Symptoms and characteristics of cancer patient visits to an emergency room.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18306-e18306
Author(s):  
Michael Gallaway ◽  
Nimi Idaikkadar
Keyword(s):  
Cancer Patients ◽  
Acute Care ◽  
International Classification Of Diseases ◽  
Population Based ◽  
P Value ◽  
Surveillance Program ◽  
Cancer Type ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Ed Visits

e18306 Background: Cancer patients are increasingly likely to visit an emergency department (ED) for acute care compared to the general population. Cancer patients who visit the ED often have long wait times, increased exposure to infection, and lesser quality treatment. The Centers for Medicare & Medicaid Services (CMS) is encouraging efforts to decrease survivor acute care visits. The purpose of this study was to examine cancer-related ED visits using a national population-based sample to understand why they are seeking care in an ED. Methods: A retrospective cohort study of U.S. patients who visited EDs between June 1, 2017 and May 31, 2018 was conducted using the National Syndromic Surveillance Program (NSSP) BioSense Platform. Cancer patients were identified using International Classification of Diseases, 10th Revision (ICD-10) codes for any cancer type and specifically for cancers of the bladder, female breast, cervix, colon and rectum, kidney, liver, lung, ovary, pancreas, prostate, or uterus. Symptoms were identified using syndromic definitions and key-word queries. Significance testing (p-value ≤0.01), was used to assess differences in the prevalence of symptoms by cancer type. Results: There were 97 million visits to EDs during the study period, 710,297 (0.8%) were among cancer survivors. Slightly more were female (50.1%) than male (49.5%); more were aged 65 or older (53.6%) than 18-64 (1.4-35.3%). The most common symptoms were pain (19%), gastrointestinal (14%), respiratory (12%), neurologic (5%), fever (5%), and injury (4%). Prevalence of symptoms differed significantly by cancer type. Some symptoms were higher among those with specific cancer types compared to all cancers in aggregate: pain (cervical, liver, pancreas); gastrointestinal (pancreas, liver, colorectal); respiratory (lung); neurologic (liver, lung), fever (pancreas, liver), injury (prostate), and bleeding (colorectal, liver). Conclusions: Use of NSSP data enabled a descriptive characterization of more than half of the U.S. ED visits among cancer patients. These comprehensive findings inform best practices to reduce unplanned acute care and help inform possible modifications in treatment and care protocols among survivors of specific cancers.

scholarly journals Use of Complementary Traditional Chinese Medicines by Adult Cancer Patients in Taiwan: A Nationwide Population-Based Study

2017 ◽  
Vol 17 (2) ◽  
pp. 531-541 ◽  
Author(s):  
Yi-Ting Kuo ◽  
Tung-Ti Chang ◽  
Chih-Hsin Muo ◽  
Mei-Yao Wu ◽  
Mao-Feng Sun ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Metabolic Diseases ◽  
Medical Center ◽  
Intrahepatic Bile Duct ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Cancer Type ◽  
White Collar Workers ◽  
Classification Of Diseases ◽  
Nutritional And Metabolic Diseases

