluations.his prospective single-center cohort study used computed

omographic (CT) angiographic “triple rule-out” to evaluate01 patients stratified as having low-to-moderate risk of acuteoronary syndrome (ACS) by thrombolysis in myocardial in-arction scoring. A triple rule-out protocol allowed for accuratedentification of coronary disease, pulmonary embolism, aorticissection or other thoracic disease. A disease process otherhan coronary atherosclerosis explained the presenting symp-oms in 11% of this population. Clinically important non-oronary diagnoses that could not explain a patient’s presentingymptoms were identified in an additional 14% of patients.leven percent of this cohort had moderate to severe coronaryisease requiring further imaging or inpatient workup as deter-ined by an emergency physician or cardiologist. Seventy-six

ercent of those patients with no more than mild coronaryisease were discharged home or treated without further diag-ostic imaging. At 30-day follow-up, the negative predictivealue of coronary CT angiography for ACS was 99.4% in thisatient population. No adverse outcomes were reported at 30ays. The authors conclude that triple rule-out CT angiographyllows for safe and accurate disposition of a population withow-to-moderate risk for ACS. Coronary CT angiography pre-luded additional cardiac testing in the majority of patients anday represent a more timely and cost-effective strategy for

isk-stratifying this patient population.[Chris Davis, MD,

Denver Health Medical Center, Denver, CO]

Comment: Although this study represents only a small pa-ient population and included only one interpreting radiologist,t represents an encouraging effort to safely disposition thoseatients with low-to-moderate risk of ACS, often without fur-her need of diagnostic imaging or hospitalization.

ISO-OMOLALITY VERSUS LOW-OSMOLALITYODINATED CONTRAST MEDIUM AT INTRAVENOUSONTRAST-ENHANCED COMPUTED TOMOGRAPHY:FFECT ON KIDNEY FUNCTION. Nguyen SA, Suranyi P,avenel JH, et al. Radiology 2008;248:97–105.

This single-center, randomized, double-blind prospectiverial investigated the effects of an iso-osmolality contrast me-ium compared with a low-osmolality agent on renal functionn high-risk patients undergoing intravenous (i.v.) contrast-nhanced computed tomography (CT). Patients were adultsged � 18 years undergoing CT scan with i.v. contrast who hadbaseline serum creatinine (SCr) � 1.5 mg/dL or glomerularltration rate (GFR) � 60 mL/min. Exclusion criteria included:regnancy or lactation, receiving contrast 7 days before study,revious anaphylaxis to contrast, acute renal failure or chronicemodialysis, heart or renal transplant, or recent use of potentiallyephrotoxic medications or nonsteroidal anti-inflammatory med-cations other than aspirin. Serial measurements of SCr andFR were recorded at baseline, within 24 h of CT (day 1), andn days 2 and 3. Follow-up occurred at 30 and 90 days to

ecord adverse events. Between September 2004 and July 2006,