101 National Trends in Emergency Department Ondansetron Use and Clinical Outcomes Among Children with Acute Gastroenteritis

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e72-e73
Author(s):  
Sarah Rogers ◽  
Stephen Freedman ◽  
Terry Klassen ◽  
Brett Burstein
Keyword(s):  
Emergency Department ◽  
Acute Gastroenteritis ◽  
Multivariable Analysis ◽  
Population Level ◽  
Subject Area ◽  
Fluid Administration ◽  
Cross Sectional ◽  
Ed Visits ◽  
Nationally Representative ◽  
Over Time

Abstract Primary Subject area Emergency Medicine - Paediatric Background Acute gastroenteritis (AGE) is among the most common illnesses for which children are evaluated in the Emergency Department (ED). Among children with AGE, ondansetron has been shown to reduce vomiting, intravenous (IV) fluid administration and hospitalizations when administered in the ED. Objectives To determine whether increasing ondansetron administration is associated with a concomitant decline in IV rehydration and hospitalization among children presenting with AGE in a broad, nationally representative ED sample. Design/Methods This was a cross-sectional analysis of the US Centers for Disease Control and Prevention (CDC) National Hospital Ambulatory Medical Care Survey (NHAMCS) database from 2006 to 2015. Children < 18 years old with a discharge diagnosis of AGE were included for analysis. Survey weighting procedures were applied to generate population-level estimates and to perform multivariable logistic regression to identify factors associated with ondansetron administration. Results There were an estimated 15.1 million (95% CI 13.5-16.7) visits for AGE during the 10-year study period. AGE visits increased as a proportion of all pediatric ED visits over time (4.6% in 2006, 5.7% in 2015; p-trend=0.013). The mean patient age was 4.7 (95% CI 4.5-5.0) years, and most visits were to non-teaching (86.6%, 95% CI 83.3-89.3%) and non-pediatric (83.4%, 95% CI 78.2-87.5%) hospitals. The proportion of patients receiving ondansetron increased over time (11.8% in 2006, 62.5% in 2015; p-trend < 0 .001), both in the ED (10.6% in 2006, 55.5% in 2015; p-trend < 0 .001) and as outpatient prescriptions (3.3% in 2006, 45.3% in 2015; p-trend < 0 .001). Over the same period, there was no change in hospitalizations (2.9% overall, 95% CI 2.2-3.7%; p-trend=0.144). IV hydration for AGE decreased (31.8% in 2006, 24.9% in 2015; p-trend < 0 .048), as did IV fluid administration across all other pediatric ED visits (10.3% in 2006, 7.8% in 2015; p-trend < 0 .023). After adjustment for patient- and hospital-level factors, the odds ratio for IV rehydration among children with AGE was 0.97 (95% CI 0.92-1.01). Multivariable analysis found younger age (aOR 0.94, 95% CI 1.04-1.09), Medicaid/Medicare insurance (aOR 0.74; 95% CI 0.57-0.97), and presentation to a teaching hospital (aOR 0.74; 95% CI 0.54-0.99) were inversely associated with ondansetron administration. Other antiemetics most commonly used were promethazine (7.4%, 95% CI 5.9-9.2%), metoclopramide (1.8%, 95% CI 1.3-2.5%) and trimethobenzamide (1.5%, 95% CI 1.1-2.1%). Antimotility agents, H2-receptor blockers, and probiotics were infrequently used. Conclusion Both ED and outpatient prescribing of ondansetron for children with AGE increased; however, no concomitant decline was observed in hospitalizations or IV rehydration. Guidelines and quality improvement efforts are needed to target ondansetron administration to children most likely to benefit to minimize adverse events and costs associated with overuse.

scholarly journals Quantifying Emergency Department Visits From Sport and Recreation: Focus on the Lower Extremity and Knee, 1997–2009

2016 ◽  
Vol 51 (4) ◽  
pp. 309-316 ◽  
Author(s):  
Matthew S. Tenan
Keyword(s):  
Emergency Department ◽  
Lower Extremity ◽  
Population Level ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Sample Survey ◽  
Ed Visits ◽  
Nationally Representative ◽  
Sport And Recreation

