Increasing use of CT requested by emergency department physicians in tertiary hospitals in Western Australia 2003–2015: an analysis of linked administrative data

ObjectiveThis study aimed to examine trends in number of CT scans requested by tertiary emergency department (ED) physicians in Western Australia (WA) from 2003 to 2015 across broad demographic and presentation characteristics, anatomical areas and presented symptoms.DesignAn observational cross-sectional study over study period from 2003 to 2015.SettingLinked administrative health service data at individual level from WA.ParticipantsA total of 1 666 884 tertiary hospital ED presentations of people aged 18 years or older were included in this studyMain outcome measureNumber of CT scans requested by tertiary ED physicians in an ED presentation.MethodsPoisson regression models were used to assess variation and trends in number of CT scans requested by ED physicians across demographic characteristics, clinical presentation characteristics and anatomical areas.ResultsOver the entire study duration, 71 per 1000 ED episodes had a CT requested by tertiary ED physicians. Between 2003 and 2015, the rate of CT scanning almost doubled from 58 to 105 per 1000 ED presentations. After adjusted for all observed characteristics, the rate of CT scans showed a downward trend from 2009 to 2011 and subsequent increase. Males, older individuals, those attending ED as a result of pain, those with neurological symptoms or injury or with higher priority triage code were the most likely to have CT requested by tertiary ED physicians.ConclusionsNoticeable changes in the number of CTs requested by tertiary ED physicians corresponded to the time frame of major health reforms happening within WA and nationally.

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Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v8i2.28839 ◽

2021 ◽

Vol 8 (2) ◽

pp. 105-111

Author(s):

Sunil Adhikari ◽

Suraj Rijal ◽

Darlene Rose House

Keyword(s):

Emergency Department ◽

Gastrointestinal Bleeding ◽

Variceal Bleeding ◽

Clinical Presentation ◽

Upper Gastrointestinal Bleeding ◽

Tertiary Hospital ◽

Clinical Profile ◽

Ulcer Bleeding ◽

Cross Sectional ◽

Upper Gastrointestinal

Introduction: Upper gastrointestinal bleeding is an acute emergency condition. It is an important cause for the hospital admission. This study descriptively analyses the clinical profile of upper gastrointestinal bleeding presenting to a tertiary hospital in Nepal. Method: This is a cross-sectional study of patients presenting with upper gastrointestinal bleeding from 01 Oct 2018 to 30 Sep 2019 at Patan Hospital Emergency Department, Patan Academy of Health Sciences, Nepal. Patient’s demographics, clinical presentation, duration of illness before presenting to Emergency, vitals, and laboratory parameters were descriptively analyzed. Ethical approval was obtained. Result: There were 121 patients, male 82(67.8%) and female 38(31.4%) aging 14 to 90 years. Fifty-three patients (43.8 %) presented with hematemesis, 38(31.4%) with melena, and 27(22.3%) with both hematemesis and melena. Variceal bleeding was the main cause of upper gastrointestinal bleeding found in 73(60.33%) followed by ulcer bleeding in 48(39.66%). Conclusion: Variceal bleeding was the main cause of upper gastrointestinal bleeding and hematemesis was the most common clinical presentation in patients presenting to the Emergency Department.

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The Impact of the Lisbon Football Derby on the Profile of Emergency Department Admissions

Acta Médica Portuguesa ◽

10.20344/amp.4980 ◽

2014 ◽

Vol 27 (6) ◽

pp. 700 ◽

Cited By ~ 2

Author(s):

André Almeida ◽

Mónica Eusébio ◽

Jaime Almeida ◽

Matteo Boattini

Keyword(s):

