scholarly journals P122: Emergency department length of stay for alcohol intoxicated patients presenting with head injury

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S119
Author(s):  
C. Varner ◽  
S.L. McLeod ◽  
C. Thompson ◽  
B. Borgundvaag
Keyword(s):  
Emergency Department ◽  
Randomized Controlled Trial ◽  
Head Injury ◽  
Length Of Stay ◽  
Alcohol Intoxication ◽  
Controlled Trial ◽  
Care Hospital ◽  
Randomized Controlled ◽  
Ed Visits ◽  
Study Inclusion

Introduction: Excessive consumption of alcohol is associated with harm and responsible for up to 30% of emergency department (ED) visits. ED visits and length of stay (LOS) related to alcohol intoxication have increased over the last decade. The objective of this study was to compare the ED LOS of alcohol intoxicated and non-alcohol intoxicated patients presenting to the ED with acute head injury. Methods: This was a nested cohort analysis of patients screened for enrollment in a randomized controlled trial assessing minor traumatic brain injury (MTBI) discharge instructions in the ED of an academic tertiary care hospital (annual census 65,000). Patients aged 18 to 64 years presenting to the ED with a Canadian Emergency Department Information System (CEDIS) chief complaint of a head injury or suspected concussion occurring within 24 hours were eligible for study inclusion. Patients were identified as acutely intoxicated by their treating clinical providers. ED LOS for patients acutely intoxicated and those not intoxicated was compared using a Mann-Whitney U test using the Hodges-Lehmann method. Proportional differences were assessed using chi-square statistics. Results: A total of 164 patients were included in the analysis, 46 (28.0%) intoxicated and 118 (72.0%) not intoxicated. Median (IQR) ED LOS was 2.9 (1.5, 6.6) hours for intoxicated and 1.8 (1.3, 2.9) hours for non-intoxicated patients (Δ1.1 hours; 95% CI: 0.4, 1.8). Arrival by ambulance was higher in the intoxicated (73.9%) compared to the non-intoxicated (29.7%) group (Δ44.3%; 95% CI: 27.6, 57.1). Patients were more likely to have experienced assault in the intoxicated (34.8%) compared to the non-intoxicated (6.8%) group (Δ28.0%; 95% CI: 14.5, 42.8). There no difference in the proportion of patients who arrived after daytime hours, had a brain computed tomography, received analgesia in the ED, had another traumatic injury or had a history of psychiatric illness. Conclusion: One third of patients screened for a randomized controlled trial for MTBI were deemed ineligible for study inclusion due to acute alcohol intoxication. Alcohol intoxication was associated with prolonged ED LOS. Future studies specifically aimed at identifying factors that impact care on this frequent ED patient population are needed.

scholarly journals LO45: Does the use of point of care ultrasonography improve survival in emergency department patients with undifferentiated hypotension? The first Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHOC-ED1) Study; an international randomized controlled trial

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S43
Author(s):  
P.R. Atkinson ◽  
J. Milne ◽  
L. Diegelmann ◽  
H. Lamprecht ◽  
M. Stander ◽  
...  
Keyword(s):  
Emergency Department ◽  
Randomized Controlled Trial ◽  
Length Of Stay ◽  
Diagnostic Accuracy ◽  
Standard Care ◽  
Primary Outcome ◽  
Point Of Care ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Secondary Outcomes

Introduction: Point of care ultrasound (PoCUS) is an established tool in the initial management of patients with undifferentiated hypotension in the emergency department (ED). While PoCUS protocols have been shown to improve early diagnostic accuracy, there is little published evidence for any mortality benefit. We report the findings from our international multicenter randomized controlled trial, assessing the impact of a PoCUS protocol on survival and key clinical outcomes. Methods: Recruitment occurred at 7 centres in North America (4) and South Africa (3). Scans were performed by PoCUS-trained physicians. Screening at triage identified patients (SBP<100 or shock index>1), randomized to PoCUS or control (standard care and no PoCUS) groups. Demographics, clinical details and study findings were collected prospectively. Initial and secondary diagnoses were recorded at 0 and 60 minutes, with ultrasound performed in the PoCUS group prior to secondary assessment. The primary outcome measure was 30-day/discharge mortality. Secondary outcome measures included diagnostic accuracy, changes in vital signs, acid-base status, and length of stay. Categorical data was analyzed using Fishers test, and continuous data by Student T test and multi-level log-regression testing. (GraphPad/SPSS) Final chart review was blinded to initial impressions and PoCUS findings. Results: 258 patients were enrolled with follow-up fully completed. Baseline comparisons confirmed effective randomization. There was no difference between groups for the primary outcome of mortality; PoCUS 32/129 (24.8%; 95% CI 14.3-35.3%) vs. Control 32/129 (24.8%; 95% CI 14.3-35.3%); RR 1.00 (95% CI 0.869 to 1.15; p=1.00). There were no differences in the secondary outcomes; ICU and total length of stay. Our sample size has a power of 0.80 (α:0.05) for a moderate effect size. Other secondary outcomes are reported separately. Conclusion: This is the first RCT to compare PoCUS to standard care for undifferentiated hypotensive ED patients. We did not find any mortality or length of stay benefits with the use of a PoCUS protocol, though a larger study is required to confirm these findings. While PoCUS may have diagnostic benefits, these may not translate into a survival benefit effect.

