Evaluating the Causes and Frequency of Frequent Referral to the Emergency Department of Imam Khomeini Educational Hospital in Sari

Introduction: Emergency department is one of the most important units of a hospital. In general, the most serious cases are referred to emergency department, and the highest numbers of hospital admissions occur in the emergency department. This study aimed to obtain a comprehensive estimate of the number of frequent visitors to the emergency department of Imam Khomeini educational hospital, Sari. Materials and Methods: This cross-sectional descriptive study was performed retrospectively by referring to the patient medical records at the Sari Imam Khomeini education hospital. The records were screened to identify frequent emergency department visitors in 2017. Data analysis was performed using SPSS 21. Results: The number of emergency department visitors in the Sari Imam Khomeini Hospital in 2017 was 29,765; of them, 594 (6.2%) were repeat visitors and were included in this study. The mean age of the frequent emergency department visitors was 56.17 years. The most common complaint was weakness and lethargy in 39.9% patients, abdominal pain in 30%, shortness of breath in 14%, and other causes in 14%. The most common underlying disorders were anemia, followed by obstruction pulmonary disease. Conclusion: We obtained detailed data of frequent emergency department visitors to aid the development of suitable evidence-based policies. New policies are necessary for the management of various sections of the emergency department and inpatient admissions. Such policies will allow better decision-making for non-emergency patients and outpatient admissions.

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First Surveillance of Violence against Women during COVID-19 Lockdown: Experience from “Niguarda” Hospital in Milan, Italy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073801 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3801

Author(s):

Giulio Nittari ◽

Getu Gamo Sagaro ◽

Alessandro Feola ◽

Mattia Scipioni ◽

Giovanna Ricci ◽

...

Keyword(s):

Emergency Department ◽

Violence Against Women ◽

Social Problem ◽

Medical Records ◽

Hospital Admissions ◽

Daily News ◽

The People ◽

Notable Increase

Violence against women emerges with tragic regularity in the daily news. It is now an evident trace of a dramatic social problem, the characteristics of which are not attributable to certain economic, cultural, or religious conditions of the people involved but affect indiscriminately, in a unanimous way, our society. The study is a survey about the number of hospital admissions due to episodes attributable to violence against women, recorded by the Niguarda Hospital in Milan in the period 1 March–30 May from 2017 to 2020. This period, in 2020, corresponds to the coronavirus Lockdown in Italy. All the medical records of the Emergency department were reviewed, and the extracted data classified in order to identify the episodes of violence against women and the features of the reported injuries and the characteristics of the victims. The data did not show an increase in the number of cases in 2020 compared to previous years, but we did find a notable increase in the severity of injuries.

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Mohs micrographic surgery: a study of 83 cases

Anais Brasileiros de Dermatologia ◽

10.1590/s0365-05962012000200006 ◽

2012 ◽

Vol 87 (2) ◽

pp. 228-234 ◽

Cited By ~ 7

Author(s):

Flavianne Sobral Cardoso Chagas ◽

Bruno de Santana Silva

Keyword(s):

Cell Carcinoma ◽

Medical Records ◽

Cross Sectional Study ◽

Mohs Micrographic Surgery ◽

Micrographic Surgery ◽

Cross Sectional ◽

The Mean ◽

Nasal Region ◽

Cure Rates ◽

Observation Period

BACKGROUND: Mohs micrographic surgery can achieve high cure rates in the treatment of skin cancer and remove a minimum of healthy tissue. OBJECTIVES: To characterize patients undergoing Mohs micrographic surgery and study issues related to the number of surgical stages. METHODS: A descriptive, retrospective, cross-sectional study was conducted in a micrographic surgery reference center for the period of 2004 to 2010. Data was collected from medical records of 79 patients (83 surgeries). RESULTS: We studied 43 women and 36 men. The mean age was 57.5 ± 14,6 years. Skin types II and III were the most frequent, accounting for 41% and 36.1%, respectively. The most frequent tumor was the basal cell carcinoma (89.1%), and the solid subtype was the most common (44.6%), followed by sclerodermiform histological subtype (32%).The most frequent location was the nasal region (44.6%). The large majority of the operated tumors were recurrent lesions (72.7%). Half of the tumors measured 2 cm or more. In 68.7% of the cases two or more surgical stages were necessary for the removal of the tumors. The observation period was 2 or more years in 75% of the tumors. There was 01 post-Mohs recurrence and 02 patients had metastases during the observation period (both with squamous cell carcinoma). CONCLUSION: The findings coincide with those of the literature, recurrent tumors and tumors larger than 2cm needed more surgical stages for their removal, although there was no statistic difference (p=0,12 and 0,44 respectively).

