Diagnostic Accuracy of the HINTS Exam in an Emergency Department: A Retrospective Chart Review

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

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4.59 Involuntary Patients in the Pediatric Emergency Department: A Retrospective Chart Review

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1016/j.jaac.2018.09.284 ◽

2018 ◽

Vol 57 (10) ◽

pp. S223

Author(s):

Clare Gray ◽

Paula F. Cloutier ◽

Bronwyn Thomson ◽

Emile Chan ◽

Sarah Reid ◽

...

Keyword(s):

Emergency Department ◽

Chart Review ◽

Retrospective Chart Review ◽

Pediatric Emergency ◽

Pediatric Emergency Department

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Diagnostic Accuracy of Neurological Problems in the Emergency Department

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100008921 ◽

2008 ◽

Vol 35 (3) ◽

pp. 335-341 ◽

Cited By ~ 44

Author(s):

Jeremy J Moeller ◽

Joelius Kurniawan ◽

Gordon J Gubitz ◽

John A Ross ◽

Virender Bhan

Keyword(s):

Emergency Department ◽

Diagnostic Accuracy ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Primary Headache ◽

Final Diagnosis ◽

Initial Diagnosis ◽

Educational Strategies ◽

Diagnostic Uncertainty ◽

Peripheral Vertigo

Background:Previous studies describe significant rates of misdiagnosis of stroke, seizure and other neurological problems, but there are few studies examining diagnostic accuracy of all emergency referrals to a neurology service. This information could be useful in focusing the neurological education of physicians who assess and refer patients with neurological complaints in emergency departments.Methods:All neurological consultations in the emergency department at a tertiary-care teaching hospital were recorded for six months. The initial diagnosis of the requesting physician was recorded for each patient. This was compared to the initial diagnosis of the consulting neurologist and to the final diagnosis, as determined by retrospective chart review.Results:Over a six-month period, 493 neurological consultations were requested. The initial diagnosis of the requesting physician agreed with the final diagnosis in 60.4% (298/493) of cases, and disagreed or was uncertain in 35.7% of cases (19.1% and 16.6% respectively). In 3.9% of cases, the initial diagnosis of both the referring physician and the neurologist disagreed with the final diagnosis. Common misdiagnoses included neurocardiogenic syncope, peripheral vertigo, primary headache and psychogenic syndromes. Often, these were initially diagnosed as stroke or seizure.Conclusions:Our data indicate that misdiagnosis or diagnostic uncertainty occurred in over one-third of all neurological consultations in the emergency department setting. Benign neurological conditions, such as migraine, syncope and peripheral vertigo are frequently mislabeled as seizure or stroke. Educational strategies that emphasize emergent evaluation of these common conditions could improve diagnostic accuracy, and may result in better patient care.

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The mortality of ill infants with false tooth extraction in a rural Ugandan emergency department

Journal of Public Health in Africa ◽

10.4081/jphia.2017.582 ◽

2017 ◽

Vol 8 (1) ◽

Author(s):

Amyna Husain ◽

M. Douglas Baker ◽

Mark C. Bisanzo ◽

Martha W. Stevens

Keyword(s):

Emergency Department ◽

Tooth Extraction ◽

Chart Review ◽

Statistical Significance ◽

Univariate Analysis ◽

Retrospective Chart Review ◽

Cultural Practice ◽

Fluid Bolus ◽

Significant Difference ◽

To Receive

False tooth extraction (FTE), a cultural practice in East Africa used to treat fever and diarrhea in infants, has been thought to increase infant mortality. The mortality of clinically similar infants with and without false tooth extraction has not previously been examined. The objective of our retrospective cohort study was to examine the mortality, clinical presentation, and treatment of infants with and without false tooth extraction. We conducted a retrospective chart review of records of infants with diarrhea, sepsis, dehydration, and fever in a rural Ugandan emergency department. Univariate analysis was used to test statistical significance. We found the mortality of infants with false tooth extraction (FTE+) was 18% and without false tooth extraction (FTE−) was 14% (P=0.22). The FTE+ study group, and FTE− comparison group, had similar proportions of infants with abnormal heart rate and with hypoxia. There was a significant difference in the portion of infants that received antibiotics (P=0.001), and fluid bolus (P=0.002). Although FTE+ infants had clinically similar ED presentations to FTE− infants, the FTE+ infants were significantly more likely to receive emergency department interventions, and had a higher mortality than FTE− infants.

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Appropriateness of Imaging Decisions for Low Back Pain Presenting to the Emergency Department: A Retrospective Chart Review Study

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab103 ◽

2021 ◽

Author(s):

Adrian Traeger ◽

Gustavo C Machado ◽

Sally Bath ◽

Martin Tran ◽

Lucinda Roper ◽

...

