Patient Characteristics of Persons Dead on Arrival Received in a Danish Emergency Department: A Retrospective Review of Health Records

Introduction: Patients with diabetes who are in emerging adulthood, defined as the life stage between 18-29 years, have unique challenges in managing their illness and are at risk of acute complications and loss to follow-up. The studys objective was to describe emergency department (ED) utilization for hyperglycemia in emerging adults with diabetes and to characterize 30-day outcomes including return visits and admission for hyperglycemia. Methods: This was a health records review of emerging adults presenting over a one-year period to four tertiary care EDs with a diagnosis of hyperglycemia, diabetic ketoacidosis or hyperosmolar hyperglycemic state. Research personnel collected data on patient characteristics, treatment, disposition, and determined if patients returned to the ED for hyperglycemia within 30 days. Descriptive statistics were used to summarize the data where appropriate. Results: There were 185 ED encounters for hyperglycemia, representing 116 unique emerging adult patients. Mean (SD) age was 23 (3.5) years and 50.9% were female. 80 (69.0%) had known type 1 diabetes, 11 (9.5%) had type 2, and 25 (21.5%) were newly diagnosed in the ED. Of 185 visits, 98 (53.0%) resulted in hospital admission. 56 (30.3%) returned to the ED for hyperglycemia within 30 days of their initial encounter, and 21 (11.4%) resulted in admission on this subsequent visit. Conclusion: We characterized ED utilization and 30-day outcomes of emerging adults with diabetes for hyperglycemia. Future research should focus on earlier identification of those at higher risk for recurrent ED visits or admission and the efficacy of interventions to prevent these adverse outcomes.

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Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab047 ◽

2021 ◽

Author(s):

Karoline Stentoft Rybjerg Larsen ◽

Marianne Lisby ◽

Hans Kirkegaard ◽

Annemette Krintel Petersen

Keyword(s):

Emergency Department ◽

Electronic Patient Record ◽

Hospital Admissions ◽

Functional Decline ◽

Patient Characteristics ◽

Risk Of Death ◽

Record Data ◽

Emergency Department Patients ◽

One Year ◽

Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

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Characteristics of Parkinson’s Disease in Patients with and without Cognitive Impairment

Journal of Parkinson s Disease ◽

10.3233/jpd-202190 ◽

2021 ◽

pp. 1-12

Author(s):

Julie Chandler ◽

Radhika Nair ◽

Kevin Biglan ◽

Erin A. Ferries ◽

Leanne Munsie ◽

...

Keyword(s):

Parkinson’S Disease ◽

Emergency Department ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Memory Loss ◽

Patient Characteristics ◽

Emergency Department Visits ◽

Administrative Claims ◽

Newly Diagnosed ◽

Comorbidity Burden

Background: Characterizing patients with Parkinson’s disease (PD) and cognitive impairment is important toward understanding their natural history. Objective: Understand clinical, treatment, and cost characteristics of patients with PD pre- and post-cognitive impairment (memory loss/mild cognitive impairment/dementia or dementia treatment) recognition. Methods: 2,711 patients with PD newly diagnosed with cognitive impairment (index) were identified using administrative claims data. They were matched (1:1) on age and gender to patients with PD and no cognitive impairment (controls). These two cohorts were compared on patient characteristics, healthcare resource utilization, and total median costs for 3 years pre- and post-index using Chi-square tests, t-tests, and Wilcoxon rank-sum tests. Logistic regression was used to identify factors predicting cognitive impairment. Results: Comorbidity indices for patients with cognitive impairment increased during the 6-year study period, especially after the index. Enrollment in Medicare Advantage Prescription Drug plans vs. commercial (OR = 1.60), dual Medicare/Medicaid eligibility (OR = 1.36), cerebrovascular disease (OR = 1.24), and PD medication use (OR = 1.46) were associated with a new cognitive impairment diagnosis (all p < 0.05). A greater proportion of patients with cognitive impairment had hospitalizations and emergency department visits and higher median total healthcare costs than controls for each year pre- and post-index. Conclusion: In patients with PD newly diagnosed with cognitive impairment, comorbidity burden, hospitalizations, emergency department visits, and total costs peaked 1-year pre- and post-identification. These data coupled with recommendations for annual screening for cognitive impairment in PD support the early diagnosis and management of cognitive impairment in order to optimize care for patients and their caregivers.

