P0780TRENDS IN EMERGENCY DEPARTMENT USE IN PATIENTS DIAGNOSED WITH HYPERKALAEMIA: AN ANALYSIS OF A U.S. NATIONAL EMERGENCY DEPARTMENT DATABASE

Abstract Background and Aims Hyperkalaemia (HK) refers to increased serum potassium concentration, with possible severe effects on health outcomes and resource utilisation. HK is prevalent in patients suffering from heart failure, chronic kidney disease (CKD) and diabetes mellitus and its risk is increased by medications, e.g. inhibitors of the renin-angiotensin-aldosterone system (RAAS). The objective of this study was to examine trends in emergency department (ED) use in patients diagnosed with HK. Method The latest available 2016 Nationwide Emergency Department Sample (NEDS) data set from the Healthcare Cost and Utilization Project was analysed to estimate the burden of ED visits in patients with HK. Patients with an ICD-10 diagnosis code E87.5 (Hyperkalaemia) or E87.8 (Other disorders of electrolyte and fluid balance, not elsewhere classified; included due to the incidence of miscoding HK) were included. The rate of comorbidities (diabetes, CKD, heart failure and hypertension) were assessed using previously validated ICD-10 codes. Results In 2016, there were an estimated 1,322,071 ED visits with a diagnosis of HK, out of which 6.7% were recorded as the primary diagnosis. The vast majority of these ED visits resulted in same hospital admission (1,075,492 hospital stays). The rate of ED visits and hospital admission were 409.1 and 332.8 per 100,000 persons respectively. The mean (SE) age was 61.8 (0.21) years and 52% were male. Patients had high rate of comorbidities: diabetes 43.1%, hypertension 62.0%, CKD 44.4%, heart failure 23.1%, non-dialysis CKD 12.1% and CKD requiring dialysis 12.1%. In patients with primary diagnosis of HK, the mean (SD) hospital length of stay was 3.3 (4.2) days and total mean (SD) hospital charges were $34,923 ($100,435). Conclusion Patients with HK represent an expensive health care burden, as well as suffering with high rates of comorbidities and ED visits. There is an urgent need for new treatment options in the acute setting to improve outcomes for patients with HK.

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Clinical and Economic Outcomes Associated with Emergency Department Visits in Patients with Immune Thrombocytopenia,

Blood ◽

10.1182/blood.v118.21.4209.4209 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4209-4209

Author(s):

Z John Lu ◽

Mark D. Danese ◽

Marc Halperin ◽

Melissa Eisen ◽

Robert Deuson

Keyword(s):

