Frequent Emergency Department Visits After Spontaneous Intracerebral Hemorrhage: Who Is at Risk?

Background: The long-term prognosis of spontaneous intracerebral hemorrhage (SICH) is poor. Frequent emergency department (ED) visits can signal increased risk of hospitalization and death. There are no studies describing the risk of frequent ED visits after SICH. Methods: Retrospective cohort study of a community representative consecutive SICH survivors (2009-2015) from southern Portugal. Logistic regression analysis was performed to identify sociodemographic and clinical factors associated with frequent ED visits (≥4 visits) within the first year after hospital discharge. Results: A total of 360 SICH survivors were identified, 358 (98.6%) of whom were followed. The median age was 72; 64% were males. The majority of survivors (n = 194, 54.2%) had at least 1 ED visit. Reasons for ED visits included infections, falls with trauma, and isolated neurological symptoms. Forty-four (12.3%) SICH survivors became frequent ED visitors. Frequent ED visitors were older and had more hospitalizations ( P < .001) and ED visits ( P < .001) prior to the SICH, unhealthy alcohol use ( P = .049), longer period of index SICH hospitalization ( P = .032), pneumonia during hospitalization ( P = .001), and severe neurological impairment at discharge ( P = .001). Pneumonia during index hospitalization (odds ratio [OR]: 3.08; confidence interval [CI]: 1.39-6.76; P = .005) and history of ED visits prior to SICH (OR: 1.64; CI: 1.19-2.26, P = .003) increased the likelihood of becoming a frequent ED visitor. Conclusions: Predictors of frequent ED visits are identifiable at hospital discharge and during any ED visit. Improvement of transitional care and identification of at-risk patients may help reduce multiple ED visits.

Download Full-text

Emergency Department Visits for Opioid Overdoses Among Patients With Cancer

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz233 ◽

2019 ◽

Vol 112 (9) ◽

pp. 938-943 ◽

Cited By ~ 5

Author(s):

Vikram Jairam ◽

Daniel X Yang ◽

James B Yu ◽

Henry S Park

Keyword(s):

At Risk ◽

Emergency Department ◽

Statistical Tests ◽

Temporal Trends ◽

The United States ◽

Emergency Department Visits ◽

Multivariable Logistic Regression Analysis ◽

Opioid Overdose ◽

Patients With Cancer ◽

Ed Visits

Abstract Background Patients with cancer may be at risk of high opioid use due to physical and psychosocial factors, although little data exist to inform providers and policymakers. Our aim is to examine overdoses from opioids leading to emergency department (ED) visits among patients with cancer in the United States. Methods The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample was queried for all adult cancer-related patient visits with a primary diagnosis of opioid overdose between 2006 and 2015. Temporal trends and baseline differences between patients with and without opioid-related ED visits were evaluated. Multivariable logistic regression analysis was used to identify risk factors associated with opioid overdose. All statistical tests were two-sided. Results Between 2006 and 2015, there were a weighted total of 35 339 opioid-related ED visits among patients with cancer. During this time frame, the incidence of opioid-related ED visits for overdose increased twofold (P < .001). On multivariable regression (P < .001), comorbid diagnoses of chronic pain (odds ratio [OR] 4.51, 95% confidence interval [CI] = 4.13 to 4.93), substance use disorder (OR = 3.54, 95% CI = 3.28 to 3.82), and mood disorder (OR = 3.40, 95% CI = 3.16 to 3.65) were strongly associated with an opioid-related visit. Patients with head and neck cancer (OR = 2.04, 95% CI = 1.82 to 2.28) and multiple myeloma (OR = 1.73, 95% CI = 1.32 to 2.26) were also at risk for overdose. Conclusions Over the study period, the incidence of opioid-related ED visits in patients with cancer increased approximately twofold. Comorbid diagnoses and primary disease site may predict risk for opioid overdose.

Download Full-text

Drinking water residence time in distribution networks and emergency department visits for gastrointestinal illness in Metro Atlanta, Georgia

Journal of Water and Health ◽

10.2166/wh.2009.022 ◽

2009 ◽

Vol 7 (2) ◽

pp. 332-343 ◽

Cited By ~ 31

Author(s):

Sarah C. Tinker ◽

Christine L. Moe ◽

Mitchel Klein ◽

W. Dana Flanders ◽

Jim Uber ◽

...

