scholarly journals Toxicologic Exposures in California Emergency Departments in 2011 and Its Risk Factors

2021 ◽  
Vol 22 (5) ◽  
pp. 1139-1145
Author(s):  
Shahram Loftipour ◽  
Connie Au ◽  
Soheil Saadat ◽  
Tim Bruckner ◽  
Parvati Singh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Substance Use ◽  
Native American ◽  
Cross Sectional Study ◽  
Public Health Issue ◽  
Median Income ◽  
Cross Sectional ◽  
Patients Âgés ◽  
Demographic Groups ◽  
Ed Visits

Introduction: Toxicologic exposures (TE) are a major preventable public health issue, with most cases due to unintentional causes. Although these cases are well documented and reported via the National Poison Data System, there is little information regarding toxicologic exposure cases in the emergency department (ED). The aim of this study was to identify demographic groups at risk for potential poisoning. Methods: This was a cross-sectional study. We used data from the California State Emergency Department Database (SEDD) 2011 for statistical analysis. Results: The study included 10,124,598 ED visits in California in 2011. The prevalence of TE was 383.4 (379.6-387.3) per 100,000 visits. Toxicologic exposures were most common among patients aged <10 years (555.4, 95% confidence interval [CI]: 544.5-566.5 per 100,000 visits). Overall, TE was more common among males. White patients showed the highest prevalence of TE compared to other racial groups (P <0.001). Subpopulation analysis showed Native American female patients ages 10-19 had a noticeably higher prevalence of TE (1,464.4, 95% CI: 802.9-2444.9 per 100,000). The prevalence of TE was higher in households of higher median income (P <0.001). Prevalence of TE among those with a history of substance use was also elevated. Conclusion: Toxicologic exposure cases in the ED are elevated in particular age and race/ethnicity groups, as well as among those with a diagnosis of substance use disorder. The strength of association between these factors and TE in the general population may be different because we examined ED visits only. Further preventive and education strategies are necessary and should target the demographic groups identified in this epidemiological study.

scholarly journals P118: Older adults in the emergency department: a retrospective cross-sectional study of the geriatric population in Edmonton emergency departments

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S106-S107
Author(s):  
K. Morch ◽  
R. Schonnop ◽  
A. Gauri ◽  
D. Ha
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Geriatric Patient ◽  
Geriatric Patients ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Region ◽  
Area Of Interest ◽  
Ed Visits

Introduction: The geriatric patient population accounts for an ever increasing proportion of emergency department (ED) visits. Geriatric centered EDs are an emerging area of interest and research. Though there have been past studies looking at older patient presentations at individual hospitals, there is limited data describing geriatric presentations within an entire Canadian geographic health region. This study characterizes the population of older adults utilizing the EDs in the Edmonton Zone, a health region that comprises a total of eleven tertiary (T), urban community (UC) and rural community (RC) hospitals. Methods: This retrospective cross-sectional study targeted all patients ≥65 years presenting to the Edmonton Zone EDs between April 1, 2017 to March 31, 2018. Data was extracted from the Emergency Department Information System (EDIS) database for ten EDs in the health region. Clinical and administrative data points were extracted and examined for each site. Results: We analyzed 100,813 ED geriatric patient visits during our study period, accounting for 18.7% of total ED visits to the Edmonton Zone. The five most common triage complaints at ED presentation were shortness of breath, abdominal pain, chest pain with cardiac features, general weakness, and back pain. CTAS scores 1-3 were assigned to 77.8% of geriatric presentations (T: 86.3%, UC: 77.4%, RC: 60.9%). 27.3% of geriatric patients had presented to an ED within the past 30 days (T: 30.0%, UC: 25.4%, RC: 27.7%). On average, 35.3% of older adult ED visits involved a consultation (T: 51.7%, UC 30.8%, RC 14.6%) and approximately 25% of geriatric patients were admitted to hospital during their ED visit (T: 42.8%, UC: 19.4%, RC: 7.1%). The average length of stay (LOS) in the ED (hh:mm) was 10:19 (T: 10:24, UC: 11:38, RC: 5:43). Overall, 2.4% of all geriatric patients left an ED without being seen after initial registration (T: 2.7%, UC: 2.2%, RC: 2.1%). Conclusion: Older adults represent a significant proportion of the ED visits in the Edmonton Zone. The triage acuity, LOS, re-presentation, consultation and admission rates varied based on the type of ED, which has implications for resource allocation within the health region. Our results can also direct future targeted initiatives and quality improvement projects to the various types of EDs in the Edmonton Zone, and facilitate planning of ED services for older adults in other health regions who have a similar geographic distribution of care sites.

