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.

Epidemiology of fishing related upper extremity injuries presenting to the emergency department in the United States

2018 ◽  
Vol 46 (3) ◽  
pp. 319-323 ◽  
Author(s):  
Joseph A. Gil ◽  
Gregory Elia ◽  
Kalpit N. Shah ◽  
Brett D. Owens ◽  
Christopher Got
Keyword(s):  
United States ◽  
Emergency Department ◽  
Upper Extremity ◽  
The United States ◽  
Extremity Injuries

Trends in the Contribution of Emergency Departments to the Provision of Hospital-Associated Health Care in the USA

2017 ◽  
Vol 48 (2) ◽  
pp. 267-288 ◽  
Author(s):  
David Marcozzi ◽  
Brendan Carr ◽  
Aisha Liferidge ◽  
Nicole Baehr ◽  
Brian Browne
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
Emergency Departments ◽  
The United States ◽  
National Hospital ◽  
Patient Centered ◽  
National Hospital Discharge Survey ◽  
Delivery Of Care ◽  
The Usa

Traditional approaches to assessing the health of populations focus on the use of primary care and the delivery of care through patient-centered homes, managed care resources, and accountable care organizations. The use of emergency departments (EDs) has largely not been given consideration in these models. Our study aimed to determine the contribution of EDs to the health care received by Americans between 1996 and 2010 and to compare it with the contribution of outpatient and inpatient services using National Hospital Ambulatory Medical Care Survey and National Hospital Discharge Survey databases. We found that EDs contributed an average of 47.7% of the hospital-associated medical care delivered in the United States, and this percentage increased steadily over the 14-year study period. EDs are a major source of medical care in the United States, especially for vulnerable populations, and this contribution increased throughout the study period. Including emergency care within health reform and population health efforts would prove valuable to supporting the health of the nation.

scholarly journals PEAK LOWER EXTREMITY SOCCER INJURIES OCCUR IMMEDIATELY FOLLOWING GROWTH IN ADOLESCENTS: AN EPIDEMIOLOGIC REVIEW OF EMERGENCY DEPARTMENT VISITS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0021
Author(s):  
Aidan P. Wright ◽  
Aaron J. Zynda ◽  
Jane S. Chung ◽  
Philip L. Wilson ◽  
Henry B. Ellis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Lower Extremity ◽  
Emergency Departments ◽  
Skeletal Maturity ◽  
Epidemiologic Study ◽  
The United States ◽  
Emergency Department Visits ◽  
Injury Surveillance System ◽  
Lower Extremity Injuries ◽  
Extremity Injuries

BACKGROUND: Soccer has become the most popular youth sport in the world. Within the last decade, there has been limited epidemiologic research on pediatric soccer-related injuries based on sex and age. PURPOSE: To examine trends associated with soccer injuries presenting to emergency departments and to describe differences in injury pattern and location based on sex and age during periods of growth. METHODS: An epidemiologic study was conducted utilizing publicly accessible data from the National Electronic Injury Surveillance System (NEISS). The NEISS compiles Emergency Department (ED) data on all injuries presenting to the approximately 100 participating network hospitals in the United States. Information on all soccer-related injuries occurring in ages 7-19 from January 2009 – December 2018 was extracted and summary statistics were calculated. RESULTS: Approximately 54,287 pediatric soccer-related injuries were identified. The average age for all injuries was 13.3 years, and males (60.50%) presented more often than females (39.50%). Concussions and head injuries (15.57%) were most commonly reported overall, with a greater percentage occurring in females than males (17.44% vs. 14.35%). The ankle (15.3%) was the second most common injury location with females also presenting more commonly than males (18.71% vs. 13.62%). Age and sex-based evaluation noted peaks in lower extremity injuries in females younger than in males. Both ankle (F=13-15 years, M=15-17 years) and knee (F=14 years, M=16 years) injuries peaked at ages coinciding with recognized sex-based lower extremity skeletal maturity (Figure 1). CONCLUSION: Peak pediatric soccer-related ankle and knee injuries presenting to emergency departments occur at different ages in females and males and appear to, on average, coincide with maturation (age 14 in females and 16 in males). Lower extremity injuries significantly increase nearing the completion of lower extremity growth, and may indicate appropriate timing for differential sex-specific injury prevention programs within soccer. [Figure: see text]

