Abstract 3898: Predictors Of Admissions In Patients Presenting To Emergency Department With Transient Ischemic Attacks In United States- A National Survey

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nauman Tariq ◽  
Saqib A Chaudhry ◽  
Ashter Rizvi ◽  
M Fareed K Suri ◽  
Gustavo J Rodriguez ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
Primary Diagnosis ◽  
Transient Ischemic Attacks ◽  
Hospital Type ◽  
Nationally Representative

Background: The estimates of patients who present with transient ischemic attacks (TIA) in the emergency departments (ED) of United states and their disposition including factors that determine hospital admission are not well understood. Objective: We used a nationally representative database to determine the rate and predictors of admission in TIA patients presenting to the ED. Methods: We analyzed the data from National Emergency Department Sample (NEDS 2006-2007) for all patients presenting with primary diagnosis of TIAs in the United States. Samples were weighted to provide national estimates of TIA hospitalizations and identify factors that increase the odds of hospital admission including age, sex, type of insurance, hospital type (urban teaching, urban nonteaching and non urban). Multivariate logistic regression analysis was used to identify predictors of hospital admission. Results: Of the total of 631750 patients presenting with TIA to the EDs in a period of two years in US, 41, 9447 (66.4%) were admitted to the hospital. In the multivariate analysis, independent factors associated with hospital admissions were women (odds ratio[OR] 1.042, 95% confidence interval [CI] 1.014-1.071, p =0.003) , Medicare insurance type (OR 0.82, 95% CI 0.88-0.93, p<0.0001), and urban non-teaching hospital ED (OR 0.825, 95% CI 0.778-0.875, p<0.0001). Conclusion: Approximately 70% of all patients presenting with TIAs to the EDs within United States are admitted. Factors unrelated to patients condition such as insurance status and ED affiliated hospital type play an important role in the decision to admit TIA patients to the hospitals.

Emergency Department Visits due to Scabies in the United States: A Retrospective Analysis of a Nationally Representative Emergency Department Sample

2019 ◽  
Author(s):  
Raghav Tripathi ◽  
Konrad D Knusel ◽  
Harib H Ezaldein ◽  
Jeremy S Bordeaux ◽  
Jeffrey F Scott
Keyword(s):  
United States ◽  
Emergency Department ◽  
Retrospective Analysis ◽  
The United States ◽  
Cost Of Care ◽  
Emergency Department Visits ◽  
Limited Information ◽  
Targeted Interventions ◽  
Ed Visits ◽  
Nationally Representative

Abstract Background Limited information exists regarding the burden of emergency department (ED) visits due to scabies in the United States. The goal of this study was to provide population-level estimates regarding scabies visits to American EDs. Methods This study was a retrospective analysis of the nationally representative National Emergency Department Sample from 2013 to 2015. Outcomes included adjusted odds for scabies ED visits, adjusted odds for inpatient admission due to scabies in the ED scabies population, predictors for cost of care, and seasonal/regional variation in cost and prevalence of scabies ED visits. Results Our patient population included 416 017 218 ED visits from 2013 to 2015, of which 356 267 were due to scabies (prevalence = 85.7 per 100 000 ED visits). The average annual expenditure for scabies ED visits was $67 125 780.36. The average cost of care for a scabies ED visit was $750.91 (±17.41). Patients visiting the ED for scabies were most likely to be male children from lower income quartiles and were most likely to present to the ED on weekdays in the fall, controlling for all other factors. Scabies ED patients that were male, older, insured by Medicare, from the highest income quartile, and from the Midwest/West were most likely to be admitted as inpatients. Older, higher income, Medicare patients in large Northeastern metropolitan cities had the greatest cost of care. Conclusion This study provides comprehensive nationally representative estimates of the burden of scabies ED visits on the American healthcare system. These findings are important for developing targeted interventions to decrease the incidence and burden of scabies in American EDs.

scholarly journals The Demographics of Fractures and Dislocations Across the Entire United States due to Common Sports and Recreational Activities

