Impact of the COVID-19 pandemic on pediatric emergency department utilization for head injuries
Head injuries are a leading cause of death and disability in children, accounting for numerous emergency department (ED) visits. It is unclear how the COVID-19 pandemic has influenced healthcare utilization for pediatric head injuries. We hypothesize that the proportion of ED visits attributable to head injury and severity will increase during the COVID-19 era. Retrospective study using electronic health record data to compare proportion and severity of head injury for children 0-21 years of age from three urban mid-Atlantic EDs in the pre-COVID-19 era (March-June 2019) and COVID-19 era (March-June 2020). Controlling for confounders, logistic regression analyses assessed ORs of head injury outcomes. The χ2 analyses identified differences in patient characteristics. The proportion of head injury visits within the ED population significantly increased during the COVID-19 era (adjusted OR (aOR)=1.2, 95% CI 1.1 to 1.4). Proportion of visits requiring hospitalization for head injury increased by more than twofold in the COVID-19 era (aOR=2.3, 95% CI 1.3 to 4.3). Use of head CT imaging did not significantly change in the COVID-19 era (aOR=1.0, 95% CI 0.7 to 1.6). The proportion of ED visits and hospitalizations for head injury increased during the COVID-19 era. This could be due to changes in the level of supervision and risk exposures in the home that occurred during the pandemic, as well as differences in postinjury care, level of awareness regarding injury severity, and threshold for seeking care, all of which may have influenced pediatric healthcare utilization for head injuries.
Sanika Satoskar
Oluwakemi B Badaki
Andrea C Gielen
Eileen M McDonald
Leticia M Ryan
J Investig Med
. 2022 Aug;70(6):1416-1422. doi: 10.1136/jim-2021-002292. Epub 2022 May 11.
2022
English
Quality Indicators for Geriatric Emergency Care
acute pain; cognitive; department patients; elderly emergency; emergency medical services; Emergency Medicine; emergency service; geriatrics; Health care; health services for the aged; Health care; hip fracture patients; hospital; impairment; nursing-homes; of health care; of-care; older emergency; quality; quality indicators; transitional care
Emergency departments (EDs), similar to other health care environments, are concerned with improving the quality of patient care. Older patients comprise a large, growing, and particularly vulnerable subset of ED users. The project objective was to develop ED-specific quality indicators for older patients to help practitioners identify quality gaps and focus quality improvement efforts. The Society for Academic Emergency Medicine (SAEM) Geriatric Task Force, including members representing the American College of Emergency Physicians (ACEP), selected three conditions where there are quality gaps in the care of older patients: cognitive assessment, pain management, and transitional care in both directions between nursing homes and EDs. For each condition, a content expert created potential quality indicators based on a systematic review of the literature, supplemented with expert opinion when necessary. The original candidate quality indicators were modified in response to evaluation by four groups: the Task Force, the SAEM Geriatric Interest Group, and audiences at the 2007 SAEM Annual Meeting and the 2008 American Geriatrics Society Annual Meeting. The authors offer 6 quality indicators for cognitive assessment, 6 for pain management, and 11 for transitions between nursing homes and EDs. These quality indicators will help researchers and clinicians target quality improvement efforts. The next steps will be to test the feasibility of capturing the quality indicators in existing medical records and to measure the extent to which each quality indicator is successfully met in current emergency practice.
Terrell K M; Hustey F M; Hwang U; Gerson L W; Wenger N S; Miller D K; Force Saem Geriatric Task
Academic Emergency Medicine
2009
2009-05
Journal Article
<a href="http://doi.org/10.1111/j.1553-2712.2009.00382.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2009.00382.x</a>
Iatrogenic emergency medicine procedure complications and associated trouble-shooting strategies.
Humans; Emergency medicine; Training; Emergency Medicine/education; Emergency Service; Error management; Iatrogenic injury; Procedure complication; Quality improvement; Hospital/*organization & administration/standards; Iatrogenic Disease/*epidemiology/*prevention & control; Quality Improvement/*organization & administration/standards; Safety Management/*organization & administration/standards
PURPOSE: The purpose of this paper is to provide a consolidated reference for the acute management of selected iatrogenic procedural injuries occurring in the emergency department (ED). DESIGN/METHODOLOGY/APPROACH: A literature search was performed utilizing PubMed, Scopus, Web of Science and Google Scholar for studies through March of 2017 investigating search terms "iatrogenic procedure complications," "error management" and "procedure complications," in addition to the search terms reflecting case reports involving the eight below listed procedure complications. FINDINGS: This may be particularly helpful to academic faculty who supervise physicians in training who present a higher risk to cause such injuries. ORIGINALITY/VALUE: Emergent procedures performed in the ED present a higher risk for iatrogenic injury than in more controlled settings. Many physicians are taught error-avoidance rather than how to handle errors when learning procedures. There is currently very limited literature on the error management of iatrogenic procedure complications in the ED.
Ahmed Rami A; Hughes Patrick G; Wong Ambrose H; Gray Kaley M; Ballas Derek A; Khobrani Ahmad; Selley Robert D; McQuown Colleen
International journal of health care quality assurance
2018
2018-10
<a href="http://doi.org/10.1108/IJHCQA-08-2017-0157" target="_blank" rel="noreferrer noopener">10.1108/IJHCQA-08-2017-0157</a>
Recreational injuries among older Americans, 2001.
Female; Male; Aged; United States; Confidence Intervals; Human; Descriptive Statistics; Emergency Service; Disease Surveillance; Gerontologic Care; 80 and Over; Cycling – In Old Age; Exercise – In Old Age; Injury Pattern – Evaluation – In Old Age; Recreation – In Old Age – United States; Sex Factors – In Old Age; Sports – In Old Age; Wounds and Injuries – Epidemiology – In Old Age
OBJECTIVE: To describe the epidemiology of non-fatal recreational injuries among older adults treated in United States emergency departments including national estimates of the number of injuries, types of recreational activities, and diagnoses. METHODS: Injury data were provided by the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), a nationally representative subsample of 66 out of 100 NEISS hospitals. Potential cases were identified using the NEISS-AIP definition of a sport and recreation injury. The authors then reviewed the two line narrative to identify injuries related to participation in a sport or recreational activity among men and women more than 64 years old. RESULTS: In 2001, an estimated 62 164 (95% confidence interval 35 570 to 88 758) persons \textgreater/=65 years old were treated in emergency departments for injuries sustained while participating in sport or recreational activities. The overall injury rate was 177.3/100 000 population with higher rates for men (242.5/100 000) than for women (151.3/100 000). Exercising caused 30% of injuries among women and bicycling caused 17% of injuries among men. Twenty seven percent of all treated injuries were fractures and women (34%) were more likely than men (21%) to suffer fractures. CONCLUSIONS: Recreational activities were a frequent cause of injuries among older adults. Fractures were common. Many of these injuries are potentially preventable. As more persons engage in recreational activities, applying known injury prevention strategies will help to reduce the incidence of these injuries.
Gerson L W; Stevens J A
Injury Prevention (1353-8047)
2004
2004-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1136/ip.2004.005256" target="_blank" rel="noreferrer noopener">10.1136/ip.2004.005256</a>
A research agenda for geriatric emergency medicine.
Aged; Physicians; Health Services Research; Emergency Medicine; Geriatric Assessment; Emergency Service; Research Priorities; Health Resource Utilization; Prehospital Care; Trauma – Therapy – In Old Age; Emergency Care – In Old Age; Emergency – Education
OBJECTIVES: The Research Agenda Setting Process (RASP), part of the American Geriatric Society's (AGS's) project 'Increasing Geriatric Expertise in Surgical and Related Medical Specialties,' was designed to define a research agenda for the geriatrics aspects of participating specialties. This paper presents a summary of the research agenda for emergency medicine. METHODS: The RASP was developed by the AGS in conjunction with experts from the participating specialty organizations. A 'content expert' (CE) for each specialty developed a Medline search strategy in conjunction with RAND Health librarians. The CE reviewed the search to identify papers that were germane to research in the emergency care of older patients. The CE and a senior writing group member drafted a paper that synthesized the current literature and suggested areas for further research. A panel consisting of AGS members and emergency physicians with geriatrics expertise reviewed this paper. The research agenda was further refined at a two-day retreat. Two senior geriatricians reviewed the resulting paper. RESULTS: The Medline search for emergency medicine resulted in a list of 3,348 articles; 299 articles were pertinent and reviewed. The search for trauma resulted in a list of 1,838 articles; 133 were reviewed. Research agenda items were defined for multiple topics within geriatric emergency medicine and trauma. CONCLUSION: A research agenda for geriatric emergency medicine has been developed, using a combination of review of current literature and expert opinion.
Wilber S T; Gerson L W
Academic Emergency Medicine
2003
2003-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2003.tb01999.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2003.tb01999.x</a>
Case finding for cognitive impairment in elderly emergency department patients.
Female; Male; Aged; Odds Ratio; Geriatric Assessment; Academic Medical Centers; Confidence Intervals; Psychological Tests; Human; Cross Sectional Studies; Funding Source; Logistic Regression; Emergency Service; Psychophysiology; Gerontologic Care; 80 and Over; Cognition Disorders – Diagnosis – In Old Age; Cognition Disorders – Epidemiology; Frail Elderly – Psychosocial Factors; Memory Disorders – Diagnosis
Gerson L W; Counsell S R; Fontanarosa P B; Smucker W D
Annals of emergency medicine
1994
1994-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0196-0644(94)70319-1" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(94)70319-1</a>
Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial.
