Analysis of Inpatient and Emergency Department Serial Troponin Testing Intervals in the United States

2020 ◽  
Author(s):  
Andrew Fletcher ◽  
Erik Forsman ◽  
Brian R Jackson
Keyword(s):  
United States ◽  
Emergency Department ◽  
Median Time ◽  
Emergency Departments ◽  
The United States ◽  
Published Data ◽  
Time Interval ◽  
Time Intervals ◽  
Convenience Sample ◽  
Facility Level

Abstract Background Serial measurement of cardiac troponins (cTn) is central to the diagnosis of myocardial infarction. The time intervals between individual measurements may impact the speed and reliability of diagnosis. Published recommendations exist for these time intervals, but there is little previously published data on actual intervals in routine clinical settings. Methods Retrospective analysis of cTn testing intervals was performed from a convenience sample of 37 hospitals. All 37 provided data on inpatient tests and 19 also provided separate data for tests ordered in their emergency departments. Facilities included both academic and community hospitals across the United States. For each facility, the median time interval between serial cTn order collections was determined separately for inpatient orders and emergency department orders. Results The facility-level median time intervals between serial inpatient cTn test orders ranged from 3.17 to 7.32 hours. Facility-level median time intervals between serial emergency department cTn orders ranged from 1.48 to 4.23 hours. There was no observed difference between academic and nonacademic facilities. Conclusion Typical time intervals between serial cTn orders varied widely across hospitals, and in many cases reflected suboptimal care. Time intervals were generally shorter for cTn testing ordered in emergency departments. Existing testing protocols should be re-examined.

scholarly journals Child Development and Pediatric Sport and Recreational Injuries by Age

2014 ◽  
Vol 49 (6) ◽  
pp. 780-785 ◽  
Author(s):  
David C. Schwebel ◽  
Carl M. Brezausek
Keyword(s):  
United States ◽  
Emergency Department ◽  
Emergency Departments ◽  
Injury Risk ◽  
The United States ◽  
Emergency Department Visits ◽  
Sociocultural Factors ◽  
Childhood And Adolescence ◽  
Injury Surveillance System ◽  
Sport And Recreation

Context: In 2010, 8.6 million children were treated for unintentional injuries in American emergency departments. Child engagement in sports and recreation offers many health benefits but also exposure to injury risks. In this analysis, we consider possible developmental risk factors in a review of age, sex, and incidence of 39 sport and recreational injuries. Objective: To assess (1) how the incidence of 39 sport and recreational injuries changed through each year of child and adolescent development, ages 1 to 18 years, and (2) sex differences. Design Descriptive epidemiology study. Setting: Emergency department visits across the United States, as reported in the 2001–2008 National Electronic Injury Surveillance System database. Patients or Other Participants: Data represent population-wide emergency department visits in the United States. Main Outcome Measure(s) Pediatric sport- and recreation-related injuries requiring treatment in hospital emergency departments. Results: Almost 37 pediatric sport or recreational injuries are treated hourly in the United States. The incidence of sport- and recreation-related injuries peaks at widely different ages. Team-sport injuries tend to peak in the middle teen years, playground injuries peak in the early elementary ages and then drop off slowly, and bicycling injuries peak in the preteen years but are a common cause of injury throughout childhood and adolescence. Bowling injuries peaked at the earliest age (4 years), and injuries linked to camping and personal watercraft peaked at the oldest age (18 years). The 5 most common causes of sport and recreational injuries across development, in order, were basketball, football, bicycling, playgrounds, and soccer. Sex disparities were common in the incidence of pediatric sport and recreational injuries. Conclusions: Both biological and sociocultural factors likely influence the developmental aspects of pediatric sport and recreational injury risk. Biologically, changes in perception, cognition, and motor control might influence injury risk. Socioculturally, decisions must be made about which sport and recreational activities to engage in and how much risk taking occurs while engaging in those activities. Understanding the developmental aspects of injury data trends allows preventionists to target education at specific groups.