2019 ◽  
Vol 12 (2) ◽  
pp. 159-169
Author(s):  
Cory Meixner ◽  
Randall T. Loder
Keyword(s):  
United States ◽  
Emergency Department ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
Emergency Department Visits ◽  
Level Of Evidence ◽  
Injury Surveillance System ◽  
Joint Dislocation ◽  
Recreational Activities ◽  
Inline Skating

Background: There exists little nationwide data regarding fracture and dislocation patterns across a wide variety of sporting activities for all ages and sexes. Hypothesis: Participant demographics (age and sex) will vary with regard to fracture and joint dislocation sustained during sport-related activities. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Methods: The National Electronic Injury Surveillance System All Injury Program data 2005 through 2013 were accessed; 18 common sports and recreational activities in the United States were selected. Statistical software was used to calculate the numbers of fractures and dislocations, and incidence was calculated using US Census Bureau data. Multivariate logistic regression analysis determined the odds ratios (ORs) for the occurrence of a fracture or dislocation. Results: A fracture occurred in 20.6% and a joint dislocation in 3.6% of the emergency department visits for sports-related injuries; annual emergency department visit incidence was 1.51 for fractures and 0.27 for dislocations (per 1000 people). Most of the fractures occurred in football (22.5%). The OR for fracture was highest for inline skating (OR, 6.03), males (OR, 1.21), Asians, whites, and Amerindians compared with blacks (OR, 1.46, 1.25, and 1.18, respectively), and those older than 84 years (OR, 4.77). Most of the dislocations occurred in basketball (25.7%). The OR for dislocation was highest in gymnastics (OR, 4.08), males (OR, 1.50), Asians (OR, 1.75), and in those aged 20 to 24 years (OR, 9.04). The most common fracture involved the finger, and the most common dislocation involved the shoulder. Conclusion: Inline skating had the greatest risk for fracture, and gymnastics had the greatest risk for joint dislocation. Clinical Relevance: This comprehensive study of the risks of sustaining a fracture or dislocation from common sports activities across all age groups can aid sports health providers in a better understanding of those sports at high risk and be proactive in prevention mechanisms (protective gear, body training).

scholarly journals National Trends in Leukemia Related Emergency Department Visits, Health Care Burden and Disposition Rate in the United States, 2010-2014

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4695-4695
Author(s):  
Mohamed Mokhtar Bakr ◽  
Umar Zahid ◽  
Pavan Tenneti ◽  
Alsadiq Waleed Al-Hillan ◽  
Faiz Anwer
Keyword(s):  
United States ◽  
Health Care ◽  
Emergency Department ◽  
Hospital Admission ◽  
The United States ◽  
Emergency Department Visits ◽  
P Value ◽  
Health Care Burden ◽  
Ed Visits ◽  
National Trends