Keyword(s):

Emergency Department ◽

Low Back Pain ◽

Back Pain ◽

Chart Review ◽

Imaging Modality ◽

Cauda Equina ◽

Retrospective Chart Review ◽

Low Back ◽

Review Study ◽

Hospital Emergency Departments

ABSTRACT Background Imaging for low back pain is widely regarded as a target for efforts to reduce low value care. We aimed to estimate the prevalence of overuse and underuse of lumbar imaging in the Emergency Department. Methods Retrospective chart review study of five public hospital Emergency Departments in Sydney, Australia, in 2019/20. We reviewed the clinical charts of consecutive adult patients who presented with a complaint of low back pain and extracted clinical features relevant to a decision to request lumbar imaging. We estimated the proportion of encounters where a decision to request lumbar imaging was inappropriate (overuse) or where a clinician did not request an appropriate and informative lumbar imaging test when indicated (underuse). Results 649 patients presented with a complaint of low back pain of which 158 (24.3%) were referred for imaging. 79 (12.2%) had a combination of features suggesting lumbar imaging was indicated according to clinical guidelines. The prevalence of overuse and underuse of lumbar imaging was 8.8% (57 of 649 cases, 95%CI 6.8% to 11.2%) and 4.3% (28 of 649 cases, 95%CI 3.0% to 6.1%), respectively. 13 cases were classified as underuse because the patient was referred for an uninformative imaging modality (e.g. referred for radiography for suspected cauda equina syndrome). Conclusion In this study of emergency care there was evidence of overuse of lumbar imaging, but also underuse through failure to request lumbar imaging when indicated or referral for an uninformative imaging modality. These three issues seem more important targets for quality improvement than solely focusing on overuse.

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Safety and tolerability of i.v. push piperacillin/tazobactam within an emergency department

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa114 ◽

2020 ◽

Vol 77 (13) ◽

pp. 1051-1053

Author(s):

William Blake Hays ◽

Tara Flack

Keyword(s):

Emergency Department ◽

Single Dose ◽

Allergic Reaction ◽

Broad Spectrum ◽

Chart Review ◽

Retrospective Chart Review ◽

Primary Objective ◽

Drug Reactions ◽

Broad Spectrum Antibiotic ◽

Peripheral Site

Abstract Purpose Piperacillin/tazobactam is a broad-spectrum antibiotic that is widely used and commonly administered via the intravenous (i.v.) piggyback route over 0.5 to 4.0 hours. Recommendations for i.v. push (IVP) administration of piperacillin/tazobactam are lacking due to the high osmolality of the solution. The primary objective of this study was to retrospectively assess the safety and tolerability of piperacillin/tazobactam administered peripherally by IVP. Methods. A retrospective chart review was conducted to evaluate adverse drug reactions after administration of a single dose of IVP piperacillin/tazobactam through a peripheral line in an emergency department from August 2016 through November 2017. Results A total of 1,813 patients received 1 dose of IVP piperacillin/tazobactam during the study timeframe. Three hundred patients were randomly selected for assessment of safety and tolerability. Two hundred ninety-nine patients (99.7%) tolerated IVP piperacillin/tazobactam. One patient had an allergic reaction that included itching and hives. No infusion-related reactions were documented. Conclusion IVP administration of piperacillin/tazobactam through a peripheral site is safe and tolerable for adult patients.

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P047: Emergency department practice patterns of UTI investigation among the delirious elderly: a retrospective chart review

CJEM ◽

10.1017/cem.2020.253 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S81-S81

Author(s):

R. Pinnell ◽

P. Joo

Keyword(s):

Emergency Department ◽

Elderly Patients ◽

Chart Review ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Urinary Symptoms ◽

Categorical Variables ◽

Continuous Variables ◽

Indwelling Catheter ◽

Exact Test

Introduction: Delirium is a common emergency department (ED) presentation in elderly patients. Urinary tract infection (UTI) investigation and treatment are often initiated in delirious patients in the absence of specific urinary symptoms, despite a paucity of evidence to support this practice. The purpose of this study is to describe the prevalence of UTI investigation, diagnosis and treatment in delirious elderly patients in the ED. Methods: We performed a retrospective chart review of elderly patients presenting to the ED at The Ottawa Hospital between January 15-July 30, 2018 with a chief complaint of confusion or similar. Exclusion criteria were pre-existing and current UTI diagnosis, Glasgow Coma Scale <13, current indwelling catheter or nephrostomy tube, transfers between hospitals, and leaving without being seen. The primary outcome was the proportion of patients for whom urine tests (urinalysis or culture) or antibiotic treatment were ordered. Secondary outcomes were associations between patient characteristics, rates of UTI investigation, and patient outcomes. Descriptive values were reported as proportions with exact binomial confidence intervals for categorical variables and means with standard deviations for continuous variables. Comparisons were conducted with Fischer's exact test for categorical variables and t-tests for continuous variables. Results: After analysis of 1039 encounters with 961 distinct patients, 499 encounters were included. Urine tests were conducted in 324 patients (64.9% [60.6-69.1]) and antibiotics were prescribed to 176 (35.2% [31.1-39.6]). Overall 57 patients (11.4% [8.8-14.5]) were diagnosed with UTI, of which only 12 (21.1% [11.4-33.9]) had any specific urinary symptom. For those patients who had no urinary symptoms or other obvious indication for antibiotics (n = 342), 199 (58.2% [52.8-63.5]) received urine tests and 62 (18.1% [14.2-22.6]) received antibiotics. Patients who received urine tests were older (82.4 ± 8.8 vs. 78.3 ± 8.4 years, p < 0.001) but did not differ in sex distribution from those than those who did not. Additionally, patients who received antibiotics were more likely to be admitted (OR = 2.6 [1.48-4.73]) and had higher mortality at 30 days (OR = 4.2 [1.35-12.91]) and 6 months (OR = 3.2 [1.33-7.84]) than those who did not. Conclusion: Delirious patient without urinary symptoms in the ED were frequently investigated and treated for UTI despite a lack of evidence regarding whether this practice is beneficial.

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