Keyword(s):

Emergency Department ◽

Drinking Water ◽

Residence Time ◽

Distribution Networks ◽

Emergency Department Visits ◽

Residence Times ◽

Water Residence Time ◽

Increased Risk ◽

Ed Visits ◽

Zip Code

We examined whether the average water residence time, the time it takes water to travel from the treatment plant to the user, for a zip code was related to the proportion of emergency department (ED) visits for gastrointestinal (GI) illness among residents of that zip code. Individual-level ED data were collected from all hospitals located in the five-county metro Atlanta area from 1993 to 2004. Two of the largest water utilities in the area, together serving 1.7 million people, were considered. People served by these utilities had almost 3 million total ED visits, 164,937 of them for GI illness. The relationship between water residence time and risk for GI illness was assessed using logistic regression, controlling for potential confounding factors, including patient age and markers of socioeconomic status (SES). We observed a modestly increased risk for GI illness for residents of zip codes with the longest water residence times compared with intermediate residence times (odds ratio (OR) for Utility 1 = 1.07, 95% confidence interval (CI)=1.03, 1.10; OR for Utility 2 = 1.05, 95% CI = 1.02, 1.08). The results suggest that drinking water contamination in the distribution system may contribute to the burden of endemic GI illness.

Download Full-text

Community Need Index (CNI): a simple tool to predict emergency department utilization after hospital discharge from the trauma service

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000239 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000239 ◽

Cited By ~ 1

Author(s):

Dih-Dih Huang ◽

Mahmoud Z Shehada ◽

Kristina M Chapple ◽

Nathaniel S Rubalcava ◽

Jonathan L Dameworth ◽

...

Keyword(s):

Emergency Department ◽

Hospital Discharge ◽

Injury Severity ◽

Hospital Length Of Stay ◽

Emergency Department Utilization ◽

Blunt Injury ◽

Trauma Patients ◽

Increased Risk ◽

Ed Visits ◽

Zip Code

BackgroundEmergency department (ED) visits after hospital discharge may reflect failure of transition of care to the outpatient setting. Reduction of postdischarge ED utilization represents an opportunity for quality improvement and cost reduction. The Community Need Index (CNI) is a Zip code-based score that accounts for a community’s unmet needs with respect to healthcare and is publicly accessible via the internet. The purpose of this study was to determine if patient CNI score is associated with postdischarge ED utilization among hospitalized trauma patients.MethodsLevel 1 trauma patient admitted between January 2014 and June 2016 were stratified by 30-day postdischarge ED utilization (yes/no). CNI is a nationwide Zip code-based score (1.0–5.0) and was determined per patient from the CNI website. Higher scores indicate greater barriers to healthcare per aggregate socioeconomic factors. Patients with 30-day postdischarge ED visits were compared with those without, evaluating for differences in CNI score and clinical and demographic characteristics.Results309 of 3245 patients (9.5%) used the ED. The ED utilization group was older (38.3±15.7 vs. 36.3±16.4 years, p=0.034), more injured (Injury Severity Score 10.4±8.7 vs. 7.7±8.0, p<0.001), and more likely to have had in-hospital complications (17.5% vs. 5.4%, p<0.001). Adjusted for patient age, injury severity, gender, race/ethnicity, penetrating versus blunt injury, alcohol above the legal limit, illicit drug use, the presence of one or more complications and comorbidities, hospital length of stay, and insurance category, CNI score ≥4 was associated with increased utilization (OR 2.0 [95% CI 1.4 to 2.9, p<0.001]).DiscussionCNI is an easily accessible score that independently predicts postdischarge ED utilization in trauma patients. Patients with CNI score ≥4 are at significantly increased risk. Targeted intervention concerning discharge planning for these patients represents an opportunity to decrease postdischarge ED utilization.Level of evidenceIII, Prognostic and Epidemiological.

Download Full-text

Documentation of Firearm Safety Screening During Emergency Department Visits for Assault-Related Injury

Health Promotion Practice ◽

10.1177/15248399211029340 ◽

2021 ◽

pp. 152483992110293

Author(s):

Lauren B. Mulcahy ◽

Monika K. Goyal ◽

Joanna Cohen

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Retrospective Chart Review ◽

High Risk Group ◽

Emergency Department Visits ◽

Washington Dc ◽

Increased Risk ◽

Icd 10 ◽

Ed Visits ◽

Firearm Safety

Assault-injured youth have an increased risk of future violence. Identifying firearm access among youth in the emergency department (ED) creates an opportunity for interventions aimed at reducing future violent events. We performed this study to determine the extent to which children with assault-related injuries are screened for access to firearms in the ED. We performed a retrospective chart review of all medical records from adolescent ED visits to an academic, tertiary care pediatric hospital in Washington DC with ICD-10 codes related to assault in a 3-month period. We found that among 252 assault-related encounters, none had any documentation of firearm access in the provider note, social work note, or psychiatry consultant note. Therefore, we concluded that firearm access screening is rarely documented in ED visits among patients who present for an assault, highlighting an important missed opportunity for firearm access screening among this high-risk group.

