scholarly journals Evaluating Children with Otitis Media for Bacteremia or Urinary Tract Infection

2010 ◽  
Vol 2010 ◽  
pp. 1-5
Author(s):  
Daniel Yawman ◽  
Patrick Mahar ◽  
Aaron Blumkin ◽  
Gregory Conners
Keyword(s):  
Emergency Department ◽  
Blood Culture ◽  
Otitis Media ◽  
Urine Culture ◽  
Acute Otitis Media ◽  
Young Patients ◽  
National Hospital ◽  
Old Patients ◽  
Care Survey ◽  
Ambulatory Medical Care

Background.It is unclear if clinicians evaluate for concurrent bacteremia or UTI in young patients diagnosed with acute otitis media (AOM).Objectives.To describe how often, and under which circumstances, emergency providers investigate for bacteremia or UTI in 2–36 month olds with AOM.Methods.Cases of AOM were analyzed from the 2001–2004 National Hospital Ambulatory Medical Care Survey (NHAMCS)-Emergency Department dataset.Results.AOM was diagnosed in 17% of the 10,847 recorded visits of 2–36 month olds. Of these visits, laboratory testing included: CBC: 7%, Blood culture: 4%, urinalysis or urine culture: 5%, and any of these tests: 9%. Rates of testing for 2–6 month olds with temperature≥ 38.0(CBC: 13%, blood culture: 9%, urinalysis or urine culture: 7%, any of the tests: 14%) were not significantly different from testing of patients aged 6–12 months, or 12–36 months (allP>.1). Patients with temperature of≥39.0were more likely to have all tests, with the exception of urine investigation, than patients with temperature between 38.0 and 38.9.Conclusions.17% of 2–36 month old patients seen in the emergency department are diagnosed with AOM. Investigating for bacteremia or UTI in these patients is not routine, even in febrile infants.

scholarly journals The influence of patient race on the use of diagnostic imaging in United States emergency departments: data from the National Hospital Ambulatory Medical Care survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Andrew B. Ross ◽  
Vivek Kalia ◽  
Brian Y. Chan ◽  
Geng Li
Keyword(s):  
United States ◽  
Health Care ◽  
Emergency Department ◽  
Diagnostic Imaging ◽  
Race And Ethnicity ◽  
National Hospital ◽  
Patient Race ◽  
Care Survey ◽  
Race Ethnicity ◽  
Ambulatory Medical Care

Abstract Background An established body of literature has shown evidence of implicit bias in the health care system on the basis of patient race and ethnicity that contributes to well documented disparities in outcomes. However, little is known about the influence of patient race and ethnicity on the decision to order diagnostic radiology exams in the acute care setting. This study examines the role of patient race and ethnicity on the likelihood of diagnostic imaging exams being ordered during United States emergency department encounters. Methods Publicly available data from the National Hospital Ambulatory Medical Care Survey Emergency Department sample for the years 2006–2016 was compiled. The proportion of patient encounters where diagnostic imaging was ordered was tabulated by race/ethnicity, sub-divided by imaging modality. A multivariable logistic regression model was used to evaluate the influence of patient race/ethnicity on the ordering of diagnostic imaging controlling for other patient and hospital characteristics. Survey weighting variables were used to formulate national-level estimates. Results Using the weighted data, an average of 131,558,553 patient encounters were included each year for the 11-year study period. Imaging was used at 46% of all visits although this varied significantly by patient race and ethnicity with white patients receiving medical imaging at 49% of visits and non-white patients at 41% of visits (p < 0.001). This effect persisted in the controlled regression model and across all imaging modalities with the exception of ultrasound. Other factors with a significant influence on imaging use included patient age, gender, insurance status, number of co-morbidities, hospital setting (urban vs non-urban) and hospital region. There was no evidence to suggest that the disparate use of imaging by patient race and ethnicity changed over the 11-year study time period. Conclusion The likelihood that a diagnostic imaging exam will be ordered during United States emergency department encounters differs significantly by patient race and ethnicity even when controlling for other patient and hospital characteristics. Further work must be done to understand and mitigate what may represent systematic bias and ensure equitable use of health care resources.

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