Emergency Hospital Admissions from Care-Homes: Who, Why and What Happens? A Cross-Sectional Study

AimsTo quantify the frequency, characteristics, geographical variation and costs of emergency hospital care for suspected seizures.DesignCross-sectional study using routinely collected data (Hospital Episode Statistics).SettingThe National Health Service in England 2007–2013.ParticipantsAdults who attended an emergency department (ED) or were admitted to hospital.ResultsIn England (population 2011: 53.11 million, 41.77 million adults), suspected seizures gave rise to 50 111 unscheduled admissions per year among adults (≥18 years). This is 47.1% of unscheduled admissions for neurological conditions and 0.71% of all unscheduled admissions. Only a small proportion of admissions for suspected seizures were coded as status epilepticus (3.5%) and there were a very small number of dissociative (non-epileptic) seizures. The median length of stay for each admission was 1 day, the median cost for each admission was £1651 ($2175) and the total cost of all admissions for suspected seizures in England was £88.2 million ($116.2 million) per year. 16.8% of patients had more than one admission per year. There was significant geographical variability in the rate of admissions corrected for population age and gender differences and some areas had rates of admission which were consistently higher than the average.ConclusionsOur data show that suspected seizures are the most common neurological cause of admissions to hospital in England, that readmissions are common and that there is significant geographical variability in admission rates. This variability has not previously been reported in the published literature. The cause of the geographical variation is unknown; important factors are likely to include prevalence, deprivation and clinical practice and these require further investigation. Dissociative seizures are not adequately diagnosed during ED attendances and hospital admissions.

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Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data

BMJ ◽

10.1136/bmj.j84 ◽

2017 ◽

pp. j84 ◽

Cited By ~ 108

Author(s):

Isaac Barker ◽

Adam Steventon ◽

Sarah R Deeny

Keyword(s):

General Practice ◽

Ambulatory Care ◽

Continuity Of Care ◽

Hospital Admissions ◽

Cross Sectional Study ◽

Ambulatory Care Sensitive Conditions ◽

Sectional Study ◽

Cross Sectional ◽

Level Data ◽

Ambulatory Care Sensitive

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The cost of emergency hospital admissions for falls on snow and ice in England during winter 2009/10: a cross sectional analysis

Environmental Health ◽

10.1186/1476-069x-10-60 ◽

2011 ◽

Vol 10 (1) ◽

Cited By ~ 13

Author(s):

Caryl Beynon ◽

Sacha Wyke ◽

Ian Jarman ◽

Mark Robinson ◽

Jenny Mason ◽

...

Keyword(s):

Hospital Admissions ◽

Cross Sectional ◽

Emergency Hospital ◽

Emergency Hospital Admissions ◽

Cross Sectional Analysis ◽

The Cost ◽

Sectional Analysis ◽

Snow And Ice

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To what extent are GCS and AVPU equivalent to each other when assessing the level of consciousness of children with head injury? A cross-sectional study of UK hospital admissions.

BMJ Open ◽

10.1136/bmjopen-2018-023216 ◽

2018 ◽

Vol 8 (11) ◽

pp. e023216 ◽

Cited By ~ 5

Author(s):

Amy GL Nuttall ◽

Katie M Paton ◽

Alison M Kemp

Keyword(s):

Head Injury ◽

Hospital Admissions ◽

Diagnostic Yield ◽

Cross Sectional Study ◽

Initial Assessment ◽

Clear Correlation ◽

Sectional Study ◽

Cross Sectional ◽

Significant Difference ◽

Level Of Consciousness

ObjectiveTo evaluate utility and equivalence of Glasgow Coma Scale (GCS) and the Alert, Voice, Pain, Unresponsive (AVPU) scale in children with head injury.DesignCross sectional study.SettingUK hospital admissions: September 2009–February 2010.Patients<15 years with head injury.InterventionsGCS and/or AVPU at injury scene and in emergency departments (ED).Main outcomeMeasures used, the equivalence of AVPU to GCS, GCS at the scene predicting GCS in ED, CT results by age, hospital type.ResultsLevel of consciousness was recorded in 91% (5168/5700) in ED (43%: GCS/30.5%: GCS+AVPU/17.3%: AVPU) and 66.1% (1190/1801) prehospital (33%: GCS/26%GCS+AVPU/7%: AVPU). Failure to record level of consciousness and the use of AVPU were greatest for infants. Correlation between AVPU and median GCS in 1147 children <5 years: A=15, V=14, P=8, U=3, for 1163 children ≥5 years: A=15, V=13, P=11, U=3. There was no significant difference in the proportion of infants who had a CT whether AVPU=V/P/U or GCS<15. However diagnostic yield of intracranial injury or depressed fracture was significantly greater for V/P/U than GCS<15 :7/7: 100% (95% CI 64.6% to 100%) versus 5/17: 29.4% (95% CI 13.3% to 53.1%). For children >1 year significantly more had a CT scan when GCS<14 was recorded than ‘V/P/U only’ and the diagnostic yield was greater. Prehospital GCS and GCS in the ED were the same for 77.4% (705/911).ConclusionThere was a clear correlation between Alert and GCS=15 and between Unresponsive and GCS=3 but a wider range of GCS scores for responsive to Pain or Voice that varied with age. AVPU was valuable at initial assessment of infants and did not adversely affect the proportion of infants who had head CT or the diagnostic yield.

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Effect of the COVID-19 lockdown on disease recognition and utilisation of healthcare services in the older population in German: a cross-sectional study

Age and Ageing ◽

10.1093/ageing/afaa260 ◽

2020 ◽

Author(s):

Bernhard Michalowsky ◽

Wolfgang Hoffmann ◽

Jens Bohlken ◽

Karel Kostev

Keyword(s):

Hospital Admissions ◽

Healthcare Services ◽

Routine Care ◽

Cross Sectional Study ◽

Age Group ◽

Sectional Study ◽

Long Term Effects ◽

Older Population ◽

Cross Sectional

Abstract Background There is little evidence about the utilisation of healthcare services and disease recognition in the older population, which was urged to self-isolate during the COVID-19 lockdown. Objectives We aimed to describe the utilisation of physician consultations, specialist referrals, hospital admissions and the recognition of incident diseases in Germany for this age group during the COVID-19 lockdown. Design Cross-sectional observational study. Setting 1,095 general practitioners (GPs) and 960 specialist practices in Germany. Subjects 2.45 million older patients aged 65 or older. Methods The number of documented physician consultations, specialist referrals, hospital admissions and incident diagnoses during the imposed lockdown in 2020 was descriptively analysed and compared to 2019. Results Physician consultations decrease slightly in February (−2%), increase before the imposed lockdown in March (+9%) and decline in April (−18%) and May (−14%) 2020 compared to the same periods in 2019. Volumes of hospital admissions decrease earlier and more intensely than physician consultations (−39 versus −6%, respectively). Overall, 15, 16 and 18% fewer incident diagnoses were documented by GPs, neurologists and diabetologists, respectively, in 2020. Diabetes, dementia, depression, cancer and stroke were diagnosed less frequently during the lockdown (−17 to −26%), meaning that the decrease in the recognition of diseases was greater than the decrease in physician consultations. Conclusion The data suggest that organisational changes were adopted quickly by practice management but also raise concerns about the maintenance of routine care. Prospective studies should evaluate the long-term effects of lockdowns on patient-related outcomes.

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