The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope.
case management; geriatrics; InterQual; syncope
BACKGROUND: McKesson's InterQual criteria are widely used in hospitals to determine if patients should be classified as observation or inpatient status, but the accuracy of the criteria is unknown. OBJECTIVE: We sought to determine whether InterQual criteria accurately predicted length of stay (LOS) in older patients with syncope. METHODS: We conducted a secondary analysis of a cohort study of adults >/=60 years of age who had syncope. We calculated InterQual criteria and classified the patient as observation or inpatient status. Outcomes were whether LOS were less than or greater than 2 midnights. RESULTS: We analyzed 2361 patients; 1227 (52.0%) patients were male and 1945 (82.8%) were white, with a mean age of 73.2 +/- 9.0 years. The median LOS was 32.6 h (interquartile range 24.2-71.8). The sensitivity of InterQual criteria for LOS was 60.8% (95% confidence interval 57.9-63.6%) and the specificity was 47.8% (95% confidence interval 45.0-50.5%). CONCLUSIONS: In older adults with syncope, those who met InterQual criteria for inpatient status had longer LOS compared with those who did not; however, the accuracy of the criteria to predict length of stay over 2 days is poor, with a sensitivity of 60% and a specificity of 48%. Future research should identify criteria to improve LOS prediction.
Chang Anna Marie; Hollander Judd E; Su Erica; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
The Journal of emergency medicine
2020
2020-04-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.jemermed.2020.02.020" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2020.02.020</a>
Frequency of Abnormal and Critical Lab Results in Older Patients Presenting to the Emergency Department with Syncope
Syncope is a common and costly chief complaint among patients presenting to the emergency department (ED), accounting for 740,000 ED visits annually with an estimated annual cost of $2.4 billion per year in the United States.1,2 Syncope presents a diagnostic dilemma for clinicians in the ED since differentiating serious and benign causes of syncope can be challenging, particularly in the older adult. Routine laboratory testing with complete blood count (CBC) and basic metabolic panel (BMP) is commonly ordered for patients presenting to the ED with syncope.
Moore Andrew B; Su Erica; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
2019
2019-12-14
Journal Article
<a href="http://doi.org/10.1111/acem.13906" target="_blank" rel="noreferrer noopener">10.1111/acem.13906</a>
PMID: 31837233
Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score
STUDY OBJECTIVE: Older adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes. METHODS: We performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome. RESULTS: We enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670). CONCLUSION: Among older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.
Probst Marc A; Gibson Thomas; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Annals Of Emergency Medicine
2019
2019-10-23
Journal Article
<a href="http://doi.org/10.1016/j.annemergmed.2019.08.429" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2019.08.429</a>
PMID: 31668571
Variation in diagnostic testing for older patients with syncope in the emergency department
Cost; Diagnostic testing; Emergency department; Near syncope; Syncope; Variation; Yield
Background Older adults presenting with syncope often undergo intensive diagnostic testing with unclear benefit. We determined the variation, frequency, yield, and costs of tests obtained to evaluate older persons with syncope.
Su Erica; Nicks Bret A; Shah Manish N; Adler David H; Bastani Aveh; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Malveau Susan E; Nishijima Daniel K; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Yagapen Annick N; Weiss Robert E; Gibson Thomas A; Baugh Christopher W; Sun Benjamin C
American Journal of Emergency Medicine
2019
2019-05
<a href="http://doi.org/10.1016/j.ajem.2018.07.043" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2018.07.043</a>
Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?
OBJECTIVES: An estimated 1.2 million annual emergency department (ED) visits for syncope/near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and natriuretic peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/serious cardiac outcomes in adult patients presenting with syncope. METHODS: A prespecified secondary analysis of a prospective, observational trial enrolling participants ≥ age 60 presenting with syncope, at 11 United States hospitals, was conducted between April 2013 and September 2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow-up. Within 3 hours of consent, hscTnT and NT-proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT and 2010 Cobas, respectively. Primary outcome was combined 30-day all-cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistic regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods. RESULTS: The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT-proBNP levels. HscTnT levels ≤ 5 ng/L were associated with a 4% (95% confidence interval [CI] = 3%-5%) outcome risk, and hscTnT > 50 ng/L, a 29% (95% CI = 26%-33%) risk. NT-proBNP levels ≤ 125 ng/L were associated with a 4% (95% CI = 4%-5%) risk, and NT-proBNP > 2,000 ng/L a 29% (95% CI = 25%-32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings. CONCLUSIONS: hscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope.