Background. Many patients with cancer seek complementary and alternative medicine treatments. We investigated the use of traditional Chinese medicine (TCM) by adult cancer patients in Taiwan. Methods. We reviewed the Registry for Catastrophic Illness Patients Database of Taiwan, and included all adult patients diagnosed cancer, based on the International Classification of Diseases (ninth revision), from 2001 to 2009 and followed until 2011. This database allowed categorization of patients as TCM users (n = 74 620) or non-TCM users (n = 508 179). All demographic and clinical claims data were analyzed. Results. Compared with non-TCM users, TCM users were younger and more likely to be female, white-collar workers, and reside in highly urbanized areas. The average interval between cancer diagnosis and TCM consultation was 15.3 months. The most common cancer type was breast cancer in TCM users (19.4%), and intrahepatic bile duct cancer in non-TCM users (13.6%). The major condition for which TCM users visited clinics were endocrine, nutritional and metabolic diseases, and immunity disorders (23.2%). A total of 33.1% of TCM users visited TCM clinics more than 9 times per year and their time from diagnosis to first TCM consultation was 5.14 months. The most common TCM treatment was Chinese herbal medicine. The common diseases for which cancer patients sought TCM treatment were insomnia, malaise and fatigue, dizziness and headache, gastrointestinal disorders, myalgia and fasciitis, anxiety, and depression. Overall, TCM users had a lower adjusted hazard ratio (aHR) for mortality (aHR = 0.69, 95% CI = 0.68-0.70) after adjustment for age, sex, urbanization of residence, occupation, annual medical center visits, and annual non–medical center visits. Conclusions. This study provides an overview of TCM usage among adult cancer patients in Taiwan. TCM use varied among patients with different types of cancer. Physicians caring for cancer patients should pay more attention to their patients’ use of complementary TCM.

A Mixed-Methods Comparison of a National and State Opioid Overdose Surveillance Definition

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 31S-39S
Author(s):  
Danielle M. Brathwaite ◽  
Catherine S. Wolff ◽  
Amy I. Ising ◽  
Scott K. Proescholdbell ◽  
Anna E. Waller
Keyword(s):  
North Carolina ◽  
False Positive ◽  
False Positive Rate ◽  
International Classification Of Diseases ◽  
Opioid Overdose ◽  
The North ◽  
Classification Of Diseases ◽  
Positive Rate ◽  
Icd 10 ◽  
Ed Visits

Objectives We assessed the differences between the first version of the Centers for Disease Control and Prevention (CDC) opioid surveillance definition for suspected nonfatal opioid overdoses (hereinafter, CDC definition) and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) surveillance definition to determine whether the North Carolina definition should include additional International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and/or chief complaint keywords. Methods Two independent reviewers retrospectively reviewed data on North Carolina emergency department (ED) visits generated by components of the CDC definition not included in the NC DETECT definition from January 1 through July 31, 2018. Clinical reviewers identified false positives as any ED visit in which available evidence supported an alternative explanation for patient presentation deemed more likely than an opioid overdose. After individual assessment, reviewers reconciled disagreements. Results We identified 2296 ED visits under the CDC definition that were not identified under the NC DETECT definition during the study period. False-positive rates ranged from 2.6% to 41.4% for codes and keywords uniquely identifying ≥10 ED visits. Based on uniquely identifying ≥10 ED visits and a false-positive rate ≤10.0%, 4 of 16 ICD-10-CM codes evaluated were identified for NC DETECT definition inclusion. Only 2 of 25 keywords evaluated, “OD” and “overdose,” met inclusion criteria to be considered a meaningful addition to the NC DETECT definition. Practice Implications Quantitative and qualitative trends in coding and keyword use identified in this analysis may prove helpful for future evaluations of surveillance definitions.

scholarly journals Predictors of Cerebral Arteriovenous Malformation Mortality: A Single-center, Five-year Retrospective Study

2021 ◽  
Vol 9 (3) ◽  
pp. 213-218
Author(s):  
Patricio Garcia-Espinosa ◽  
Edgar Botello-Hernández ◽  
Gabriela Torres-Hernández ◽  
Clarissa Guerrero-Cavazos ◽  
Estefania Villareal-Garza ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Univariate Analysis ◽  
International Classification Of Diseases ◽  
University Hospital ◽  
P Value ◽  
Predictors Of Mortality ◽  
The Hours ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
History Of

