scholarly journals Analysis of Emergency Department Visits for All Reasons by Adults with Depression in the United States

2020 ◽  
Author(s):  
Tyler Hill ◽  
Yun Jiang ◽  
Christopher Friese ◽  
Lynae Darbes ◽  
Christopher K. Blazes ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Clinical Characteristics ◽  
The United States ◽  
Emergency Department Visits ◽  
Admission Rates ◽  
Representative Study ◽  
Care Survey ◽  
Nationally Representative ◽  
Ambulatory Medical Care

Abstract Background : We aimed to characterize Emergency Department (ED) utilization and outcomes of patients with depression seeking emergency care for all reasons. Methods : Using 2014–2016 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, clinical characteristics, and disposition of patients with depression versus those without depression. Results : Approximately 10,626,184 (11.4%) out of 92,899,685 annual ED visits were by patients with depression. ED patients with depression were mostly non-Hispanic White (74.0%) and were less likely to be male than patients without depression (aOR: 0.56; [95%] CI: 0.56–0.56). ED patients with depression were more likely to be admitted to the hospital (aOR: 1.56; CI: 1.55–1.56) and intensive care unit (ICU) (aOR: 1.28; CI: 1.27–1.28) than patients without depression. Among ED patients with depression, males were more likely than females to be seeking emergency care for psychiatric reasons (aOR: 2.04; CI: 2.03–2.05) and to present with overdose/poisoning (aOR: 1.35; CI: 1.34–1.36). Conclusions : We described the unique demographic, socioeconomic, and clinical characteristics of ED patients with depression, using the most comprehensive, nationally representative study to date. We revealed notable gender disparities in rates and reasons for admissions. The higher hospital and ICU admission rates of ED patients with depression suggests this population requires a higher level of emergency care, for reasons that remain poorly understood.

scholarly journals 1099. Antibiotic Prescriptions for Acute Gastroenteritis during Office and Emergency Department Visits–United States, 2006–2015

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S330-S330
Author(s):  
Jennifer P Collins ◽  
Louise Francois Watkins ◽  
Laura M King ◽  
Monina Bartoces ◽  
Katherine Fleming-Dutra ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Medical Care ◽  
Acute Gastroenteritis ◽  
Antibiotic Use ◽  
The United States ◽  
Emergency Department Visits ◽  
Antibiotic Prescribing ◽  
Care Survey ◽  
Ambulatory Medical Care

Abstract Background Acute gastroenteritis (AGE) is a major cause of office and emergency department (ED) visits in the United States. Most patients can be managed with supportive care alone, although some require antibiotics. Limiting unnecessary antibiotic use can minimize side effects and the development of resistance. We used national data to assess antibiotic prescribing for AGE to target areas for stewardship efforts. Methods We used the 2006–2015 National Hospital Ambulatory Medical Care Survey of EDs and National Ambulatory Medical Care Survey to describe antibiotic prescribing for AGE. An AGE visit was defined as one with a new problem (<3 months) as the main visit indication and an ICD-9 code for bacterial or viral gastrointestinal infection or AGE symptoms (nausea, vomiting, and/or diarrhea). We excluded visits with ICD-9 codes for Clostridium difficile or an infection usually requiring antibiotics (e.g., pneumonia). We calculated national annual percentage estimates based on weights of sampled visits and used an α level of 0.01, recommended for these data. Results Of the 12,191 sampled AGE visits, 13% (99% CI: 11–15%) resulted in antibiotic prescriptions, equating to an estimated 1.3 million AGE visits with antibiotic prescriptions annually. Antibiotics were more likely to be prescribed in office AGE visits (16%, 99% CI: 12–20%) compared with ED AGE visits (11%, 99% CI: 9–12%; P < 0.01). Among AGE visits with antibiotic prescriptions, the most frequently prescribed were fluoroquinolones (29%, 99% CI: 21–36%), metronidazole (18%, 99% CI: 13–24%), and penicillins (18%, 99% CI: 11–24%). Antibiotics were prescribed for 25% (99% CI: 8–42%) of visits for bacterial AGE, 16% (99% CI: 12–21%) for diarrhea without nausea or vomiting, and 11% (99% CI: 8–15%) for nausea, vomiting, or both without diarrhea. Among AGE visits with fever (T ≥ 100.9oF) at the visit, 21% (99% CI: 11–31%) resulted in antibiotic prescriptions. Conclusion Patients treated for AGE in office settings were significantly more likely to receive prescriptions for antibiotics compared with those seen in an ED, despite likely lower acuity. Antibiotic prescribing was also high for visits for nausea or vomiting, conditions that usually do not require antibiotics. Antimicrobial stewardship for AGE is needed, especially in office settings. Disclosures All authors: No reported disclosures.