scholarly journals Barriers to recruitment into a randomized controlled trial comparing two modes of emergency department-initiated palliative care 

2020 ◽  
Author(s):  
Julia A Brickey ◽  
Mara Flannery ◽  
Allison M Cuthel ◽  
Jeanne Cho ◽  
Corita R. Grudzen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Randomized Controlled Trial ◽  
Care Delivery ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Time Period ◽  
Ed Visits ◽  
Study Designs

Abstract Background: Emergency department (ED) visits among older adults are common near the end of life. Palliative care has been shown to reduce ED visits and to increase quality of life among patients, but recruitment into these programs is often challenging. Methods: Research coordinators monitored factors that prevented enrollment into a multi-site randomized controlled trial investigating two modes of community-based palliative care delivery for patients in the ED who are discharged home. Reasons for non-participation were documented and analyzed to identify themes within refusal data. Results: Enrollment rate across all sites was 45%. Of the 504 eligible patients who refused to participate, 237 (47.0%) refused due to barriers related to illness severity. Patients commonly refused due to misconceptions/stigma related to palliative care (123 [24.4%]). One-hundred forty-three patients (28.4%) refused due to the mode of palliative care delivery. Less commonly, patients refused due to general research barriers (16.5%), family/caregiver barriers (11.7%), and physician-related barriers (.1%). Discussion: Patients with advanced illnesses often refuse to participate in palliative care research due to the severity of their illness, misconceptions about palliative care, and the mode of care delivery. Robust training programs are crucial to overcome these misconceptions and to educate patients and providers about the role of palliative care. Future palliative care programs and study designs should recognize the burden this vulnerable population endures and consider alternative modes of care delivery in an effort to increase participation and enrollment. Clinical Trials Registration: NCT03325985, October 30, 2017, https://clinicaltrials.gov/ct2/show/NCT03325985Trial Time Period: March 28, 2018 – January 31, 2020

scholarly journals Asthma in Adolescents: A Randomized, Controlled Trial of an Asthma Program for Adolescents and Young Adults with Severe Asthma

2002 ◽  
Vol 9 (4) ◽  
pp. 253-259 ◽  
Author(s):  
Robert L Cowie ◽  
Margot F Underwood ◽  
Cinde B Little ◽  
Ian Mitchell ◽  
Sheldon Spier ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Randomized Controlled Trial ◽  
Asthma Control ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Randomized Controlled ◽  
Disease Specific

BACKGROUND: Asthma is common and is often poorly controlled in adolescent subjects.OBJECTIVE: To determine the impact of an age-specific asthma program on asthma control, particularly on exacerbations of asthma requiring emergency department treatment, and on the quality of life of adolescents with asthma.METHODS: The present randomized, controlled trial included patients who were 15 to 20 years of age and had visited emergency departments for management of their asthma. The interventional group attended an age-specific asthma program that included assessment, education and management by a team of asthma educators, respiratory therapists and respiratory physicians. In the control group, spirometry was performed, and the patients continued to receive usual care from their regular physicians. The outcomes were assessed by a questionnaire six months after entry into the study.RESULTS: Ninety-three subjects entered the study and were randomly assigned to the intervention or control group. Of these, only 62 patients were available for review after six months. Subjects in both the control and the intervention groups showed a marked improvement in their level of asthma control, reflected primarily by a 73% reduction in the rate of emergency department attendance for asthma. Other indexes of disease control, including disease-specific quality of life, as assessed by questionnaires, were improved. There was, however, no discernible difference between the subjects in the two groups, with the exception of an improvement in favour of the intervention group in the symptom (actual difference 0.7, P=0.048) and emotional (actual difference 0.8, P=0.028) domains of the asthma quality of life questionnaire. The overall quality of life score favoured the intervention group by a clinically relevant difference of 0.6, but this difference did not reach statistical significance (P=0.06).CONCLUSIONS: Although all subjects demonstrated a significant improvement in asthma control and quality of life, the improvement attributable to this intervention was limited to two domains in disease-specific quality of life.

scholarly journals Impact of a Triage Liaison Physician on Emergency Department Overcrowding and Throughput: A Randomized Controlled Trial

2007 ◽  
Vol 14 (8) ◽  
pp. 702-708 ◽  
Author(s):  
Brian R. Holroyd ◽  
Michael J. Bullard ◽  
Karen Latoszek ◽  
Debbie Gordon ◽  
Sheri Allen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Emergency Department Overcrowding ◽  
Randomized Controlled
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