Abstract National Trends in Leukemia Related Emergency Department Visits, Health Care Burden and Disposition Rate in the United States, 2010-2014. Background: Recently emergency department (ED) utilization has been increasing for the management of acute conditions. Utilization of ED healthcare services by hematology and oncology patients have been documented previously. Cancer patients frequently visit the EDs with acute symptoms, that may require further assessment, management, and even hospitalization. Whether the incidence of leukemia related ED visits has altered is unknown. The aim of this study was to analyze the trend of leukemia related ED visits, healthcare cost associated with the visit and the discharge disposition from ED. Methods: We utilized Nationwide Emergency Department Sample (NEDS) dataset for this study. NEDS is a part of the Healthcare Cost and Utilization Project (HCUP) database and contains the information of more than 950 United States (US) hospitals that is weighted to the national estimates. We used five years of data from 2010 to 2014 to examine the trends in prevalence and rates of ED visits, cost, and disposition (such as admission, discharge and death in ED). We defined patients with leukemia (acute myeloid, chronic myeloid, acute lymphocytic, and chronic lymphocytic leukemias) by using the international classification of disease, 9th revision, clinical modification (ICD-9-CM) codes. Cochrane-Armitage test was used to assess the trend of leukemia ER visits over five years. We used estimated US census population to calculate the rate of leukemia related ED visits. Furthermore, we assessed the predictors of hospital admission by using multivariable logistic regression model. Results: Between 2010 to 2014, a nationally weighted estimate of 771,510 patients visited ED with leukemia. The frequency of leukemia related ED visits increased 21.7% from 138,038 to 167,935 during this period that accounted for 0.12% of all ED visits. The rate of leukemia related ED visits increased 20.5% from 44 to 53 per 100,000 census population, which was statistically significant (p=0.04) on a trend test. The total national cost of leukemia related visit increased by 81% from $544 million in 2010 to $984 million in 2014 (p-value<0.001). While the mean cost of each leukemia related ED visit increased 50.7% from $2367 in 2010 to $3566 in 2014 (p-value <0.001). Rate of discharge to home from ED for leukemia related visits increased 31.6% (from 22.88% in 2010 to 30.12% in 2014) (p<0.05). Similarly, the rate of in hospital admission decreased 9% from 2010 to 2014. The rate of death in a leukemia related visit remained same (0.17%) from 2010 to 2013 but in 2014 death rate increased from 0.17% to 0.23% (p-value >0.05). In an adjusted multivariable logistic regression analysis, increasing age (OR 1.02 95% CI 1.024, 1.027), male gender (OR 1.15, 95% CI 1.114, 1.188), patient location in metropolitan area (OR 2.08, 95% CI 1.88, 2.22) and northeast location (OR 1.16, 95% CI 1.03, 1.32) were found to be significantly associated with the higher odds of in hospital admission following leukemia related ED visits. While few other variables like residents of higher income quartile and those holding Medicaid, insurance were also found to be positively associated with the hospitalization but were not statistically significant (OR>1.00, p>0.05). Conclusions: There is an increasing trend of leukemia related ED utilization and associated total and mean/median costs over time, while the rate of hospitalization for leukemia associated visit from ED have decreased. Oncology providers need to plan care accordingly to reduce ER visits and hospital admission for patients with leukemia. Disclosures No relevant conflicts of interest to declare.

scholarly journals Appropriateness of Hospital Admission for Emergency Department Patients with Bronchiolitis: Secondary Analysis (Preprint)

2018 ◽  
Author(s):  
Gang Luo ◽  
Michael D Johnson ◽  
Flory L Nkoy ◽  
Shan He ◽  
Bryan L Stone
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Predictive Model ◽  
Hospital Admissions ◽  
The United States ◽  
Operational Definition ◽  
Emergency Department Visits ◽  
Threshold Values ◽  
Emergency Department Patients ◽  
Definition Of

BACKGROUND Bronchiolitis is the leading cause of hospitalization in children under 2 years of age. Each year in the United States, bronchiolitis results in 287,000 emergency department visits, 32%-40% of which end in hospitalization. Frequently, emergency department disposition decisions (to discharge or hospitalize) are made subjectively because of the lack of evidence and objective criteria for bronchiolitis management, leading to significant practice variation, wasted health care use, and suboptimal outcomes. At present, no operational definition of appropriate hospital admission for emergency department patients with bronchiolitis exists. Yet, such a definition is essential for assessing care quality and building a predictive model to guide and standardize disposition decisions. Our prior work provided a framework of such a definition using 2 concepts, one on safe versus unsafe discharge and another on necessary versus unnecessary hospitalization. OBJECTIVE The goal of this study was to determine the 2 threshold values used in the 2 concepts, with 1 value per concept. METHODS Using Intermountain Healthcare data from 2005-2014, we examined distributions of several relevant attributes of emergency department visits by children under 2 years of age for bronchiolitis. Via a data-driven approach, we determined the 2 threshold values. RESULTS We completed the first operational definition of appropriate hospital admission for emergency department patients with bronchiolitis. Appropriate hospital admissions include actual admissions with exposure to major medical interventions for more than 6 hours, as well as actual emergency department discharges, followed by an emergency department return within 12 hours ending in admission for bronchiolitis. Based on the definition, 0.96% (221/23,125) of the emergency department discharges were deemed unsafe. Moreover, 14.36% (432/3008) of the hospital admissions from the emergency department were deemed unnecessary. CONCLUSIONS Our operational definition can define the prediction target for building a predictive model to guide and improve emergency department disposition decisions for bronchiolitis in the future.