Background: Arteriovenous Malformations (AVMs) are abnormalities in intracranial vessels between the arterial and venous systems. This study aimed to identify the predictors of mortality in patients that presented to our hospital with AVMs, ruptured or unruptured, and correlate them to those available in the literature. Methods: An analytical, observational, retrospective study was performed to review data of patients with cerebral AVMs in the University Hospital “Dr José Eleuterio González” from January 2016 to December 2020. Clinical files were reviewed based on AVMs diagnosis according to the  International Classification of Diseases 10th Revision, ICD-10. Variables were subjected to a univariate analysis and those found significant (p-value < 0.05) were subjected to a logistic regression. Results: A total of 80 patients were included in our study. Most of the participants were females (56.3%) and three were pregnant. The most common presenting symptom was holocranial headache (34 cases) occurring between the hours of 22:00 to 7:00. The most significant predictors of mortality were a total bleeding volume greater than 9.18 cm3 (p = 0.010), the presence of more than one symptom (p = 0.041), and a history of previous cerebral intraparenchymal hemorrhage (p = 0.014). Conclusion: Results demonstrated an important association between intracranial bleeding and mortality. Ultimately, more prospective studies are needed to determine predictor factors for mortality in AVMs patients.

scholarly journals Links Between Strokes and Hereditary Hemorrhagic Telangiectasia: A Population-Based Study

2018 ◽  
Vol 46 (1) ◽  
pp. 44-50
Author(s):  
Farah N. Chowdhury ◽  
G. Sanjaya Chandrarathne ◽  
Kristopher D. Masilamani ◽  
Jennifer T. N. LaBranche ◽  
Shaun Malo ◽  
...  
Keyword(s):  
General Population ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Female Gender ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Stroke Subtype ◽  
Stroke Incidence ◽  
Centre Of Excellence ◽  
Classification Of Diseases ◽  
Icd 10

AbstractBackgroundHereditary hemorrhagic telangiectasia (HHT) is a disease of abnormal vasculature where patients are predisposed to strokes of multiple etiologies. We assessed yearly stroke incidence among Albertans with HHT and compared with the general population. Given the tendency for stroke in HHT patients, we expected HHT patients to have higher stroke incidence, in particular at younger ages.MethodsPopulation-based administrative health data on inpatient and ambulatory admissions were extracted over a 16-year period using International Classification of Diseases (ICD)-9 and ICD-10, Canada codes. We analyzed overall occurrence of strokes in Alberta by age, gender, stroke subtype, and diagnosis of HHT.ResultsThe age-standardized incidence rate of stroke in HHT was 450 per 100,000 compared with 260 per 100,000 in the general population with a rate ratio of 1.73 (95% confidence interval (CI) [1.046-2.842]). This study found a higher HHT prevalence in Alberta (1 in 3800) compared to the world average of 1 in 5000. Women were also more likely to be diagnosed with HHT, with a 3.25:1 female gender preponderance in the yearly incidence.InterpretationThis study not only shows that HHT patients are at higher risk of having a stroke but also quantifies that risk using an age-adjusted metric in Alberta. This province has a higher than expected disease burden of HHT, with the majority of cases affecting women. Our study found that acute ischemic strokes and transient ischemic attacks are far more common than hemorrhage in HHT. As HHT is a rare, multi-system, chronic disease, these patients should be referred to an HHT Centre of Excellence.

scholarly journals Acute Care Use by Breast Cancer Patients on Adjuvant Chemotherapy in Alberta: Demonstrating the Importance of Measurement to Improving Quality

2021 ◽  
Vol 28 (6) ◽  
pp. 4420-4431
Author(s):  
Che Hsuan David Wu ◽  
May Lynn Quan ◽  
Shiying Kong ◽  
Yuan Xu ◽  
Jeffrey Q. Cao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Acute Care ◽  
Population Based ◽  
Breast Cancer Patients ◽  
Increased Risk ◽  
Institutional Differences ◽  
Improvement Programs ◽  
Ed Visits

Breast cancer patients receiving adjuvant chemotherapy are at increased risk of acute care use. The incidence of emergency department (ED) visits and hospitalizations (H) have been characterized in other provinces but never in Alberta. We conducted a retrospective population-based cohort study using administrative data of women with stage I-III breast cancer receiving adjuvant chemotherapy. Rates of ED and H use in the 180 days following chemotherapy initiation were determined, and logistic regression was performed to identify risk factors. We found that 47% of women receiving adjuvant chemotherapy experienced ED or H, which compared favourably to other provinces. However, Alberta had the highest rate of febrile neutropenia-related ED visits, and among the highest chemotherapy-related ED visits. The incidence of acute care use increased over time, and there were significant institutional differences despite operating under a single provincial healthcare system. Our study demonstrates the need for systematic measurement and the importance of quality improvement programs to address this gap.