scholarly journals Emergency Department Visits and Trends Related to Cocaine, Psychostimulants, and Opioids in the United States, 2008-2018

2021 ◽  
Author(s):  
Leslie W. Suen ◽  
Thibaut Davy-Mendez ◽  
Kathy T. LeSaint ◽  
Elise D. Riley ◽  
Phillip Coffin
Keyword(s):  
Emergency Department ◽  
Drug Toxicity ◽  
The United States ◽  
Emergency Department Visits ◽  
Opioid Use ◽  
Stimulant Use ◽  
Care Survey ◽  
Ed Visits ◽  
Nationally Representative ◽  
Psychiatric Complications

Abstract Background Drug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of US ED visits related to cocaine and psychostimulant use, compared to opioid use. Methods We used 2008–2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. We excluded visits related to ≥2 of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness. Results Cocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70–5.13; psychostimulant aOR 2.46, 95% CI 1.42–4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69; 95% CI 1.83–3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30–0.73) compared to opioid-related ED visits. Conclusion Presentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.

scholarly journals Emergency department visits by patients with venous thromboembolism, 1998-2009

2012 ◽  
Vol 1 (1) ◽  
pp. 1 ◽  
Author(s):  
Hussain Yusuf ◽  
James Tsai ◽  
Azfar-E-Alam Siddiqi ◽  
Sheree Boulet ◽  
J. Michael Soucie
Keyword(s):  
Emergency Department ◽  
Venous Thromboembolism ◽  
The United States ◽  
Primary Diagnosis ◽  
Emergency Department Visits ◽  
Term Care ◽  
Vein Thrombosis ◽  
Care Survey ◽  
Outpatient Settings ◽  
Ambulatory Medical Care

Background: Substantial morbidity and mortality may result from venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Many VTE cases are diagnosed in outpatient settings, such as emergency departments. The purpose of this study was to estimate and characterize emergency department visits by patients with a primary diagnosis of VTE. Methods: Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 1998-2009 were analyzed.  NHAMCS uses a complex multistage design to sample non-federal short-term care hospitals across the United States.  Emergency department visits with a primary diagnosis of VTE were identified using ICD-9-CM codes indicating a primary diagnosis of DVT or PE. Results: Between 2006-2009, an annual average of 201,000 (95% confidence interval [CI]: 152,000-251,000) emergency department visits were made in the U.S. by patients with a primary diagnosis of VTE as per the criteria used in this study, which was a rate of approximately 67 (95% CI 50-83) per 100,000 population.  The rates during 1998-2001 and 2002-2005 were 31 (95% CI 21-40) and 46 (95% CI 35-57), respectively. The rate of visits with a primary diagnosis of VTE was higher among patients >61 years of age, when compared to younger patients.  Among visits between 1998-2009, selected characteristics that differed between visits by patents with  and without a primary diagnosis of VTE included the patient having been discharged from a hospital in the past seven days (11.7%, vs. 2.1%, p<0.01). Conclusion: A substantial number of emergency department visits are made by patients with a primary diagnosis of VTE. Groups with higher likelihood of VTE related visits may include older adults and those recently discharged from a hospital.

scholarly journals Emergency Department Visits for Mental Health Conditions Among US Children, 2001-2011

