scholarly journals Emergency Department Visits with Obstructive Sleep Apnea in the United States

2021 ◽  
Author(s):  
Jianguo Guo ◽  
Mengzhu Sun ◽  
Yan-Cun Liu ◽  
Jiao Pei ◽  
Hui Fan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Resource Utilization ◽  
Clinical Characteristics ◽  
Admission Rate ◽  
The United States ◽  
Emergency Department Visits ◽  
X Rays ◽  
Medical Resources ◽  
Hospital Admission Rate ◽  
Icu Admission

Abstract Background: We aimed to reveal the differences among patients with OSA and without OSA in the Emergency Department (ED), including the utilization medical resources and treatment status. Methods: Using 2016–2017 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, clinical characteristics, and the relationship with other diseases of patients with OSA versus those without OSA. Results: About 5,985,955 (2.8%) out of 215,240,000 annual ED visits were by patients with OSA. Among all of the reasons for ED Visit, patients with OSA who with Respiratory symptoms were 1.38 times (95% CI:1.06-1.78) more likely to seek for treatment than those with general symptoms, and who with Cardiovascular and Lymphatic symptoms were 1.44 times (95% CI:0.96-2.17) more likely to seek for treatment than those with general symptoms. In terms of gender, males were 1.28 times (95% CI:1. 10-1.48) more likely to have OSA than females. The hospital admission rate (30.3% vs. 13.7%, 95% CI: 1.47-2.11) and ICU admission rate (4.3% vs. 1.7%, 95% CI: 1.06-2.32) of OSA patients were higher than those of non OSA patients, also they were more likely to die in the ED or hospital (26.6%, P< 0.01) . Besides, rate of blood tests performed was 1.94 times higher (95% CI: 1.61-2.33), rate of any imaging performed was 1.63 times higher (95% CI: 1.37-1.92), rate of X-rays performed in ED was 1.54 times higher (95% CI: 1.31-1.81).Conclusions: By using the NHAMCS-ED dataset, we described the demographics, ED resource utilization, and clinical characteristics of Emergency Department patients with OSA. Based on that, the ED patients with OSA will increase the hospitalization rate, the ICU admission rate, adverse outcomes, and occupation of medical resources. Therefore, we should pay attention to the process of diagnosis and treatment of patients with OSA, in order to reduce the physiological and economic burden of patients, and improve the quality of life of patients.

How to Create a Hot Foot Line to Prevent Diabetes-Related Amputations: Instant Triage for Emergency Department and Inpatient Consultations

2019 ◽  
Vol 109 (2) ◽  
pp. 174-179
Author(s):  
John D. Miller ◽  
Eric J. Lew ◽  
Nicholas A. Giovinco ◽  
Christian Ochoa ◽  
Vincent L. Rowe ◽  
...  
Keyword(s):  
Emergency Department ◽  
Lower Extremity ◽  
Admission Rate ◽  
The United States ◽  
Adverse Outcomes ◽  
Emergency Department Visits ◽  
Tissue Loss ◽  
Hospital Admission Rate ◽  
Team Members ◽  
Below The Knee

Emergency department visits for lower extremity complications of diabetes are extremely common throughout the world. Surprisingly, recent data suggest that such visits generate an 81.2% hospital admission rate with an annual bill of at least $1.2 billion in the United States alone. The likelihood of amputation and other subsequent adverse outcomes is strongly associated with three factors: 1) wound severity (degree of tissue loss), 2) ischemia, and 3) foot infection. Using these factors, this article outlines the basic principles needed to create an evidence-based, rapid foot assessment for diabetic foot ulcers presenting to the emergency department, and suggests the establishment of a “hot foot line” for an organized, expeditious response from limb salvage team members. We present a nearly immediate assessment and referral system for patients with atraumatic tissue loss below the knee that has the potential to vastly expedite lower extremity triage in the emergency room setting through greater collaboration and organization.

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.