Clark Carol L; Gibson Thomas A; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
2019
2019-05
<a href="http://doi.org/10.1111/acem.13709" target="_blank" rel="noreferrer noopener">10.1111/acem.13709</a>
Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis
STUDY OBJECTIVE: Many adults with syncope are hospitalized solely for observation and testing. We seek to determine whether hospitalization versus outpatient management for older adults with unexplained syncope is associated with a reduction in postdisposition serious adverse events at 30 days. METHODS: We performed a propensity score analysis using data from a prospective, observational study of older adults with unexplained syncope or near syncope who presented to 11 emergency departments (EDs) in the United States. We enrolled adults (≥60 years) who presented with syncope or near syncope. We excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data were collected on all patients. The primary outcome was rate of post-ED serious adverse events at 30 days. RESULTS: We enrolled 2,492 older adults with syncope and no serious ED diagnosis from April 2013 to September 2016. Mean age was 73 years (SD 8.9 years), and 51% were women. The incidence of serious adverse events within 30 days after the index visit was 7.4% for hospitalized patients and 3.19% for discharged patients, representing an unadjusted difference of 4.2% (95% confidence interval 2.38% to 6.02%). After propensity score matching on risk of hospitalization, there was no statistically significant difference in serious adverse events at 30 days between the hospitalized group (4.89%) and the discharged group (2.82%) (risk difference 2.07%; 95% confidence interval -0.24% to 4.38%). CONCLUSION: In our propensity-matched sample of older adults with unexplained syncope, for those with clinical characteristics similar to that of the discharged cohort, hospitalization was not associated with improvement in 30-day serious adverse event rates.
Probst Marc A; Su Erica; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Annals of Emergency Medicine
2019
2019-05
<a href="http://doi.org/10.1016/j.annemergmed.2019.03.031" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2019.03.031</a>
Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes
Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode. METHODS: This study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60 years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of 30-day serious outcome. The secondary outcome was 30-day serious cardiac arrhythmia. In multivariate analysis, we assessed whether prior syncope was an independent predictor of 30-day serious events. RESULTS: The study cohort included 3580 patients: 1281 (35.8%) had prior syncope and 2299 (64.2%) were presenting with first episode of syncope. 498 (13.9%) patients had 1 prior episode while 771 (21.5%) had >1 prior episode. Those with recurrent syncope were more likely to have congestive heart failure, coronary artery disease, previous diagnosis of arrhythmia, and an abnormal ECG. Overall, 657 (18.4%) of the cohort had a serious outcome by 30 days after index ED visit. In multivariate analysis, we found no significant difference in risk of events (adjusted odds ratio 1.09; 95% confidence interval 0.90-1.31; p = 0.387). CONCLUSION: In older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events.
Chang Anna Marie; Hollander Judd E; Su Erica; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
The American Journal of Emergency Medicine
2019
2019-05
<a href="http://doi.org/10.1016/j.ajem.2018.08.004" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2018.08.004</a>
Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope.
STUDY OBJECTIVE: Controversy remains in regard to the risk of adverse events for patients presenting with syncope compared with near-syncope. The purpose of our study is to describe the difference in outcomes between these groups in a large multicenter cohort of older emergency department (ED) patients. METHODS: From April 28, 2013, to September 21, 2016, we conducted a prospective, observational study across 11 EDs in adults (>/=60 years) with syncope or near-syncope. A standardized data extraction tool was used to collect information during their index visit and at 30-day follow-up. Our primary outcome was the incidence of
Bastani Aveh; Su Erica; Adler David H; Baugh Christopher; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Malveau Susan E; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Yagapen Annick N; Weiss Robert E; Sun Benjamin C
Annals of emergency medicine
2019
2019-03
<a href="http://doi.org/10.1016/j.annemergmed.2018.10.032" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2018.10.032</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>
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>
Optimal Older Adult Emergency Care: Introducing Multidisciplinary Geriatric Emergency Department Guidelines From the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic...
