Unplanned blood use within 24 hours of emergency department presentation: A cohort study in an ageing population

There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.

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Emergency Department Presentation of Childhood Malignancies

Emergency Medicine Clinics of North America ◽

10.1016/s0733-8627(20)30646-5 ◽

1993 ◽

Vol 11 (2) ◽

pp. 517-529

Author(s):

Emily S. Pollack

Keyword(s):

Emergency Department ◽

Emergency Department Presentation ◽

Childhood Malignancies

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Diabetic Ketoacidosis at Emergency Department Presentation During the First Months of the SARS-CoV-2 Pandemic in Israel: A Multicenter Cross-Sectional Study

Diabetes Therapy ◽

10.1007/s13300-021-01049-3 ◽

2021 ◽

Author(s):

Ron Jacob ◽

Giora Weiser ◽

Danna Krupik ◽

Dania Takagi ◽

Shuny Peled ◽

...

Keyword(s):

Emergency Department ◽

Diabetic Ketoacidosis ◽

Cross Sectional Study ◽

Emergency Department Presentation ◽

Sectional Study ◽

Cross Sectional

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Prospective validation of an 11-gene mRNA host response score for mortality risk stratification in the intensive care unit

Scientific Reports ◽

10.1038/s41598-021-91201-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Andrew R. Moore ◽

Jonasel Roque ◽

Brian T. Shaller ◽

Tola Asuni ◽

Melissa Remmel ◽

...

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Whole Blood ◽

Messenger Rna ◽

Emergency Department Presentation ◽

Gene Score ◽

Net Reclassification Improvement ◽

Improvement Index ◽

Gene Mrna

AbstractSeveral clinical calculators predict intensive care unit (ICU) mortality, however these are cumbersome and often require 24 h of data to calculate. Retrospective studies have demonstrated the utility of whole blood transcriptomic analysis in predicting mortality. In this study, we tested prospective validation of an 11-gene messenger RNA (mRNA) score in an ICU population. Whole blood mRNA from 70 subjects in the Stanford ICU Biobank with samples collected within 24 h of Emergency Department presentation were used to calculate an 11-gene mRNA score. We found that the 11-gene score was highly associated with 60-day mortality, with an area under the receiver operating characteristic curve of 0.68 in all patients, 0.77 in shock patients, and 0.98 in patients whose primary determinant of prognosis was acute illness. Subjects with the highest quartile of mRNA scores were more likely to die in hospital (40% vs 7%, p < 0.01) and within 60 days (40% vs 15%, p = 0.06). The 11-gene score improved prognostication with a categorical Net Reclassification Improvement index of 0.37 (p = 0.03) and an Integrated Discrimination Improvement index of 0.07 (p = 0.02) when combined with Simplified Acute Physiology Score 3 or Acute Physiology and Chronic Health Evaluation II score. The test performed poorly in the 95 independent samples collected > 24 h after emergency department presentation. Tests will target a 30-min turnaround time, allowing for rapid results early in admission. Moving forward, this test may provide valuable real-time prognostic information to improve triage decisions and allow for enrichment of clinical trials.

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Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

BMJ ◽

10.1136/bmj.n49 ◽

2021 ◽

pp. n49

Author(s):

Jeffrey J Perry ◽

Marco L A Sivilotti ◽

Marcel Émond ◽

Ian G Stiell ◽

Grant Stotts ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Carotid Artery ◽

Confidence Interval ◽

Carotid Endarterectomy ◽

Likelihood Ratio ◽

Transient Ischaemic Attack ◽

Carotid Artery Stenting ◽

Stroke Risk ◽

Ischaemic Attack

Abstract Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack. Design Prospective cohort study. Setting 13 Canadian emergency departments over five years. Participants 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke. Main outcome measures The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit. Results Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days. Conclusion The Canadian TIA Score stratifies patients’ seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.

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