Factors Affecting Unscheduled Return Visits to the Emergency Department among Minor Head Injury Patients

Study Objectives. Differences between returning and non-returning minor head injury (MHI) emergency department (ED) patients, between the characteristics of the first visit and revisit, and between admitted and nonadmitted returning patients were investigated. Methods. This was a retrospective study. All discharged ED patients with ICD-9 codes 850.0 to 850.9, 920, and 959.01 in 2013 were enrolled. Patients’ demographic data, vital signs, Glasgow Coma Scale, ED diagnosis, length of stay, triage levels, ED examinations performed, and comorbidities were recorded for analysis. Results. A total of 2,815 patients were enrolled. Of 57 (2%) patients who revisited the ED, 47 (82%) were discharged from the ED and ten (18%) were admitted to the hospital. Patients who returned to the ED were older, and they exhibited more comorbidities. Those who presented with vomiting, triage level of 1 or 2, and GCS score of <15 and who received more blood tests during their first visit were more likely to be admitted when they returned to the ED. Conclusions. Discharging MHI patients who are older or exhibit comorbidities only when symptoms and concerns are relieved completely, providing clear discharge instructions, and arranging timely clinical follow-ups may help reduce such patients’ return rate.

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Determinants of pyelonephritis onset in patients with obstructive urolithiasis

Urologia Journal ◽

10.1177/03915603211035244 ◽

2021 ◽

pp. 039156032110352

Author(s):

Georges Abi Tayeh ◽

Ali Safa ◽

Julien Sarkis ◽

Marwan Alkassis ◽

Nour Khalil ◽

...

Keyword(s):

Emergency Department ◽

Renal Colic ◽

Demographic Data ◽

Vital Signs ◽

Kidney Injury ◽

Stone Size ◽

Positive Urine ◽

Life Threatening ◽

Fat Stranding ◽

Obstructive Pyelonephritis

Background: Acute obstructive pyelonephritis due to urolithiasis represents a medico-surgical emergency that can lead to life-threatening complications. There are still no established factors that reliably predict progression toward acute pyelonephritis in patients presenting with a simple renal colic. Objective: To investigate clinical and paraclinical factors that are associated with the onset of acute obstructive pyelonephritis. Methods: Patients presenting to the emergency department for renal colic with obstructive urolithiasis on imaging were enrolled in the study. Demographic data, vital signs, medical comorbidities, blood test results, urinalysis, and radiological findings were recorded. Obstructive pyelonephritis was defined by the presence of two or more of the following criteria: fever, flank pain or costovertebral angle tenderness, and a positive urine culture. Results: Seventeen patients out of 120 presenting with renal colic, were diagnosed with acute obstructive pyelonephritis (14%). Parameters that were associated with the onset of obstructive pyelonephritis were: diabetes ( p = 0.03), elevated CRP ( p = 0.01), stone size (>5 mm) ( p = 0.03), dilatation of renal pelvis ( p = 0.01), peri-renal fat stranding ( p = 0.02), and positive nitrites on urinalysis ( p < 0.01). Hyperleukocytosis, acute kidney injury, multiple stones, pyuria (>10/mm3), hypertension, and were not associated with the onset of obstructive pyelonephritis. Conclusion: This study showed that known diabetic status, elevated CRP, positive urine nitrites, stone size (>5 mm), pyelic dilatation, and peri-renal fat stranding were associated with the onset of pyelonephritis in patients presenting to the emergency department with obstructive urolithiasis.

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Tablet-Based Patient-Centered Decision Support for Minor Head Injury in the Emergency Department: Pilot Study

JMIR mhealth and uhealth ◽

10.2196/mhealth.8732 ◽

2017 ◽

Vol 5 (9) ◽

pp. e144 ◽

Cited By ~ 11

Author(s):

Navdeep Singh ◽

Erik Hess ◽

George Guo ◽

Adam Sharp ◽

Brian Huang ◽

...