Age Factors; Physicians; Emergency Medicine; Practice Guidelines; Medical Organizations; Multidisciplinary Care Team; Emergency Nurses Association; Geriatrics; Emergency; Patient Care – Methods; Emergency Care – Methods
Carpenter Christopher R; Bromley Marilyn; Caterino Jeffrey M; Chun Audrey; Gerson Lowell W; Greenspan Jason; Hwang Ula; John David P; Lyons William L; Platts-Mills Timothy F; Mortensen Betty; Ragsdale Luna; Rosenberg Mark; Wilber Scott T
Academic Emergency Medicine
2014
2014-07
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/acem.12415" target="_blank" rel="noreferrer noopener">10.1111/acem.12415</a>
Optimal Older Adult Emergency Care: Introducing Multidisciplinary Geriatric Emergency Department Guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic...
Aged; Quality Improvement; Practice Guidelines; Emergency Patients; Multidisciplinary Care Team; American College of Emergency Physicians; American Geriatrics Society; Emergency Nurses Association; Society for Academic Emergency Medicine; Emergency Medicine – Standards; Geriatrics – Standards; Emergency Care – Standards – In Old Age; Gerontologic Care – Standards
In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments ( EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing.
Carpenter Christopher R; Bromley Marilyn; Caterino Jeffrey M; Chun Audrey; Gerson Lowell W; Greenspan Jason; Hwang Ula; John David P; Lyons William L; Platts-Mills Timothy F; Mortensen Betty; Ragsdale Luna; Rosenberg Mark; Wilber Scott T
Journal of the American Geriatrics Society
2014
2014-07
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/jgs.12883" target="_blank" rel="noreferrer noopener">10.1111/jgs.12883</a>
Predictors of Clinically Significant Echocardiography Findings in Older Adults with Syncope: A Secondary Analysis.
BACKGROUND: Syncope is a common reason for visiting the emergency department (ED) and is associated with significant healthcare resource utilization. OBJECTIVE: To develop a risk-stratification tool for clinically significant findings on echocardiography among older adults presenting to the ED with syncope or nearsyncope. DESIGN: Prospective, observational cohort study from April 2013 to September 2016. SETTING: Eleven EDs in the United States. PATIENTS: We enrolled adults (=60 years) who presented to the ED with syncope or near-syncope who underwent transthoracic echocardiography (TTE). MEASUREMENTS: The primary outcome was a clinically significant finding on TTE. Clinical, electrocardiogram, and laboratory variables were also collected. Multivariable logistic regression analysis was used to identify predictors of significant findings on echocardiography. RESULTS: A total of 3,686 patients were enrolled. Of these, 995 (27%) received echocardiography, and 215 (22%) had a significant finding on echocardiography. Regression analysis identified five predictors of significant finding: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T \textgreater14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide \textgreater125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%). CONCLUSIONS: If validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography. REGISTRATION: ClinicalTrials.gov Identifier NCT01802398.
Probst Marc A; Gibson Thomas A; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Journal of hospital medicine
2018
2018-12
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/10.12788/jhm.3082" target="_blank" rel="noreferrer noopener">10.12788/jhm.3082</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>
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>
Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial.
*Emergency Service; *Wheelchairs; Aged; Female; Hospital; Humans; Male; Pain Measurement; Pain/*prevention & control; Patient Satisfaction; Prospective Studies
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 Scott T; Burger Barbara; Gerson Lowell W; Blanda Michelle
Academic emergency medicine : official journal of the Society for 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/10.1197/j.aem.2004.10.016" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2004.10.016</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>
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>
A research agenda for geriatric emergency medicine.
*Emergency Service; *Geriatric Assessment; *Health Services Research; Aged; Cardiopulmonary Resuscitation; Emergency Medicine/education; Geriatrics/education; Hospital; Humans; Outcome Assessment (Health Care); Wounds and Injuries/therapy
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 Scott T; Gerson Lowell W
Academic emergency medicine : official journal of the Society for 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>
Assessment of emergency medicine residents' computer knowledge and computer skills: time for an upgrade?
