scholarly journals 1430. Descriptive Epidemiology of Emergency Department Visits with cUTI in the US, 2012-2018

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S797-S797
Author(s):  
Marya Zilberberg ◽  
Brian Nathanson ◽  
Kate Sulham ◽  
Andrew F Shorr
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Healthcare System ◽  
Emergency Department Visits ◽  
Principal Diagnosis ◽  
Research Support ◽  
The Us ◽  
Ed Visits ◽  
Tract Infections

Abstract Background Urinary tract infections (UTI) represent a substantial burden to the healthcare system. In the early 2000s annual UTI admissions numbered 100,000, and these infections resulted in over 1 million emergency department (ED) visits. While only a fraction of total UTI volume, the estimated cost of complicated (cUTI) to the healthcare system exceeded &3.5 billion. We set out to evaluate the contemporary burden of cUTI in the US in terms of ED visits annually. Methods We conducted a retrospective multicenter cohort study within the National Emergency Department (NEDS) database, a 20-percent stratified sample of all US hospital-based EDs, from 2012-2018, to explore characteristics of patients discharged with a cUTI diagnosis. We applied a previously published algorithm to identify cUTI using administrative coding. We applied survey methods to develop national estimates. Results Among 3,010,997 ED visits with cUTI, 43.3% were female, and 59.0% were age 65 years or older. Commensurately, Medicare was the primary payor in 62.8% of the visits. The majority of the patients (59.1%) presented to metropolitan teaching hospitals, and plurality were in the Southern US (39.6%). There was a narrow range in the visits’ seasonal variation, from 6.4% occurring in February to 7.9% in October. cUTI was the principal diagnosis in 48.5% of all cUTI visits. In the remaining 51.5%, sepsis was the most common principal diagnosis (33.9%), but severe sepsis and septic shock codes each appeared in 4.9%. Of all cUTI ED visits, 21.4% had catheter-associated UTI. While only 19.8% had a code for pyelonephritis, 2,050,548 (68.1%) were admitted to the hospital. Mortality in the ED was 0.02%. Conclusion During the seven-year span, there were over 3 million ED visits for cUTI. Although fewer than 1 in 10 patients met criteria for severe sepsis/septic shock, approximately 2/3rds of cUTI patients presenting to the ED were subsequently hospitalized. Disclosures Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Kate Sulham, MPH, Spero Therapeutics (Consultant) Andrew F. Shorr, MD, MPH, MBA, Merck (Consultant)

EPR19-069: Opioid Use Among Cancer Patients Undergoing Surgery and Their Associated Risk of Re-admissions and Emergency Department Visits in the 1-Year Postsurgical Period

2019 ◽  
Vol 17 (3.5) ◽  
pp. EPR19-069 ◽  
Author(s):  
Siyana Kurteva ◽  
Robyn Tamblyn ◽  
Ari Meguerditchian
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Healthcare System ◽  
Emergency Department Visits ◽  
Administrative Claims ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Ed Visits ◽  
Opioid Users ◽  
The Impact

Background: Prescription opioid use and overdose has steadily increased over the past years, resulting in a dramatic increase in opioid-related emergency department (ED) visits and hospitalizations. Methods: This study used a prospective cohort of cancer patients having undergone surgery in Montreal (Quebec) to describe their post-discharge opioid use and identify potential patterns of unplanned health service use (ED visits, hospitalizations). Provincial health administrative claims were used to measure opioid dispensation as well as hospital re-admissions and ED visits. The hospital warehouse, patient chart and patient interview will be used to further describe patient’s medical profile. Marginal structural models will be used to model the association between use of opioids and risk of ED visits and hospitalizations. Inverse probability of treatment and censoring weights will be constructed to properly adjust for confounders that may be unbalanced between the opioid and non–opioid users as well as to account for competing risk due to mortality. Reasons for the re-admissions will also be presented as part of the analyses. Covariates will include patient comorbidities, medication history, and healthcare system characteristics such as nurse-to-patient and attending physician-to-patient ratios. Results (interim): A total of 821 were included in the study; of these, 73% (n=597) were admitted for a cancer procedure. At postoperative discharge, 605 (74%) of patients had at least one opioid dispensation, of which the majority (67%) were oxycodone with hydromorphone being the second most prescribed (28%). Among those who filled a prescription, mean age was 66 (13.4), 68% had no previous history of opioid use, and 10% have had 3 or more dispensing pharmacies in the year prior to admission, compared to less than 1% for the non–opioid users. Overall, 343 people refilled their opioid prescription at least once and 128 at least twice during the 1-year postoperative period. Among cancer patients who were opioid users, 214 ED visits occurred in the 1 year after surgery compared to only 40 for the non-cancer opioid users. Conclusion: This study will help to identify the risk profile of cancer patients who are most likely to continue using opioids for prolonged periods following surgical procedures as well as quantify the impact of opioid use and its associated burden on the healthcare system in order to identify areas for possible interventions.

scholarly journals Emergency department visits and hospitalisations for asthma, COPD and respiratory tract infections: what is the role of respiratory viruses, and return to school in September, January and March?

