Risk Factors Predicting the Necessity of Renal Ultrasound in the Emergency Department

Objectives: Renal ultrasound (US) is widely used for diagnosing renal pathologies, though few of them, such as obstructive uropathy, require emergent urological intervention. During on-call hours, when medical staff is limited, it is important to prioritize which renal US examinations will be done. The aim of this study was to evaluate patient risk factors to predict the necessity of emergent renal US in the emergency department (ED). Material and Methods: All adult patients referred for renal US from the ED, during on-call hours from May 2015 to April 2017, were retrospectively included. The mean age was 64 years (18–98). Data were collected from the patients’ medical records. Urological intervention performed within the first 24 h following the US examination was recorded. Multivariate analysis was performed. Results: About 66% of the patients did not have a permanent urethral catheter, history of renal stones, or known abdominal or pelvic mass. None of these patients required an urgent urological intervention. The receiver operating characteristic curve was calculated at 0.883, 95% CI (0.84–0.92). Conclusion: Using only three variables, we can greatly reduce the number of renal US examinations done at on-call hours allowing for prioritization of only the necessary examinations.

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Stroke prediction in patients presenting with isolated dizziness in the emergency department

Scientific Reports ◽

10.1038/s41598-021-85725-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

June-sung Kim ◽

Hong Jun Bae ◽

Muyeol Kim ◽

Shin Ahn ◽

Chang Hwan Sohn ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Multivariate Analysis ◽

Acute Stroke ◽

Neurological Deficits ◽

Cerebrovascular Injury ◽

Risk Patients ◽

History Of ◽

Independent Risk Factors ◽

Record Review

AbstractDiagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. The aim of this study was to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population. This was an observational, retrospective record review of consecutive 2215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of > 65 years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65 years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.

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Differing Contributions of Classical Risk Factors to Type 2 Diabetes in Multi-Ethnic Malaysian Populations

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15122813 ◽

2018 ◽

Vol 15 (12) ◽

pp. 2813

Author(s):

Noraidatulakma Abdullah ◽

Nor Abdul Murad ◽

John Attia ◽

Christopher Oldmeadow ◽

Mohd Kamaruddin ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Type 2 Diabetes ◽

Family History ◽

Characteristic Curve ◽

Lifestyle Factors ◽

Predictive Utility ◽

Family History Of Diabetes ◽

History Of

The prevalence of type 2 diabetes is escalating rapidly in Asian countries, with the rapid increase likely attributable to a combination of genetic and lifestyle factors. Recent research suggests that common genetic risk variants contribute minimally to the rapidly rising prevalence. Rather, recent changes in dietary patterns and physical activity may be more important. This nested case-control study assessed the association and predictive utility of type 2 diabetes lifestyle risk factors in participants from Malaysia, an understudied Asian population with comparatively high disease prevalence. The study sample comprised 4077 participants from The Malaysian Cohort project and included sub-samples from the three major ancestral groups: Malay (n = 1323), Chinese (n = 1344) and Indian (n = 1410). Association of lifestyle factors with type 2 diabetes was assessed within and across ancestral groups using logistic regression. Predictive utility was quantified and compared between groups using the Area Under the Receiver-Operating Characteristic Curve (AUC). In predictive models including age, gender, waist-to-hip ratio, physical activity, location, family history of diabetes and average sleep duration, the AUC ranged from 0.76 to 0.85 across groups and was significantly higher in Chinese than Malays or Indians, likely reflecting anthropometric differences. This study suggests that obesity, advancing age, a family history of diabetes and living in a rural area are important drivers of the escalating prevalence of type 2 diabetes in Malaysia.

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Stroke prediction in patients presenting with isolated dizziness in the emergency department

10.21203/rs.3.rs-118052/v1 ◽

2020 ◽

Author(s):

June-sung Kim ◽

Hong Jun Bae ◽

Muyeol Kim ◽

Shin Ahn ◽

Chang Hwan Sohn ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Multivariate Analysis ◽

Acute Stroke ◽

Neurological Deficits ◽

Cerebrovascular Injury ◽

Risk Patients ◽

History Of ◽

Independent Risk Factors ◽

Record Review

Abstract Diagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. This study tried to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population. This was an observational, retrospective record review of consecutive 2,215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1,239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1,239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of > 65 years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65 years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.

