scholarly journals Secular trends in emergency department encounters for concussion at US children's hospitals by age group (2008–2017)

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S22.2-S22
Author(s):  
Amy Linabery ◽  
Kara Seaton ◽  
Alicia Zagel ◽  
Alicen Spaulding ◽  
Gretchen Cutler ◽  
...  
Keyword(s):  
Emergency Department ◽  
Public Awareness ◽  
Weighted Least Squares ◽  
Age Groups ◽  
Secular Trends ◽  
Medical Attention ◽  
Age Group ◽  
Admission Rates ◽  
Pediatric Hospitals ◽  
Over Time

BackgroundIncreased concussion rates in US youth have been documented since 2000. Concomitant rises in healthcare utilization for concussion are likely attributable to public health, media, and legislative initiatives aimed at increasing public awareness of the importance of seeking medical attention after injury. Utilization trends in young children have not been well-documented, however.ObjectiveTo characterize recent secular trends in pediatric emergency department (ED) encounters for concussion by 4-year age group.MethodsUsing Children's Hospital Association's Pediatric Health Information System data, we examined a retrospective cohort of patients aged 2–17 years with an ED encounter for concussion at 22 US pediatric hospitals with continuous data between 2008 and 2017. Average annual change in rates of ED visits for concussion and sports-/recreation-related concussion, imaging, and admissions were estimated via weighted least-squares regression.ResultsED encounters with a primary indication of concussion comprised 0.8% (n = 86,393) of all ED encounters in 2008–2017. Over time, ED concussion visits in 6–17-year-olds increased by 0.5–1.1 per 1,000 ED encounters per year (all Ptrend< 0.0001), while rates among 2-5-year-olds remained stable (Ptrend = 0.72). Rates for sports-/recreation-related concussions increased significantly across all age groups (<0.0001 ≤ Ptrend ≤ 0.01). Absolute number undergoing any imaging increased in all age groups; however, due to increased ED concussion encounters, the rate of imaging decreased overall (−29.7/1,000 ED concussion encounters/year; Ptrend < 0.0001) and across all age groups; the imaging rate decreased less for 2-5-year-olds (−19.6/1,000 encounters/year; Ptrend < 0.0001). Likewise, admission rates declined significantly over time overall (−10.1/1,000 encounters/y; Ptrend = 0.0006) and for all age groups.ConclusionsED concussion encounter rates in US youth aged 6–17 years continue to increase at pediatric hospitals, suggesting awareness efforts have been effective. Conversely, imaging and admission rates have decreased, indicating efforts to curtail unnecessary irradiation and intervention have also been successful. Trends in 2-5-year-olds were somewhat different from older youth and should be explored further.

scholarly journals OP0248 PREMATURE MORTALITY BURDEN FOR SYSTEMIC SCLEROSIS: NATIONWIDE POPULATION-BASED STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 156.1-156
Author(s):  
E. Yen ◽  
D. Singh ◽  
M. Wu ◽  
R. Singh
Keyword(s):  
Rheumatoid Arthritis ◽  
United States ◽  
Disease Burden ◽  
Age Groups ◽  
Premature Mortality ◽  
Population Based ◽  
Age Group ◽  
Population Based Study ◽  
Mortality Burden ◽  
Over Time

