Change in urban and non-urban pattern of ED use during the COVID-19 pandemic in 28 Michigan hospitals: an observational study

ObjectiveTo assess the trends in visits, overall and by age, to urban and non-urban emergency departments (EDs), and visits resulting in admission to hospital before and during the COVID-19 pandemic using a large regional database.SettingA large regional database of 28 EDs during the COVID-19 pandemic in Michigan, with an index case of 11 March 2020 and peak in the first week of April.ParticipantsED visits during the first 5 months of the calendar year were included and compared with the previous year. Facilities where these participants were seen were classified as urban or non-urban, with comparisons of total visits, COVID-like cases, paediatric and trauma.Outcome measuresDaily visits to EDs of patients presenting with COVID-like symptoms, trauma, age patterns and total cases, and stratified between urban and non-urban settings.ResultsThere were 1 732 852 visits across the 2 years, 953 407 between study and comparison periods, and 457 130 visits defined as COVID-like (median age 44 years). Total ED visits decreased to 48% of the previous year, showing a delayed-inverse relationship with COVID-19. Trauma cases dropped but returned to the pre-COVID-19 rate by the end of May in Urban centres. Paediatric cases decreased to 20% of the previous year by the end of April. The oldest age groups showed the least change in ED visits in response to the pandemic.ConclusionsThis large US Midwestern state study describes a dramatic decrease in ED visits after the onset of the COVID-19 pandemic in Michigan, including stratification by varying ages and trauma, demonstrating the tangible impact of the COVID-19 pandemic on urban and non-urban EDs.

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Why are people increasingly attending the emergency department? A study of the French healthcare system

Emergency Medicine Journal ◽

10.1136/emermed-2018-208333 ◽

2019 ◽

Vol 36 (9) ◽

pp. 548-553 ◽

Cited By ~ 2

Author(s):

Helene Colineaux ◽

Fanny Pelissier ◽

Laure Pourcel ◽

Thierry Lang ◽

Michelle Kelly-Irving ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Regression Models ◽

Age Groups ◽

Average Increase ◽

Linear Regression Models ◽

Clinical Classification ◽

Therapeutic Procedures ◽

Ed Visits

ObjectiveIt is often asserted that the crowding phenomenon in emergency departments (ED) can be explained by an increase in visits considered as non-urgent. The aim of our study was to quantify the increase in ED visit rates and to determine whether this increase was explained by non-severe visit types.MethodsThis observational study covers all ED visits between 2002 and 2015 by adult inhabitants of the Midi-Pyrénées region in France. Their characteristics were collected from the emergency visit summaries. We modelled the visit rates per year using linear regression models, and an increase was considered significant when the 95% CIs did not include zero. The severity of the patients’ condition during ED visit was determined through the ‘Clinical Classification of Emergency’ score. Non-severe visits were those where the patient was stable, and the physician deemed no intervention necessary. Intermediate-severity visits concerned patients who were stable but requiring diagnostic or therapeutic procedures.ResultsThe 37 studied EDs managed >7 million visits between 2002 and 2015. There was an average increase of +4.83 (95% CI 4.33 to 5.32) visits per 1000 inhabitants each year. The increase in non-severe visit types was +0.88 (95% CI 0.42 to 1.34) per 1000 inhabitants, while the increase in intermediate-severity visit types was +3.26 (95% CI 2.62 to 3.91) per 1000 inhabitants. This increase affected all age groups and all sexes.DiscussionIt appears that the increase in ED use is not based on an increase in non-severe visit types, with a greater impact of intermediate-severity visit types requiring diagnostic or therapeutic procedures in ED.