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Prognostic significance of urine paraquat concentrations of patients with acute paraquat poisoning on admission at the emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907917742873 ◽

2018 ◽

Vol 25 (1) ◽

pp. 3-11 ◽

Cited By ~ 1

Author(s):

Xiaowei Liu ◽

Tao Ma ◽

Zhi Liu

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Characteristic Curve ◽

Prognostic Significance ◽

Urine Concentration ◽

Paraquat Poisoning ◽

Independent Risk Factors ◽

Receiver Operating

Objective: To assess the prognostic significance of urine paraquat concentrations of patients with acute paraquat poisoning on admission at the emergency department. Methods: Patients with acute paraquat poisoning admitted to the emergency department were recruited. Survivors and non-survivors were compared with regard to urinary paraquat concentration. The urinary level predictive of mortality was assessed by receiver operating characteristic curve. Risk factors of mortality were evaluated by regression analysis. Results: The overall mortality rate was 70.9% over the 28-day follow-up period. There was a significant difference in the urine paraquat concentrations recorded on admission between non-surviving and surviving patients ( p = 0.022). Receiver operating characteristic curve analysis revealed that the area under the curve when applied to receiver operating characteristic of the admission urine paraquat concentrations for predicting mortality was 0.854 with a cut-off value of 34.5 µg/mL. The dose of paraquat ingested, arterial lactate, and urine concentration were independent risk factors predicting 28-day mortality. The time interval between ingestion and hemoperfusion, arterial lactate, and urine concentration of paraquat were independent risk factors predicting acute kidney injury, while the partial pressure of carbon dioxide (PaCO2) and urine concentration of paraquat were independent risk factors predicting acute lung injury. Conclusion: The urine concentrations of paraquat on admission at emergency department demonstrated predictive ability for the prognosis of patients with acute paraquat poisoning.

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Abstract 49: Male Sex is Associated With Cervical Artery Dissection in Patients With Fibromuscular Dysplasia

Stroke ◽

10.1161/str.51.suppl_1.49 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Charlotte Arnaud ◽

Marion Boulanger ◽

Aurélien Lorthioir ◽

Laurence Amar ◽

Arshid Azarine ◽

...

Keyword(s):

Risk Factors ◽

Fibromuscular Dysplasia ◽

Pooled Analysis ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

University Hospitals ◽

The Us ◽

Cervical Artery ◽

History Of ◽

Male Sex

Background: Cervical artery dissection (CeAD) is one of the most frequent manifestations of fibromuscular dysplasia (FMD). However, the risk factors for CeAD are unknown. We investigated factors associated with CeAD in the ARCADIA (Assessment of Renal and Cervical Artery Dysplasia) registry and performed a pooled analysis of published and unpublished data. Methods: Patients included were women and men ≥18 years, diagnosed with renal, cervical, or intracranial artery FMD, prospectively recruited at 16 university hospitals in France and Belgium. Diagnosis of CeAD was established by stroke specialists in each participating center, according to standard diagnostic criteria. Associations between CeAD and potential determinants were assessed by calculations of crude and adjusted odds ratios. Results: Among 469 patients (415 women) with FMD, 68 (14.5%) had CeAD. CeAD patients were younger, more likely to be men and to have a history of migraine, and less likely to have a history of hypertension, than non-CeAD patients. In the multivariate analysis, male sex (OR=2.75 ; CI95% 1.39-5.46), history of migraine (OR=1.93 ; 1.08-3.44), age >50 years (OR=0.41 ; 0.23-0.74), history of hypertension (OR=0.35 ; 0.19-0.63), and the number of vascular beds involved by FMD >=3 (OR=2.46 ; 1.13-5.35) remained significantly associated with CeAD. We collected data from 2 published studies and unpublished data from the US and the European Registries. There was no overlap between studies. In a pooled analysis (289 CeAD in 1933 patients), male sex was significantly associated with CeAD (pooled OR=2.04 ; 1.41-2.95, I2=0%, Figure). Conclusion: In patients with FMD, male sex and multisite involvement are associated with of CeAD, in addition to other previous known risk factors.

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Risk factors of vitamin K antagonist overcoagulation

Thrombosis and Haemostasis ◽

10.1160/th08-04-0265 ◽

2008 ◽

Vol 100 (10) ◽

pp. 685-692 ◽

Cited By ~ 11

Author(s):

Gwenaëlle Cadiou ◽

Rémi Varin ◽

Hervé Levesque ◽

Vanessa Grassi ◽

Jacques Benichou ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Medical History ◽