Background:Premature mortality is an important way to quantify disease burden. Patients with systemic sclerosis (SSc) can die prematurely of disease, however, the premature mortality burden of SSc is unknown. The years of potential life lost (YPLL), in addition to age-standardized mortality rate (ASMR) in younger ages, can be used as measures of premature death.Objectives:To evaluate the premature mortality burden of SSc by calculating: 1) the proportions of SSc deaths as compared to deaths from all other causes (non-SSc) by age groups over time, 2) ASMR for SSc relative to non-SSc-ASMR by age groups over time, and 3) the YPLL for SSc relative to other autoimmune diseases.Methods:This is a population-based study using a national mortality database of all United States residents from 1968 through 2015, with SSc recorded as the underlying cause of death in 46,798 deaths. First, we calculated the proportions of deaths for SSc and non-SSc by age groups for each of 48 years and performed joinpoint regression trend analysis1to estimate annual percent change (APC) and average APC (AAPC) in the proportion of deaths by age. Second, we calculated ASMR for SSc and non-SSc causes and ratio of SSc-ASMR to non-SSc-ASMR by age groups for each of 48 years, and performed joinpoint analysis to estimate APC and AAPC for these measures (SSc-ASMR, non-SSc-ASMR, and SSc-ASMR/non-SSc-ASMR ratio) by age. Third, to calculate YPLL, each decedent’s age at death from a specific disease was subtracted from an arbitrary age limit of 75 years for years 2000 to 2015. The years of life lost were then added together to yield the total YPLL for each of 13 preselected autoimmune diseases.Results:23.4% of all SSc deaths as compared to 13.5% of non-SSc deaths occurred at <45 years age in 1968 (p<0.001, Chi-square test). In this age group, the proportion of annual deaths decreased more for SSc than for non-SSc causes: from 23.4% in 1968 to 5.7% in 2015 at an AAPC of -2.2% (95% CI, -2.4% to -2.0%) for SSc, and from 13.5% to 6.9% at an AAPC of -1.5% (95% CI, -1.9% to -1.1%) for non-SSc. Thus, in 2015, the proportion of SSc and non-SSc deaths at <45 year age was no longer significantly different. Consistently, SSc-ASMR decreased from 1.0 (95% CI, 0.8 to 1.2) in 1968 to 0.4 (95% CI, 0.3 to 0.5) per million persons in 2015, a cumulative decrease of 60% at an AAPC of -1.9% (95% CI, -2.5% to -1.2%) in <45 years old. The ratio of SSc-ASMR to non-SSc-ASMR also decreased in this age group (cumulative -20%, AAPC -0.3%). In <45 years old, the YPLL for SSc was 65.2 thousand years as compared to 43.2 thousand years for rheumatoid arthritis, 18.1 thousand years for dermatomyositis,146.8 thousand years for myocarditis, and 241 thousand years for type 1 diabetes.Conclusion:Mortality at younger ages (<45 years) has decreased at a higher pace for SSc than from all other causes in the United States over a 48-year period. However, SSc accounted for more years of potential life lost than rheumatoid arthritis and dermatomyositis combined. These data warrant further studies on SSc disease burden, which can be used to develop and prioritize public health programs, assess performance of changes in treatment, identify high-risk populations, and set research priorities and funding.References:[1]Yen EY….Singh RR. Ann Int Med 2017;167:777-785.Disclosure of Interests:None declared

Secular trends in invasive meningococcal disease, Massachusetts, 1988–2011: what happened to invasive disease?

2014 ◽  
Vol 142 (12) ◽  
pp. 2483-2490 ◽  
Author(s):  
A. H. PERUSKI ◽  
P. KLUDT ◽  
R. S. PATEL ◽  
A. DeMARIA
Keyword(s):  
Meningococcal Disease ◽  
Age Groups ◽  
Substantial Reduction ◽  
Invasive Disease ◽  
Secular Trends ◽  
Invasive Meningococcal Disease ◽  
Age Group ◽  
Meningococcal Vaccine ◽  
Average Annual Incidence ◽  
Potential Factors

SUMMARYInvasive meningococcal disease (IMD) reported to the Massachusetts Department of Public Health from 1988 to 2011 was reviewed. The average annual incidence of IMD/100 000 decreased from 1·57 [95% confidence interval (CI) 1·42–1·73] for 1988–1991 to 0·22 (95% CI 0·17–0·29) for 2008–2011. The pattern of decreasing incidence over time differed by age group. There was a decrease in IMD/100 000 in the 0–4 years age group after 1991 from 10·92 (95% CI 8·08–14·70) in 1991 to 5·76 (95% CI 3·78–8·72) in 1992. Incidence in the 0–4 years age group remained below 5/100 000 per year on average thereafter. A substantial reduction in incidence in all age groups was observed between 2000 and 2009, which began before the introduction of conjugate meningococcal vaccine in 2005. Marked reductions in incidence of IMD in Massachusetts, and elsewhere, deserve further investigation with respect to potential factors that go beyond the introduction and deployment of improved meningococcal vaccines.