Few authors have reported nationally representative data on the number of sport and recreation (SR) injuries resulting in emergency department (ED) visitation. The existing studies have only provided 1 or 2 years of data and are not longitudinal in nature.Context: To use a novel algorithmic approach to determine if ED visitation is due to SR, resulting in a substantially larger longitudinal dataset.Objective: Descriptive epidemiology study.Design: Hospital.Setting: The National Hospital Ambulatory Medical Care Survey, a stratified random-sample survey of US hospital EDs was combined for years 1997–2009. There were 15 699 unweighted patient visits determined to be from SR.Patients or Other Participants: A custom algorithm classified SR visits based on the International Classification of Diseases, Ninth Revision, Clinical Modification E-code and pattern recognition of narrative text. Sport and recreation visits were assessed by age and categorized according to broad injury classifications. Additional quantification was performed on SR visits for lower extremity and knee-specific injuries. Sample weights were applied to provide national annual estimates.Main Outcome Measure(s): Annually, 4 243 000 ED visits resulted from SR. The largest classification of injury from SR was sprains and strains (896 000/y). Males had substantially more SR-related ED visits than females (2 929 000/y versus 1 314 000/y). For patients 10–49 years old, 1 093 000 lower extremity and 169 000 knee-specific injury visits annually were from SR. For both injury types, males had a higher rate of ED visitation; however, females had 25% and 39% greater odds of visitation for lower extremity and knee-specific injury, respectively.Results: The burden on the health system of ED visits from SR was substantial. Males presented in the ED at a higher rate for SR injury, though females had a higher proportion of lower extremity and knee-specific injury ED visitations from SR. This longitudinal analysis of population-level data provides the information to target research on specific subpopulations to mitigate SR injury.Conclusions:

Socioeconomic and Geographic Disparities in Emergency Department Visits due to Alcohol in Ontario: A Retrospective Population-level Study from 2003 to 2017: Disparités Socio-Économiques et Géographiques Dans les Visites au Service D’urgence en raison de L’alcool en Ontario: Une étude Rétrospective Dans la Population, de 2003 à 2017

2021 ◽  
pp. 070674372110273
Author(s):  
Daniel Myran ◽  
Amy Hsu ◽  
Elizabeth Kunkel ◽  
Emily Rhodes ◽  
Haris Imsirovic ◽  
...  
Keyword(s):  
Emergency Department ◽  
Low Income ◽  
Population Level ◽  
Emergency Department Visits ◽  
Income Quintile ◽  
Urban Settings ◽  
Rural Settings ◽  
Ed Visits ◽  
Over Time ◽  
Age And Sex

Objective: While the overall health system burden of alcohol is large and increasing in Canada, little is known about how this burden differs by sociodemographic factors. The objectives of this study were to assess sociodemographic patterns and temporal trends in emergency department (ED) visits due to alcohol to identify emerging and at-risk subgroups. Methods: We conducted a retrospective population-level cohort study of all individuals aged 10 to 105 living in Ontario, Canada. We identified ED visits due to alcohol between 2003 and 2017 using defined International Classification of Diseases, 10th edition, codes from a pre-existing indicator. We calculated annual age- and sex-standardized, and age- and sex-specific rates of ED visits and compared overall patterns and changes over time between urban and rural settings and income quintiles. Results: There were 829,662 ED visits due to alcohol over 15 years. Rates of ED visits due to alcohol were greater for individual living in the lowest- compared to the highest-income quintile neighbourhoods, and disparities (rate ratio lowest to highest quintile) increased with age from 1.22 (95% CI, 1.19 to 1.25) in 15- to 18-year-olds to 4.17 (95% CI, 4.07 to 4.28) in 55- to 59-year-olds. Rates of ED visits due to alcohol were significantly greater in rural settings (56.0 per 10,000 individuals, 95% CI, 55.7 to 56.4) compared to urban settings (44.8 per 10,000 individuals, 95% CI, 44.7 to 44.9), particularly for young adults. Increases in rates of visits between 2003 and 2017 were greater in rural versus urban settings (82 vs. 68% increase in age- and sex-standardized rates) and varied across sociodemographic subgroups with the largest annual increases in rates of visits in young (15 to 29) low-income women (6.9%, 95%CI, 6.7 to 7.3) and the smallest increase in older (45 to 59) high-income men (2.7, 95%CI, 2.4 to 3.0). Conclusion: Alcohol harms display unique patterns with the highest burden in rural and lower-income populations. Rural–urban and income-based disparities differ by age and sex and have increased over time, which offers an imperative and opportunity for further interventions by clinicians and policy makers.