Emergency Department ◽

Time Frame ◽

Subsequent Increase ◽

Manchester Triage System ◽

Sports Events ◽

Period Data ◽

Global Increase ◽

Time Frames ◽

The Impact ◽

Urgency Level

Background: Variations in emergency department admissions have been reported to happen as a result of major sports events. The work presented assessed changes in volume and urgency level of visits to a major Emergency Department in Lisbon during and after the city’s football derby. Material and Methods: Volume of attendances and patient urgency level, according to the Manchester Triage System, were retrospectively analyzed for the 2008-2011 period. Data regarding 24-hour periods starting 45 minutes before kick-off was collected, along with data from similar periods on the corresponding weekdays in the previous years, to be used as controls. Data samples were organized according to time frame (during and after the match), urgency level, and paired accordingly. Results: A total of 14 relevant periods (7 match and 7 non-match) were analyzed, corresponding to a total of 5861 admissions. During the match time frame, a 20.6% reduction (p = 0.06) in the total number of attendances was found when compared to non-match days. MTS urgency level sub-analysis only showed a statistically significant reduction (26.5%; p = 0.05) in less urgent admissions (triage levels green-blue). Compared to controls, post-match time frames showed a global increase in admissions (5.6%; p = 0.45), significant only when considering less urgent ones (18.9%; p = 0.05). Discussion: A decrease in the total number of emergency department attendances occurred during the matches, followed by a subsequent increase in the following hours. These variations only reached significance among visits triaged green-blue. Conclusion: During major sports events an overall decrease in emergency department admissions seems to take place, especially due to a drop in visits associated with less severe conditions. Keywords: Emergency Service, Hospital; Triage; Sports; Soccer; Portugal.

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Coccygeal Morphology on Multislice Computed Tomography in a Tertiary Hospital in India

Asian Spine Journal ◽

10.4184/asj.2017.11.5.694 ◽

2017 ◽

Vol 11 (5) ◽

pp. 694-699 ◽

Cited By ~ 1

Author(s):

Venkatraman Indiran ◽

Vadivalagianambi Sivakumar ◽

Prabakaran Maduraimuthu

Keyword(s):

Computed Tomography ◽

Indian Population ◽

Normal Population ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Ct Scans ◽

Type I ◽

Cross Sectional ◽

Ethnic Populations ◽

The Mean

<sec><title>Study Design</title>A retrospective, cross-sectional study of 213 patients who presented for abdominal computed tomography (CT) scans to assess coccygeal morphology in the Indian population.</sec><sec><title>Purpose</title>There have been relatively few studies of coccygeal morphology in the normal population and none in the Indian population. We aimed to estimate coccygeal morphometric parameters in the Indian population.</sec><sec><title>Overview of Literature</title>Coccygeal morphology has been studied in European, American, Korean, and Egyptian populations, with few differences in morphology among populations.</sec><sec><title>Methods</title>A retrospective analysis of 213 abdominal CT scans (114 males and 99 females; age, 7–88 years; mean age, 47.3 years) was performed to evaluate the number of coccygeal segments, coccyx type, sacrococcygeal and intercoccygeal fusion and subluxation, coccygeal spicules, sacrococcygeal straight length, and sacrococcygeal and intercoccygeal curvature angles. Results were analyzed for differences in morphology with respect to sex and coccyx type.</sec><sec><title>Results</title>Types I and II coccyx were the most common. Most subjects had four coccygeal vertebrae; 93 subjects (43.66%) had partial or complete sacrococcygeal fusion. Intercoccygeal fusion was common, occurring in 193 subjects. Eighteen subjects had coccygeal spicules. The mean coccygeal straight length was 33.8 mm in males and 31.5 mm in females; the mean sacrococcygeal curvature angle was 116.6° in males and 111.6° in females; the mean intercoccygeal curvature angle was 140.94° in males and 145.10° in females.</sec><sec><title>Conclusions</title>Type I was the most common coccyx type in our study, as in Egyptian and Western populations. The number of coccygeal vertebrae and prevalence of sacrococcygeal and intercoccygeal fusion in the Indian population were similar to those in the Western population. The mean coccygeal straight length and mean sacrococcygeal curvature angle were higher in males, whereas the intercoccygeal curvature angle was higher in females. Information on similarities and differences in coccygeal morphology between different ethnic populations could be useful in imaging and treating patients presenting with coccydynia.</sec>

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Peripheral intravenous cannula insertion and use in a tertiary hospital emergency department: A cross-sectional study

Australasian Emergency Care ◽

10.1016/j.auec.2020.02.001 ◽

2020 ◽

Vol 23 (3) ◽

pp. 166-172

Author(s):

Clare Thomas ◽

C.J. Cabilan ◽

Amy N.B. Johnston

Keyword(s):

Emergency Department ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Hospital Emergency Department ◽

Sectional Study ◽

Hospital Emergency ◽

Cross Sectional ◽

Intravenous Cannula

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Rose Angina Questionnaire: Validation in emergency department to detect myocardial infarction in a tertiary hospital of eastern Nepal

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919836573 ◽

2019 ◽

Vol 27 (5) ◽

pp. 257-261

Author(s):

Masum Poudel ◽

Rabin Bhandari ◽

Gyanendra Malla ◽

Dharanidhar Baral ◽

Samyog Uprety ◽

...

