Physical examination of psychiatric patients who presented at emergency department in a tertiary care hospital in Sultanate of Oman

2017 ◽  
Vol 41 (S1) ◽  
pp. S335-S335
Author(s):  
S. Alhuseini
Keyword(s):  
Emergency Department ◽  
Physical Examination ◽  
Psychiatric Patients ◽  
Demographic Data ◽  
Tertiary Care ◽  
Vital Signs ◽  
University Hospital ◽  
Psychiatric History ◽  
Care Hospital ◽  
Physical Assessment

ObjectiveTo examine the completeness of physical assessment of patients presenting with psychiatric problems to the emergency department (ED).MethodsThis was observational study based on a retrospective review of the medical records of patients who attended the ED of Sultan Qaboos university hospital and referred to the on-duty psychiatrist for assessment over a 12-month period. All patients aged 16 years and above, who presented to the ED with a psychiatric complaint were included in the study. A data collection sheet was designed to gather each patient's demographic data such as age and gender, past psychiatric history, nature of the presenting complaints, thoroughness of physical assessment, medications prescribed by the ED doctor prior to psychiatric assessment, and whether the patient was discharged, admitted to a psychiatry.ResultsA total of 202 patients met the inclusion criteria. The mean age of the patients was 34.2 years. Females represented 56% of the sample. The majority of the study group (60.4%) were patients with a documented past psychiatric history. Physical examination was conducted in the ED for 61.4% of the patients, while vital signs were recorded for 68.8% of them. Approximately, 31% of the patients required injectable psychotropic medications as tranquillizers in the ED. Patients with an isolated psychiatric complaint coupled with a documented past psychiatric history were more likely to be referred to the on-call psychiatrist without a physical examination by the ED doctors.ConclusionIn our institution, not all patients with psychiatric presentations had a complete physical examination by the ED doctors.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan

2020 ◽  
Vol 36 (6) ◽  
Author(s):  
Noman Ali ◽  
Nadeem Ullah Khan ◽  
Shahid Waheed ◽  
Syed Mustahsan
Keyword(s):  
Emergency Department ◽  
Enteric Fever ◽  
Care Center ◽  
Tertiary Care ◽  
Practical Importance ◽  
University Hospital ◽  
Categorical Variables ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Continuous Variables

Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital. Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever. Results: A total of one hundred and fifty five patients were included. Out of these 97 (62.6%) were males and 58 (37.4%) were females. Most patients (25.2%, n= 39) were diagnosed as malaria followed closely by dengue fever (n=33, 21.3%) and then enteric fever (n= 10, 6.5%). while 41.9% (n=65) were diagnosed as suspected viral fever based on clinical judgment and inconclusive laboratory results. Conclusion: Malaria was found to be the most common confirmed cause of acute undifferentiated fever followed by dengue and enteric fever. The provision of accurate epidemiological data will enable resources to be directed towards key areas and will be of practical importance to clinicians. doi: https://doi.org/10.12669/pjms.36.6.2334 How to cite this:Ali N, Khan NU, Waheed S, Mustahsan S. Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2334 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Explicit Diagnostic Criteria for Transient Ischemic Attacks Used in the Emergency Department Are Highly Sensitive and Specific

2020 ◽  
pp. 1-6
Author(s):  
Carl H. Göbel ◽  
Sarah C. Karstedt ◽  
Thomas F. Münte ◽  
Hartmut Göbel ◽  
Sebastian Wolfrum ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Criteria ◽  
Sensitivity And Specificity ◽  
Clinical Symptoms ◽  
Correct Diagnosis ◽  
Tertiary Care ◽  
High Sensitivity ◽  
University Hospital ◽  
Care Hospital ◽  
Transient Ischemic Attacks

<b><i>Background:</i></b> Making a correct diagnosis of a transient ischemic attack (TIA) is prone to errors because numerous TIA mimics exist and there is a shortage of evidence-based diagnostic criteria for TIAs. In this study, we applied for the first time the recently proposed explicit diagnostic criteria for transient ischemic attacks (EDCT) to a group of patients presenting to the emergency department of a large German tertiary care hospital with a suspected TIA. The aim was to determine the sensitivity and specificity of the EDCT in its clinical application. <b><i>Methods:</i></b> A total of 128 patients consecutively presenting to the emergency department of the University Hospital of Lübeck, Germany, under the suspicion of a TIA were prospectively interviewed about their clinical symptoms at the time of presentation. The diagnosis resulting from applying the EDCT was compared to the diagnosis made independently by the senior physicians performing the usual diagnostic work-up (“gold standard”), allowing calculation of sensitivity and specificity of the EDCT. <b><i>Results:</i></b> EDCT achieved a sensitivity of 96% and a specificity of 88%. When adding the additional criterion F (“the symptoms may not be better explained by another medical or mental disorder”), specificity significantly increased to 98%. <b><i>Conclusions:</i></b> The data show that the EDCT in its modified version as proposed by us are a highly useful tool for clinicians. They display a high sensitivity and specificity to accurately diagnose TIAs in patients referred to the emergency department with a suspected TIA.