scholarly journals Temporal Trends of Emergency Department Visits of Patients with Atrial Fibrillation: A Nationwide Population-Based Study

2020 ◽  
Vol 9 (5) ◽  
pp. 1485
Author(s):  
So-Ryoung Lee ◽  
Eue-Keun Choi ◽  
Seo-Young Lee ◽  
Euijae Lee ◽  
Kyung-Do Han ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Temporal Trends ◽  
Population Based ◽  
Emergency Department Visits ◽  
Cross Sectional ◽  
Ed Visits ◽  
Management Approaches ◽  
Sectional Analysis ◽  
Over Time

We aimed to describe temporal trends in emergency department (ED) visits of patients with atrial fibrillation (AF) over 12 years. A repeated cross-sectional analysis of ED visits in AF patients using the Korean nationwide claims database between 2006 and 2017 were conducted. We identified AF patients who had ≥1 ED visits. The incidence of ED visits among total AF population, cause of ED visit, and clinical outcomes were evaluated. During 12 years, the annual numbers of AF patients who attended ED at least once a year continuously increased (40,425 to 99,763). However, the annual incidence of ED visits of AF patients was stationary at about 30% because the number of total AF patients also increased during the same period. The most common cause of ED visits was cerebral infarction. Although patients had a higher risk profile over time, the 30-day and 90-day mortality after ED visit decreased over time. ED visits due to ischemic stroke, intracranial hemorrhage, and myocardial infarction decreased, whereas ED visits due to AF, gastrointestinal bleeding, and other major bleeding slightly increased among total AF population over 12 years. A substantial proportion of AF patients attended ED every year, and the annual numbers of AF patients who visited the ED significantly increased over 12 years. Optimized management approaches in a holistic and integrated manner should be provided to reduce ED visits of AF patients.

Abstract 88: Increasing False Positive Diagnoses May Lead to Overestimation of Stroke Incidence, Particularly in the Young

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Abhinav J Appukutty ◽  
Lesli E Skolarus ◽  
Mellanie V Springer ◽  
William J Meurer ◽  
James F Burke
Keyword(s):  
Older Adults ◽  
False Positive ◽  
Age Groups ◽  
Vascular Risk Factor ◽  
The United States ◽  
Cross Sectional ◽  
Stroke Incidence ◽  
Ed Visits ◽  
Over Time

Introduction: Stroke incidence is reportedly increasing in younger adults. While increasing vascular risk factor prevalence has been suggested as a cause, the reasons for rising stroke incidence in the young are not clear. We explored several alternate explanations: trends in neurologically-focused emergency department (ED) visits, differential diagnostic classification of stroke and TIA over time, and changes in the use of advanced imaging in young and older adults. Methods: We performed a retrospective, serial, cross-sectional study on a nationally representative sample of all ED visits in the United States to quantify changes in patterns of neurologically-focused ED visits, stroke and TIA diagnoses, and rates of MRI utilization for young (18 – 44 years) and older (65+ years) adults over a 17-year period (1995 – 2000; 2005 – 2015) using National Hospital Ambulatory Medical Care Survey (NHAMCS) data. Results: In young adults, 0.4% (95% CI 0.3% – 0.5%) of neurologically-focused ED visits resulted in a primary diagnosis of stroke vs. 6.8% (95% CI 6.2% – 7.5%) for older adults. In both populations, the incidence of neurologically-focused ED visits has increased over time (+111/100,000 population/year, 95% CI +94 – +130 in the young vs. +70/100,000 population/year, 95% CI +34 – +108 in older adults). There was no evidence of differential classification of TIA to stroke over time (OR 1.001 per year, 95% CI 0.926 – 1.083 in the young; OR 1.003 per year, 95% CI 0.982 – 1.026 in older adults) and no evidence of disproportionate rise in MRI utilization for neurologically-focused ED visits in the young (OR 1.057 per year, 95% CI 1.028 – 1.086 in the young; OR 1.095 per year, 95% CI 1.066 – 1.125 in older adults). Conclusions: If the specificity of stroke diagnosis amongst ED visits is similar amongst young and older populations, then the combination of data observed here, including (1) a lower prior probability of stroke diagnoses in the young and (2) an increasing trend in neurologically-focused ED visits in both age groups, suggests that false positive diagnoses will increase over time, with a faster rise in the young compared to older adults. These data suggest a potential explanation that may contribute to higher stroke incidence in the young and merits further scrutiny.