Vitamin K ◽

Female Gender ◽

Vitamin K Antagonist ◽

High Morbidity ◽

Duration Of Hospitalization ◽

History Of ◽

Previous Medical History

SummaryThe aims of this case-control study were to identify in vitamin K antagonist (VKA)-treated unselected patients, factors associated with international normalised ratio (INR) values: (i) greater than 6.0.;and (ii) ranging from 4.0 to 6.0 complicated with bleeding. We also assessed VKA-related morbidity in these patients. During a two-month period, 4,188 consecutive and unselected patients were referred to our Emergency Department. At admission, the medical records of each patient and two age- and sex-matched controls were reviewed for: both duration and indication of VKA therapy, previous medical history of VKA-related haemorrhage, underlying co-morbidities, concomitant medications other than VKA, duration of hospitalization and deaths’ causes. Of these 4,188 subjects,50 case-patients (1.19%) were identified; both case-patients and controls did not differ as regards indications and patterns of VKA therapy. Interestingly, two-thirds of case-patients were women, suggesting that female gender may be a risk factor of VKA over-coagulation onset. We identified the following risk factors of VKA over-coagulation: previous medical history of INR levels over therapeutic range, therapy with antibiotics, amiodarone and proton pump inhibitors, as well as fever. A total of 88% of case-patients were hospitalized; mean duration of patients’ hospitalization was seven days [range:1–56 days];no patient died from major bleeding. Our study underscores that it is of utmost importance to consider the strength of indication before starting VKA therapy, as this therapy has been responsible for as high as 1.19% of admissions in unselected subjects referred to an Emergency Department. Our data therefore suggest that internists should be aware of VKA-related high morbidity, particularly in situations at risk of VKA over-coagulation.

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Predictors of ICU admission and long-term outcomes in overdose presentations to Emergency Department

Australasian Psychiatry ◽

10.1177/1039856219889317 ◽

2020 ◽

Vol 28 (1) ◽

pp. 75-79

Author(s):

Mark Savage ◽

Ross Kung ◽

Cameron Green ◽

Brandon Thia ◽

Dinushka Perera ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Emergency Department ◽

Psychiatric Illness ◽

Atypical Antipsychotics ◽

Long Term Outcomes ◽

Icu Admission ◽

History Of

Objective: To describe the characteristics of patients presenting to an Emergency Department (ED) following overdoses; to identify risk factors for intensive care unit (ICU) admission among these patients; and to identify the rate of mortality and repeat overdose presentations over four years. Methods: Adult patients presenting to ED following drug overdose during 2014 were included. Data were collected from medical notes and hospital databases. Results: During the study period, 654 patients presented to ED 800 times following overdose. Seventy-eight (9.8%) resulted in ICU admission, and 59 (7.4%) required intubation; 57.2% had no history of overdose presentations, and 72.9% involved patients with known psychiatric illness. Overdose of atypical antipsychotics (AAP), age and history of prior overdose independently predicted ICU admission. A third of patients ( n = 196, 30%) had subsequent presentations to ED following overdose, in the four years from their index presentation, with an all-cause four-year mortality of 3.4% ( n = 22). Conclusion: A history of overdose, use of AAP and older age were risk factors for ICU admission following ED presentations. Over a third of patients had repeat overdose presentation in the four-year follow-up with a mortality of 3.4%.

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Incidence and Risk Factors for Bilateral Nephrolithiasis: A Large Case-retrospective Study

10.21203/rs.3.rs-414196/v1 ◽

2021 ◽

Author(s):

Xiong Yang ◽

Zhi Li ◽

Shiyong Qi ◽

Linguo Xie ◽

Qiduo Shi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Multivariate Analysis ◽

Kidney Stones ◽

Statistical Significance ◽

Univariate Analysis ◽

Renal Stones ◽

Urinary Stones ◽

Preoperative Imaging ◽

History Of

Abstract To determine the incidence and risk factors of bilateral kidney stones. Utilized the retrospective analysis method on demographic characteristics and clinical data of patients with renal stones in the Second Hospital of Tianjin Medical University. Grouped patients into unilateral and bilateral renal stones according to preoperative imaging and ultrasound examination. Univariate and multivariate analysis methods were used to evaluate the factors that may cause bilateral stones. The study included 7587 patients with kidney stones in total, of whom 4983 had unilateral kidney stones (including 2719 left stones and 2264 right stones), and 2604 had bilateral kidney stones (34.3%). By comparing the unilateral stones group with the bilateral stones group, the univariate analysis demonstrated that weight, body mass index (BMI), history of nephrolithiasis, diabetes mellitus (DM), hypertension, gout, and the maximal stone diameter had statistical significance. Binary logistic regression multivariate analysis demonstrated that BMI, history of nephrolithiasis, diabetes mellitus, hypertension, gout, and the maximal stone diameter were independent risk factors for bilateral urinary stones. This study shows that 34.3% of patients with kidney stones were diagnosed as having bilateral kidney stones; BMI and the maximal stone diameter are positively correlated with the incidence of bilateral kidney stones; Patients with a history of nephrolithiasis, diabetes, hypertension, and gout have a significantly higher risk of having bilateral kidney stones.

