scholarly journals Gender Difference in Predisposing Factors of Overdose

2020 ◽  
Author(s):  
Sheng-Teck Tan ◽  
Chih-Hung Lo ◽  
Chen-Hao Liao ◽  
Yu-Jang Su
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Gender Difference ◽  
Suicide Attempts ◽  
Vital Signs ◽  
Length Of Hospital Stay ◽  
Predisposing Factors ◽  
Coding System ◽  
Icd 10 ◽  
Period Data

Abstract Background Drug overdose is a one of common situations in emergency department (ED). We investigate gender difference and predisposing factors of overdose in emergency department (ED).Materials and Methods We retrospectively analyzed overdose reports from January 2018 to August 2019. We selected study cases by the ICD-10 coding system which include T36 to T50. A total of 299 overdose reports were collected during this period. Data were collected including Glasgow coma scale and vital signs on arrival (including body temperature, heart rate, systolic blood pressure, and diastolic blood pressure, gender, age, marital status, arrival time, season on admission, previous suicide attempts, psychiatric history, related comorbidities, recent argues, categories of overdose with or without concurrent ethanol use, length of hospital stay and survival to discharge were analyzed.Results The 196 enrolled patients ranged in age from 14 to 92 years (mean ± standard deviation (S.D.): 39.2 ± 18.3). Of them, male intentional overdose patients were 8.1 years older than female ones (45.3 ± 19.5 vs. 37.2 ± 17.5, respectively; p < 0.05)Conclusion The most top three kinds of substance overdose are benzodiazepine (42.9%), mixed medications (32.1%) and acetaminophen (6.1%). Physicians should notify the centers of suicide prevention to pay concern about who are middle-aged male, facing conflicts, especially in the spring.

scholarly journals Gender Difference in Predisposing Factors of Overdose

2020 ◽  
Author(s):  
Sheng-Teck Tan ◽  
Chih-Hung Lo ◽  
Chen-Hao Liao ◽  
Yu-Jang Su
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Gender Difference ◽  
Hospital Stay ◽  
Suicide Attempts ◽  
Vital Signs ◽  
Length Of Hospital Stay ◽  
Predisposing Factors ◽  
Coding System ◽  
Icd 10

Abstract Background Drug overdose is a one of common situations in emergency department (ED). We investigate gender difference and predisposing factors of overdose in emergency department (ED).Materials and MethodsWe retrospectively analyzed overdose reports from January 2018 to August 2019. We selected study cases by the ICD-10 coding system which include T36 to T50. A total of 299 overdose reports were collected during this period. Data were collected including Glasgow coma scale and vital signs on arrival (including body temperature, heart rate, systolic blood pressure, and diastolic blood pressure, gender, age, marital status, arrival time, season on admission, previous suicide attempts, psychiatric history, related comorbidities, recent argues, categories of overdose with or without concurrent ethanol use, length of hospital stay and survival to discharge were analyzed. ResultsThe 196 enrolled patients ranged in age from 14 to 92 years (mean ± standard deviation (S.D.): 39.2 ± 18.3). Of them, male intentional overdose patients were 8.1 years older than female ones (45.3 ± 19.5 vs. 37.2 ± 17.5, respectively; p<0.05) Most intentional overdose cases occurred during the Spring season (n=63, 32.1%), especially in male patients (n=28, 57.1%; p<0.001). About 11.2% (22/196) and 2% (4/196) of total patients hospitalized to ward and intensive care units, respectively. Length of hospital stay is 2 ± 4.1 days.ConclusionThe most top three kinds of substance overdose are benzodiazepine (42.9%), mixed medications (32.1%) and acetaminophen (6.1%). Physicians should notify the centers of suicide prevention to pay concern about who are middle-aged male, facing conflicts, especially in the spring.

scholarly journals An emergency department medical record review for adolescent intentional self-harm injuries