Abstract P220: Disparity In Hospital Admissions And Length Of Stay Based On Income Status For Emergency Department Hypertensive Crisis Visits: A Cross-sectional Study Using The Nationwide Emergency Department Sample

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Shreya Srivastava ◽  
Bhargav Vemulapalli ◽  
Alexis K Okoh ◽  
John Kassotis
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Regression Model ◽  
Household Income ◽  
Hypertensive Crisis ◽  
Cross Sectional ◽  
Delivery Of Care ◽  
Income Status ◽  
Ed Visits ◽  
Income Quartile

Introduction: Racial, gender and lower socioeconomic status have been shown to negatively impact the delivery of care. How this impacts the management of hypertensive crisis (HC) remains unclear. Objective: Identify disparities on admission frequency and length of stay (LOS) among those presenting with HC, as a function of household income. Methods: This is a cross-sectional analysis of 2016 ED visits and supplemental Inpatient data from the Nationwide Emergency Department Sample. Median household income quartiles were established. A multivariable logistic regression model was used to estimate odds of admission in each income quartile. A multivariable linear regression model was used to predict LOS. Results: After applying sample weighting, the total number of ED visits was 33,728 with 25442, 6906, and 1380 visits for hypertensive urgency (HU), emergency (HE) and unspecified crisis, respectively. There were 13191, 8889, 6401, 5247 visits in the (1 st ) lowest, 2 nd , 3 rd and 4 th (highest) income quartiles, respectively. The median age was 61 and 58 years for HU and HE, respectively. The most common comorbidity was chronic kidney disease. Individuals with the highest income, had a lower odds of admission compared to the lowest quartile [Adjusted Odds Ratio: 0.41, 95% CI: 0.22,0.74] ( Figure 1a ). There was a significant linear association between income quartile and LOS across all HC and HE [beta coefficient: 0.411, 0.407 p value = 0.015, 0.019] ( Figure 1b ). Conclusions: In this study, patients with lower income were more likely to be admitted, while those with higher income exhibited a longer LOS. Clinicians must be made aware these disparities to ensure the equitable delivery of care.

scholarly journals Paid employment and common mental disorders in 50–64-year olds: analysis of three cross-sectional nationally representative survey samples in 1993, 2000 and 2007

2017 ◽  
Vol 28 (1) ◽  
pp. 88-99
Author(s):  
G. Perera ◽  
G. Di Gessa ◽  
L. M. Corna ◽  
K. Glaser ◽  
R. Stewart
Keyword(s):  
Mental Health ◽  
Employment Status ◽  
Common Mental Disorders ◽  
Common Mental Disorder ◽  
Psychiatric Morbidity ◽  
Housing Tenure ◽  
Cross Sectional ◽  
Paid Employment ◽  
Nationally Representative ◽  
Over Time