scholarly journals Contact surveys reveal heterogeneities in age-group contributions to SARS-CoV-2 dynamics in the United States

2021 ◽  
Author(s):  
Taylor Chin ◽  
Dennis M. Feehan ◽  
Caroline O. Buckee ◽  
Ayesha S. Mahmud
Keyword(s):  
United States ◽  
Age Groups ◽  
The United States ◽  
Contact Rate ◽  
Age Group ◽  
Contact Rates ◽  
Contact Patterns ◽  
Age Structured ◽  
The Impact ◽  
Over Time

SARS-CoV-2 is spread primarily through person-to-person contacts. Quantifying population contact rates is important for understanding the impact of physical distancing policies and for modeling COVID-19, but contact patterns have changed substantially over time due to shifting policies and behaviors. There are surprisingly few empirical estimates of age-structured contact rates in the United States both before and throughout the COVID-19 pandemic that capture these changes. Here, we use data from six waves of the Berkeley Interpersonal Contact Survey (BICS), which collected detailed contact data between March 22, 2020 and February 15, 2021 across six metropolitan designated market areas (DMA) in the United States. Contact rates were low across all six DMAs at the start of the pandemic. We find steady increases in the mean and median number of contacts across these localities over time, as well as a greater proportion of respondents reporting a high number of contacts. We also find that young adults between ages 18 and 34 reported more contacts on average compared to other age groups. The 65 and older age group consistently reported low levels of contact throughout the study period. To understand the impact of these changing contact patterns, we simulate COVID-19 dynamics in each DMA using an age-structured mechanistic model. We compare results from models that use BICS contact rate estimates versus commonly used alternative contact rate sources. We find that simulations parameterized with BICS estimates give insight into time-varying changes in relative incidence by age group that are not captured in the absence of these frequently updated estimates. We also find that simulation results based on BICS estimates closely match observed data on the age distribution of cases, and changes in these distributions over time. Together these findings highlight the role of different age groups in driving and sustaining SARS-CoV-2 transmission in the U.S. We also show the utility of repeated contact surveys in revealing heterogeneities in the epidemiology of COVID-19 across localities in the United States.

The Influence of Age and Experience on the Performance of a Data Entry Task

1997 ◽  
Vol 41 (1) ◽  
pp. 144-147 ◽  
Author(s):  
Sara J. Czaja ◽  
Joseph Sharit
Keyword(s):  
Task Performance ◽  
Age Differences ◽  
Age Groups ◽  
Data Entry ◽  
Age Effects ◽  
Group Differences ◽  
Age Group ◽  
Age Related ◽  
Task Experience ◽  
Over Time

Findings from research examining age and computer task performance indicate that older people perform less well than younger people on these types of tasks. The present study examined whether age-related performance differences are maintained with task experience. To address this issue one hundred and ten subjects, ranging in age from 20—75 yrs., performed a data entry task over a three day period. The task represented a simulation of a real world job. The data indicated significant age differences in work output (amount of data entered). Further, although there were significant improvements in performance with increased task experience across subjects, age group differences were maintained over time. With respect to errors there were no age effects and there was a significant reduction in errors across the three days. However, the pattern of change varied across age groups. These results are consistent with other studies which suggest that experience does not compensate for age effects for tasks which emphasize speed of processing.

scholarly journals Can age-distribution be an indicator of the goodness of COVID-19 testing?