scholarly journals Emergency Department Use and Hospital Admissions Among Patients With End-Stage Renal Disease in the United States

2016 ◽  
Vol 176 (10) ◽  
pp. 1563 ◽  
Author(s):  
Brendan P. Lovasik ◽  
Rebecca Zhang ◽  
Jason M. Hockenberry ◽  
Justin D. Schrager ◽  
Stephen O. Pastan ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Hospital Admissions ◽  
The United States ◽  
Emergency Department Use ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals 1651. The Impact of the 2017–2018 Influenza Season on Acute Care Hospitals in the United States: A Qualitative Evaluation of Immediate Responses and Future Preparedness

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S603-S604
Author(s):  
Gavin H Harris ◽  
Kimberly J Rak ◽  
Jeremy M Kahn ◽  
Derek C Angus ◽  
Erin A Caplan ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Acute Care ◽  
Hospital Admissions ◽  
Influenza Season ◽  
Acute Care Hospitals ◽  
The United States ◽  
Lessons Learned ◽  
Annual Reports ◽  
The Impact

Abstract Background The 2017–2018 influenza season was characterized by high illness severity, wide geographic spread, and prolonged duration compared with recent years in the United States – resulting in an increased number of emergency department evaluations and hospital admissions. The current study explored how US hospitals perceived the impact of influenza during this time period, including effects on patient volumes, ways in which hospitals responded, and how lessons learned were incorporated into future influenza preparedness. Methods We conducted semi-structured phone interviews with capacity management personnel in short-term acute care hospitals across the United States. A random hospital sample was created using Centers for Medicare and Medicaid Services annual reports. Hospitals self-identified key informants who were involved with throughput and capacity. The interview guide was developed and pilot tested by a team of clinicians and qualitative researchers, with interviews conducted between April 2018 and January 2019. We performed thematic content analysis to identify how hospitals experienced the 2017–2018 influenza season. Results We achieved thematic saturation after 53 interviews. Responses conformed to three thematic domains: impacts on staff and patient care, immediate staffing and capacity responses, and future preparedness (Table 1). Hospitals almost universally reported increased emergency department and inpatient volumes that frequently resulted in strain across the hospital. Strain was created by both increased patient volume and staff shortages due to influenza illness. As strategies to address strain, respondents reported the use of new protocols, new vaccination policies, additional staffing, suspected-influenza treatment areas, and more frequent hospital administration meetings. Many hospitals reported increased diversion time. Despite experiencing high levels of strain, some hospitals reported no changes to their future influenza preparation plans. Conclusion Acute care hospitals experienced significant strain as a result of the 2017–2018 influenza season. Hospitals implemented a range of immediate responses to seasonal influenza, but generally did not report future planning specific to influenza. Disclosures All authors: No reported disclosures.

ESTIMATING PREVALENCE AND TIME COURSE OF SARS-CoV-2 BASED ON NEW HOSPITAL ADMISSIONS AND PCR TESTS: Data posted in the COVID 19 tracking website for RT-PCR (PCR) results and hospital admissions are used to estimate the prevalence of the SARS-CoV-2 pandemic in the United States (1). Hospital admissions mitigate positive sampling bias in PCR tests due to their initially limited test numbers and application as a diagnostic, instead of a surveying tool. As of July 31, the United States' cumulative recovered population is estimated at 47% or 155 million. The remaining susceptible population is 53%, or 47% excepting the 6% infectious population. The estimated mortality rate of the cumulative recovered population is 0.09% death per case. New (Preprint)

2020 ◽  
Author(s):  
Jose Gonzalez
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Hospital Admission ◽  
Time Course ◽  
Hospital Admissions ◽  
Sampling Bias ◽  
The United States ◽  
Rt Pcr ◽  
Admission Data ◽  
Eastern Seaboard