Keyword(s):

Emergency Department ◽

Decision Support ◽

Pilot Study ◽

Head Injury ◽

Minor Head Injury ◽

Patient Centered

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Professional practice assessment for minor head injury management in emergency department and clinical impact of a simulation-based training: interventional study (before/after)

Turkish Journal of Trauma and Emergency Surgery ◽

10.14744/tjtes.2020.91589 ◽

2020 ◽

Author(s):

Pierre Vandingenen

Keyword(s):

Emergency Department ◽

Head Injury ◽

Professional Practice ◽

Clinical Impact ◽

Minor Head Injury ◽

Interventional Study ◽

Injury Management ◽

Simulation Based ◽

Practice Assessment

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211 Head CT Utilization for Minor Head Injury: What Motivates Patients to Present to the Emergency Department for Evaluation, and Why Do Emergency Physicians Choose to Evaluate Them With CT?

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2011.06.240 ◽

2011 ◽

Vol 58 (4) ◽

pp. S248

Author(s):

B.J. Derrick ◽

J.W. Quaas ◽

D.E. Wiener ◽

R.M. Polan ◽

M. Chawla ◽

...

Keyword(s):

Emergency Department ◽

Head Injury ◽

Minor Head Injury ◽

Emergency Physicians ◽

Head Ct ◽

Ct Utilization

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Patients Who Refuse Transportation by Ambulance: A Case Series

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00037808 ◽

1997 ◽

Vol 12 (4) ◽

pp. 45-50 ◽

Cited By ~ 8

Author(s):

John E. Hipskind ◽

JM Gren ◽

DJ Barr

Keyword(s):

Medical Information ◽

Life Support ◽

Motor Vehicle ◽

Demographic Data ◽

Vital Signs ◽

Case Series ◽

Advanced Life Support ◽

Care Program ◽

Motor Vehicle Crash ◽

Discharge Instructions

AbstractIntroduction:Patients refusing hospital transportation occurs in 5% to 25% of out-of-hospital calls. Little is known about these calls. This study was needed to determine the demographics, inherent risks, and timing of refused calls.Methods:This was a prospective review of all run sheets of patients who refused transportation were collected for a two month period. Demographic data and medical information was collected. Each run was placed into one of three categories of need for transport and further evaluation: 1) minimal; 2) moderate; and 3) definite. The Greater Elgin Area Mobile Intensive Care Program (GEA-MICP) based at Sherman Hospital in Elgin, Illinois, was the setting. The GEA-MICP is an Emergency Medical Services (EMS) system comprised of 17 advanced life support (ALS) ambulance agencies servicing northeastern Illinois. Study subjects were all patients who refused transportation to a hospital by ALS ambulance during July 1993 and February 1994. Paramedics were required to complete a run sheet for all calls.Results:Overall, 30% (683 of2,270) of all runs resulted in refusal of transportation. Patients who most commonly refused transportation were asymptomatic, 11–40 years old and involved in a motor vehicle crash. They usually had no past medical history, normal vital signs, and a normal mental status. Patients generally signed for their own release after evaluation. The average time to arrival was 4.2 minutes and average time spent on scene by paramedics was 18.4 minutes. Of the patients, 72% were judged to have minimal need, 25% were felt to have a moderate need, and 3% were felt to definitely need transport to a hospital for further evaluation and/or treatment.Conclusion:There are many cases when EMS are activated, but transportation is refused. Most refusals occur after paramedic evaluation. Providing paramedics with primary care training and protocols would standardize care given to patients and provide a mechanism for discharge instructions and follow-up for those who chose not to be transported to a hospital. Patients judged to require further treatment had unique characteristics. These data may be useful in identifying potentially sicker patients allowing a concentrated effort to transport this subset of patients to a hospital.

