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| Unknown | 1992-06-06 | 225.1 KB |
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| Confidence | Program | Detection | Match Type | Support
|
|---|
| 66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
| 1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
| 100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
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|00000510| 53 6f 63 7d 0d 0a 24 56 | 6f 6c 75 6d 65 7b 33 35 |Soc}..$V|olume{35|
|00000520| 7d 0d 0a 24 50 61 67 65 | 7b 33 39 38 2d 34 30 34 |}..$Page|{398-404|
|00000530| 7d 0d 0a 24 44 61 74 65 | 7b 4d 61 79 20 31 39 38 |}..$Date|{May 198|
|00000540| 37 7d 0d 0a 24 59 42 56 | 6f 6c 7b 31 39 38 39 20 |7}..$YBV|ol{1989 |
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|00000580| 0d 0a 24 59 42 45 64 69 | 74 6f 72 7b 44 72 2e 20 |..$YBEdi|tor{Dr. |
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|000036a0| 74 75 72 65 20 68 69 70 | 2c 20 74 72 61 75 6d 61 |ture hip|, trauma|
|000036b0| 20 74 79 70 65 2c 20 61 | 67 65 2c 20 61 6e 64 20 | type, a|ge, and |
|000036c0| 67 65 6e 64 65 72 20 61 | 73 20 64 65 74 65 72 6d |gender a|s determ|
|000036d0| 69 6e 61 6e 74 73 20 6f | 66 3b 0d 0a 41 67 65 20 |inants o|f;..Age |
|000036e0| 68 69 70 20 66 72 61 63 | 74 75 72 65 20 61 6e 64 |hip frac|ture and|
|000036f0| 7d 0d 0a 24 4a 6f 75 72 | 6e 61 6c 7b 4a 20 4f 72 |}..$Jour|nal{J Or|
|00003700| 74 68 6f 70 20 52 65 73 | 7d 0d 0a 24 56 6f 6c 75 |thop Res|}..$Volu|
|00003710| 6d 65 7b 35 7d 0d 0a 24 | 50 61 67 65 7b 32 34 32 |me{5}..$|Page{242|
|00003720| 2d 32 34 36 7d 0d 0a 24 | 44 61 74 65 7b 31 39 38 |-246}..$|Date{198|
|00003730| 37 7d 0d 0a 24 59 42 56 | 6f 6c 7b 31 39 38 39 20 |7}..$YBV|ol{1989 |
|00003740| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 45 6d 65 |Year Boo|k of Eme|
|00003750| 72 67 65 6e 63 79 20 4d | 65 64 69 63 69 6e 65 7d |rgency M|edicine}|
|00003760| 0d 0a 24 43 68 61 70 74 | 65 72 7b 34 2d 37 30 7d |..$Chapt|er{4-70}|
|00003770| 0d 0a 24 59 42 45 64 69 | 74 6f 72 7b 44 72 2e 20 |..$YBEdi|tor{Dr. |
|00003780| 57 61 67 6e 65 72 7d 0d | 0a 24 54 61 62 6c 65 7b |Wagner}.|.$Table{|
|00003790| 7d 0d 0a 24 43 6f 6d 6d | 65 6e 74 61 74 6f 72 7b |}..$Comm|entator{|
|000037a0| 57 2e 50 2e 20 42 75 72 | 64 69 63 6b 2c 20 4d 2e |W.P. Bur|dick, M.|
|000037b0| 44 2e 7d 0d 0a 0d 0a 43 | 6f 70 79 72 69 67 68 74 |D.}....C|opyright|
|000037c0| 20 28 63 29 20 59 65 61 | 72 20 42 6f 6f 6b 20 4d | (c) Yea|r Book M|
|000037d0| 65 64 69 63 61 6c 20 50 | 75 62 6c 69 73 68 65 72 |edical P|ublisher|
|000037e0| 73 2c 20 49 6e 63 2e 2c | 20 31 39 38 39 0d 0a 0d |s, Inc.,| 1989...|
|000037f0| 0a 31 39 38 39 20 59 65 | 61 72 20 42 6f 6f 6b 20 |.1989 Ye|ar Book |
|00003800| 6f 66 20 45 6d 65 72 67 | 65 6e 63 79 20 4d 65 64 |of Emerg|ency Med|
|00003810| 69 63 69 6e 65 20 28 52 | 29 0d 0a 0d 0a 43 68 61 |icine (R|)....Cha|
|00003820| 70 74 65 72 20 34 2d 2d | 53 70 65 63 69 61 6c 20 |pter 4--|Special |
|00003830| 45 6d 65 72 67 65 6e 63 | 69 65 73 0d 0a 0d 0a 47 |Emergenc|ies....G|
|00003840| 65 72 69 61 74 72 69 63 | 0d 0a 0d 0a 2d 2d 2d 2d |eriatric|....----|
|00003850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003860| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003890| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 54 72 |--------|----..Tr|
|000038a0| 61 75 6d 61 20 54 79 70 | 65 2c 20 41 67 65 2c 20 |auma Typ|e, Age, |
|000038b0| 61 6e 64 20 47 65 6e 64 | 65 72 20 61 73 20 44 65 |and Gend|er as De|
|000038c0| 74 65 72 6d 69 6e 61 6e | 74 73 20 6f 66 20 48 69 |terminan|ts of Hi|
|000038d0| 70 20 46 72 61 63 74 75 | 72 65 0d 0a 0d 0a 48 65 |p Fractu|re....He|
|000038e0| 64 6c 75 6e 64 20 52 2c | 20 4c 69 6e 64 67 72 65 |dlund R,| Lindgre|
|000038f0| 6e 20 55 0d 0a 28 48 75 | 64 64 69 6e 67 65 20 48 |n U..(Hu|ddinge H|
|00003900| 6f 73 70 2c 20 53 77 65 | 64 65 6e 29 0d 0a 4a 20 |osp, Swe|den)..J |
|00003910| 4f 72 74 68 6f 70 20 52 | 65 73 20 35 3a 32 34 32 |Orthop R|es 5:242|
|00003920| 2d 32 34 36 2c 20 31 39 | 38 37 0d 0a 2d 2d 2d 2d |-246, 19|87..----|
|00003930| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003940| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003950| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003960| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003970| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00003980| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|.... |
|00003990| 20 54 72 61 75 6d 61 20 | 74 79 70 65 20 77 61 73 | Trauma |type was|
|000039a0| 20 61 6e 61 6c 79 7a 65 | 64 20 69 6e 20 70 61 74 | analyze|d in pat|
|000039b0| 69 65 6e 74 73 20 61 67 | 65 64 20 32 30 20 6f 72 |ients ag|ed 20 or|
|000039c0| 20 6d 6f 72 65 20 79 65 | 61 72 73 20 77 68 6f 20 | more ye|ars who |
|000039d0| 66 72 6f 6d 20 31 39 37 | 32 20 74 6f 0d 0a 31 39 |from 197|2 to..19|
|000039e0| 38 31 20 73 75 73 74 61 | 69 6e 65 64 20 66 65 6d |81 susta|ined fem|
|000039f0| 6f 72 61 6c 20 6e 65 63 | 6b 20 61 6e 64 20 74 72 |oral nec|k and tr|
|00003a00| 6f 63 68 61 6e 74 65 72 | 69 63 20 66 72 61 63 74 |ochanter|ic fract|
|00003a10| 75 72 65 73 2e 20 20 49 | 6e 20 74 68 69 73 20 70 |ures. I|n this p|
|00003a20| 65 72 69 6f 64 2c 20 31 | 39 2c 31 32 38 0d 0a 66 |eriod, 1|9,128..f|
|00003a30| 72 61 63 74 75 72 65 73 | 20 77 65 72 65 20 72 65 |ractures| were re|
|00003a40| 63 6f 72 64 65 64 20 69 | 6e 20 53 74 6f 63 6b 68 |corded i|n Stockh|
|00003a50| 6f 6c 6d 20 43 6f 75 6e | 74 79 20 68 6f 73 70 69 |olm Coun|ty hospi|
|00003a60| 74 61 6c 73 2e 20 20 49 | 6e 6a 75 72 69 65 73 20 |tals. I|njuries |
|00003a70| 72 65 73 75 6c 74 69 6e | 67 20 66 72 6f 6d 0d 0a |resultin|g from..|
|00003a80| 68 69 67 68 2d 65 6e 65 | 72 67 79 20 61 6e 64 20 |high-ene|rgy and |
|00003a90| 6c 6f 77 2d 65 6e 65 72 | 67 79 20 74 72 61 75 6d |low-ener|gy traum|