scholarly journals COVID-19 Pandemic Impact on Emergency Department Visits and Quality of Service: A Comparative Cross-Sectional Study in a Tertiary Centre

2021 ◽  
pp. 471-483
Author(s):  
Maram Mohammed Jaboua ◽  
Warif Jameel Abdulhaq ◽  
Nada Saeed Almuntashiri ◽  
Sarah Saud Almohammdi ◽  
Asayel Qeblan Aldajani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
Emergency Department Visits ◽  
Critical Conditions ◽  
Sectional Study ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Ed Visits

Background: The COVID-19 pandemic has contributed to a devastating impact on emergency departments worldwide, resulting in a global crisis with various health consequences. We aimed to evaluate this impact on an emergency department (ED) visit of critical conditions such as Acute Coronary Syndrome (ACS), Cerebrovascular accident (CVA), Sepsis and Febrile neutropenia (FN), and to assess the quality of the ED after new adaptive measures were applied. Methods: This is a comparative cross-sectional study to assess the number of patients who presented to the ED of King Abdullah Medical city with the specified diagnosis. We collected data via the E-medical records. We compared the data over three periods pre-lockdown, lockdown and post lockdown in years 2019-2021. For quality measurement, Adaa (Ministry of Health's program) was used to calculate the percentage of patients who stayed 4 hours or less in the ED. Results: The total number of ED visits in the specified periods of study was 8387. The total numbers of patients for 2019, 2020, and 2020 respectively were 2011 (, ACS 70.4%, CVA 16.3%, sepsis and FN 13.3%.), 2733 (ACS 73.1%, CVA 9.9%, sepsis and FN 17.0%), and 3643 (ACS 64.0%, CVA 19.4%, sepsis and FN 16.7). The average percentage of patients who stayed 4 hours or less in the ED was 60% and 57.5% for 2020 and 2021, respectively. Conclusion: Although we expected reductions in ED visits during COVID-19 periods, we found that visits were rising through the years 2019-2021.

Association of asthma with osteopenia, osteoporosis, osteomalacia, and fractures

2020 ◽  
Vol 41 (2) ◽  
pp. 112-119 ◽  
Author(s):  
Mohammed S. Shaheen ◽  
Jonathan I. Silverberg
Keyword(s):  
Emergency Department ◽  
The United States ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Pathologic Fractures ◽  
Ed Visits ◽  
National Emergency ◽  
The Relationship

Background: Previous studies that examined the relationship between asthma, osteoporosis, and pathologic fractures found conflicting results. Objective: To determine whether asthma is associated with osteopenia, osteoporosis, osteomalacia, and fractures in U.S. adults. Methods: A cross-sectional study of 198,102,435 children and adults, including 10,129,307 with asthma, from the 2006‐2012 National Emergency Department Sample, which includes a representative 20% sample of emergency department (ED) visits throughout the United States. Results: ED visits of patients with versus without asthma were associated with higher odds of osteopenia (7 of 7 years: multivariable logistic regression of all years pooled; adjusted odds ratio [aOR] 1.45 [95% confidence interval {CI}, 1.41‐1.50]), osteoporosis (7 of 7 years: aOR 1.85 [95% CI, 1.82‐1.88]), osteomalacia (7 of 7 years: aOR 2.00 [95% CI, 1.61‐2.49]), and pathologic fractures (7 of 7 years: OR 1.24 [95% CI, 1.20‐1.27]). Patients with asthma and with long-term glucocorticoid use had higher odds of osteoporosis, osteopenia, osteomalacia, and fractures compared with patients with asthma and without long-term glucocorticoid use. Patients with asthma and with fractures incurred significantly more inpatient admissions, and higher costs of ED and inpatient care. Conclusion: ED visits with asthma were associated with osteopenia, osteoporosis, osteomalacia, and pathologic fractures.

scholarly journals Factors and outcomes associated with paediatric emergency department arrival patterns through the day

