The relationship between admission glucose and lactate with critical illness amongst adult patients presenting to the emergency department

Introduction: It is critical for planning, clinical care and resource optimization to understand patterns of emergency department (ED) utilization. Individuals who have experienced adverse childhood experiences (ACE) are known to have more unhealthy behaviors and worse health outcomes as adults and therefore may be more frequent ED users. Adverse childhood experiences include physical, sexual and emotional abuse or neglect, substance abuse in the family, witnessing violence, having a parent incarcerated or parents getting divorced or separated. To date there are few studies exploring the relationship between ACE and ED utilization. Methods: This a mixed qualitative and quantitative study. It includes analysis of data collected through a survey, a retrospective chart review and focus group discussions. The survey was administered to a convenience sample of adult patients (CTAS 2 -5) presenting to EDs in Kingston Ontario, and consisted of two validated tools that measured exposure to ACE and resiliency. Demographic data and ED utilization frequency for 12 months prior to the index visit were extracted from an electronic medical record for each patient completing the survey. A sample of participants with a high ACE burden (ACE score > 4) were invited to participate in focus groups to explore their experiences of care in the ED. Demographic, ED utilization and health status data were summarized and statistically significant patterns between high ACE and lower ACE patients were determined using Chi2t or t-tests. Transcripts from the focus groups were thematically analyzed using NVivo software by 2 independent researchers. Results: 1693 surveys were collected, 301 (18%) were deemed to have a high ACE score, data analysis is ongoing. The primary outcome is the relationship between ACE and the frequency of ED utilization among adult patients presenting to EDs in Kingston, ON. Secondary outcomes include evaluating the role of resilience as a potential mitigating factor, describing the demographics of high ACE burden frequent ED visitors, and the experiences of care for individuals with high ACE burden in the ED. These outcomes will be utilized to inform hypotheses for future studies and potential interventions aimed at optimizing ED utilization and patient care experience. Conclusion: This study provides novel insight into the relationship between ACE burden and ED utilization while also describing the demographics and experiences of care for ED patients with a high ACE score. Data analysis is on-going.

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Faculty Opinions recommendation of Critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected pulmonary embolism.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718012076.793477097 ◽

2013 ◽

Author(s):

Rashmi Kothari

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Adult Patients ◽

Suspected Pulmonary Embolism ◽

Critical Issues

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Asthma as a comorbidity in adult patients receiving treatment in an emergency department, ambulatory surgery and inpatient for back pain in a large, inner city, municipal New York hospital.

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2018.12.683 ◽

2019 ◽

Vol 143 (2) ◽

pp. AB224

Author(s):

Nneoma Obiejemba ◽

Obinna Obiejemba ◽

Sairaman Nagarajan ◽

Roshni Naik ◽

Rauno Joks

Keyword(s):

Emergency Department ◽

New York ◽

Back Pain ◽

Inner City ◽

Ambulatory Surgery ◽

Adult Patients ◽

York Hospital

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Covid-19 and acute conjunctivitis: Controversial data from a tertiary refferral Italian center

European Journal of Ophthalmology ◽

10.1177/1120672121991049 ◽

2021 ◽

pp. 112067212199104

Author(s):

Giuseppe D’Amico Ricci ◽

Claudia Del Turco ◽

Elena Belcastro ◽

Marco Palisi ◽

Mario R Romano ◽

...

Keyword(s):

Emergency Department ◽

Odds Ratio ◽

Signs And Symptoms ◽

Time Span ◽

Nasopharyngeal Swab ◽

Eye Disorders ◽

Eye Examination ◽

The Relationship ◽

Acute Conjunctivitis ◽

Piedmont Region

Purpose: Although acute conjunctivitis has been listed from the beginning as a possible sign of COVID-19, the likelihood of this association remains unclear. The aim of this study was to investigate the relationship between COVID-19 and conjunctivitis. Methods: In this retrospective, observational study, we recruited all patients with signs and symptoms of acute conjunctivitis seen at the Eye Emergency Department (ED), Turin Eye Hospital, between 01/01/2020 and 12/05/2020 and cross-checked our data with the Piedmont Region online COVID-19 registry in the same period. Results: Among 10,065 patients seen at our ED during the timespan considered, 88 underwent a nasopharyngeal swab (NS) for SARS-CoV-2 detection within 4 weeks before/after our examination. On average, NS was performed −0.72 ± 1.8 weeks before/after eye examination. Of the 77 patients with a negative NS, 26 (33.8%) had a diagnosis of acute conjunctivitis, whereas the remaining 51 (66.2%) had other eye disorders. Among the 11 patients with COVID-19, 7 (63,6%) had a diagnosis of acute conjunctivitis. We found a non-statistically significant increase in NS positivity rate (21.2%) among cases examined at our ED for acute conjunctivitis, compared to the NS positivity rate (7.3%) in patients examined for all other eye conditions ( p = 0.092). The Odds Ratio of having a positive NS in patients with acute conjunctivitis was 3.43 (95% I.C. = 0.9–12.8, p = 0.06). Considering online-registry data of Turin population during the same time-span, among 2441 positive NS cases only 27 (1.1%) presented with acute conjunctivitis. Conclusion: Our results do not reveal a statistically significant correlation between COVID-19 and acute conjunctivitis. Synopsis The present study analyzes retrospectively data from a tertiary eye referral center to investigate the relationship between COVID-19 infection and conjunctivitis.

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Interpreting Anion Gap Values in Adult and Pediatric Patients: Examining the Reference Interval

The Journal of Applied Laboratory Medicine ◽

10.1373/jalm.2019.029496 ◽

2019 ◽

Vol 5 (1) ◽

pp. 126-135

Author(s):

Nadia Ayala-Lopez ◽

Roa Harb

Keyword(s):

Emergency Department ◽

Intensive Care ◽

Pediatric Patients ◽

Reference Interval ◽

Adult Patients ◽

Anion Gap ◽

Moderate Degree ◽

New Haven ◽

Repeated Testing ◽

Median Percent Change

Abstract Background The anion gap is primarily used in the diagnosis of acid-base disorders. We conducted a study to determine the anion gap reference interval in our patient population, investigated the workup of abnormal vs normal anion gaps, and examined the anion gap variation upon repeated testing. Methods A retrospective review was performed on 17137 adult and pediatric patients who presented to Yale-New Haven Hospital outpatient clinics, emergency department, or intensive care units between 2012 and 2017. Results We derived a new reference interval of 7 to 18 mmol/L with a median of 13 mmol/L in healthy adults with no significant differences owing to partitioning by sex or age. Based on the new reference interval, 5%, 23%, and 18% of healthy, emergency department, and intensive care unit adult patients, respectively, were misclassified as having high values with the previous interval of 6 to 16 mmol/L. However, there were no significant differences in the number of tests ordered in patients with anion gaps above and below the upper limit of the previous reference interval. The majority of increased anion gaps that were repeated normalized by 12 h. In a subgroup of healthy adult patients with annual testing, the median percent change in each patient's anion gap from 2015 to 2016 was approximately 13%. Conclusions The anion gap should be used with an appropriate reference interval to avoid misclassification. There may be a moderate degree of individuality that argues for comparing the anion gap with its baseline value in the same patient pending further studies that formally derive its biological variation.

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