scholarly journals Unintentional Drug Overdoses in Virginia: Analysis of Syndromic and Death Data

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Amanda Wahnich ◽  
Kathrin Hobron ◽  
Erin E. Austin ◽  
Tim Powell
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Drug Overdose ◽  
The United States ◽  
Emergency Department Visits ◽  
Opiate Use ◽  
Accurate Picture ◽  
Drug Overdoses ◽  
Considerable Morbidity ◽  
The Relationship

Substance abuse results in considerable morbidity each year in the United States. The relationship between drug overdose emergency department visits and deaths that opiate use contributed to or caused in Virginia was assessed for 2012-2013 to determine if syndromic surveillance data can be used to provide a real-time and accurate picture of the population at risk for drug overdose. Drug overdose emergency department visits showed divergent demographics from opiate deaths with respect to sex and age distributions. This may indicate a shift in the population previously identified as at risk for drug use morbidity.

Management of Poisoning and Drug Overdose

2021 ◽  
Author(s):  
Timothy J Wiegand ◽  
Manish M Patel ◽  
Kent R. Olson
Keyword(s):  
Emergency Department ◽  
Drug Overdose ◽  
Activated Charcoal ◽  
Hospital Admissions ◽  
Clinical Laboratory ◽  
The United States ◽  
Emergency Department Visits ◽  
The Body ◽  
Smoke Inhalation ◽  
Drug Induced

Drug overdose and poisoning are leading causes of emergency department visits and hospital admissions in the United States, accounting for more than 500,000 emergency department visits and 11,000 deaths each year. This chapter discusses the approach to the patient with poisoning or drug overdose, beginning with the initial stabilization period in which the physician proceeds through the ABCDs (airway, breathing, circulation, dextrose, decontamination) of stabilization. The management of some of the more common complications of poisoning and drug overdose are summarized and include coma, hypotension and cardiac dysrhythmias, hypertension, seizures, hyperthermia, hypothermia, and rhabdomyolysis. The physician should also perform a careful diagnostic evaluation that includes a directed history, physical examination, and the appropriate laboratory tests. The next step is to prevent further absorption of the drug or poison by decontaminating the skin or gastrointestinal tract and, possibly, by administering antidotes and performing other measures that enhance elimination of the drug from the body. The diagnosis and treatment of overdoses of a number of specific drugs and poisons that a physician may encounter, as well as food poisoning and smoke inhalation, are discussed. Tables present the ABCDs of initial stabilization of the poisoned patient; mechanisms of drug-induced hypotension; causes of cardiac disturbances; drug-induced seizures; drug-induced hyperthermia; autonomic syndromes induced by drugs or poison; the use of the clinical laboratory in the initial diagnosis of poisoning; methods of gastrointestinal decontamination; methods of and indications for enhanced drug removal; toxicity of common beta blockers; common stimulant drugs; corrosive agents; dosing of digoxin-specific antibodies; poisoning with ethylene glycol or methanol; manifestations of excessive acetylcholine activity; common tricyclic and other antidepressants; seafood poisonings; drugs or classes that require activated charcoal treatment; and special circumstances for use of activated charcoal. This review contains 3 figures, 22 tables, and 198 references.

scholarly journals Emergency Department Visits for Opioid Overdoses Among Patients With Cancer

2019 ◽  
Vol 112 (9) ◽  
pp. 938-943 ◽  
Author(s):  
Vikram Jairam ◽  
Daniel X Yang ◽  
James B Yu ◽  
Henry S Park
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Statistical Tests ◽  
Temporal Trends ◽  
The United States ◽  
Emergency Department Visits ◽  
Multivariable Logistic Regression Analysis ◽  
Opioid Overdose ◽  
Patients With Cancer ◽  
Ed Visits

Abstract Background Patients with cancer may be at risk of high opioid use due to physical and psychosocial factors, although little data exist to inform providers and policymakers. Our aim is to examine overdoses from opioids leading to emergency department (ED) visits among patients with cancer in the United States. Methods The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample was queried for all adult cancer-related patient visits with a primary diagnosis of opioid overdose between 2006 and 2015. Temporal trends and baseline differences between patients with and without opioid-related ED visits were evaluated. Multivariable logistic regression analysis was used to identify risk factors associated with opioid overdose. All statistical tests were two-sided. Results Between 2006 and 2015, there were a weighted total of 35 339 opioid-related ED visits among patients with cancer. During this time frame, the incidence of opioid-related ED visits for overdose increased twofold (P < .001). On multivariable regression (P < .001), comorbid diagnoses of chronic pain (odds ratio [OR] 4.51, 95% confidence interval [CI] = 4.13 to 4.93), substance use disorder (OR = 3.54, 95% CI = 3.28 to 3.82), and mood disorder (OR = 3.40, 95% CI = 3.16 to 3.65) were strongly associated with an opioid-related visit. Patients with head and neck cancer (OR = 2.04, 95% CI = 1.82 to 2.28) and multiple myeloma (OR = 1.73, 95% CI = 1.32 to 2.26) were also at risk for overdose. Conclusions Over the study period, the incidence of opioid-related ED visits in patients with cancer increased approximately twofold. Comorbid diagnoses and primary disease site may predict risk for opioid overdose.

