US during the initial management or follow-up of pa- tients with soft tissue injuries with potential foreign objects. Özlem Erol, MD Levent Özçakar, MD Alp Çetin, MD Department of Physical Medicine and Rehabilitation Hacettepe University Medical School Ankara, Turkey doi:10.1016/j.jemermed.2008.10.008 REFERENCES 1. Ginsburg MJ, Ellis GL, Flom LL. Detection of soft-tissue foreign bodies by plain radiography, xerography, computed tomography, ultrasonography. Ann Emerg Med 1990;19:701–3. 2. Orlinsky M, Knittel P, Feit T, Chan L, Mandavia D. The compar- ative accuracy of radiolucent foreign body detection using ultra- sonography. Am J Emerg Med 2000;18:401–3. 3. Friedman DI, Forti RJ, Wall SP, Crain EF. The utility of bedside ultrasound and patient perception in detecting soft tissue foreign bodies in children. Pediatr Emerg Care 2005;21:487–92. e PAUCITY OF MEDICAL INFORMATION HELD BY PATIENTS IN THEIR HOMES FOR CONSULTATION BY MEDICAL EMERGENCY CREWS e To the Editor: Good clinical recordkeeping (patient history, treatments administered, test results, lifestyle details) is a key com- ponent of overall medical patient management. The question arises, however, whether doctors in charge al- ways have access to clinical information on their pa- tients, when and as required. We assessed the availability of health documents in patients’ homes during interven- tions by emergency services, and whether the availability and content of these documents had an impact on patient management. This was a 3-month prospective observational study (November 2003–January 2004) carried out by mobile intensive care units, staffed by an emergency physician, a nurse anesthetist, and an emergency medical techni- cian. The physician of the emergency crews called to patients’ homes to complete a questionnaire on the med- ical documents held by patients aged 18 years or over who had at some stage spent time in the hospital. The physician also indicated whether, in his opinion, missing documents might have influenced diagnosis and triage. A total of 139 questionnaires were analyzed (88% of pa- tients met inclusion criteria). The out-of-hospital diag- noses were as follows: cardiovascular (41%), respiratory (19%), neurological (8%), gastrointestinal (8%), intoxi- cations (5%), and other (19%). Mean patient age was 68  16 years, and 45% of patients were women. Eighty- three (60%) patients had been previously admitted to the general ward, 21 (15%) to the intensive care unit, 6 (4%) to the intensive unit, and information was not specified in 39 (28%). Overall, 23% (95% confidence interval [CI] 16.0 –29.9) of patients possessed a hospital report at home. The other types of documents held by the patients at home were a patient-held record (“carnet de santé”) (4%), an electrocardiogram (ECG) (37%), and a prescrip- tion (75%). The patient-held record (carnet de santé) was a kind of notebook belonging to the patient, which had been done to report all the patient’s medical follow-up (history, hospitalization, treatment, main laboratory tests, X-ray study results). Fifty-five percent (95% CI 32.0 – 78.0) of the patients who had been in an intensive care cardiology unit had an ECG tracing. According to the emergency crew physician, the availability of these doc- uments had an impact on diagnosis in 49% of cases, treatment in 29%, and triage in 40%. Missing documen- tation could have adversely affected decisions relating to 28% of patients. The most common example concerns a patient with suspicion of coronary disease who had been hospitalized in a cardiologic unit before. The emergency team was called to the patient’s home due to chest pain. It was an atypical pain but the ECG was abnormal, without elevation of ST segment. The physician could not make an appropriate diagnosis and orientation of the patient without knowing the conclusion of the previous hospitalization or without access to a previous ECG. In one case, the patient could stay at home, in the other case he had to be hospitalized. In conclusion, many patients with known disease do not have useful medical files at home. This lack of information can have an adverse effect on their manage- ment in emergency situations. Providing patients with a minimum number of relevant documents on their dis- charge from the hospital could lead to improvements in care. The main limitation of this study was the weak number of included patients. However, it was a first observational assessment, which needs to be continued with a more complete study as a case-control study. Michel Galinski, MD Gael Hubert, MD Ghislain Dhissi, MD Michel Desmaizières, MD Gilles Lenoir, MD Frederic Adnet, MD, PHD Avicenne Hospital Bobigny, France doi:10.1016/j.jemermed.2009.05.005 The Journal of Emergency Medicine 503