Emergency departments with physician residents are less effective in determining which children require hospital admission

BackgroundChemotherapy-induced diarrhoea (CID) is a common side effect of cancer treatment. While cytotoxic agents are the main cause of CID, targeted drugs, immunotherapy and radiotherapy can also cause diarrhoea. Patients with severe CID often require hospital admission for intravenous fluid resuscitation and supportive treatment. In other patient populations, such as children with infectious diarrhoea, therapy is based on evidence from randomised-controlled clinical trials. In contrast, few trials have investigated CID management, and hence, treatment guidelines are largely based on expert opinion.MethodsWe conducted an online survey on CID management and institutional routines across Europe to obtain a more detailed picture of current practice in CID treatment. We analysed the responses from a total of 156 clinicians from 83 different medical centres in 31 countries.ResultsCID (any grade) is recognised as a common clinical problem in patients undergoing antitumoral treatment and it can require hospital admission in a substantial subgroup of patients. There is a strong consensus among clinicians as to the choice of resuscitation strategies and drug treatment for severe CID; 85.9% (n=134) of all respondents prefer intravenous crystalloid fluids and 95.5% (n=149) routinely use loperamide. In sharp contrast, we have identified disparities in the use of bowel rest in CID; approximately half of all participants (57.7%; n=90) consider bowel rest in initial CID management, while the remainder (42.3%; n=66) does not.ConclusionsAs previous studies have shown that bowel rest is associated with adverse outcomes in diarrhoea due to causes other than chemotherapy, the results from this survey suggest that further research is needed as to its role in CID.

Download Full-text

Does mad honey poisoning require hospital admission?

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2008.03.021 ◽

2009 ◽

Vol 27 (4) ◽

pp. 424-427 ◽

Cited By ~ 21

Author(s):

Abdulkadir Gunduz ◽

Emine Sayın Meriçé ◽

Ahmet Baydın ◽

Murat Topbaş ◽

Hüküm Uzun ◽

...

Keyword(s):

Hospital Admission ◽

Require Hospital Admission ◽

Mad Honey

Download Full-text

Progress in Cheerleading Safety: Update on the Epidemiology of Cheerleading Injuries Presenting to US Emergency Departments, 2010-2019

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211038895 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110388

Author(s):

Amy L. Xu ◽

Krishna V. Suresh ◽

R. Jay Lee

Keyword(s):

Hospital Admission ◽

Emergency Departments ◽

Hospital Admissions ◽

Head Injuries ◽

Injury Rate ◽

The United States ◽

Annual Number ◽

Hospital Admission Rate ◽

Closed Head Injuries ◽

Closed Head

Background: Although the athleticism required of cheerleaders has increased, the risks of cheerleading have been less studied as compared with other sports. Purpose: To update our understanding of the epidemiology of cheerleading-related injuries. Study Design: Descriptive epidemiology study. Methods: We analyzed the National Electronic Injury Surveillance System (NEISS) for cheerleading-related injuries presenting to nationally representative emergency departments (EDs) in the United States from January 2010 through December 2019. Extracted data included patient age and sex, injury characteristics (diagnosis, body region injured, time of year, and location where injury occurred), and hospital disposition. Using patient narratives, we recorded the cheerleading skills, settings, and mechanisms that led to injury. NEISS sample weights were used to derive national estimates (NEs) from actual case numbers. Results: From 2010 to 2019, a total of 9868 athletes (NE = 350,000; 95% CI, 250,000-450,000) aged 5-25 years presented to US EDs for cheerleading injuries. The annual number of injuries decreased by 15%, from 982 (NE = 35,000; 95% CI, 27,000-44,000) to 897 (NE = 30,000; 95% CI, 18,000-42,000) ( P = .048), corresponding to a 27% decline in the injury rate per 100,000 cheerleaders ( P < .01). The annual number of injuries caused by performing stunts decreased by 24%, from 240 (NE = 8700; 95% CI, 6700-11,000) to 216 (NE = 6600; 95% CI, 4000-9200) ( P = .01), with a 36% decline in the corresponding injury rate per 100,000 cheerleaders ( P < .01). Despite these decreases, annual incidence of concussions/closed head injuries increased by 44%, from 128 (NE = 3800; 95% CI, 2900-4700) to 171 (NE = 5500; 95% CI, 3400-7700) ( P = .02), and patients requiring hospital admission increased by 118%, from 18 (NE = 330; 95% CI, 250-410) to 24 (NE = 720; 95% CI, 440-1000) ( P < .01). The hospital admission rate increased by 9.0% ( P = .02). Conclusion: The number of cheerleading-related injuries presenting to US EDs decreased from 2010 to 2019. However, the incidence of concussions/closed head injuries and hospital admissions increased, suggesting that further measures are needed to improve safety for cheerleaders.