Aims.Associations between employment status and mental health are well recognised, but evidence is sparse on the relationship between paid employment and mental health in the years running up to statutory retirement ages using robust mental health measures. In addition, there has been no investigation into the stability over time in this relationship: an important consideration if survey findings are used to inform future policy. The aim of this study is to investigate the association between employment status and common mental disorder (CMD) in 50–64-year old residents in England and its stability over time, taking advantage of three national mental health surveys carried out over a 14-year period.Methods.Data were analysed from the British National Surveys of Psychiatric Morbidity of 1993, 2000 and 2007. Paid employment status was the primary exposure of interest and CMD the primary outcome – both ascertained identically in all three surveys (CMD from the revised Clinical Interview Schedule). Multivariable logistic regression models were used.Results.The prevalence of CMD was higher in people not in paid employment across all survey years; however, this association was only present for non-employment related to poor health as an outcome and was not apparent in those citing other reasons for non-employment. Odds ratios for the association between non-employment due to ill health and CMD were 3.05 in 1993, 3.56 in 2000, and 2.80 in 2007, after adjustment for age, gender, marital status, education, social class, housing tenure, financial difficulties, smoking status, recent physical health consultation and activities of daily living impairment.Conclusions.The prevalence of CMD was higher in people not in paid employment for health reasons, but was not associated with non-employment for other reasons. Associations had been relatively stable in strength from 1993 to 2007 in those three cross-sectional nationally representative samples.

Reduced rate of postpartum readmissions among homeless compared with non-homeless women in New York: a population-based study using serial, cross-sectional data

2021 ◽  
pp. bmjqs-2020-012898
Author(s):  
Rie Sakai-Bizmark ◽  
Hiraku Kumamaru ◽  
Dennys Estevez ◽  
Sophia Neman ◽  
Lauren E M Bedel ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Random Effect ◽  
Safety Net ◽  
Homeless Women ◽  
Homeless Population ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Ed Visits ◽  
Income Quartile

ObjectiveTo assess differences in rates of postpartum hospitalisations among homeless women compared with non-homeless women.DesignCross-sectional secondary analysis of readmissions and emergency department (ED) utilisation among postpartum women using hierarchical regression models adjusted for age, race/ethnicity, insurance type during delivery, delivery length of stay, maternal comorbidity index score, other pregnancy complications, neonatal complications, caesarean delivery, year fixed effect and a birth hospital random effect.SettingNew York statewide inpatient and emergency department databases (2009–2014).Participants82 820 and 1 026 965 postpartum homeless and non-homeless women, respectively.Main outcome measuresPostpartum readmissions (primary outcome) and postpartum ED visits (secondary outcome) within 6 weeks after discharge date from delivery hospitalisation.ResultsHomeless women had lower rates of both postpartum readmissions (risk-adjusted rates: 1.4% vs 1.6%; adjusted OR (aOR) 0.87, 95% CI 0.75 to 1.00, p=0.048) and ED visits than non-homeless women (risk-adjusted rates: 8.1% vs 9.5%; aOR 0.83, 95% CI 0.77 to 0.90, p<0.001). A sensitivity analysis stratifying the non-homeless population by income quartile revealed significantly lower hospitalisation rates of homeless women compared with housed women in the lowest income quartile. These results were surprising due to the trend of postpartum hospitalisation rates increasing as income levels decreased.ConclusionsTwo factors likely led to lower rates of hospital readmissions among homeless women. First, barriers including lack of transportation, payment or childcare could have impeded access to postpartum inpatient and emergency care. Second, given New York State’s extensive safety net, discharge planning such as respite and sober living housing may have provided access to outpatient care and quality of life, preventing adverse health events. Additional research using outpatient data and patient perspectives is needed to recognise how the factors affect postpartum health among homeless women. These findings could aid in lowering readmissions of the housed postpartum population.

