Multivariate analysis of the impact of weather and air pollution on emergency department visits for unprovoked seizure among children: A retrospective clinical observational study

Introduction: Air pollution is associated with adverse health outcomes. However, its impact on emergency health services is less well understood. We investigated the impact of air pollution on nation-wide emergency department (ED) visits and hospital admissions to public hospitals in Singapore. Materials and Methods: Anonymised administrative and clinical data of all ED visits to public hospitals in Singapore from January 2010 to December 2015 were retrieved and analysed. Primary and secondary outcomes were defined as ED visits and hospital admissions, respectively. Conditional Poisson regression was used to model the effect of Pollutant Standards Index (PSI) on each outcome. Both outcomes were stratified according to subgroups defined a priori based on age, diagnosis, gender, patient acuity and time of day. Results: There were 5,791,945 ED visits, of which 1,552,187 resulted in hospital admissions. No significant association between PSI and total ED visits (Relative risk [RR], 1.002; 99.2% confidence interval [CI], 0.995–1.008; P = 0.509) or hospital admissions (RR, 1.005; 99.2% CI, 0.996–1.014; P = 0.112) was found. However, for every 30-unit increase in PSI, significant increases in ED visits (RR, 1.023; 99.2% CI, 1.011–1.036; P = 1.24 × 10˗6) and hospital admissions (RR, 1.027; 99.2% CI, 1.010–1.043; P = 2.02 × 10˗5) for respiratory conditions were found. Conclusion: Increased PSI was not associated with increase in total ED visits and hospital admissions, but was associated with increased ED visits and hospital admissions for respiratory conditions in Singapore. Key words: Epidemiology, Healthcare utilisation, PSI, Public health, Time series

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Multivariate analysis of the impact of weather and air pollution on emergency department visits for night-time headaches among children: retrospective, clinical observational study

BMJ Open ◽

10.1136/bmjopen-2020-046520 ◽

2021 ◽

Vol 11 (4) ◽

pp. e046520

Author(s):

Hiroshi Yamaguchi ◽

Kandai Nozu ◽

Shinya Ishiko ◽

Hiroaki Nagase ◽

Takeshi Ninchoji ◽

...

Keyword(s):

Emergency Department ◽

Air Pollution ◽

Multivariate Analysis ◽

Poisson Regression ◽

Positive Relationship ◽

Emergency Department Visits ◽

Night Time ◽

Mean Temperature ◽

Number Of Patients ◽

Kobe City

ObjectivesTo examine the association between the number of visits to the emergency department (ED) by children for night-time headaches and exposure to multifaceted factors, such as meteorological conditions and air pollution.DesignWe conducted a clinical observational time-series analysis study.SettingWe reviewed consecutive patients younger than 16 years of age at the primary ED centre in Kobe city, Japan, during the night shift (19:30–7:00 hours) between 1 January 2011 and 31 December 2019.ParticipantsIn total, 265 191 children visited the ED; 822 presented with headache during the study period.Primary outcome measuresWe investigated the effects of meteorological factors and air pollutants by multivariate analysis of Poisson regression estimates. A subanalysis included the relationship between the number of patients with night-time headaches and the above factors by sex. Furthermore, the effect of typhoon landing on patient visits for headache was also analysed. Headache was not classified because examinations were performed by general paediatricians (non-specialists).ResultsThe number of patients with night-time headaches displayed distinct seasonal changes, with peaks during the summer. Multivariate analysis of Poisson regression estimates revealed a significant positive relationship between the number of patients for headache and mean temperature. Subanalysis by sex indicated a positive relationship between the number of patients with headache and mean temperature in both sexes; however, it was significant only for females. No relationship was found between the number of patients with headache and air pollution. There was no change in the number of patients for night-time headaches 3 days before and after typhoon landing.ConclusionsHigh temperature is the main factor for visiting ED for night-time headaches among children in Kobe city. Our results suggest that preventive measures against night-time headaches may be possible by reducing time spent outside during summer.