Medical Expenditures on and by Immigrant Populations in the United States: A Systematic Review

2018 ◽  
Vol 48 (4) ◽  
pp. 601-621 ◽  
Author(s):  
Lila Flavin ◽  
Leah Zallman ◽  
Danny McCormick ◽  
J. Wesley Boyd
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
Health Care Policy ◽  
Age Groups ◽  
Health Care Expenditures ◽  
The United States ◽  
Public And Private ◽  
Health Insurance Markets ◽  
Private And Public

In health care policy debates, discussion centers around the often-misperceived costs of providing medical care to immigrants. This review seeks to compare health care expenditures of U.S. immigrants to those of U.S.-born individuals and evaluate the role which immigrants play in the rising cost of health care. We systematically examined all post-2000, peer-reviewed studies in PubMed related to health care expenditures by immigrants written in English in the United States. The reviewers extracted data independently using a standardized approach. Immigrants’ overall expenditures were one-half to two-thirds those of U.S.-born individuals, across all assessed age groups, regardless of immigration status. Per capita expenditures from private and public insurance sources were lower for immigrants, particularly expenditures for undocumented immigrants. Immigrant individuals made larger out-of-pocket health care payments compared to U.S.-born individuals. Overall, immigrants almost certainly paid more toward medical expenses than they withdrew, providing a low-risk pool that subsidized the public and private health insurance markets. We conclude that insurance and medical care should be made more available to immigrants rather than less so.

Analysis of Inpatient and Emergency Department Serial Troponin Testing Intervals in the United States

2020 ◽  
Author(s):  
Andrew Fletcher ◽  
Erik Forsman ◽  
Brian R Jackson
Keyword(s):  
United States ◽  
Emergency Department ◽  
Median Time ◽  
Emergency Departments ◽  
The United States ◽  
Published Data ◽  
Time Interval ◽  
Time Intervals ◽  
Convenience Sample ◽  
Facility Level

Abstract Background Serial measurement of cardiac troponins (cTn) is central to the diagnosis of myocardial infarction. The time intervals between individual measurements may impact the speed and reliability of diagnosis. Published recommendations exist for these time intervals, but there is little previously published data on actual intervals in routine clinical settings. Methods Retrospective analysis of cTn testing intervals was performed from a convenience sample of 37 hospitals. All 37 provided data on inpatient tests and 19 also provided separate data for tests ordered in their emergency departments. Facilities included both academic and community hospitals across the United States. For each facility, the median time interval between serial cTn order collections was determined separately for inpatient orders and emergency department orders. Results The facility-level median time intervals between serial inpatient cTn test orders ranged from 3.17 to 7.32 hours. Facility-level median time intervals between serial emergency department cTn orders ranged from 1.48 to 4.23 hours. There was no observed difference between academic and nonacademic facilities. Conclusion Typical time intervals between serial cTn orders varied widely across hospitals, and in many cases reflected suboptimal care. Time intervals were generally shorter for cTn testing ordered in emergency departments. Existing testing protocols should be re-examined.

scholarly journals Child Development and Pediatric Sport and Recreational Injuries by Age

2014 ◽  
Vol 49 (6) ◽  
pp. 780-785 ◽  
Author(s):  
David C. Schwebel ◽  
Carl M. Brezausek
Keyword(s):  
United States ◽  
Emergency Department ◽  
Emergency Departments ◽  
Injury Risk ◽  
The United States ◽  
Emergency Department Visits ◽  
Sociocultural Factors ◽  
Childhood And Adolescence ◽  
Injury Surveillance System ◽  
Sport And Recreation