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Anna Hansen ◽  
Dessi Slavova ◽  
Gena Cooper ◽  
Jaryd Zummer ◽  
Julia Costich
Keyword(s):  
Emergency Department ◽  
Suicide Attempt ◽  
Suicide Ideation ◽  
Suicide Attempts ◽  
International Classification Of Diseases ◽  
Case Definition ◽  
Coding System ◽  
Icd 10 ◽  
Self Harm ◽  
Coding Guidelines

Abstract Background Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study developed a definition for identifying intentional self-harm (ISH) injuries in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. The definition is based on the injury-reporting framework proposed by the Centers for Disease Control and Prevention. The study sought to estimate the definition’s positive predictive value (PPV), and the proportion of ISH injuries with intent to die (i.e., suicide attempt). Methods The study definition, based on first-valid external cause-of-injury ICD-10-CM codes X71-X83, T14.91, T36-T65, or T71, captured 207 discharge records for initial encounters for ISH in one Kentucky ED. Medical records were reviewed to confirm provider-documented diagnosis for ISH, and identify intent to die or suicide ideation. The PPV of the study definition for capturing provider-documented ISH injuries was reported with its 95% confidence interval (95% CI). Results The estimated PPV for the study definition to capture ISH injuries was 88.9%, 95% CI (83.8%, 92.8%). The estimated percentage of ISH with intent to die was 45.9, 95% CI (47.1, 61.0%). The ICD-10-CM code “suicide attempt” (T14.91) captured only 7 cases, but coding guidelines restrict assignment of this code to cases in which the mechanism of the suicide attempt is unknown. Conclusions The proposed case definition supported a robust PPV for ISH injuries. Our findings add to the evidence that the current ICD-10-CM coding system and coding guidelines do not allow identification of ISH with intent to die; modifications are needed to address this issue.

scholarly journals Predisposing factors for hypoglycaemia in the emergency department

2019 ◽  
Vol 47 (6) ◽  
pp. 2404-2412 ◽  
Author(s):  
Yu-Jang Su ◽  
Chia-Jung Liao
Keyword(s):  
Emergency Department ◽  
Liver Enzymes ◽  
Vital Signs ◽  
Length Of Hospital Stay ◽  
Predisposing Factors ◽  
Advanced Age ◽  
Age Group ◽  
Elevated Liver Enzymes ◽  
Elevated Systolic Blood Pressure ◽  
Northern Taiwan

Objective Hypoglycaemia is a common complication of diabetes mellitus. Previous studies suggest that hypoglycaemic episodes may occur with other comorbidities, influencing the outcome of recovery. Recognising the predisposing factors for hypoglycaemic episodes in the emergency department is important. Therefore, we investigated the characteristics of and predisposing factors for hypoglycaemia in the emergency department. Methods Data from 186 patients were retrospectively collected from a medical centre in northern Taiwan. We divided the patients into the advanced-age group (132 patients) and the younger group (54 patients). Associated data collected for statistical analysis included vital signs on arrival, first measured blood glucose level, laboratory results, related comorbidities, length of hospital stay, and survival to discharge. Results Hypoglycaemia was more frequently observed in women in the advanced-age group than in the younger group. Tachycardia and elevated systolic blood pressure were less predominant in the advanced-age group than younger group. More patients in the advanced-age group had concurrent infection, and more patients in the younger group had liver dysfunction, elevated liver enzymes, liver cirrhosis, and concurrent stroke. Conclusions Closer attention should be paid to the possibility of infection in patients of advanced age. Liver disease and stroke need to be ruled out in younger patients.

scholarly journals Positive Predictive Value of ICD-10-CM Definitions for Adolescent Intentional Self-Harm: An Emergency Department Medical Record Review

2020 ◽  
Author(s):  
Anna Hansen ◽  
Dessi Slavova ◽  
Gena Cooper ◽  
Jaryd Zummer ◽  
Julia F Costich
Keyword(s):  
Emergency Department ◽  
Suicide Attempt ◽  
Positive Predictive Value ◽  
Medical Record ◽  
Predictive Value ◽  
Suicide Attempts ◽  
Pediatric Population ◽  
Icd 10 ◽  
Self Harm ◽  
Coding Guidelines