Emergency Department ◽

Research Funding ◽

Immune Thrombocytopenia ◽

Primary Diagnosis ◽

Secondary Diagnosis ◽

Employment Equity ◽

Ed Visits ◽

Equity Ownership ◽

The Mean ◽

Total Charges

Abstract Abstract 4209 Introduction: Immune thrombocytopenia (ITP) is characterized by low platelet counts, spontaneous bruising, mucosal bleeding, and, more seriously, intracranial hemorrhage. The disease is associated with a high risk of complications, often requiring visits to emergency departments (ED), with possible subsequent hospitalization. To date, information about ED visits in ITP patients, including frequency, cost, hospitalization risk, and mortality risk, has not been well documented, although such data are critical to the understanding of the clinical and financial implications of poorly-controlled, chronic ITP. We used the 2007 Nationwide Emergency Department Sample (NEDS) to examine resource utilization, ED visits, and hospitalization charges in the US. Methods: The 2007 NEDS contains about 27 million ED records from over 970 hospitals in 27 Healthcare Cost and Utilization Project (HCUP) Partner States, representing a 20% stratified sample of US hospital-based ED visits. The database includes hospital and patient characteristics, diagnoses and procedures, disposition from ED including hospitalization and mortality, discharge diagnosis-related group (DRG) for subsequent hospitalizations, and total charges. Its large sample size enables analyses of relatively rare conditions such as ITP. All ED visits in the database were separated into two groups: visits with ITP as one of the diagnoses (ICD-9-CM diagnosis code of 287.31), and those without a diagnosis of ITP. Outcomes and resource use were separately evaluated in these two groups, as well as in several subgroups within the ITP group defined by age and whether the ITP diagnosis was the primary or a secondary diagnosis. Results: Approximately 8,348 (∼0.03%) of all ED visits in the 2007 NEDS database were in patients with ITP (28% as the primary diagnosis), of which nearly 60% were by female patients and 88% by adult patients (≥18 years old). Medicare or Medicaid was listed as the primary payer in 58% of the visits. Seventy-five percent of the ED visits in ITP patients led to hospitalizations, compared with less than 16% of ED visits in non-ITP patients (p < 0.0001). In ITP patients, 3% of the ED visits ended in death, compared with 0.6% in non-ITP patients (p < 0.0001). The mean total charges for ED visits in ITP patients were $1,650 compared with $1,495 for all others (p<0.0001). The average length of stay (LOS) during hospitalizations subsequent to ED visits was >1.5 days longer (6.5 vs. 5.0 days; p < 0.0001) for ITP patients. The mean total combined charges during the ED visit and resulting hospitalization were >60% higher ($47,000 vs. $29,000; p < 0.0001) for ITP patients. Subgroup analyses of ED visits in ITP patients by age showed that in the majority of visits by pediatric patients (<18 years old), ITP was identified as the primary diagnosis (61%) compared with only 24% among visits by adult patients. Furthermore, visits by adult ITP patients were less likely to result in routine discharge (18% vs. 50%), more likely to result in hospitalization (80% vs. 43%), and were associated with higher mortality compared with pediatric ITP patients (4% vs. 0.1%; p < 0.0001 for all comparisons). ED visits identified with ITP as the primary diagnosis were associated with a higher rate of subsequent hospitalizations (81% vs. 73%), but lower total charges and mortality ($1,490 vs. $1,710, and 2% vs. 4%) respectively, compared with those identified with ITP as a secondary diagnosis (p < 0.0001 for all comparisons). Conclusion: ED visits in ITP patients were associated with significantly worse outcomes, higher resource utilization, and greater total charges. For patients with ITP, younger age and a primary diagnosis of ITP were generally associated with better outcomes following ED visits. More robust and rigorous analyses controlling for patient and hospital heterogeneities will be conducted to confirm these findings. Disclosures: Lu: Amgen: Consultancy, Equity Ownership, Research Funding. Danese:Amgen: Consultancy, Research Funding. Halperin:Amgen: Consultancy, Research Funding. Eisen:Amgen: Employment, Equity Ownership. Deuson:Amgen: Employment, Equity Ownership.

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Time Trends, Predictors, and Outcome of Emergency Department Use for Gout: A Nationwide US Study

The Journal of Rheumatology ◽

10.3899/jrheum.151419 ◽

2016 ◽

Vol 43 (8) ◽

pp. 1581-1588 ◽

Cited By ~ 6

Author(s):