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Association between Social Media Use for Health Purpose and Depressive Symptoms: A Cross-Sectional Survey (Preprint)

10.2196/preprints.25007 ◽

2020 ◽

Author(s):

Hee Yun Lee ◽

Yan Luo ◽

Cho Rong Won ◽

Jiyoung Lee ◽

Jeongwon Baik

Keyword(s):

Social Media ◽

Depressive Symptoms ◽

Social Networking Sites ◽

Inverse Relationship ◽

Age Groups ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Use Of Social Media ◽

The Relationship ◽

Health Purpose

BACKGROUND The use of social media or social networking sites (SNS) is increasing across all age groups, and one of the primary motives of using SNS is to seek health-related information. Although previous research examining the effect of SNS use on depression exist, studies regarding the effect of SNS use for health purpose on depression is limited. OBJECTIVE Our study aims to explore the relationship between SNS use for health purpose and depression across the four age groups (18-34 years old, 35-49 years old, 50-64 years old, and above 65 years old). METHODS A sample of 6,789 adults aged 18 and older was extracted from a 2017 and 2018 Health Information National Trends Survey (HINTS). Univariate and bivariate analyses to examine the association between each variable and four age groups were conducted. Multiple linear regression analyses to predict depression level among participants with use of SNS for health purpose were conducted. RESULTS SNS use for health purpose and depression were positively associated for three age groups but not for those 65 years or older (=0.13, P<0.05; =0.08, P<0.05; =0.09, P<0.05). Income and self-reported health status indicated an inverse relationship for all age groups. The relationship with marital status differed based on age group with 18 and 34 years old showing an inverse relationship (=-0.13, P<0.01) while 65 years or older showing a positive relationship (=0.06, P<0.05). Gender was positively associated among those in the 35-49 years old (=0.09, P<0.05) and 65 years or older (=0.07, P<0.05). Being Non-Hispanic White was positively associated with depression among 50-64 years old (=0.07, P<0.001) and 65 years or older (=0.08, P<0.05). CONCLUSIONS Age-tailored education on determining accurate and reliable information shared via SNS is needed to reduce depressive symptoms.

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Candidate Age as a Factor in Promotability Ratings

Public Personnel Management ◽

10.1177/009102609202100207 ◽

1992 ◽

Vol 21 (2) ◽

pp. 197-210 ◽

Cited By ~ 11

Author(s):

Taylor Cox ◽

Stella M. Nkomo

Keyword(s):

Job Performance ◽

Field Study ◽

Inverse Relationship ◽

Age Groups ◽

Performance Ratings ◽

Job Tenure ◽

Moderator Variable

This paper presents research addressed to understanding how candidate age affects promotability. A field study of 125 lower-level managers indicated that age had an inverse relationship with promotability for both young and older managers and also appeared to serve as a moderator variable for the job tenure and education factors. Job tenure and education were relevant criteria only for the younger managers. By contrast, job performance ratings were significant for both age groups. Alternative explanations for the results and the implications of the findings are discussed.

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

Stroke ◽

10.1161/str.51.suppl_1.88 ◽

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.

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Phone-Related Distracted Walking Injuries as a Function of Age and Walking Environment

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181321651104 ◽

2021 ◽

Vol 65 (1) ◽

pp. 611-615

Author(s):

Zheng Haolan ◽

Isabella M. Campbell ◽

Wayne C.W. Giang*

Keyword(s):

Emergency Department ◽

Surveillance System ◽

Age Groups ◽

Injury Surveillance ◽

Future Research ◽

Home Environments ◽

Injury Surveillance System ◽

Different Types ◽

Ed Visits ◽

Walking Environment

Using phones while walking has been a factor that has led to accidents and injuries. However, few studies have analyzed the propensity of injuries due to distracted walking for different age groups and in different types of walking environments. This study aims to examine the number of emergency department (ED) visits due to distracted walking across different age groups and walking environments using a publicly available dataset, the National Electronic Injury Surveillance System (NEISS) database. The results suggest that there were an estimated 29140 distracted walking injuries between the years 2011-2019. Individuals between 11 and 20 years old had the most injuries, followed by 21 to 30, and 31 to 40. Furthermore, the proportion of estimated injuries that occurred in different walking environments differed across age groups. Safety-orient interventions for future research for stairs and home environments were also recommended in the present study.