Download Full-text

Patient‐Reported Outcomes Predict Future Emergency Department Visits and Hospital Admissions in Patients With Stroke

Journal of the American Heart Association ◽

10.1161/jaha.120.018794 ◽

2021 ◽

Vol 10 (6) ◽

Author(s):

Irene L. Katzan ◽

Nicolas Thompson ◽

Andrew Schuster ◽

Dolora Wisco ◽

Brittany Lapin

Keyword(s):

Emergency Department ◽

Patient Reported Outcomes ◽

Prediction Models ◽

Hospital Admissions ◽

Emergency Department Visits ◽

Mitigation Strategies ◽

Increased Risk ◽

Patient Reported ◽

Ed Visits ◽

Unplanned Admissions

Background Identification of stroke patients at increased risk of emergency department (ED) visits or hospital admissions allows implementation of mitigation strategies. We evaluated the ability of the Patient‐Reported Outcomes Information Measurement System (PROMIS) patient‐reported outcomes (PROs) collected as part of routine care to predict 1‐year emergency department (ED) visits and admissions when added to other readily available clinical variables. Methods and Results This was a cohort study of 1696 patients with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or transient ischemic attack seen in a cerebrovascular clinic from February 17, 2015, to June 11, 2018, who completed the following PROs at the visit: Patient Health Questionnaire‐9, Quality of Life in Neurological Disorders cognitive function, PROMIS Global Health, sleep disturbance, fatigue, anxiety, social role satisfaction, physical function, and pain interference. A series of logistic regression models was constructed to determine the ability of models that include PRO scores to predict 1‐year ED visits and all‐cause and unplanned admissions. In the 1 year following the PRO encounter date, 1046 ED visits occurred in 548 patients; 751 admissions occurred in 453 patients. All PROs were significantly associated with future ED visits and admissions except PROMIS sleep. Models predicting unplanned admissions had highest optimism‐corrected area under the curve (range, 0.684–0.724), followed by ED visits (range, 0.674–0.691) and then all‐cause admissions (range, 0.628–0.671). PROs measuring domains of mental health had stronger associations with ED visits; PROs measuring domains of physical health had stronger associations with admissions. Conclusions PROMIS scales improve the ability to predict ED visits and admissions in patients with stroke. The differences in model performance and the most influential PROs in the prediction models suggest differences in factors influencing future hospital admissions and ED visits.

Download Full-text

Impact of Extremely Hot Days on Emergency Department Visits for Cardiovascular Disease among Older Adults in New York State

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16122119 ◽

2019 ◽

Vol 16 (12) ◽

pp. 2119 ◽

Cited By ~ 3

Author(s):

Mengxuan Li ◽

Benjamin A. Shaw ◽

Wangjian Zhang ◽

Elizabeth Vásquez ◽

Shao Lin

Keyword(s):

Older Adults ◽

Emergency Department ◽

New York ◽

New York State ◽

Emergency Department Visits ◽

York State ◽

Mean Temperature ◽

Increased Risk ◽

Hot Days ◽

Ed Visits

Prior studies have reported the impact of ambient heat exposure on heat-related illnesses and mortality in summer, but few have assessed its effect on cardiovascular diseases (CVD) morbidity, and the association difference by demographics and season. This study examined how extremely hot days affected CVD-related emergency department (ED) visits among older adults from 2005–2013 in New York State. A time-stratified case-crossover design was used to assess the heat–CVD association in summer and transitional months (April–May and September–October). Daily mean temperature >95th percentile of regional monthly mean temperature was defined as an extremely hot day. Extremely hot days were found to be significantly associated with increased risk of CVD-related ED visits at lag day 5 (OR: 1.02, 95% CI: 1.01–1.04) and lag day 6 (OR: 1.01, 95% CI: 1.00–1.03) among older adults in summer after controlling for PM2.5 concentration, relative humidity, and barometric pressure. Specifically, there was a 7% increased risk of ischemic heart disease on the day of extreme heat, and increased risks of hypertension (4%) and cardiac dysrhythmias (6%) occurred on lag days 5 and 6, respectively. We also observed large geographic variations in the heat–CVD associations.

