Here is a quick look at three articles published in the December issue of Annals of Emergency Medicine. Visit www.annemergmed.com to read the full text.

Relationship Between Pain Severity and Outcomes in Patients Presenting With Potential Acute Coronary Syndromes

By M. Edwards, A.M. Chang, A.C. Matsuura, M. Green, J.M. Robey, and J.E. Hollander

• What is already known on this topic: Pain scores are routinely measured in all emergency department patients.
• What question this study addressed: Is pain score severity associated with the final diagnosis of acute myocardial infarction?
• What this study adds to our knowledge: Of 3,306 patients, 3.2% were diagnosed with a myocardial infarction. Severe pain defined as an 11-point numeric rating scale, 9 or 10 was not strongly associated with a diagnosis of myocardial infarction (adjusted relative risk, 1.43 [0.91-2.22]).
• How this might change clinical practice: Pain severity should not be used as a predictor of MI.

Intraosseous Versus Intravenous Vascular Access During Out-of-Hospital Cardiac Arrest: A Randomized Controlled Trial

By R. Reades, J.R. Studnek, S. Vandeventer, and J. Garrett

• What is already known on this topic: Based primarily on observational research, intraosseous needle insertion for prehospital vascular access is common.
• What question this study addressed: This study assessed the proportion of first-attempt successes and procedural time in insertion of humeral interosseous, tibial interosseous, and standard peripheral IV lines in patients with out-of-hospital cardiac arrest.
• What this study adds to our knowledge: In this study of 113 paramedics treating 182 patients, tibial intraosseous placement had the highest success rate and fastest time to access, though peripheral IV access was associated with a larger infused fluid volume.
• How this is relevant to clinical practice: For arrest or unconscious patients who require immediate vascular access but are unlikely to require large-volume fluid resuscitation, tibial intraosseous needle placement is advantageous.

Cervical Spine Magnetic Resonance Imaging in Alert, Neurologically Intact Trauma Patients With Persistent Midline Tenderness and Negative Computed Tomography Results

By H.M. Ackland, P.A. Cameron, D.K. Varma, G.J. Fitt, D.J. Cooper, R. Wolfe, G.M. Malham, J.V. Rosenfeld, O.D. Williamson, and S.M. Liew

• What is already known on this topic: Among alert, neurologically intact trauma patients with midline cervical spine tenderness but negative CT, some have soft-tissue injury on MRI.
• What question this study addressed: How frequent are such injuries, and what clinical features predict them?
• What this study adds to our knowledge: In this prospective study of 178 patients with midline pain and a CT negative for acute injury, 44% had acute injury on MRI, 33/78 of whom were treated with cervical collars and 5/78 given operative treatment. Advanced degenerative joint disease, thoracolumbar fracture, and multidirectional forces predicted greater degree of injury.
• How this is relevant to clinical practice: These results cannot be applied to the general population of trauma patients. Further study may determine what variables are useful.