scholarly journals Spatial patterns of epilepsy-related emergency department visits in California

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Jim E. Banta ◽  
Askari Addison ◽  
W. Lawrence Beeson
Keyword(s):  
Emergency Department ◽  
Los Angeles ◽  
Primary Diagnosis ◽  
Emergency Department Visits ◽  
Spatial Scan Statistic ◽  
Increased Risk ◽  
Ed Visits ◽  
Socio Demographic Factors ◽  
Patients With Epilepsy ◽  
Design And Methods

<p><em>Background</em>. Socio-demographic factors are associated with increased emergency department (ED) use among patients with epilepsy. However, there has been limited spatial analysis of such visits.<br /><em>Design and methods.</em> California ED visit at the patient ZIP Code level were examined using Kulldorf’s spatial scan statistic to identify clusters of increased risk for epilepsy-related visits. Logistic regression was used to examine the relative importance of patient socio-demographics, Census-based and hospital measures. <br /><em>Results</em>. During 2009-2011 there were 29,715,009 ED visits at 330 hospitals, of which 139,235 (0.5%) had epilepsy (International Classification of Disease-9 345.xx) as the primary diagnosis. Three large urban clusters of high epilepsy-related ED visits were centred in the cities of Los Angeles, Oakland and Stockton and a large rural clus- ter centred in Kern County. No consistent pattern by age, race/ethnicity, household structure, and income was observed among all clusters. Regression found only the Los Angeles cluster significant after adjusting for other measures. <br /><em>Conclusions.</em> Geospatial analysis within a large and geographically diverse region identified a cluster within its most populous city having an increased risk of ED visits for epilepsy independent of selected socio-demographic and hospital measures. Additional research is necessary to determine whether elevated rates of ED visits represent increased prevalence of epilepsy or an inequitable system of epilepsy care.</p>

scholarly journals Frequent Emergency Department Visits After Spontaneous Intracerebral Hemorrhage: Who Is at Risk?

2018 ◽  
Vol 8 (4) ◽  
pp. 166-170
Author(s):  
Jerina Nogueira ◽  
Pedro Abreu ◽  
Patrícia Guilherme ◽  
Ana Catarina Félix ◽  
Fátima Ferreira ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Intracerebral Hemorrhage ◽  
Hospital Discharge ◽  
Transitional Care ◽  
Neurological Impairment ◽  
Emergency Department Visits ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Increased Risk ◽  
Ed Visits

Background: The long-term prognosis of spontaneous intracerebral hemorrhage (SICH) is poor. Frequent emergency department (ED) visits can signal increased risk of hospitalization and death. There are no studies describing the risk of frequent ED visits after SICH. Methods: Retrospective cohort study of a community representative consecutive SICH survivors (2009-2015) from southern Portugal. Logistic regression analysis was performed to identify sociodemographic and clinical factors associated with frequent ED visits (≥4 visits) within the first year after hospital discharge. Results: A total of 360 SICH survivors were identified, 358 (98.6%) of whom were followed. The median age was 72; 64% were males. The majority of survivors (n = 194, 54.2%) had at least 1 ED visit. Reasons for ED visits included infections, falls with trauma, and isolated neurological symptoms. Forty-four (12.3%) SICH survivors became frequent ED visitors. Frequent ED visitors were older and had more hospitalizations ( P < .001) and ED visits ( P < .001) prior to the SICH, unhealthy alcohol use ( P = .049), longer period of index SICH hospitalization ( P = .032), pneumonia during hospitalization ( P = .001), and severe neurological impairment at discharge ( P = .001). Pneumonia during index hospitalization (odds ratio [OR]: 3.08; confidence interval [CI]: 1.39-6.76; P = .005) and history of ED visits prior to SICH (OR: 1.64; CI: 1.19-2.26, P = .003) increased the likelihood of becoming a frequent ED visitor. Conclusions: Predictors of frequent ED visits are identifiable at hospital discharge and during any ED visit. Improvement of transitional care and identification of at-risk patients may help reduce multiple ED visits.

scholarly journals Impact of meteorological parameters and air pollution on emergency department visits for cardiovascular diseases in the city of Zagreb, Croatia