Download Full-text

Spatial patterns of epilepsy-related emergency department visits in California

Journal of Public Health Research ◽

10.4081/jphr.2015.441 ◽

2015 ◽

Vol 4 (1) ◽

Cited By ~ 3

Author(s):

Jim E. Banta ◽

Askari Addison ◽

W. Lawrence Beeson

Keyword(s):

Emergency Department ◽

Los Angeles ◽

Primary Diagnosis ◽

Emergency Department Visits ◽

Spatial Scan Statistic ◽

Increased Risk ◽

Ed Visits ◽

Socio Demographic Factors ◽

Patients With Epilepsy ◽

Design And Methods

Background. Socio-demographic factors are associated with increased emergency department (ED) use among patients with epilepsy. However, there has been limited spatial analysis of such visits. Design and methods. California ED visit at the patient ZIP Code level were examined using Kulldorf’s spatial scan statistic to identify clusters of increased risk for epilepsy-related visits. Logistic regression was used to examine the relative importance of patient socio-demographics, Census-based and hospital measures. Results. During 2009-2011 there were 29,715,009 ED visits at 330 hospitals, of which 139,235 (0.5%) had epilepsy (International Classification of Disease-9 345.xx) as the primary diagnosis. Three large urban clusters of high epilepsy-related ED visits were centred in the cities of Los Angeles, Oakland and Stockton and a large rural clus- ter centred in Kern County. No consistent pattern by age, race/ethnicity, household structure, and income was observed among all clusters. Regression found only the Los Angeles cluster significant after adjusting for other measures. Conclusions. Geospatial analysis within a large and geographically diverse region identified a cluster within its most populous city having an increased risk of ED visits for epilepsy independent of selected socio-demographic and hospital measures. Additional research is necessary to determine whether elevated rates of ED visits represent increased prevalence of epilepsy or an inequitable system of epilepsy care.

Download Full-text

Abstract P117: Frailty and Outcomes among Heart Failure Patients in the Community

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap117 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Sheila M McNallan ◽

Shannon M Dunlay ◽

Mandeep Singh ◽

Alanna M Chamberlain ◽

Margaret M Redfield ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Emergency Department Visits ◽

Physical Component Score ◽

Risk Of Death ◽

Increased Risk ◽

Ed Visits

Objective: To determine among community heart failure (HF) patients whether frailty is associated with an increased risk of hospitalization, emergency department (ED) visits and death, independently of comorbidities. Background: Frailty is associated with adverse outcomes in some populations; however the prognostic value of frailty among HF patients is not fully documented, particularly for healthcare utilization. Methods: Olmsted, Dodge and Fillmore County residents with HF between 10/2007 and 12/2010 were prospectively recruited to undergo frailty assessment. Frailty was defined as 3 or more of the following: unintentional weight loss >10 lbs. in 1 year, physical exhaustion, weak grip strength, and slowness and low activity measured by the SF-12 physical component score. Intermediate frailty was defined as having 1-2 components. To account for repeated events, Anderson-Gill modeling was used to determine if frailty predicted hospitalization or ED visits. Cox proportional hazards regression examined associations between frailty and death. Results: Among 409 patients (mean age 73±13, 58% male), 19% were frail and 55% had intermediate frailty. Within one year, 449 hospitalizations, 523 ED visits and 34 deaths occurred. There was a positive graded association between frailty and hospitalization and ED visits (Table). After adjustment for age, sex, ejection fraction and comorbidity, frailty was associated with an 80% increased risk of hospitalization and a 60% increased risk of ED visits. Frailty was also associated with more than a 2-fold increased risk of death after adjustment. Conclusion: In the community, frailty is prevalent and is a strong and independent predictor of hospitalizations, ED visits and death among HF patients. As it is independent from coexisting comorbidities, frailty defines new avenues for intervention and should be formally assessed clinically. Hazard Ratios (95% CI) for Hospitalizations, Emergency Department Visits and Death by Frailty Status Not Frail Intermediate Frail Frail P for trend Hospitalization Crude 1.00 1.46 (1.05-2.02) 2.15 (1.45-3.19) <0.001 Fully-adjusted 1.00 1.29 (0.94-1.77) 1.82 (1.22-2.73) 0.005 Emergency Department Visits Crude 1.00 1.59 (1.14-2.21) 1.88 (1.22-2.90) 0.002 Fully-adjusted 1.00 1.46 (1.05-2.05) 1.58 (1.01-2.48) 0.034 Death Crude 1.00 1.40 (0.73-2.69) 3.98 (2.01-7.90) <0.001 Fully-adjusted 1.00 0.87 (0.44-1.73) 2.42 (1.19-4.95) 0.003

Download Full-text

Associations between meteorological factors and emergency department visits for unintentional falls during Ontario winters

Health Promotion and Chronic Disease Prevention in Canada ◽

10.24095/hpcdp.41.12.01 ◽

2021 ◽

Vol 41 (12) ◽

pp. 401-412

Author(s):

David Huynh ◽

Caleigh Tracy ◽

Wendy Thompson ◽

Felix Bang ◽

Steven R. McFaull ◽

...