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 1691. Pre- and Post-Hospitalization Resource Utilization and Costs Associated with Urinary Tract Infection (UTI) in both Commercial and Medicare Populations

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S829-S829
Author(s):  
David Melnick ◽  
Nayiri Baljian ◽  
Akash Jain ◽  
Katherine Sulham
Keyword(s):  
Emergency Department ◽  
Urinary Tract ◽  
Resource Utilization ◽  
Index Date ◽  
The United States ◽  
Emergency Department Visits ◽  
Index Hospitalization ◽  
Medicare Patients ◽  
Pharmacy Benefits ◽  
Tract Infections

Abstract Background In the United States, urinary tract infections (UTIs) result in an estimated 7 million office visits, 1 million emergency department visits, and over 500,000 hospitalizations with an associated annual cost of $1.6 billion. Little is known regarding pre- and post-hospitalization resource use. Here, we quantify resource utilization and costs associated with both commercially insured and Medicare patients hospitalized for UTI. Methods A retrospective multi-center study using data from the MarketScan® Commercial and Medicare Supplemental Databases was performed. Inclusion criteria: (1) inpatient hospital admission with a primary ICD-10 diagnosis for UTI between October 1, 2015 and December 31, 2017 (index hospitalization), (2) at least 6 months of continuous enrollment and pharmacy benefits prior to the index date, (3) at least 12 months of continuous enrollment and pharmacy benefits after the index date, (4) patient age &lt; 64 (Commercial) or ≥65 (Medicare) on the index date. Demographics, hospitalization characteristics, antibiotic use, and resource utilization/costs in the pre- and post-index periods were examined. Results 5,248 Commercial and 7,791 Medicare patients were eligible for analysis. 29.7% and 24.1% of Medicare and Commercial patients, respectively, were male. 5.9% of Medicare patients had a claim for skilled nursing facilities (SNF) in the 14 days pre-index admission (1.0% Commercial), 9.1% had emergency department claims (13.1% Commercial), and 39.8% had office visit claims (49.9% Commercial). Post-hospitalization, 20.3% (1.3% Commercial) were discharged to SNF and 15.4% (4.7%) were discharged to home health services. Mean insurer UTI-related costs were $8,677 (Commercial) and $5,358 (Medicare) in the 6 months pre-index hospitalization. Similarly, costs were $21,135 (Commercial) and $22,342 (Medicare) in the 12 months post hospitalization ($3,944 and $2,988 in the first 30 days post-discharge, respectively). Conclusion UTI is associated with substantial costs and resource utilization to insurers in both pre- and post-hospitalization settings. Understanding total costs of care and location of service may aid in cost-reduction strategies for treating UTI. Disclosures David Melnick, MD, Spero Therapeutics (Employee)Spero Therapeutics (Employee) Nayiri Baljian, n/a, Spero Therapeutics (Employee) Akash Jain, PhD, Spero Therapeutics (Employee) Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor)

scholarly journals Emergency Department Visits From 2014 to 2018 for Head Injuries in Youth Non-Tackle Football Compared With Other Sports

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097540
Author(s):  
Jessica M. Zendler ◽  
Ron Jadischke ◽  
Jared Frantz ◽  
Steve Hall ◽  
Grant C. Goulet
Keyword(s):  
United States ◽  
Emergency Department ◽  
Head Injury ◽  
Head Injuries ◽  
The United States ◽  
Emergency Department Visits ◽  
Head Region ◽  
Cerebral Contusion ◽  
Common Diagnosis ◽  
Tackle Football