2016 ◽  
Vol 67 (3) ◽  
pp. 240-246 ◽  
Author(s):  
Sanja Pintarić ◽  
Ivan Zeljković ◽  
Gordana Pehnec ◽  
Višnja Nesek ◽  
Mislav Vrsalović ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Emergency Department ◽  
Air Temperature ◽  
Negative Correlation ◽  
Significant Negative Correlation ◽  
Primary Diagnosis ◽  
Emergency Department Visits ◽  
University Hospitals ◽  
Emergency Visits ◽  
Ed Visits

Abstract The aim of this study was to investigate whether nitrogen dioxide (NO2), ozone (O3), and certain meteorological conditions had an impact on cardiovascular disease (CVD)-related emergency department (ED) visits in the metropolitan area of Zagreb. This retrospective, ecological study included 20,228 patients with a cardiovascular disease as their primary diagnosis who were examined in the EDs of two Croatian University Hospitals, Sisters of Charity and Holy Spirit, in the study period July 2008-June 2010. The median of daily CVD-related ED visits during the study period was 28 and was the highest during winter. A significant negative correlation was found between CVD-related emergency visits and air temperature measured no more than three days prior to the visit, and the highest negative correlation coefficient was measured two days earlier (R=0.266, p≤0.001). The number of CVD-related emergency visits significantly correlated with the average NO2 concentration on the same day (R=0.191, p<0.001). The results of multiple stepwise regression analysis showed that the number of CVD-related emergency visits depended on air temperature, and NO2 and O3 concentrations. The higher the air temperatures, the lower the number of daily CVD-related emergency visits (p<0.001). An increase in NO2 concentrations (p=0.005) and a decrease in O3 concentrations of two days earlier (p=0.006) led to an increase in CVD-related ED visits. In conclusion, the decrease in O3 concentrations and the increase in NO2, even if below the legally binding thresholds, could be associated with an increase in CVD-related emergency visits and a similar effect was observed with lower temperature measured no more than three days prior to the visit.

scholarly journals Incidence and factors associated with emergency department visits for recurrent skin and soft tissue infections in patients in California, 2005–2011

2016 ◽  
Vol 145 (4) ◽  
pp. 746-754 ◽  
Author(s):  
L. MAY ◽  
E. Y. KLEIN ◽  
E. M. MARTINEZ ◽  
N. MOJICA ◽  
L. G. MILLER
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Geographical Location ◽  
Risk Groups ◽  
Primary Diagnosis ◽  
Emergency Department Visits ◽  
Soft Tissue Infections ◽  
Discharge Data ◽  
Factors Associated ◽  
Ed Visits

SUMMARYMore than 2 million visits for skin and soft tissue infections (SSTIs) are seen in US emergency departments (EDs) yearly. Up to 50% of patients with SSTIs, suffer from recurrences, but associated factors remain poorly understood. We performed a retrospective study of patients with primary diagnosis of SSTI between 2005 and 2011 using California ED discharge data from the State Emergency Department Databases and State Inpatient Databases. Using a multivariable logistic regression, we examined factors associated with a repeat SSTI ED visits up to 6 months after the initial SSTI. Among 197 371 SSTIs, 16·3% were associated with a recurrent ED visit. We found no trend in recurrent visits over time (χ2 trend = 0·68, P = 0·4). Race/ethnicity, age, geographical location, household income, and comorbidities were all associated with recurrent visits. Recurrent ED visits were associated with drug/alcohol abuse or liver disease [odds ratio (OR) 1·4, 95% confidence interval (CI) 1·3–1·4], obesity (OR 1·3, 95% CI 1·2–1·4), and in infections that were drained (OR 1·1, 95% CI 1·1–1·1) and inversely associated with hospitalization after initial ED visit (OR 0·4, 95% CI 0·3–0·4). In conclusion, we found several patient-level factors associated with recurrent ED visits. Identification of these high-risk groups is critical for future ED-based interventions.

scholarly journals Drinking water residence time in distribution networks and emergency department visits for gastrointestinal illness in Metro Atlanta, Georgia