2020 ◽  
Vol 6 (4) ◽  
pp. 00593-2020
Author(s):  
Imran Satia ◽  
Adil Adatia ◽  
Sarah Yaqoob ◽  
Justina M. Greene ◽  
Paul M. O'Byrne ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Emergency Department Visits ◽  
Human Rhinovirus ◽  
After School ◽  
Return To School ◽  
Ed Visits ◽  
Tract Infections ◽  
Event Rates

BackgroundAsthma exacerbations increase in September coinciding with children returning to school. The aim of this study was to investigate whether this occurs 1) for COPD and respiratory tract infections (RTIs); 2) after school resumes in January and March; and 3) identify which viruses may be responsible.MethodsEmergency department (ED) visits and admissions for asthma, COPD and RTIs and the prevalence of viruses in Ontario, Canada were analysed daily between 2003 and 2013. ED visits and admissions were provided by the Canadian Institute for Health Information. Viral prevalence was obtained from the Centre for Immunisation and Respiratory Infectious Diseases.ResultsED visits and admissions rates demonstrated a biphasic pattern. Lowest rates occurred in July and August and the highest rates in September for asthma, and after December for COPD and RTI. The increase in rates for 30 days before and after school return in September was greatest for children with asthma <15 years (2.4–2.6×). Event rates fell after school return in January for all three conditions ranging from 10–25%, and no change followed March break for asthma and COPD. Human rhinovirus was prevalent in summer with a modest relationship to asthma rates in September. The prevalence of respiratory syncytial virus, influenza A and coronavirus was associated with sustained event rates for COPD and RTIs.ConclusionsAsthma, COPD and RTIs increase in September but do not occur after return to school in January and March. Human rhinovirus is associated with ED visits and admissions only in September.

scholarly journals 658. Cost-effectiveness of Molecular Diagnostic Assays for the Therapy of Severe Sepsis and Septic Shock in the Emergency Department

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S302-S302
Author(s):  
Ioannis Zacharioudakis ◽  
Fainareti Zervou ◽  
Fadi Shehadeh ◽  
Eleftherios Mylonakis ◽  
Eleftherios Mylonakis
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Cost Effectiveness ◽  
Molecular Diagnostic ◽  
Molecular Testing ◽  
Decision Analysis Model ◽  
Research Support ◽  
Assay Sensitivity ◽  
Wide Range

Abstract Background Sepsis presents a major burden to the emergency department (ED). Because empiric inappropriate antimicrobial therapy (IAAT) is associated with increased mortality, rapid molecular assays may decrease IAAT and improve outcomes.We evaluated the cost-effectiveness of molecular testing as an adjunct to blood cultures in patients with severe sepsis or septic shock evaluated in the ED. Methods We developed a decision analysis model with the primary outcome the incremental cost-effectiveness ratio expressed in terms of deaths averted. Costs were dependent on the assay price and the patients’ length of stay (LOS). Three base-case scenarios regarding the difference in LOS between patients receiving appropriate (AAT) and IAAT were described.Sensitivity analyses regarding the assay cost and sensitivity, and its ability to guide changes from IAAT to AAT were performed. Results Under baseline assumptions, molecular testing was cost-saving when the LOS differed by 4 days between patients receiving IAAT and AAT (ICER −$7,302/death averted). Our results remained robust in sensitivity analyses for assay sensitivity ≥52%, panel efficiency ≥39%, and assay cost ≤$270. In the extreme case that the LOS of patients receiving AAT and IAAT was the same, the ICER remained ≤$20,000/death averted for every studied sensitivity (i.e., 0.5–0.95), panel efficiency ≥34%, and assay cost ≤$313. For 2 days difference in LOS, the bundle approach was dominant when the assay cost was ≤$135 and the panel efficiency was ≥77%. Conclusion The incorporation of molecular tests in the management of sepsis in the ED has the potential to improve outcomes and be cost-effective for a wide range of clinical scenarios. Disclosures Eleftherios Mylonakis, MD PhD, Sanofi-Pasteur: Grant/Research Support; T2 Biosystems: Grant/Research Support.