scholarly journals Enhanced Surveillance of Nonfatal Emergency Department Opioid Overdoses in California

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Natalie Demeter ◽  
Jaynia Angela Anderson ◽  
Mar-y-sol Pasquires ◽  
Stephen Wirtz
Keyword(s):  
Emergency Department ◽  
Drug Overdose ◽  
Health Planning ◽  
Age Groups ◽  
Emergency Department Visits ◽  
Public Health Issue ◽  
Opioid Overdose ◽  
Heroin Overdose ◽  
Drug Overdoses ◽  
Ed Visits

ObjectiveTo track and monitor nonfatal emergency department opioid overdoses in California for use in the statewide response in the opioid epidemic.IntroductionThe opioid epidemic is a multifaceted public health issue that requires a coordinated and dynamic response to address the ongoing changes in the trends of opioid overdoses. Access to timely and accurate data allows more targeted and effective programs and policies to prevent and reduce fatal and nonfatal drug overdoses in California. As a part of a Centers for Disease Control and Prevention Enhanced State Opioid Overdose Surveillance grant, the goals of this surveillance are to more rapidly identify changes in trends of nonfatal drug overdose, opioid overdose, and heroin overdose emergency department visits; identify demographic groups or areas within California that are experiencing these changes; and to provide these data and trends to state and local partners addressing the opioid crisis throughout California. Emergency department (ED) visit data are analyzed on an ongoing quarterly basis to monitor the proportion of all ED visits that are attributed to nonfatal drug, opioid, and heroin overdoses as a portion of the statewide opioid overdose surveillance.MethodsCalifornia emergency department data were obtained from the California Office of Statewide Health Planning and Development. Data were (and continue to be) analyzed by quarter as the data become available, starting in quarter 1 (Q1) 2016 through Q1 2018. Quarters were defined as standard calendar quarters; January-March (Q1), April-June (Q2), July-September (Q3), and October-December (Q4). Counts of nonfatal ED visits for all drug overdoses, all opioid overdoses, and heroin overdoses were defined by the following ICD-10 codes in the principle diagnosis or external cause of injury fields respectively; T36X-T50X (all drug), T40.0X-T40.4X T40.6 and T40.69 (all opioid), and T40.1X (heroin). Eligible ED visits were limited to CA residents, patients greater than 10 years of age, initial encounters, and were classified as unintentional overdoses or overdoses of undetermined intent. Overdose ED visits are described by quarter, drug, sex, and age for Q1 2016 – Q1 2018.ResultsOn average, 6,450 emergency department visits in California are attributed to drug overdose every quarter. Between Q1 2016 and Q1 2018, on average 1,785 (range: 1,559-2,011 ED visits) of those visits were due to opioid overdoses and a further 924 (52%) of those ED visits were due to heroin overdoses. About 26-30% of all drug overdose ED visits were for opioid overdoses in California during Q1 2016 – Q1 2018. Quarterly, that is around 6.00-7.64 opioid overdose ED visits for every 10,000 ED visits (Table 1), with about half those (3.09-4.30 ED visits) being heroin overdose ED visits. Males accounted for approximately 52% of all drug overdose ED visits, 65% of all opioid overdose ED visits, and 76% of all heroin overdose ED visits per quarter. Across all quarters, 25-34 year olds had the highest proportion of emergency department visits attributed to opioid and heroin overdose compared to all other age groups. However, 11-24 year olds had the highest proportion of emergency department visits attributed to all drug overdoses compared to all other age groups for all quarters except one. Between Q1 2016 and Q1 2018, the proportion of emergency department visits attributed to all drug overdoses increased by 1.8%, all opioid overdoses increased 3.1%, and heroin overdoses increased by 13.5%.ConclusionsOverall trends for the proportion of all emergency department visits for all drug overdoses and all opioid overdoses are relatively stable over this time period, however the proportion of heroin overdose ED visits shows a more substantial increase between Q1 2016 and Q1 2018. In addition, heroin overdose ED visits account for over half of all opioid overdose ED visits during this time in California. Ongoing surveillance of drug, opioid, and heroin overdose ED visits is a crucial component of assessing and responding to the opioid overdose crisis in California and helps to better understand the demographics of those who could be at risk of a future fatal opioid overdose. Timely data such as these (in addition to prescribing, hospitalization, and death data) can inform local and statewide efforts to reduce opioid overdoses and deaths. 