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Are ED-based violence intervention programmes effective in reducing revictimisation and perpetration in victims of violence? A systematic review

Emergency Medicine Journal ◽

10.1136/emermed-2019-208970 ◽

2020 ◽

pp. emermed-2019-208970

Author(s):

James Matthew Brice ◽

Adrian A Boyle

Keyword(s):

Literature Review ◽

Outcome Measures ◽

Community Violence ◽

Age Groups ◽

Cochrane Library ◽

Violence Intervention ◽

Violence Perpetration ◽

Victims Of Violence ◽

Randomised Controlled ◽

The Cochrane Library

ObjectivesCommunity violence bears significant human and economic costs. Furthermore, victims requiring ED treatment are at a greater risk of violent reinjury, arrest due to perpetration and violent death. We aimed to evaluate the effectiveness of ED-based violence intervention programmes (EVIPs), which aim to reduce future violence involvement in these individuals.MethodsWe performed a systematic literature review searching MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, The Cochrane Library and Web of Science, in addition to hand-searching. Randomised controlled trials (RCTs) were included if they enrolled victims of community violence requiring ED treatment, evaluated interventions taking place in the ED and used violent revictimisation, arrests or intermediate outcome measures as endpoints. We included trials that had a Jadad score of 2 or above.Results297 records were identified, and 13 articles were included in our final qualitative analysis, representing 10 RCTs and 9 different EVIPs. The risk of selection bias was low; the risk of performance, detection and attrition bias was moderate. 9 out of 13 papers reported statistically significant improvements in one or more outcome measures related to violence, including violent reinjury and arrests due to violence perpetration.ConclusionThe results of this literature review show that EVIPs may be capable of reducing violent reinjury and arrests due to violence perpetration. Larger RCTs, taking place in different regions, in different age groups and using different techniques, are justified to determine which conditions may be required for success and whether EVIPs are generalisable.

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Effect of the SARS outbreak on visits to a community hospital emergency department

CJEM ◽

10.1017/s148180350001397x ◽

2006 ◽

Vol 8 (05) ◽

pp. 323-328 ◽

Cited By ~ 11

Author(s):

Michael Heiber ◽

W.Y. Wendy Lou

Keyword(s):

Emergency Department ◽

Community Hospital ◽

Early Stage ◽

Age Groups ◽

Respiratory Illness ◽

Hospital Emergency Department ◽

Infants And Toddlers ◽

Hospital Emergency ◽

Ed Visits ◽

Number Of Visits

ABSTRACTObjectives:To examine the effect of severe acute respiratory syndrome (SARS) on visits to a community hospital emergency department (ED) during the early stage of the Toronto outbreak in 2003 and for the same period in 2004. We focused on visits for respiratory illness (SARS-like symptoms) and different age groups.Methods:This study is a retrospective review of ED discharge diagnoses obtained from a computerized database, examining the 4-week period starting March 28 for the years 2001-2004. We obtained the discharge diagnosis, age and visit date for each ED patient during the relevant time intervals, then compared visit data from 2003 and 2004 with a baseline derived from the average number of visits during 2001 and 2002. We constructed groupings based on age and respiratory-illness symptoms.Results:During the SARS outbreak in 2003, ED visits declined by 21% (95% confidence interval [CI], 18%–24%) over the 4-week study period. The greatest reduction was for combined infant and toddler visits (69%; 95% CI, 58%–79%); these did not recover the following year. However, during the SARS outbreak there was a large increase in the number of visits for respiratory illnesses in adults (61%; 95% CI, 46%–75%) and in teenagers (132%; 95% CI, 82%–182%).Conclusions:During the SARS outbreak, total ED visits fell. The relative decline was most notable for infants and toddlers. By contrast, there was an increase in respiratory illness–related visits for adults and teenagers. In 2004, the year following the SARS outbreak, visit patterns shifted toward baseline levels, but ED visits by infants and toddlers remained depressed.