|00003aa0| 61 20 77 65 72 65 20 64 | 69 73 74 69 6e 67 75 69 |a were d|istingui|
|00003ab0| 73 68 65 64 2e 0d 0a 20 | 20 20 20 20 4d 6f 64 65 |shed... | Mode|
|00003ac0| 72 61 74 65 20 74 6f 20 | 73 65 76 65 72 65 20 74 |rate to |severe t|
|00003ad0| 72 61 75 6d 61 20 63 61 | 75 73 69 6e 67 20 70 72 |rauma ca|using pr|
|00003ae0| 6f 78 69 6d 61 6c 20 66 | 65 6d 6f 72 61 6c 20 66 |oximal f|emoral f|
|00003af0| 72 61 63 74 75 72 65 73 | 20 69 6e 63 72 65 61 73 |ractures| increas|
|00003b00| 65 64 0d 0a 63 6f 6e 74 | 69 6e 75 61 6c 6c 79 20 |ed..cont|inually |
|00003b10| 77 69 74 68 20 61 64 76 | 61 6e 63 69 6e 67 20 61 |with adv|ancing a|
|00003b20| 67 65 2c 20 62 75 74 20 | 66 72 61 63 74 75 72 65 |ge, but |fracture|
|00003b30| 73 20 72 65 73 75 6c 74 | 69 6e 67 20 66 72 6f 6d |s result|ing from|
|00003b40| 20 6d 6f 64 65 72 61 74 | 65 20 74 72 61 75 6d 61 | moderat|e trauma|
|00003b50| 0d 0a 69 6e 63 72 65 61 | 73 65 64 20 74 68 65 20 |..increa|sed the |
|00003b60| 6d 6f 73 74 2e 20 20 54 | 68 65 20 69 6e 63 69 64 |most. T|he incid|
|00003b70| 65 6e 63 65 20 6f 66 20 | 6c 6f 77 2d 65 6e 65 72 |ence of |low-ener|
|00003b80| 67 79 20 66 72 61 63 74 | 75 72 65 73 20 64 6f 75 |gy fract|ures dou|
|00003b90| 62 6c 65 64 20 65 76 65 | 72 79 20 36 20 79 65 61 |bled eve|ry 6 yea|
|00003ba0| 72 73 0d 0a 69 6e 20 6d | 65 6e 20 61 6e 64 20 65 |rs..in m|en and e|
|00003bb0| 76 65 72 79 20 34 2d 35 | 20 79 65 61 72 73 20 69 |very 4-5| years i|
|00003bc0| 6e 20 77 6f 6d 65 6e 2e | 20 20 41 20 66 61 6c 6c |n women.| A fall|
|00003bd0| 20 6f 6e 20 74 68 65 20 | 73 61 6d 65 20 6c 65 76 | on the |same lev|
|00003be0| 65 6c 20 77 61 73 20 72 | 65 70 6f 72 74 65 64 20 |el was r|eported |
|00003bf0| 69 6e 0d 0a 61 73 73 6f | 63 69 61 74 69 6f 6e 20 |in..asso|ciation |
|00003c00| 77 69 74 68 20 38 31 25 | 20 6f 66 20 61 6c 6c 20 |with 81%| of all |
|00003c10| 70 72 6f 78 69 6d 61 6c | 20 66 65 6d 6f 72 61 6c |proximal| femoral|
|00003c20| 20 66 72 61 63 74 75 72 | 65 73 2e 20 20 4f 6e 6c | fractur|es. Onl|
|00003c30| 79 20 61 62 6f 75 74 20 | 35 25 20 6f 66 0d 0a 66 |y about |5% of..f|
|00003c40| 72 61 63 74 75 72 65 73 | 20 69 6e 20 6d 65 6e 20 |ractures| in men |
|00003c50| 61 6e 64 20 61 62 6f 75 | 74 20 31 25 20 6f 66 20 |and abou|t 1% of |
|00003c60| 74 68 6f 73 65 20 69 6e | 20 77 6f 6d 65 6e 20 77 |those in| women w|
|00003c70| 65 72 65 20 63 61 75 73 | 65 64 20 62 79 20 74 72 |ere caus|ed by tr|
|00003c80| 61 66 66 69 63 0d 0a 61 | 63 63 69 64 65 6e 74 73 |affic..a|ccidents|
|00003c90| 2e 0d 0a 20 20 20 20 20 | 4d 65 6e 6f 70 61 75 73 |... |Menopaus|
|00003ca0| 65 20 64 6f 65 73 20 6e | 6f 74 20 61 70 70 65 61 |e does n|ot appea|
|00003cb0| 72 20 74 6f 20 69 6e 66 | 6c 75 65 6e 63 65 20 73 |r to inf|luence s|
|00003cc0| 69 67 6e 69 66 69 63 61 | 6e 74 6c 79 20 74 68 65 |ignifica|ntly the|
|00003cd0| 20 69 6e 63 69 64 65 6e | 63 65 20 6f 66 20 62 6f | inciden|ce of bo|
|00003ce0| 6e 65 0d 0a 66 72 61 63 | 74 75 72 65 2e 20 20 54 |ne..frac|ture. T|
|00003cf0| 68 65 20 61 67 65 2d 72 | 65 6c 61 74 65 64 20 69 |he age-r|elated i|
|00003d00| 6e 63 72 65 61 73 65 20 | 69 6e 20 6c 6f 77 2d 65 |ncrease |in low-e|
|00003d10| 6e 65 72 67 79 20 66 72 | 61 63 74 75 72 65 73 20 |nergy fr|actures |
|00003d20| 69 6e 20 77 6f 6d 65 6e | 20 69 73 20 6e 6f 74 0d |in women| is not.|
|00003d30| 0a 68 69 67 68 65 72 20 | 61 66 74 65 72 20 6d 65 |.higher |after me|
|00003d40| 6e 6f 70 61 75 73 65 2c | 20 61 6e 64 20 61 20 70 |nopause,| and a p|
|00003d50| 61 72 61 6c 6c 65 6c 20 | 70 61 74 74 65 72 6e 20 |arallel |pattern |
|00003d60| 6f 66 20 61 67 65 2d 72 | 65 6c 61 74 65 64 20 69 |of age-r|elated i|
|00003d70| 6e 63 72 65 61 73 65 20 | 69 73 20 73 65 65 6e 0d |ncrease |is seen.|
|00003d80| 0a 69 6e 20 6d 61 6c 65 | 73 2e 20 20 4c 65 73 73 |.in male|s. Less|
|00003d90| 65 6e 69 6e 67 20 62 6f | 6e 65 20 73 74 72 65 6e |ening bo|ne stren|
|00003da0| 67 74 68 20 61 6e 64 20 | 64 65 63 72 65 61 73 69 |gth and |decreasi|
|00003db0| 6e 67 20 6e 65 75 72 6f | 6d 75 73 63 75 6c 61 72 |ng neuro|muscular|
|00003dc0| 20 63 6f 6e 74 72 6f 6c | 20 77 69 74 68 0d 0a 61 | control| with..a|
|00003dd0| 64 76 61 6e 63 69 6e 67 | 20 61 67 65 20 6d 61 79 |dvancing| age may|
|00003de0| 20 62 65 20 69 6d 70 6f | 72 74 61 6e 74 20 66 61 | be impo|rtant fa|
|00003df0| 63 74 6f 72 73 20 69 6e | 20 74 68 65 20 69 6e 63 |ctors in| the inc|
|00003e00| 72 65 61 73 69 6e 67 20 | 69 6e 63 69 64 65 6e 63 |reasing |incidenc|
|00003e10| 65 20 6f 66 20 66 72 61 | 63 74 75 72 65 0d 0a 69 |e of fra|cture..i|
|00003e20| 6e 20 6f 6c 64 65 72 20 | 70 65 72 73 6f 6e 73 2e |n older |persons.|
|00003e30| 20 20 44 65 63 72 65 61 | 73 69 6e 67 20 62 6f 6e | Decrea|sing bon|
|00003e40| 65 20 73 74 72 65 6e 67 | 74 68 20 70 72 6f 62 61 |e streng|th proba|
|00003e50| 62 6c 79 20 69 73 20 74 | 68 65 20 73 69 6e 67 6c |bly is t|he singl|
|00003e60| 65 20 6d 6f 73 74 0d 0a | 69 6d 70 6f 72 74 61 6e |e most..|importan|
|00003e70| 74 20 66 61 63 74 6f 72 | 2e 0d 0a 0d 0a 50 6f 73 |t factor|.....Pos|
|00003e80| 74 2d 43 6f 6d 6d 65 6e | 74 0d 0a 0d 0a 20 20 20 |t-Commen|t.... |
|00003e90| 20 20 54 68 65 20 64 61 | 74 61 20 62 61 6e 6b 20 | The da|ta bank |
|00003ea0| 6f 66 20 70 61 74 69 65 | 6e 74 20 69 6e 66 6f 72 |of patie|nt infor|
|00003eb0| 6d 61 74 69 6f 6e 20 61 | 63 63 75 6d 75 6c 61 74 |mation a|ccumulat|
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|00003ee0| 70 75 62 6c 69 63 6c 79 | 20 66 75 6e 64 65 64 20 |publicly| funded |
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|00003f00| 6e 20 70 72 6f 76 65 73 | 20 69 6e 76 61 6c 75 61 |n proves| invalua|
|00003f10| 62 6c 65 2e 20 20 54 68 | 65 73 65 20 66 69 6e 64 |ble. Th|ese find|
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|00003f40| 20 6f 6e 73 65 74 20 6f | 66 20 64 69 6d 69 6e 69 | onset o|f dimini|