*Computer Literacy; *Internship and Residency/statistics & numerical data; Computer User Training; Computers/*statistics & numerical data; Cross-Sectional Studies; Emergency Medicine/*education; Humans; Prospective Studies; Surveys and Questionnaires; Task Performance and Analysis
OBJECTIVE: To describe emergency medicine residents' (EMRs') personal computer (PC) use and educational needs and to compare their perceived and actual PC skills. METHODS: This was a prospective, cross-sectional study. Subjects were all EMRs at seven midwestern Accreditation Council for Graduate Medical Education (ACGME) residency programs. The EMRs completed a questionnaire about their PC use and ability to perform 23 tasks derived from two national retail-training programs. The tasks covered word processing, slide making, and Internet use. The EMRs then took a three-part test performing the skills in the questionnaire. Two independent raters scored the tests. Frequencies with 95% confidence intervals (95% CIs) were calculated for categorical data. Positive and negative predictive values were used to report information comparing residents' performance with their self-assessment of skills. Cohen's kappa was used to test agreement between raters. RESULTS: One hundred twenty-four of 158 (79%) eligible EMRs participated. Since not all participants engaged in all parts of the study, the sample size varies between 121 and 124. One hundred one of 122 (83%; 95% CI = 75 to 89) owned a PC. The EMRs use home PCs a mean of 3.8 hours/week for physician duties and use residency PCs 1.9 hours/week (range 0-20). Ninety-six of 122 (79%; 95% CI = 70 to 86) EMRs reported no formal PC training during residency. Thirty-five percent (43/122; 95% CI = 27 to 44) passed the word-processing test and 50% (62/123; 95% CI = 41 to 60) passed the slide-making test. Reasons for failure were because of errors and not having a presentable product. Thirty-eight of 122 (31%; 95% CI = 23 to 40) failed the literature search, including 33 who said they could perform it. One hundred fifteen of 123 (94%; 95% CI = 88 to 98) EMRs were able to find an Internet address, including ten who stated they could not. Twenty-one percent of the residents who attempted any test (26/124; 95% CI = 14 to 29) passed all three tests. There was no association between year of training and success on the tests (p = 0.374). Thirty-seven of 115 (32%; 95% CI = 24 to 42) EMRs said they had insufficient PC training to meet their physician needs. CONCLUSIONS: Emergency medicine residents have much access to computer technology and possess some computer skills; however, many are unable to produce a usable product or conduct a literature search. Emergency medicine residents have not had sufficient computer training prior to residency. The computer skills of EMRs should be assessed through skills testing rather than self-assessment, and computer training during residency should be improved.
Jwayyed Sharhabeel; Park Tammy K; Blanda Michelle; Wilber Scott T; Gerson Lowell W; Meerbaum Sharon O; Beeson Michael S
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2002
2002-02
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.1553-2712.2002.tb00231.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2002.tb00231.x</a>
Outcomes of Patients With Syncope and Suspected Dementia.
80 and Over; Aged; Dementia – Diagnosis – In Old Age; Dementia – Risk Factors; Dementia – Therapy; Emergency; Human; Iatrogenic Disease; Inpatients; Interviews; Length of Stay; Middle Age; Office Visits; Outcome Assessment; Outcomes (Health Care); Patient Assessment; Patient Discharge; Physicians; Prospective Studies; Surveys; Syncope – Diagnosis; Syncope – In Old Age; Syncope – Mortality
OBJECTIVES: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. METHODS: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. RESULTS: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. CONCLUSIONS: Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.
Holden Timothy R; Shah Manish N; Gibson Tommy A; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2018
2018-03
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/acem.13414" target="_blank" rel="noreferrer noopener">10.1111/acem.13414</a>
Altered mental status in older emergency department patients.
Aged; Emergency Service; Hospital/*statistics & numerical data; Humans; Incidence; Mental Disorders/diagnosis/*epidemiology; Mental Status Schedule; United States/epidemiology
This article reviews the significance of altered mental status in older emergency department patients. Specific diagnoses are discussed, including delirium, stupor and coma, and dementia, with a focus on delirium. Finally, an approach to all older patients is suggested that should result in increased clinician comfort with older patients, improved ability to communicate with other physicians, increased quality of care, and improved patient and family satisfaction.
