Associations among emergency room visits, parenting styles, and psychopathology among pediatric patients with sickle cell

The hallmarks of sickle cell disease are anemia and vasculopathy. The aim of this study was to assess the association between air pollution and children's emergency room visits of sickle cell patients. We adopted a case-crossover design. Daily counts of children's and adolescents' sickle cell disease emergency room visits from the pediatric emergency unit in São Paulo, Brazil, were evaluated from September 1999 to December 2004, matching by temperature, humidity and controlling for day of the week. Interquartile range increases of the four-day moving averages of PM10, NO2, SO2, CO, and O3 were associated with increases of 18.9% (95%CI: 11.2-26.5), 19% (95%CI: 8.3-29.6), 14.4% (95%CI: 6.5-22.4), 16,5% (95%CI: 8.9-24.0), and 9.8% (95%CI: 1.1-18.6) in total sickle cell emergency room visits, respectively. When the analyses were stratified by pain, PM10 was found to be 40.3% higher than in sickle cell patients without pain symptoms. Exposure to air pollution can affect the cardiovascular health of children and may promote a significant health burden in a sensitive group.

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Effectiveness of a Regional Poison Center in Reducing Excess Emergency Room Visits for Children's Poisonings

PEDIATRICS ◽

10.1542/peds.72.2.164 ◽

1983 ◽

Vol 72 (2) ◽

pp. 164-169 ◽

Cited By ~ 1

Author(s):

Claire Chafee-Bahamon ◽

Frederick H. Lovejoy

Keyword(s):

Emergency Room ◽

Hospital Care ◽

Pediatric Patients ◽

Effective Means ◽

Poison Center ◽

Emergency Room Visits ◽

Emergency Rooms ◽

Poison Centers ◽

Hospital Visits ◽

The Impact

A study was done to assess the necessity of hospital care for poisoning episodes in children less than 5 years old and to evaluate the impact of a regional poison center on the use of emergency rooms for pediatric poisonings. Of the pediatric patients seen in emergency rooms for acute poisonings, 63% did not require the services of a hospital; 95% did not contact the regional poison center before going to the hospital. When all poisoning episodes were considered, the regional poison center was found to reduce significantly pediatric visits to emergency rooms. Of parents who did not call the poison center, 44% went to an emergency room whereas less than 1% of parents who called the poison center went to a hospital (P < .001). Moreover, 28% of those who did not call made unnecessary visits to the hospital compared with only 0.5% of parents who called the poison center (P < .001). A regional poison center was found to be an effective means of decreasing unnecessary hospital visits for pediatric poisonings. Regional poison centers, however, need to further their impact by addressing outreach efforts to parents who do not call poison centers, emergency rooms, and pediatricians.

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Increased Outpatient Care Can Reduce Hospital Stays for Sickle Cell Patients

Blood ◽

10.1182/blood.v126.23.5578.5578 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5578-5578

Author(s):

Danny A. Landau ◽

Kaitlyn Steininger ◽

Erica Landis

Keyword(s):