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Osteochondral Defects in Hallux Rigidus

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00194 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0019

Author(s):

David Ciufo ◽

Michelle Lawson ◽

Benjamin Strong ◽

Benedict DiGiovanni

Keyword(s):

Outcome Measures ◽

Demographic Data ◽

Age Groups ◽

Operative Management ◽

Hallux Rigidus ◽

Entire Cohort ◽

Sf 36 ◽

The Difference ◽

Component Scores

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus, or 1st metatarsophalangeal (MTP) joint degeneration, is commonly encountered in foot and ankle practice. Operative management can include a dorsal cheilectomy, a motion sparing procedure to reduce impingement. Hallux rigidus affects patients across all age groups, and etiologies may include trauma, first ray hypermobility, pes planus, or hallux valgus. First MTP joint trauma may result in an osteochondral defect (OCD). Literature is sparse regarding OCD management in the 1st MTPJ, as is follow-up data on cheilectomy using validated outcome measures. We hypothesize that the presence of an OCD is associated with symptomatic hallux rigidus at a lower Coughlin and Shurnas grade. We also hypothesize that OCD treatment concurrent with cheilectomy leads to outcomes equivalent to patients treated with isolated hallux rigidus. Methods: A retrospective review of prospectively collected data was performed. All patients of a single surgeon were reviewed based on the CPT code (28289) for cheilectomy from 1/1/2011 to 12/31/2015. Demographic data, presence/drilling of an OCD on operative reports, and Coughlin grading were recorded. All patients had taken the FAAM and SF-36 preoperatively per the surgeon’s routine preoperative data collection. After approval by the institutional review board, all patients were contacted by telephone for follow-up and answered the FAAM, SF-36 and Patient Acceptable Symptom State (PASS) questionnaires. Visual analog scores (VAS), patient satisfaction, complications, and whether they would opt for surgery again were recorded.Paired T-tests were performed to evaluate improvement in FAAM activity of daily living (ADL), FAAM sport, SF-36 physical component scores (PCS), and SF-36 mental component scores (MCS). Two-tailed T-tests were performed to evaluate the difference in groups with and without OCDs. Results: Seventy-one patients met inclusion criteria. Follow-up was obtained from 28 patients (29 feet) for analysis, 10 with OCDs. Mean responder age was 53.1 years (32.6-70.9), with average 4 year follow-up (minimum 2 years). Patients with OCDs had lower Coughlin grade (p<0.01) and trended towards lower age (p=0.07), but similar improvement in FAAM sport (p=0.43), SF-36 PCS (p=0.33), and MCS (p=0.46). Patients with OCDs trended towards greater improvement in FAAM ADL (p=0.07). The entire cohort demonstrated significant improvements (p<0.01) in ADL, Sport, PCS, and MCS after cheilectomy. ADL and Sport scores met the MCID of 8 and 9 points, respectively. MCID is not well-defined for SF-36. One patient required subsequent fusion. Conclusion: Cheilectomy is an effective surgical option for improving function and pain in the setting of hallux rigidus, as measured at intermediate-term follow-up with validated patient outcome measures. Patients with a 1st MTP joint OCD become symptomatic at a younger age and with a lower radiographic grade of hallux rigidus. These patients demonstrate equivalent improvements in the FAAM sport, SF-36 PCS and MCS while trending towards greater improvement in the FAAM ADL score as those without OCDs. The presence and treatment of a 1st MTP joint OCD should be considered in younger patients with symptomatic hallux rigidus and lower radiographic severity.

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The impact of demonetisation on the utilisation of hospital services, patient outcomes and finances: a multicentre observational study from India

BMJ Global Health ◽

10.1136/bmjgh-2020-002509 ◽

2020 ◽

Vol 5 (9) ◽

pp. e002509

Author(s):

Tarun K George ◽

John Victor Peter ◽

Lakshmanan Jeyaseelan ◽

Bijesh Yadav ◽

Shalom Patole ◽

...