Abstract Background Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study proposed a definition for identifying intentional self-harm injuries (ISHIs) in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes and sought to estimate: (1) the definition’s positive predictive value (PPV) in a pediatric population treated in one Kentucky ED, and (2) the proportion of Intentional self-harm injuries (ISHIs) with intent to die (i.e., suicide attempt) that cannot be captured by ICD-10-CM codes and can only be identified by a medical record abstraction. Methods The study definition captured initial encounters for ISHIs based on first valid external cause-of-injury self-harm codes in the ICD-10-CM range X71-X83, T14.91, T36-T65, or T71. Medical records for a random sample of 207 ED discharge records were reviewed following a specified protocol. The PPV for the study definition was reported with its 95% confidence interval (95%CI). Results The estimated PPV for the study definition’s ability to capture true ISHIs was 88.9%, 95%CI (83.8%, 92.8%). The estimated percentage of ISHIs with intent to die was 45.9%, 95%CI (47.1%, 61.0%). The ICD-10-CM code “suicide attempt” (T14.91) captured only 7 cases, but coding guidelines allow assignment of this code only when the mechanism of the suicide attempt is unknown. Conclusions This study demonstrated a critical shortcoming in U.S. morbidity surveillance. The ICD-10-CM coding system and coding guidelines do not allow accurate identification of ISHIs with intent to die; modifications are needed to address this issue.

Clinical and laboratory characteristics of patients presenting to a tertiary care center emergency department with invasive group A streptococcal infections

CJEM ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 368-374
Author(s):  
Karly Dudar ◽  
Shalyn Littlefield ◽  
Meghan Garnett
Keyword(s):  
Emergency Department ◽  
Care Center ◽  
Tertiary Care ◽  
Vital Signs ◽  
High Volume ◽  
Geographic Area ◽  
Streptococcal Infections ◽  
Invasive Group ◽  
Icd 10 ◽  
Group A

ABSTRACTObjectivesThe aim of this study was to describe the clinical and laboratory characteristics of invasive group A streptococcal infections in a geographic area that sees a high volume of cases.MethodsWe conducted a health records review of consecutive patients presenting to the Thunder Bay Regional Health Sciences Centre Emergency Department (ED) in 2016–2017 with a diagnosis of invasive group A streptococcal infection using ICD-10 codes. Patient demographics, host characteristics, triage vital signs, laboratory values, culture sites, and disposition were described using univariate and bivariate statistics.ResultsForty-four adult cases were identified over 2 years, with a median age of 44 years (interquartile range, 35–52). The most prevalent risk factors were diabetes mellitus (45%), current or previous alcohol abuse (39%), and current or previous intravenous drug use (34%). The two most abnormal triage vitals signs were a heart rate ≥ 100 beats per minute in 32 (73%) cases and a respiratory rate ≥ 20 breaths per minute in 27 (63%) cases. The temperature was ≥ 38°C in only 14 (32%) of cases. The C-reactive protein (CRP) was always elevated when measured, and greater than 150 mg/L in 20 (71%) of cases. One-third of patients had an ED visit in the preceding 7 days before the diagnosis of invasive group A Streptococcus.ConclusionsInvasive group A streptococcal infections often present insidiously in adult patients with mild tachycardia and tachypnea at triage. The CRP was the most consistently abnormal laboratory investigation.

Consultation with the Specialist

1993 ◽  
Vol 14 (6) ◽  
pp. 237-238
Author(s):  
James Seidel
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Physical Examination ◽  
Local Community ◽  
Community Hospital ◽  
Vital Signs ◽  
Neurologic Examination ◽  
The Right ◽  
Spine Radiographs ◽  
Large Hematoma