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Association between endometriosis, headache, and migraine

Journal of Endometriosis and Pelvic Pain Disorders ◽

10.1177/2284026518818975 ◽

2019 ◽

Vol 11 (1) ◽

pp. 19-24 ◽

Cited By ~ 4

Author(s):

Burcin Karamustafaoglu Balci ◽

Zehra Kabakci ◽

Damla Y Guzey ◽

Bartu Avci ◽

Murathan Guler ◽

...

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

Medical Records ◽

Cross Sectional Study ◽

Control Group ◽

Cross Sectional ◽

Autonomic Nervous ◽

Screening Questions ◽

The Mean ◽

Id Migraine

Introduction: Available data suggest that there is an association between endometriosis and a group of disorders including autonomic nervous system irregularities. A deeper understanding of relationship between endometriosis and autonomic nervous system is needed as it may lead to novel discoveries on the causes or consequences of endometriosis. In this study, we analyzed the prevalence of migraine in patients with endometriosis. Methods: In this cross-sectional study, medical records of women were reviewed through January 2013 to December 2017. Women with laparoscopically proven endometriosis (n = 185) were compared with those without endometriosis (n = 168). The 3-item screening questions (ID Migraine™) test was used to screen migraine. Data were analyzed using SPSS v25 (IBM Corporation). The χ2 test was used for analyzing the nominal parameters and group comparisons. Pearson χ2 was used to study the association between endometriosis and migraine. Results: The mean age was 31.86 ± 4.49 years of the endometriosis group and 28.95 ± 5.11 years of the controls (p = 0.408). The two pre-screening questions of ID Migraine test were answered positively by 86 patients of the endometriosis group (75.4%) and by 53 patients of the control group (54.6%) (p = 0.001). Of these patients, 51 (44.7% of endometriosis group) and 26 (26.8% of control group) were diagnosed as having migraine using 3-item Migraine questionnaire (p = 0.007). Conclusion: This study showed that the prevalence of migraine was significantly higher in patients with endometriosis. Because there is a strong correlation, patients with endometriosis should be screened for headache and migraine to increase the benefits of care.

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Clinical characteristics and outcome of vasculitides

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v3i2.20267 ◽

2016 ◽

Vol 3 (2) ◽

pp. 3-9

Author(s):

Buddhi Prasad Paudyal ◽

Anjana Education Rajbhandari

Keyword(s):

Medical Records ◽

Clinical Characteristics ◽

Cross Sectional Study ◽

Health Sciences ◽

Small Vessel ◽

Small Vessel Vasculitis ◽

Cross Sectional ◽

The Mean ◽

Schonlein Purpura ◽

Overall Mortality

Introductions: Vasculitides can cause significant morbidity and mortality if not treated on time. There is lack of data locally. This study aims to define the pattern, clinical characteristics, and outcome of vasculitides.Methods: This was a cross sectional study between January 2011 and December 2015 at Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal. The medical records of patients diagnosed with vasculitides in adults rheumatology service of the hospital were reviewed.Results: Ninety six patients were diagnosed with vasculitides during the study period. The mean age was 42.2 years. Sixty nine (71.8%) patient had small vessel, 20 (20.8%) large vessel and five (5.2%) had variable vessel vasculitides. Seventy five patients (78.1%) had primary and 21 (21.8%) secondary vasculitides. Cutaneous leucocytoclasticangitis was seen in 27 (28.1%), Takayasu arteritis in 17 (17.7), Henoch-Schonlein purpura in 11 (11.4%) and Rheumatoid arthritis associated vasculitis in nine patients. Purpura was present in all 96 (100%). The overall mortality was 9 (9.3%).Conclusions: Primary vasculitides were more common than secondary forms. Small vessel vasculitis was the most common. Cutaneous symptoms were predominant features. The mortality was attributed to active disease, sepsis, and complications of the primary disease. Journal of Patan Academy of Health Sciences. 2016 Dec;3(2):3-9