Download Full-text

Comparative Effectiveness of Direct Admission & Admission through Emergency Departments for Children: A Randomized Stepped Wedge Study Protocol

10.21203/rs.3.rs-52189/v1 ◽

2020 ◽

Author(s):

JoAnna K. Leyenaar ◽

Corrie E McDaniel ◽

Stephanie Acquilano ◽

Andrew Schaefer ◽

Martha L. Bruce ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hospital Admission ◽

Emergency Departments ◽

Controlled Trial ◽

Healthcare Systems ◽

Care Practice ◽

Stepped Wedge ◽

Randomized Controlled ◽

Experience Of Care ◽

Direct Admission

Abstract Background: Approximately 2 million children are hospitalized each year in the United States, with more than three-quarters of non-elective hospitalizations admitted through emergency departments (EDs). Direct admission, defined as admission to hospital without first receiving care in the hospital’s ED, may offer benefits for patients and healthcare systems in quality, timeliness, and experience of care. While ED utilization patterns are well studied, there is a paucity of research comparing the effectiveness of direct and ED admissions. The overall aim of this project is to compare the effectiveness of a standardized direct admission approach to admission beginning in the ED for hospitalized children.Methods/Design: We will conduct a stepped wedge cluster randomized controlled trial at 3 structurally and geographically diverse hospitals. A total of 70 primary and urgent care practice sites in the hospitals’ catchment areas will be randomized to a time point when they will begin participation in the multi-stakeholder informed direct admission program. This crossover will be unidirectional and occur at 4 time points, six months apart, over a 24-month implementation period. Our primary outcome will be the timeliness of clinical care provision. Secondary outcomes include: (i) parent-reported experience of care; (ii) unanticipated transfer to the intensive care unit within 6 hours of hospital admission; and (iii) rapid response calls within 6 hours of hospital admission. We anticipate that 190 children and adolescents will be directly admitted, with 1506 admitted through EDs. Analyses will compare the effectiveness of direct admission to admission through the ED, and will evaluate the causal effect of implementing a direct admission program using linear regression with random effects for referring practice clusters and time period fixed effects. We will further examine heterogeneity of treatment effects based on hypotheses specified a priori. In addition, we will conduct a mixed-methods process evaluation to assess reach, effectiveness, adoption, implementation and maintenance of our direct admission intervention.Discussion: Our study represents the first randomized controlled trial to compare the effectiveness of direct admission to admission through the ED for pediatric patients. Our scientific approach, pairing a stepped-wedge design with a multi-level assessment of barriers to and facilitators of implementation, will generate valuable data about how positive findings can be reproduced across other healthcare systems.Trial registration: This trial is registered in ClinicalTrials.gov (NCT04192799, registered December 10, 2019, https://clinicaltrials.gov/ct2/show/NCT04192799)

Download Full-text

Prevalence of acute kidney injury in myeloma patients visiting U.S. emergency departments: A nationwide analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e20548 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e20548-e20548

Author(s):

Umar Zahid ◽

Preethi Ramachandran ◽

Lutfi Alasadi ◽

Puneet Bedi ◽

Sergiy Shurin ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Hospital Admission ◽

Hospital Stay ◽

Emergency Departments ◽

Multivariable Analysis ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

National Study ◽

Urban Residents

e20548 Background: Patients diagnosed with multiple myeloma (MM) frequently visit emergency departments (ED) with complications, commonly with kidney disease. However, data regarding the prevalence of acute kidney injury (AKI) and its effects on patient outcome, economic burden, length of hospital stay and mortality among these patients are lacking. Methods: From the Nationwide Emergency Department Sample, we obtained 7-year (2010-2016) data of myeloma patients who visited ED. Baseline characteristics of these patients with and without AKI were compared. The multivariable regression model was used to estimate hospital admission, length of stay, healthcare burden and in-hospital mortality in patients with and without AKI. Results: Between 2010-2016, 657,392 adult myeloma patients visited ED at an increased rate from 35 to 45 per 100,000 census population. The prevalence of AKI was 22.5% (n = 147,743) with a stable trend over the study period. AKI was more common in patients with relapsed MM (33.5%) than those in remission (18.6%) or never achieving remission (22.4%) (P < 0.001), male (24.1 vs 20.6% in female, P < 0.001), age ≥65 years (24.1%) vs 18-44 years (12.9%), or 45-64 years (19.3%)(P < 0.001) and urban (23.3%) vs non-urban residents (17.9%)(P < 0.001). The majority patients with AKI were hospitalized (96.5%) compared with those without AKI (69.6%) (P < 0.001). In multivariable analysis, odds of hospitalization was higher in patients with AKI (OR: 8.8, P < 0.001) after adjusting age, gender, co-morbidities and other demographics. Median hospital stay was longer in patients with AKI compared to those without (6 vs 4 days, P < 0.001). Median ED and total hospitalization charges were higher in patients with AKI (ED: $2,057; total: $45,414) vs without AKI (ED: $1,853; total: $29,299) (P < 0.001). In the multivariable adjusted-model, odds of in-hospital mortality was significantly higher in patients not in remission (OR: 1.8), patients with relapse (OR: 2.3), AKI (OR: 2.2), age ≥ 65 years (OR: 1.4), male (OR: 1.1) and urban residents (OR:1.2). Conclusions: In this largest national study of MM patients visiting ED, patients with AKI had higher in-hospital admission, ED and total charges, length of hospital stays, and mortality, both by univariate and multivariate analysis. Prevalence of AKI and mortality were highest in patients with MM relapse.