Jasvinder A. Singh ◽

Shaohua Yu

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Renal Failure ◽

Heart Disease ◽

Time Trends ◽

Primary Diagnosis ◽

Older Age ◽

Discharge Disposition ◽

Ed Visits ◽

Income Quartile

Objective.To assess gout-related emergency department (ED) use/charges and discharge disposition.Methods.We used the US National ED Sample (NEDS) data to examine the time trends in total ED visits and charges and ED-related hospitalizations with gout as the primary diagnosis. We assessed multivariable-adjusted predictors of ED charges and hospitalization for gout-related visits using the 2012 NEDS data.Results.There were 180,789, 201,044, and 205,152 ED visits in 2009, 2010, and 2012 with gout as the primary diagnosis, with total ED charges of $195 million, $239 million, and $287 million, respectively; these accounted for 0.14%–0.16% of all ED visits. Mean/median 2012 ED charges/visit were $1398/$956. Of all gout-related ED visits, 7.7% were admitted to the hospital in 2012. Mean/median length of hospital stay was 3.9/2.6 days and mean/median inpatient charge/admission with gout as the primary diagnosis was $22,066/$15,912 in 2012. In multivariable-adjusted analyses, these factors were associated with higher ED charges: older age, female sex, highest income quartile, being uninsured, metropolitan residence, Western United States hospital location, heart disease, renal failure, heart failure, hypertension (HTN), diabetes, osteoarthritis (OA), and chronic obstructive pulmonary disease (COPD). These factors were associated with higher odds of hospitalization: older age, Northeast location, metropolitan teaching hospital, higher income quartile, heart disease, renal failure, heart failure, hyperlipidemia, HTN, diabetes, COPD, and OA, whereas self-pay insurance status was associated with lower odds of hospitalization, following an ED visit for gout.Conclusion.Absolute ED use and charges for gout increased over time, but relative use remained stable. Modifiable comorbidity factors associated with higher gout-related use should be targeted to reduce morbidity and healthcare use.

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Emergency Department Utilization During Self-Administered Outpatient Parenteral Antimicrobial Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.786 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S332-S332

Author(s):

Anisha Ganguly ◽

Larry Brown ◽

Deepak Agrawal ◽

Kavita Bhavan

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Antimicrobial Therapy ◽

Hospital Admissions ◽

Hospital Charges ◽

Emergency Department Utilization ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Before And After ◽

Ed Visits ◽

Hospital To Home

Abstract Background Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) has been established as a clinically safe and effective alternative to inpatient or outpatient extended-course intravenous antibiotics while reducing healthcare resource utilization. However, previous research has not confirmed that transferring patients from the hospital to home for treatment does not cause a compensatory increase in emergency department (ED) visits. We sought to validate S-OPAT clinical safety and healthcare costs associated with S-OPAT by confirming that S-OPAT does not increase ED utilization during treatment. Methods We conducted a before-after study of ED utilization among S-OPAT patients. We compared ED visits, hospital admissions resulting from ED visits, hospital admissions due to OPAT-related causes, and hospital charges associated with all ED visits 60 days before and after initiation of S-OPAT. A 60-day time frame was selected to effectively encompass the maximum treatment duration (8 weeks) for S-OPAT. Paired t-tests were used to compare the change in ED utilization before and after initiation of S-OPAT. Results Among our cohort of 944 S-OPAT patients, 430 patients visited the ED 60 days before or after starting treatment. Of the patients with ED visits, 69 were admitted to the hospital for OPAT-related causes and 228 incurred hospital charges from their visit. Initiation of S-OPAT was associated with a statistically significant reduction in total ED visits, all-cause hospital admission, OPAT-related hospital admission, and hospital charges (see Table 1). Conclusion Our review of ED utilization among S-OPAT patients demonstrates a reduction in multiple parameters of ED utilization with the initiation of S-OPAT treatment. Our findings confirm that S-OPAT does not yield an increase, but rather a decrease, in ED visits with the transfer of patients from hospital to home. Disclosures All authors: No reported disclosures.

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LO18: Access to take home naloxone in the Royal Alexandra Hospitals emergency department for patients at risk of an opioid overdose

CJEM ◽

10.1017/cem.2018.80 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S12-S13

Author(s):

D. W. Dabbs ◽

K. Dong ◽

K. Lavergne ◽

H. Brooks ◽

E. Hyshka

Keyword(s):

