The immune checkpoints storm in COVID‐19: Role as severity markers at emergency department admission

Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.

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Variation in Emergency Department Admission Rates in US Children’s Hospitals

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2015.01.033 ◽

2015 ◽

Vol 48 (3) ◽

pp. 404

Author(s):

Cara Bergamo

Keyword(s):

Emergency Department ◽

Children's Hospitals ◽

Emergency Department Admission ◽

Admission Rates ◽

Children’S Hospitals

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Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity

Diagnosis ◽

10.1515/dx-2015-0028 ◽

2016 ◽

Vol 3 (1) ◽

pp. 23-30 ◽

Cited By ~ 5

Author(s):

James Eames ◽

Arie Eisenman ◽

Richard J. Schuster

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Medical Center ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Admission Diagnosis ◽

Mortality And Morbidity ◽

Emergency Department Admission ◽

Icu Length Of Stay ◽

Discordant Group

AbstractPrevious studies have shown that changes in diagnoses from admission to discharge are associated with poorer outcomes. The aim of this study was to investigate how diagnostic discordance affects patient outcomes.: The first three digits of ICD-9-CM codes at admission and discharge were compared for concordance. The study involved 6281 patients admitted to the Western Galilee Medical Center, Naharyia, Israel from the emergency department (ED) between 01 November 2012 and 21 January 2013. Concordant and discordant diagnoses were compared in terms of, length of stay, number of transfers, intensive care unit (ICU) admission, readmission, and mortality.: Discordant diagnoses was associated with increases in patient mortality rate (5.1% vs. 1.5%; RR 3.35, 95% CI 2.43, 4.62; p<0.001), the number of ICU admissions (6.7% vs. 2.7%; RR 2.58, 95% CI 2.07, 3.32; p<0.001), hospital length of stay (3.8 vs. 2.5 days; difference 1.3 days, 95% CI 1.2, 1.4; p<0.001), ICU length of stay (5.2 vs. 3.8 days; difference 1.4 days, 95% CI 1.0, 1.9; p<0.001), and 30 days readmission (14.11% vs. 12.38%; RR 1.14, 95% CI 1.00, 1.30; p=0.0418). ED length of stay was also greater for the discordant group (3.0 vs. 2.9 h; difference 8.8 min; 95% CI 0.1, 0.2; p<0.001): These findings indicate discordant admission and discharge diagnoses are associated with increases in morbidity and mortality. Further research should identify modifiable causes of discordance.

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Correction to: Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study

European Radiology Experimental ◽

10.1186/s41747-021-00215-3 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Cristian Giuseppe Monaco ◽

Federico Zaottini ◽

Simone Schiaffino ◽

Alessandro Villa ◽

Gianmarco Della Pepa ◽

...

Keyword(s):

Emergency Department ◽

Severity Score ◽

X Ray ◽

Emergency Department Admission ◽

Centre Study ◽

Chest X Ray

An amendment to this paper has been published and can be accessed via the original article.

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Prospective Validation of a Checklist to Predict Short‐term Death in Older Patients After Emergency Department Admission in Australia and Ireland

Academic Emergency Medicine ◽

10.1111/acem.13664 ◽

2018 ◽

Vol 26 (6) ◽

pp. 610-620 ◽

Cited By ~ 4

Author(s):

Magnolia Cardona ◽

Michael O'Sullivan ◽

Ebony T. Lewis ◽

Robin M. Turner ◽

Frances Garden ◽

...

Keyword(s):

Emergency Department ◽

Older Patients ◽

Short Term ◽

Emergency Department Admission

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Variation In Emergency Department Admission Rates Among Medicare Patients: Does The Physician Matter?

Health Affairs ◽

10.1377/hlthaff.2020.00670 ◽

2021 ◽

Vol 40 (2) ◽

pp. 251-257

Author(s):

Peter B. Smulowitz ◽

A. James O’Malley ◽

Lawrence Zaborski ◽

J. Michael McWilliams ◽

Bruce E. Landon

Keyword(s):

Emergency Department ◽

Emergency Department Admission ◽

Admission Rates ◽

Medicare Patients

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Abstract 257: Cutting Down the Lag- an Assessment of the Delay in the House Staff’s Evaluation of an Admission

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.257 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Jason G Kaplan ◽

Arjun Kanwal ◽

John Berquist ◽

Samuel Eis ◽

Rabia Zahid ◽

...

Keyword(s):

Emergency Department ◽

Response Time ◽

Current System ◽

Lag Time ◽

P Value ◽

Post Intervention ◽

Emergency Department Admission ◽

Admission Time ◽

Evaluation Time ◽

The Mean

Background: At this institution, a delay occurs between the time the emergency department admits a patient and the admitting service’s evaluation of the patient. Since the emergency department is run on paper charting, the current system, at night, involves the emergency department writing a name and a diagnosis in the emergency department’s admission book. The night residents’ job is to admit teaching patients to the teaching service. The current system requires the night resident to physically go to the emergency department and look in the admissions book to find out about a new admission. This lack of communication can cause a great delay in evaluation of a new admission, which can be problematic. The catalyst for this study was an adverse event where a stroke was missed in the emergency department and the patient was not evaluated by the admitting service for 15 hours falling well outside the tPA window. Decreasing the delay in thorough evaluation is crucial in proper treatment of many cardiovascular conditions, which are time sensitive and can potentially prevent a catastrophic outcome. Intervention: Residents on the admitting service will be first asked to document their evaluation time without intervention, which will be documented with the emergency department admission time to establish a baseline. In addition to the current system of manually checking the admissions book in the emergency department, the ward clerk will page the night staff when new admissions are written in the book. Residents on the admitting service will then document their evaluation time with this new intervention, along with the emergency department admission time. The goal of this new system is to decrease the time the patient is waiting to be evaluated by the admitting service. Results: The mean lag time pre-intervention (N=20) was 73 minutes with a range of 0-279 minutes. Post-intervention (N=25) the mean lag time was 82 minutes with a range of 5- 337 minutes. The P-value of this study was 0.707. Residents on the admitting service were very compliant with documenting their evaluation times. Admitting residents did note the pages were inconsistent and were often missed. The rate of pages successfully sent out was not documented. Conclusion: The lag time before and after intervention was not found to be statistically significant. Pages were inconsistently sent out but did not impact the internal validity of the study. Since the study tested if paging the on-call residents improved the delay in evaluation, the ability to reliably send the page is as important as the response time. The paging system in this study was used as an augmentation to the current system out of some trepidation that pages could be missed and thus negatively impacting the response time. Due to the statistically insignificant data, it can be concluded that the paging system made no impact on the response time patients were seen by the admitting residents.

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