Abstract 16989: Clinical Outcomes of Atrial Fibrillation With Hyperthyroidism

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
MUHAMMAD ZUBAIR Z KHAN ◽  
Kirtenkumar Patel ◽  
Ashwani Gupta ◽  
Jordesha Hodge ◽  
Krunalkumar Patel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Multivariate Regression Analysis ◽  
International Classification Of Diseases ◽  
P Value ◽  
All Cause Mortality ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Cardiac Manifestation

Introduction: Atrial fibrillation (Afib) is a common cardiac manifestation of hyperthyroidism. The data regarding outcomes of A fib with and without hyperthyroidism are lacking. Hypothesis: We hypothesized that patients with Afib and hyperthyroidism have better clinical outcomes, compared with Afib patients without hyperthyroidism. Methods: We queried National Inpatient Sample database for years 2015 - 2017 using Validated International Classification of Diseases and Clinical Modification (ICD-10-CM) codes for atrial fibrillation and hyperthyroidism. Patients were separated into 2 groups- A fib with hyperthyroidism and A fib without hyperthyroidism. Results: Study was conducted on 68,095,278 pateints. A total of 9,727,295 Afib patients were identified, out of which 90,635(0.9%) had hyperthyroidism. The prevalence of hyperthyroidism was higher in patients with Afib (0.9% vs 0.4%, p value <0.001), compared with patients without A fib. Using multivariate regression analysis after adjusting for various confounding factors, the odds ratio of Afib with hyperthyroidism was 2.08 (CI 2.07 - 2.10 P<.0001). Afib patients with hyperthyroidism were younger, (70.9 vs75.1 years, p<0.0001) and more likely to be female (63.9% vs 47% p<0.0001) as compared with Afib patients without hyperthyroidism. Afib patients with hyperthyroidism had lower prevalence of CAD (36.4% vs 43.8%,p<0.0001), cardiomyopathy(24.1% vs 25.9%,p<0.0001), valvular disease (6.9% vs 7.4%,p<0.0001), hypertension(60.7% vs 64.4%,p<0.0001) , and diabetes mellitus (28.9% vs 31.8%,p<0.0001). Afib with hyperthyroidism group had lower all-cause mortality (3.3% vs 4.8%, p<0.0001), shorter mean length of stay (5.7 ±6.6 vs 5.9±6.6 days,p<0.0001) and hospitalization cost ($14968±21871 vs $15955±22233, p<0.0001). The disposition to home was higher in Afib with hyperthyroidism patients (50.6% vs 41.8 p<0.0001). Conclusions: Presence of hyperthyroidism is associated with Afib in both univariate and multivariate analysis. Afib patients with hyperthyroidism have better clinical outcomes, compared with Afib patients without hyperthyroidism.

scholarly journals Proteinuria and Psoriasis Risk: A Nationwide Population-Based Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2356
Author(s):  
Eun Hui Bae ◽  
Bongseong Kim ◽  
Su Hyun Song ◽  
Tae Ryom Oh ◽  
Sang Heon Suh ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
Population Based ◽  
Renal Outcome ◽  
Persistent Proteinuria ◽  
Inflammatory Dermatosis ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Stage Renal Disease ◽  
End Stage

