scholarly journals Weight-for-Age Percentile as a Pediatric Predictor of Emergency Department Outcome

2019 ◽  
Vol 6 ◽  
pp. 2333794X1987703
Author(s):  
Vishal Naik ◽  
Cheryl Lefaiver ◽  
Avni Dervishi ◽  
Vinod Havalad
Keyword(s):  
Emergency Department ◽  
Severity Index ◽  
Normal Weight ◽  
Independent Effect ◽  
Key Factors ◽  
Emergency Severity Index ◽  
Logistic Regression Models ◽  
Younger Age ◽  
Ed Visits ◽  
Weight For Age

This study is a retrospective cohort study that examines the association between weight-for-age percentile and pediatric admission incidence from the emergency department (ED) for all diagnoses. The charts of 1432 pediatric patients under 18 years with ED visits from 2013 to 2015 at a tertiary children’s hospital were reviewed. Analyses of subject age/weight stratifications were performed, along with ED disposition, reason for visit, and Emergency Severity Index (ESI). Multivariable logistic regression models were used to evaluate the independent effect of weight-for-age percentile on ED disposition while controlling for age, ESI, and reason for visit. Underweight subjects were more likely to be admitted than their normal weight counterparts when analyzed overall (odds ratio [OR] = 2.58, P < .01) and by age: less than 2.0 years of age (OR = 2.04, P = .033), between 2.01 and 6.0 years of age (OR = 8.60, P = .004), and between 6.01 and 13.0 years of age (OR = 3.83, P = .053). Younger age (OR = 0.935, P < .001) and higher acuity (OR = 3.49, P < .001) were also significant predictors of admission. No significant associations were found between weight and likelihood of admission for patients older than 13.01 years or between overweight/obese weight categories and admission for any age subgroups. This study suggests that underweight children younger than 13 years are at higher risk to be admitted from the ED than their normal weight, overweight, and obese counterparts. Even when controlling for other key factors, such as the ESI, a lower weight-for-age percentile was a reliable predictor of hospitalization.

The Affordable Care Act and emergency department use by low acuity patients in a US hospital

2020 ◽  
pp. 095148482094359
Author(s):  
Daniel Keyes ◽  
Hisham Valiuddin ◽  
Hassan Mouzaihem ◽  
Patrick Stone ◽  
Jaqueline Vidosh
Keyword(s):  
Emergency Department ◽  
Affordable Care Act ◽  
Cohort Analysis ◽  
Severity Index ◽  
Chi Square ◽  
Before And After ◽  
Primary Care Patients ◽  
Ed Visits ◽  
The Affordable Care Act ◽  
Status Data

Background The Affordable Care Act (ACA) is one of the biggest healthcare reforms in US history. A key issue is the ACAs effect on low acuity, potentially primary care patients. This study evaluates the effect of the ACA on low acuity patients seen in the emergency department (ED). Methods This is an age-period-cohort analysis for a community hospital ED in Michigan, from 2009 to 2015. Patients were stratified by age, year seen, emergency severity index (ESI) and insurance status. Data were compared between before and after ACA along with descriptive statistics, Chi-square and Student t-tests. The primary outcome was the change in ED usage by low acuity. Patients > 65 were used as a temporal control. Results 305,350 ED visits were analyzed. ED visits with ESI 4/5 increased from 11.9% to 14.8%. Patients < 19 years increased from 25.5% to 34.3% (p = .0026). Ages 19–25 increased from 16.3% to 19.7% (p = 0.0515). Ages 26–64 increased from 11% to 14.9% (p = 0.0129). Ages > 65 increased from 5.1% to 6.5%. Patients < 65 showed a decreased uninsured rate from 12.30% to 6.28% (p < 0.0001). Comparatively, for age > 65: uninsured rate remained the same 0.46% to 0.49%. Conclusion Low acuity ED visits increased with the ACA reform in conjunction with a more insured population.

scholarly journals Sulfur Dioxide and Emergency Department Visits for Stroke and Seizure

2012 ◽  
Vol 2012 ◽  
pp. 1-7
Author(s):  
Mieczysław Szyszkowicz ◽  
Eugeniusz Porada ◽  
Neil Tremblay ◽  
Eric Grafstein
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Sulfur Dioxide ◽  
Regression Models ◽  
Conditional Logistic Regression ◽  
Emergency Department Visits ◽  
Cerebrovascular Accidents ◽  
Logistic Regression Models ◽  
Female Patients ◽  
Ed Visits

The purpose of this study was to assess an association between ambient sulfur dioxide and the number of emergency department (ED) visits for ischemic stroke and seizure. The study used data collected in a Vancouver (Canada) hospital in the years 1999–2003. Daily ED visits diagnosed as ministroke, stroke, or seizure were investigated using the case-crossover technique. Conditional logistic regression models were applied to estimate the odds ratios (ORs) and their respective 95% confidence intervals (CIs). The models included temperature and relative humidity in the form of natural splines. The results were reported for an increase in interquartile range ((IQR),IQR=1.9ppb for SO2). Positive and statistically significant associations were obtained for SO2and ischemic stroke for all patients (OR=1.12; CI 1.02, 1.23; lag 3) and for female patients (OR=1.17; CI 1.01, 1.33; lag 0). In the case of ED visits for seizure, for female patients the results were also statistically significant (OR=1.15; CI 1.02, 1.28; lag 1 andOR=1.18; CI 1.05, 1.32; lag 2). These findings suggest that cases of ischemic cerebrovascular accidents are associated with acute exposure to ambient sulfur dioxide.

scholarly journals Effect of emergency severity index implementation on the waiting time for patients to receive health services in the emergency department

2020 ◽  
Vol 37 (4) ◽  
pp. 369-380
Author(s):  
Akbar Sarvari ◽  
Hosein Habibzadeh ◽  
Leyla Alilu ◽  
Naser Sheikhi
Keyword(s):  
Emergency Department ◽  
Health Services ◽  
Waiting Time ◽  
Intervention Group ◽  
Simple Random Sampling ◽  
Severity Index ◽  
Emergency Severity Index ◽  
Post Intervention ◽  
Before And After ◽  
To Receive

The waiting time for patients in the emergency department to receive health services influences many processes in this department. This research aimed to determine the effect of implementation and deployment of emergency severity index (ESI) on the waiting time for patients to receive health services in the emergency department. This quasi-experimental study was performed on 736 patients who were referred to the emergency department of Imam Khomeini Hospital of Mahabad. For the ESI triage implementation, 368 patients were assigned to the pre-intervention group and 368 patients were selected for the post-intervention group, using a simple random sampling. Before and after the ESI triage implementation, the waiting time for patients to receive services was measured and recorded using a chronometer. For data analysis, Chi-square, Mann-Whitney and Kruskal-Wallis tests were used. Before and after the intervention, both groups were homogeneous in terms of demographic variables (p > 0.05). The results of Mann-Whitney test indicate that implementation of emergency severity index (ESI) has a positive effect on the decrease of average time intervals to provide health services, as well as on the entire length of stay in the emergency department (p < 0.05). Given the effect of the ESI triage implementation that reduced the waiting time for patients to receive health services, ESI is recommended for training nurses and other emergency staff.

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