scholarly journals Paediatric tic-like presentations during the COVID-19 pandemic

2021 ◽  
pp. archdischild-2021-323002
Author(s):  
Sarah Buts ◽  
Morvwen Duncan ◽  
Tamsin Owen ◽  
Davide Martino ◽  
Tamara Pringsheim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Neurodevelopmental Disorders ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Therapeutic Strategies ◽  
Sudden Onset ◽  
Female Adolescents ◽  
Previous Diagnosis ◽  
Predominantly Female ◽  
Dramatic Presentation

Background and aimClinical centres have seen an increase in tic-like movements during the COVID-19 pandemic. A series of children and adolescents are described.MethodsA retrospective chart review of 34 consecutive paediatric patients presenting with sudden onset tic-like movements, seen over 6 months.Results94% of patients were female, with an average age of sudden onset or increase of tic-like movements of 13.7 years. 44% had a previous diagnosis of tics, and 47% initially presented to an emergency department. Comorbid psychiatric and neurodevelopmental disorders were reported in 91% with 68% reporting anxiety.ConclusionWe highlight a dramatic presentation of sudden onset functional tic-like movements in predominantly female adolescents to help inform identification and management. There is need to research the neurobiological underpinnings and environmental exacerbating factors leading to these presentations and to explore effective therapeutic strategies.

Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

2021 ◽  
pp. 082585972110033
Author(s):  
Elizabeth Hamill Howard ◽  
Rachel Schwartz ◽  
Bruce Feldstein ◽  
Marita Grudzen ◽  
Lori Klein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life Care ◽  
Older Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
One Year

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.

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

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.

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

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.

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

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.

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

CJEM ◽  
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.

High-flow oxygen in patients undergoing procedural sedation in the emergency department: A retrospective chart review

2016 ◽  
Vol 29 (1) ◽  
pp. 33-39
Author(s):  
David Thomson ◽  
Timothy Cowan ◽  
Conrad Loten ◽  
Christina Botfield ◽  
Elizabeth Holliday ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
High Flow ◽  
Procedural Sedation ◽  
High Flow Oxygen

scholarly journals Incidence, Etiology, and Outcomes of Altered Mental Status in the Perioperative Setting of Liver Transplantation

2017 ◽  
Vol 8 (3) ◽  
pp. 124-128 ◽  
Author(s):  
Christopher Lening ◽  
Vatche G. Agopian ◽  
Ronald W. Busuttil ◽  
David S. Liebeskind
Keyword(s):  
Liver Transplantation ◽  
Mental Status ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Altered Mental Status ◽  
Sudden Onset ◽  
Transplant Patients ◽  
Significant Difference ◽  
Presentation Group

Background: We examined neurologic consultations for altered mental status in perioperative liver transplant patients to determine the overall incidence, to assess the presumed etiology and the data reviewed to determine that etiology, and to assess outcomes. Methods: Retrospective chart review conducted for all 728 adult patients receiving orthotopic liver transplantation (OLT) between January 01, 2010, to June 30, 2014, with identification of 218 receiving neurology consults between 30 days pre-OLT and 90 days post-OLT, with review of all records necessary to determine initial findings and follow-up examination. Results: Seventy-three consults for 69 patients were identified, with 27 felt to be altered since a procedure, 20 with sudden-onset altered mentation, and 26 with gradual or waxing–waning course. A single underlying etiology was identified in only 19 cases, with multiple factors involved in all others, with metabolic, toxic, infectious, and structural etiologies most often implicated. There was no statistically significant difference in outcome for those with altered mental status consults versus the total OLT population, though the sudden-onset presentation group did show significantly increased mortality rates. Conclusions: This systematic study illustrates the variety of potential causes of altered mentation within the perioperative setting of liver transplantation. Workup including neuroimaging (preferably magnetic resonance imaging), infectious cultures, and expanded metabolic laboratory tests should be undertaken.

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