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Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study

10.21203/rs.3.rs-22231/v3 ◽

2020 ◽

Author(s):

Julia Brandenberger ◽

Christian Pohl ◽

Florian Vogt ◽

Thorkild Tylleskär ◽

Nicole Ritz

Keyword(s):

Health Care ◽

Emergency Department ◽

Retrospective Study ◽

Hospital Admissions ◽

Tertiary Care ◽

Median Number ◽

Care Hospital ◽

Children With Medical Complexity ◽

Cross Sectional ◽

Number Of Visits

Abstract BackgroundAsylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital.MethodsWe performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups.Results A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1-2) in the asylum-seeking and 2 (IQR 1-4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (>15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. ConclusionsHospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.

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Results of Classification of Korean Triage And Acute Scale of Patients Visiting The Emergency Department

10.21203/rs.3.rs-711845/v1 ◽

2021 ◽

Author(s):

Kyeongmin Jang ◽

Sung Hwan Kim

Keyword(s):

Emergency Department ◽

Medical Records ◽

Research Study ◽

Emergency Department Visits ◽

Descriptive Research ◽

High Severity ◽

Emergency Department Stay ◽

Scale Levels ◽

The Mean

Abstract BackgroundNot much is known about the results of the severity classification according to the time of visit to the emergency department and the appropriateness of using a public ambulance when visiting the emergency department.MethodsThis descriptive research study retrospectively reviewed and analyzed the medical records of patients who visited the emergency department of the B general hospital in Seoul from January to December 2019.ResultsA total of 54,297 patients were included in the analysis. Of the total, 34,629 (63.8%) patients visited directly while 14,065 (25.9%) visited through public ambulances, and 10,328 (73.4%) of patients using public ambulances were discharged home. The numbers of daytime and nighttime patients were 24,891 (45.8%) and 29,406 (54.2%), respectively. The mean length of emergency department stay (LoS) of patients classified as emergency was 326 minutes, while that of non-emergency patients was 159 minutes. In addition, the mean LoS of patients classified as Korean triage and acuity scale levels 1 and 2 was 427 min and 430 min, respectively, which was longer than the total of 236 minutes.ConclusionWe confirmed that patients who visited the emergency department using public ambulances accounted for about 25% of all emergency department visits, and of which 70% were discharged home. In addition, patients with high severity showed a longer mean LoS, and daytime showed higher severity and more patients than nighttime.

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The prevalence of potentially beneficial and harmful drug-drug interactions in intensive care units

Drug Metabolism and Personalized Therapy ◽

10.1515/dmpt-2018-0034 ◽

2019 ◽

Vol 34 (1) ◽

Cited By ~ 1

Author(s):

Hossein Ali Mehralian ◽

Jafar Moghaddasi ◽

Hossein Rafiei

Keyword(s):