Ohio; Aged; Sensitivity and Specificity; Prospective Studies; Pain Measurement; Patient Satisfaction; Outpatients; Hospitals; Self Report; Confidence Intervals; Human; Descriptive Statistics; Funding Source; Scales; Data Analysis Software; Surveys; Coefficient Alpha; Summated Rating Scaling; Emergency Service; Community; Treatment Outcomes; Emergency Patients; Beds and Mattresses; Interior Design and Furnishings; Patient Positioning; Single-Blind Studies; 80 and Over; Pain – Prevention and Control – In Old Age
OBJECTIVES: Pain related to the gurney is a frequent complaint of older emergency department (ED) patients. The authors hypothesized that these patients may have less pain and higher satisfaction if allowed to sit in a reclining hospital chair. METHODS: A single-blind, randomized controlled trial was performed. Patients 65 years old or older who were able to sit upright, transfer, and engage in normal conversation were eligible. Severely ill or cognitively impaired patients were excluded. Patients were randomized to either remain on the gurney or transfer to the chair after initial evaluation. Patients reported pain at arrival (t0), at one hour (t1), and at two hours (t2) using a 0-10 pain scale, and satisfaction at study completion on a 0-10 scale. The primary outcome was a decrease in pain between t0 and t1 or no pain at both t0 and t1. This outcome was analyzed using a 95% confidence interval for the difference between proportions; exclusion of zero was considered significant. RESULTS: Sixty-six patients in each group were enrolled. There was no difference in demographics between groups, but the chair patients were more likely to have pain at t0 than the gurney patients. More chair patients than gurney patients had a successful primary outcome (97% vs. 76%, 21% difference, 95% CI=10% to 32%). The mean satisfaction score was higher in the chair group than in the gurney group (8.1 vs. 6.0, 2.1 difference, 95% CI=1.4% to 2.8%). CONCLUSIONS: The simple modification of allowing older ED patients to sit in reclining chairs resulted in less pain and higher satisfaction.
Wilber S T; Burger B; Gerson L W; Blanda M
Academic Emergency Medicine
2005
2005-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2005.tb00846.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2005.tb00846.x</a>
Home modification to prevent falls by older ED patients.
Female; Male; Aged; Prospective Studies; Confidence Intervals; Human; Chi Square Test; Funding Source; Data Analysis Software; Logistic Regression; T-Tests; Emergency Service; Accidents; Consumer Health Information; Home Environment; Home Safety; Pamphlets; 80 and Over; Accidental Falls – Prevention and Control; Home – Prevention and Control
This trial was conducted at 11 EDs to test the effectiveness of distributing fall prevention information to patients 65 years or older. Intervention patients were given 2 brochures and received a reminder call 2 weeks later. All patients were called at 1 month and asked if they made home safety modifications. Three hundred ninety-seven patients were enrolled (118 control, 279 intervention). Seventy-six percent had complete follow up interviews. Nine percent of control and 8% of intervention patients reported a home modification (95% confidence interval on difference, -8.1% to 5.5%). Patients who fell in the prior year had a 2.0 increased odds (95% confidence interval, 0.8-4.6) of making a home modification. The similar home modification rates in the 2 study groups suggest that even minimum discussion (eg, the informed consent procedure) may increase patients' fall prevention activities. The stronger association in patients who fell suggests that a targeted program may have added benefit. Copyright © 2005 by Elsevier Science (USA).
Gerson L W; Camargo CA Jr; Wilber S T
American Journal of Emergency Medicine
2005
2005-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajem.2005.02.035" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2005.02.035</a>
Does functional decline prompt emergency department visits and admission in older patients?
Female; Male; Ohio; Aged; Prospective Studies; Hospitals; Activities of Daily Living; Confidence Intervals; Human; Convenience Sample; Questionnaires; Cross Sectional Studies; Descriptive Statistics; Funding Source; Data Analysis Software; Surveys; Coefficient Alpha; Clinical Assessment Tools; Emergency Service; Community; Geriatric Functional Assessment; 80 and Over; Emergency Care – In Old Age; Functional Status – In Old Age; Health Resource Utilization – In Old Age; Patient Admission – In Old Age
BACKGROUND: Older patients may visit the emergency department (ED) when their illness affects their function. OBJECTIVES: To quantify the function of older ED patients, to assess whether functional decline (FD) had occurred, and to determine whether function contributes to the ED visit and hospital admission. METHODS: The authors performed an institutional review board-approved, prospective, cross-sectional study in a community teaching hospital ED. Eligible patients were older than 74 years of age, with an illness at least 48 hours old. Patients from a nursing facility and those without a proxy who were unable or unwilling to complete the questions were excluded. The Older Americans Resources and Services Questionnaire, which tests seven instrumental activities of daily living (IADL) and seven physical ADLs (PADL), was used. Data are presented as means or proportions with 95% confidence intervals (95% CI), and comparisons as 95% CI for the difference between proportions. RESULTS: The authors enrolled 90 patients (mean age, 81.6 yr [SD +/- 4.9], 40% male). Dependence in at least one IADL was reported by 68% (95% CI = 57% to 77%), and in at least one PADL by 61% (95% CI = 50% to 71%). Functional decline was reported by 74% (95% CI = 64% to 83%). Two thirds of those with IADL decline and three quarters of those with PADL decline said that this contributed to their ED visit. Seventy-seven percent with, and 63% without, IADL decline were admitted (14% difference, 95% CI = -6.1% to 33%). Seventy-nine percent with and 61% without PADL decline were admitted (18% difference, 95% CI = -1.4% to 38%). CONCLUSIONS: Functional decline is common in older ED patients and contributes to ED visits in older patients; its role in admission is unclear.
Wilber S T; Blanda M; Gerson L W
Academic Emergency Medicine
2006
2006-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2006.01.006" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2006.01.006</a>
The Six-item Screener to Detect Cognitive Impairment in Older Emergency Department Patients.
Female; Male; Aged; Sensitivity and Specificity; Prospective Studies; ROC Curve; Geriatric Assessment; Academic Medical Centers; Confidence Intervals; Psychological Tests; Human; Cross Sectional Studies; Emergency Service; Cognition Disorders – Diagnosis; Emergency Medicine – Equipment and Supplies
BACKGROUND: Cognitive impairment due to delirium or dementia is common in older emergency department (ED) patients. To prevent errors, emergency physicians (EPs) should use brief, sensitive tests to evaluate older patient's mental status. Prior studies have shown that the Six-Item Screener (SIS) meets these criteria. OBJECTIVES: The goal was to verify the performance of the SIS in a large, multicenter sample of older ED patients. METHODS: A prospective, cross-sectional study was conducted in three urban academic medical center EDs. English-speaking ED patients \textgreater or = 65 years old were enrolled. Patients who received medications that could affect cognition, were too ill, were unable to cooperate, were previously enrolled, or refused to participate were excluded. Patients were administered either the SIS or the Mini-Mental State Examination (MMSE), followed by the other test 30 minutes later. An MMSE of 23 or less was the criterion standard for cognitive impairment; the SIS cutoff was 4 or less for cognitive impairment. Standard operator characteristics of diagnostic tests were calculated with 95% confidence intervals (CIs), and a receiver operating characteristic curve was plotted. RESULTS: The authors enrolled 352 subjects; 111 were cognitively impaired by MMSE (32%, 95% CI = 27% to 37%). The SIS was 63% sensitive (95% CI = 53% to 72%) and 81% specific (95% CI = 75% to 85%). The area under the receiver operating characteristic curve was 0.77 (95% CI = 0.72 to 0.83). CONCLUSIONS: The sensitivity of the SIS was lower than in prior studies. The reasons for this lower sensitivity are unclear. Further study is needed to clarify the ideal brief mental status test for ED use.
Wilber S T; Carpenter CR; Hustey FM
Academic Emergency Medicine
2008
2008-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2008.00158.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2008.00158.x</a>
Research Priorities for High-quality Geriatric Emergency Care: Medication Management, Screening, and Prevention and Functional Assessment.
Aged; Emergency Medicine; Middle Age; Emergency Service; Prescribing Patterns; Geriatrics; Patient Care – Methods; Patient Assessment – Methods; Disease – Prevention and Control; Drug Evaluation – Methods; Health Screening – Methods; Lorazepam – Administration and Dosage; Warfarin – Adverse Effects
Carpenter Christopher R; Heard Kennon; Wilber Scott T; Ginde Adit A; Stiffler Kirk; Gerson Lowell W; Wenger Neal S; Miller Douglas K
Academic Emergency Medicine
2011
2011-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2011.01092.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2011.01092.x</a>
Posted Emergency Department Wait Times Are Not Always Accurate.
Analysis of Variance; Emergency Medicine; Human; Cross Sectional Studies; Descriptive Statistics; Data Analysis; Retrospective Design; Emergency Service; Waiting Rooms
Jouriles Nicholas; Simon Erin L; Griffin Peter; Williams Carolyn Jo; Haller Nairmeen Awad; Ufberg Jacob W
Academic Emergency Medicine
2013
2013-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/acem.12107" target="_blank" rel="noreferrer noopener">10.1111/acem.12107</a>
Interactive Relationship Between Parent and Child Event Appraisals and Child PTSD Symptoms After an Injury.