|00003f50| 73 68 69 6e 67 20 62 6f | 6e 65 20 73 74 72 65 6e |shing bo|ne stren|
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|00003f80| 70 72 65 76 69 6f 75 73 | 6c 79 20 73 75 67 67 65 |previous|ly sugge|
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|00003fa0| 65 73 74 72 6f 67 65 6e | 20 75 73 65 20 69 73 20 |estrogen| use is |
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|00004400| 63 69 65 73 0d 0a 0d 0a | 47 65 72 69 61 74 72 69 |cies....|Geriatri|
|00004410| 63 0d 0a 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |c....---|--------|
|00004420| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004430| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004440| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004450| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004460| 2d 2d 2d 2d 2d 0d 0a 53 | 75 72 76 69 76 61 6c 20 |-----..S|urvival |
|00004470| 41 66 74 65 72 20 54 72 | 61 75 6d 61 20 69 6e 20 |After Tr|auma in |
|00004480| 47 65 72 69 61 74 72 69 | 63 20 50 61 74 69 65 6e |Geriatri|c Patien|
|00004490| 74 73 0d 0a 0d 0a 44 65 | 4d 61 72 69 61 20 45 4a |ts....De|Maria EJ|
|000044a0| 2c 20 4b 65 6e 6e 65 79 | 20 50 52 2c 20 4d 65 72 |, Kenney| PR, Mer|
|000044b0| 72 69 61 6d 20 4d 41 2c | 20 43 61 73 61 6e 6f 76 |riam MA,| Casanov|
|000044c0| 61 20 4c 41 2c 20 47 61 | 6e 6e 20 44 53 0d 0a 28 |a LA, Ga|nn DS..(|
|000044d0| 42 72 6f 77 6e 20 55 6e | 69 76 2c 20 50 72 6f 76 |Brown Un|iv, Prov|
|000044e0| 69 64 65 6e 63 65 3b 20 | 52 68 6f 64 65 20 49 73 |idence; |Rhode Is|
|000044f0| 6c 61 6e 64 20 48 6f 73 | 70 2c 20 50 72 6f 76 69 |land Hos|p, Provi|
|00004500| 64 65 6e 63 65 29 0d 0a | 41 6e 6e 20 53 75 72 67 |dence)..|Ann Surg|
|00004510| 20 32 30 36 3a 37 33 38 | 2d 37 34 33 2c 20 44 65 | 206:738|-743, De|
|00004520| 63 65 6d 62 65 72 20 31 | 39 38 37 0d 0a 2d 2d 2d |cember 1|987..---|
|00004530| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004540| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004550| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004560| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004570| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 0d |--------|-----...|
|00004580| 0a 41 62 73 74 72 61 63 | 74 0d 0a 0d 0a 20 20 20 |.Abstrac|t.... |
|00004590| 20 20 54 6f 6f 20 6c 69 | 74 74 6c 65 20 69 73 20 | Too li|ttle is |
|000045a0| 6b 6e 6f 77 6e 20 61 62 | 6f 75 74 20 74 68 65 20 |known ab|out the |
|000045b0| 66 75 6e 63 74 69 6f 6e | 61 6c 20 72 65 63 6f 76 |function|al recov|
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|000045e0| 75 72 76 69 76 65 20 73 | 65 72 69 6f 75 73 20 69 |urvive s|erious i|
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|00004610| 20 63 6f 6e 73 65 63 75 | 74 69 76 65 20 70 61 74 | consecu|tive pat|
|00004620| 69 65 6e 74 73 20 6f 6c | 64 65 72 0d 0a 74 68 61 |ients ol|der..tha|
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|00004640| 65 72 65 20 68 6f 73 70 | 69 74 61 6c 69 7a 65 64 |ere hosp|italized|
|00004650| 20 69 6e 20 61 20 32 2d | 79 65 61 72 20 70 65 72 | in a 2-|year per|
|00004660| 69 6f 64 20 77 69 74 68 | 20 74 72 61 75 6d 61 20 |iod with| trauma |
|00004670| 6f 74 68 65 72 20 74 68 | 61 6e 0d 0a 74 68 65 72 |other th|an..ther|
|00004680| 6d 61 6c 20 74 72 61 75 | 6d 61 2c 20 70 65 6e 65 |mal trau|ma, pene|
|00004690| 74 72 61 74 69 6e 67 20 | 69 6e 6a 75 72 79 2c 20 |trating |injury, |
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|000046c0| 54 68 65 20 6d 65 61 6e | 20 61 67 65 0d 0a 77 61 |The mean| age..wa|
|000046d0| 73 20 37 36 20 79 65 61 | 72 73 20 61 6e 64 20 74 |s 76 yea|rs and t|
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|000046f0| 65 76 65 72 69 74 79 20 | 53 63 6f 72 65 20 77 61 |everity |Score wa|
|00004700| 73 20 31 37 2e 39 2e 20 | 20 42 6c 75 6e 74 20 69 |s 17.9. | Blunt i|
|00004710| 6e 6a 75 72 79 20 77 61 | 73 20 6d 6f 73 74 0d 0a |njury wa|s most..|
|00004720| 6f 66 74 65 6e 20 63 61 | 75 73 65 64 20 62 79 20 |often ca|used by |
|00004730| 61 20 66 61 6c 6c 20 6f | 72 20 6d 6f 74 6f 72 20 |a fall o|r motor |
|00004740| 76 65 68 69 63 6c 65 20 | 61 63 63 69 64 65 6e 74 |vehicle |accident|
|00004750| 2e 20 20 4e 65 61 72 6c | 79 20 74 77 6f 20 74 68 |. Nearl|y two th|
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|00004770| 69 65 6e 74 73 20 68 61 | 64 20 68 65 61 64 2d 6e |ients ha|d head-n|
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|00004790| 20 36 30 25 20 68 61 64 | 20 69 6e 6a 75 72 79 20 | 60% had| injury |
|000047a0| 74 6f 20 6d 75 6c 74 69 | 70 6c 65 20 62 6f 64 79 |to multi|ple body|
|000047b0| 20 72 65 67 69 6f 6e 73 | 2e 0d 0a 4d 6f 73 74 20 | regions|...Most |
|000047c0| 70 61 74 69 65 6e 74 73 | 20 68 61 64 20 70 72 65 |patients| had pre|
|000047d0| 65 78 69 73 74 69 6e 67 | 20 63 61 72 64 69 61 63 |existing| cardiac|
|000047e0| 20 6f 72 20 70 75 6c 6d | 6f 6e 61 72 79 20 64 69 | or pulm|onary di|
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|00004810| 73 20 72 65 71 75 69 72 | 65 64 20 73 75 72 67 69 |s requir|ed surgi|
|00004820| 63 61 6c 20 74 72 65 61 | 74 6d 65 6e 74 2c 20 61 |cal trea|tment, a|
|00004830| 6e 64 20 69 6e 20 6d 6f | 73 74 20 74 68 69 73 20 |nd in mo|st this |
|00004840| 77 61 73 0d 0a 65 6d 65 | 72 67 65 6e 74 2e 20 20 |was..eme|rgent. |
|00004850| 4d 6f 72 65 20 74 68 61 | 6e 20 34 30 25 20 6f 66 |More tha|n 40% of|
|00004860| 20 74 68 65 20 70 61 74 | 69 65 6e 74 73 20 68 61 | the pat|ients ha|
|00004870| 64 20 63 6f 6d 70 6c 69 | 63 61 74 69 6f 6e 73 2c |d compli|cations,|
|00004880| 20 75 73 75 61 6c 6c 79 | 20 63 61 72 64 69 61 63 | usually| cardiac|
|00004890| 20 6f 72 0d 0a 70 75 6c | 6d 6f 6e 61 72 79 20 69 | or..pul|monary i|
|000048a0| 6e 20 6e 61 74 75 72 65 | 2e 20 20 4f 6e 6c 79 20 |n nature|. Only |