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The Initial Factors with Strong Predictive Value in Relation to Six-Month Outcome among Patients Operated due to Extra-Axial Hematomas

Diagnostics ◽

10.3390/diagnostics10030174 ◽

2020 ◽

Vol 10 (3) ◽

pp. 174 ◽

Cited By ~ 2

Author(s):

Bartłomiej Kulesza ◽

Jakub Litak ◽

Cezary Grochowski ◽

Adam Nogalski ◽

Radosław Rola

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Prognostic Value ◽

Epidural Hematoma ◽

Brain Injuries ◽

Demographic Data ◽

Traumatic Brain Injuries ◽

Factors Affecting ◽

Craniocerebral Injuries ◽

Gcs Score

Introduction: Traumatic brain injuries (TBI) are a real social problem, with an upward trend worldwide. The most frequent consequence of a traumatic brain injury is extra-axial hemorrhage, i.e., an acute subdural (SDH) and epidural hematoma (EDH). Most of the factors affecting the prognosis have been analyzed on a wide group of traumatic brain injuries. Nonetheless, there are few studies analyzing factors influencing the prognosis regarding patients undergoing surgery due to acute subdural and epidural hematoma. The aim of this study was to identify the factors which have the strongest prognostic value in relation to the 6-month outcome of the patients undergoing surgery for SDH and EDH. Patients and methods: The study included a group of 128 patients with isolated craniocerebral injuries. Twenty eight patients were operated upon due to EDH, and a group of 100 patients were operated upon due to SDH. The following factors from the groups were analyzed: demographic data, physiological factors, laboratory factors, computed tomography scan characteristics, and time between the trauma and the surgery. All of these factors were correlated in a multivariate analysis with the six-month outcome in the Glasgow outcome scale. Results: The factors with the strongest prognostic value are GCS score, respiration rate, saturation, glycaemia and systolic blood pressure. Conclusion: Initial GCS score, respiratory rate, saturation, glycaemia and systolic blood pressure were the factors with the strongest prognostic value.

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Prehospital Vital Signs Accurately Predict Initial Emergency Department Vital Signs

Prehospital and Disaster Medicine ◽

10.1017/s1049023x2000028x ◽

2020 ◽

Vol 35 (3) ◽

pp. 254-259

Author(s):

Marc D. Trust ◽

Morgan Schellenberg ◽

Subarna Biswas ◽

Kenji Inaba ◽

Vincent Cheng ◽

...

Keyword(s):

Emergency Department ◽

Intraclass Correlation ◽

Vital Signs ◽

Correlation Coefficients ◽

Trauma Team ◽

Urban Setting ◽

Trauma Patients ◽

Level I ◽

Gcs Score ◽

Good Agreement

AbstractIntroduction:Prehospital vital signs are used to triage trauma patients to mobilize appropriate resources and personnel prior to patient arrival in the emergency department (ED). Due to inherent challenges in obtaining prehospital vital signs, concerns exist regarding their accuracy and ability to predict first ED vitals.Hypothesis/Problem:The objective of this study was to determine the correlation between prehospital and initial ED vitals among patients meeting criteria for highest levels of trauma team activation (TTA). The hypothesis was that in a medical system with short transport times, prehospital and first ED vital signs would correlate well.Methods:Patients meeting criteria for highest levels of TTA at a Level I trauma center (2008-2018) were included. Those with absent or missing prehospital vital signs were excluded. Demographics, injury data, and prehospital and first ED vital signs were abstracted. Prehospital and initial ED vital signs were compared using Bland-Altman intraclass correlation coefficients (ICC) with good agreement as >0.60; fair as 0.40-0.60; and poor as <0.40).Results:After exclusions, 15,320 patients were included. Mean age was 39 years (range 0-105) and 11,622 patients (76%) were male. Mechanism of injury was blunt in 79% (n = 12,041) and mortality was three percent (n = 513). Mean transport time was 21 minutes (range 0-1,439). Prehospital and first ED vital signs demonstrated good agreement for Glasgow Coma Scale (GCS) score (ICC 0.79; 95% CI, 0.77-0.79); fair agreement for heart rate (HR; ICC 0.59; 95% CI, 0.56-0.61) and systolic blood pressure (SBP; ICC 0.48; 95% CI, 0.46-0.49); and poor agreement for pulse pressure (PP; ICC 0.32; 95% CI, 0.30-0.33) and respiratory rate (RR; ICC 0.13; 95% CI, 0.11-0.15).Conclusion:Despite challenges in prehospital assessments, field GCS, SBP, and HR correlate well with first ED vital signs. The data show that these prehospital measurements accurately predict initial ED vitals in an urban setting with short transport times. The generalizability of these data to settings with longer transport times is unknown.

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