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Descriptive Analysis ◽

Final Diagnosis ◽

True Positive Rate ◽

Tertiary Hospital ◽

True Positive ◽

True Negative ◽

Cross Sectional ◽

Female Ratio

Background: Rose Angina Questionnaire (RAQ) is a useful screening questionnaire for ischemic heart disease validated in different settings; however, its diagnostic ability to predict myocardial infarction (MI) in the emergency is less clear. Objectives: To find out the usefulness of RAQ to predict MI in patients presenting to the emergency. Methods: A cross-sectional study was conducted at the BP Koirala Institute of Health Sciences (BPKIHS), a teaching hospital in eastern Nepal from 1 January to 30 March 2017, after ethical clearance from the Institutional Review Committee. Informed consent was obtained from the patients for their anonymised information to be published in this study The samples were collected from 100 patients with chest pain aged 40 to 70 years presenting to the emergency. RAQ was applied and its performance to detect MI was compared with emergency and cardiologist diagnosis of MI. Sensitivity, specificity, positive predictive value and negative value were calculated along with descriptive analysis. Results: A total of 100 patients were analysed with the mean age of 63.78 years (SD 11.60) and male to female ratio of 1.94. RAQ detected 58 cases (63.8%) with emergency department (ED) diagnosis of MI (true positive) and identified 3 (33.3%) cases with non-MI (true negative). The true positive rate for RAQ to detect MI after cardiologist consultation was 71.6%. RAQ had a sensitivity of 84.91% (95% confidence interval (CI) 72.41% –93.25%) to detect positive troponin, 63.74% (52.99–73.56) to detect positive electrocardiogram (ECG) and 71.60% (95% CI 60.5% to 81.07%) to detect final diagnosis of MI. Conclusion: RAQ is a good screening tool to detect MI in the emergency that can be used in isolation or in combination with other diagnostic modalities to detect it early.

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A two-year review of adult emergency department mortality at Tikur Anbesa specialized tertiary hospital, Addis Ababa, Ethiopia

BMC Emergency Medicine ◽

10.1186/s12873-021-00429-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hanna Daniel Yosha ◽

Achamyelesh Tadele ◽

Sisay Teklu ◽

Kidest Getu Melese

Keyword(s):

Emergency Department ◽

Traffic Accidents ◽

Road Traffic ◽

Addis Ababa ◽

Multiple Logistic Regression Analysis ◽

Retrospective Chart Review ◽

Tertiary Hospital ◽

Cross Sectional ◽

Triage Category ◽

Hiv Aids

Abstract Background Adult emergency department mortality remains high in resource-limited lower-income countries. The majority of deaths occur within the first 24 h of presentation to the emergency department. Many of these mortality’s can be alleviated with appropriate interventions. This study was aimed to assess the magnitude, cause, and factors related to very early mortality in patients presented to the emergency department of Tikur Anbesa Specialized Tertiary Hospital, Ethiopia from March 2018 to 2020. Methods This is a cross-sectional retrospective chart review. Retrospective data were collected from the records of all patients who died within 72 h of emergency department presentation from March 2018 to 2020. Data entered using Epi data 4.2.1 and analyzed using SPSS Version 23. Using the Chi-square test, binary and multiple logistic regression analysis were carried out to measure the association of variables of interest and very early emergency mortality. P-value < 0.05, odds ratio with 95% CI were used to identify the significant factors. Results Between March 2018 to 2020, 30,086 patients visited the ED and 604 patients died within 72 h of presentation (274 died within 24 h and 232 within > 24–72 h). Shock (36.7%) and road traffic accidents (3.16%) were the major causes of death. Triage category red AOR 0.23 95% CI 0.1–0.55 and duration of illness 4–24 h AOR 0.47 95% CI 0.26–0.87 were significantly associated with decreased very early emergency department mortality. Meanwhile, co-morbid disease HIV AIDS AOR 2.72 95% CI 1.01–7.30 and residence Addis Ababa AOR 2.78 95% CI 1.36–5.68 and Oromia AOR 3.23 95% CI 1.58–6.54 were found significantly associated with increased very early emergency department mortality. Conclusions and recommendations The mortality burden of a road traffic accident and shock in the TASTH is significant and the magnitude of ED mortality differs between these groups. Residence Addis Ababa and Oromia, triage category red, co-morbid disease HIV AIDS, and duration of symptom 4–24 h were significantly associated with early emergency department mortality. Early detection and intervention are required to minimize emergency mortality.