2014 ◽  
Vol 53 (14) ◽  
pp. 1359-1366 ◽  
Author(s):  
Alan E. Simon ◽  
Kenneth C. Schoendorf
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Emergency Department Visits ◽  
Health Issues ◽  
White Children ◽  
Mental Health Issues ◽  
Health Related ◽  
Care Survey ◽  
Ambulatory Medical Care ◽  
Us Children

We examined mental health–related visits to emergency departments (EDs) among children from 2001 to 2011. We used the National Hospital Ambulatory Medical Care Survey—Emergency Department, 2001-2011 to identify visits of children 6 to 20 years old with a reason-for-visit code or ICD-9-CM diagnosis code reflecting mental health issues. National percentages of total visits, visit counts, and population rates were calculated, overall and by race, age, and sex. Emergency department visits for mental health issues increased from 4.4% of all visits in 2001 to 7.2% in 2011. Counts increased 55 000 visits per year and rates increased from 13.6 visits/1000 population in 2001 to 25.3 visits/1000 in 2011 ( P < .01 for all trends). Black children (all ages) had higher visit rates than white children and 13- to 20-year-olds had higher visit rates than children 6 to 12 years old ( P < .01 for all comparisons). Differences between groups did not decline over time.

Emergency Department Visits due to Scabies in the United States: A Retrospective Analysis of a Nationally Representative Emergency Department Sample

2019 ◽  
Author(s):  
Raghav Tripathi ◽  
Konrad D Knusel ◽  
Harib H Ezaldein ◽  
Jeremy S Bordeaux ◽  
Jeffrey F Scott
Keyword(s):  
United States ◽  
Emergency Department ◽  
Retrospective Analysis ◽  
The United States ◽  
Cost Of Care ◽  
Emergency Department Visits ◽  
Limited Information ◽  
Targeted Interventions ◽  
Ed Visits ◽  
Nationally Representative

Abstract Background Limited information exists regarding the burden of emergency department (ED) visits due to scabies in the United States. The goal of this study was to provide population-level estimates regarding scabies visits to American EDs. Methods This study was a retrospective analysis of the nationally representative National Emergency Department Sample from 2013 to 2015. Outcomes included adjusted odds for scabies ED visits, adjusted odds for inpatient admission due to scabies in the ED scabies population, predictors for cost of care, and seasonal/regional variation in cost and prevalence of scabies ED visits. Results Our patient population included 416 017 218 ED visits from 2013 to 2015, of which 356 267 were due to scabies (prevalence = 85.7 per 100 000 ED visits). The average annual expenditure for scabies ED visits was $67 125 780.36. The average cost of care for a scabies ED visit was $750.91 (±17.41). Patients visiting the ED for scabies were most likely to be male children from lower income quartiles and were most likely to present to the ED on weekdays in the fall, controlling for all other factors. Scabies ED patients that were male, older, insured by Medicare, from the highest income quartile, and from the Midwest/West were most likely to be admitted as inpatients. Older, higher income, Medicare patients in large Northeastern metropolitan cities had the greatest cost of care. Conclusion This study provides comprehensive nationally representative estimates of the burden of scabies ED visits on the American healthcare system. These findings are important for developing targeted interventions to decrease the incidence and burden of scabies in American EDs.

Current management of migraine in US emergency departments: An analysis of the National Hospital Ambulatory Medical Care Survey

Cephalalgia ◽  
2014 ◽  
Vol 35 (4) ◽  
pp. 301-309 ◽  
Author(s):  
Benjamin W Friedman ◽  
Jason West ◽  
David R Vinson ◽  
Mia T Minen ◽  
Andrew Restivo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Medical Care ◽  
Emergency Departments ◽  
Emergency Department Visits ◽  
Opioid Use ◽  
National Hospital ◽  
Frequency Of Use ◽  
Care Survey ◽  
Ambulatory Medical Care

