Conclusions: Nine percent of patients presenting to the ED with acute diverticulitis were under 41 years of age. Although the disease does not appear to take a more aggressive course in younger patients, the epidemiology and clinical features in this group are unique and pose special challenges to emergency health care providers. 100 Fecal Occult Blood Testing Does Not Predict Major Gastrointestinal Bleeding in Heparinized Patients Bennett CJ, Moskovitz J, Mayo DD, Witting MD/University of Maryland, Baltimore, MD Study Objectives: It is a generally accepted practice to perform a digital rectal examination and a fecal occult blood test (FOBT) prior to administering intravenous heparin. However, the ability of a positive FOBT result to predict gastrointestinal (GI) bleeding after administration of heparin has not been documented. The goal of this study was to estimate the likelihood of GI bleeding associated with a positive FOBT result in patients receiving intravenous heparin. Methods: This was a retrospective, double-cohort study. Inclusion criteria were the following: age 18 years, admission during the 6-year study period, treatment with continuous heparin infusion, completion of a FOBT in the 48 hours prior to initiation of heparin, and at least two sequential high partial thromboplastin time (PTT) measurements. Patients receiving anticoagulation as outpatients were excluded. The main outcome was major GI bleed, as defined by physical exam evidence of GI bleed plus a drop in hematocrit of 5 points, need for transfusion, or death within 1 hour after detection of the bleed. Data were collected using standard chart review methodology. We categorized patients with bleeding into those with major GI bleed, minor GI bleed, and major bleed of questionable source. Results: A total of 624 patients were included in the analysis, of which 61 had positive FOBT results and 563 had negative results. Eleven patients had GI bleeds: 3 major GI bleeds, 1 minor GI bleed, and 7 major bleeds of questionable source. One of the 61 (1.6%) patients with a positive FOBT result had a major GI bleed, compared with 2 of the 563 (0.4%) with a negative FOBT result, for a risk difference of 1.2% [(-)2% - (+)5%, 95% CI, p=0.3]. If major bleeds of questionable source were categorized as a major GI bleed, then 2 of the 61 (3.3%) patients with positive FOBT results had a GI bleed, compared with 8 of the 563 (1.4%) patients with negative FOBT results, for a risk difference of 1.9% [(-)3% - (+)6%, 95% CI, p=0.3]. Conclusion: We found no significant difference in the incidence of major GI bleeding between patients with positive FOBT results and those with negative FOBT results prior to heparinization. This observation was consistent whether or not we included major bleeds of questionable source in the major GI bleed category. We estimate the risk difference of major GI bleeding associated with a positive FOBT result at 1.2% in patients receiving heparin. 101 The Utility of Routine Reticulocyte Count in Uncomplicated Vaso-Occlusive Crisis Due to Sickle Cell Disease Garman A, Lyon M, Kutlar A/Medical College of Georgia, Augusta, GA Study Objectives: A common component of emergency department (ED) care of sickle cell (SC) patients presenting with vaso-occlusive crisis is measurement of the reticulocyte count. The reticulocyte count is a measure of immature red blood cells (RBC) and should be elevated with acute RBC destruction that occurs during a vaso- occlusive crisis (VOC). When the bone marrow fails to respond to the acute anemia due to RBC destruction, an aplastic crisis may be present. However, aplastic crises are quite rare. Our objective is to evaluate the utility of routine reticulocyte count measurement in uncomplicated VOC due to SC disease. Methods: This was a retrospective chart review of all patients with SC disease and pain suggestive of VOC presenting to an academic ED with an average annual census of 78,000 patients. Inclusion criteria included any SC patient older than 18 years presenting to the ED with pain and had a reticulocyte measurement as part of their ED evaluation. Exclusion criteria included fever (38.5 oC), hypotension (BP 90/ 60), hypoxia (oxygen saturation 100) was not regarded as an exclusion criterion. Patients who did not receive routine care at the institution’s SC clinic were excluded. Reticulocyte count along with presenting hemoglobin and baseline hemoglobin were the variables used to determine the presence of aplastic crisis on presentation to the ED. Charts of SC patients admitted to the hospital were reviewed for development of aplastic crisis. All discharged patients were evaluated for a return visit within 10 days to the ED