scholarly journals A Comparison of Emergency Department Admission Diagnoses and Discharge Diagnoses: Retrospective Study

2003 ◽  
Vol 10 (2) ◽  
pp. 70-75 ◽  
Author(s):  
HS Chiu ◽  
KF Chan ◽  
CH Chung ◽  
K Ma ◽  
KW Au
Keyword(s):  
Emergency Department ◽  
Young Adults ◽  
Retrospective Study ◽  
Diagnostic Accuracy ◽  
Diagnostic Tools ◽  
Admission Diagnosis ◽  
Discharge Diagnosis ◽  
Emergency Department Admission ◽  
Hospital Discharge Diagnosis ◽  
Male Sex

Objective To study the accuracy of emergency department admission diagnosis and the effect of investigations on diagnostic accuracy. Design Retrospective study in a two-month period. Setting Accident & Emergency Department of a public general hospital, which had four in-patient specialties – Medicine, Surgery, Paediatrics and Orthopaedics. Subjects All cases admitted through the emergency department in the study period. Main outcome measures Degree of correlation between emergency department admission diagnosis and hospital discharge diagnosis. Results Of all admission diagnoses, 71.4% fully or partially matched the final discharge diagnoses. The accuracy of diagnosis was statistically better in traumatic cases, the male sex and young adults. Diagnostic accuracy varied with the specialty involved and investigations taken. Conclusion History and physical examination remained the most important diagnostic tools in the emergency department. In general, simple investigations available at the emergency department were not helpful in improving diagnostic accuracy.

Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity

Diagnosis ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 23-30 ◽  
Author(s):  
James Eames ◽  
Arie Eisenman ◽  
Richard J. Schuster
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Medical Center ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Admission Diagnosis ◽  
Mortality And Morbidity ◽  
Emergency Department Admission ◽  
Icu Length Of Stay ◽  
Discordant Group

AbstractPrevious studies have shown that changes in diagnoses from admission to discharge are associated with poorer outcomes. The aim of this study was to investigate how diagnostic discordance affects patient outcomes.: The first three digits of ICD-9-CM codes at admission and discharge were compared for concordance. The study involved 6281 patients admitted to the Western Galilee Medical Center, Naharyia, Israel from the emergency department (ED) between 01 November 2012 and 21 January 2013. Concordant and discordant diagnoses were compared in terms of, length of stay, number of transfers, intensive care unit (ICU) admission, readmission, and mortality.: Discordant diagnoses was associated with increases in patient mortality rate (5.1% vs. 1.5%; RR 3.35, 95% CI 2.43, 4.62; p<0.001), the number of ICU admissions (6.7% vs. 2.7%; RR 2.58, 95% CI 2.07, 3.32; p<0.001), hospital length of stay (3.8 vs. 2.5 days; difference 1.3 days, 95% CI 1.2, 1.4; p<0.001), ICU length of stay (5.2 vs. 3.8 days; difference 1.4 days, 95% CI 1.0, 1.9; p<0.001), and 30 days readmission (14.11% vs. 12.38%; RR 1.14, 95% CI 1.00, 1.30; p=0.0418). ED length of stay was also greater for the discordant group (3.0 vs. 2.9 h; difference 8.8 min; 95% CI 0.1, 0.2; p<0.001): These findings indicate discordant admission and discharge diagnoses are associated with increases in morbidity and mortality. Further research should identify modifiable causes of discordance.

scholarly journals Profile of the Population Cared for in a Referral Emergency Unit

2011 ◽  
Vol 19 (3) ◽  
pp. 548-556 ◽  
Author(s):  
Gabriella Novelli Oliveira ◽  
Michele de Freitas Neves Silva ◽  
Izilda Esmenia Muglia Araujo ◽  
Marco Antonio Carvalho-Filho
Keyword(s):  
Emergency Department ◽  
Young Adults ◽  
Back Pain ◽  
Retrospective Study ◽  
Chest Pain ◽  
Young Women ◽  
Adult Population ◽  
Low Complexity ◽  
University Hospital ◽  
Emergency Unit