Background Published data from 1998 revealed that most patients treated for migraine in an emergency department received opioids. Over the intervening years, a large body of evidence has emerged demonstrating the efficacy and safety of non-opioid alternatives. Expert opinion during these years has cautioned against use of opioids for migraine. Our objectives were to compare current frequency of use of various medications for acute migraine in US emergency departments with use of these same medications in 1998 and to identify factors independently associated with opioid use. Methods We analyzed National Hospital Ambulatory Medical Care Survey data from 2010, the most current dataset available. The National Hospital Ambulatory Medical Care Survey is a public dataset collected and distributed by the Centers for Disease Control and Prevention. It is a multi-stage probability sample from randomly selected emergency departments across the country, designed to be representative of all US emergency department visits. We included in our analysis all patients with the ICD9 emergency department discharge diagnosis of migraine. We tabulated frequency of use of specific medications in 2010 and compared these results with the 1998 data. Using a logistic regression model, into which all of the following variables were entered, we explored the independent association between any opioid use in 2010 and sex, age, race/ethnicity, geographic region, type of hospital, triage pain score and history of emergency department use within the previous 12 months. Results In 2010, there were 1.2 (95% confidence interval 0.9, 1.4) million migraine visits to US emergency departments. Including opioid-containing oral analgesic combinations, opioids were administered in 59% of visits (95% confidence interval 51, 67). The most commonly used parenteral agent, hydromorphone, was used in 25% (95% confidence interval 19, 33) of visits in 2010 versus less than 1% (95% confidence interval 0, 3) in 1998. Conversely, use of meperidine had decreased markedly over the same timeframe. In 2010, it was used in just 7% (95% confidence interval 4, 12) of visits compared to 37% (95% confidence interval 29, 45) in 1998. Metoclopramide, the most commonly used anti-dopaminergic, was administered in 17% (95% confidence interval 12, 23) of visits in 2010 and 3% (95% confidence interval 1, 6) of visits in 1998. Use of any triptan was relatively uncommon in 2010 (7% (95% confidence interval 4, 11) of visits) and in 1998 (10% (95% confidence interval 6, 15) of visits). Of the predictor variables listed above, only emergency department use within the previous 12 months was associated with opioid administration (adjusted odds ratio: 2.87 (95% confidence interval 1.03, 7.97)). Conclusions In spite of recommendations to the contrary, opioids are still used in more than half of all emergency department visits for migraine. Though use of meperidine has decreased markedly between 1998 and 2010, it has largely been replaced by hydromorphone. Opioid use in migraine visits is independently associated with prior visits to the same emergency department in the previous 12 months.

scholarly journals Emergency Department Visits by Patients with Substance Use Disorder in the United States

2021 ◽  
Vol 22 (5) ◽  
pp. 1076-1085
Author(s):  
Xingyu Zhang ◽  
Ningyuan Wang ◽  
Fengsu Hou ◽  
Yaseen Ali ◽  
Aaron Dora-Laskey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Clinical Characteristics ◽  
The United States ◽  
Emergency Department Visits ◽  
Ed Visits ◽  
Emergency Department Patients ◽  
A Site ◽  
Injured Patients

Introduction: We aimed to characterize emergency department (ED) utilization and clinical characteristics of patients with substance use disorder (SUD) seeking emergency care for all reasons. Methods: Using 2016–2017 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, and clinical characteristics of patients with SUD vs those without SUD. Results: Of all adult ED visits (N = 27,609) in the US in 2016–2017, 11.1% of patients had SUD. Among ED patients with SUD, they were mostly non-Hispanic White (62.5%) and were more likely to be male (adjusted odds ratio [aOR] 1.80 confidence interval [CI], 1.66-1.95). Emergency department patients with SUD were also more likely to return to the ED within 72 hours (aOR 1.32, CI, 1.09-1.61) and more likely to be admitted to the hospital (aOR 1.28, CI, 1.14-1.43) and intensive care unit (aOR 1.40, CI, 1.05-1.85). Conclusion: Patients with SUD have specific demographic, socioeconomic, and clinical characteristics associated with their ED visits. These findings highlight the importance of recognizing co-existing SUD as risk factors for increasing morbidity in acutely ill and injured patients, and the potential role of the ED as a site for interventions aimed at reducing harm from SUD.

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