Wilber Scott T
Emergency medicine clinics of North America
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/10.1016/j.emc.2006.01.011" target="_blank" rel="noreferrer noopener">10.1016/j.emc.2006.01.011</a>
Optimal older adult emergency care: Introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.
*Practice Guidelines as Topic; Aged; AMERICAN College of Emergency Physicians; AMERICAN Geriatrics Society; ELDER care; EMERGENCY medical services; EMERGENCY medical services – Standards; EMERGENCY medicine; Emergency Medicine – Standards; Emergency Medicine/*standards; EMERGENCY Nurses Association; Emergency Service; Emergency Service – Standards; GERIATRICS; Geriatrics – Standards; Geriatrics/*standards; HEALTH care teams; Hospital/standards; Humans; Interdisciplinary Communication; Interprofessional Relations; Medical; Medical Organizations; MEDICAL protocols; OLD age; PATIENTS; Practice Guidelines; QUALITY assurance; Societies; SOCIETY for Academic Emergency Medicine (U.S.); United States
Carpenter Christopher R; Bromley Marilyn; Caterino Jeffrey M; Chun Audrey; Gerson Lowell W; Greenspan Jason; Hwang Ula; John David P; Lyons William L; Platts-Mills Timothy F; Mortensen Betty; Ragsdale Luna; Rosenberg Mark; Wilber Scott T
Annals of emergency medicine
2014
2014-05
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.annemergmed.2014.03.002" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2014.03.002</a>
Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes.
Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode. METHODS: This study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of
Chang Anna Marie; Hollander Judd E; Su Erica; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
The American journal of emergency medicine
2018
2018-08
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/10.1016/j.ajem.2018.08.004" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2018.08.004</a>
Frailty defined by the SHARE Frailty Instrument and adverse outcomes after an ED visit.
*Emergency Medical Services; *Frail Elderly; 80 and over; 80 and Over; Activities of Daily Living; Aged; Emergency Medical Services; Emergency Service; Female; Frail Elderly; Geriatric Assessment – Methods; Geriatric Assessment/*methods; Health Screening; Hospital; Humans; Longitudinal Studies; Male; Mass Screening; Prospective Studies
Stiffler Kirk A; Wilber Scott T; Frey Jennifer; McQuown Colleen M; Poland Scott
The American journal of emergency medicine
2016
2016-12
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/10.1016/j.ajem.2016.09.001" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2016.09.001</a>
Noncontrast abdomen/pelvis computed tomographic scan in the evaluation of older adults.
*Contrast Media; *Tomography; Abdomen; Abdomen/*diagnostic imaging; Abdominal Pain – Etiology; Abdominal Pain/*etiology; Aged; Contrast Media; Humans; Pelvis; Pelvis/*diagnostic imaging; Retrospective Design; Retrospective Studies; Tomography; X-Ray Computed – Methods; X-Ray Computed/methods
McQuown Colleen M; Frey Jennifer A; Wilber Scott T
The American journal of emergency medicine
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/10.1016/j.ajem.2016.08.011" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2016.08.011</a>
Evaluation of ED patient and visitor understanding of living wills and do-not-resuscitate orders.
*Emergency Service; *Health Knowledge; *Living Wills; *Resuscitation Orders; *Visitors to Patients; 80 and over; 80 and Over; Aged; Attitude to Health; Attitudes; Emergency Service; Hospital; Humans; Living Wills; Practice; Questionnaires; Resuscitation Orders; Surveys and Questionnaires; Visitors to Patients
Bhalla Mary Colleen; Ruhlin Michael U; Frey Jennifer A; Wilber Scott T
The American journal of emergency medicine
2015
2015-03
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/10.1016/j.ajem.2014.10.030" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2014.10.030</a>
Weakness and fatigue in older ED patients in the United States.