Emergency Department ◽

Chart Review ◽

Target Population ◽

Tertiary Hospital ◽

Primary Diagnosis ◽

Opioid Overdose ◽

Risk Of Mortality ◽

Patients At Risk ◽

Ed Visits ◽

The Mean

Introduction: Take Home Naloxone (THN) programs prevent death from opioid poisoning by training laypersons to recognize an overdose and administer naloxone. Dispensing THN through the emergency department (ED) is particularly critical because an ED visit for opioid poisoning strongly predicts future mortality. Many EDs have implemented THN programs, yet almost no literature examines the reach of such initiatives. To address this gap, we conducted a chart review of all patients presenting for opioid poisoning to an urban tertiary hospital, with a large ED-based THN program. This exploratory study hypothesized that more than 50% of ED patients presenting for opioid poisoning would be offered a THN kit. Methods: Data on demographics, clinical characteristics, and THN kit dispensing were extracted and analyzed from the charts of all ED patients presenting with a primary diagnosis of opioid poisoning between April 1 2016 and April 30 2017. Logistic regression analyzed predictors of being offered a THN kit. Results: A total of 347 ED visits for 301 unique patients occurred during the study period. The mean age ± SD of patients was 38 ± 14 years, and 69% were male. In 49% of ED visits, a THN kit was offered; 73% of these episodes had a THN kit dispensation. Patients who were male (AOR=1.94; 95% CI 1.11 - 3.40), and reported that their overdose was unintentional (AOR=2.95; 95% CI 1.04 8.35) and caused by illegal opioids (AOR=4.73; 95% CI 2.63 8.52) were significantly more likely to be offered a THN kit. Conclusion: ED-based THN programs have the potential to reach significant proportions of patients at high risk of mortality. However, these programs may have differential reach within the target population. Further research is needed to examine barriers and facilitators to offering all eligible ED patients a THN kit.

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P060: Incidence of child and youth presentations to the emergency department for addictions and mental health

CJEM ◽

10.1017/cem.2018.258 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S78-S78

Author(s):

H. Hair ◽

K. Huebert ◽

M. Bercov ◽

N. Fraser ◽

A. Allen

Keyword(s):

Mental Health ◽

Emergency Department ◽

Group Analysis ◽

Clinical Information ◽

Primary Diagnosis ◽

Health And Wellness ◽

Changing Trends ◽

Icd 10 ◽

Self Harm ◽

Ed Visits

Introduction: As reported by the Canadian Institute for Health Information, the rate of child and youth emergency department (ED) visits for mental health complaints increased by 50% between 2007 and 2015. Improving care for these patients has been identified as a major priority of Alberta Health Services As part of a multi-phased approach to improving care, the Emergency and the Addiction and Mental Health Strategic Clinical Networks undertook an analysis of administrative data to define incidence in Alberta and changing trends. Methods: The data analyzed included 5 different clinical information systems encompassing the 17 highest volume hospitals in Alberta, from April 2013 to March 2016. Patient encounters were included if the patient was under 25 years of age at the time of visit, and if the encounter included a CEDIS Presenting Complaint and/or an ICD-10 Primary Diagnosis relating to Addiction and/or Mental Health (AMH). A total of 54,810 patient encounters were included. Data was analyzed using descriptive statistics. Sub-group analysis was undertaken based upon age, presenting complaint, and primary diagnosis. Results: The incidence of children and youth presenting to an ED with an AMH complaint and an AMH primary diagnosis increased 22% and 7%, respectively, from 2013/14 to 2015/16. Admissions of patients were constant throughout this period. The largest increase in ED visits occurred among children aged 7-10, with a 60% increase in visits defined by presenting complaint and a 21% increase in primary diagnosis. The second largest increase was in young adults aged 18-21 with a 26% increase defined by presenting complaint, and a 12% increase in primary diagnosis. Analyzed by age group, the largest increase in primary diagnosis between 2013/14 and 2015/16 was seen in Depression/Suicidal/Self Harm with a 667% increase among ages 0-6, and a 79% increase among ages 7-10. The second highest increase was for Anxiety/Situational Crisis with a 223% increase among ages 0-6, and 74% among children aged 7-10. Conclusion: Within Alberta there has been a substantial increase in the incidence of child and youth visits to the ED for issues of mental health and addictions. It is clear is that these changing trends are placing an increased burden on our healthcare system and necessitate strategic planning to ensure the health and wellness of our patients.