Female; Male; Child; Glasgow Coma Scale; Self Report; Parents; Human; Questionnaires; Cross Sectional Studies; Descriptive Statistics; Scales; One-Way Analysis of Variance; Regression; T-Tests; Emergency Service; Stress Disorders; DSM; Severity of Injury; Post-Traumatic – Symptoms – In Infancy and Childhood; Trauma – In Infancy and Childhood
Morris Adam; Lee Timothy; Delahanty Douglas
Psychological Trauma: Theory, Research, Practice & Policy
2013
2013-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1037/a0029894" target="_blank" rel="noreferrer noopener">10.1037/a0029894</a>
Characteristics of Prehospital ST-segment Elevation Myocardial Infarctions.
Female; Male; Prospective Studies; Emergency Medical Services; Demography; Data Collection; Patient Care; Academic Medical Centers; Confidence Intervals; Human; Data Analysis; Middle Age; Outcomes (Health Care); Emergency Service; Databases; Angioplasty; Race Factors; Prehospital Care; Percutaneous Coronary; Transluminal; Myocardial Infarction – Diagnosis; Myocardial Infarction – Therapy; Cardiac Patients – Evaluation; Chest Pain – Diagnosis; Myocardial Infarction – Symptoms; ST Segment – Evaluation
Introduction. Despite attention directed at treatment times of ST-segment elevation myocardial infarctions (STEMIs), little is known about the types of STEMIs presenting to the emergency department (ED). Objective. The purpose of this study was to determine the relative frequencies and characteristics of emergency medical services (EMS) STEMIs compared with those in patients who present to the ED by walk-in. This information may be applied in EMS training, system planning, and public education. Methods. This was a query of a prospectively gathered database of all STEMIs in patients presenting to Summa Akron City Hospital ED in 2009 and 2010. We collected demographic information, chief complaint, mode and time of arrival, and STEMI pattern (anterior, lateral, inferior, or posterior). We excluded transfers and in-hospital STEMIs. We calculated means, percentages, significance, and 95% confidence intervals (CIs) ± 10%. Results. We analyzed data from 308 patients. Most patients (241/308, 78%, CI 73%-83%) arrived by EMS, were male (203/308, 66%, CI 60%-71%), and were white (286/308, 93%, CI 89%-96%). Patients arriving by EMS were older (average 63 years, range 35-95) than walk-in patients (average 57 years, range 24-92). Two percent (5/241, 2%, CI 1%-5%) of EMS STEMI patients were under 40 years of age, compared with 10% (7/67, 10%, CI 4%-20%) of walk-in patients (p = 0.0017). The most common chief complaint was chest pain (278/308, 90%, CI 86%-93%). Inferior STEMIs were most common (167/308, 54%, CI 49%-60%), followed by anterior (127/308, 41%, CI 48%-60%), lateral (8/308, 3%, CI 1%-5%), and posterior (6/308, 2%, CI 1%-4%). A day-of-the-week analysis showed that no specific day was most common for STEMI presentation. Forty percent (122/308, 40%, CI 34%-45%) of patients presented during open catheterization laboratory hours (Monday through Friday, 0730-1700 hours). There was no significant statistical difference between EMS and walk-in patients with regard to STEMI pattern or patient demographics. Conclusions. In this study, 95% (294/308) of all STEMIs were inferior or anterior infarctions, and these types of presentations should be stressed in EMS education. Most STEMI patients at this institution arrived by ambulance and during off-hours. Younger patients were more likely to walk in. We need further study, but we may have identified a target population for future interventions. Key words: emergency medical services; allied health personnel; electrocardiography; myocardial infarction; heart catheterization; STEMI
Celik Daniel H; Mencl Francis R; DeAngelis Anthony; Wilde Joshua; Steer Sheila H; Wilber Scott T; Frey Jennifer A; Bhalla Mary Colleen
Prehospital Emergency Care
2013
2013-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3109/10903127.2013.785619" target="_blank" rel="noreferrer noopener">10.3109/10903127.2013.785619</a>
The Growing Threat of Pyelonephritis Caused by Antibiotic-resistant Escherichia coli.
Adult; Female; Male; Pregnancy; Urinalysis; Community-Acquired Infections; Cell Culture Techniques; Emergency Service; Drug Resistance; Microbial; Microbial Culture and Sensitivity Tests; Antiinfective Agents; Escherichia Coli; Escherichia Coli Infections; Biological Phenomena; Immunocompromised Host; Fluoroquinolone; Antibiotics – Administration and Dosage; Escherichia Coli Infections – Diagnosis; Pyelonephritis – Complications; Pyelonephritis – Diagnosis; Pyelonephritis – Etiology; Pyelonephritis – Risk Factors
The article focuses on a bacteria Escherichia coli which lead to occurrence of pyelonephritis with increasing resistance of Escherichia coli for empiric antibiotics. Topics discussed include need for making choices of empiric antibiotic by clinicians which will be based on patterns of local resistance, association of extended spectrum beta lactamase (ESBL) with healthcare acquisition and mentions drawback of ertapenem like difficulty in oral conversion.
Watkins Richard R
Infectious Disease Alert
2016
2016-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Dual Antibiotic Therapy Is Not Routinely Necessary for Uncomplicated Cellulitis.
Emergency Service; Emergency Patients; Bacterial Toxins; Cellulitis; Cephalexin; Methicillin-Resistant Staphylococcus Aureus; Sulfamethoxazole
A randomized, multicenter, placebo-controlled clinical trial that enrolled patients presenting to emergency departments with uncomplicated cellulitis found the addition of trimethoprim-sulfamethoxazole to cephalexin did not lead to better outcomes.
Watkins Richard R
Hospital Medicine Alert
2017
2017-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Trauma attending in the resuscitation room: does it affect outcome?
Adult; Humans; Time Factors; Retrospective Studies; Workforce; Survival Rate; Quality of Health Care; *Outcome and Process Assessment (Health Care); *Resuscitation; *Trauma Centers; Personnel Staffing and Scheduling; Wounds and Injuries/mortality/therapy; Emergency Service; Hospital; Hospital/*statistics & numerical data; Medical Staff
Although there are no Class I data supporting the regionalization of trauma care the consensus is that trauma centers decrease morbidity and mortality. However, the controversy continues over whether trauma surgeons should be in-house or take call from home. The current literature does not answer the question because in all of the recent studies the attendings who took call from home were in the resuscitation room guiding the care. We believe the correct question is: Does the presence of the trauma attending in the resuscitation room make a difference? At a university-affiliated Level II trauma center data from the trauma registry, resuscitation room flowsheet, and dictated admission notes were reviewed on all patients over a 6-month period. Data points were: attending present in the resuscitation room, standard demographics, resuscitation room time, time to operating room (OR), time to CT scan, length of stay, complications, and mortality. A total of 943 patients were studied with 216 (23%) having the attending present in the resuscitation room and 727 (77%) without the attending present. The groups were similar in terms of age, sex, Injury Severity Score, percentage Injury Severity Score greater than 15 (16-17.1%), and mechanism of injury (24-29% penetrating). Of all the data points studied only time to the OR had a statistically significance difference (P \textless 0.05) with it taking 43.8 minutes (+/-20.1) when the attending was present and 109.4 minutes (+/-107) when the attending was absent. There were also no missed injuries, delays to the OR, or inappropriate workups when the attendings were present. Only the time to the OR reached statistical significance. The time to the OR is indicative of the decision-making process in the resuscitation room, and it is in this area that the attendings' presence is the most useful. Also, we believe that it is important that there were no missed injuries, delays to the OR, or inappropriate workups when the attendings were present in the resuscitation room. This again speaks to the decision-making process. We believe that these data support the need for the attending to be present in the resuscitation room to facilitate accurate and timely decisions regardless of whether they take the call from home or in-house.
Porter J M; Ursic C
The American surgeon
2001
2001-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Toxic streptococcal syndrome.
Adult; Female; Humans; Pharyngitis/*complications; Streptococcus pyogenes; Sinusitis/*complications; Streptococcal Infections/*complications; Diagnosis; Emergency Service; Hospital; Differential; Shock; Septic/blood/*diagnosis/etiology
The streptococcal toxic shocklike syndrome is a recently recognized, multisystem disorder that shares many of the features of staphylococcal toxic shock syndrome, but is caused by toxins elaborated by group A beta-hemolytic Streptococcus. We describe a patient who fulfilled the major criteria for the clinical diagnosis of toxic shock syndrome (fever, hypotension, multisystem dysfunction, and diffuse macular erythroderma followed by desquamation) and who demonstrated serologic evidence suggesting streptococcal infection. In patients presenting with clinical findings consistent with a toxic shocklike syndrome, the emergency physician should consider streptococcal infection as a potential etiology.
Gallo U E; Fontanarosa P B
Annals of emergency medicine
1990
1990-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0196-0644(05)82299-1" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(05)82299-1</a>
Recognition of subarachnoid hemorrhage.