Intensive Care ◽

Drug Interaction ◽

Drug Interactions ◽

Intensive Care Units ◽

Medical Records ◽

Potential Ddis ◽

Cross Sectional ◽

Text Book ◽

The Mean ◽

Potential Interactions

Abstract Background The present study was conducted with the aim of investigating the prevalence of potentially beneficial and harmful drug-drug interactions (DDIs) in intensive care units (ICUs). Methods The present cross-sectional prospective study was conducted in two ICUs in Shahr-e Kord city, Iran. The study sample was consisted of 300 patients. The Drug Interaction Facts reference text book [Tatro DS. Drug interaction facts. St Louis, MO: Walters Kluwer Health, 2010.] was used to determine the type and the frequency of the DDIs. Results The participants consisted of 189 patients men and 111 women. The mean age of patients was 44.2 ± 24.6 years. Totally, 60.5% of patients had at least one drug-drug interaction in their profile. The total number of DDIs found was 663 (the mean of the total number of drug-drug interactions was 2.4 interactions per patient). Of all the 663 interactions, 574 were harmful and others were beneficial. In terms of starting time, 98 of the potential interactions were rapid and 565 of them were delayed. In terms of severity, 511 of the potential interactions were moderate. Some of the drugs in the patients’ medical records including phenytoin, dopamine, ranitidine, corticosteroid, dopamine, heparin, midazolam, aspirin, magnesium, calcium gluconate, and antibiotics, the type of ventilation, the type of nutrition and the duration of hospital stay were among the factors that were associated with high risk of potential DDIs (p < 0.05). Conclusions The prevalence of potentially beneficial and harmful DDIs, especially harmful drug-drug interactions, is high in ICUs and it is necessary to reduce these interactions by implementing appropriate programs and interventions.

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High-Cost, High-Need Users of Acute Unscheduled HIV Care: A Cross-Sectional Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa037 ◽

2020 ◽

Vol 7 (2) ◽

Author(s):

Conor Grant ◽

Colm Bergin ◽

Sarah O’Connell ◽

John Cotter ◽

Clíona Ní Cheallaigh

Keyword(s):

Emergency Department ◽

Hospital Admissions ◽

High Volume ◽

Cross Sectional Study ◽

Emergency Department Visits ◽

Hiv Care ◽

Psychiatric Disease ◽

Cross Sectional ◽

Unscheduled Care ◽

Cumulative Length

Abstract Background High-cost, high-need users are defined as patients who accumulate large numbers of emergency department visits and hospital admissions that might have been prevented by relatively inexpensive early interventions and primary care. This phenomenon has not been previously described in HIV-infected individuals. Methods We analyzed the health records of HIV-infected individuals using scheduled or unscheduled inpatient or outpatient health care in St James’s Hospital, Dublin, Ireland, from October 2014 to October 2015. Results Twenty-two of 2063 HIV-infected individuals had a cumulative length of stay >30 days in the study period. These individuals accrued 99 emergency department attendances and 1581 inpatient bed days, with a direct cost to the hospital of >€1 million during the study period. Eighteen of 22 had potentially preventable requirements for unscheduled care. Two of 18 had a late diagnosis of HIV. Sixteen of 18 had not been successfully engaged in outpatient HIV care and presented with consequences of advanced HIV. Fourteen of 16 of those who were not successfully engaged in care had ≥1 barrier to care (addiction, psychiatric disease, and/or homelessness). Conclusions A small number of HIV-infected individuals account for a high volume of acute unscheduled care. Intensive engagement in outpatient care may prevent some of this usage and ensuing costs.

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NECROTISING FASCIITIS : PREVELANCE AND DISTRIBUTION OF CAUSATIVE MICROORGANISM IN A MALAYSIA TERTIARY HOSPITAL - A 2 YEAR STUDY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00048 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0004

Author(s):

A.H M.Asyraf ◽

S Ashraf- Fareeq ◽

S Zulfahrizzat ◽

HS Arvinder-Singh ◽

Vasantha Kumari Neela ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Klebsiella Pneumoniae ◽