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Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.791 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S333-S334

Author(s):

So Lim Kim ◽

Angela Everett ◽

Susan J Rehm ◽

Steven Gordon ◽

Nabin Shrestha

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Hospital Admission ◽

Vascular Access ◽

Antimicrobial Therapy ◽

Cleveland Clinic ◽

Emergency Department Visits ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Ed Visits ◽

Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

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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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Descriptive exploration of overdose codes in hospital and emergency department discharge data to inform development of drug overdose morbidity surveillance indicator definitions in ICD-10-CM

Injury Prevention ◽

10.1136/injuryprev-2019-043520 ◽

2021 ◽

Vol 27 (S1) ◽

pp. i27-i34

Author(s):

Leigh M Tyndall Snow ◽

Katelyn E Hall ◽

Cody Custis ◽

Allison L Rosenthal ◽

Emilia Pasalic ◽

...

Keyword(s):

Emergency Department ◽

Adverse Effects ◽

Drug Overdose ◽

International Classification Of Diseases ◽

Primary Diagnosis ◽

Epidemiological Surveillance ◽

Discharge Data ◽

Aggregated Data ◽

Data Coding ◽

Icd 10

BackgroundIn October 2015, discharge data coding in the USA shifted to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), necessitating new indicator definitions for drug overdose morbidity. Amid the drug overdose crisis, characterising discharge records that have ICD-10-CM drug overdose codes can inform the development of standardised drug overdose morbidity indicator definitions for epidemiological surveillance.MethodsEight states submitted aggregated data involving hospital and emergency department (ED) discharge records with ICD-10-CM codes starting with T36–T50, for visits occurring from October 2015 to December 2016. Frequencies were calculated for (1) the position within the diagnosis billing fields where the drug overdose code occurred; (2) primary diagnosis code grouped by ICD-10-CM chapter; (3) encounter types; and (4) intents, underdosing and adverse effects.ResultsAmong all records with a drug overdose code, the primary diagnosis field captured 70.6% of hospitalisations (median=69.5%, range=66.2%–76.8%) and 79.9% of ED visits (median=80.7%; range=69.8%–88.0%) on average across participating states. The most frequent primary diagnosis chapters included injury and mental disorder chapters. Among visits with codes for drug overdose initial encounters, subsequent encounters and sequelae, on average 94.6% of hospitalisation records (median=98.3%; range=68.8%–98.8%) and 95.5% of ED records (median=99.5%; range=79.2%–99.8%), represented initial encounters. Among records with drug overdose of any intent, adverse effect and underdosing codes, adverse effects comprised an average of 74.9% of hospitalisation records (median=76.3%; range=57.6%–81.1%) and 50.8% of ED records (median=48.9%; range=42.3%–66.8%), while unintentional intent comprised an average of 11.1% of hospitalisation records (median=11.0%; range=8.3%–14.5%) and 28.2% of ED records (median=25.6%; range=20.8%–40.7%).ConclusionResults highlight considerations for adapting and standardising drug overdose indicator definitions in ICD-10-CM.

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Heat Waves and Emergency Department Visits Among the Homeless, San Diego, 2012–2019

American Journal of Public Health ◽

10.2105/ajph.2021.306557 ◽

2022 ◽

Vol 112 (1) ◽

pp. 98-106

Author(s):

Lara Schwarz ◽

Edward M. Castillo ◽

Theodore C. Chan ◽

Jesse J. Brennan ◽

Emily S. Sbiroli ◽

...