Adult; Female; Humans; Male; Middle Aged; Adolescent; Aged; Retrospective Studies; Neurologic Examination; Tomography; Headache/etiology; Central Nervous System Diseases/etiology; Nausea/etiology; Subarachnoid Hemorrhage/complications/*diagnosis; Vomiting/etiology; Emergency Service; Hospital; 80 and over; X-Ray Computed
The medical records of 109 patients who presented to the emergency department during a five-year period with proven nontraumatic, spontaneous subarachnoid hemorrhage (SAH) were retrospectively reviewed. The clinical presentation, diagnostic modalities used, and accuracy of diagnosis by emergency physicians were analyzed. The most common historical features were headache (81 patients, or 74%), nausea or vomiting (85 patients, or 77%), and loss of consciousness (58 patients, or 53%). Nonexertional activities preceding SAH were more frequent than exertional events (57% vs 21%). Neurologic findings were present in 70 patients (64%) and consisted primarily of altered levels of consciousness. Thirty-eight patients (35%) had nuchal rigidity. Ninety-six emergency cranial computed tomography scans were performed, of which 91 were diagnostic for SAH (sensitivity, 95%). Lumbar puncture was performed on two patients with normal computed tomography scans and revealed bloody spinal fluid. The overall diagnostic accuracy by emergency physicians was 85%. The correct diagnosis was delayed in 16 patients (15%), the majority of whom had headaches and normal neurologic examinations. Atypical symptoms, the warning leak syndrome, and the need for prompt diagnosis and therapy are reviewed.
Fontanarosa P B
Annals of emergency medicine
1989
1989-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0196-0644(89)80059-9" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(89)80059-9</a>
A biopsychosocial profile of the geriatric population who frequently visit the emergency department.
Female; Humans; Male; Retrospective Studies; Sex Factors; African Americans; Ohio/epidemiology; European Continental Ancestry Group; Demography; *Aged/psychology; Marriage; Emergency Service; Hospital/*statistics & numerical data
Over the last two decades the emergency department has become the primary source of health care for a large segment of the population. While this practice is discouraged by ED staff and primary care providers, it is an unfortunate reality. Recent literature has examined the use of the ED from many different angles. Areas investigated include various demographics (age, sex, race, etc.), method of payment, presenting complaint, and availability of primary care. Repeated inappropriate use of ED services by individuals (the so called "frequent fliers") has also attracted attention. The interest in this sub-population of patients is presumably due to the prevalence as well as the excessive costs of this behavior. In the present study a retrospective chart review was used to establish the biopsychosocial profiles of geriatric patients identified as being frequently seen in the emergency department for non-urgent conditions. Even though only 11% of the US population is age 65 or older, the elderly in America consume 30% of the health care resources, and in the next 20 years that figure is expected to climb to 50% (1). Demographics, ED presentation, diagnosis, and treatment as well as past medical history were collected. The objectives of the study were to identify these elderly frequent fliers and determine what could be the reasons behind the inappropriate use of emergency department resources by these patients. The average age of the sample was 74. The marital status of the sample was as follows: 42.4% widowed, 27.2% married, 15% divorced, and 18.5% single. Over half (52.6%) of those patients were brought to the ED by ambulance. The most common presenting complaint was chest pain (20.8%), followed by somatic complaints (18.9%), GI (16.1%), dyspnea (13.7%), and change in mental status (12.8%). The most prevalent ED diagnosis was psychiatric (18.4%) in nature. The other diagnoses were somatic (16.6%), GI (11.8%), and pulmonary (10.9%). 88.5% of the sample reported to have a primary care physician. However, 45% of the ED visits occurred between 9 AM and 5 PM at a time when a physician should have been available. The admission rate for this sample was 21.9%, which is half what has been found in the "normal" elderly, as reported by McDonald and Abrahams.
Brokaw M; Zaraa A S
Ohio medicine : journal of the Ohio State Medical Association
1991
1991-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Use of Fine-scale Geospatial Units and Population Data to Evaluate Access to Emergency Care.
Adult; Female; Humans; *Censuses; *Travel; Geographic Information Systems/*instrumentation; Health Services Accessibility/*statistics & numerical data; Male; Middle Aged; Ohio; Regression Analysis; Socioeconomic Factors; Spatial Analysis; Time Factors; Odds Ratio; Confidence Intervals; Human; Surveys; Blacks; Hispanics; Regression; Emergency Service; Hospital/*statistics & numerical data; Census; Geographic Information Systems; Housing; Population Density; Emergency Care – Utilization – Ohio; Emergency Service – Utilization – Ohio
Introduction: Time to facility is a crucial element in emergency medicine (EM). Fine-scale geospatial units such as census block groups (CBG) and publicly available population datasets offer a low-cost and accurate approach to modeling geographic access to and utilization of emergency departments (ED). These methods are relevant to the emergency physician in evaluating patient utilization patterns, emergency medical services protocols, and opportunities for improved patient outcomes and cost utilization. We describe the practical application of geographic information system (GIS) and fine-scale analysis for EM using Ohio ED access as a case study. Methods: Ohio ED locations (n=198), CBGs (n=9,238) and 2015 United States Census five-year American Community Survey (ACS) socioeconomic data were collected July-August 2016. We estimated drive time and distance between population-weighted CBGs and nearest ED using ArcGIS and 2010 CBG shapefiles. We examined drive times vs. ACS characteristics using multinomial regression and mapping. Results: We categorized CBGs by centroid-ED travel time in minutes: \textless10 (73.4%; n=6,774), 10-30 (25.1%; n=2,315), and \textgreater30 (1.5%; n=141). CBGs with increased median age, Hispanic and non-Hispanic Black population, and college graduation rates had significantly decreased travel time. CBGs with increased low-income populations (adjusted odds ratio [AOR] [1.03], 95% confidence interval [CI] [1.01-1.04]) and vacant housing (AOR [1.06], 95% CI [1.05-1.08]) had increased odds of \textgreater30 minute travel time. Conclusion: Use of fine-scale geographic analysis and population data can be used to evaluate geographic accessibility and utilization of EDs. Methods described offer guidance to approaching questions of geographic accessibility and have numerous ED and pre-hospital applications.
Joyce Katherine M; Burke Ryan C; Veldman Thomas J; Beeson Michelle M; Simon Erin L
The western journal of emergency medicine
2018
2018-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.5811/westjem.2018.9.38957" target="_blank" rel="noreferrer noopener">10.5811/westjem.2018.9.38957</a>
Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system.
*National Academies of Science; *Population Dynamics; 80 and over; Aged; and Medicine (U.S.) Health and Medicine Division; Disaster Planning; Emergency Service; Engineering; Health Policy/*trends; Health Services for the Aged/*trends; Hospital/*trends; Humans; United States
Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue.
Wilber Scott T; Gerson Lowell W; Terrell Kevin M; Carpenter Christopher R; Shah Manish N; Heard Kennon; Hwang Ula
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2006
2006-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2006.09.050" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2006.09.050</a>
Does functional decline prompt emergency department visits and admission in older patients?
80 and over; Activities of Daily Living; Age Distribution; Aged; Cross-Sectional Studies; Decision Making; Emergency Service; Female; Frail Elderly/*statistics & numerical data; Health Surveys; Hospital/*statistics & numerical data; Humans; Male; Ohio; Patient Acceptance of Health Care/statistics & numerical data; Patient Admission/*statistics & numerical data; Patient Discharge/statistics & numerical data; Prospective Studies; Sex Distribution
BACKGROUND: Older patients may visit the emergency department (ED) when their illness affects their function. OBJECTIVES: To quantify the function of older ED patients, to assess whether functional decline (FD) had occurred, and to determine whether function contributes to the ED visit and hospital admission. METHODS: The authors performed an institutional review board-approved, prospective, cross-sectional study in a community teaching hospital ED. Eligible patients were older than 74 years of age, with an illness at least 48 hours old. Patients from a nursing facility and those without a proxy who were unable or unwilling to complete the questions were excluded. The Older Americans Resources and Services Questionnaire, which tests seven instrumental activities of daily living (IADL) and seven physical ADLs (PADL), was used. Data are presented as means or proportions with 95% confidence intervals (95% CI), and comparisons as 95% CI for the difference between proportions. RESULTS: The authors enrolled 90 patients (mean age, 81.6 yr [SD +/- 4.9], 40% male). Dependence in at least one IADL was reported by 68% (95% CI = 57% to 77%), and in at least one PADL by 61% (95% CI = 50% to 71%). Functional decline was reported by 74% (95% CI = 64% to 83%). Two thirds of those with IADL decline and three quarters of those with PADL decline said that this contributed to their ED visit. Seventy-seven percent with, and 63% without, IADL decline were admitted (14% difference, 95% CI = -6.1% to 33%). Seventy-nine percent with and 61% without PADL decline were admitted (18% difference, 95% CI = -1.4% to 38%). CONCLUSIONS: Functional decline is common in older ED patients and contributes to ED visits in older patients; its role in admission is unclear.
Wilber Scott T; Blanda Michelle; Gerson Lowell W
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2006
2006-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2006.01.006" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2006.01.006</a>
Screening for adolescent depression in a pediatric emergency department.