|000048b0| 36 25 20 68 61 64 20 73 | 79 73 74 65 6d 69 63 20 |6% had s|ystemic |
|000048c0| 73 65 70 73 69 73 2e 20 | 20 54 68 65 20 68 6f 73 |sepsis. | The hos|
|000048d0| 70 69 74 61 6c 20 6d 6f | 72 74 61 6c 69 74 79 20 |pital mo|rtality |
|000048e0| 72 61 74 65 0d 0a 77 61 | 73 20 32 31 25 2e 20 4e |rate..wa|s 21%. N|
|000048f0| 6f 6e 73 75 72 76 69 76 | 6f 72 73 20 68 61 64 20 |onsurviv|ors had |
|00004900| 6d 6f 72 65 20 66 72 65 | 71 75 65 6e 74 20 63 6f |more fre|quent co|
|00004910| 6d 70 6c 69 63 61 74 69 | 6f 6e 73 2c 20 69 6e 63 |mplicati|ons, inc|
|00004920| 6c 75 64 69 6e 67 20 63 | 61 72 64 69 61 63 0d 0a |luding c|ardiac..|
|00004930| 63 6f 6d 70 6c 69 63 61 | 74 69 6f 6e 73 20 61 6e |complica|tions an|
|00004940| 64 20 70 72 6f 6c 6f 6e | 67 65 64 20 76 65 6e 74 |d prolon|ged vent|
|00004950| 69 6c 61 74 6f 72 20 64 | 65 70 65 6e 64 65 6e 63 |ilator d|ependenc|
|00004960| 65 2e 20 20 4d 6f 72 74 | 61 6c 69 74 79 20 77 61 |e. Mort|ality wa|
|00004970| 73 20 69 6e 63 72 65 61 | 73 65 64 20 69 6e 0d 0a |s increa|sed in..|
|00004980| 70 61 74 69 65 6e 74 73 | 20 61 67 65 64 20 38 30 |patients| aged 80|
|00004990| 20 6f 72 20 6d 6f 72 65 | 2e 20 20 44 69 73 63 72 | or more|. Discr|
|000049a0| 69 6d 69 6e 61 6e 74 20 | 61 6e 61 6c 79 73 69 73 |iminant |analysis|
|000049b0| 20 79 69 65 6c 64 65 64 | 20 61 20 47 65 72 69 61 | yielded| a Geria|
|000049c0| 74 72 69 63 20 54 72 61 | 75 6d 61 0d 0a 53 75 72 |tric Tra|uma..Sur|
|000049d0| 76 69 76 61 6c 20 53 63 | 6f 72 65 20 28 47 54 53 |vival Sc|ore (GTS|
|000049e0| 53 29 20 74 68 61 74 20 | 70 72 65 64 69 63 74 65 |S) that |predicte|
|000049f0| 64 20 74 68 65 20 6f 75 | 74 63 6f 6d 65 20 63 6f |d the ou|tcome co|
|00004a00| 72 72 65 63 74 6c 79 20 | 69 6e 20 6d 6f 72 65 20 |rrectly |in more |
|00004a10| 74 68 61 6e 20 39 30 25 | 20 6f 66 0d 0a 74 68 65 |than 90%| of..the|
|00004a20| 20 70 61 74 69 65 6e 74 | 73 20 28 46 69 67 20 34 | patient|s (Fig 4|
|00004a30| 2d 31 31 29 2e 20 20 54 | 68 65 20 47 54 53 53 20 |-11). T|he GTSS |
|00004a40| 69 73 20 62 61 73 65 64 | 20 6f 6e 20 61 67 65 2c |is based| on age,|
|00004a50| 20 49 6e 6a 75 72 79 20 | 53 65 76 65 72 69 74 79 | Injury |Severity|
|00004a60| 20 53 63 6f 72 65 2c 20 | 61 6e 64 0d 0a 70 72 65 | Score, |and..pre|
|00004a70| 73 65 6e 63 65 20 6f 66 | 20 63 61 72 64 69 61 63 |sence of| cardiac|
|00004a80| 20 61 6e 64 20 73 65 70 | 74 69 63 20 63 6f 6d 70 | and sep|tic comp|
|00004a90| 6c 69 63 61 74 69 6f 6e | 73 2e 20 20 41 67 67 72 |lication|s. Aggr|
|00004aa0| 65 73 73 69 76 65 20 63 | 61 72 65 20 66 6f 72 20 |essive c|are for |
|00004ab0| 70 61 74 69 65 6e 74 73 | 0d 0a 6f 6c 64 65 72 20 |patients|..older |
|00004ac0| 74 68 61 6e 20 38 30 20 | 79 65 61 72 73 20 77 68 |than 80 |years wh|
|00004ad0| 6f 20 68 61 76 65 20 73 | 65 76 65 72 65 20 69 6e |o have s|evere in|
|00004ae0| 6a 75 72 79 20 61 6e 64 | 20 61 20 68 69 67 68 20 |jury and| a high |
|00004af0| 47 54 53 53 20 6d 61 79 | 20 62 65 20 66 75 74 69 |GTSS may| be futi|
|00004b00| 6c 65 2c 20 62 75 74 0d | 0a 66 75 72 74 68 65 72 |le, but.|.further|
|00004b10| 20 73 74 75 64 79 20 69 | 73 20 6e 65 65 64 65 64 | study i|s needed|
|00004b20| 20 74 6f 20 63 6f 6e 66 | 69 72 6d 20 74 68 69 73 | to conf|irm this|
|00004b30| 20 72 65 73 75 6c 74 2e | 20 20 46 6f 72 20 67 65 | result.| For ge|
|00004b40| 72 69 61 74 72 69 63 20 | 70 61 74 69 65 6e 74 73 |riatric |patients|
|00004b50| 20 77 69 74 68 0d 0a 6d | 6f 64 65 72 61 74 65 20 | with..m|oderate |
|00004b60| 6f 76 65 72 61 6c 6c 20 | 69 6e 6a 75 72 79 20 73 |overall |injury s|
|00004b70| 65 76 65 72 69 74 79 2c | 20 68 6f 77 65 76 65 72 |everity,| however|
|00004b80| 2c 20 72 6f 75 74 69 6e | 65 20 61 67 67 72 65 73 |, routin|e aggres|
|00004b90| 73 69 76 65 20 63 61 72 | 65 20 69 73 20 69 6e 64 |sive car|e is ind|
|00004ba0| 69 63 61 74 65 64 2e 0d | 0a 0d 0a 50 6f 73 74 2d |icated..|...Post-|
|00004bb0| 43 6f 6d 6d 65 6e 74 0d | 0a 0d 0a 20 20 20 20 20 |Comment.|... |
|00004bc0| 41 6c 74 68 6f 75 67 68 | 20 74 68 65 20 65 6c 64 |Although| the eld|
|00004bd0| 65 72 6c 79 20 61 72 65 | 20 73 65 72 69 6f 75 73 |erly are| serious|
|00004be0| 6c 79 20 69 6e 6a 75 72 | 65 64 20 6c 65 73 73 20 |ly injur|ed less |
|00004bf0| 66 72 65 71 75 65 6e 74 | 6c 79 20 74 68 61 6e 20 |frequent|ly than |
|00004c00| 61 6e 79 20 6f 74 68 65 | 72 0d 0a 70 6f 70 75 6c |any othe|r..popul|
|00004c10| 61 74 69 6f 6e 20 67 72 | 6f 75 70 2c 20 74 68 65 |ation gr|oup, the|
|00004c20| 20 6d 6f 72 74 61 6c 69 | 74 79 20 6f 66 20 74 72 | mortali|ty of tr|
|00004c30| 61 75 6d 61 74 69 7a 65 | 64 2c 20 65 6c 64 65 72 |aumatize|d, elder|
|00004c40| 6c 79 20 70 61 74 69 65 | 6e 74 73 20 69 73 20 68 |ly patie|nts is h|
|00004c50| 69 67 68 65 72 20 74 68 | 61 6e 0d 0a 74 68 61 74 |igher th|an..that|
|00004c60| 20 69 6e 20 61 6c 6c 20 | 6f 74 68 65 72 20 61 67 | in all |other ag|
|00004c70| 65 20 67 72 6f 75 70 73 | 2e 20 20 47 65 72 69 61 |e groups|. Geria|
|00004c80| 74 72 69 63 20 70 61 74 | 69 65 6e 74 73 20 68 61 |tric pat|ients ha|
|00004c90| 76 65 20 61 6c 73 6f 20 | 62 65 65 6e 20 73 74 75 |ve also |been stu|
|00004ca0| 64 69 65 64 20 74 68 65 | 0d 0a 6c 65 61 73 74 20 |died the|..least |
|00004cb0| 61 66 74 65 72 20 74 72 | 61 75 6d 61 2e 0d 0a 20 |after tr|auma... |
|00004cc0| 20 20 20 20 54 68 69 73 | 20 73 74 75 64 79 20 73 | This| study s|
|00004cd0| 75 67 67 65 73 74 73 20 | 74 68 65 20 75 74 69 6c |uggests |the util|
|00004ce0| 69 7a 61 74 69 6f 6e 20 | 6f 66 20 61 20 47 54 53 |ization |of a GTS|
|00004cf0| 53 20 74 6f 20 70 72 65 | 64 69 63 74 20 6d 6f 72 |S to pre|dict mor|
|00004d00| 74 61 6c 69 74 79 20 69 | 6e 0d 0a 74 72 61 75 6d |tality i|n..traum|
|00004d10| 61 74 69 7a 65 64 20 67 | 65 72 69 61 74 72 69 63 |atized g|eriatric|