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Retrospective review of dog bite injuries in children presenting to a South Australian tertiary children's hospital emergency department

Journal of Paediatrics and Child Health ◽

10.1111/jpc.12642 ◽

2014 ◽

Vol 50 (10) ◽

pp. 791-794 ◽

Cited By ~ 18

Author(s):

Su C Chiam ◽

Nicholas S Solanki ◽

Michelle Lodge ◽

Malcolm Higgins ◽

Anthony L Sparnon

Keyword(s):

Emergency Department ◽

Retrospective Review ◽

Hospital Emergency Department ◽

Dog Bite ◽

Hospital Emergency ◽

Children's Hospital ◽

Children’S Hospital ◽

Bite Injuries

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Over-the-Counter Medication Prescribing in a Pediatric Emergency Department: Health Records Review

Journal of Emergency Nursing ◽

10.1016/j.jen.2021.09.003 ◽

2021 ◽

Author(s):

Cassandra Faye Newell ◽

LeChelle DeLea Nelson

Keyword(s):

Emergency Department ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Over The Counter ◽

Health Records ◽

Counter Medication ◽

Medication Prescribing

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Electronic health records in ambulances: the ERA multiple-methods study

Health Services and Delivery Research ◽

10.3310/hsdr08100 ◽

2020 ◽

Vol 8 (10) ◽

pp. 1-140

Author(s):

Alison Porter ◽

Anisha Badshah ◽

Sarah Black ◽

David Fitzpatrick ◽

Robert Harris-Mayes ◽

...

Keyword(s):

Emergency Department ◽

Health Services ◽

Electronic Health Records ◽

Case Studies ◽

Routine Data ◽

Health Economy ◽

Multiple Methods ◽

Health Records ◽

Electronic Health ◽

Future Work

Background Ambulance services have a vital role in the shift towards the delivery of health care outside hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department. The introduction of information technology in ambulance services to electronically capture, interpret, store and transfer patient data can support out-of-hospital care. Objective We aimed to understand how electronic health records can be most effectively implemented in a pre-hospital context in order to support a safe and effective shift from acute to community-based care, and how their potential benefits can be maximised. Design and setting We carried out a study using multiple methods and with four work packages: (1) a rapid literature review; (2) a telephone survey of all 13 freestanding UK ambulance services; (3) detailed case studies examining electronic health record use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and (4) a knowledge-sharing workshop. Results We found limited literature on electronic health records. Only half of the UK ambulance services had electronic health records in use at the time of data collection, with considerable variation in hardware and software and some reversion to use of paper records as services transitioned between systems. The case studies found that the ambulance services’ electronic health records were in a state of change. Not all patient contacts resulted in the generation of electronic health records. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the electronic health records. Ambulance clinicians continued to use indirect data input approaches (such as first writing on a glove) even when using electronic health records. The primary function of electronic health records in all services seemed to be as a store for patient data. There was, as yet, limited evidence of electronic health records’ full potential being realised to transfer information, support decision-making or change patient care. Limitations Limitations included the difficulty of obtaining sets of matching routine data for analysis, difficulties of attributing any change in practice to electronic health records within a complex system and the rapidly changing environment, which means that some of our observations may no longer reflect reality. Conclusions Realising all the benefits of electronic health records requires engagement with other parts of the local health economy and dealing with variations between providers and the challenges of interoperability. Clinicians and data managers, and those working in different parts of the health economy, are likely to want very different things from a data set and need to be presented with only the information that they need. Future work There is scope for future work analysing ambulance service routine data sets, qualitative work to examine transfer of information at the emergency department and patients’ perspectives on record-keeping, and to develop and evaluate feedback to clinicians based on patient records. Study registration This study is registered as Health and Care Research Wales Clinical Research Portfolio 34166. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 10. See the NIHR Journals Library website for further project information.

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Qualitative and quantitative analysis of emergency department cardiac arrest publications