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The impact of urgent care centers on nonemergent emergency department visits

Health Services Research ◽

10.1111/1475-6773.13631 ◽

2021 ◽

Author(s):

Lindsay Allen ◽

Janet R. Cummings ◽

Jason M. Hockenberry

Keyword(s):

Emergency Department ◽

Emergency Department Visits ◽

Urgent Care ◽

Urgent Care Centers ◽

The Impact

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Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design

BMC Health Services Research ◽

10.1186/s12913-021-06557-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Axel Kaehne ◽

Paula Keating

Keyword(s):

Emergency Department ◽

Service Use ◽

Emergency Department Visits ◽

Service Utilisation ◽

Specific Patient ◽

Access Points ◽

Latent Demand ◽

Frequent Attenders ◽

Cohort Design ◽

The Impact

Abstract Background Emergency department (ED) attendances are contributing to rising costs of the National Health Service (NHS) in England. Critically assessing the impact of new services to reduce emergency department use can be difficult as new services may create additional access points, unlocking latent demand. The study evaluated an Acute Visiting Scheme (AVS) in a primary care context. We asked if AVS reduces overall ED demand and whether or not it changed utilisation patterns for frequent attenders. Method The study used a pre post single cohort design. The impact of AVS on all-cause ED attendances was hypothesised as a substitution effect, where AVS duty doctor visits would replace emergency department visits. Primary outcome was frequency of ED attendances. End points were reduction of frequency of service use and increase of intervals between attendances by frequent attenders. Results ED attendances for AVS users rose by 47.6%. If AVS use was included, there was a more than fourfold increase of total service utilisation, amounting to 438.3%. It shows that AVS unlocked significant latent demand. However, there was some reduction in the frequency of ED attendances for some patients and an increase in time intervals between ED attendances for others. Conclusion The study demonstrates that careful analysis of patient utilisation can detect a differential impact of AVS on the use of ED. As the new service created additional access points for patients and hence introduces an element of choice, the new service is likely to unlock latent demand. This study illustrates that AVS may be most useful if targeted at specific patient groups who are most likely to benefit from the new service.

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Different levels of care for follow-up of adults with congenital heart disease: a cost analysis scrutinizing the impact on medical costs, hospitalizations, and emergency department visits

The European Journal of Health Economics ◽

10.1007/s10198-021-01300-5 ◽

2021 ◽

Author(s):

Ruben Willems ◽

◽

Fouke Ombelet ◽

Eva Goossens ◽

Katya De Groote ◽

...

Keyword(s):

Emergency Department ◽

Congenital Heart Disease ◽

Heart Disease ◽

Cost Analysis ◽

Congenital Heart ◽

Emergency Department Visits ◽

Levels Of Care ◽

The Impact ◽

Different Levels

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Emergency department visits for dental problems among adults with private dental insurance: A national observational study

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.02.001 ◽

2021 ◽

Vol 44 ◽

pp. 166-170

Author(s):

Troy B. Amen ◽

Inkyu Kim ◽

Gregory Peters ◽

Alba Gutiérrez-Sacristán ◽

Nathan Palmer ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Emergency Department Visits ◽

Dental Insurance

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Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

Injury Epidemiology ◽

10.1186/s40621-021-00308-y ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Lauren Alexis De Crescenzo ◽

Barbara Alison Gabella ◽

Jewell Johnson

Keyword(s):

Public Health ◽

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Interrupted Time Series ◽

Emergency Department Visits ◽

Control And Prevention ◽

Icd 10 ◽

Ed Visits ◽

The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

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COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic Referrals

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.101 ◽

2020 ◽

Vol 47 (5) ◽

pp. 693-696 ◽

Cited By ~ 12

Author(s):

Maria Bres Bullrich ◽

Sebastian Fridman ◽

Jennifer L. Mandzia ◽

Lauren M. Mai ◽

Alexander Khaw ◽

...

Keyword(s):

Emergency Department ◽

Stroke Prevention ◽

Stroke Unit ◽

Emergency Department Visits ◽

Related Factors ◽

Hospital Policies ◽

The Government ◽

Stroke Center ◽

The Impact ◽

Prevention Clinic

Abstract:We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.

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