|00004d20| 20 70 61 74 69 65 6e 74 | 73 2e 20 20 42 65 63 61 | patient|s. Beca|
|00004d30| 75 73 65 20 74 68 65 20 | 49 6e 6a 75 72 79 20 53 |use the |Injury S|
|00004d40| 65 76 65 72 69 74 79 20 | 53 63 6f 72 65 20 28 49 |everity |Score (I|
|00004d50| 53 53 29 20 61 6c 6f 6e | 65 0d 0a 69 73 20 61 20 |SS) alon|e..is a |
|00004d60| 70 6f 6f 72 20 70 72 65 | 64 69 63 74 6f 72 20 6f |poor pre|dictor o|
|00004d70| 66 20 73 75 72 76 69 76 | 61 6c 20 69 6e 20 74 68 |f surviv|al in th|
|00004d80| 65 73 65 20 70 61 74 69 | 65 6e 74 73 2c 20 74 68 |ese pati|ents, th|
|00004d90| 65 20 61 75 74 68 6f 72 | 73 20 70 65 72 66 6f 72 |e author|s perfor|
|00004da0| 6d 65 64 0d 0a 64 69 73 | 63 72 69 6d 69 6e 61 6e |med..dis|criminan|
|00004db0| 74 20 61 6e 61 6c 79 73 | 69 73 3b 20 74 68 69 73 |t analys|is; this|
|00004dc0| 20 72 65 76 65 61 6c 65 | 64 20 74 68 61 74 20 6f | reveale|d that o|
|00004dd0| 75 74 63 6f 6d 65 20 28 | 65 2e 67 2e 2c 20 73 75 |utcome (|e.g., su|
|00004de0| 72 76 69 76 61 6c 29 20 | 77 61 73 20 72 65 6c 61 |rvival) |was rela|
|00004df0| 74 65 64 0d 0a 74 6f 20 | 34 20 76 61 72 69 61 62 |ted..to |4 variab|
|00004e00| 6c 65 73 3a 20 20 49 53 | 53 2c 20 61 67 65 2c 20 |les: IS|S, age, |
|00004e10| 61 6e 64 20 74 68 65 20 | 70 72 65 73 65 6e 63 65 |and the |presence|
|00004e20| 20 6f 66 20 63 61 72 64 | 69 61 63 20 6f 72 20 73 | of card|iac or s|
|00004e30| 65 70 74 69 63 20 63 6f | 6d 70 6c 69 63 61 74 69 |eptic co|mplicati|
|00004e40| 6f 6e 73 2e 0d 0a 20 20 | 20 20 20 49 74 20 77 6f |ons... | It wo|
|00004e50| 75 6c 64 20 63 65 72 74 | 61 69 6e 6c 79 20 62 65 |uld cert|ainly be|
|00004e60| 20 6f 66 20 69 6e 74 65 | 72 65 73 74 20 74 6f 20 | of inte|rest to |
|00004e70| 74 72 79 20 74 6f 20 75 | 6e 69 66 79 20 74 68 65 |try to u|nify the|
|00004e80| 73 65 20 63 6f 6e 63 65 | 70 74 73 20 69 6e 20 61 |se conce|pts in a|
|00004e90| 6e 0d 0a 65 66 66 6f 72 | 74 20 74 6f 20 64 65 74 |n..effor|t to det|
|00004ea0| 65 72 6d 69 6e 65 20 61 | 6e 20 49 53 53 20 74 68 |ermine a|n ISS th|
|00004eb0| 61 74 20 77 6f 75 6c 64 | 20 63 6f 76 65 72 20 79 |at would| cover y|
|00004ec0| 6f 75 6e 67 20 61 64 75 | 6c 74 20 6d 61 6c 65 73 |oung adu|lt males|
|00004ed0| 2c 20 74 68 65 20 6d 6f | 73 74 0d 0a 66 72 65 71 |, the mo|st..freq|
|00004ee0| 75 65 6e 74 6c 79 20 74 | 72 61 75 6d 61 74 69 7a |uently t|raumatiz|
|00004ef0| 65 64 20 67 72 6f 75 70 | 20 5b 31 5d 3b 20 70 65 |ed group| [1]; pe|
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|00004f10| 2c 20 69 6e 20 77 68 6f | 6d 20 74 72 61 75 6d 61 |, in who|m trauma|
|00004f20| 20 69 73 20 74 68 65 0d | 0a 6c 65 61 64 69 6e 67 | is the.|.leading|
|00004f30| 20 63 61 75 73 65 20 6f | 66 20 64 65 61 74 68 20 | cause o|f death |
|00004f40| 61 6e 64 20 64 69 73 61 | 62 69 6c 69 74 79 20 5b |and disa|bility [|
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|00004f60| 63 20 70 61 74 69 65 6e | 74 73 2e 20 20 54 68 65 |c patien|ts. The|
|00004f70| 20 67 6f 61 6c 0d 0a 73 | 68 6f 75 6c 64 20 62 65 | goal..s|hould be|
|00004f80| 20 61 20 72 65 66 69 6e | 65 6d 65 6e 74 20 61 6e | a refin|ement an|
|00004f90| 64 20 63 6f 6e 63 6f 6d | 69 74 61 6e 74 20 64 65 |d concom|itant de|
|00004fa0| 63 72 65 6d 65 6e 74 20 | 69 6e 20 74 72 61 75 6d |crement |in traum|
|00004fb0| 61 20 73 63 6f 72 65 20 | 70 72 6f 6c 69 66 65 72 |a score |prolifer|
|00004fc0| 61 74 69 6f 6e 0d 0a 69 | 6e 20 66 61 76 6f 72 20 |ation..i|n favor |
|00004fd0| 6f 66 20 61 20 67 6c 6f | 62 61 6c 20 74 72 61 75 |of a glo|bal trau|
|00004fe0| 6d 61 20 73 63 6f 72 69 | 6e 67 20 73 79 73 74 65 |ma scori|ng syste|
|00004ff0| 6d 20 74 68 61 74 20 77 | 6f 75 6c 64 20 62 65 20 |m that w|ould be |
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|00005010| 6c 0d 0a 70 61 74 69 65 | 6e 74 73 2e 0d 0a 20 20 |l..patie|nts... |
|00005020| 20 20 20 46 72 6f 6d 20 | 74 68 65 20 70 65 72 73 | From |the pers|
|00005030| 70 65 63 74 69 76 65 20 | 6f 66 20 65 6d 65 72 67 |pective |of emerg|
|00005040| 65 6e 63 79 20 63 61 72 | 65 2c 20 74 68 65 20 47 |ency car|e, the G|
|00005050| 54 53 53 2c 20 61 73 20 | 69 74 20 69 73 20 70 72 |TSS, as |it is pr|
|00005060| 65 73 65 6e 74 6c 79 0d | 0a 63 6f 6e 73 74 69 74 |esently.|.constit|
|00005070| 75 74 65 64 2c 20 63 61 | 6e 20 62 65 20 63 72 69 |uted, ca|n be cri|
|00005080| 74 69 63 69 7a 65 64 20 | 66 6f 72 20 6e 6f 74 20 |ticized |for not |
|00005090| 69 6e 63 6f 72 70 6f 72 | 61 74 69 6e 67 20 63 65 |incorpor|ating ce|
|000050a0| 72 74 61 69 6e 20 70 72 | 65 68 6f 73 70 69 74 61 |rtain pr|ehospita|
|000050b0| 6c 0d 0a 76 61 72 69 61 | 62 6c 65 73 2c 20 65 2e |l..varia|bles, e.|
|000050c0| 67 2e 2c 20 65 6e 64 6f | 74 72 61 63 68 65 61 6c |g., endo|tracheal|
|000050d0| 20 69 6e 74 75 62 61 74 | 69 6f 6e 2c 20 68 79 70 | intubat|ion, hyp|
|000050e0| 6f 74 65 6e 73 69 6f 6e | 20 6f 6e 20 61 72 72 69 |otension| on arri|
|000050f0| 76 61 6c 20 69 6e 20 74 | 68 65 0d 0a 65 6d 65 72 |val in t|he..emer|
|00005100| 67 65 6e 63 79 20 64 65 | 70 61 72 74 6d 65 6e 74 |gency de|partment|
|00005110| 20 28 45 44 29 2c 20 61 | 6e 64 20 49 53 53 20 63 | (ED), a|nd ISS c|
|00005120| 68 61 6e 67 65 73 20 61 | 66 74 65 72 20 69 6e 74 |hanges a|fter int|
|00005130| 65 72 76 65 6e 74 69 6f | 6e 2c 20 62 65 63 61 75 |erventio|n, becau|
|00005140| 73 65 20 68 61 6c 66 20 | 6f 66 0d 0a 61 6c 6c 20 |se half |of..all |
|00005150| 74 72 61 75 6d 61 20 64 | 65 61 74 68 73 20 6f 63 |trauma d|eaths oc|
|00005160| 63 75 72 20 62 65 66 6f | 72 65 20 68 6f 73 70 69 |cur befo|re hospi|
|00005170| 74 61 6c 69 7a 61 74 69 | 6f 6e 20 5b 33 5d 2e 20 |talizati|on [3]. |
|00005180| 20 46 75 72 74 68 65 72 | 6d 6f 72 65 2c 20 75 73 | Further|more, us|
|00005190| 65 20 6f 66 20 74 68 65 | 0d 0a 47 54 53 53 20 69 |e of the|..GTSS i|
|000051a0| 6e 20 74 68 65 20 45 44 | 20 62 79 20 65 6d 65 72 |n the ED| by emer|