Keyword(s):

Emergency Department ◽

San Diego ◽

Heat Waves ◽

Positive Association ◽

Emergency Department Visits ◽

Psychiatric Consultation ◽

Vulnerability Factors ◽

Exact Matching ◽

Data Set ◽

Ed Visits

Objectives. To determine the effect of heat waves on emergency department (ED) visits for individuals experiencing homelessness and explore vulnerability factors. Methods. We used a unique highly detailed data set on sociodemographics of ED visits in San Diego, California, 2012 to 2019. We applied a time-stratified case–crossover design to study the association between various heat wave definitions and ED visits. We compared associations with a similar population not experiencing homelessness using coarsened exact matching. Results. Of the 24 688 individuals identified as experiencing homelessness who visited an ED, most were younger than 65 years (94%) and of non-Hispanic ethnicity (84%), and 14% indicated the need for a psychiatric consultation. Results indicated a positive association, with the strongest risk of ED visits during daytime (e.g., 99th percentile, 2 days) heat waves (odds ratio = 1.29; 95% confidence interval = 1.02, 1.64). Patients experiencing homelessness who were younger or elderly and who required a psychiatric consultation were particularly vulnerable to heat waves. Odds of ED visits were higher for individuals experiencing homelessness after matching to nonhomeless individuals based on age, gender, and race/ethnicity. Conclusions. It is important to prioritize individuals experiencing homelessness in heat action plans and consider vulnerability factors to reduce their burden. (Am J Public Health. 2022;112(1):98–106. https://doi.org/10.2105/AJPH.2021.306557 )

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Abstract WP289: Increasing Emergency Department Use of Advanced Neuroimaging in the Mechanical Thrombectomy Era

Stroke ◽

10.1161/str.51.suppl_1.wp289 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Lauren E Mamer ◽

Keith E Kocher ◽

James Cranford ◽

Phillip A Scott

Keyword(s):

Emergency Department ◽

Emergency Departments ◽

Mechanical Thrombectomy ◽

Ct Perfusion ◽

Mandatory Reporting ◽

Data Set ◽

Stroke Treatment ◽

Mri Brain ◽

Ed Visits ◽

Prospective Longitudinal

Introduction: Data supporting mechanical thrombectomy substantially expanded both the time available for treatment and need for advanced neuroimaging in patients with suspected stroke. These factors potentially increase emergency department (ED) use of neuroimaging resources, though the existence and magnitude of effect is unknown, particularly in a broad hospital population including non-stroke center emergency departments. Hypothesis: ED use of CT-angiography (CTA) and CT-Perfusion (CTP) imaging is both increasing and accelerating from 2013 to 2018. Methods: Prospective, longitudinal, single-state cohort study of ED visits using existing California OSHPD dataset (a mandatory reporting database of all CA-licensed, non-federal, emergency department encounters either discharged or transferred) from 2013 to 2018. NCHCT (CPT 70450), CTA Head (CPT 70496), CTP (CPT 0042T) and MRI Brain (CPT 70553) use in the data set, as determined by Common Procedural Terminology (CPT) codes, was analyzed using descriptive statistics and tests of comparison. Results: All advanced neuroimaging increased during the period. Use of NCHCT increased 61% over the study period, from 2,432 to 3,922 per 100,000 ED visits (p trend < .001). Use of CTA increased 405%, from 39 to 197 per 100,000 encounters (p trend < .001). Use of CTP increased 230%, from 3 to 10 per 100,000 encounters (p trend < .001). Use of MRI Brain increased 19%, from 52 to 62 per 100,000 encounters (p trend < .001). On a year-over-year basis, both CTA and CTP use is accelerating, with substantial increases noted between 2017 and 2018. Conclusions: We identified recent, substantial, temporal changes in CTA and CTP neuroimaging acquisition among CA emergency departments in the nascent mechanical thrombectomy era. Dramatic changes in CTA and CTP use suggest that changes are occurring in ED evaluation of neurological emergencies. If true, this differs substantially from the speed of ED acceptance of rt-PA for stroke treatment. Further analysis from the CA OSHPD and other (NEDS) datasets is planned to better understand the patient, hospital, and clinical factors driving these neuroimaging trends in the ED.

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