Cardiac arrest and related mortality in emergency departments in the United States: Analysis of the nationwide emergency department sample

Resuscitation ◽  
2020 ◽  
Vol 157 ◽  
pp. 166-173
Author(s):  
Roshini Ravindran ◽  
Chun Shing Kwok ◽  
Chun Wai Wong ◽  
Jolanta M. Siller-Matula ◽  
Purvi Parwani ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Cardiac Arrest ◽  
Emergency Departments ◽  
The United States ◽  
Related Mortality

The Feasibility and Impact of Prospective Medication Review in the Emergency Department

2017 ◽  
Vol 31 (1) ◽  
pp. 22-28
Author(s):  
Billy Sin ◽  
Kwong Lau ◽  
Richard Tong ◽  
Josel Ruiz ◽  
Kimberly Sarosky ◽  
...  
Keyword(s):  
Emergency Department ◽  
Median Time ◽  
Medication Review ◽  
Retrospective Cohort ◽  
Medication Use ◽  
Time Interval ◽  
Time Intervals ◽  
Cost Avoidance ◽  
Median Time Interval ◽  
Effective Use

Objective: We evaluated the feasibility and impact of prospective medication review (PMR) in the emergency department (ED). Methods: This was a retrospective cohort study of all nonadmitted ED patients who were prescribed medication orders by ED clinicians from September 2014 to September 2015 to determine the time intervals utilized during each step of the medication use process and quantify the number of interventions conducted by the pharmacist and cost avoidance accrued from the interventions. Results: A total of 834 medication orders were included for evaluation. The median time for order verification, order verification to dispense, and dispense to administration were 3 minutes (interquartile range [IQR] = 1-7 minutes), 20 minutes (IQR = 7-45 minutes), and 10 minutes (IQR = 6-16 minutes). The median time interval for order verification was longer during the overnight pharmacy shift (median = 5 minutes, IQR = 2-9 minutes) compared to the day and evening shifts (median = 3 minutes, IQR = 1-6 minutes). A total of 563 interventions were recommended by the pharmacists and accepted by ED clinicians. These interventions equated to US$47 585 worth of cost avoidance. Conclusion: The PMR is a feasible process that resulted in safe and effective use of medications without causing delays to patient care.

Pediatric Hand and Upper Extremity Injuries Presenting to Emergency Departments in the United States: Epidemiology and Health Care–Associated Costs

Hand ◽  
2019 ◽  
pp. 155894471986688 ◽  
Author(s):  
Alfred Lee ◽  
David L. Colen ◽  
Justin P. Fox ◽  
Benjamin Chang ◽  
Ines C. Lin
Keyword(s):  
United States ◽  
Health Care ◽  
Emergency Department ◽  
Upper Extremity ◽  
Emergency Departments ◽  
Age Groups ◽  
The United States ◽  
Primary Diagnosis ◽  
Trauma Patients ◽  
Extremity Injuries

Background: Upper extremity injuries represent one of the most common pediatric conditions presenting to emergency departments (EDs) in the United States. We aim to describe the epidemiology, trends, and costs of pediatric patients who present to US EDs with upper extremity injuries. Methods: Using the National Emergency Department Sample, we identified all ED encounters by patients aged <18 years associated with a primary diagnosis involving the upper extremity from 2008 to 2012. Patients were divided into 4 groups by age (≤5 years, 6-9 years, 10-13 years, and 14-17 years) and a trauma subgroup. Primary outcomes were prevalence, etiology, and associated charges. Results: In total, 11.7 million ED encounters were identified, and 89.8% had a primary diagnosis involving the upper extremity. Fracture was the most common injury type (28.2%). Dislocations were common in the youngest group (17.7%) but rare in the other 3 (range = 0.8%-1.6%). There were 73.2% of trauma-related visits, most commonly due to falls (29.9%); 96.9% of trauma patients were discharged home from the ED. There were bimodal peaks of incidence in the spring and fall and a nadir in the winter. Emergency department charges of $21.2 billion were generated during the 4 years studied. While volume of visits decreased during the study, associated charges rose by 1.21%. Conclusions: Pediatric upper extremity injuries place burden on the economy of the US health care system. Types of injuries and anticipated payers vary among age groups, and while total yearly visits have decreased over the study period, the average cost of visits has risen.