scholarly journals The Challenge of Using an Antigen Test as a Screening Tool for SARS-CoV-2 Infection in an Emergency Department: Experience of a Tertiary Care Hospital in Southern Italy

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Daniela Loconsole ◽  
Francesca Centrone ◽  
Caterina Morcavallo ◽  
Silvia Campanella ◽  
Anna Sallustio ◽  
...  
Keyword(s):  
Emergency Department ◽  
Predictive Value ◽  
Demographic Data ◽  
Tertiary Care ◽  
Previous History ◽  
Area Under The Curve ◽  
Care Hospital ◽  
Antigen Test ◽  
Operating Characteristics ◽  
Likelihood Ratios

Background. In emergency hospital settings, rapid diagnosis and isolation of SARS-CoV-2 patients are required. The aim of the study was to evaluate the performance of an antigen chemiluminescence enzymatic immunoassay (CLEIA) and compare it with that of Real-time Reverse transcription-Polymerase Chain Reaction (RT-qPCR), the gold standard assay, to assess its suitability as a rapid diagnostic method for managing patients in the emergency department (ED). Methods. Consecutive patients with no previous history of SARS-CoV-2 infection attending the ED of the Policlinico Hospital of Bari between 23rd October and 4th November 2020 were enrolled. Clinical and demographic data were collected for all patients. Nasopharyngeal swabs collected on admission were subjected both to molecular (RT-qPCR) and antigen (CLEIA) tests for SARS-CoV-2. The performance of the CLEIA antigen test was analyzed using R Studio software and Microsoft Excel. Receiver operating characteristics were also performed. Results. A total of 911 patients were enrolled, of whom 469 (51.5%) were male. Of the whole cohort, 23.7% tested positive for SARS-CoV-2 by RT-qPCR and 24.5% by CLEIA. The overall concordance rate was 96.8%. The sensitivity, specificity, positive predictive value, and negative predictive value of the antigen test were 94.9% (95% CI, 91.9–97.0), 97.4% (95% CI, 96.5–98.1), 91.9% (95% CI, 89.0–94.0), and 98.4% (95% CI, 97.4–99.1), respectively. The area under the curve (AUC) was 0.99. The kappa coefficient was 0.91. The overall positive and negative likelihood ratios were 37 (95% CI 23-58) and 0.05 (95% CI, 0.03–0.09), respectively. Conclusions. Data analysis demonstrated that the antigen test showed very good accuracy for discriminating SARS-CoV-2-infected patients from negative participants. The CLEIA is suitable for rapid clinical diagnosis of patients in hospital settings, particularly in EDs with a high prevalence of symptomatic patients and where a rapid turnaround time is critical. Timely and accurate testing for SARS-CoV-2 plays a crucial role in limiting the spread of the virus.

scholarly journals PNEUMONIA

2018 ◽  
Vol 25 (05) ◽  
pp. 744-748
Author(s):  
Anwar Hussain Abbasi ◽  
Shahab Abid ◽  
Shahab Abid
Keyword(s):  
Acute Stroke ◽  
Economic Transition ◽  
Demographic Data ◽  
Tertiary Care ◽  
Chronic Atrial Fibrillation ◽  
University Hospital ◽  
Care Hospital ◽  
Medical Department ◽  
Risk Of Death ◽  
Number Of Patients