2020 ◽  
Author(s):  
Amirhoshang Hoseinpour Dehkordi ◽  
Reza Nemati ◽  
Pouya Tavousi
Keyword(s):  
Lower Bound ◽  
Age Distribution ◽  
Age Groups ◽  
Estimation Method ◽  
Developed Countries ◽  
Age Group ◽  
Testing Strategies ◽  
Reported Data ◽  
Over Time ◽  
Mitigation Policies

AbstractIt has been evident that the faster, more accurate, and more comprehensive testing can help policymakers assess the real impact of COVID-19 and help them with when and how strict the mitigation policies should be. Nevertheless, the exact number of infected ones could not be measured due to the lack of comprehensive testing. In this paper, first of all, we will investigate the relation of transmission of COVID-19 with age by observing timed data in multiple countries. Then, we compare the COVID-19 CFR with the age-demography data. and as a result, we have proposed a method for estimating a lower bound for the number of positive cases by using the reported data on the oldest age group and the regions’ population age-distributions. The proposed estimation method improved the expected similarity between the age-distribution of positive cases and regions’ populations. Thus, using the publicly accessible data for several developed countries, we show how the improvement of testing over the course of several months has made it clear for the community that different age groups are equally prone to becoming COVID positive. The result shows that the age demography of COVID-19 gets similar to the age-demography of the population, together with the reduction of CFR over time. In addition, countries with less CFR have more similar COVID-19’s age-distribution, which is caused by more comprehensive testing, than ones who have higher CFR. This leads us to a better estimation for positive cases in different testing strategies. Having knowledge of this fact helps policymakers enforce more effective policies for controlling the spread of the virus.

scholarly journals A clinical study of complications of diphtheria

2019 ◽  
Vol 5 (4) ◽  
pp. 1052
Author(s):  
Pooja Arya ◽  
Manphool S. Maharia ◽  
Ramesh K. Kadela ◽  
Deepchand .
Keyword(s):  
Emergency Department ◽  
Clinical Study ◽  
Mucous Membrane ◽  
Early Stage ◽  
Neurological Complication ◽  
Age Groups ◽  
Active Immunization ◽  
Age Group ◽  
Medical College ◽  
Prompt Treatment

<p class="abstract"><strong>Background:</strong> Diphtheria is an acute infectious preventable disease of childhood caused by <em>C</em>. <em>diphtheriae</em>. Diphtheria is a localized infection of mucous membrane or skin.</p><p class="abstract"><strong>Methods:</strong> The present study was carried out in the Department of Otorhinolaryngology S.P. Medical College and associated group of hospital. In this study all cases of diphtheria and all age groups which attended ENT OPD and emergency department during period from 1/1/2010 to 31/12/2010 were included.  </p><p class="abstract"><strong>Results:</strong> In the present study highest numbers of cases were recorded among 5-10 years of age followed by 0-5 year of age group. 57.59% patients were male and 42.41% patients were female. It was found that occurrence of diphtheria was highest in month November and October and was quit frequent during September and December. No cases during April, June and July. It was observed that most common post diphtheria complication was myocarditis (23.42%) followed by neurological complication.</p><p class="abstract"><strong>Conclusions:</strong> In order to prevent complication of the disease active immunization is customary and in order to detect the disease at early stage and for prompt treatment masses should be educated regarding the dreadful nature of the disease.</p>

scholarly journals PECARN rule in diagnostic process of pediatric patients with minor head trauma in emergency department

2021 ◽  
Author(s):  
Alessandro Gambacorta ◽  
Marianna Moro ◽  
Antonietta Curatola ◽  
Federica Brancato ◽  
Marcello Covino ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Ionizing Radiation ◽  
Head Trauma ◽  
Pediatric Patients ◽  
Age Groups ◽  
Diagnostic Process ◽  
Risk Category ◽  
Age Group ◽  
Minor Head Trauma