2009 ◽  
Vol 7 (2) ◽  
pp. 332-343 ◽  
Author(s):  
Sarah C. Tinker ◽  
Christine L. Moe ◽  
Mitchel Klein ◽  
W. Dana Flanders ◽  
Jim Uber ◽  
...  
Keyword(s):  
Emergency Department ◽  
Drinking Water ◽  
Residence Time ◽  
Distribution Networks ◽  
Emergency Department Visits ◽  
Residence Times ◽  
Water Residence Time ◽  
Increased Risk ◽  
Ed Visits ◽  
Zip Code

We examined whether the average water residence time, the time it takes water to travel from the treatment plant to the user, for a zip code was related to the proportion of emergency department (ED) visits for gastrointestinal (GI) illness among residents of that zip code. Individual-level ED data were collected from all hospitals located in the five-county metro Atlanta area from 1993 to 2004. Two of the largest water utilities in the area, together serving 1.7 million people, were considered. People served by these utilities had almost 3 million total ED visits, 164,937 of them for GI illness. The relationship between water residence time and risk for GI illness was assessed using logistic regression, controlling for potential confounding factors, including patient age and markers of socioeconomic status (SES). We observed a modestly increased risk for GI illness for residents of zip codes with the longest water residence times compared with intermediate residence times (odds ratio (OR) for Utility 1 = 1.07, 95% confidence interval (CI)=1.03, 1.10; OR for Utility 2 = 1.05, 95% CI = 1.02, 1.08). The results suggest that drinking water contamination in the distribution system may contribute to the burden of endemic GI illness.

Documentation of Firearm Safety Screening During Emergency Department Visits for Assault-Related Injury

2021 ◽  
pp. 152483992110293
Author(s):  
Lauren B. Mulcahy ◽  
Monika K. Goyal ◽  
Joanna Cohen
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
High Risk Group ◽  
Emergency Department Visits ◽  
Washington Dc ◽  
Increased Risk ◽  
Icd 10 ◽  
Ed Visits ◽  
Firearm Safety

Assault-injured youth have an increased risk of future violence. Identifying firearm access among youth in the emergency department (ED) creates an opportunity for interventions aimed at reducing future violent events. We performed this study to determine the extent to which children with assault-related injuries are screened for access to firearms in the ED. We performed a retrospective chart review of all medical records from adolescent ED visits to an academic, tertiary care pediatric hospital in Washington DC with ICD-10 codes related to assault in a 3-month period. We found that among 252 assault-related encounters, none had any documentation of firearm access in the provider note, social work note, or psychiatry consultant note. Therefore, we concluded that firearm access screening is rarely documented in ED visits among patients who present for an assault, highlighting an important missed opportunity for firearm access screening among this high-risk group.

scholarly journals Patient‐Reported Outcomes Predict Future Emergency Department Visits and Hospital Admissions in Patients With Stroke

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Irene L. Katzan ◽  
Nicolas Thompson ◽  
Andrew Schuster ◽  
Dolora Wisco ◽  
Brittany Lapin
Keyword(s):  
Emergency Department ◽  
Patient Reported Outcomes ◽  
Prediction Models ◽  
Hospital Admissions ◽  
Emergency Department Visits ◽  
Mitigation Strategies ◽  
Increased Risk ◽  
Patient Reported ◽  
Ed Visits ◽  
Unplanned Admissions

Background Identification of stroke patients at increased risk of emergency department (ED) visits or hospital admissions allows implementation of mitigation strategies. We evaluated the ability of the Patient‐Reported Outcomes Information Measurement System (PROMIS) patient‐reported outcomes (PROs) collected as part of routine care to predict 1‐year emergency department (ED) visits and admissions when added to other readily available clinical variables. Methods and Results This was a cohort study of 1696 patients with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or transient ischemic attack seen in a cerebrovascular clinic from February 17, 2015, to June 11, 2018, who completed the following PROs at the visit: Patient Health Questionnaire‐9, Quality of Life in Neurological Disorders cognitive function, PROMIS Global Health, sleep disturbance, fatigue, anxiety, social role satisfaction, physical function, and pain interference. A series of logistic regression models was constructed to determine the ability of models that include PRO scores to predict 1‐year ED visits and all‐cause and unplanned admissions. In the 1 year following the PRO encounter date, 1046 ED visits occurred in 548 patients; 751 admissions occurred in 453 patients. All PROs were significantly associated with future ED visits and admissions except PROMIS sleep. Models predicting unplanned admissions had highest optimism‐corrected area under the curve (range, 0.684–0.724), followed by ED visits (range, 0.674–0.691) and then all‐cause admissions (range, 0.628–0.671). PROs measuring domains of mental health had stronger associations with ED visits; PROs measuring domains of physical health had stronger associations with admissions. Conclusions PROMIS scales improve the ability to predict ED visits and admissions in patients with stroke. The differences in model performance and the most influential PROs in the prediction models suggest differences in factors influencing future hospital admissions and ED visits.