*Adolescent Behavior; Adolescent; Adult; Age Distribution; Comorbidity; Cross-Sectional Studies; Depression/classification/*diagnosis/*epidemiology; Emergency Service; Female; Hospital/*statistics & numerical data; Hospitalization/statistics & numerical data; Humans; Logistic Models; Male; Mass Screening/*instrumentation/*statistics & numerical data; Ohio/epidemiology; Patient Participation/statistics & numerical data; Pediatrics/*statistics & numerical data; Prevalence; Psychiatric Status Rating Scales; Transportation of Patients/statistics & numerical data; Wounds and Injuries/epidemiology
OBJECTIVES: To describe the prevalence of depressive symptoms in adolescents presenting to the emergency department (ED) and to describe their demographics and outcomes compared with adolescents endorsing low levels of depressive symptoms. METHODS: The Beck Depression Inventory-2nd edition (BDI-II) was used to screen all patients 13-19 years of age who presented to the ED during the period of study. The BDI-II is a 21-item self-report instrument used to measure the presence and severity of depressive symptoms in adolescents and adults. Demographics and clinical outcomes of screening-program participants were abstracted by chart review. Patients were categorized into one of four severity categories (minimal, mild, moderate, or severe) and one of three presenting complaint categories (medical, trauma, mental health). RESULTS: Four hundred eighty-seven patients were approached, and 351(72%) completed the screening protocol. Participants endorsed minimal (n = 192, 55%), mild (n = 52, 15%), moderate (n = 41, 11%), or severe depressive symptoms (n = 66, 19%). Those with moderate or severe depressive symptoms were more likely to be hospitalized. Of patients completing the BDI-II, 72% with psychiatric, 12% with traumatic, and 19% with medical chief complaints endorsed either moderate or severe depressive symptoms. CONCLUSIONS: Depressive symptoms are prevalent in this screening sample, regardless of presenting complaint. A substantial proportion of patients with nonpsychiatric chief complaints endorsed moderate or severe depressive symptoms. A screening program might allow earlier identification and referral of patients at risk for depression.
Scott Emily Gale; Luxmore Brett; Alexander Heather; Fenn Robin L; Christopher Norman C
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2006
2006-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2005.11.085" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2005.11.085</a>
An evaluation of two screening tools for cognitive impairment in older emergency department patients.
*Psychiatric Status Rating Scales; Aged; Cognition Disorders/*diagnosis; Cross-Sectional Studies; Emergency Medicine/*instrumentation; Emergency Service; Female; Geriatrics/*instrumentation; Hospital; Humans; Male; Prospective Studies; Sensitivity and Specificity
OBJECTIVES: Screening for cognitive impairment in older emergency department (ED) patients is recommended to ensure quality care. The Mini-Mental State Examination (MMSE) may be too long for routine ED use. Briefer alternatives include the Six-Item Screener (SIS) and the Mini-Cog. The objective of this study was to describe the test characteristics of the SIS and the Mini-Cog compared with the MMSE when administered to older ED patients. METHODS: This institutional review board-approved, prospective, randomized study was performed in a university-affiliated teaching hospital ED. Eligible patients were 65 years and older and able to communicate in English. Patients who were unable or unwilling to perform testing, who were medically unstable, or who received medications affecting their mental status were excluded. Patients were randomized to receive the SIS or the Mini-Cog by the treating emergency physician. Investigators administered the MMSE 30 minutes later. An SIS score of
Wilber Scott T; Lofgren Samuel D; Mager Thomas G; Blanda Michelle; Gerson Lowell W
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2005
2005-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2005.01.017" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2005.01.017</a>
Emergency department use and barriers to wellness: a survey of emergency department frequent users.
*Emergency department; *Frequent user; *Health Services Accessibility/statistics & numerical data; *Survey; Emergency Service; Emergency Service – Utilization; Female; Health Services Accessibility – Statistics and Numerical Data; Health Services Needs and Demand – Statistics and Numerical Data; Health Services Needs and Demand/statistics & numerical data; Hospital/*statistics & numerical data; Human; Humans; Interviews; Interviews as Topic; Male; Middle Age; Middle Aged; Prospective Studies; Surveys and Questionnaires; Trauma Centers – Utilization; Trauma Centers/statistics & numerical data
BACKGROUND: There is no common understanding of how needs of emergency department (ED) frequent users differ from other patients. This study sought to examine how to best serve this population. Examinations of why ED frequent users present to the ED, what barriers to care exist, and what service offerings may help these patients achieve an optimal level of health were conducted. METHODS: We performed a prospective study of frequent ED users in an adult only, level 1 trauma center with approximately 90,000 visits per year. Frequent ED users were defined as those who make four or more ED visits in a 12 month period. Participants were administered a piloted structured interview by a trained researcher querying demographics, ED usage, perceived barriers to care, and potential aids to maintaining health. RESULTS: Of 1,523 screened patients, 297 were identified as frequent ED users. One hundred frequent ED users were enrolled. The mean age was 48 years (95% CI 45-51). The majority of subjects were female (64%, 64/100, 95% CI 55-73%), white (61%, 60/98, 95% CI 52-71%) and insured by Medicaid (55%, 47/86, 95% CI 44-65%) or Medicare (23%, 20/86, 95% CI 14-32%). Subjects had a median of 6 ED visits, and 2 inpatient admissions in the past 12 months at this hospital. Most frequent ED users (61%, 59/96, 95% CI 52-71%) stated the primary reason for their visit was that they felt that their health problem could only be treated in an ED. Transportation presented as a major barrier to few patients (7%, 7/95, 95% CI 3-14%). Subjects stated that "after-hours options, besides the ED for minor health issues" (63%, 60/95, 95% CI 53-73%) and having "a nurse to work with you one-on-one to help manage health care needs" (53%, 50/95, 95% CI
Birmingham Lauren E; Cochran Thaddeus; Frey Jennifer A; Stiffler Kirk A; Wilber Scott T
BMC emergency medicine
2017
2017-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1186/s12873-017-0126-5" target="_blank" rel="noreferrer noopener">10.1186/s12873-017-0126-5</a>
Willingness and Ability of Older Adults in the Emergency Department to Provide Clinical Information Using a Tablet Computer.
*aged; *Attitude to Computers; *Computers; *data collection; *elderly; *emergency department; *Emergency Service; 80 and over; 80 and Over; ACADEMIC medical centers; Academic Medical Centers – North Carolina; Aged; Computers; Confidence Intervals; CONFIDENCE intervals; Convenience Sample; Cross Sectional Studies; CROSS-sectional method; Cross-Sectional Studies; Descriptive Statistics; DESCRIPTIVE statistics; Emergency Care – In Old Age; EMERGENCY medical services; Emergency Service; Female; Handheld; Hospital; HOSPITAL emergency services; Human; Humans; LONGITUDINAL method; Male; Mass Screening/*instrumentation; MEDICAL cooperation; Multicenter Studies; New Jersey; NEW Jersey; North Carolina; NORTH Carolina; OLD age; Patient Attitudes – Evaluation – In Old Age; PATIENTS' attitudes; Portable – Utilization – In Old Age; PORTABLE computers; Prospective Studies; RESEARCH; SCALE analysis (Psychology); Scales; STATISTICAL sampling; Summated Rating Scaling; Surveys and Questionnaires; United States; User-Computer Interface
OBJECTIVES: To estimate the proportion of older adults in the emergency department (ED) who are willing and able to use a tablet computer to answer questions. DESIGN: Prospective, ED-based cross-sectional study. SETTING: Two U.S. academic EDs. PARTICIPANTS: Individuals aged 65 and older. MEASUREMENTS: As part of screening for another study, potential study participants were asked whether they would be willing to use a tablet computer to answer eight questions instead of answering questions orally. A custom user interface optimized for older adults was used. Trained research assistants observed study participants as they used the tablets. Ability to use the tablet was assessed based on need for assistance and number of questions answered correctly. RESULTS: Of 365 individuals approached, 248 (68%) were willing to answer screening questions, 121 of these (49%) were willing to use a tablet computer; of these, 91 (75%) were able to answer at least six questions correctly, and 35 (29%) did not require assistance. Only 14 (12%) were able to answer all eight questions correctly without assistance. Individuals aged 65 to 74 and those reporting use of a touchscreen device at least weekly were more likely to be willing and able to use the tablet computer. Of individuals with no or mild cognitive impairment, the percentage willing to use the tablet was 45%, and the percentage answering all questions correctly was 32%. CONCLUSION: Approximately half of this sample of older adults in the ED was willing to provide information using a tablet computer, but only a small minority of these were able to enter all information correctly without assistance. Tablet computers may provide an efficient means of collecting clinical information from some older adults in the ED, but at present, it will be ineffective for a significant portion of this population.
Brahmandam Sruti; Holland Wesley C; Mangipudi Sowmya A; Braz Valerie A; Medlin Richard P; Hunold Katherine M; Jones Christopher W; Platts-Mills Timothy F
Journal of the American Geriatrics Society
2016
2016-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/jgs.14366" target="_blank" rel="noreferrer noopener">10.1111/jgs.14366</a>
Short-term functional decline and service use in older emergency department patients with blunt injuries.