Emergency Room ◽

Sickle Cell ◽

Conflicts Of Interest ◽

Length Of Hospital Stay ◽

Hospital Charge ◽

Pain Medication ◽

Emergency Room Visits ◽

Hospital Stays ◽

The Cost ◽

Hospital Days

Abstract Introduction: Sickle cell disease is associated with frequent hospitalizations and emergency room visits when patients enter vasooclusive crisis. This is associated with lengthy hospitalization that can be time life interrupting for patients, increase hospital cost, and limit bed availability for other patients. Some patients with sickle cell have higher inpatient requirements than others due to the frequency of crisis. Recognizing the issues associated with this, we began scheduling patients for frequent outpatient IV fluids and pain medication to try and prevent ER visits and lengthy hospital stays. We are reporting the experience of three of our patients who have had the most frequent hospitalizations and emergency room visits. Methods: Patients who had the highest rate of hospitalizations and emergency room visits were offered regular outpatient intravenous and pain medication during the week (up to four times per week) on an as needed basis. Chairs were reserved for these purposes so on demand therapy could be offered without significant delays. The number of ER visits and hospital stays were counted from 12 months before and 12 months after we started offering this. For one of the three patients, data on length of hospital stay could not be accurately determined due to a lengthy hospitalization for infection rather than sickle cell pain crisis, but his emergency room visits were still counted. Basic hospitalization cost for daily hospital charge was also considered, but additional costs such as drug administration, diet, imaging, etc. were not. Results: In the 12 months prior to starting regular outpatient IV fluids, there were 48 aggregate emergency room visits compared to 26 in the 12 months after, a reduction of 38%. Inpatient hospital days before were 91 before and 46 post (49%). Cost for hospital days were reduced from $224497 to $113480 (49%). Conclusion: While offering more outpatient support to our sickle cell patients with the highest hospital demand, we can cut hospital days in half, and limit ER visits and also reduce the cost for inpatient care. Increasing outpatient support, when feasible, should be considered for sickle cell patients who require regular hospitalizations. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

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Economic Burden of Sickle Cell Disease among Children and Adults.

Blood ◽

10.1182/blood.v110.11.958.958 ◽

2007 ◽

Vol 110 (11) ◽

pp. 958-958 ◽

Cited By ~ 2

Author(s):

Abraham G. Hartzema ◽

Teresa L. Kauf ◽

Thomas D. Coates ◽

Liu Huazhi ◽

Nakita Mody-Patel

Keyword(s):

Sickle Cell Disease ◽

Emergency Room ◽

Medical Care ◽

Resource Utilization ◽

Sickle Cell ◽

Economic Burden ◽

Medical Costs ◽

Emergency Room Visits ◽

Cell Disease ◽

The Cost

Abstract Background: The economic burden of sickle cell disease (SCD) has not been determined. Cost-of-care estimates improve health care planning, inform research priorities, and contribute to an understanding of the cost-effectiveness of new SCD treatments. The objectives of this study were examine resource utilization in the Florida Medicaid population; to estimate the cost of medical care for SCD patients; and to examine the proportion of medical care costs attributable to SCD versus other morbidities. Methods: Pediatric (0 – 19 years; y) and adult (> 20 y) patients with a diagnosis of SCD between 1/2001–12/2005 were identified from Florida Medicaid claims. Patients with at least 1 inpatient or 2 outpatient SCD claims at least 30 days apart and ≥6 Medicaid-eligible months, not necessarily consecutive, were included in the analysis. Medicaid administrative data consist of medical and pharmacy utilization and reimbursement claims for medically-needy and low-income recipients. Resource utilization and costs were estimated using paid claims for hospitalizations, emergency room visits, outpatient visits, pharmacy claims, and other care (blood transfusions, hydroxyurea, iron chelation, serum ferritin tests). Claims containing a primary or secondary ICD-9 code indicating SCD were considered “SCD-related”; all other claims were classified as “non-SCD-related”. Individuals aged >65 y and/or dually eligible for Medicare or other health insurance were excluded. Annualized costs were estimated by multiplying mean cost per patient-month by 12. All costs were inflated to 2005 US$ using the medical care component of the Consumer Price Index. Results: A total of 4,294 individuals met study inclusion criteria. Mean age at first claim was 14.5 y (range: 0–64 y; SD 13.2); 55.8% were female; 79.1% African-American. Mean SCD-related costs for pediatric (0–9 y) and adolescent (10–19 y) patients were estimated at $5,292 and $11,508 per year, respectively. Overall, 66% of total medical costs were related to SCD. The distribution of SCD-related costs was bimodal, with the youngest (0–9 y) and oldest (50–64 y) having the lowest proportion of SCD-related costs (53.7% and 35.3%, respectively). Non-SCD-related costs increased with age, ranging from $4,548 annually for ages 0–9 to $16,656 for ages 50–64. While SCD accounted for the largest proportion of total medical costs for patients 10–19 y (77.27%; $11,508), absolute SCD costs were highest for patients 30–39 y (67.1%; $21,792). Cost distributions were similar for males and females. Hospitalizations accounted for 80.5% of all SCD-related costs; emergency room visits, 3.2%; office visits, 0.9%; outpatient drugs, 3.6%; other medical care, 11.7%. Total discounted medical costs (3%) for a SCD patient from birth through age 45 were estimated at $448,460, with 67% of costs related to SCD. Conclusion: Our results suggest that the burden of SCD is substantial. Moreover, non-SCD-related medical costs for SCD patients are considerably higher than expenditures reported for the general US population. While our results reflect the payer’s perspective, the clinical, humanistic, and economic burden of care on individual patients also is likely high. Interventions designed to prevent SCD complications and keep patients out of the hospital may reduce the significant economic burden of the disease.