Context: In 2010, 8.6 million children were treated for unintentional injuries in American emergency departments. Child engagement in sports and recreation offers many health benefits but also exposure to injury risks. In this analysis, we consider possible developmental risk factors in a review of age, sex, and incidence of 39 sport and recreational injuries. Objective: To assess (1) how the incidence of 39 sport and recreational injuries changed through each year of child and adolescent development, ages 1 to 18 years, and (2) sex differences. Design Descriptive epidemiology study. Setting: Emergency department visits across the United States, as reported in the 2001–2008 National Electronic Injury Surveillance System database. Patients or Other Participants: Data represent population-wide emergency department visits in the United States. Main Outcome Measure(s) Pediatric sport- and recreation-related injuries requiring treatment in hospital emergency departments. Results: Almost 37 pediatric sport or recreational injuries are treated hourly in the United States. The incidence of sport- and recreation-related injuries peaks at widely different ages. Team-sport injuries tend to peak in the middle teen years, playground injuries peak in the early elementary ages and then drop off slowly, and bicycling injuries peak in the preteen years but are a common cause of injury throughout childhood and adolescence. Bowling injuries peaked at the earliest age (4 years), and injuries linked to camping and personal watercraft peaked at the oldest age (18 years). The 5 most common causes of sport and recreational injuries across development, in order, were basketball, football, bicycling, playgrounds, and soccer. Sex disparities were common in the incidence of pediatric sport and recreational injuries. Conclusions: Both biological and sociocultural factors likely influence the developmental aspects of pediatric sport and recreational injury risk. Biologically, changes in perception, cognition, and motor control might influence injury risk. Socioculturally, decisions must be made about which sport and recreational activities to engage in and how much risk taking occurs while engaging in those activities. Understanding the developmental aspects of injury data trends allows preventionists to target education at specific groups.

scholarly journals Monitoring Sexual Violence Trends in Emergency Department Visits Using Syndromic Data From the National Syndromic Surveillance Program—United States, January 2017–December 2019

2021 ◽  
Vol 111 (3) ◽  
pp. 485-493
Author(s):  
Ashley Schappell D'Inverno ◽  
Nimi Idaikkadar ◽  
Debra Houry
Keyword(s):  
United States ◽  
Emergency Department ◽  
Sexual Violence ◽  
Syndromic Surveillance ◽  
Age Groups ◽  
The United States ◽  
Emergency Department Visits ◽  
Surveillance Program ◽  
Time Period ◽  
Ed Visits

Objectives. To report trends in sexual violence (SV) emergency department (ED) visits in the United States. Methods. We analyzed monthly changes in SV rates (per 100 000 ED visits) from January 2017 to December 2019 using Centers for Disease Control and Prevention’s National Syndromic Surveillance Program data. We stratified the data by sex and age groups. Results. There were 196 948 SV-related ED visits from January 2017 to December 2019. Females had higher rates of SV-related ED visits than males. Across the entire time period, females aged 50 to 59 years showed the highest increase (57.33%) in SV-related ED visits, when stratified by sex and age group. In all strata examined, SV-related ED visits displayed positive trends from January 2017 to December 2019; 10 out of the 24 observed positive trends were statistically significant increases. We also observed seasonal trends with spikes in SV-related ED visits during warmer months and declines during colder months, particularly in ages 0 to 9 years and 10 to 19 years. Conclusions. We identified several significant increases in SV-related ED visits from January 2017 to December 2019. Syndromic surveillance offers near-real-time surveillance of ED visits and can aid in the prevention of SV.

scholarly journals Characteristics of Upper Extremity Trauma Patients from Division of Orthopedics and Traumatology in Department of Surgery RSUP Dr. Mohammad Hoesin Since Januari 1 st - December 31 st 2019

2021 ◽  
Vol 4 (2) ◽  
pp. 305-315
Author(s):  
Ridnia Nur Istiqomah ◽  
Wiria Aryanta
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Upper Extremity ◽  
Traffic Accident ◽  
Health Care Service ◽  
Health Care Facilities ◽  
Trauma Patients ◽  
Extremity Trauma ◽  
Wide Range ◽  
Upper Extremity Trauma