*Activities of Daily Living; 80 and over; 80 and Over; Academic Medical Centers; Activities of Daily Living; Aged; Bone/physiopathology/therapy; Clinical Assessment Tools; Comorbidity; Confidence Intervals; Descriptive Statistics; Emergency Care – In Old Age; Emergency Patients – In Old Age; Emergency Service; Family; Female; Fisher's Exact Test; Fractures; Functional Status – In Old Age; Geriatric Assessment; Geriatric Functional Assessment; Health Resource Utilization – In Old Age; Hospital/*statistics & numerical data; Hospitals; Human; Humans; Logistic Models; Logistic Regression; Longitudinal Studies; Male; Mental Status Schedule; Nonpenetrating – In Old Age; Nonpenetrating/*physiopathology/*therapy; OARS Multidimensional Functional Assessment Questionnaire; Odds Ratio; Ohio; Outcome Assessment; Outpatients; P-Value; Predictive Value of Tests; Prospective Studies; Questionnaires; Record Review; ROC Curve; Scales; Summated Rating Scaling; Surveys and Questionnaires; T-Tests; Teaching; Treatment Outcome; Treatment Outcomes; Wounds
BACKGROUND: Injuries are a common reason for emergency department (ED) visits by older patients. Although injuries in older patients can be serious, 75% of these patients are discharged home after their ED visit. These patients may be at risk for short-term functional decline related to their injuries or treatment. OBJECTIVES: The objectives were to determine the incidence of functional decline in older ED patients with blunt injuries not requiring hospital admission for treatment, to describe their care needs, and to determine the predictors of short-term functional decline in these patients. METHODS: This institutional review board-approved, prospective, longitudinal study was conducted in two community teaching hospital EDs with a combined census of 97,000 adult visits. Eligible patients were \textgreater or = 65 years old, with blunt injuries \textless48 hours old, who could answer questions or had a proxy. We excluded those too ill to participate; skilled nursing home patients; those admitted for surgery, major trauma, or acute medical conditions; patients with poor baseline function; and previously enrolled patients. Interviewers collected baseline data and the used the Older Americans Resources and Services (OARS) questionnaire to assess function and service use. Potential predictors of functional decline were derived from prior studies of functional decline after an ED visit and clinical experience. Follow-up occurred at 1 and 4 weeks, when the OARS questions were repeated. A three-point drop in activities of the daily living (ADL) score defined functional decline. Data are presented as means and proportions with 95% confidence intervals (CIs). Logistic regression was used to model potential predictors with functional decline at 1 week as the dependent variable. RESULTS: A total of 1,186 patients were evaluated for eligibility, 814 were excluded, 129 refused, and 13 were missed, leaving 230 enrolled patients. The mean (+/-SD) age was 77 (+/-7.5) years, and 70% were female. In the first week, 92 of 230 patients (40%, 95% CI = 34% to 47%) had functional decline, 114 of 230 (49%, 95% CI = 43% to 56%) had new services initiated, and 76 of 230 had an unscheduled medical contact (33%, 95% CI = 27% to 39%). At 4 weeks, 77 of 219 had functional decline (35%, 95% CI = 29% to 42%), 141 of 219 had new services (65%, 95% CI = 58% to 71%), and 123 of 219 had an unscheduled medical contact (56%, 95% CI = 49% to 63%), including 15% with a repeated ED visit and 11% with a hospital admission. Family members provided the majority of new services at both time periods. Significant predictors of functional decline at 1 week were female sex (odds ratio [OR] = 2.2, 95% CI = 1.1 to 4.5), instrumental ADL dependence (IADL; OR = 2.5, 95% CI = 1.3 to 4.8), upper extremity fracture or dislocation (OR = 5.5, 95% CI = 2.5 to 11.8), lower extremity fracture or dislocation (OR = 4.6, 95% CI = 1.4 to 15.4), trunk injury (OR = 2.4, 95% CI = 1.1 to 5.3), and head injury (OR = 0.48, 95% CI = 0.23 to 1.0). CONCLUSIONS: Older patients have a significant risk of short-term functional decline and other adverse outcomes after ED visits for injuries not requiring hospitalization for treatment. The most significant predictors of functional decline are upper and lower extremity fractures.
Wilber Scott T; Blanda Michelle; Gerson Lowell W; Allen Kyle R
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2010
2010-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2010.00799.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2010.00799.x</a>
Do elder emergency department patients and their informants agree about the elder's functioning?
*Activities of Daily Living; *Attitude to Health; *Geriatric Assessment; *Health Status; *Self-Assessment; Aged; Bias; Cross-Sectional Studies; Emergency Service; Emergency Treatment/*methods/standards; Family/*psychology; Female; Hospital; Humans; Inpatients/*psychology; Interviews as Topic/*standards; Male; Medical History Taking/*methods/standards; Mental Health; Quality of Life; Surveys and Questionnaires/*standards
OBJECTIVE: To compare elder patients' and their informants' ratings of the elder's physical and mental function measured by a standard instrument, the Medical Outcomes Study Short Form 12 (SF-12). METHODS: This was a randomized, cross-sectional study conducted at a university-affiliated community teaching hospital emergency department (census 65,000/year). Patients \textgreater69 years old, arriving on weekdays between 10 AM and 7 PM, able to engage in English conversation, and consenting to participate were eligible. Patients too ill to participate were excluded. Informants were people who accompanied and knew the patient. Elder patients were randomized 1:1 to receive an interview or questionnaire version of the SF-12. The questionnaire was read to people unable to read. Two trained medical students administered the instrument. The SF-12 algorithm was used to calculate physical (PCS) and mental (MCS) component scores. Oral and written versions were compared using analysis of variance. The PCS and MCS scores between patient-informant pairs were compared with a matched t-test. Alpha was 0.05. RESULTS: One hundred six patients and 55 informants were enrolled. The patients' average (+/-SD) age was 77 +/- 5 years; 59 (56%; 95% CI = 46% to 65%) were women. There was no significant difference for mode of administration in PCS (p = 0.53) or MCS (p = 0.14) scores. Patients rated themselves higher on physical function than did their proxies. There was a 4.1 (95% CI = 99 to 7.2) point difference between patients' and their proxies' physical component scores (p = 0.01). Scores on the mental component were quite similar. The mean difference between patients and proxies was 0.49 (95% CI = 3.17 to 4.16). The half point higher rating by patients was not statistically significant (p = 0.79). CONCLUSIONS: Elders' self-ratings of physical function were higher than those of proxies who knew them. There was no difference in mental function ratings between patients and their proxies. Switching from informants' to patients' reports in evaluating elders' physical function in longitudinal studies may introduce error.
Gerson L W; Blanda M; Dhingra P; Davis J M; Diaz S R
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2001
2001-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2001.tb00191.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2001.tb00191.x</a>
Multicenter study of case finding in elderly emergency department patients.
*Geriatric Assessment; *Mass Screening; 80 and over; Activities of Daily Living; Aged; Emergency Service; Feasibility Studies; Female; Hospital; Humans; Male; Morbidity; Patient Acceptance of Health Care; Prevalence; Prospective Studies; Surveys and Questionnaires; United States
OBJECTIVES: To assess the feasibility of a brief comprehensive case-finding program for detecting functional, cognitive, and social impairments among elderly ED patients and to estimate the prevalence of unknown, undetected, or untreated impairments elderly patients may have. METHODS: A multicenter prospective study conducted at five private and public hospital EDs in five different communities across the country. Patients aged 60 years and older released to their homes during 52 randomly selected evening and weekend shifts between February 1 and April 30, 1993, were eligible for the case-finding program. They were evaluated by medical students who received special training (instructional videotape, supervised examinations, and conference calls) in the administration of a standardized 17-item protocol that included an interview and simple tests of function. The patients' physicians were notified of the screening results and were asked to return a one-month follow-up questionnaire. The physicians answered whether the presumed problem had been confirmed and whether a treatment plan for a new problem had been developed. RESULTS: Patient acceptance of the case-finding program was good; 252 of 338 eligible patients (75%) agreed to participate, and 281 conditions were detected for 242 screened patients (96%). The most frequently reported problems were with: performing the activities of daily living (79%); vision (55%); lack of influenza vaccination (54%); home environment (49%); mental status (46%); general health (41%); falls (40%); and depression (36%). The physicians returned questionnaires for 153 patients (63%); 76 patients (50%) were evaluated at follow-up visits, during which 47 newly identified problems (62%) were confirmed and treatment plans were developed for 25 problems (53%) among 21 patients. A mean time of 17.7 +/- 10.2 minutes was required to complete the screen. CONCLUSIONS: A brief comprehensive case-finding program for functional, cognitive, and social impairment among elderly ED patients is feasible. The screening uncovered a significant amount of morbidity among older patients visiting EDs.
Gerson L W; Rousseau E W; Hogan T M; Bernstein E; Kalbfleisch N
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
1995
1995-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.1995.tb03626.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.1995.tb03626.x</a>
Consensus statement on advancing research in emergency department operations and its impact on patient care.
Congresses and Conferences; Consensus; Emergency Medical Services; Emergency Medicine; Emergency Service; Health Services Research/*organization & administration; Hospital/*organization & administration/standards; Humans; Information Dissemination; Multicenter Studies as Topic; Outcome Assessment (Health Care); Patient Care – Methods; Patient Care/*trends; Public Health; Qualitative Studies; Research – Evaluation; Systems Analysis
The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications.
Yiadom Maame Yaa A B; Ward Michael J; Chang Anna Marie; Pines Jesse M; Jouriles Nick; Yealy Donald M
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2015
2015-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/acem.12695" target="_blank" rel="noreferrer noopener">10.1111/acem.12695</a>
In situ simulation to assess workplace attitudes and effectiveness in a new facility.