Abstract P299: Changes in Race-Sex Specific Population Attributable Fraction for Obesity-Related Diabetes, 2001-2016

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Natalie Cameron ◽  
Megan McCabe ◽  
Lucia Petito ◽  
Norrina B Allen ◽  
Mercedes R Carnethon ◽  
...  
Keyword(s):  
Population Attributable Fraction ◽  
Population Level ◽  
Attributable Fraction ◽  
Incident Diabetes ◽  
Obesity Prevalence ◽  
Longitudinal Assessment ◽  
Prevalence Of Obesity ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Over Time

Introduction: Estimating effects of population-level increases in obesity on diabetes has important implications for public health policy. Therefore, we used the population attributable fraction (PAF) to quantify trends in the burden of obesity on incident diabetes in key sex and race/ethnicity subgroups over time. Hypothesis: PAFs for obesity attributable incident diabetes will be greatest for women, differ by race/ethnicity and increase over time. Methods: Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we estimated unadjusted and adjusted hazard ratios (HRs) of obesity on incident diabetes mellitus (DM). We included non-Hispanic White (NHW), non-Hispanic Black (NHB) and Hispanic-Mexican (MA) MESA participants with available data on body mass index and key covariates and without DM at baseline. Next, we estimated the prevalence of obesity in four pooled groups of NHANES survey cycles from 2001-2016 with similar characteristics to MESA participants (age 45-80 years, NHW, NHB, and MA without cardiovascular disease). Lastly, we combined estimates from MESA and NHANES to quantify unadjusted and adjusted PAFs (adjusted for age, income, education, physical activity and diet). Leveraging the objective longitudinal assessment of incident DM in MESA and a nationally representative sample of NHANES, we estimated broadly generalizable PAF estimates over time. Results: Of 3869 MESA participants, mean age was 61 (± 10) years with 47% men, 56% NHW, 31% NHB, and 13% MA. Incidence of DM was 11% with overall adjusted HR of 2.75 (95% CI 2.26, 3.34) for obesity. Prevalence of obesity increased from 34% (32, 37) in 2001-2004 to 41% (39, 44) in 2013-2016. Overall adjusted PAFs ranged from 0.23 to 0.52 over the study period (TABLE), with greatest estimates in NHW women. Conclusions: In conclusion, over time, the proportion of diabetes due to obesity has increased across multiple subgroups of the population, further highlighting the health burden of obesity in the population.

Emergency Department Visits due to Scabies in the United States: A Retrospective Analysis of a Nationally Representative Emergency Department Sample

2019 ◽  
Author(s):  
Raghav Tripathi ◽  
Konrad D Knusel ◽  
Harib H Ezaldein ◽  
Jeremy S Bordeaux ◽  
Jeffrey F Scott
Keyword(s):  
United States ◽  
Emergency Department ◽  
Retrospective Analysis ◽  
The United States ◽  
Cost Of Care ◽  
Emergency Department Visits ◽  
Limited Information ◽  
Targeted Interventions ◽  
Ed Visits ◽  
Nationally Representative

Abstract Background Limited information exists regarding the burden of emergency department (ED) visits due to scabies in the United States. The goal of this study was to provide population-level estimates regarding scabies visits to American EDs. Methods This study was a retrospective analysis of the nationally representative National Emergency Department Sample from 2013 to 2015. Outcomes included adjusted odds for scabies ED visits, adjusted odds for inpatient admission due to scabies in the ED scabies population, predictors for cost of care, and seasonal/regional variation in cost and prevalence of scabies ED visits. Results Our patient population included 416 017 218 ED visits from 2013 to 2015, of which 356 267 were due to scabies (prevalence = 85.7 per 100 000 ED visits). The average annual expenditure for scabies ED visits was $67 125 780.36. The average cost of care for a scabies ED visit was $750.91 (±17.41). Patients visiting the ED for scabies were most likely to be male children from lower income quartiles and were most likely to present to the ED on weekdays in the fall, controlling for all other factors. Scabies ED patients that were male, older, insured by Medicare, from the highest income quartile, and from the Midwest/West were most likely to be admitted as inpatients. Older, higher income, Medicare patients in large Northeastern metropolitan cities had the greatest cost of care. Conclusion This study provides comprehensive nationally representative estimates of the burden of scabies ED visits on the American healthcare system. These findings are important for developing targeted interventions to decrease the incidence and burden of scabies in American EDs.

Sign in / Sign up

Export Citation Format

Share Document