Introduction: Stroke is a major cause of death and disability globally, with anexpected rise in number of patients with ageing and economic transition of developing countries.Pneumonia is one of the major complications after stroke. Stroke associated pneumoniaincreases risk of death by three fold and is the major cause of morbidity and mortality afterthe stroke. Objective: To determine the frequency and factors leading to stroke associatedpneumonia in all acute stroke patients admitted at a tertiary care hospital. Study Design: Caseseries. Setting: Medical Department, Aga Khan University Hospital (AKUH), Karachi. Period:six months and extended from 1st July 2015 to 31st December 2015. Material and methods:All adult patients (age 14 years and above) admitted through emergency room in the medicalward of Aga khan university hospital Karachi with the diagnosis of acute stroke on the basis ofMRI findings were enrolled after taking informed consent through Non purposive consecutivesampling technique. Demographic data like age and sex were recorded. Diagnosis of strokeassociated pneumonia was made on basis of CDC criteria for pneumonia. All analyses wasconducted by using the Statistical package for social science SPSS (Release 19.0, standardversion, copyright © SPSS; 1989-02). Results: A total of 157 patients admitted with a mean ageof the inducted patients were 61.75 ± 13.91 years. According to this stratification, 23 patients(14.65%) were aged less than 45 years and remaining 134 subjects (85.35%) were above theage of 45 years among them 110 were males (70.1 %) and 47 were females (29.9 %). Strokeassociated pneumonia was found in 33 (21%) out of 157 patients. Out of 33 patients havingstroke associated pneumonia; 14 (42.4%) patients had Diabetes mellitus. Out of 33 patientshaving stroke associated pneumonia; 28 (84.8%) patients had hypertension. Out of 33 patientshaving stroke associated pneumonia; 2 (6%) had COPD. Out of 33 patients having strokeassociated pneumonia; 2(6%) had Chronic Atrial Fibrillation. Out of 33 patients having strokeassociated pneumonia; 21 (63.6%) patients had impaired swallowing. Conclusion: Strokeassociated pneumonia is the common and serious complication after stroke. All the effortsshould be taken to control various factors leading to stroke associated pneumonia like DM,hypertension, and impaired swallowing to improve stroke outcome.

scholarly journals Lost diagnoses in not otherwise specified headache in Emergency Department

2021 ◽  
Author(s):  
Antonio Granato ◽  
Laura D’Acunto ◽  
Maria Elisa Morelli ◽  
Giulia Bellavita ◽  
Franco Cominotto ◽  
...  
Keyword(s):  
Emergency Department ◽  
Neurological Diseases ◽  
Demographic Data ◽  
Tertiary Care ◽  
Final Diagnosis ◽  
University Hospital ◽  
Primary Headaches ◽  
Not Otherwise Specified ◽  
Facial Neuralgia ◽  
Precise Diagnosis

Abstract The diagnosis of Not Otherwise Specified (NOS) headaches in the Emergency Department (ED) is frequent despite many specialist visits performed. The aim of the study was to examine specialist visits carried out in the patients discharged from ED with diagnosis of NOS headache to evaluate discrepancies between specialist and ED diagnosis at discharge. We retrospectively (1.6.2018–31.12.2018) analyzed all the patients admitted with non-traumatic headache to the ED of the tertiary-care University Hospital of Trieste. We evaluated the patients discharged from ED with a final diagnosis of NOS headache and who underwent at least one specialist examination. Demographic data, specialist and ED diagnosis were analyzed.  One hundred twenty-four patients (93 F, 31 M, mean age 44 ± 15 years) were included. 71.8% of patients were examined only by a neurologist, 12.9% by non-neurologists, 15.3% by both neurologist and non-neurologist. Only 37% of the patients received a precise diagnosis. Neurologist made a diagnosis slightly more frequently than the other consultants (40.5% vs 37.5%). Neurologists diagnosed primary headaches, headaches secondary to neurological diseases, and facial neuralgia, instead non-neurologists diagnosed only headaches secondary to non-neurological diseases. Primary headaches were diagnosed in 25.7% of cases, migraine being the most frequent. Physicians did not report any specialist diagnoses in the ED discharge sheet. Specialist consultants made specific diagnoses in about one-third of patients that were not reported as final in the discharge records by the ED physician. This leads to a loss of diagnoses and to an overestimation of NOS headache.

scholarly journals Stroke patients presenting to the emergency department of a tertiary care hospital

2021 ◽  
Vol 8 (2) ◽  
pp. 85-90
Author(s):  
Suraj Rijal ◽  
Sunil Adhikari ◽  
Darlene Rose House
Keyword(s):  
Emergency Department ◽  
Demographic Data ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Common Disease ◽  
Care Hospital ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Presenting Symptoms ◽  
Ethical Approval