Abstract Aim: To evaluate the efficacy of the PECARN Rule (PR) in preventing the presence of clinically important traumatic brain (ciTBI).Methods: A retrospective study was performed to our hospital between July 2015 and June 2020. Data of all children <18 years of age admitted to the Emergency Department (ED), within the 24 hours after a head trauma with GCS ≥14, were analysed. PR was retrospectively applied to all patientsResults: 3832 patients were enrolled, 2613 patients ≥2 years and 1219 were younger. In the group of children ≥2 years, 10 presented ciTBI of which 7 underwent neurosurgery and 3 hospitalized. Applying the PR, no patient with ciTBI would have been discharged without a diagnosis. Between children <2 years, only 3 patients presented ciTBI, 2 underwent neurosurgery and 1 hospitalized. According the PR also in this age group no ciTBI would have been discharged without diagnosis. Conclusions: We demonstrate the total effectiveness of the PR in our setting. We found 100% sensitivity in both age groups in identifying patients with ciTBI. Therefore, in patients classified in the low-risk category, it is a duty of the physician not to expose the child to ionizing radiation.

Abstract 72: Temporal Trends in Stroke Incidence Over Time by Sex and Age in the Greater Cincinnati Northern Kentucky Stroke Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Tracy E Madsen ◽  
Jane C Khoury ◽  
Michelle Leppert ◽  
Kathleen Alwell ◽  
Charles J Moomaw ◽  
...  
Keyword(s):  
Older Adults ◽  
Temporal Trends ◽  
Age Groups ◽  
Incidence Rates ◽  
Age Group ◽  
Bonferroni Correction ◽  
Stroke Incidence ◽  
Stroke Study ◽  
Trends Over Time ◽  
Over Time

Introduction: Data from the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) through 2010 showed that over time, stroke incidence rates decreased to a greater extent in men than in women. We aimed to determine whether this difference continued through 2015 and whether the differences are driven by particular age groups. Methods: Within the GCNKSS population of 1.3 million, all incident strokes among residents ≥20 years old were ascertained at all local hospitals during 7/93–6/94 and calendar years 1999, 2005, 2010, and 2015. Out-of-hospital cases were sampled. Sex-specific incidence rates per 100,000 were adjusted for age and race, standardized to the 2010 U.S. Census. Trends over time by sex were compared (overall and age-stratified); a Bonferroni correction was applied for multiple comparisons. Results: In total over the five study periods, there were 9721 incident strokes (ischemic, ICH, and SAH); 56.4% were women. Incidence of ischemic strokes decreased from 254 (95%CI 236,272) in 1993/4 to 177 (95%CI 164,189) in 2015 among men (p<.0001 for trend over time) and from 204 (95%CI 192,217) in 1993/4 to 151 (95%CI 141,161) in 2015 among women (p<.0001). Incidence of ICH/ SAH did not change significantly over time in either sex. In age-stratified analyses, among women, incidence of all strokes decreased among older adults (65–84 years) but not in other age categories (Figure). Among men, incidence over time decreased among older adults (65–84 and ≥ 85 years) but increased in young adults (20–44 years). Conclusions: Stroke incidence decreased between the early 1990s and 2015 for both sexes, contrary to previous data on trends through 2010 which demonstrated a significant decrease in men but not women. Temporal changes are being driven by the 65–84 year age group in both men and women, as well as the ≥ 85 age group in men. Future prevention strategies should target young and middle age adults for both sexes as well as those over 85 for women.

Examining Trends in Sepsis and Sepsis Management by Non-Physician Clinicians in a Rural Ugandan Emergency Department Over a Decade.

