scholarly journals P1286Atrial fibrillation and infection among acute patients in the Emergency Department: a multicentre cohort study of prevalence and prognosis

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
T Graversgaard Hansen ◽  
A Brandes ◽  
M Brabrand ◽  
U Ekelund ◽  
J Lundager ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Multicentre Cohort Study ◽  
Acute Patients ◽  
Multicentre Cohort

scholarly journals Evaluation of outcome relevance of quality indicators in the emergency department (ENQuIRE): study protocol for a prospective multicentre cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038776
Author(s):  
Susanne Drynda ◽  
Wencke Schindler ◽  
Anna Slagman ◽  
Johannes Pollmanns ◽  
Dirk Horenkamp-Sonntag ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Quality Indicators ◽  
Patient Outcomes ◽  
Claims Data ◽  
Quality Measures ◽  
Patient Questionnaire ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

IntroductionQuality of emergency department (ED) care affects patient outcomes substantially. Quality indicators (QIs) for ED care are a major challenge due to the heterogeneity of patient populations, health care structures and processes in Germany. Although a number of quality measures are already in use, there is a paucity of data on the importance of these QIs on medium-term and long-term outcomes. The evaluation of outcome relevance of quality indicators in the emergency department study (ENQuIRE) aims to identify and investigate the relevance of QIs in the ED on patient outcomes in a 12-month follow-up.Methods and analysisThe study is a prospective non-interventional multicentre cohort study conducted in 15 EDs throughout Germany. Included are all patients in 2019, who were ≥18 years of age, insured at the Techniker Krankenkasse (statutory health insurance (SHI)) and gave their written informed consent to the study.The primary objective of the study is to assess the effect of selected quality measures on patient outcome. The data collected for this purpose comprise medical records from the ED treatment, discharge (claims) data from hospitalised patients, a patient questionnaire to be answered 6–8 weeks after emergency admission, and outcome measures in a 12-month follow-up obtained as claims data from the SHI.Descriptive and analytical statistics will be applied to provide summaries about the characteristics of QIs and associations between quality measures and patient outcomes.Ethics and disseminationApproval of the leading ethics committee at the Medical Faculty of the University of Magdeburg (reference number 163/18 from 19 November 2018) has been obtained and adapted by responsible local ethics committees.The findings of this work will be disseminated by publication of peer-reviewed manuscripts and presentations as conference contributions (abstracts, poster or oral presentations).Moreover, results will be discussed with clinical experts and medical associations before being proposed for implementation into the quality management of EDs.Trial registration numberGerman Clinical Trials Registry (DRKS00015203); Pre-results.

scholarly journals Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018190 ◽  
Author(s):  
Marcel Émond ◽  
Valérie Boucher ◽  
Pierre-Hugues Carmichael ◽  
Philippe Voyer ◽  
Mathieu Pelletier ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Cohort Study ◽  
Length Of Stay ◽  
Hospital Length ◽  
Cognitive Status ◽  
Hospital Ward ◽  
Hospital Length Of Stay ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

ObjectiveWe aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment.DesignThis is a prospective observational multicentre cohort study (March–July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward.SettingThe study took place in four Canadian EDs.Participants338 included patients: (1) aged ≥65 years; (2) who had an ED stay ≥8 hours; (3) were admitted to hospital ward and (4) were independent/semi-independent.Main outcome(s) and measure(s)The primary outcomes of this study were incident delirium in the ED or within 24 hours of ward admission and ED and hospital LOS. Functional and cognitive status were assessed using validated Older Americans Resources and Services and the modified Telephone Interview for Cognitive Status tools. The Confusion Assessment Method was used to detect incident delirium. Univariate and multivariate analyses were conducted to evaluate outcomes.ResultsMean age was 76.8 (±8.1), 17.7% were aged >85 years old and 48.8% were men. The mean incidence of delirium was 12.1% (n=41). Median IQR ED LOS was 32.4 (24.5–47.9) hours and hospital LOS was 146.6 (75.2–267.8) hours. Adjusted mean hospital LOS was increased by 105.4 hours (4.4 days) (95% CI 25.1 to 162.0, P<0.001) for patients who developed an episode of delirium compared with non-delirious patient.ConclusionsAn incident delirium was observed in one of eight independent/semi-independent older adults after an 8-hour ED exposure. An episode of delirium increases hospital LOS by 4 days and therefore has important implications for patients and could contribute to ED overcrowding through a deleterious feedback loop.

scholarly journals Comparison of Glasgow Admission Prediction Score and Amb Score in predicting need for inpatient care