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Exploring emergency department visits: factors influencing individuals’ decisions, knowledge of triage systems and waiting times, and experiences during visits to a tertiary hospital in Saudi Arabia

International Journal of Emergency Medicine ◽

10.1186/s12245-019-0254-7 ◽

2019 ◽

Vol 12 (1) ◽

Author(s):

Nawaf Alhabdan ◽

Faisal Alhusain ◽

Abdulkareem Alharbi ◽

Muatassem Alsadhan ◽

Moath Hakami ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Primary Care Physicians ◽

Waiting Times ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Care Physician ◽

Emergency Department Visits ◽

Cross Sectional ◽

Validated Questionnaire

Abstract Background In recent years, there has been an increased utilization of emergency departments (EDs) in many countries. Additionally, it is reported that there are major delays in delivering care to ED patients. Longer waiting times are associated with poor patient satisfaction, whereas an understanding of the triage process increases satisfaction. This study aimed to assess ED visitor’s awareness of the triage procedure and their preferences regarding delayed communication. Methods Cross-sectional study of King Abdulaziz Medical City – Emergency Department visitors using a previously validated questionnaire (Seibert 2014) which was translated to Arabic, piloted, and then used for this study. Results A total of 334 questionnaires were returned. The mean age of respondents was 33 years. Regarding primary care physicians, only 16% of respondents said that they have one. About 21% of those tried to communicate with them before coming to the ED. Even though only 11% of respondents knew exactly what triage is, 51% were able to correctly explain why some patients are seen before others. Statistical analysis did not show any factors that are associated with increased knowledge of triage. Most respondents (75%) want to hear updates regarding delays with 69% of them preferring to be updated every 30 min. Conclusions This study showed that the majority of patients do not know what triage means and that most of them want to know how the ED works. Moreover, a lot of respondents said that they do not have a primary care physician. These results support increasing patient awareness by education and involving them if any delay happens.

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Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample

Diagnosis ◽

10.1515/dx-2013-0038 ◽

2014 ◽

Vol 1 (2) ◽

pp. 155-166 ◽

Cited By ~ 65

Author(s):

David E. Newman-Toker ◽

Ernest Moy ◽

Ernest Valente ◽

Rosanna Coffey ◽

Anika L. Hines

Keyword(s):

Emergency Department ◽

Large Population ◽

Population Based ◽

Teaching Hospitals ◽

Older Individuals ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Cerebrovascular Events ◽

Asian Pacific ◽

Sectional Analysis

AbstractSome cerebrovascular events are not diagnosed promptly, potentially resulting in death or disability from missed treatments. We sought to estimate the frequency of missed stroke and examine associations with patient, emergency department (ED), and hospital characteristics.Cross-sectional analysis using linked inpatient discharge and ED visit records from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases and 2008–2009 State ED Databases across nine US states. We identified adult patients admitted for stroke with a treat-and-release ED visit in the prior 30 days, considering those given a non-cerebrovascular diagnosis as probable (benign headache or dizziness diagnosis) or potential (any other diagnosis) missed strokes.There were 23,809 potential and 2243 probable missed strokes representing 12.7% and 1.2% of stroke admissions, respectively. Missed hemorrhages (n=406) were linked to headache while missed ischemic strokes (n=1435) and transient ischemic attacks (n=402) were linked to headache or dizziness. Odds of a probable misdiagnosis were lower among men (OR 0.75), older individuals (18–44 years [base]; 45–64:OR 0.43; 65–74:OR 0.28; ≥75:OR 0.19), and Medicare (OR 0.66) or Medicaid (OR 0.70) recipients compared to privately insured patients. Odds were higher among Blacks (OR 1.18), Asian/Pacific Islanders (OR 1.29), and Hispanics (OR 1.30). Odds were higher in non-teaching hospitals (OR 1.45) and low-volume hospitals (OR 1.57).We estimate 15,000–165,000 misdiagnosed cerebrovascular events annually in US EDs, disproportionately presenting with headache or dizziness. Physicians evaluating these symptoms should be particularly attuned to the possibility of stroke in younger, female, and non-White patients.

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Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study

BMC Public Health ◽

10.1186/s12889-020-10082-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Julia Brandenberger ◽

Christian Pohl ◽

Florian Vogt ◽

Thorkild Tylleskär ◽

Nicole Ritz

Keyword(s):

Health Care ◽

Emergency Department ◽

Retrospective Study ◽

Hospital Admissions ◽

Tertiary Care ◽

Tertiary Hospital ◽

Care Hospital ◽

Children With Medical Complexity ◽

Cross Sectional ◽

Number Of Visits

Abstract Background Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital. Methods We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups. Results A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1–2) in the asylum-seeking and 2 (IQR 1–4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (> 15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. Conclusions Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.

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