Psoriasis, a chronic inflammatory dermatosis, has been associated with chronic kidney disease or end-stage renal disease. However, the association of the changes or amount of proteinuria with psoriasis development has not been evaluated. Using the Korean National Health Screening database, we assessed psoriasis development until 2018 in 6,576,851 Koreans who underwent health examinations in 2009 and 2011. Psoriasis was defined using the International Classification of Diseases, 10th revision (ICD-10) code L40. The risk of psoriasis was evaluated according to change in proteinuria (never [Neg (no proteinuria)/Neg], new [Neg/Pos (proteinuria present)], past [Pos/Neg] and persistent [Pos/Pos] proteinuria) and the proteinuria amount. During a median 7.23-year follow-up, 162,468 (2.47%) individuals developed psoriasis. After adjustments, the hazard ratio (HR) for psoriasis was higher in the persistent proteinuria group (1.32 [1.24–1.40]) than in the never proteinuria group. The past proteinuria group showed better renal outcome (1.03 [1.00–1.07]) than the new (1.05 [1.01–1.07]) and never proteinuria (reference, 1.00) groups did. The amount of random urine proteinuria was associated with increased HR for psoriasis. Subgroup analyses for age, sex, estimated glomerular filtration rate (eGFR), hypertension and diabetes showed that the persistent proteinuria group had a higher risk of psoriasis than the never proteinuria group, especially at eGFR < 60 mL/min/1.73 m2. Persistent proteinuria is associated with psoriasis risk, and the proteinuria amount significantly affects psoriasis development.

scholarly journals Risk of Suicide After a Cancer Diagnosis in England: A Population-Based Study

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 228s-228s
Author(s):  
K. Henson ◽  
R. Brock ◽  
J. Charnock ◽  
B. Wickramasinghe ◽  
O. Will ◽  
...  
Keyword(s):  
At Risk ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Suicide Risk ◽  
Population Level ◽  
Population Based ◽  
Psychological Support ◽  
Cancer Type ◽  
Increased Risk ◽  
Icd 10

Background: Previous research has identified an increased risk of suicide among cancer patients, however this has not been investigated at a population level in England. Those subgroups of patients most at risk need to be identified to ensure appropriate access to psychological support. Aim: To examine the variation in suicide risk among individuals diagnosed with cancer in England. Methods: We identified 4,453,547 individuals (21 million person-years at risk) aged 18 to 99 years at diagnosis of cancer during 1995 to 2015 from the national cancer registry, and followed them up until 31 August 2017. The outcomes of interest were both suicide and open verdicts (ICD-10 X60-X84, Y87.0, Y10-Y34 [excluding Y33.9, Y87.2]). Population-based expected deaths were as published by ONS [2]. We calculated standardized mortality ratios (SMRs) and absolute excess risks (AERs), and explored variation in suicide risk by cancer type, age at death, sex, deprivation, ethnicity, and years since cancer diagnosis. Results: 2352 cancer patients died by suicide. This was 0.08% of all deaths. The overall SMR for suicide was 1.19 (95% CI 1.14-1.24) and AER per 10,000 person-years was 0.18 (0.13-0.22). The risk was highest among individuals diagnosed with mesothelioma, with a 4.34-fold risk corresponding to 4.00 extra deaths per 10,000 person-years. This was followed by pancreatic (3.94-fold), esophageal (2.53-fold), lung (2.52-fold), and stomach (2.14-fold) cancer (all significantly elevated). Suicide risk was highest in the first 6 months following cancer diagnosis (SMR: 2.64 [2.42-2.89]), but a significantly increased risk persisted for 2 years (SMR: 1.21 [1.08-1.35]). Conclusion: Despite low numbers, the elevated risk of suicide in patients with certain cancers is a concern, representing potentially preventable deaths. The increased risk in the first 6 months after diagnosis, which is consistent with previous studies, highlights unmet needs for psychological support delivered alongside cancer diagnosis and treatment. Our findings suggest a need for improved risk stratification across cancer services, followed by targeted psychological support.