Acquiring knowledge concerning the characteristics of the population that seeks an emergency department can support the planning of health actions. This study identifies the socio-demographic profile and the main complaints of the adult population cared for in a Referral Emergency Unit (RECU). This descriptive and retrospective study was conducted in the RECU of a university hospital in the State of Sao Paulo, Brazil. The sample was composed of the service’s care forms generated for the period between January and December 2008. The instrument was based on data contained in the care forms. Young women (14 to 54 years old), residents of neighborhoods near the RECU, spontaneously sought the service during the week from 7am to 7pm. The most frequent complaints were headache, back pain, abdominal and chest pain. The conclusion is that most of the sample was young adults, of productive age, female, who spontaneously sought the service on weekdays during the day. Most complaints were of low complexity.

scholarly journals Frontline Screening for SARS-CoV-2 Infection at Emergency Department Admission by Third Generation Rapid Antigen Test: Can We Spare RT-qPCR?

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 818
Author(s):  
Valeria Cento ◽  
Silvia Renica ◽  
Elisa Matarazzo ◽  
Maria Antonello ◽  
Luna Colagrossi ◽  
...  
Keyword(s):  
Emergency Department ◽  
False Negative ◽  
Real Life ◽  
Digital Pcr ◽  
Diagnostic Tools ◽  
Third Generation ◽  
Emergency Department Admission ◽  
Active Viral Replication ◽  
Microfluidic Assays ◽  
Antigen Tests

To complement RT-qPCR testing for diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, many countries have introduced the use of rapid antigen tests. As they generally display lower real-life performances than expected, their correct positioning as frontline screening is still controversial. Despite the lack of data from daily clinical use, third generation microfluidic assays (such as the LumiraDx SARS-CoV-2 Ag test) have recently been suggested to have similar performances to RT-qPCR and have been proposed as alternative diagnostic tools. By analyzing 960 nasopharyngeal swabs from 960 subjects at the emergency department admissions of a tertiary COVID-19 hospital, LumiraDx assay demonstrated a specificity of 97% (95% CI: 96–98), and a sensitivity of 85% (95% CI: 82–89) in comparison with RT-qPCR, which increases to 91% (95% CI: 86–95) for samples with a cycle threshold ≤ 29. Fifty false-negative LumiraDx-results were confirmed by direct quantification of genomic SARS-CoV-2 RNA through droplet-digital PCR (median (IQR) load = 5880 (1657–41,440) copies/mL). Subgenomic N and E RNAs were detected in 52% (n = 26) and 56% (n = 28) of them, respectively, supporting the presence of active viral replication. Overall, the LumiraDx test complies with the minimum performance requirements of the WHO. Yet, the risk of a misrecognition of patients with active COVID-19 persists, and the need for confirmatory RT-qPCR should not be amended.

scholarly journals Quality assessment of discharge summaries from an emergency department in eastern Nepal

2017 ◽  
Vol 13 (3) ◽  
pp. 41-47
Author(s):  
Rajani Giri ◽  
R Bhandari ◽  
M Poudel ◽  
P P Gupta
Keyword(s):  
Emergency Department ◽  
Drug Allergy ◽  
Hospital Admissions ◽  
Clinical Information ◽  
Discharge Summary ◽  
Admission Diagnosis ◽  
Discharge Diagnosis ◽  
Ease Of Access ◽  
Outpatient Settings ◽  
Discharge Summaries

Background: Discharge summaries are intended to transfer important clinical information from inpatient to outpatient settings and between hospital admissions. A good discharge summary helps physician to provide continuity of care which will in turn improve patient outcomes. Despite the importance of the discharge summary, there has been relatively little research in this area in Nepal. We therefore decided to review discharge summaries of patients discharged from emergency department in eastern Nepal.Objective: To assess the completeness of discharge summaries from emergency department. Methods: A total of 360 discharge summaries, representing 20% of discharge from the emergency department of B.P. Koirala Institute of Health Sciences, Nepal were randomly selected and evaluated. Quality of discharge for completeness was evaluated using recommendations by Joint Commission on Accreditation of Hospital for the presence or absence of the following key items: admission diagnosis, drug allergy, physical examination, significant laboratory test and results, discharge diagnosis, procedures, discharge medication (including dose and duration), follow up and attending physician signature.Results: The proportion of discharge summaries missing particular component of vital data ranged from less than 4% (no discharge medications) to 97% (no mention of drug allergy). Information was missing on patients discharge condition (74%), hospital course (61%), discharge instruction (57%) and the discharge diagnosis in (13%). Most of the discharge summaries were partially structured representing 75%. Ease of access to the diagnosis was 78%.Conclusions: Though most of the discharge summaries were structured and access to the diagnosis was 78%, considerable deficiencies in the completeness of discharge summaries were found. Health Renaissance 2015;13 (3): 41-47