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 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>

scholarly journals Opioid Epidemic in the United States: Empirical Trends, and A Literature Review of Social Determinants and Epidemiological, Pain Management, and Treatment Patterns

2019 ◽  
Vol 8 (2) ◽  
pp. 89-100 ◽  
Author(s):  
Gopal K Singh ◽  
Isaac E. Kim, Jr. ◽  
Mehrete Girmay ◽  
Chrisp Perry ◽  
Gem P. Daus ◽  
...  
Keyword(s):  
Pain Management ◽  
Social Determinants ◽  
Drug Overdose ◽  
The United States ◽  
Opioid Epidemic ◽  
The Us ◽  
Drug Overdoses ◽  
Race Ethnicity ◽  
Overdose Mortality ◽  
Racial Ethnic

Objectives: Dramatic increases in opioid and drug overdose mortality have occurred in the United States (US) over the past two decades. To address this national public health crisis and identify gaps in the literature, we analyzed recent empirical trends in US drug overdose mortality by key social determinants and conducted a selective review of the recent literature on the magnitude of the opioid crisis facing different racial/ethnic, socioeconomic, and rural-urban segments of the US population. Methods: We used the 1999-2017 mortality data from the US National Vital Statistics System to analyze trends in drug overdose mortality by race/ethnicity, age, and geographic area. Log-linear regression was used to model mortality trends. Using various key words and their combinations, we searched PubMed and Google Scholar for select peerreviewed journal articles and government reports published on the opioid epidemic between 2010 and 2018. Results: Our original analysis and review indicate marked increases in drug overdose mortality overall and by race/ethnicity and geographic regions, with adolescents and young adults experiencing steep increases in mortality between 1999 and 2017. Our selective search yielded 405 articles, of which 39 publications were selected for detailed review. Suicide mortality from drug overdose among teens aged 12-19 increased consistently between 2009 and 2017, particularly among teen girls. The rise of efficient global supply chains has increased opioid prescription use and undoubtedly contributed to the opioid epidemic. Many other important contributing factors to the epidemic include lack of education and economic opportunities, poor working conditions, and low social capital in disadvantaged communities. Conclusions and Global Health Implications: Our analysis and review indicate substantial disparities in drug overdoses and related mortality, pain management, and treatment outcomes according to social determinants. Increases in drug overdoses and resultant mortality are not only unique to the US, but have also been observed in other industrialized countries. Healthcare systems, community leaders, and policymakers addressing the opioidepidemic should focus on upstream structural factors including education, economic opportunity, social cohesion, racial/ethnic disadvantage, geographic isolation, and life satisfaction. Key words: • Opioids • Drug overdose • Mortality • Pain management • Treatment • Race/Ethnicity • Social determinants • Health disparities Copyright © 2019 Singh et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Management of Evacuee Surge from a Disaster Area: Solutions to Avoid Non-Emergent, Emergency Department Visits

2007 ◽  
Vol 22 (3) ◽  
pp. 220-223 ◽  
Author(s):  
Charlene B. Irvin ◽  
Jenny G. Atas
Keyword(s):  
Emergency Department ◽  
Hurricane Katrina ◽  
The United States ◽  
Emergency Department Visits ◽  
Disaster Area ◽  
Medical Evaluation ◽  
Number Of Patients ◽  
Medical Directors ◽  
States Experience ◽  
New Location

AbstractIntroduction:Many emergency departments (EDs) in the United States experience daily overcrowding, and a rapid influx of evacuees fleeing a disaster area can pose a substantial burden. Some of these evacuees may require ED care. However, others lack an alternative to the ED to address non-emergent medical concerns (prescription refills or outpatient referral).Objective:The objective of this study was to describe a successful multidisciplinary Hurricane Katrina Evacuation Center, explain the services offered, and determine the center's effects on referrals to local EDs.Methods:Data were collected concerning the number of patients utilizing the medical evaluation center and compared to the total number of evacuees to determine the proportion that utilized medical care. The data concerning patients given prescriptions was obtained by the estimation of the two medical directors of the Center, and therefore, is inexact.Results:During the five weeks the center was operational, 631 of 716 evacuees (88%) requested medical evaluation, and >80% of those had prescriptions written. Only four (<1%) patients were transported to local EDs.Conclusion:An evacuee evaluation center provides a convenient non-ED alternative for evacuees to address their non-emergent medical concerns and can be used to ease their transition to a new location.

Hospital Emergency Department Visits Attributed to Pulpal and Periapical Disease in the United States in 2006

2011 ◽  
Vol 37 (1) ◽  
pp. 6-9 ◽  
Author(s):  
Romesh P. Nalliah ◽  
Veeratrishul Allareddy ◽  
Satheesh Elangovan ◽  
Nadeem Karimbux ◽  
Min Kyeong Lee ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
The United States ◽  
Emergency Department Visits ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Periapical Disease
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