scholarly journals Impact of Extremely Hot Days on Emergency Department Visits for Cardiovascular Disease among Older Adults in New York State

2019 ◽  
Vol 16 (12) ◽  
pp. 2119 ◽  
Author(s):  
Mengxuan Li ◽  
Benjamin A. Shaw ◽  
Wangjian Zhang ◽  
Elizabeth Vásquez ◽  
Shao Lin
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
New York ◽  
New York State ◽  
Emergency Department Visits ◽  
York State ◽  
Mean Temperature ◽  
Increased Risk ◽  
Hot Days ◽  
Ed Visits

Prior studies have reported the impact of ambient heat exposure on heat-related illnesses and mortality in summer, but few have assessed its effect on cardiovascular diseases (CVD) morbidity, and the association difference by demographics and season. This study examined how extremely hot days affected CVD-related emergency department (ED) visits among older adults from 2005–2013 in New York State. A time-stratified case-crossover design was used to assess the heat–CVD association in summer and transitional months (April–May and September–October). Daily mean temperature >95th percentile of regional monthly mean temperature was defined as an extremely hot day. Extremely hot days were found to be significantly associated with increased risk of CVD-related ED visits at lag day 5 (OR: 1.02, 95% CI: 1.01–1.04) and lag day 6 (OR: 1.01, 95% CI: 1.00–1.03) among older adults in summer after controlling for PM2.5 concentration, relative humidity, and barometric pressure. Specifically, there was a 7% increased risk of ischemic heart disease on the day of extreme heat, and increased risks of hypertension (4%) and cardiac dysrhythmias (6%) occurred on lag days 5 and 6, respectively. We also observed large geographic variations in the heat–CVD associations.

Emergency department visits related to functional abdominal pain in the pediatric age group

2017 ◽  
Vol 65 (4) ◽  
pp. 803-806 ◽  
Author(s):  
Chaitanya Pant ◽  
Abhishek Deshpande ◽  
Thomas J Sferra ◽  
Mojtaba Olyaee
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Hospital Admissions ◽  
Temporal Trends ◽  
Primary Diagnosis ◽  
Emergency Department Visits ◽  
Age Group ◽  
Functional Abdominal Pain ◽  
Cross Sectional ◽  
Ed Visits

To analyze visits to and admissions from the emergency department (ED) in children with a primary diagnosis of functional abdominal pain (FAP). This was a cross-sectional study using data from the Nationwide Emergency Department Sample (HCUP-NEDS 2008–2012). FAP-related ED visits were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The most frequent secondary diagnoses associated with FAP-related ED visits were also extracted. In 2012, a total of 796,665 children presented to the ED with a primary diagnosis of FAP. This correlated to a rate of 11.5 ED visits/1000 population. The highest incidence of ED visits was observed for children in the 10–14-year age group; median (IQR) age of 11 (8) years. In analyzing the temporal trends associated with FAP-related ED visits, we observed an increase in both the overall number of visits (14.0%) as well as the population-adjusted incidence (16.0%) during the period 2008–2012. This coincided with a decreasing trend in hospital admissions from the ED; from 1.4% in 2008 to 1.0% in 2012 (−28.5%). The overwhelming majority (96.7%) of patients with FAP who presented to the ED were treated and released. On multivariate analysis, the leading factor associated with an increased likelihood of admission from the ED was teaching hospital status (aOR 2.07; 95% CI 1.97 to 2.18). The secondary diagnosis most commonly associated with FAP-related ED visits was nausea and/or emesis (19.8%). Pediatric FAP-related ED visits increased significantly from the period 2008 to 2012. However, the incidence of hospital admissions from the ED declined during the same period.