Case Report Bobbi, a 5-year-old, was playing "catch" on the lawn of his surburban home. When he went to fetch the ball that had rolled into the street, he was struck by an automobile traveling about 25 miles per hour. Witnesses reported that Bobbi's body was lifted up by the car and thrown about 12 feet onto the pavement. A neighbor responded immediately and noted that Bobbi was responsive to verbal commands and had a large bump on the front of his head and a swollen right thigh. The Emergency Medical Services System was activated, and within 10 minutes he was transported to the emergency department at the local community hospital. Bobbi was in obvious pain but was awake and responded to questions. He knew his sister's and teachers' names, but did not remember being struck by the car. His vital signs were: respirations 35/min; pulse, 100/min; blood pressure, 98/68 mm Hg; and temperature, 36.5°C. Physical examination was remarkable for a large hematoma on the right frontal and parietal areas of the skull and a swollen tender right thigh. Bobbi's spine was normal upon physical examination, and the neurologic examination was normal except for some retrograde amnesia. There was no spinal swelling or tenderness, and cervical spine radiographs were normal

scholarly journals Could We Use Vital Signs and Lactate Levels Together to Predict the Prognosis in Abdominal Pain?

Acta Medica ◽  
2021 ◽  
pp. 1-6
Author(s):  
Filiz Froohari Damarsoy ◽  
Nalan Metin Aksu ◽  
Elif Öztürk ◽  
Meltem Akkaş
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Systolic Blood Pressure ◽  
Pulse Rate ◽  
Venous Blood ◽  
Vital Signs ◽  
Common Diagnosis ◽  
Intracystic Hemorrhage ◽  
Lactate Levels

Objectives: Abdominal pain occupies most of the emergency department admissions. This entity leads to research various markers for the early detection of causes in patients presenting with abdominal pain. There is limited data about collaborations between lactate levels and vital signs at admission in abdominal pain. Materials and Methods: Patients aged 18 years and older, who had presented with abdominal pain to the Emergency Department, in total 102 patients, were included to the study. The patients’ demographics, vital signs, abdominal physical examination findings, diagnosis and outcomes of patients were recorded. The 1 ml venous blood samples were collected by blood gase injectors from the patients and lactate levels were analyzed. Results: Female patients’ percentile was 68,6% and mean age was 39 years old. The systolic blood pressure levels were normal in 45 patients, low in 26% patients and high in 29% patients. The seventy-six of the patients had normal pulse rate and 26 of them were tachycardic. Most common diagnosis was non-specific abdominal pain (37,25%) and the least common was ovarian torsion/intracystic hemorrhage (0,98%) and obstruction due to hernia (0,98%). There was no statistically significant relation between lactate level and pulse rate (p=0,637), systolic blood pressure (p=0,052), diastolic blood pressure (p=0,095), respiratory rate (p=0,527), body temperature (p=0,040) and oxygen saturation (p=0,905). Similarly, no significant association occurred between lactate levels and diagnosis and outcomes. Conclusion: Further studies including more patients groups have to be done in order to attain more reliable data about this topic.

scholarly journals The association between vital signs and clinical outcomes in emergency department patients of different age categories

2022 ◽  
pp. emermed-2020-210628
Author(s):  
Bart GJ Candel ◽  
Renée Duijzer ◽  
Menno I Gaakeer ◽  
Ewoud ter Avest ◽  
Özcan Sir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Older Patients ◽  
Vital Signs ◽  
Risk Scores ◽  
Case Mix ◽  
Peripheral Oxygen Saturation ◽  
The Impact

BackgroundAppropriate interpretation of vital signs is essential for risk stratification in the emergency department (ED) but may change with advancing age. In several guidelines, risk scores such as the Systemic Inflammatory Response Syndrome (SIRS) and Quick Sequential Organ Failure Assessment (qSOFA) scores, commonly used in emergency medicine practice (as well as critical care) specify a single cut-off or threshold for each of the commonly measured vital signs. Although a single cut-off may be convenient, it is unknown whether a single cut-off for vital signs truly exists and if the association between vital signs and in-hospital mortality differs per age-category.AimsTo assess the association between initial vital signs and case-mix adjusted in-hospital mortality in different age categories.MethodsObservational multicentre cohort study using the Netherlands Emergency Department Evaluation Database (NEED) in which consecutive ED patients ≥18 years were included between 1 January 2017 and 12 January 2020. The association between vital signs and case-mix adjusted mortality were assessed in three age categories (18-65; 66-80; >80 years) using multivariable logistic regression. Vital signs were each divided into five to six categories, for example, systolic blood pressure (SBP) categories (≤80, 81–100, 101–120, 121–140, >140 mm Hg).ResultsWe included 101 416 patients of whom 2374 (2.3%) died. Adjusted ORs for mortality increased gradually with decreasing SBP and decreasing peripheral oxygen saturation (SpO2). Diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) had quasi-U-shaped associations with mortality. Mortality did not increase for temperatures anywhere in the range between 35.5°C and 42.0°C, with a single cut-off around 35.5°C below which mortality increased. Single cut-offs were also found for MAP <70 mm Hg and respiratory rate >22/min. For all vital signs, older patients had larger increases in absolute mortality compared with younger patients.ConclusionFor SBP, DBP, SpO2 and HR, no single cut-off existed. The impact of changing vital sign categories on prognosis was larger in older patients. Our results have implications for the interpretation of vital signs in existing risk stratification tools and acute care guidelines.