BACKGROUND Serological testing for SARS-CoV-2 antibodies showed a lack of response in close to 50% of formerly afflicted patients. In addition, antibodies were found to be transient, and concentration index to disease severity. These findings made this classical method for the estimation of the recovered population from COVID-19 of limited value. The method presented on this paper relying on % RT-PCR testing and controlling for sampling bias with new hospital admission data provides an effective alternative for estimation of the extent and time course of the SARS-CoV-2 epidemic. OBJECTIVE The method presented on this paper relying on % RT-PCR testing and controlling for sampling bias with new hospital admission data provides an effective alternative for estimation of the extent and time course of the SARS-CoV-2 epidemic. METHODS Daily results for %RT-PCR, Total Test Results, Hospitalized Currently, Hospitalized Cumulative available at COVID-19 Tracking Project are used to estimate mitigation of sampling bias of RT-PCR results and daily Hospital Admissions. Since at high daily testing levels and low % positives RT-PCR evidence of sampling bias disappears, it is correlated to daily Hospital Admissions and this correlate value used to mitigate the % RT-PCR findings where sampling bias is present. This information is used to estimate time course of the infection. Knowing that the disease lasts for an average of 20 days allows the integration of the time course values to obtain cumulative recovered population. RESULTS Prevalence and time course of the SARS-CoV-2 pandemic in the United States are estimated. The recovered population amounts to 47%. The states of the eastern seaboard, as exemplified by New York and Massachusetts, display a sudden early onslaught of the pandemic. While California, Texas, and Florida lagged. Mortality rate is twice higher in the eastern seaboard states compared to the entire nation and the other presented states. Given the large number of the convalescent population mortality is about 0.09% nationwide. CONCLUSIONS Novel approach to estimating time course and prevalence shows that the recovered population is much larger, and consequently, mortality rate (0.09%) about a factor of 10 lower than currently recognized.

Pediatric Hand and Upper Extremity Injuries Presenting to Emergency Departments in the United States: Epidemiology and Health Care–Associated Costs

Hand ◽  
2019 ◽  
pp. 155894471986688 ◽  
Author(s):  
Alfred Lee ◽  
David L. Colen ◽  
Justin P. Fox ◽  
Benjamin Chang ◽  
Ines C. Lin
Keyword(s):  
United States ◽  
Health Care ◽  
Emergency Department ◽  
Upper Extremity ◽  
Emergency Departments ◽  
Age Groups ◽  
The United States ◽  
Primary Diagnosis ◽  
Trauma Patients ◽  
Extremity Injuries

Background: Upper extremity injuries represent one of the most common pediatric conditions presenting to emergency departments (EDs) in the United States. We aim to describe the epidemiology, trends, and costs of pediatric patients who present to US EDs with upper extremity injuries. Methods: Using the National Emergency Department Sample, we identified all ED encounters by patients aged <18 years associated with a primary diagnosis involving the upper extremity from 2008 to 2012. Patients were divided into 4 groups by age (≤5 years, 6-9 years, 10-13 years, and 14-17 years) and a trauma subgroup. Primary outcomes were prevalence, etiology, and associated charges. Results: In total, 11.7 million ED encounters were identified, and 89.8% had a primary diagnosis involving the upper extremity. Fracture was the most common injury type (28.2%). Dislocations were common in the youngest group (17.7%) but rare in the other 3 (range = 0.8%-1.6%). There were 73.2% of trauma-related visits, most commonly due to falls (29.9%); 96.9% of trauma patients were discharged home from the ED. There were bimodal peaks of incidence in the spring and fall and a nadir in the winter. Emergency department charges of $21.2 billion were generated during the 4 years studied. While volume of visits decreased during the study, associated charges rose by 1.21%. Conclusions: Pediatric upper extremity injuries place burden on the economy of the US health care system. Types of injuries and anticipated payers vary among age groups, and while total yearly visits have decreased over the study period, the average cost of visits has risen.

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