|000051b0| 67 65 6e 63 79 20 70 68 | 79 73 69 63 69 61 6e 73 |gency ph|ysicians|
|000051c0| 20 69 73 20 6f 66 20 6c | 69 6d 69 74 65 64 20 76 | is of l|imited v|
|000051d0| 61 6c 75 65 20 62 65 63 | 61 75 73 65 20 73 65 70 |alue bec|ause sep|
|000051e0| 73 69 73 20 61 6e 64 0d | 0a 6d 61 6e 79 20 63 61 |sis and.|.many ca|
|000051f0| 72 64 69 61 63 20 63 6f | 6d 70 6c 69 63 61 74 69 |rdiac co|mplicati|
|00005200| 6f 6e 73 20 61 72 65 20 | 72 61 74 68 65 72 20 64 |ons are |rather d|
|00005210| 65 6c 61 79 65 64 20 65 | 76 65 6e 74 73 2e 20 20 |elayed e|vents. |
|00005220| 53 65 70 74 69 63 20 61 | 6e 64 20 63 61 72 64 69 |Septic a|nd cardi|
|00005230| 61 63 0d 0a 63 6f 6d 70 | 6c 69 63 61 74 69 6f 6e |ac..comp|lication|
|00005240| 73 2c 20 68 6f 77 65 76 | 65 72 2c 20 61 72 65 20 |s, howev|er, are |
|00005250| 32 20 76 61 72 69 61 62 | 6c 65 73 20 74 68 61 74 |2 variab|les that|
|00005260| 20 69 6e 64 65 65 64 20 | 63 61 6e 20 62 65 20 61 | indeed |can be a|
|00005270| 76 6f 69 64 65 64 20 6f | 72 20 6d 69 74 69 67 61 |voided o|r mitiga|
|00005280| 74 65 64 0d 0a 74 68 72 | 6f 75 67 68 20 6d 6f 72 |ted..thr|ough mor|
|00005290| 65 20 61 67 67 72 65 73 | 73 69 76 65 20 61 6e 64 |e aggres|sive and|
|000052a0| 20 76 69 67 69 6c 61 6e | 74 20 63 61 72 65 2e 0d | vigilan|t care..|
|000052b0| 0a 20 20 20 20 20 54 68 | 65 20 47 54 53 53 20 6e |. Th|e GTSS n|
|000052c0| 65 65 64 73 20 74 6f 20 | 62 65 20 6d 6f 64 69 66 |eeds to |be modif|
|000052d0| 69 65 64 20 74 6f 20 69 | 6e 63 6c 75 64 65 20 70 |ied to i|nclude p|
|000052e0| 72 65 68 6f 73 70 69 74 | 61 6c 20 76 61 72 69 61 |rehospit|al varia|
|000052f0| 62 6c 65 73 2c 20 61 66 | 74 65 72 20 77 68 69 63 |bles, af|ter whic|
|00005300| 68 0d 0a 69 74 73 20 70 | 72 65 64 69 63 74 69 76 |h..its p|redictiv|
|00005310| 65 20 76 61 6c 75 65 20 | 6e 65 65 64 73 20 74 6f |e value |needs to|
|00005320| 20 62 65 20 74 65 73 74 | 65 64 20 69 6e 20 61 20 | be test|ed in a |
|00005330| 6d 75 6c 74 69 63 65 6e | 74 65 72 20 74 72 69 61 |multicen|ter tria|
|00005340| 6c 2e 2d 2d 45 2e 4a 2e | 20 41 6c 6c 69 73 6f 6e |l.--E.J.| Allison|
|00005350| 2c 0d 0a 4a 72 2c 20 4d | 2e 44 2e 0d 0a 24 55 6e |,..Jr, M|.D...$Un|
|00005360| 69 71 75 65 5f 49 44 7b | 59 52 42 30 36 31 30 35 |ique_ID{|YRB06105|
|00005370| 7d 0d 0a 24 54 69 74 6c | 65 7b 44 69 61 67 6e 6f |}..$Titl|e{Diagno|
|00005380| 73 69 6e 67 20 50 73 79 | 63 68 69 61 74 72 69 63 |sing Psy|chiatric|
|00005390| 20 44 69 73 6f 72 64 65 | 72 73 20 69 6e 20 41 64 | Disorde|rs in Ad|
|000053a0| 6f 6c 65 73 63 65 6e 74 | 20 46 65 6d 61 6c 65 73 |olescent| Females|
|000053b0| 20 57 69 74 68 20 41 62 | 64 6f 6d 69 6e 61 6c 20 | With Ab|dominal |
|000053c0| 50 61 69 6e 7d 0d 0a 24 | 41 75 74 68 6f 72 7b 0d |Pain}..$|Author{.|
|000053d0| 0a 52 69 73 73 65 72 2c | 20 57 4c 0d 0a 4d 75 6c |.Risser,| WL..Mul|
|000053e0| 6c 69 6e 73 2c 20 44 0d | 0a 42 75 74 6c 65 72 2c |lins, D.|.Butler,|
|000053f0| 20 50 4d 0d 0a 57 65 73 | 74 2c 20 4d 53 7d 0d 0a | PM..Wes|t, MS}..|
|00005400| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 55 6e 69 |$Affilia|tion{Uni|
|00005410| 76 20 6f 66 20 54 65 78 | 61 73 2c 20 48 6f 75 73 |v of Tex|as, Hous|
|00005420| 74 6f 6e 7d 0d 0a 24 53 | 75 62 6a 65 63 74 7b 50 |ton}..$S|ubject{P|
|00005430| 73 79 63 68 69 61 74 72 | 69 63 20 64 69 73 6f 72 |sychiatr|ic disor|
|00005440| 64 65 72 73 2c 20 64 69 | 61 67 6e 6f 73 69 73 20 |ders, di|agnosis |
|00005450| 69 6e 20 61 64 6f 6c 65 | 73 63 65 6e 74 20 66 65 |in adole|scent fe|
|00005460| 6d 61 6c 65 73 20 77 69 | 74 68 20 61 62 64 6f 6d |males wi|th abdom|
|00005470| 69 6e 61 6c 20 70 61 69 | 6e 3b 0d 0a 50 61 69 6e |inal pai|n;..Pain|
|00005480| 20 61 62 64 6f 6d 69 6e | 61 6c 2c 20 69 6e 20 61 | abdomin|al, in a|
|00005490| 64 6f 6c 65 73 63 65 6e | 74 20 66 65 6d 61 6c 65 |dolescen|t female|
|000054a0| 73 2c 20 61 6e 64 20 70 | 73 79 63 68 69 61 74 72 |s, and p|sychiatr|
|000054b0| 69 63 20 64 69 73 6f 72 | 64 65 72 73 3b 0d 0a 41 |ic disor|ders;..A|
|000054c0| 64 6f 6c 65 73 63 65 6e | 74 20 66 65 6d 61 6c 65 |dolescen|t female|
|000054d0| 73 20 77 69 74 68 20 61 | 62 64 6f 6d 69 6e 61 6c |s with a|bdominal|
|000054e0| 20 70 61 69 6e 2c 20 64 | 69 61 67 6e 6f 73 69 6e | pain, d|iagnosin|
|000054f0| 67 20 70 73 79 63 68 69 | 61 74 72 69 63 20 64 69 |g psychi|atric di|
|00005500| 73 6f 72 64 65 72 73 20 | 69 6e 3b 0d 0a 41 62 64 |sorders |in;..Abd|
|00005510| 6f 6d 65 6e 20 70 61 69 | 6e 20 69 6e 20 61 64 6f |omen pai|n in ado|
|00005520| 6c 65 73 63 65 6e 74 20 | 66 65 6d 61 6c 65 73 2c |lescent |females,|
|00005530| 20 61 6e 64 20 70 73 79 | 63 68 69 61 74 72 69 63 | and psy|chiatric|
|00005540| 20 64 69 73 6f 72 64 65 | 72 73 7d 0d 0a 24 4a 6f | disorde|rs}..$Jo|
|00005550| 75 72 6e 61 6c 7b 4a 20 | 41 64 6f 6c 65 73 63 20 |urnal{J |Adolesc |
|00005560| 48 65 61 6c 74 68 20 43 | 61 72 65 7d 0d 0a 24 56 |Health C|are}..$V|
|00005570| 6f 6c 75 6d 65 7b 38 7d | 0d 0a 24 50 61 67 65 7b |olume{8}|..$Page{|
|00005580| 34 33 31 2d 34 33 35 7d | 0d 0a 24 44 61 74 65 7b |431-435}|..$Date{|
|00005590| 53 65 70 74 65 6d 62 65 | 72 20 31 39 38 37 7d 0d |Septembe|r 1987}.|
|000055a0| 0a 24 59 42 56 6f 6c 7b | 31 39 38 39 20 59 65 61 |.$YBVol{|1989 Yea|
|000055b0| 72 20 42 6f 6f 6b 20 6f | 66 20 45 6d 65 72 67 65 |r Book o|f Emerge|
|000055c0| 6e 63 79 20 4d 65 64 69 | 63 69 6e 65 7d 0d 0a 24 |ncy Medi|cine}..$|
|000055d0| 43 68 61 70 74 65 72 7b | 34 2d 37 32 7d 0d 0a 24 |Chapter{|4-72}..$|
|000055e0| 59 42 45 64 69 74 6f 72 | 7b 44 72 2e 20 57 61 67 |YBEditor|{Dr. Wag|
|000055f0| 6e 65 72 7d 0d 0a 24 54 | 61 62 6c 65 7b 54 61 62 |ner}..$T|able{Tab|
|00005600| 6c 65 20 4f 6d 69 74 74 | 65 64 7d 0d 0a 24 43 6f |le Omitt|ed}..$Co|
|00005610| 6d 6d 65 6e 74 61 74 6f | 72 7b 44 2e 4b 2e 20 57 |mmentato|r{D.K. W|