scholarly journals 1508. Hospitalizations and Emergency Department Visits for Respiratory Syncytial Virus Among Infants Aged < 1 year in the United States: An Analysis of Nationwide Inpatient and Emergency Room Data

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S757-S758
Author(s):  
Mina Suh ◽  
Xiaohui Jiang ◽  
Naimisha Movva ◽  
Joh Frysek ◽  
Lauren Bylsma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Syncytial Virus ◽  
Emergency Room ◽  
The United States ◽  
Emergency Department Visits ◽  
Sensitivity Analyses ◽  
Inpatient Setting ◽  
Ed Visits ◽  
Syncytial Virus ◽  
Tract Infections

Abstract Background Respiratory syncytial virus (RSV) is a common cause of illness and hospitalization for infants and children globally. The objective of this study was to characterize the burden of RSV and all-cause bronchiolitis (ACB) inpatient hospitalizations and emergency room department (ED) visits in U.S. infants aged &lt; 1 year with the most recent years of data available. Figure 1. RSV and ACB hospitalizations among US infants &lt;1 year old (NIS 2016) Figure 2. ED visits due to RSV and ACB among US infants &lt; 1 year old (NEDS 2016) Methods The National (Nationwide) Inpatient Sample (NIS) and the Nationwide Emergency Department Sample (NEDS), which are large national publicly available all-payer databases in the U.S., were used to estimate the burden of RSV in 2016 based on ICD-9 and 10 codes. The proportions of hospitalizations or ED visits due to RSV in infants aged &lt; 1 year were quantified. Due to the potential of missing RSV encounters based on coding practices, ACB was also evaluated. Based on availability of variables and data recency, 2011 NIS data were used to describe RSV burden by age in months. Sensitivity analyses were conducted with NIS and NEDS data from other years (2011-2015). Results A clear seasonal pattern was observed for RSV hospitalizations and RSV ED visits with a peak in December-February and a trough in June-August in 2016. During the RSV season and peak months, RSV was a leading cause of hospitalization (12065/45490=27% in Jan and 12050/45080=27% in Feb) and ED visits (26423/316709=8% in Jan and 24721/306397=8% in Feb)) among U.S. infants under 1 year of age. Similar patterns were seen for ACB in 2016 (38% hospitalization and 17-18% ED visits in Jan and Feb) and for RSV and ACB in the other years. For the inpatient setting in 2011, RSV hospitalizations were the highest among the youngest patients (except those aged &lt;1 month) and decreased with age during the RSV season and peak months. Conclusion These results show that during the RSV season, RSV and ACB were a leading cause of hospitalization and ED visit among US infants under 1 year of age. Current policy does not support routine RSV testing of clinical lower respiratory tract infections (LRTIs) among infants. In that context, as an approximation of RSV LRTI visits in each setting, ACB can be considered an upper bound and RSV can be considered a lower bound of the true proportion of hospital encounters associated with RSV in these settings.. Disclosures Mina Suh, MPH, International Health, EpidStrategies (Employee) Xiaohui Jiang, MS, EpidStrategies (Employee)

scholarly journals National rates of non-fatal emergency department visits and hospitalisations due to fall-related injuries in older adults 2010–2014 and 2016: transitioning from ICD-9-CM to ICD-10-CM

2021 ◽  
Vol 27 (S1) ◽  
pp. i75-i78
Author(s):  
Briana L Moreland ◽  
Elizabeth R Burns ◽  
Yara K Haddad
Keyword(s):  
Emergency Department ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Injury Rates ◽  
Fall Injury ◽  
The Us ◽  
Before And After ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Ed Visits

BackgroundThis study describes rates of non-fatal fall-injury emergency department (ED) visits and hospitalisations before and after the US 2015 transition from the 9th to 10th revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM to ICD-10-CM).MethodsED visit and hospitalisation data for adults aged 65+ years were obtained from the 2010–2016 Healthcare Cost and Utilisation Project. Differences in fall injury rates between 2010 and 2014 (before transition), and 2014 and 2016 (before and after transition) were analysed using t-tests.ResultsFor ED visits, rates did not differ significantly between 2014 and 2016 (4288 vs 4318 per 100 000, respectively). Hospitalisation rates were lower in 2014 (1232 per 100 000) compared with 2016 (1281 per 100 000).ConclusionIncreased rates of fall-related hospitalisations could be an artefact of the transition or may reflect an increase in the rate of fall-related hospitalisations. Analyses of fall-related hospitalisations across the transition should be interpreted cautiously.