Association Between Neonates With Laryngomalacia and Neonatal Abstinence Syndrome

2021 ◽  
pp. 000348942110482
Author(s):  
Elizabeth J. Abraham ◽  
David O’Neil Danis ◽  
Jessica R. Levi
Keyword(s):  
International Classification Of Diseases ◽  
Population Based ◽  
Withdrawal Symptoms ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Neonatal Withdrawal ◽  
Registry Analysis

Objective: Laryngomalacia (LM) is the most common congenital anomaly of the larynx. The cause of LM is still largely unknown, but a neurological mechanism has gained the most acceptance. There have not been any studies examining the prevalence of LM in infants with Neonatal Abstinence Syndrome (NAS). The aim of our study is to determine if infants with NAS are more likely to be diagnosed with LM. Methods: This study was a population-based inpatient registry analysis. We examined nationwide neonatal discharges in 2016 using the Kids’ Inpatient Database (KID). Only patients listed as neonates were included. The International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes for neonatal withdrawal symptoms from maternal use of drugs of addiction (P96.1) and diagnoses denoting LM were used. To quantify associations between the LM and NAS groups, prevalence rates and odds ratios (ORs) were used. Results: There were 3 970 065 weighted neonatal discharges in the 2016 KID. Among patients included in our dataset, 0.809% (32 128) had NAS and 0.075% (2974) had LM. There was an increased odds ratio for neonates with NAS and LM (OR of 2.85, 95% CI = 2.24-3.63) compared to infants without NAS. Multiple logistic regression accounting for possible confounders produced an adjusted OR of 1.68 (95% CI = 1.29-2.19). Conclusion: Our study found an association between NAS and LM. This suggests that prenatal exposure to opioids or possibly the sequelae of withdrawal symptoms may be risk factors for the development of LM.

scholarly journals Clinical Association between Gout and Parkinson’s Disease: A Nationwide Population-Based Cohort Study in Korea

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1292
Author(s):  
Ji Hyoun Kim ◽  
In Ah Choi ◽  
Aryun Kim ◽  
Gilwon Kang
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cohort Study ◽  
Incidence Rate ◽  
Univariate Analysis ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Female Sex ◽  
Classification Of Diseases ◽  
Icd 10

Background and Objectives: This retrospective cohort study aimed to investigate the association between gout and Parkinson’s disease (PD) in Korea. Materials and Methods: Overall, 327,160 patients with gout and 327,160 age- and sex-matched controls were selected from the Korean National Health Insurance Service (NHIS) database. PD incidence was evaluated by reviewing NHIS records during the period from 2002 to 2019. Patients with a diagnosis of gout (International Classification of Diseases-10 (ICD-10), M10) who were prescribed medications for gout, including colchicine, allopurinol, febuxostat, and benzbromarone for at least 90 days were selected. Patients with PD who were assigned a diagnosis code (ICD-G20) and were registered in the rare incurable diseases (RID) system were extracted. Results: During follow-up, 912 patients with gout and 929 control participants developed PD. The incidence rate (IR) of overall PD (per 1000 person-years) was not significantly different between both groups (0.35 vs. 0.36 in gout and control groups, respectively). The incidence rate ratio (IRR) was 0.98 (95% CI: 0.89–1.07). The cumulative incidence of PD was not significantly different between the groups. No association between gout and PD was identified in univariate analysis (HR = 1.00, 95% CI: 0.91–1.10, p = 0.935). HR increased significantly with old age (HR = 92.08, 198, and 235.2 for 60–69 years, 70–79 years, and over 80 years, respectively), female sex (HR = 1.21, 95% CI: 1.07–1.37, p = 0.002), stroke (HR = 1.95, 95% CI: 1.76–2.16, p < 0.001), and hypertension (HR = 1.16, 95% CI: 1.01–1.34, p = 0.04). Dyslipidemia exhibited an inverse result for PD (HR = 0.6, 95% CI: 0.52–0.68, p < 0.001). Conclusions: This population-based study did not identify an association between gout and PD. Age, female sex, stroke, and hypertension were identified as independent risk factors for PD, and dyslipidemia demonstrated an inverse result for PD.

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