Keyword(s):

Observational Study ◽

Control Period ◽

Healthcare Utilisation ◽

Bayesian Regression ◽

Seasonal Effect ◽

Variable Effect ◽

For Profit ◽

Tertiary Hospitals ◽

Ed Visits ◽

The Impact

BackgroundThis study assessed trends in healthcare utilisation in relation to the implementation of an economic policy in India wherein 500 and 1000 rupee notes were demonetised.MethodsIn this ambidirectional observational study of private not-for-profit hospitals, data on hospital outpatient and inpatient numbers, surgeries, emergency department (ED) visits, obstetric admissions and mortality were obtained for pre-demonetisation (September/October 2016), early (November/December 2016) and late demonetisation (January/February 2017), and post-demonetisation periods (March/April 2017) and compared with the control period (2015–2016) from 11 centres (three tertiary hospitals; eight secondary). A Bayesian regression analysis was performed to adjust for seasonal (winter) effect. Monthly financial data, including the proportion of cash versus non-cash transactions, were collected.FindingsOverall, at the pooled all-hospital level, Bayesian analysis showed non-significant increase in outpatients (535.4, 95% CI −7097 to 8116) and decrease in deaths (–6.3 per 1000 inpatients, 95% CI −15.45 to 2.75) and a significant decrease in inpatients (−145.6, 95% CI −286.4 to −10.63) during demonetisation. Analysis at the level of secondary and tertiary hospitals showed a variable effect. For individual hospitals, after adjusting for the seasonal effect, some hospitals observed a significant reduction in outpatient (n=2) and inpatient (n=3) numbers, ED visits (n=4) and mortality (n=2) during demonetisation, while others reported significantly increased outpatient numbers (n=3) and ED visits (n=2). Deliveries remained unchanged during demonetisation in the hospitals that provided the service. There was no significant reduction in hospital incomes during demonetisation. In tertiary hospitals, there was a significant increase in non-cash component of transactions from 35% to 60% (p=0.02) that persisted beyond the demonetisation period.ConclusionsThe effect of demonetisation on healthcare utilisation was variable. Some hospitals witnessed a significant reduction in utilisation in some areas, while others reported increased utilisation. There was an increase in non-cash transactions that persisted beyond the period of demonetisation.

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Hand hygiene compliance among healthcare workers in Ghana’s health care institutions: An observational study

Journal of Patient Safety and Risk Management ◽

10.1177/2516043520958579 ◽

2020 ◽

Vol 25 (5) ◽

pp. 177-186

Author(s):

Aaron Asibi Abuosi ◽

Samuel Kaba Akoriyea ◽

Gloria Ntow-Kummi ◽

Joseph Akanuwe ◽

Patience Aseweh Abor ◽

...

Keyword(s):

Health Care ◽

Observational Study ◽

Hand Hygiene ◽

Outcome Measures ◽

Healthcare Workers ◽

Hand Hygiene Compliance ◽

Hand Washing ◽

Job Aids ◽

The Mean ◽

Hygiene Compliance

Objective To assess hand hygiene compliance in selected primary hospitals in Ghana. Design A cross-sectional health facility-based observational study was conducted in primary health care facilities in five regions in Ghana. A total of 546 healthcare workers including doctors, nurses, midwives and laboratory personnel from 106 health facilities participated in the study. Main outcome measures The main outcome measures included availability of hand hygiene materials and alcohol job aids; compliance with moments of hand hygiene; and compliance with steps in hygienic hand washing. These were assessed using descriptive statistics. Results The mean availability of hand hygiene material and alcohol job aids was 75% and 71% respectively. This was described as moderately high, but less desirable. The mean hand hygiene compliance with moments of hand hygiene was 51%, which was also described asmoderately high, but less desirable. It was observed that, generally, hand hygiene was performed after procedures than before. However, the mean compliance with steps in hygienic hand washing was 86%, which was described as high and desirable. Conclusion Healthcare workers are generally competent in performance of hygienic hand washing. However, this does not seem to influence compliance with moments of hand hygiene. Efforts must therefore be made to translate the competence of healthcare workers in hygienic hand washing into willingness to comply with moments of hand hygiene, especially contact with patients.

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