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Effects of Environmental Changes on Emergency Rooms Visits for Adult Sickle Cell Disease

Blood ◽

10.1182/blood.v128.22.4861.4861 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4861-4861

Author(s):

Samip Master ◽

Abhishek Patel ◽

Richard Preston Mansour

Keyword(s):

Sickle Cell Disease ◽

Emergency Room ◽

Adult Patient ◽

Sickle Cell ◽

Acute Pain ◽

Emergency Room Visit ◽

Environmental Changes ◽

Emergency Room Visits ◽

Cell Disease ◽

Weather Changes

Background: Acute pain crises from vaso occlusive episodes are major cause of morbidity, hospitalization and emergency room visits for patients with sickle cell disease. Major causes of acute painful crises have been attributed to dehydration, infections and fever. Weather change has also been attributed as one of the major cause of acute pain crises by physicians and patients. Data on effects of environmental changes on acute pain crises in patients with sickle cell disease is mixed. Here we report our investigation to see if number of emergency room visits for adult patients with SCD were associated with environmental changes. Method: At our hematology clinic we take care of around 300 adult patients with SCD and we have on average around 11,000 emergency room visit per years from these patients. Electronically from EHR (Electronic health Record), we pulled out data on number of emergency room visit every day for adult patient with SCD in year 2015.We also gathered data on daily environmental changes from a national weather website for the year 2015 and collected data on daily temperature changes, humidity and precipitation/rain in our area. We did analysis to see if there was any correlation between the weather changes and emergency room visit. Results: As shown in graphs below, there was no correlation between the number of ER visits and weather changes in adult patient with SCD. Conclusion: Our analysis showed that there was no correlation between number of ER visit for adult patient with SCD and weather changes like -temperature, humidity and precipitation/rain. ER Visits and Precipitation ER visits, temperature and humidity Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

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All-Cause Health Care Resource Utilization in Individuals with Sickle Cell Disease

Blood ◽

10.1182/blood.v126.23.5582.5582 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5582-5582

Author(s):

Jigar Rajpura ◽

Joseph Thomas

Keyword(s):