|00005620| 61 67 6e 65 72 2c 20 4d | 2e 44 2e 7d 0d 0a 0d 0a |agner, M|.D.}....|
|00005630| 43 6f 70 79 72 69 67 68 | 74 20 28 63 29 20 59 65 |Copyrigh|t (c) Ye|
|00005640| 61 72 20 42 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |ar Book |Medical |
|00005650| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|00005660| 2c 20 31 39 38 39 0d 0a | 0d 0a 31 39 38 39 20 59 |, 1989..|..1989 Y|
|00005670| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 45 6d 65 72 |ear Book| of Emer|
|00005680| 67 65 6e 63 79 20 4d 65 | 64 69 63 69 6e 65 20 28 |gency Me|dicine (|
|00005690| 52 29 0d 0a 0d 0a 43 68 | 61 70 74 65 72 20 34 2d |R)....Ch|apter 4-|
|000056a0| 2d 53 70 65 63 69 61 6c | 20 45 6d 65 72 67 65 6e |-Special| Emergen|
|000056b0| 63 69 65 73 0d 0a 0d 0a | 50 73 79 63 68 69 61 74 |cies....|Psychiat|
|000056c0| 72 69 63 0d 0a 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ric....-|--------|
|000056d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000056e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000056f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005700| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005710| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 44 69 61 67 6e 6f 73 |-------.|.Diagnos|
|00005720| 69 6e 67 20 50 73 79 63 | 68 69 61 74 72 69 63 20 |ing Psyc|hiatric |
|00005730| 44 69 73 6f 72 64 65 72 | 73 20 69 6e 20 41 64 6f |Disorder|s in Ado|
|00005740| 6c 65 73 63 65 6e 74 20 | 46 65 6d 61 6c 65 73 20 |lescent |Females |
|00005750| 57 69 74 68 20 41 62 64 | 6f 6d 69 6e 61 6c 20 50 |With Abd|ominal P|
|00005760| 61 69 6e 0d 0a 0d 0a 52 | 69 73 73 65 72 20 57 4c |ain....R|isser WL|
|00005770| 2c 20 4d 75 6c 6c 69 6e | 73 20 44 2c 20 42 75 74 |, Mullin|s D, But|
|00005780| 6c 65 72 20 50 4d 2c 20 | 57 65 73 74 20 4d 53 0d |ler PM, |West MS.|
|00005790| 0a 28 55 6e 69 76 20 6f | 66 20 54 65 78 61 73 2c |.(Univ o|f Texas,|
|000057a0| 20 48 6f 75 73 74 6f 6e | 29 0d 0a 4a 20 41 64 6f | Houston|)..J Ado|
|000057b0| 6c 65 73 63 20 48 65 61 | 6c 74 68 20 43 61 72 65 |lesc Hea|lth Care|
|000057c0| 20 38 3a 34 33 31 2d 34 | 33 35 2c 20 53 65 70 74 | 8:431-4|35, Sept|
|000057d0| 65 6d 62 65 72 20 31 39 | 38 37 0d 0a 2d 2d 2d 2d |ember 19|87..----|
|000057e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000057f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005800| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005810| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005820| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00005830| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|.... |
|00005840| 20 50 73 79 63 68 69 61 | 74 72 69 63 20 64 69 73 | Psychia|tric dis|
|00005850| 6f 72 64 65 72 73 20 61 | 72 65 20 63 6f 6d 6d 6f |orders a|re commo|
|00005860| 6e 6c 79 20 61 73 73 6f | 63 69 61 74 65 64 20 77 |nly asso|ciated w|
|00005870| 69 74 68 20 61 62 64 6f | 6d 69 6e 61 6c 20 70 61 |ith abdo|minal pa|
|00005880| 69 6e 20 69 6e 0d 0a 61 | 64 6f 6c 65 73 63 65 6e |in in..a|dolescen|
|00005890| 74 73 2c 20 62 75 74 20 | 74 68 65 73 65 20 63 61 |ts, but |these ca|
|000058a0| 6e 20 62 65 20 64 69 66 | 66 69 63 75 6c 74 20 74 |n be dif|ficult t|
|000058b0| 6f 20 64 69 61 67 6e 6f | 73 65 2e 20 20 54 68 65 |o diagno|se. The|
|000058c0| 20 63 6c 69 6e 69 63 61 | 6c 20 76 61 6c 75 65 20 | clinica|l value |
|000058d0| 6f 66 20 34 0d 0a 73 69 | 6d 70 6c 65 2c 20 73 65 |of 4..si|mple, se|
|000058e0| 6c 66 2d 61 64 6d 69 6e | 69 73 74 65 72 65 64 20 |lf-admin|istered |
|000058f0| 70 73 79 63 68 69 61 74 | 72 69 63 20 73 63 61 6c |psychiat|ric scal|
|00005900| 65 73 2d 2d 74 68 65 20 | 43 68 69 6c 64 72 65 6e |es--the |Children|
|00005910| 27 73 20 44 65 70 72 65 | 73 73 69 6f 6e 0d 0a 49 |'s Depre|ssion..I|
|00005920| 6e 76 65 6e 74 6f 72 79 | 20 28 43 44 49 29 2c 20 |nventory| (CDI), |
|00005930| 74 68 65 20 53 74 61 74 | 65 20 61 6e 64 20 54 72 |the Stat|e and Tr|
|00005940| 61 69 74 20 41 6e 78 69 | 65 74 79 20 53 63 61 6c |ait Anxi|ety Scal|
|00005950| 65 73 20 6f 66 20 74 68 | 65 20 53 70 69 65 6c 62 |es of th|e Spielb|
|00005960| 65 72 67 65 72 0d 0a 53 | 74 61 74 65 2d 54 72 61 |erger..S|tate-Tra|
|00005970| 69 74 20 41 6e 78 69 65 | 74 79 20 49 6e 76 65 6e |it Anxie|ty Inven|
|00005980| 74 6f 72 79 20 28 53 54 | 41 49 29 2c 20 61 6e 64 |tory (ST|AI), and|
|00005990| 20 74 68 65 20 43 6f 64 | 64 69 6e 67 74 6f 6e 20 | the Cod|dington |
|000059a0| 4c 69 66 65 2d 45 76 65 | 6e 74 73 20 53 63 61 6c |Life-Eve|nts Scal|
|000059b0| 65 20 66 6f 72 0d 0a 41 | 64 6f 6c 65 73 63 65 6e |e for..A|dolescen|
|000059c0| 74 73 2d 2d 61 73 20 61 | 6e 20 61 64 6a 75 6e 63 |ts--as a|n adjunc|
|000059d0| 74 20 69 6e 20 74 68 65 | 20 64 69 61 67 6e 6f 73 |t in the| diagnos|
|000059e0| 69 73 20 6f 66 20 61 62 | 64 6f 6d 69 6e 61 6c 20 |is of ab|dominal |
|000059f0| 70 61 69 6e 20 69 6e 20 | 61 64 6f 6c 65 73 63 65 |pain in |adolesce|
|00005a00| 6e 74 73 20 77 61 73 0d | 0a 65 78 61 6d 69 6e 65 |nts was.|.examine|
|00005a10| 64 20 69 6e 20 61 20 70 | 72 6f 73 70 65 63 74 69 |d in a p|rospecti|
|00005a20| 76 65 20 73 74 75 64 79 | 20 6f 66 20 34 30 20 61 |ve study| of 40 a|
|00005a30| 64 6f 6c 65 73 63 65 6e | 74 20 67 69 72 6c 73 2e |dolescen|t girls.|
|00005a40| 20 20 54 68 65 20 44 69 | 61 67 6e 6f 73 74 69 63 | The Di|agnostic|
|00005a50| 20 61 6e 64 0d 0a 53 74 | 61 74 69 73 74 69 63 61 | and..St|atistica|
|00005a60| 6c 20 4d 61 6e 75 61 6c | 20 6f 66 20 4d 65 6e 74 |l Manual| of Ment|
|00005a70| 61 6c 20 44 69 73 6f 72 | 64 65 72 73 2c 20 65 64 |al Disor|ders, ed|
|00005a80| 20 49 49 49 2c 20 77 61 | 73 20 75 73 65 64 20 69 | III, wa|s used i|
|00005a90| 6e 20 74 68 65 20 64 69 | 61 67 6e 6f 73 69 73 20 |n the di|agnosis |
|00005aa0| 6f 66 0d 0a 70 73 79 63 | 68 69 61 74 72 69 63 20 |of..psyc|hiatric |
|00005ab0| 64 69 73 6f 72 64 65 72 | 73 2e 0d 0a 20 20 20 20 |disorder|s... |