*Attitude of Health Personnel; *Patient Simulation; Adult; Emergency Service; Hospital/*organization & administration; Hospitals; Humans; Inservice Training/methods; Patient Care Team/*organization & administration; Patient Safety/*standards; Self Efficacy; Teaching/organization & administration; Trauma Centers/*organization & administration; Workforce
INTRODUCTION: In situ simulation within new facilities holds the promise of identifying latent safety threats. The aim of this study was to identify if in situ simulation can also impact important employee perceptions and attitudes. METHODS: In the current study, health care professionals of an adult, urban, community teaching hospital level 1 trauma center participated in simulated scenarios in a new emergency department. Before and after the simulated scenarios, participants provided responses to the variables regarding their ability to work in the new facility and other work-related variables. RESULTS: Significant increases in communication (P = 0.05), facility clinical readiness (P \textless 0.05), self-efficacy (P \textless 0.01), trauma readiness (P \textless 0.01), and work space satisfaction (P \textless 0.05) were found from presimulation to postsimulation. The results also demonstrated a significant decrease from presimulation to postsimulation with performance beliefs (P \textless 0.001). Finally, cardiac readiness did not reveal a significant change from presimulation to postsimulation. DISCUSSION: In situ simulation exercises before practicing clinically in a new facility can both increase familiarity with new clinical environments and impact important organizational outcomes. Thus, simulation in a new work space can influence factors important to employees, organizations, and patients.
Gardner Aimee King; Ahmed Rami A; George Richard L; Frey Jennifer A
Simulation in healthcare : journal of the Society for Simulation in Healthcare
2013
2013-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/SIH.0b013e31829f7347" target="_blank" rel="noreferrer noopener">10.1097/SIH.0b013e31829f7347</a>
Cardiac Output Monitoring Managing Intravenous Therapy (COMMIT) to Treat Emergency Department Patients with Sepsis.
Adult; Aged; Cardiac Output/*physiology; Emergency Service; Female; Fluid Therapy/*methods; Hospital/*statistics & numerical data; Humans; Lactic Acid/therapeutic use; Male; Middle Aged; Monitoring; Multicenter Studies as Topic; Physiologic/methods; Prospective Studies; Sepsis/*physiopathology/*therapy; Septic/physiopathology/therapy; Shock; Stroke Volume/physiology
OBJECTIVE: Fluid responsiveness is proposed as a physiology-based method to titrate fluid therapy based on preload dependence. The objectives of this study were to determine if a fluid responsiveness protocol would decrease progression of organ dysfunction, and a fluid responsiveness protocol would facilitate a more aggressive resuscitation. METHODS: Prospective, 10-center, randomized interventional trial. INCLUSION CRITERIA: suspected sepsis and lactate 2.0 to 4.0 mmol/L. Exclusion criteria (abbreviated): systolic blood pressure more than 90 mmHg, and contraindication to aggressive fluid resuscitation. INTERVENTION: fluid responsiveness protocol using Non-Invasive Cardiac Output Monitor (NICOM) to assess for fluid responsiveness (\textgreater10% increase in stroke volume in response to 5 mL/kg fluid bolus) with balance of a liter given in responsive patients. CONTROL: standard clinical care. OUTCOMES: primary-change in Sepsis-related Organ Failure Assessment (SOFA) score at least 1 over 72 h; secondary-fluids administered. Trial was initially powered at 600 patients, but stopped early due to a change in sponsor's funding priorities. RESULTS: Sixty-four patients were enrolled with 32 in the treatment arm. There were no significant differences between arms in age, comorbidities, baseline vital signs, or SOFA scores (P \textgreater 0.05 for all). Comparing treatment versus Standard of Care-there was no difference in proportion of increase in SOFA score of at least 1 point (30% vs. 33%) (note bene underpowered, P = 1.0) or mean preprotocol fluids 1,050 mL (95% confidence interval [CI]:
Hou Peter C; Filbin Michael R; Napoli Anthony; Feldman Joseph; Pang Peter S; Sankoff Jeffrey; Lo Bruce M; Dickey-White Howard; Birkhahn Robert H; Shapiro Nathan I
Shock (Augusta, Ga.)
2016
2016-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/SHK.0000000000000564" target="_blank" rel="noreferrer noopener">10.1097/SHK.0000000000000564</a>
Cutaneous abscesses in children: epidemiology in the era of methicillin-resistant Staphylococcus aureus in a pediatric emergency department.
*Methicillin-Resistant Staphylococcus aureus; Abscess – Epidemiology; Abscess – Microbiology; Abscess/*epidemiology/microbiology; Anti-Bacterial Agents/*therapeutic use; Antibiotics – Therapeutic Use; Child; Emergency Service; Female; Hospital; Human; Humans; Infant; Infectious – Epidemiology; Infectious – Microbiology; Male; Methicillin-Resistant Staphylococcus Aureus; Pediatrics; Preschool; Recurrence; Retrospective Design; Retrospective Studies; Skin Diseases; Soft Tissue Infections – Epidemiology; Soft Tissue Infections – Microbiology; Soft Tissue Infections/*epidemiology/microbiology; Staphylococcal Skin Infections/*epidemiology/microbiology
OBJECTIVE: Skin and soft tissue infections are a major public health issue. Previous literature suggests a recurrence rate of 4% in children. The purpose of this study was to examine the epidemiology, body location, and history of previous infections among children in the emergency department setting. METHODS: A retrospective study was performed using electronic medical records from all subjects treated in a large pediatric emergency department with attending physician diagnosis and billing codes indicative of a cutaneous abscess from July 1, 2007, to December 31, 2007. Descriptive statistics were used to evaluate abscess location, prior history of infection, bacterial etiology, and patient disposition. RESULTS: Three hundred eighteen abscess visits occurred in 308 individual subjects; 79% were due to methicillin-resistant Staphylococcus aureus. Approximately 14% of subjects presented with more than 1 abscess. Those 2 years or younger were more likely to have buttock abscesses (P \textless 0.001). Of the 192 subjects for whom responses were documented, 82 (43%) had a history of a prior abscess. Children 2 years or younger were significantly more likely to be hospitalized or go to the operating room: 49% versus 15% (P \textless 0.001). CONCLUSIONS: Many children with a cutaneous abscess have a prior history of infection. Multiple abscesses are common. Young children are more likely to have abscesses in the diaper area or be hospitalized. Studies of effective hygiene practices and interventions to reduce recurrence are urgently needed.
Holsenback Heather; Smith Lisa; Stevenson Michelle D
Pediatric emergency care
2012
2012-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/PEC.0b013e31825d20e1" target="_blank" rel="noreferrer noopener">10.1097/PEC.0b013e31825d20e1</a>
Precordial Catch Syndrome in Elite Swimmers With Asthma.
Adolescence; Adolescent; Asthma – Complications; Asthma/*complications; Chest Pain – Etiology; Chest Pain/*etiology; Emergency Service; Hospital; Humans; Male; Swimming; Syndrome; Thoracic Wall; Thorax
Precordial catch syndrome is a benign cause of chest pain in children and adolescents that remains underrecognized. Because of distinctive symptoms, precordial catch syndrome is not necessarily a diagnosis of exclusion. However, a detailed history eliciting diagnostic features is important, along with a physical examination excluding other pathologic disorders. We present the cases of 2 elite swimmers with asthma who had acute episodes of precordial catch syndrome, one associated with an acute asthma exacerbation and one not, while swimming during competitive swim meets that required rescue efforts for both and eventual evaluation in the emergency department.
Hayes Don Jr; Younger Bradley R; Mansour Heidi M; Strawbridge Heather
Pediatric emergency care
2016
2016-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/PEC.0000000000000715" target="_blank" rel="noreferrer noopener">10.1097/PEC.0000000000000715</a>
The educational experience of pediatric emergency medicine fellows in the use and application of procedural sedation/analgesia.
*Fellowships and Scholarships; Analgesia/*methods; Analgesics/administration & dosage/*therapeutic use; Anesthesiology/*education; Clinical Competence/standards; Conscious Sedation/*methods; Curriculum/standards; Data Collection; Emergency Medicine/*education; Emergency Service; Hospital; Humans; Hypnotics and Sedatives/administration & dosage/*therapeutic use; Pediatrics/*education; Teaching/statistics & numerical data
OBJECTIVES: The purpose of this study is to describe the clinical and educational experience provided to the pediatric emergency medicine (PEM) fellows in procedural sedation/analgesia during their course of training. METHODS: A nonanonymous survey was completed by the program director of each Accreditation Council for Graduate Medical Education (ACGME)-accredited PEM fellowship program listed in the 2001 to 2002 Graduate Medical Education Directory. Information relating to program demographics, agents available for use in the emergency department (ED), and the educational opportunities offered to trainees was sought. RESULTS: Each of the 32 ACGME-accredited programs completed the survey. Thirty programs report using procedural sedation and analgesia (PSA) to facilitate the completion of nonpainful and 32 programs to facilitate the completion of painful procedures in the ED. Twenty-nine programs (92%) permit their fellows to provide PSA independently after meeting credentialing criteria at their institution. Formal didactic sessions, direct supervision of procedures, and dedicated journal clubs were the 3 most frequently cited educational methods reported. The educational method chosen was not predicted by the ED type, the size of the training program, or by the volume of patients evaluated in the ED. Twelve program directors report their belief that a minimum number of procedures should be completed prior to completion of the training program. CONCLUSION: There is wide variation in the educational methods used by PEM fellowship training programs in procedural sedation/analgesia.