scholarly journals 1427. Healthcare Resource Utilization During Hospitalizations with UTI in the US, 2018

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S796-S796
Author(s):  
Marya Zilberberg ◽  
Brian Nathanson ◽  
Kate Sulham
Keyword(s):  
Urinary Tract ◽  
Healthcare System ◽  
Resource Utilization ◽  
Hospital Admissions ◽  
Cleveland Clinic ◽  
Hospital Charges ◽  
Research Support ◽  
Hospitalization Costs ◽  
The Us ◽  
Tract Infections

Abstract Background Urinary tract infection (UTI) as the reason for hospitalization costs the US healthcare system nearly &3 billion annually, and is on the rise. We set out to explore the full burden of UTI hospitalizations in the US, including admissions both for UTI and with UTI. Methods We conducted a cross-sectional multicenter study within the National Inpatient Sample (NIS) database, a 20% stratified sample of discharges from US hospitals, from 2018, to explore hospital resource utilization of patients discharged with a UTI diagnosis. We divided UTI into mutually exclusive categories of complicated (cUTI), uncomplicated (uUTI), and catheter-associated (CAUTI), in addition to healthcare-associated (HAUTI). We calculated unadjusted hospital charges, costs, average reimbursements, and length of stay (LOS) associated with these infections. Results Among 2,837,385 discharges with a UTI code, 77.9% were uUTI, 17.6% cUTI (80.2% HAUTI), and 4.4% CAUTI; UTI was principal diagnosis in only 17.0%. Median [interquartile range, IQR] LOS ranged from 4 [3-8] days in uUTI and cUTI to 5 [3-9] days in CAUTI. Overall median [IQR] hospital charges and costs were lowest in uUTI (&36,335 [&19,920-&70,745] and &8,898 [&5,408-&16,092], respectively) and highest in cUTI (&39,690 [&21,997-&75,739] and &9,713 [&5,923-&17,423], respectively), with the HAUTI subgroup being most costly (&44,650 [&24,642-&85,628] and &10,945 [&6,573-&19,634], respectively). “Septicemia or Severe Sepsis without MV &gt;96 Hours with MCC” was the most common DRG in uUTI (13.2%) and cUTI (14.2%), with the corresponding median [IQR] reimbursements of &11,057 [&7,028-&17,757] and &12,226 [&7,889-&19,216], respectively. In contrast, CAUTI was most commonly (44.7%) reimbursed under “Kidney and Urinary Tract Infections without MCC” at &8,635 [&5,693-&13,718]. Conclusion The nearly 3 million hospital admissions with a UTI represent 8% of all annual admissions in the US. Though the majority are considered uncomplicated, all categories are nearly equally costly. Given that over 80% of all UTI-associated admissions are with UTI as a secondary diagnosis, annual estimates of primary UTI costs likely significantly underrepresent the true economic burden of UTI on the US healthcare system. Disclosures Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Kate Sulham, MPH, Spero Therapeutics (Consultant)

An Analysis of US Emergency Department Visits From Falls From Skiing, Snowboarding, Skateboarding, Roller-Skating, and Using Nonmotorized Scooters

2015 ◽  
Vol 55 (8) ◽  
pp. 738-744 ◽  
Author(s):  
Brian H. Nathanson ◽  
Kara Ribeiro ◽  
Philip L. Henneman
Keyword(s):  
Emergency Department ◽  
Odds Ratio ◽  
Pediatric Patients ◽  
Healthcare Research ◽  
Emergency Department Visits ◽  
Primary Analysis ◽  
Discharge Data ◽  
The Us ◽  
Skiing Injuries ◽  
Ed Visits

We analyzed the US incidence of emergency department (ED) visits and hospitalizations for falls from skiing, snowboarding, skateboarding, roller-skating, and nonmotorized scooters in 2011. The outcome was hospital admission from the ED. The primary analysis compared pediatric patients aged 1 to 17 years to adults aged 18 to 44 years. The analysis used ICD-9 E-codes E885.0 to E885.4 using discharge data from the Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Approximately 214 000 ED visits met study criteria. Skiing injuries had the highest percentage of hospitalizations (3.30% in pediatric patients and 6.65% in adults 18-44 years old). Skateboard and snowboard injuries were more likely to require hospitalization than roller skating injuries in pediatric patients (odds ratio = 2.42; 95% CI = 2.14-2.75 and odds ratio = 1.83; 95% CI =1.55-2.15, respectively). In contrast, skateboard and snowboard injuries were less severe than roller-skating injuries in adults.

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

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 &lt; 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P &lt; 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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