Introduction: Stroke is one of the most common causes of morbidity and mortality in Nepal. It is the 3rd most common cause of death worldwide. In Nepal Non-communicable diseases in Nepal(NCDs) states that stroke accounts for 42% of all deaths and is estimated to reach about 66.3% of all deaths by 2030. Method: A retrospective cross-sectional study of all stroke patients seen in Patan Hospital Emergency Department for a period of 1 y. Demographic data, presenting complaint, time of onset of symptoms, time presenting to the Emergency, patient’s risk factors for stroke, head CT findings (hemorrhagic or ischemic stroke) were analyzed descriptively. Ethical approval was taken. Result: Total 170 patients (96 males i.e.56.5% and 74 females i.e. 43.5%) were analyzed. 130(76.5%) were ischemic CVA and 40 (23.5%) were hemorrhagic CVA. The most common presenting symptoms was hemiparesis and speech changes. Conclusion: Stroke is a common disease seen in Nepal, with higher percentages of hemorrhagic stroke.

scholarly journals AN OBSERVATIONAL STUDY OF MEDICATION ERRORS AMONG PSYCHIATRIC PATIENTS IN A TERTIARY CARE HOSPITAL

2018 ◽  
Vol 11 (11) ◽  
pp. 340
Author(s):  
Reenu Jose ◽  
Krishnaveni K ◽  
Jesna Maria ◽  
Shanmuga Sundaram R ◽  
Sambathkumar R
Keyword(s):  
Observational Study ◽  
Psychiatric Patients ◽  
Demographic Data ◽  
Tertiary Care ◽  
Clinical History ◽  
Care Hospital ◽  
Male Patients ◽  
The Common ◽  
Psychiatric Department

Objective: The objective of this study is to evaluate the common medication error (ME), and its causes, category, and severity by using suitable questionnaire.Methods: A prospective observational study was carried out for 6 months in a psychiatric department. Demographic data, clinical history, and complete prescription were noted.Results: A total of 120 psychiatric cases were collected, among that 116 MEs were identified in which male patients were 64 (55%) and females 52 (44.8%). The number of MEs occurred due to physician was 67 (57.7%), due to nurses was 15 (12.9%), and combined was 38 (32.7%). Incomplete prescription was the main type of error that we found. About 43.1% of the error we identified was informed to the staff and and no specific action was needed for 37.1% of errors. In our study, we found that majority of 54 (46.5%) errors were categorized under category B, but there was no harm to the patient.Conclusion: The present study concluded that most of the patients admitted in the psychiatry department would experience MEs. Clinical pharmacist can play a major role in the early detection and prevention of MEs and thus can improve the quality of care to the patients.

scholarly journals Developing a Trauma Registry for the Emergency Department of a Tertiary Care Hospital in Egypt: A Step Toward Success

2020 ◽  
Author(s):  
Ahmed A. Khalil ◽  
Maged El-Setouhy ◽  
Jon Mark Hirshon ◽  
Mohamed El-Shinawi
Keyword(s):  
Emergency Department ◽  
Trauma Registry ◽  
Road Traffic ◽  
Tertiary Care ◽  
Eastern Mediterranean Region ◽  
Developed Countries ◽  
Healthcare Systems ◽  
University Hospital ◽  
World Health ◽  
Care Hospital

Abstract Background: Trauma continues to be a common problem affecting global healthcare systems. Accordingly, different types of trauma have been considered major causes of morbidity and mortality with approximately 5 million deaths per year. Road traffic injuries, in particular, have been recognized by the World Health Organization as the sixth leading cause of death in the eastern Mediterranean region. Developed countries have realized the importance of implementing registries across all healthcare systems in order to improve service quality. Unfortunately, Egypt has yet to establish a national trauma registry in its hospitals. Although data banks have been available in a few hospitals, they have been inconsistent. Purpose: The present study aimed at developing a trauma registry for a major tertiary hospital in Cairo. Methods: To this end, data from 202 patients admitted to the emergency department of Ain Shams University Hospital due to trauma were collected. Procedures and actions used were then described to create a trauma registry from January to December 2017. Results: The collected data were statistically analyzed, after which the epidemiological distribution of the trauma patients was described. Accordingly, our results showed that among the included patients, 65% were men, while most were single, illiterate, and unemployed. Thereafter, statistics regarding trauma circumstances were generated. In conclusion, the present study found that hospital trauma registries can be established, are essential for improving the quality of healthcare services, and should be utilized ubiquitously throughout the country’s hospitals in order to establish a national registry.

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