An Effective Diabetic Ketoacidosis Prevention Intervention in Children With Type 1 Diabetes

The objective of this study was to evaluate the effectiveness of a brief, office-based educational intervention to increase parent or patient recognition of the early warning signs and symptoms of diabetic ketoacidosis (DKA). Forty-two patients aged > 13 years and 34 parents of children aged ≤ 13 years were given a pretest questionnaire about their knowledge of signs and symptoms of DKA and sick day management practices. They received a brief refresher course on sick day management specific to their treatment modality (pump vs. injection) and were given a take-home flow sheet of guidelines for diabetes sick day management. Subjects were retested with the same knowledge questionnaire after 6 to 12 months. Patients or parents scored higher on the posttest than the pretest and called the emergency line for assistance more frequently ( p = .032) following the intervention. Emergency department visits were significantly reduced in adolescents ( p = .024). A short educational intervention and printed management tool is effective in improving sick day and DKA knowledge and appears to be effective in reducing emergency department visits by increasing utilization of a diabetes emergency line for early outpatient intervention.

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Multisite medical record review of emergency department visits for traumatic brain injury

Injury Prevention ◽

10.1136/injuryprev-2019-043510 ◽

2021 ◽

Vol 27 (S1) ◽

pp. i42-i48

Author(s):

Barbara A Gabella ◽

Jeanne E Hathaway ◽

Beth Hume ◽

Jewell Johnson ◽

Julia F Costich ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Skull Fracture ◽

Signs And Symptoms ◽

International Classification Of Diseases ◽

Emergency Department Visits ◽

Intracranial Injury ◽

Imaging Results ◽

Icd 10

BackgroundIn 2016, the CDC in the USA proposed codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for identifying traumatic brain injury (TBI). This study estimated positive predictive value (PPV) of TBI for some of these codes.MethodsFour study sites used emergency department or trauma records from 2015 to 2018 to identify two random samples within each site selected by ICD-10-CM TBI codes for (1) intracranial injury (S06) or (2) skull fracture only (S02.0, S02.1-, S02.8-, S02.91) with no other TBI codes. Using common protocols, reviewers abstracted TBI signs and symptoms and head imaging results that were then used to assign certainty of TBI (none, low, medium, high) to each sampled record. PPVs were estimated as a percentage of records with medium-certainty or high-certainty for TBI and reported with 95% confidence interval (CI).ResultsPPVs for intracranial injury codes ranged from 82% to 92% across the four samples. PPVs for skull fracture codes were 57% and 61% in the two university/trauma hospitals in each of two states with clinical reviewers, and 82% and 85% in the two states with professional coders reviewing statewide or nearly statewide samples. Margins of error for the 95% CI for all PPVs were under 5%.DiscussionICD-10-CM codes for traumatic intracranial injury demonstrated high PPVs for capturing true TBI in different healthcare settings. The algorithm for TBI certainty may need refinement, because it yielded moderate-to-high PPVs for records with skull fracture codes that lacked intracranial injury codes.

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National Study of U.S. Emergency Department Visits With Diabetic Ketoacidosis, 1993-2003

Diabetes Care ◽

10.2337/dc06-0627 ◽

2006 ◽

Vol 29 (9) ◽

pp. 2117-2119 ◽

Cited By ~ 24

Author(s):

A. A. Ginde ◽

A. J. Pelletier ◽

C. A. Camargo

Keyword(s):

Emergency Department ◽

Diabetic Ketoacidosis ◽

Emergency Department Visits ◽

National Study

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Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol

BMJ Open ◽

10.1136/bmjopen-2019-030030 ◽

2019 ◽

Vol 9 (10) ◽

pp. e030030

Author(s):

Filipa Pereira ◽

Pauline Roux ◽

Marie Santiago-Delefosse ◽

Armin von Gunten ◽

Boris Wernli ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Mixed Methods ◽

Chronic Conditions ◽

Management Practices ◽

Medication Management ◽

Emergency Department Visits ◽

Mixed Methods Study ◽

Multiple Chronic Conditions ◽

At Home

IntroductionOptimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes.Methods and analysisA mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles—made up of patient-related, medication-related and environment-related factors—of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky’s quadruple aim.Ethics and disseminationEthical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers’ and patients’ associations.

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Multisite medical record review of emergency department visits for unspecified injury of head following the ICD-10-CM coding transition

Injury Prevention ◽

10.1136/injuryprev-2019-043517 ◽

2021 ◽

Vol 27 (S1) ◽

pp. i13-i18 ◽

Cited By ~ 1

Author(s):

Alexis Peterson ◽

Barbara A Gabella ◽

Jewell Johnson ◽

Beth Hume ◽

Ann Liu ◽

...

Keyword(s):

Emergency Department ◽

Medical Records ◽

Health Resources ◽

Signs And Symptoms ◽

Health Department ◽

International Classification Of Diseases ◽

Emergency Department Visits ◽

Medical Documentation ◽

Diagnosis Code ◽

Imaging Results

IntroductionIn 2016, a proposed International Classification of Diseases, Tenth Edition, Clinical Modification surveillance definition for traumatic brain injury (TBI) morbidity was introduced that excluded the unspecified injury of head (S09.90) diagnosis code. This study assessed emergency department (ED) medical records containing S09.90 for evidence of TBI based on medical documentation.MethodsState health department representatives in Maryland, Kentucky, Colorado and Massachusetts reviewed a target of 385 randomly sampled ED records uniquely assigned the S09.90 diagnosis code (without proposed TBI codes), which were initial medical encounters among state residents discharged home during October 2015–December 2018. Using standardised abstraction procedures, reviewers recorded signs and symptoms of TBI, and head imaging results. A tiered case confirmation strategy was applied that assigned a level of certainty (high, medium, low, none) to each record based on the number and type of symptoms and imaging results present in the record. Positive predictive value (PPV) of S09.90 by level of TBI certainty was calculated by state.ResultsWide variation in PPV of sampled ED records assigned S09.90: 36%–52% had medium or high evidence of TBI, while 48%–64% contained low or no evidence of a TBI. Loss of consciousness was mentioned in 8%–24% of sampled medical records.DiscussionExclusion of the S09.90 code in surveillance estimates may result in many missed TBI cases; inclusion may result in counting many false positives. Further, missed TBI cases influenced by incidence estimates, based on the TBI surveillance definition, may lead to inadequate allocation of public health resources.

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