80 and over; 80 and Over; Aged; Cross Sectional Studies; Cross-Sectional Studies; Demography; Fatigue – Diagnosis; Fatigue – Epidemiology; Fatigue/diagnosis/*epidemiology; Female; Health Care Surveys; Human; Humans; Male; Muscle Weakness – Diagnosis; Muscle Weakness – Epidemiology; Muscle Weakness/diagnosis/*epidemiology; Prevalence; Surveys; United States; United States/epidemiology
BACKGROUND: The objectives of this study are to estimate the prevalence of weakness and fatigue visits in older emergency department (ED) patients, to compare demographics and resource use in these patients with those without these complaints, and to determine their ED diagnoses and disposition. METHODS: We performed a cross-sectional cohort analysis of ED visits in patients aged older than 65 years from the 2003 to 2007 National Hospital Ambulatory Medical Care Surveys. Weakness and fatigue visits had a reason for visit code of generalized weakness (1020.0) or tiredness and exhaustion (1015.0); the comparison cohort lacked these codes. Descriptive data are presented as totals, means, and proportions with 95% confidence intervals (CIs). Comparisons between cohorts used chi(2) for proportions and the adjusted Wald test for means. RESULTS: There were an estimated 575 million ED visits, those aged 65 years and older made 14.7% (95% CI, 14.2-15.3) of visits. Overall, 6.0% (95% CI, 5.6-6.4) of these visits had weakness and fatigue; this was the fifth most common primary reason for visit. Weakness and fatigue visits increased with age. Weakness and fatigue visits had longer ED lengths of stay (300 vs 249 minutes, P \textless .001), more diagnostic tests (7.7 vs 5.0, P \textless .001), procedures (5.7 vs 4.7, P \textless .001), and hospital admissions (55% vs 35%, P \textless .001). The most common primary diagnoses for the weakness and fatigue cohort were "other malaise and fatigue," pneumonia, and urinary tract infection. CONCLUSION: Weakness and fatigue are common in older ED patients. These patients undergo more tests and procedures, and most are admitted.
Bhalla Mary Colleen; Wilber Scott T; Stiffler Kirk A; Ondrejka Jason E; Gerson Lowell W
The American journal of emergency medicine
2014
2014-11
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/j.ajem.2014.08.027" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2014.08.027</a>
Predictors of epinephrine autoinjector needle length inadequacy.
*Needles; Adolescence; Adolescent; Adult; Anaphylaxis – Drug Therapy; Anaphylaxis/*drug therapy; Body Mass Index; Cross Sectional Studies; Cross-Sectional Studies; Epinephrine – Administration and Dosage; Epinephrine/*administration & dosage; Equipment Design; Equipment Failure; Female; Human; Humans; Injections; Intramuscular – Equipment and Supplies; Intramuscular/instrumentation; Male; Middle Age; Middle Aged; Needles; Prospective Studies; Quadriceps Muscle/*anatomy & histology/diagnostic imaging; Quadriceps Muscles – Anatomy and Histology; Quadriceps Muscles – Ultrasonography; Sex Factors; Sympathomimetics – Administration and Dosage; Sympathomimetics/*administration & dosage; Ultrasonography; Young Adult
BACKGROUND: Self-administered epinephrine is the primary out-of-hospital treatment of anaphylaxis. Intramuscular injection of epinephrine results in higher peak plasma concentration than subcutaneous injection. With the prevalence of obesity, autoinjectors may not have an adequate needle length for intramuscular injection. OBJECTIVES: To measure muscle depth and evaluate predictors of autoinjector needle length inadequacy. METHODS: We performed a prospective cross-sectional study of a convenience sample of low acuity emergency department patients aged 18 to 55 years. We recorded demographic data, measured thigh circumference, and calculated body mass index (BMI). Using ultrasound, we took depth-to-muscle measurements of the vastus lateralus in a standing position, with and without gentle pressure to simulate muscle compression that occurs with correct autoinjector use. We conducted univariate analyses using chi(2) and t tests with P
Bhalla Mary Colleen; Gable Brad D; Frey Jennifer A; Reichenbach Matthew R; Wilber Scott T
The American journal of emergency medicine
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/10.1016/j.ajem.2013.09.001" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2013.09.001</a>
Home modification to prevent falls by older ED patients.
Accidental Falls/*prevention & control; Accidents; Aged; Female; Home/*prevention & control; Humans; Male; Prospective Studies; Safety
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.
Gerson Lowell W; Camargo Carlos A Jr; Wilber Scott T
The 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>