Medical Records ◽

Group B Streptococcus ◽

Tertiary Hospital ◽

Lower Limbs ◽

Cross Sectional ◽

Causative Microorganism ◽

The Mean ◽

Group B

The objective of this study was to evaluate the prevalence of microorganism isolates types, antibiotic usage preference, the prevalence of diabetic amputations in necrotizing fasciitis (NF) and predicitive factors of amputation. Methodology: This study was a cross-sectional study conducted by looking at medical records ttraced from Hospital Seremban identifying all necrotizing fasciits admissions in the year of 2017/2018. The researchers first traced all medical records via electronic medical records. All case records were reviewed and identifiers were removed. Patients with missing notes/medico-legal cases were excluded from this study. Results: A total of 159 records were traced of which none met the exclusion criteria. The mean age of patients were 56.09 (SD:12.20), mean days stayed at hospital 25.09 (17.70) and the mean number of days patients were on at least one antibiotic was 18.87 (41.78). From the total, 145 (91.2%) were suffered at the lower limbs, 68 (42.8%) suffered an amputation [of which 31 were above-knee-amputations], 97 (61.0%) suffered from sepsis and 19 (11.9%) suffered mortality. 139 (87.4%) of the patients were diabetics, 105 (66.0%) were hypertensives and 87 (54.7%) were immunocompramised. The majority were caused by unknown aetiology [103 (64.8%)], 131 (82.4%) presented with erythema/cellulitis and 116 (73.0%) had good prognosis. The commonest type of NF was type 2 [103 (64.8%)]. The top 3 commonest isolates were Pseudomonas aeruginosa (15.7%), Klebsiella pneumoniae (12.6%) and β haemolytic Group B Streptococcus (10.7%). The 3 commonest antibiotics started were ampicillin/sulbactam combination (69.8%), ceftazidime (9.4%) and amoxycillin/clavulanate (4.4%). The mean LRINEC score was 7.72 (SD:2.31). Among the 139 diabetics, 68 (48.9%) ended up with an amputation. Among the 102 patients having both diabetes and hypertension (n=102), 50% suffered an amputation. A cross tabulation done showed that Klebsiella pneumoniae (17.2%), β haemolytic Group B Streptococcus (15.5%) and Proteus mirabillis (13.8%) were the common causative organisms in an amputation. A regression analysis done to identify predictive variables for an amputation showed no statistical significant variables. Conclusion: Proper handling of seafood during preparation should be encouraged as a simple bite may turn deadly. Initiation of antibiotics according to suspected organisms should be performed to prevent worsening of soft tissue infections. Conclusion: From this study, we concluded that the commonest type of isolates at our centre was Pseudomonas aeruginosa and the commonest antibiotic choice was the ampicillin/sulbactam combination and nearly half of diabetics with NF ended up with an amputation. There were no predictive factors for an amputation among the collected variables

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Paediatric dermatological conditions in an emergency department: a single-centre study in Thailand

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001215 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001215

Author(s):

Leelawadee Techasatian ◽

Rattapon Uppala ◽

Pariwat Phungoen

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Associated Factors ◽

Hospital Admissions ◽

Cross Sectional Study ◽

Cross Sectional ◽

Paediatric Patients ◽

Drug Eruptions ◽

Dermatological Condition ◽

Mucosal Involvement

BackgroundFew studies have evaluated paediatric dermatological conditions and their associated factors that warrant admission at the emergency department.ObjectivesThe main objective of this study was to present the demographic information of paediatric dermatological conditions encountered in the emergency department and identify possible associated factors for hospital admission.MethodsThis retrospective cross-sectional study included paediatric patients who visited the emergency department between 1 January 2016 and 31 December 2019. Data collection was performed using an authorised electronic medical records programme at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.ResultsA total of 40 683 paediatric patients visited the emergency department during the study period, with 1701 cases presenting dermatological conditions. Infections were the most frequent conditions encountered in the emergency department (647, 38.0%), followed by urticaria/anaphylaxis (478, 28.1%), eczematous diseases (463, 27.2%), cutaneous drug eruptions (64, 3.7%) and miscellaneous (49, 2.9%). Among 1701 paediatric cases with dermatological conditions, only 182 cases (10.7%) were admitted to the hospital and required further management. Cases presenting cutaneous drug eruptions had the highest proportion of hospital admissions (60.9%) and were significantly different from cases in other dermatologic categories (p<0.001). The association of admission found an OR of 0.96 for every year of increase in age (95% CI 0.93 to 0.99, p=0.003).ConclusionThe present study found that the majority of patients with cutaneous conditions visiting the emergency department were non-urgent; however, dermatological emergencies exist and should not be underestimated. Younger paediatric patients presenting with dermatological condition is a population with a high risk for hospital admission. Cutaneous drug eruptions showed the highest proportion of hospital admissions compared with other dermatological categories. Therefore, physicians in the emergency department should always look for specific cutaneous signs of drug eruptions, such as target-like lesions and mucosal involvement in Steven-Johnsons syndrome/toxic epidermal necrolysis to prevent misdiagnosis of this dermatological condition.

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