2020 ◽  
Author(s):  
Sal Calo ◽  
Brian Travis Rice ◽  
John Bosco Kamugisha ◽  
Nicholas Kamara ◽  
Stacey Chamberlain
Keyword(s):  
Emergency Department ◽  
Linear Regression ◽  
Sub Saharan Africa ◽  
Sepsis Management ◽  
Suspected Infection ◽  
Admission Rates ◽  
Sub Saharan ◽  
Qsofa Score ◽  
The Impact ◽  
Over Time

Abstract Background: There is a paucity of data from Sub-Saharan Africa regarding sepsis outcomes and the impact of sepsis care on those outcomes, including the impact of care provided by non-physician clinicians (NPCs). Methods: Data were retrospectively analyzed from a rural Ugandan emergency department staffed by NPCs using a quality assurance database of adult and pediatric patient visits with and without sepsis from 2010 through 2018. Sepsis was defined as suspected infection with a qSOFA score ≥ 2. Mortality, disposition, and NPC adherence to intravenous fluid and anti-infective therapy were analyzed using chi-squared and multivariable linear regression. Results: Sepsis criteria were met in 4,847 (11.0%) cases. Sepsis cases compared to non-sepsis cases were significantly older, and had higher rates of comorbid malaria, HIV, tuberculosis, and pneumonia. They had higher admission rates (86.8% versus 66.3%), were more likely to still be admitted at three days (40.2% versus 26.2%), and had higher mortality at three days (7.8% versus 2.5%). The incidence of sepsis significantly declined over time from 16.3% in 2010 to 3.1% in 2018 while the proportion of sepsis cases with qSOFA score of ≥ 3 increased significantly over time. The decrease in incidence was largely due to a precipitous drop in malaria smear-positive sepsis. Utilizing a multivariable linear regression model, annual three-day sepsis mortality did not significantly change over time, though adherence to administration of both fluids and anti-infectives increased significantly from 12.3% in 2010 to 35.0% in 2018. Conclusions: Sepsis incidence, especially malaria smear-positive sepsis, decreased over time, while annual mortality did not change despite increased adherence to administration of anti-infectives and intravenous fluids in an NPC-staffed emergency department. Further studies are needed to investigate the contextualized use of anti-infectives and fluid resuscitation.

Age-Specific Analysis of Injury; In Between Youth and Old, Late Middle Ages Increases Injury Vulnerability (Preprint)

2020 ◽  
Author(s):  
Hansol Chang ◽  
Ji Young Min ◽  
Dajeong Yoo ◽  
Sung Yeon Hwang ◽  
Hee Yoon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Injury Prevention ◽  
Old Age ◽  
Middle Age ◽  
Age Groups ◽  
Age Group ◽  
Prevention Strategies ◽  
Group 4 ◽  
Group 3 ◽  
Group 1

BACKGROUND Injury is a leading cause of both mortality and moderate and severe disability. Injury is preventable, and there had been many injury prevention strategies in the past. Age is one factor that affects injury characteristics. OBJECTIVE This study aimed to investigate the national prevalence of injury by age groups to probe new injury prevention strategies. METHODS This data was collected retrospectively from the Emergency Department-based Injury In-depth Surveillance (EDIIS) in South Korea, including patient data who visit 25 emergency departments between January 2011 and December 2017. Patients were divided into four groups by age: 18 to 34 years as group 1; 35 to 49 years, group 2; 50 to 64 years, group 3; 65 years and over, group 4. RESULTS A total of 1,221,746 patients were included, and each age group had a different injury pattern. Group 3 injury outcomes and injured body parts are similar to Group 4. This is why old age injury prevention strategies should be devised right from middle age and not after old age. Interestingly, in our study, Group 4 and Group 1 both were unlikely to have worn seatbelt when traffic injury occurred, which is different compared to other country studies. CONCLUSIONS In our study, each age group shows diverse characteristics in the mode of injury, place, time, and outcome and Group3, which represents late middle age, shows increased vulnerability. Therefore, it is imperative that all age groups have their own injury prevention method and more caution is needed in late middle age injury. CLINICALTRIAL This data was collected retrospectively from the Emergency Department-based Injury In-depth Surveillance (EDIIS) in South Korea.This study was approved by the Institutional Review Board (IRB) of Samsung Medical Center, IRB No. 2020-05-042.

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