Background: Non-tackle football (ie, flag, touch, 7v7) is purported to be a lower-risk alternative to tackle football, particularly in terms of head injuries. However, data on head injuries in non-tackle football are sparse, particularly among youth participants. Purpose: To describe the epidemiology of  emergency department visits for head injuries due to non-tackle football among youth players in the United States and compare the data with basketball, soccer, and tackle football. Study Design: Descriptive epidemiology study. Methods: Injury data from 2014 to 2018 were obtained from the National Electronic Injury Surveillance System database. Injury reports coded for patients aged 6 to 18 years and associated with basketball, football, or soccer were extracted. Data were filtered to include only injuries to the head region, specifically, the head, ear, eyeball, mouth, or face. Football injuries were manually assigned to “non-tackle” or “tackle” based on the injury narratives. Sports & Fitness Industry Association data were used to estimate annual sport participation and calculate annual injury rates per 100,000 participant-years. Results: A total of 26,770 incident reports from 2014 to 2018 were analyzed. For head region injuries in non-tackle football, the head was the most commonly injured body part, followed by the face; the most common diagnosis was a laceration, followed by concussion and internal injury (defined as an unspecified head injury or internal head injury [eg, subdural hematoma or cerebral contusion]). The most common contacting object was another player. The projected national rate of head region injuries was lowest for non-tackle football across the 4 sports. In particular, the projected rate of injuries to the head for non-tackle football (78.0 per 100,000 participant-years) was less than one-fourth the rates for basketball (323.5 per 100,000 participant-years) and soccer (318.2 per 100,000 participant-years) and less than one-tenth the rate for tackle football (1478.6 per 100,000 participant-years). Conclusion: Among youth in the United States aged 6 to 18 years who were treated in the emergency department for injuries related to playing non-tackle football, the most common diagnosis for injuries to the head region was a laceration, followed by a concussion. Head region injuries associated with non-tackle football occurred at a notably lower rate than basketball, soccer, or tackle football.

scholarly journals Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

2021 ◽  
Author(s):  
Laura C. Blomaard ◽  
Bas de Groot ◽  
Jacinta A. Lucke ◽  
Jelle de Gelder ◽  
Anja M. Booijen ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Older Patients ◽  
Screening Program ◽  
Admission Rate ◽  
Older Patient ◽  
Hospital Admission Rate ◽  
High Risk Patients ◽  
Risk Patients

Abstract Objective The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. Methods We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. Results Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). Conclusion Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

scholarly journals Social and Medical Determinants of Cardiometabolic Health: The Big Picture

2015 ◽  
Vol 25 (4) ◽  
pp. 521 ◽  
Author(s):  
Gary A. Puckrein ◽  
Brent M. Egan
Keyword(s):  
Emergency Department ◽  
Health Disparities ◽  
Social Determinants ◽  
The United States ◽  
Emergency Department Visits ◽  
Cardiometabolic Health ◽  
Years Of Life Lost ◽  
Fee For Service ◽  
Cardiometabolic Diseases ◽  
Mean Cost

<p class="Pa7">Cardiometabolic diseases, including diabetes and heart disease, account for &gt;12 million years of life lost annually among Black adults in the United States. Health disparities are geographically localized, with ~80% of health disparities occurring within ~6000 (16%) of all 38,000 US ZIP codes. Socio-economic status (SES), behavioral and environmental fac­tors (social determinants) account for ~80% of variance in health outcomes and cluster geographically. Neighborhood SES is inversely associated with prevalent diabetes and hyper­tension, and Blacks are four times more likely than Whites to live in lowest SES neighbor­hoods. In ZIP code 48235 (Detroit, 97% Black, 16.2% unemployed, income/capita $18,343, 23.6% poverty), 1082 Medicare fee-for service (FFS) beneficiaries received care for type 2 diabetes (T2D) and coronary artery disease (CAD) in 2012. Collectively, these beneficiaries had 1082 inpatient admissions and 839 emergency department visits, mean cost $27,759/beneficiary and mortality 2.7%. Nationally in 2011, 236,222 Black Medicare FFS beneficiaries had 213,715 inpatient admissions, 191,346 emergency department visits, mean cost $25,580/beneficiary and 2.4% mortality. In addition to more prevalent hypertension and T2D, Blacks appear more susceptible to clinical complications of risk fac­tors than Whites, including hypertension as a contributor to stroke. Cardiometabolic health equity in African Americans requires interven­tions on social determinants to reduce excess risk prevalence of risk factors. Social-medical interventions to promote timely access to, delivery of and adherence with evidence-based medicine are needed to counterbal­ance greater disease susceptibility. Place-based interventions on social and medical determi­nants of health could reduce the burden of life lost to cardiometabolic diseases in Blacks. <em>Ethn Dis. </em>2015;25(4):521-524; doi:10.18865/ ed.25.4.521</p>

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