2018 ◽  
Vol 35 (4) ◽  
pp. 247-251 ◽  
Author(s):  
Allan Cameron ◽  
Dominic Jones ◽  
Eilidh Logan ◽  
Colin A O’Keeffe ◽  
Suzanne M Mason ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Hospital Admission ◽  
Hospital Stay ◽  
Inpatient Care ◽  
Area Under The Curve ◽  
Prediction Score ◽  
Royal Infirmary ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

AimWe compared the abilities of two established clinical scores to predict emergency department (ED) disposition: the Glasgow Admission Prediction Score (GAPS) and the Ambulatory Score (Ambs).MethodsThe scores were compared in a prospective, multicentre cohort study. We recruited consecutive patients attending ED triage at two UK sites: Northern General Hospital in Sheffield and Glasgow Royal Infirmary, between February and May 2016. Each had a GAPS and Ambs calculated at the time of triage, with the triage nurses and treating clinicians blinded to the scores. Patients were followed up to hospital discharge. The ability of the scores to discriminate discharge from ED and from hospital at 12 and 48 hours after arrival was compared using the area under the curve (AUC) of their receiving-operator characteristics (ROC).Results1424 triage attendances were suitable for analysis during the study period, of which 567 (39.8%) were admitted. The AUC for predicting admission was significantly higher for GAPS at 0.807 (95% CI 0.785 to 0.830), compared with 0.743 (95% CI 0.717 to 0.769) for Ambs, P<0.00001. Similar results were seen when comparing ability to predict hospital stay of >12 hour and >48 hour. GAPS was also more accurate as a binary test, correctly predicting 1057 outcomes compared with 1004 for Ambs (74.2vs70.5%, P=0.012).ConclusionThe GAPS is a significantly better predictor of need for hospital admission than Ambs in an unselected ED population.

scholarly journals External validation of computed tomography decision rules for minor head injury: prospective, multicentre cohort study in the Netherlands

BMJ ◽  
2018 ◽  
pp. k3527 ◽  
Author(s):  
Kelly A Foks ◽  
Crispijn L van den Brand ◽  
Hester F Lingsma ◽  
Joukje van der Naalt ◽  
Bram Jacobs ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Cohort Study ◽  
Head Injury ◽  
Decision Rules ◽  
Ct Scanning ◽  
Minor Head Injury ◽  
Ct Scans ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

Abstract Objective To externally validate four commonly used rules in computed tomography (CT) for minor head injury. Design Prospective, multicentre cohort study. Setting Three university and six non-university hospitals in the Netherlands. Participants Consecutive adult patients aged 16 years and over who presented with minor head injury at the emergency department with a Glasgow coma scale score of 13-15 between March 2015 and December 2016. Main outcome measures The primary outcome was any intracranial traumatic finding on CT; the secondary outcome was a potential neurosurgical lesion on CT, which was defined as an intracranial traumatic finding on CT that could lead to a neurosurgical intervention or death. The sensitivity, specificity, and clinical usefulness (defined as net proportional benefit, a weighted sum of true positive classifications) of the four CT decision rules. The rules included the CT in head injury patients (CHIP) rule, New Orleans criteria (NOC), Canadian CT head rule (CCHR), and National Institute for Health and Care Excellence (NICE) guideline for head injury. Results For the primary analysis, only six centres that included patients with and without CT were selected. Of 4557 eligible patients who presented with minor head injury, 3742 (82%) received a CT scan; 384 (8%) had a intracranial traumatic finding on CT, and 74 (2%) had a potential neurosurgical lesion. The sensitivity for any intracranial traumatic finding on CT ranged from 73% (NICE) to 99% (NOC); specificity ranged from 4% (NOC) to 61% (NICE). Sensitivity for a potential neurosurgical lesion ranged between 85% (NICE) and 100% (NOC); specificity from 4% (NOC) to 59% (NICE). Clinical usefulness depended on thresholds for performing CT scanning: the NOC rule was preferable at a low threshold, the NICE rule was preferable at a higher threshold, whereas the CHIP rule was preferable for an intermediate threshold. Conclusions Application of the CHIP, NOC, CCHR, or NICE decision rules can lead to a wide variation in CT scanning among patients with minor head injury, resulting in many unnecessary CT scans and some missed intracranial traumatic findings. Until an existing decision rule has been updated, any of the four rules can be used for patients presenting minor head injuries at the emergency department. Use of the CHIP rule is recommended because it leads to a substantial reduction in CT scans while missing few potential neurosurgical lesions.

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