Pollauf Laura A; Lutes R Esther; Ramundo Maria L; Christopher Norman C
Pediatric emergency care
2004
2004-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.pec.0000106237.72265.bb" target="_blank" rel="noreferrer noopener">10.1097/01.pec.0000106237.72265.bb</a>
Geriatric Disaster Preparedness.
80 and over; Activities of Daily Living; ADLs activities of daily living; Adult; Aged; Disaster Planning/*statistics & numerical data; disaster preparedness; Disasters; ED emergency department; Emergency Service; Female; geriatric; Geriatrics/*statistics & numerical data; Hospital/*statistics & numerical data; Humans; IADLs instrumental activities of daily living; Male; prehospital care; RA research assistant; Surveys and Questionnaires
INTRODUCTION: The elderly population has proven to be vulnerable in times of a disaster. Many have chronic medical problems for which they depend on medications or medical equipment. Some older adults are dependent on caregivers for managing their activities of daily living (ADLs), such as dressing, and their instrumental activities of daily living (IADLs), such as transportation. Problem A coordinated effort for disaster preparation in the elderly population is paramount. This study assessed the potential needs and plans of older adults in the face of a local disaster. METHODS: The setting was a community-based, university-affiliated, urban emergency department (ED) that sees more than 77,000 adult patients per year. A survey on disaster plans and resources needed if evacuated was distributed to 100 community-residing ED patients and visitors aged 65 years and older from January through July 2013. Means and proportions are reported with 95% confidence intervals (CIs). RESULTS: Data were collected from 13 visitors and 87 patients. The mean age was 76 years, and 54% were female. Thirty-one responded that they had a disaster plan in place (31/100; CI, 22.4-41.4%). Of those 31, 94% (29/31; CI, 78.6-99.2%) had food and water as part of their plan, 62% (19/29; CI, 42.2-78.2%) had a supply of medication, and 35% (12/31; CI, 21.8-57.8%) had an evacuation plan. When asked what supplies the 100 subjects might need if evacuated, 33% (CI, 23.9-43.1%) needed a walker, 15% (CI, 8.6-23.5%) needed a wheelchair, 78% (CI, 68.6-85.7%) needed glasses, 17% (CI, 10.2-25.8%) needed a hearing aid, 16% (CI, 9.4-24.7%) needed a glucometer, 93% (CI, 86.1-97.1%) needed medication, 14% (CI, 7.8-22.4%) needed oxygen, 23% (CI, 15.2-32.5%) needed adult diapers, and 21% (CI, 13.2-30.3%) had medical equipment that required electricity. Many of the subjects also required help with one or more of their ADLS, the most common being dressing (17%; CI, 10.3-26.1%), or their IADLS, the most common being transportation (39%; CI, 29.7-49.7%). Only 42% (CI, 32.3-52.7%) were interested in learning more about disaster preparation. CONCLUSION: Only a minority of the older adults in the study population had a disaster plan in place. Most of the respondents would require medications, and many would require medical supplies if evacuated.
Bhalla Mary Colleen; Burgess Amos; Frey Jennifer; Hardy William
Prehospital and disaster medicine
2015
2015-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1017/S1049023X15005075" target="_blank" rel="noreferrer noopener">10.1017/S1049023X15005075</a>
Inhaled corticosteroid use in asthmatic children receiving Ohio Medicaid: trend analysis, 1997-2001.
Administration; Adolescent; Adrenal Cortex Hormones/administration & dosage/*therapeutic use; African Americans/statistics & numerical data; Ambulatory Care/statistics & numerical data; Asthma/diagnosis/*drug therapy/ethnology; Child; Cross-Sectional Studies; Drug Utilization/statistics & numerical data/trends; Emergency Service; European Continental Ancestry Group/statistics & numerical data; Female; Hospital/statistics & numerical data; Hospitalization/statistics & numerical data; Humans; Infant; Inhalation; Male; Medicaid/*statistics & numerical data; Newborn; Ohio; Preschool; Regression Analysis; Retrospective Studies; Sex Factors; United States
BACKGROUND: In 1997, national guidelines emphasized that inhaled corticosteroids (ICSs) are key therapy for individuals with all classes of persistent asthma, including children. OBJECTIVE: To examine the effect of these guidelines via time-trend analysis of ICS dispensation among children with asthma and Ohio Medicaid insurance. METHODS: A retrospective cross-sectional analysis by yearly cohorts was performed. From January 1, 1997, to December 31, 2001, all children from birth to the age of 18 years with 6 months of Ohio Medicaid enrollment or more, 1 or more asthma diagnoses associated with a provider claim, and 1 or more prescription claims for an asthma medication in a given calendar year were identified using claims data. The daily beclomethasone equivalent (BME) dose, the daily albuterol equivalent dose, and asthma-related health care use were calculated for each child within each yearly cohort. A time-trend regression analysis of subjects enrolled in all 5 years examined factors associated with BME. RESULTS: A total of 77,557 children met the study criteria. Among the 1,475 children enrolled during all 5 years, year of enrollment was a positive independent predictor of BME after adjustment for age, race, sex, systemic steroid bursts, albuterol equivalent dose, and health care use (P \textless .001). CONCLUSIONS: The daily BME dose significantly increased for children with asthma insured by Ohio Medicaid from 1997 to 2001. However, the percentages of children receiving both ICS and a therapeutic BME dose were alarmingly low. The mean BME dose was particularly low among children with 1 or more emergency department visits, no hospitalizations, and 3 or fewer physician visits for asthma per year, suggesting that broader efforts to target this group are needed.
Stevenson Michelle D; Heaton Pamela C; Moomaw Charles J; Bean Judy A; Ruddy Richard M
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
2008
2008-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/S1081-1206(10)60049-X" target="_blank" rel="noreferrer noopener">10.1016/S1081-1206(10)60049-X</a>
Ultrasound-assisted internal jugular vein catheterization in the ED.
*Emergency Treatment; *Jugular Veins; Catheter Placement Determination; Catheterization; Central Venous; Central Venous/adverse effects/*methods; Clinical Competence; Convenience Sample; Descriptive Statistics; Emergency Care; Emergency Service; Hematoma/etiology; Hospital; Hospital/education; Human; Humans; Interventional/adverse effects/*methods; Jugular Veins – Ultrasonography; Medical Staff; Patient Selection; Prospective Studies; Record Review; Treatment Outcomes; Ultrasonography
A prospective, descriptive study is reported on the use and success of ultrasound-assisted internal jugular central vein catheterization (CVC) in the emergency department (ED). In patients not in cardiac arrest who had an indication for internal jugular CVC, lines were placed by trained ED staff using ultrasound. Data were collected prospectively on age, sex, body habitus, indication, vein visibility, number of punctures and needle passes, and success. There were 40 attempts at internal jugular CVC in 34 patients and ultrasound was used in 32 of the 40 (80%) attempts. Incidences of successful puncture and cannulation using ultrasound were 93.8% (30 of 32) and 81.3% (26 of 32), respectively, compared with 62.5% (5 of 8) and 62.5% (5 of 8) in the landmark group. In 8 patients with no visual or palpable landmarks, cannulation was successful in 100% (7 of 7) using ultrasound and in 0% (0 of 1) using landmark technique. Ultrasound-assisted internal jugular CVC is an easily learned technique that is useful in the ED. It may be especially helpful in patients in whom landmarks are not visible and not palpable.
Hrics P; Wilber S; Blanda M P; Gallo U
The American journal of emergency medicine
1998
1998-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0735-6757(98)90140-1" target="_blank" rel="noreferrer noopener">10.1016/s0735-6757(98)90140-1</a>
Emergency cardiac stress testing in the evaluation of emergency department patients with atypical chest pain.
*Exercise Test/economics; Acute Disease; Adult; Chest Pain/*etiology; Cost-Benefit Analysis; Emergencies; Emergency Service; Evaluation Studies as Topic; Feasibility Studies; Female; Hospital; Humans; Male; Middle Aged; Myocardial Ischemia/complications/*diagnosis; Prospective Studies; Retrospective Studies
STUDY OBJECTIVES: To determine the feasibility, safety, and reliability of emergency cardiac treadmill exercise stress testing (CTEST) in the evaluation of emergency department patients with atypical chest pain. DESIGN: Thirty-two patients with atypical chest pain, normal ECGs, and risk factor stratification having low-probability of coronary artery disease were evaluated prospectively using outpatient, emergency CTEST. Study patients were compared with a retrospectively selected sample of admitted patients diagnosed with atypical chest pain who met the study criteria and were evaluated with CTEST as inpatients. All patients had follow-up at three and six months after evaluation. SETTING: University-affiliated community teaching hospital with 65,000 annual ED visits. RESULTS: All patients had normal CTEST. No patient had evidence of coronary artery disease, myocardial infarction, or sudden death during the follow-up period. The average length of stay was 5.5 hours for emergency CTEST patients versus two days for inpatients. The average patient charge was $467 for ED evaluation with emergency CTEST versus $2,340 for inpatient evaluation. CONCLUSION: Emergency CTEST is a safe, efficient, cost-effective, and practical method of evaluating selected ED patients with chest pain. It is a useful aid for clinical decision making and may help to prevent unnecessary hospital admissions.
Kerns J R; Shaub T F; Fontanarosa P B
Annals of emergency medicine
1993
1993-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0196-0644(05)80793-0" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(05)80793-0</a>