Abstract P117: Frailty and Outcomes among Heart Failure Patients in the Community

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Sheila M McNallan ◽  
Shannon M Dunlay ◽  
Mandeep Singh ◽  
Alanna M Chamberlain ◽  
Margaret M Redfield ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Emergency Department Visits ◽  
Physical Component Score ◽  
Risk Of Death ◽  
Increased Risk ◽  
Ed Visits

Objective: To determine among community heart failure (HF) patients whether frailty is associated with an increased risk of hospitalization, emergency department (ED) visits and death, independently of comorbidities. Background: Frailty is associated with adverse outcomes in some populations; however the prognostic value of frailty among HF patients is not fully documented, particularly for healthcare utilization. Methods: Olmsted, Dodge and Fillmore County residents with HF between 10/2007 and 12/2010 were prospectively recruited to undergo frailty assessment. Frailty was defined as 3 or more of the following: unintentional weight loss >10 lbs. in 1 year, physical exhaustion, weak grip strength, and slowness and low activity measured by the SF-12 physical component score. Intermediate frailty was defined as having 1-2 components. To account for repeated events, Anderson-Gill modeling was used to determine if frailty predicted hospitalization or ED visits. Cox proportional hazards regression examined associations between frailty and death. Results: Among 409 patients (mean age 73±13, 58% male), 19% were frail and 55% had intermediate frailty. Within one year, 449 hospitalizations, 523 ED visits and 34 deaths occurred. There was a positive graded association between frailty and hospitalization and ED visits (Table). After adjustment for age, sex, ejection fraction and comorbidity, frailty was associated with an 80% increased risk of hospitalization and a 60% increased risk of ED visits. Frailty was also associated with more than a 2-fold increased risk of death after adjustment. Conclusion: In the community, frailty is prevalent and is a strong and independent predictor of hospitalizations, ED visits and death among HF patients. As it is independent from coexisting comorbidities, frailty defines new avenues for intervention and should be formally assessed clinically. Hazard Ratios (95% CI) for Hospitalizations, Emergency Department Visits and Death by Frailty Status Not Frail Intermediate Frail Frail P for trend Hospitalization Crude 1.00 1.46 (1.05-2.02) 2.15 (1.45-3.19) <0.001 Fully-adjusted 1.00 1.29 (0.94-1.77) 1.82 (1.22-2.73) 0.005 Emergency Department Visits Crude 1.00 1.59 (1.14-2.21) 1.88 (1.22-2.90) 0.002 Fully-adjusted 1.00 1.46 (1.05-2.05) 1.58 (1.01-2.48) 0.034 Death Crude 1.00 1.40 (0.73-2.69) 3.98 (2.01-7.90) <0.001 Fully-adjusted 1.00 0.87 (0.44-1.73) 2.42 (1.19-4.95) 0.003

Decreasing Emergency Department Visits for Children with Epilepsy

2021 ◽  
pp. 10.1212/CPJ.0000000000001109
Author(s):  
Anup D. Patel ◽  
Andrea Debs ◽  
Debbie Terry ◽  
William Parker ◽  
Mary Burch ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Children And Adolescents ◽  
Multidisciplinary Team ◽  
Outcome Measure ◽  
Emergency Department Visits ◽  
Ed Visits ◽  
One Year ◽  
Patients With Epilepsy

AbstractObjectiveEpilepsy and seizures represent a frequent cause of emergency department (ED) visits for patients. By implementing quality improvement (QI) methodology, we planned to decrease ED visits for children and adolescents with epilepsy.MethodsIn 2016, a multidisciplinary team was created to implement QI methodology to address ED visits for patients with epilepsy. Based on previous successes, further ED visit reduction was deemed possible Our aim statement was to decrease the number of ED visits, per 1000 established epilepsy patients, from 13.03 to 11.6, by December 2019 and sustain for one year.ResultsWe successfully decreased ED visits for seizure related care in patients with epilepsy from 13.03% to 10.2% per 1000 patients which resulted in a centerline shift.ConclusionUsing QI methodology, we improved the outcome measure of decreasing ED visits for children with epilepsy. Implementations of these interventions can be considered at other institutions that may lead to similar results.

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