Download Full-text

Factors Associated With Hospital Admission for Older Adults Receiving Care in U.S. Emergency Departments

The Journals of Gerontology Series A ◽

10.1093/gerona/glw207 ◽

2016 ◽

pp. glw207 ◽

Cited By ~ 1

Author(s):

Alexander X. Lo ◽

Kellie L. Flood ◽

Kevin Biese ◽

Timothy F. Platts-Mills ◽

John P. Donnelly ◽

...

Keyword(s):

Older Adults ◽

Hospital Admission ◽

Emergency Departments ◽

Factors Associated

Download Full-text

Comparative effectiveness of direct admission and admission through emergency departments for children: a randomized stepped wedge study protocol

Trials ◽

10.1186/s13063-020-04889-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

JoAnna K. Leyenaar ◽

Corrie E. McDaniel ◽

Stephanie C. Acquilano ◽

Andrew P. Schaefer ◽

Martha L. Bruce ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hospital Admission ◽

Emergency Departments ◽

Controlled Trial ◽

Healthcare Systems ◽

Care Practice ◽

Stepped Wedge ◽

Randomized Controlled ◽

Experience Of Care ◽

Direct Admission

Abstract Background Approximately 2 million children are hospitalized each year in the United States, with more than three-quarters of non-elective hospitalizations admitted through emergency departments (EDs). Direct admission, defined as admission to hospital without first receiving care in the hospital’s ED, may offer benefits for patients and healthcare systems in quality, timeliness, and experience of care. While ED utilization patterns are well studied, there is a paucity of research comparing the effectiveness of direct and ED admissions. The overall aim of this project is to compare the effectiveness of a standardized direct admission approach to admission beginning in the ED for hospitalized children. Methods/design We will conduct a stepped wedge cluster randomized controlled trial at 3 structurally and geographically diverse hospitals. A total of 70 primary and urgent care practice sites in the hospitals’ catchment areas will be randomized to a time point when they will begin participation in the multi-stakeholder informed direct admission program. This crossover will be unidirectional and occur at 4 time points, 6 months apart, over a 24-month implementation period. Our primary outcome will be the timeliness of clinical care provision. Secondary outcomes include (i) parent-reported experience of care, (ii) unanticipated transfer to the intensive care unit within 6 h of hospital admission, and (iii) rapid response calls within 6 h of hospital admission. We anticipate that 190 children and adolescents will be directly admitted, with 1506 admitted through EDs. Analyses will compare the effectiveness of direct admission to admission through the ED and will evaluate the causal effect of implementing a direct admission program using linear regression with random effects for referring practice clusters and time period fixed effects. We will further examine the heterogeneity of treatment effects based on hypotheses specified a priori. In addition, we will conduct a mixed-methods process evaluation to assess reach, effectiveness, adoption, implementation, and maintenance of our direct admission intervention. Discussion Our study represents the first randomized controlled trial to compare the effectiveness of direct admission to admission through the ED for pediatric patients. Our scientific approach, pairing a stepped wedge design with a multi-level assessment of barriers to and facilitators of implementation, will generate valuable data about how positive findings can be reproduced across other healthcare systems. Trial registration ClinicalTrials.gov NCT04192799. Registered on December 10, 2019).

Download Full-text

Do elderly patients with hip pain following trauma require hospital admission?

Injury ◽

10.1016/0020-1383(92)90170-w ◽

1992 ◽

Vol 23 (5) ◽

pp. 295-296

Author(s):

F.G. O'Dwyer ◽

W.M. Harper ◽

D.B. Finlay

Keyword(s):

Elderly Patients ◽

Hospital Admission ◽

Hip Pain ◽

Require Hospital Admission

Download Full-text