10.22514/10.22514/sv.2021.209 ◽

2021 ◽

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Prediction Models ◽

Patient Characteristics ◽

Research Direction ◽

Medical Emergency ◽

Aggregated Data ◽

Academic Publications ◽

Relationship Of ◽

Hospital Cardiac Arrest

Cardiac arrest is a medical emergency with a poor prognosis. Patient characteristics and outcomes are associated with location and are traditionally categorized into out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). Increasing evidence has revealed that cardiac arrest occurring in the emergency department is distinct from OHCA or IHCA in other locations in hospitals, but most academic publications combine these populations and apply the knowledge arising from OHCA or IHCA to patients with emergency department cardiac arrest (EDCA). The aim of this study was to identify the research direction of EDCA in the past 20 years and to analyze the characteristics and content of academic publications. We searched the MEDLINE and EMBASE databases for eligible articles until May 30, 2021. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data underwent a scoping review and analyzed qualitatively and quantitatively. In total, 52 original articles investigating EDCA were included; only 15 articles simply focused on EDCA, while other articles involved OHCA or IHCA simultaneously. There were 3 articles discussing the relationship of overcrowdedness and EDCA, 12 articles for prediction and risk factors associated with EDCA, 15 articles for epidemiology and prognosis, and 22 articles for specific diagnostic or resuscitation skills with regard to EDCA. Studies focusing on EDCA are increasing but still scarce. Applying the knowledge arising from OHCA or IHCA to EDCA is questionable, and research focused on EDCA is necessary. ED overcrowdedness-associated EDCA and prediction models for EDCA are essential topics that need further investigation.

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Questions to the article: Predicting Unscheduled Emergency Department Return Visits Among Older Adults (Preprint)

10.2196/preprints.32589 ◽

2021 ◽

Author(s):

Shu-Chun Kuo ◽

Tsair-wei Chien ◽

Willy Chou

Keyword(s):

Emergency Department ◽

Decision Tree ◽

Class Imbalance ◽

Patient Characteristics ◽

Small Sample ◽

Clinical Settings ◽

Data Set ◽

Online Module ◽

Study Results ◽

Return Visits

UNSTRUCTURED The article published on 28 July 2021 is well-written and of interest, but remains several questions that are required for clarifications, such as (1) the Figure 1 is too complex to release the decision criteria for predicting unscheduled emergency department return visits (EDRVs); (2) the Table 1 with 11 rules is not succinct for readers to capture the core features of the influencing factors on the unscheduled EDRVs, and (3) the decision tree technique using Weka software did not demonstrate an online module that can be implemented in clinical settings. We suggested three ways to improve the study in methods and illustrated examples presented in previous studies using the decision tree technique. In addition, to solve the problem of class imbalance in data should be combined with an MP4 video(or a Multimedia Appendix) to make readers easily replicate similar research in the future. The patient characteristics and variables deposited in Multimedia Appendix 1 are insufficient. A small sample of data (e.g., one-tenth from the 10-fold cross-validation method to randomly partition the data set into ten subsets in the study) should be provided for readers to verify the decision tree that can yield appropriately 76.65% and 76.95% in sensitivity and specificity, respectively, as did in predicting the unscheduled EDRVs. Otherwise, the study results are doubtable.

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Abstract 309: Prediction Chart for Neurological Outcomes of Elderly Patients with Out-of-hospital Cardiac Arrest and the Corresponding Time to Termination of Resuscitation: Evidence from a Japanese Nationwide Population-based Cohort Study

Circulation ◽

10.1161/circ.142.suppl_4.309 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Akira Funada ◽

Yoshikazu Goto ◽

Masayuki Takamura

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Elderly Patients ◽

Service Providers ◽

Patient Characteristics ◽

Case Scenario ◽

Worst Case ◽

Neurological Outcomes ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Introduction: Neurological outcomes and the appropriate duration from call receipt to termination of resuscitation (TOR) in patients with out-of-hospital cardiac arrest (OHCA) could differ according to patient characteristics. Hypothesis: We hypothesized that a prediction chart comprising prehospital variables, including age, could be useful for predicting neurological outcomes and determining the time to TOR in the field or at the emergency department. Methods: We evaluated 19,829 elderly patients with OHCA (age ≥65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC). Data were obtained from the prospectively recorded All-Japan Utstein Registry between 2011 and 2016. Patients with OHCA witnessed by emergency medical service providers were excluded. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1-2. Patients with OHCA were divided into 12 groups according to shockable rhythm (YES/NO), witness status (YES/NO), and age (65-74, 75-89, or ≥90 years). The time from call receipt to ROSC was calculated and categorized by 5-min intervals. The time from call receipt to ROSC at which the probability of 1-month CPC 1-2 decreased to <1% was defined as the call to TOR duration. Results: The overall 1-month CPC 1-2 rate was 18.9% (n = 3,756). When stratified by patient characteristics, the 1-month CPC 1-2 rates ranged from 52.3% in patients aged 65-74 years with shockable rhythm and witnessed OHCA (best-case scenario) to 1.6% in patients aged ≥90 years with non-shockable rhythm and un-witnessed OHCA (worst-case scenario). The corresponding call to TOR duration ranged from 35 to 10 min (Table). Conclusions: Neurological outcomes and the appropriate call to TOR duration differed according to patient characteristics, including age. Our prediction chart for elderly patients with OHCA could be useful for determining TOR in the field or at the emergency department.

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