Keyword(s):

Emergency Department ◽

Meteorological Factors ◽

Age Groups ◽

Logistic Models ◽

Population Based ◽

Emergency Department Visits ◽

Falls Prevention ◽

Increased Risk ◽

Ed Visits ◽

Unintentional Falls

Introduction Unintentional falls are a leading cause of injury-related hospital visits among Canadians, especially seniors. While certain meteorological conditions are suspected risk factors for fall-related injuries, few studies have quantified these associations across a wider range of age groups and with population-based datasets. Methods We applied a time-stratified case-crossover study design to characterize associations of highly-spatially-resolved meteorological factors and emergency department (ED) visits for falls, in Ontario, among those aged 5 years and older during the winter months (November to March) between 2011 and 2015. Conditional logistic models were used to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs) for these visits in relation to daily snowfall accumulation, including single-day lags of up to one week before the visit, and daily mean temperature on the day of the visit. Analyses were stratified by age and sex. Results We identified 761 853 fall-related ED visits. The odds for these visits was increased for most days up to a week after a snowfall of 0.2 cm or greater (OR = 1.05–1.08) compared to days with no snowfall. This association was strongest among adults aged 30 to 64 years (OR = 1.16–1.19). The OR for fall-related ED visits on cold days (less than −9.4 °C) was reduced by 0.05 relative to days with an average daily temperature of 3.0 °C or higher (OR = 0.95; 95% CI: 0.94, 0.96), and this pattern was evident across all ages. There were no substantive differences in the strength of this association by sex. Conclusion Snowfall and warmer winter temperatures were associated with an increased risk of fall-related ED visits during Ontario winters. These findings are relevant for developing falls prevention strategies and ensuring timely treatment.

Download Full-text

Determinants Associated With the Risk of Emergency Department Visits Among Patients Receiving Integrated Home Care Services: A 6-Year Retrospective Observational Study in a Large Italian Region

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.79 ◽

2020 ◽

Author(s):

Sara Campagna ◽

Alberto Borraccino ◽

Gianfranco Politano ◽

Alfredo Benso ◽

Marco Dalmasso ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Home Care ◽

Emergency Department Visits ◽

Clinical Record ◽

Retrospective Observational Study ◽

Italian Region ◽

Care Plans ◽

Increased Risk ◽

Ed Visits

Background: Allowing patients to remain at home and decreasing the number of unnecessary emergency room visits have become important policy goals in modern healthcare systems. However, the lack of available literature makes it critical to identify determinants that could be associated with increased emergency department (ED) visits in patients receiving integrated home care (IHC). Methods: A retrospective observational study was carried out in a large Italian region among patients with at least one IHC event between January 1, 2012 and December 31, 2017. IHC is administered from 8 am to 8 pm by a team of physicians, nurses, and other professionals as needed based on the patient’s health conditions. A clinical record is opened at the time a patient is enrolled in IHC and closed after the last service is provided. Every such clinical record was defined as an IHC event, and only ED visits that occurred during IHC events were considered. Sociodemographic, clinical and IHC variables were collected. A multivariate, stepwise logistic analysis was then performed, using likelihood of ED visit as a dependent variable. Results: A total of 29 209 ED visits were recorded during the 66 433 IHC events that took place during the observation period. There was an increased risk of ED visits in males (odds ratio [OR]=1.29), younger patients, those with a family caregiver (OR=1.13), and those with a higher number of cohabitant family members. Long travel distance from patients’ residence to the ED reduced the risk of ED visits. The risk of ED visits was higher when patients were referred to IHC by hospitals or residential facilities, compared to referrals by general practitioners. IHC events involving patients with neoplasms (OR=1.91) showed the highest risk of ED visits. Conclusion: Evidence of sociodemographic and clinical determinants of ED visits may offer IHC service providers a useful perspective to implement intervention programmes based on appropriate individual care plans and broad-based client assessment.

Download Full-text