Health Care ◽

Sickle Cell Disease ◽

Emergency Room ◽

Sickle Cell ◽

Health Care Resource ◽

Emergency Room Visits ◽

Cell Disease ◽

Term Care ◽

Outpatient Visits ◽

Hospital Days

Abstract Introduction Clinical manifestations of Sickle Cell Disease (SCD) range from frequent fatigue and anemia to severe complications involving multiple organs. We estimated all cause health care resource utilization in individuals with SCD as compared to individuals without SCD. Methods Data from the Truven multi-state Medicaid claims database were used for all analyses. Sample inclusion criteria was being enrolled in covered health plan from January 1, 2012 through December 31, 2012. A cohort of individuals with SCD was identified based on having at least one inpatient or two or more outpatient claims with ICD-9-CM codes for sickle-cell thalassemia without crisis (282.41), sickle-cell thalassemia with crisis (282.42), Sickle-cell disease, unspecified (282.60), Sickle-cell-S disease without crisis (282.61), Sickle-Cell-S disease with crisis (282.62), Sickle-cell-C disease without crisis (282.63), Sickle-cell-C disease with crisis (282.64), other sickle-cell disease without crisis (282.68), or other sickle-cell disease with crisis (282.69). From the continuously enrolled individuals, a cohort of individuals without SCD was identified by matching individuals with SCD one-to-one on age, gender, and ethnicity. Means and 95 percent confidence intervals were calculated for, number of hospitalizations, hospital days, long term care visits, long term care days, emergency room visits, and outpatient visits. Wilcoxon Mann-Whitney test was employed to assess differences in health care resource utilizations in individuals with and without SCD. Results Among 5,136,748 individuals covered in the study period, 8,652 individuals with SCD were identified and matched to 8,652 individuals without SCD. Majorities of the study sample were black (74%), female (54%), and under 24 years old (64%). Mean annual hospitalizations among individuals with SCD were 1.39 (95 percent C.I.: 1.3 to 1.4, <0.001) as compared to 0.10 (95 percent C.I.: 0.09 to 0.1, p<0.001) hospitalizations in persons without SCD. Mean annual outpatient visits in individuals with SCD were 24.7 (95 percent C.I.: 23.9 to 25.5, p<0.001) as compared to 14.18 (95 percent C.I.: 13.4 to 14.9, p<0.001) outpatient visits in persons without SCD, and, mean annual emergency room visits in individuals with SCD were 3.71 (95 percent C.I.: 3.5 to 3.9, p<0.001) as compared to 0.89 (95 percent C.I.: 0.8 to 0.9, p<0.001) emergency room visits in persons without SCD. Conclusions SCD was associated with higher annual hospitalizations, hospital days, outpatient visits and emergency room visits as compared to individuals without SCD. Disclosures Rajpura: Pfizer Inc.: Research Funding. Thomas:Pfizer Inc.: Research Funding.

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Epidemiological aspects of respiratory symptoms treated in the emergency room of a tertiary care hospital

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132013000200007 ◽

2013 ◽

Vol 39 (2) ◽

pp. 164-172 ◽

Cited By ~ 3

Author(s):

Denise Rossato Silva ◽

Vinícius Pellegrini Viana ◽

Alice Mânica Müller ◽

Ana Cláudia Coelho ◽

Gracieli Nadalon Deponti ◽

...

Keyword(s):

Emergency Room ◽

Respiratory Symptoms ◽

Pediatric Patients ◽

Tertiary Care ◽

Epidemiological Studies ◽

University Hospital ◽

Care Hospital ◽

Emergency Room Visits ◽

Prevention Measures ◽

Cross Sectional

OBJECTIVE: To evaluate the prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients, describing the major clinical syndromes diagnosed and the outcomes of the patients. METHODS: A cross-sectional study conducted in the emergency room of a tertiary care university hospital. Between November of 2008 and November of 2009, we reviewed the total number of emergency room visits per day. Children and adults who presented with at least one respiratory symptom were included in the study. The electronic medical records were reviewed, and the major characteristics of the patients were recorded. RESULTS: During the study period, there were 37,059 emergency room visits, of which 11,953 (32.3%) were motivated by respiratory symptoms. The prevalence of emergency room visits due to respiratory symptoms was 28.7% and 38.9% among adults and children, respectively. In adults, the rates of hospitalization and mortality were 21.2% and 2.7%, respectively, compared with 11.9% and 0.3%, respectively, in children. Among the adults, the time from symptom onset to emergency room visit correlated positively with the need for hospitalization (p < 0.0001), the length of the hospital stay (p < 0.0001), and the mortality rate (p = 0.028). CONCLUSIONS: We found a high prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients. Our results could inform decisions regarding the planning of prevention measures. Further epidemiological studies are needed in order to clarify the risk factors for severe respiratory symptoms.

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Increased Patient Activation Is Associated with Fewer Emergency Room Visits and Hospitalizations for Pain in Adults with Sickle Cell Disease

Pain Medicine ◽

10.1093/pm/pny194 ◽

2018 ◽

Cited By ~ 3

Author(s):

Robert M Cronin ◽

Tim Lucas Dorner ◽

Amol Utrankar ◽

Whitney Allen ◽

Mark Rodeghier ◽

...