scholarly journals Delirium Screening in the Emergency Department: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Qian Zhang ◽  
Meixi Chen ◽  
Liangying Hou ◽  
Ziqi Guo ◽  
Qing Zhang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Relative Sensitivity ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Screening Tools ◽  
Cochrane Library ◽  
Diagnostic Tools

Abstract Background: Delirium is a complex syndrome characterized by a disturbance in attention and awareness, with a prevalence of 10-20% in patients admitted to the Emergency Department (ED). Screening tools have been developed to identify delirium in the ED, but their accuracy of screening remains unclear. To address this challenge, we conducted a comprehensive meta-analysis to systematically review the accuracy of delirium screening tools currently being used to assess ED patients.Methods: PubMed, PsycINFO, EMBASE, and the Cochrane Library were searched. Studies involving ED inpatients which compared diagnostic tools with the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria as a reference standard were included. Two reviewers independently screened the studies, extracted data, and assessed the quality of studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 scale. We conducted a conventional meta-analysis for each screening tool. Then we used network meta-analysis method to calculate the relative sensitivity and specificity among the diagnostic tests. The diagnostic accuracies were then ranked through the superiority index.Results: Thirteen studies included six screening tools. The pooled sensitivity and specificity for the Confusion Assessment Method (CAM) were 0.71 and 0.98, and for 4AT (Arousal, Attention, Abbreviated Mental Test 4, Acute change) were 0.83 and 0.93, respectively. The other four tools used were only reported in one or two studies. Their sensitivity ranged from 0.70 to 1.00, and their specificity ranged from 0.64 to 0.99. Moreover, network meta-analysis indicated that the CAM and 4AT had a greater superiority index and a higher diagnostic accuracy.Conclusions: The available data suggested that both the CAM and 4AT can be used as efficient screening tools for the ED patients.

scholarly journals Predictors of admission and shunt revision during emergency department visits for shunt-treated adult patients with idiopathic intracranial hypertension

2017 ◽  
Vol 127 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Eric W. Sankey ◽  
Benjamin D. Elder ◽  
Ann Liu ◽  
Kathryn A. Carson ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Emergency Department Visits ◽  
Shunt Revision ◽  
Ophthalmological Examination ◽  
Emergency Department Admission ◽  
Factors Associated ◽  
Male Sex ◽  
And Performance

OBJECTIVEFactors associated with emergency department admission and/or shunt revision for idiopathic intracranial hypertension (IIH) are unclear. In this study, the associations of several factors with emergency department admission and shunt revision for IIH were explored.METHODSThe authors performed a retrospective review of 31 patients (169 total emergency department visits) who presented to the emergency department for IIH-related symptoms between 2003 and 2015. Demographics, comorbidities, symptoms, IIH diagnosis and treatment history, ophthalmological examination, diagnostic lumbar puncture (LP), imaging findings, and data regarding admission and management decisions were collected. Multivariable general linear models regression analysis was performed to assess the predictive factors associated with admission and shunt revision.RESULTSThirty-one adult patients with a history of shunt placement for IIH visited the emergency department a total of 169 times for IIH-related symptoms, with a median of 3 visits (interquartile range 2–7 visits) per patient. Five patients had more than 10 emergency department visits. Baseline factors associated with admission included male sex (OR 10.47, 95% CI 2.13–51.56; p = 0.004) and performance of an LP (OR 3.10, 95% CI 1.31–7.31; p = 0.01). Contrastingly, older age at presentation (OR 0.94, 95% CI 0.90–0.99; p = 0.01), and a greater number of prior emergency department visits (OR 0.94, 95% CI 0.89–0.99; p = 0.02) were slightly protective against admission. The presence of papilledema (OR 11.62, 95% CI 3.20–42.16; p < 0.001), Caucasian race (OR 40.53, 95% CI 2.49–660.09 p = 0.009), and systemic hypertension (OR 7.73, 95% CI 1.11–53.62; p = 0.03) were independent risk factors for shunt revision. In addition, a greater number of prior emergency department visits (OR 0.86, 95% CI 0.77–0.96; p = 0.009) and older age at presentation (OR 0.93, 95% CI 0.87–0.99; p = 0.02) were slightly protective against shunt revision, while there was suggestive evidence that presence of a programmable shunt (OR 0.23, 95% CI 0.05–1.14; p = 0.07) was a protective factor against shunt revision. Of note, location of the proximal catheter in the ventricle or lumbar subarachnoid space was not significantly associated with admission or shunt revision in the multivariable analyses.CONCLUSIONSThe decision to admit a shunt-treated patient from the emergency department for symptoms related to IIH is challenging. Knowledge of factors associated with the need for admission and/or shunt revision is required. In this study, factors such as male sex, younger age at presentation, lower number of prior emergency department visits, and performance of a diagnostic LP were independent predictors of admission. In addition, papilledema was strongly predictive of the need for shunt revision, highlighting the importance of an ophthalmological examination for shunt-treated adults with IIH who present to the emergency department.