or the SC clinic in which symptomatic anemia or aplastic crisis was diagnosed. Data was recorded on a standardized data sheet and 20% of the charts were reviewed by both reviewers to assure consistent data collection. Results: Over an 8-year period, 346 SC patients presented to the ED. Limiting the patient population to those presenting with pain who were patients of the institution’s SC clinic yielded 192 patients with 1885 ED visits. This correlates to an average of 9.8 ED visits over the study period per patient. There were 7 (0.4 %) cases of aplastic crisis diagnosed in the ED using the initial reticulocyte count. However, all of these patients met at least one of the study’s exclusion criterion. Two additional patients were diagnosed with aplastic crisis after during their hospital admission. Each had an elevated reticulocyte count during the ED evaluation. One presented with a hemoglobin of 8.3 mg/dl (baseline 14 mg/dl) and a reticulocyte count of 8.3%. The other presented with a hemoglobin of 3.9 mg/dl (baseline 8.3 mg/dl) and a reticulocyte count of 4.7%. Conclusion: In patients presenting to the ED with otherwise uncomplicated sickle cell VOC, routine utilization of the reticulocyte count to diagnose aplastic crisis is of little utility. 102 Does Correlation of Faculty Assessment of Emergency Medicine Residents’ Medical Knowledge Competency With Performance on the In-Training Examination Improve With Advancement Through the Program? Barlas D, Ryan JG/New York Hospital Queens, Flushing, NY Study Objectives: Faculty assessment of emergency medicine (EM) residents on the medical knowledge (MK) core competency may or may not be predictive of performance on the annual in-training examination. We sought to determine if a greater degree of faculty exposure and experience with EM residents, as determined by PGY level, improved the correlation of the faculty’s assessment of MK on quarterly summative evaluations with the score received on the EM in-training examination taken during the same time period. Methods: Data was obtained from the records of residents from an urban, established PGY 1–3 EM residency program in this observational, cohort study. Fixed, 9-point (1= Level of a medical student, 9=Level of an attending) MK core competency summative assessments by 25 board prepared/certified EM faculty during the 3rd academic quarter (Jan–Mar) were compared with the score received on the EM in-training exam for individual residents grouped by PGY year. Degree of correlation was determined using Pearson Correlation Coefficients. Results: Data from 73 quarters for 37 EM residents over 4 years was analyzed. Correlation between faculty assessment of medical knowledge and performance on the in-training exam was poor across all PGY years, but improved with each year. For PGY1 residents r=-0.08, for PGY2, r=0.03, and for PGY3 residents, r=0.43. Conclusions: Assessment of medical knowledge by EM faculty does not correlate well with residents’ performance on the in-training exam given during the same evaluation period, but improves somewhat as residents advance through their training. Alternative MK evaluation tools that better correlate with exam performance should be sought, especially for residents early in their training. 103 Is There a Doctor in the House? The Experience of Medical Students as Responders to Out-of-Hospital Emergency Medical Situations Greene T, Cho E, Shearer P/Mount Sinai School of Medicine, New York, NY Study Objectives: Outside of a hospital anyone can be called upon to deliver emergency care, but medical students exist on a spectrum between a lay person and a credentialed provider. Most medical schools teach only BLS and few have a course at the beginning of the first year to teach an approach to basic medical situations. There is no past research on this topic so how often medical students are called upon to provide such care remains unclear. We hypothesized that medical students encounter a wide variety of medical and trauma situations outside of the hospital during their medical school years. Methods: An anonymous Web-based survey was distributed to all medical students of the Mount Sinai School of Medicine, an urban institution, to assess their experience with medical situations outside of the hospital setting during their years as medical students. Multiple choice questions asked respondents to describe the type of event encountered (eg, seizure, trauma, choking) and how they responded (eg, called 911, administered CPR). When respondents entered free text the information was kept confidential and later stripped of identifiers. Research Forum Abstracts Volume , .  : September  Annals of Emergency Medicine S33