Keyword(s):

Sickle Cell Disease ◽

Emergency Room ◽

Sickle Cell ◽

Patient Activation ◽

Emergency Room Visits ◽

Cell Disease

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A Patient Event Diary Improves Self-Management In Pediatric Sickle Cell Disease Patients

Blood ◽

10.1182/blood.v122.21.1723.1723 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1723-1723

Author(s):

Jennifer Alison Busse ◽

Kranthi Nandan Seelaboyina ◽

Grace Malonga ◽

Thomas Moulton

Keyword(s):

Vitamin D ◽

Chronic Illness ◽

Sickle Cell Disease ◽

Emergency Room ◽

Patient Outcomes ◽

Sickle Cell ◽

Self Management ◽

Emergency Room Visits ◽

Cell Disease ◽

One Year

Abstract Introduction Promotion of chronic illness self-management is crucial to improve outcomes of children with sickle cell disease (SCD). Improvements in patient outcomes and quality of life as well as enhancement in health literacy and patient agency are also imperative. Through an event diary developed by the Bronx Lebanon Hospital Sickle Cell Program, our pediatric SCD patients are better able to track significant health events and health care appointments. This study seeks to validate the effectiveness of the patient event diary as a tool for improvement in self management, allowing for improvement in medication and clinic visit compliance, as well as in a reduction in number of emergency room visits. Additionally, the education section at the beginning of the diary has become an integral teaching tool and reference for patients and their families. It is our hypothesis that the event diary as an educational tool, a self management tool, and a tool for providers, will lead to better management of chronic illness and improved patient outcomes. Methods We utilized laboratory and demographic data from the Bronx Lebanon Hospital Center patient electronic medical record between July 2011 and July 2013. Our sample included a population of 50 sickle cell disease patients aged 0 to 21, median age being 7 years. Sickle cell disease types included SS (64%), SC (32%), Sβ+ thalassemia and Sβ0thalassemia (4%). We used a paired, two tailed t-test to assess patients’ medication compliance on vitamin D (22 patients) and hydroxyurea (14 patients) through 25-hydroxyvitamin D (25-OHD) and MCV (mean corpuscular volume) levels, respectively. Increased MCV was used as a proxy to indicate improved medication compliance in patients on hydroxyurea. We compared patients on hydroxyurea and vitamin D six months before receiving the event diary and six months after. Additionally, we compared compliance with hematology clinic visits one year before and one year after receiving the event diary. We also compared the number emergency room visits during the year before and the year after patients received the event diary. Results 25-OHD data from six months after receiving the event diary showed significantly improved compliance with vitamin D treatment (M = 47, SD = 20) as compared to six months before receiving the event diary (M = 26, SD = 15), t(20) = 2.1, p < 0.05. Additionally, there was a statistically significant improvement in MCV levels six months after receiving the event diary (M=101.6, SD=9.6), as opposed to six months before receiving it (M=97.7, SD=5.6), t(12)=2.2, p<0.05. When looking at patient hematology clinic appointment compliance, there was an improvement, however not statistically significant, in compliance with appointments between one year before (M=33.3%, SD=41.7%) and one year after patients received the event diary (M= 27.2%, SD=30.3%), t(17)=2.1, p=0.2. Emergency department visits did decrease, however not significantly, one year before receiving the event diary (M=1.8, SD=2.5) to one year after receiving the event diary (M= 1.3, SD=1.9), t(47)=2.0, p=0.17. Conclusions These data suggest the patient event diary has significantly improved patient self-management. We believe this effect is due to enhanced understanding of disease processes and increased confidence and skills in self-management of the disease. There is improved compliance with hydroxyurea and vitamin D, as well as a trend toward improvement in clinic visit compliance and decreased emergency room visits. The patient event diary is crucial to improved patient outcomes in the pediatric SCD population, and may be useful for other pediatric populations with chronic illness. It is a significant part of our current practice and our ability to teach and empower patients and their families to manage sickle cell disease while at home. Additionally, this tool allows for better management of patients by providers. The event diary helps to elucidate difficulties in patient self-management and gives better insight into complications patients are experiencing at home. In the future, we hope to see that with improved patient knowledge of sickle cell disease and self-management facilitated by use of the event diary, there will be significantly fewer emergency room visits, fewer hospital admissions, and most important, quality of life. Disclosures: Moulton: HRSA: Research Funding; New York State Grant: Research Funding.

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