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Acute joint pain

Oxford Cases in Medicine and Surgery ◽

10.1093/oso/9780198716228.003.0033 ◽

2015 ◽

Author(s):

Hugo Farne ◽

Edward Norris-Cervetto ◽

James Warbrick-Smith

Keyword(s):

Risk Factors ◽

Septic Arthritis ◽

Cruciate Ligament ◽

Renal Stones ◽

Acute Onset ◽

Joint Function ◽

Prosthetic Joints ◽

History Of ◽

Common Risk Factors ◽

Anterior Cruciate

The ‘must exclude’ diagnosis is septic arthritis. Not only can it destroy articular cartilage within days if not treated (hence permanently reducing joint function), but it is also associated with a mortality of about 10% due to underlying bacteraemia. Remember that pain may be referred from elsewhere. For example, hip pathology may present as knee pain, and lumbar spine pathology may present as hip pain. The causes of a single, acutely painful joint include those shown in Figure 27.1, with larger font size highlighting those that are more common. • Pain. You should characterize the pain as for any other pain along the lines of SOCRATES (see Chapter 1). Pain that worsens with movement and improves with rest is likely to be non-inflammatory. An acute onset (hours) is consistent with septic arthritis, gout/pseudogout, and trauma. A more insidious onset is more common in conditions like bursitis and tendonitis, where the relevant anatomical structure becomes inflamed with overuse. Chronic onset suggests osteoarthritis (note that some rheumatologists prefer the term osteoarthrosis to reflect the fact that the inflammation is not the primary pathology). The severity of pain can usefully be assessed by asking about joint function—for example, can the patient weight bear? • Trauma. Mr Sullivan has already said he does not remember there being any trauma, but you must always ask and make sure. Even the slightest of knocks can cause significant pain. However, this does not exclude other diagnoses—trauma can precipitate infection or gout, for example. • Common risk factors for gout. There are many potential causes of gout, but the more common ones that you should ask about include use of thiazide diuretics, recent heavy alcohol intake, chronic renal failure, and chemotherapy (high cell apoptosis, leading to degradation of DNA and excess urate). A history of renal stones or previous episodes of gout also makes gout more likely. • Common risk factors for septic arthritis. Again there are many possible risk factors, but the key ones are immunosuppression (e.g. diabetes, HIV, steroid use) and any prosthetic joints. • Risk factors for haemarthrosis. Typically due to a coagulopathy (e.g. classically haemophilia), anticoagulant use (typically warfarin) or trauma (e.g. a ruptured anterior cruciate ligament in the knee).

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Self-Reported Cardiac Risk Factors in Emergency Department Nurses and Paramedics

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00025036 ◽

2000 ◽

Vol 15 (2) ◽

pp. 14-17 ◽

Cited By ~ 12

Author(s):

Tyler W. Barrett ◽

Valerie C. Norton ◽

Matthew Busam ◽

Julie Boyd ◽

David J. Maron ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Emergency Department ◽

High Risk ◽

Cardiac Disease ◽

Cardiac Risk ◽

Smoking History ◽

Cardiac Risk Factors ◽

History Of ◽

Very High

AbstractStudy Objective:Our objective was to assess the prevalence of cardiac risk factors in a sample of urban paramedics and emergency department (ED) nurses.Methods:We asked 175 paramedics and ED nurses working at a busy, urban ED to complete a cardiovascular risk assessment. The survey asked subjects to report smoking history, diet, exercise habits, weight, stress levels, medication use, history of hypertension or cardiac disease, family history of cardiovascular disease (CVD), and cholesterol level (if known)Results:129 of 175 surveys were returned (74% return rate) by 85 paramedics and 44 nurses. The percentages of paramedics and nurses at high or very high risk for cardiac disease were 48% and 41%, respectively. Forty-one percent of female respondents and 46% of male respondents were at high or very high risk. Cigarette smoking was reported in 19% of the paramedics and 14% of the nurses. The percentages of paramedics and nurses who reported hypertension were 13% and 11%, respectively. High cholesterol was reported in 31% of paramedics and 16% of nurses.Conclusions:Forty-eight percent of paramedics and 41% of ED nurses at this center are at high or very high risk for cardiovascular disease, by self-report. Efforts should be made to better educate and intervene in this population of health-care providers in order to reduce their cardiac risk.

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