Abstract MP058: Racial and Gender Differences in Acute Ischemic Stroke Pre-hospital Documentation: Last Known Well, Pre-alert Notification and Stroke Severity, Paul Coverdell National Acute Stroke Program, 2012-2015

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Erika Odom ◽  
Sallyann Coleman King ◽  
Xin Tong ◽  
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Median Time ◽  
Emergency Services ◽  
The United States ◽  
Hospital Environment ◽  
Time Interval ◽  
Stroke Severity ◽  
Related Factors ◽  
Life Saving

Stroke is the fifth leading cause of death in the United States and a major cause of adult disability. Documentation of stroke-related factors that occur before arrival to the hospital or immediately upon arrival may be critical in determining patient eligibility for life-saving measures, including receipt of thrombolytic therapy (e.g., alteplase) and other neurointerventional treatment. There is a need to describe differences in documentation of pre-hospital measures, in order to improve overall stroke patient care. De-identified data for 216,129 stroke patients were reported by hospital personnel during the 2012-2015 Paul Coverdell National Acute Stroke Program. Chi-square tests were performed to examine the differences on demographic and pre-hospital measures by gender and race. The median age was greater for females than males (75 vs 68 years) and for whites than blacks (74 vs 63 years). A higher percentage of females had Medicare coverage than males (67.8% vs. 57.4%, p<0.001), while blacks had higher Medicaid coverage than whites (12.8% vs. 4.2%, p<0.0001). Females (49.9%) and blacks (48.8%) had the highest percentage of arrival by EMS. Among patients who arrived by emergency services, the percentage of blacks with advance notification of stroke was lower than whites (49.8% vs. 58.2%, p<0.0001). Females (53.0%) were slightly less likely to have last known well time recorded than males (53.8%). Blacks were significantly less likely to have last known well time and stroke severity recorded compared whites (p<0.0001). The median time interval between last known well and emergency department arrival for blacks were 4.8 hours, significantly longer than median time of 4.0 hours for whites (p<0.001). Differences in documentation of pre-hospital measures, particularly between racial groups, suggest room for improvement in communication of information from the pre-hospital environment to emergency department staff, which may support access to critical links in the chain of stroke survival, including activation of stroke care teams who can provide swift access to life-saving treatment.

scholarly journals BASE Jumping Injuries Presenting to Emergency Departments in the United States: an Assessment of Morbidity, Emergency Department, and Inpatient Costs

2019 ◽  
Vol 30 (2) ◽  
pp. 150-154
Author(s):  
Joseph D. Forrester ◽  
Kirbi Yelorda ◽  
Lakshika Tennakoon ◽  
David A. Spain ◽  
Kristan Staudenmayer
Keyword(s):  
United States ◽  
Emergency Department ◽  
Emergency Departments ◽  
The United States ◽  
Base Jumping

scholarly journals 611. Infectious Disease Management of Homeless and Non-Homeless Populations in United States Emergency Departments

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S366-S366
Author(s):  
Jessica Barnes ◽  
Larry Segars ◽  
Jason Wasserman ◽  
Patrick Karabon ◽  
Tracey A Taylor
Keyword(s):  
Infectious Disease ◽  
United States ◽  
Emergency Department ◽  
Infectious Diseases ◽  
Emergency Departments ◽  
The United States ◽  
Homeless Persons ◽  
Prescribing Patterns ◽  
Significant Difference ◽  
Cohort Study Design