scholarly journals Comparison of the efficacy of PSI, CURB-65, CALL and BCRSS in predicting prognosis and mortality in COVID-19 patients

2021 ◽  
Vol 38 (4) ◽  
pp. 434-439
Author(s):  
Hatice Şeyma AKÇA ◽  
Abdullah ALGIN ◽  
Serdar ÖZDEMİR ◽  
Habib SEVİMLİ ◽  
Kamil KOKULU ◽  
...  
Keyword(s):  
Emergency Department ◽  
Vital Signs ◽  
Area Under The Curve ◽  
Length Of Hospital Stay ◽  
Scoring Systems ◽  
Imaging Findings ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Best Parameter ◽  
Pcr Test

This study aimed to determine whether the PSI, CURB-65, CALL and BCRSS had any superiority over each other as a prognostic determinant in patients with COVID-19. This prospective cohort study included patients over 18 years of age that presented to the emergency department between May 12 and August 12, 2020 and had a positive COVID-19 polymerase chain reaction (PCR) test. The PSI, CURB-65, CALL and BCRS scores were calculated. SPSS version 22 was used for all statistical analyses. A total of 213 patients with a positive COVID-19 PCR result were included in the study. The total 30-day mortality rate was determined as 14.08%. PSI, CURB-65, CALL and BCRSS had a statistically significant relationship with mortality (p<0.001). The best parameter in predicting mortality was determined as PSI (area under the curve: 0.900; 95% CI: 0.972-0.828). A positive correlation was found between each scoring system, both with the length of hospital stay (PSI, CURB-65, CALL and BCRSS: r=0.696, p=0; r=0.621, p=0; r=0.75, p=0; and r=0.666, p=0, respectively). Scoring systems, which include comorbidity, vital signs as well as laboratory, imaging findings, will be more effective than other scoring systems in determining the mortality in patients with covid-19.

scholarly journals Associação entre sinais vitais e Sistema Manchester de Triagem: estudo observacional retrospectivo

2018 ◽  
Vol 16 (4) ◽  
pp. 379
Author(s):  
José Carlos Amado Martins ◽  
Helisamara Mota Guedes ◽  
Cristiane Chaves de Souza ◽  
Tânia Couto Machado Chianca
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Heart Rate ◽  
Observational Study ◽  
Pain Intensity ◽  
Vital Signs ◽  
Manchester Triage System ◽  
Risk Levels ◽  
Exposure Factor ◽  
The Mean

Aim: To evaluate the association between vital signs collected at the patient's entrance to the emergency department and the risk levels of the Manchester Triage System (MTS). Method: This is a retrospective observational study; whose sample was 154,714 patients. The exposure factor was the vital signs data, and the primary endpoint was the level of risk of MTS. Statistical, descriptive and inferential analyzes were conducted. Results: The most evaluated vital data was pain intensity; blood pressure was the least evaluated. Changes in heart rate to more or less of physiological patterns have increased the clinical priority of patients. Discussion: The higher the level of severity of MTS, the greater the variability of the mean of the vital signs evaluated. Conclusion: More severe patients tend to present greater variation in terms of vital signs on admission to the emergency department.

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