Background: Upper extremity trauma is one of the most frequent of trauma that leads to emergency department visitation in every health care facilities. A wide range of manifestations could differently be present from one area to another. Thus, the statistical prevalence number of upper extremity trauma is very important for designing and optimizing the health care service for the purpose of preventive and curative. This study aims to understand the charachteristics of patient with upper extremity trauma that admitted at RSUP Dr. Mohammad Hoesin Palembang emergency department in the period of January to December 2019. Method: This research was an observational descriptive study. Using secondary data from the medical records of Mohammad Hoesin Hospital, Palembang. Performed in the from January 2019 to December 2019. Samples were all upper extremity trauma patients who were admitted at RSUP Dr. Mohammad Hoesin Palembang emergency department in the period of study. Result: There were 54 subjects participated who met the study’s criterias. Most of them were male (76%) with the average of age around 34 years old. It is also dominated with the group of age 25-44 years old (39%), 80% of among all patients have closed and hard tissue trauma. Regio humerus is the most frequent area impacted (16 patients). Most of the patients have worked as private employees (13 patients) with education background till senior high school (38 patients). The etiology of majority trauma is traffic accident (29 patients) that lived outside Palembang area (16 patients). Conclusion: Majority of the upper extremity trauma cases of this study have characteristics as male in productive group of age and the cause of trauma is traffic accident.

scholarly journals Implementation of the COVID-19 Vulnerability Index Across an International Network of Health Care Data Sets: Collaborative External Validation Study

10.2196/21547 ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. e21547
Author(s):  
Jenna M Reps ◽  
Chungsoo Kim ◽  
Ross D Williams ◽  
Aniek F Markus ◽  
Cynthia Yang ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Decision Making ◽  
Emergency Department ◽  
Prediction Model ◽  
Emergency Department Visit ◽  
External Validation ◽  
The United States ◽  
Risk Of Bias ◽  
Data Sets

Background SARS-CoV-2 is straining health care systems globally. The burden on hospitals during the pandemic could be reduced by implementing prediction models that can discriminate patients who require hospitalization from those who do not. The COVID-19 vulnerability (C-19) index, a model that predicts which patients will be admitted to hospital for treatment of pneumonia or pneumonia proxies, has been developed and proposed as a valuable tool for decision-making during the pandemic. However, the model is at high risk of bias according to the “prediction model risk of bias assessment” criteria, and it has not been externally validated. Objective The aim of this study was to externally validate the C-19 index across a range of health care settings to determine how well it broadly predicts hospitalization due to pneumonia in COVID-19 cases. Methods We followed the Observational Health Data Sciences and Informatics (OHDSI) framework for external validation to assess the reliability of the C-19 index. We evaluated the model on two different target populations, 41,381 patients who presented with SARS-CoV-2 at an outpatient or emergency department visit and 9,429,285 patients who presented with influenza or related symptoms during an outpatient or emergency department visit, to predict their risk of hospitalization with pneumonia during the following 0-30 days. In total, we validated the model across a network of 14 databases spanning the United States, Europe, Australia, and Asia. Results The internal validation performance of the C-19 index had a C statistic of 0.73, and the calibration was not reported by the authors. When we externally validated it by transporting it to SARS-CoV-2 data, the model obtained C statistics of 0.36, 0.53 (0.473-0.584) and 0.56 (0.488-0.636) on Spanish, US, and South Korean data sets, respectively. The calibration was poor, with the model underestimating risk. When validated on 12 data sets containing influenza patients across the OHDSI network, the C statistics ranged between 0.40 and 0.68. Conclusions Our results show that the discriminative performance of the C-19 index model is low for influenza cohorts and even worse among patients with COVID-19 in the United States, Spain, and South Korea. These results suggest that C-19 should not be used to aid decision-making during the COVID-19 pandemic. Our findings highlight the importance of performing external validation across a range of settings, especially when a prediction model is being extrapolated to a different population. In the field of prediction, extensive validation is required to create appropriate trust in a model.

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