Abstract Background Studies have long documented the increased emergency department usage in the United States by homeless persons compared to their housed counterparts, as well as an increased overall prevalence of infectious diseases. However, there is a gap in knowledge on the treatment that homeless persons receive for these infectious diseases within United States emergency departments compared to their housed counterparts. This study seeks to understand this potential difference in treatment, including diagnostic services tested, procedures performed, and medications prescribed. Methods This study utilized a retrospective, cohort study design to analyze data from the 2007-2010 National Hospital Ambulatory Medical Care Survey (NHAMCS) database. Complex sample logistic regression analysis was used to compare variables, including diagnostic services, procedures, and medication classes prescribed between homeless and private residence individuals seeking emergency department treatment for infectious diseases. This provided an odds ratio to compare the two populations, which was then adjusted for confounding variables. Results Compared to private residence individuals, homeless persons were more likely (OR: 10.99, p&lt; 0.05, CI: 1.08-111.40) to receive sutures or staples when presenting with an infectious disease in United States emergency departments. Compared to private residence persons, homeless individuals were less likely (OR: 0.29, p&lt; 0.05, CI: 0.10-0.87) to be provided medications or immunizations when presenting with an infectious disease in United States emergency departments, and significant differences were detected in prescribing habits of multiple medication classes. Conclusion This study detected a significant difference in suturing/stapling and medication prescribing patterns for homeless persons with an infectious disease in United States emergency departments, compared to their housed counterparts. These results provide a platform for continual research. Disclosures All Authors: No reported disclosures

scholarly journals Emergency Department Visits From 2014 to 2018 for Head Injuries in Youth Non-Tackle Football Compared With Other Sports

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097540
Author(s):  
Jessica M. Zendler ◽  
Ron Jadischke ◽  
Jared Frantz ◽  
Steve Hall ◽  
Grant C. Goulet
Keyword(s):  
United States ◽  
Emergency Department ◽  
Head Injury ◽  
Head Injuries ◽  
The United States ◽  
Emergency Department Visits ◽  
Head Region ◽  
Cerebral Contusion ◽  
Common Diagnosis ◽  
Tackle Football

Background: Non-tackle football (ie, flag, touch, 7v7) is purported to be a lower-risk alternative to tackle football, particularly in terms of head injuries. However, data on head injuries in non-tackle football are sparse, particularly among youth participants. Purpose: To describe the epidemiology of  emergency department visits for head injuries due to non-tackle football among youth players in the United States and compare the data with basketball, soccer, and tackle football. Study Design: Descriptive epidemiology study. Methods: Injury data from 2014 to 2018 were obtained from the National Electronic Injury Surveillance System database. Injury reports coded for patients aged 6 to 18 years and associated with basketball, football, or soccer were extracted. Data were filtered to include only injuries to the head region, specifically, the head, ear, eyeball, mouth, or face. Football injuries were manually assigned to “non-tackle” or “tackle” based on the injury narratives. Sports & Fitness Industry Association data were used to estimate annual sport participation and calculate annual injury rates per 100,000 participant-years. Results: A total of 26,770 incident reports from 2014 to 2018 were analyzed. For head region injuries in non-tackle football, the head was the most commonly injured body part, followed by the face; the most common diagnosis was a laceration, followed by concussion and internal injury (defined as an unspecified head injury or internal head injury [eg, subdural hematoma or cerebral contusion]). The most common contacting object was another player. The projected national rate of head region injuries was lowest for non-tackle football across the 4 sports. In particular, the projected rate of injuries to the head for non-tackle football (78.0 per 100,000 participant-years) was less than one-fourth the rates for basketball (323.5 per 100,000 participant-years) and soccer (318.2 per 100,000 participant-years) and less than one-tenth the rate for tackle football (1478.6 per 100,000 participant-years). Conclusion: Among youth in the United States aged 6 to 18 years who were treated in the emergency department for injuries related to playing non-tackle football, the most common diagnosis for injuries to the head region was a laceration, followed by a concussion. Head region injuries associated with non-tackle football occurred at a notably lower rate than basketball, soccer, or tackle football.

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