Socio-demographic profile of suicidal hanging deaths in Delhi and the National Capital Region – a retrospective study

2021 ◽  
pp. 002581722110536
Author(s):  
Aditya Anand ◽  
Sanjay Kumar ◽  
Surya Kiran Panga ◽  
Laiba Ashraf ◽  
Dibya Sharma ◽  
...  
Keyword(s):  
Young Adults ◽  
Retrospective Study ◽  
Preventive Strategy ◽  
Demographic Analysis ◽  
National Capital Region ◽  
Demographic Profile ◽  
Capital Region ◽  
Medical College ◽  
National Capital ◽  
Male Sex

The aim of this retrospective socio-demographic analysis is to identify those at higher risk of suicidal hanging in the region of Delhi and the National Capital Region. All deaths due to suicidal hanging from January 2016 to December 2019 reported in the Vardhman Mahavir Medical College and Safdarjung Hospital were included. Suicidal hanging accounted for 2.67% of total autopsied cases; 21–30 years old represented 42.62% of the victims. Male:female ratio was 1.7:1 and 38.37% of cases were from the adjoining areas of Vasant Kunj and Vasant Vihar. Therefore, a preventive strategy should focus concern on young adults, the male sex, and areas of Vasant Kunj and Vasant Vihar.

Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Manish Bastakoti ◽  
Mohamad Muhailan ◽  
Ahmad Nassar ◽  
Tariq Sallam ◽  
Sameer Desale ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Discharge ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Admission Diagnosis ◽  
Emergency Department Admission

Abstract Objectives Published discrepancy rates between emergency department (ED) and hospital discharge (HD) diagnoses vary widely (from 6.5 to 75.6%). The goal of this study was to determine the extent of diagnostic discrepancy and its impact on length of hospital stay (LOS), up-triage to the intensive care unit (ICU) and in-hospital mortality. Methods A retrospective chart review of adult patients admitted from the ED to a hospitalist service at a tertiary hospital was performed. The ED and HD diagnoses were compared and classified as concordant, discordant, or symptom diagnoses according to predefined criteria. Logistic regression analysis was conducted to examine the associations of diagnostic discordance with in-hospital mortality and up-triage to the ICU. A linear regression model was used for the length of stay. Results Of the 636 patients whose records were reviewed, 418 (217 [51.9%] women, with a mean age of 64.1 years) were included. Overall, 318 patients (76%) had concordant diagnoses, while 91 (21.77%) had discordant diagnoses. Only 9 patients (2.15%) had symptom diagnoses. A discordant diagnosis was associated with increased mortality (OR: 3.64; 95% CI: 1.026–12.91; p=0.045) and up-triage to the ICU (OR: 5.51; 95% CI: 2.43–12.5; p<0.001). The median LOS was significantly greater for patients with discordant diagnoses (7 days) than for those with concordant diagnoses (4.7 days) (p=0.004). Symptom diagnosis did not affect the mortality or ICU up-triage. Conclusions One in five hospitalized patients had discordant HD and admission diagnoses. This diagnostic discrepancy was associated with significant impacts on patient morbidity and mortality.

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