|00005ac0| 20 45 69 67 68 74 20 70 | 61 74 69 65 6e 74 73 20 | Eight p|atients |
|00005ad0| 68 61 64 20 61 20 66 69 | 6e 61 6c 20 64 69 61 67 |had a fi|nal diag|
|00005ae0| 6e 6f 73 69 73 20 6f 66 | 20 70 73 79 63 68 69 61 |nosis of| psychia|
|00005af0| 74 72 69 63 20 64 69 73 | 6f 72 64 65 72 20 61 6e |tric dis|order an|
|00005b00| 64 20 33 32 20 68 61 64 | 0d 0a 6f 72 67 61 6e 69 |d 32 had|..organi|
|00005b10| 63 2d 64 79 73 66 75 6e | 63 74 69 6f 6e 61 6c 20 |c-dysfun|ctional |
|00005b20| 64 69 73 65 61 73 65 2e | 20 20 54 68 65 20 43 44 |disease.| The CD|
|00005b30| 49 20 28 46 69 67 20 34 | 2d 31 32 29 20 61 6e 64 |I (Fig 4|-12) and|
|00005b40| 20 74 68 65 20 53 74 61 | 74 65 20 61 6e 64 20 54 | the Sta|te and T|
|00005b50| 72 61 69 74 0d 0a 73 63 | 61 6c 65 73 20 6f 66 20 |rait..sc|ales of |
|00005b60| 74 68 65 20 53 54 41 49 | 20 73 69 67 6e 69 66 69 |the STAI| signifi|
|00005b70| 63 61 6e 74 6c 79 20 64 | 69 66 66 65 72 65 6e 74 |cantly d|ifferent|
|00005b80| 69 61 74 65 64 20 61 64 | 6f 6c 65 73 63 65 6e 74 |iated ad|olescent|
|00005b90| 73 20 77 69 74 68 20 70 | 73 79 63 68 69 61 74 72 |s with p|sychiatr|
|00005ba0| 69 63 0d 0a 64 69 73 6f | 72 64 65 72 73 20 66 72 |ic..diso|rders fr|
|00005bb0| 6f 6d 20 74 68 6f 73 65 | 20 77 69 74 68 20 6f 72 |om those| with or|
|00005bc0| 67 61 6e 69 63 2d 64 79 | 73 66 75 6e 63 74 69 6f |ganic-dy|sfunctio|
|00005bd0| 6e 61 6c 20 64 69 73 65 | 61 73 65 2e 20 20 41 6c |nal dise|ase. Al|
|00005be0| 6d 6f 73 74 20 61 6c 6c | 20 70 61 74 69 65 6e 74 |most all| patient|
|00005bf0| 73 0d 0a 77 69 74 68 20 | 61 20 70 73 79 63 68 69 |s..with |a psychi|
|00005c00| 61 74 72 69 63 20 64 69 | 73 6f 72 64 65 72 20 68 |atric di|sorder h|
|00005c10| 61 64 20 61 62 6e 6f 72 | 6d 61 6c 6c 79 20 68 69 |ad abnor|mally hi|
|00005c20| 67 68 20 73 63 6f 72 65 | 73 2c 20 77 68 65 72 65 |gh score|s, where|
|00005c30| 61 73 20 6c 6f 77 20 73 | 63 6f 72 65 73 0d 0a 75 |as low s|cores..u|
|00005c40| 73 75 61 6c 6c 79 20 65 | 66 66 65 63 74 69 76 65 |sually e|ffective|
|00005c50| 6c 79 20 65 6c 69 6d 69 | 6e 61 74 65 64 20 74 68 |ly elimi|nated th|
|00005c60| 69 73 20 63 6f 6e 64 69 | 74 69 6f 6e 2e 20 20 4e |is condi|tion. N|
|00005c70| 6f 6e 65 20 6f 66 20 74 | 68 65 20 61 64 6f 6c 65 |one of t|he adole|
|00005c80| 73 63 65 6e 74 73 20 77 | 69 74 68 0d 0a 70 73 79 |scents w|ith..psy|
|00005c90| 63 68 69 61 74 72 69 63 | 20 64 69 73 6f 72 64 65 |chiatric| disorde|
|00005ca0| 72 20 68 61 64 20 61 20 | 43 44 49 20 73 63 6f 72 |r had a |CDI scor|
|00005cb0| 65 20 6f 66 20 6d 6f 72 | 65 20 74 68 61 6e 20 31 |e of mor|e than 1|
|00005cc0| 38 2c 20 61 20 53 74 61 | 74 65 20 41 6e 78 69 65 |8, a Sta|te Anxie|
|00005cd0| 74 79 20 53 63 61 6c 65 | 0d 0a 53 63 6f 72 65 20 |ty Scale|..Score |
|00005ce0| 6f 66 20 6d 6f 72 65 20 | 74 68 61 6e 20 35 30 2c |of more |than 50,|
|00005cf0| 20 6f 72 20 61 20 54 72 | 61 69 74 20 41 6e 78 69 | or a Tr|ait Anxi|
|00005d00| 65 74 79 20 53 63 61 6c | 65 20 53 63 6f 72 65 20 |ety Scal|e Score |
|00005d10| 6f 66 20 6d 6f 72 65 20 | 74 68 61 6e 20 35 36 2e |of more |than 56.|
|00005d20| 0d 0a 20 20 20 20 20 54 | 68 65 20 43 44 49 20 61 |.. T|he CDI a|
|00005d30| 6e 64 20 62 6f 74 68 20 | 74 68 65 20 53 74 61 74 |nd both |the Stat|
|00005d40| 65 20 61 6e 64 20 54 72 | 61 69 74 20 41 6e 78 69 |e and Tr|ait Anxi|
|00005d50| 65 74 79 20 53 63 61 6c | 65 73 20 6f 66 20 74 68 |ety Scal|es of th|
|00005d60| 65 20 53 54 41 49 20 6d | 61 79 20 62 65 0d 0a 75 |e STAI m|ay be..u|
|00005d70| 73 65 66 75 6c 20 69 6e | 20 64 69 66 66 65 72 65 |seful in| differe|
|00005d80| 6e 74 69 61 74 69 6e 67 | 20 6f 72 67 61 6e 69 63 |ntiating| organic|
|00005d90| 20 64 79 73 66 75 6e 63 | 74 69 6f 6e 61 6c 20 64 | dysfunc|tional d|
|00005da0| 69 73 65 61 73 65 20 61 | 6e 64 20 61 20 70 73 79 |isease a|nd a psy|
|00005db0| 63 68 69 61 74 72 69 63 | 0d 0a 64 69 73 6f 72 64 |chiatric|..disord|
|00005dc0| 65 72 20 69 6e 20 61 64 | 6f 6c 65 73 63 65 6e 74 |er in ad|olescent|
|00005dd0| 20 67 69 72 6c 73 20 77 | 69 74 68 20 61 62 64 6f | girls w|ith abdo|
|00005de0| 6d 69 6e 61 6c 20 70 61 | 69 6e 2e 0d 0a 0d 0a 50 |minal pa|in.....P|
|00005df0| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|00005e00| 20 20 20 20 54 68 65 20 | 61 75 74 68 6f 72 73 20 | The |authors |
|00005e10| 61 74 74 65 6d 70 74 20 | 74 6f 20 75 73 65 20 61 |attempt |to use a|
|00005e20| 20 73 65 6c 66 2d 61 64 | 6d 69 6e 69 73 74 65 72 | self-ad|minister|
|00005e30| 65 64 20 70 73 79 63 68 | 69 61 74 72 69 63 20 65 |ed psych|iatric e|
|00005e40| 76 61 6c 75 61 74 69 6f | 6e 20 74 6f 0d 0a 64 69 |valuatio|n to..di|
|00005e50| 66 66 65 72 65 6e 74 69 | 61 74 65 20 62 65 74 77 |fferenti|ate betw|
|00005e60| 65 65 6e 20 6f 72 67 61 | 6e 69 63 20 64 69 73 65 |een orga|nic dise|
|00005e70| 61 73 65 20 61 6e 64 20 | 61 20 70 73 79 63 68 69 |ase and |a psychi|
|00005e80| 61 74 72 69 63 20 64 69 | 73 6f 72 64 65 72 20 69 |atric di|sorder i|
|00005e90| 6e 20 61 64 6f 6c 65 73 | 63 65 6e 74 0d 0a 67 69 |n adoles|cent..gi|
|00005ea0| 72 6c 73 20 77 69 74 68 | 20 61 62 64 6f 6d 69 6e |rls with| abdomin|
|00005eb0| 61 6c 20 70 61 69 6e 2e | 20 20 53 75 63 68 20 74 |al pain.| Such t|
|00005ec0| 65 73 74 69 6e 67 20 6d | 61 79 20 70 72 6f 76 65 |esting m|ay prove|
|00005ed0| 20 75 73 65 66 75 6c 20 | 69 6e 20 69 64 65 6e 74 | useful |in ident|
|00005ee0| 69 66 79 69 6e 67 20 61 | 0d 0a 70 73 79 63 68 69 |ifying a|..psychi|
|00005ef0| 61 74 72 69 63 20 64 69 | 73 6f 72 64 65 72 2c 20 |atric di|sorder, |
|00005f00| 62 75 74 20 69 74 20 69 | 73 20 69 6e 63 75 6d 62 |but it i|s incumb|
|00005f10| 65 6e 74 20 75 70 6f 6e | 20 74 68 65 20 65 6d 65 |ent upon| the eme|
|00005f20| 72 67 65 6e 63 79 20 70 | 68 79 73 69 63 69 61 6e |rgency p|hysician|
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