2018 ◽  
Vol 24 (5) ◽  
pp. 323-329
Author(s):  
Hathami Almubarak ◽  
Garth Meckler ◽  
Quynh Doan
Keyword(s):  
Emergency Department ◽  
Resource Allocation ◽  
Cross Sectional Study ◽  
Time Of Day ◽  
Minor Trauma ◽  
Patient Acuity ◽  
Cross Sectional ◽  
Utilization Patterns ◽  
Multivariable Regression ◽  
Ed Visits

Abstract Introduction Steadily increasing emergency department (ED) utilization has prompted efforts to increase resource allocation to meet demand. Little is known about the distribution and characteristics of patient arrivals by time of day. This study describes the variability and patterns of ED resource utilization related to patient, acuity, clinical, and disposition characteristics over a 24-hour period. Methods Retrospective cross-sectional study of all visits to a tertiary children’s hospital over a 1-year period. We use descriptive statistics to present ED visit details stratified by shift of arrival, and multivariable regression to explore the association between shift of presentation and hospital admission at index and 7-day return ED visits. Results Of 46,942 visits during the study period, 12% arrived overnight, 42% during the day, and 45% during the evening with variability in pattern of shift arrival by day of week. Overnight arrivals had a higher acuity (Canadian Triage and Acuity Scale [CTAS]) and different presenting complaints (more viral infection, less minor trauma) than day and evening arrivals, but similar ED length of stay. Shift of arrival was not associated with admission to hospital, but age, gender, socioeconomic status (SES), and day of week were. Discussion ED utilization patterns vary by shift of arrival. Though overnight arrivals represent a smaller proportion of total daily arrivals, their acuity is higher, and the spectrum of disease differs from day or evening arrivals. Conclusions Understanding variations and patterns of ED utilization by shift of arrival and day of week may be helpful in tailoring resource allocation to more accurately and specifically meet demands.

scholarly journals Utilization of Emergency Department Services by the Bedouin Population in Southern Israel

2007 ◽  
Vol 7 ◽  
pp. 330-335 ◽  
Author(s):  
Arnon Dov Cohen ◽  
Jacob Dreiher ◽  
Amir Sharf ◽  
Daniel Aharon Vardy
Keyword(s):  
Emergency Department ◽  
Family Physician ◽  
Jewish Population ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Primary Care Clinics ◽  
The Family ◽  
Ed Visits ◽  
Central Database ◽  
Age Adjusted Rates

Excessive use of the emergency department (ED) is associated with increased costs and workload in the ED, patients' inconvenience and disruption of the continuity of care. The study's goal was to describe trends in ED utilization among Bedouins living in southern Israel. A retrospective cross-sectional study was conducted in primary care clinics in southern Israel. Patients included Bedouin and Jewish patients insured by Clalit Health Services. Data was retrieved from a central database. The number of visits to the ED and age-adjusted rates of ED visits during 2000-2003 were determined in the Bedouin vs. Jewish population. All visits that ended in hospitalization were excluded. Data was stratified according to patients' residence (semi-nomadic vs. urban Bedouins) and referral origin. Age-adjusted rates of ED visits decreased from 42.9/1000 patients/month in 2000 to 38.3/1000 patients/month in 2003. There were more ED visits in the Bedouin as compared to Jewish population (38.3/1000 vs. 21.8/1000 patients/month). The decrease in ED utilization was more prominent among adult semi-nomadic Bedouins (from 60.8/1000 to 40.3/1000 patients/month). The proportion of referrals by the family physician to ED significantly decreased (among urban Bedouins: from 54.3% to 43.2%, p<0.001; among semi-nomadic Bedouins: from 53.9% to 39.9%, p<0.001), while the proportion of selfreferrals and referrals from physicians other than the family physician increased. A decrease in ED utilization by the Bedouin population during the last years was demonstrated. Utilization of ED services is still increased as compared to the non-Bedouin population. Interventions to control excessive use of ED services in the Bedouin population are currently underway.

scholarly journals After the first wave and beyond lockdown: long-lasting changes in emergency department visit number, characteristics, diagnoses, and hospital admissions

2021 ◽  
Author(s):  
Fulvio Morello ◽  
Paolo Bima ◽  
Enrico Ferreri ◽  
Michela Chiarlo ◽  
Paolo Balzaretti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Diseases ◽  
Pediatric Patients ◽  
Hospital Admissions ◽  
Cross Sectional Study ◽  
Rapid Reduction ◽  
Cross Sectional ◽  
Italian City ◽  
Ed Visits ◽  
Visit Number

AbstractThe first wave (FW) of COVID-19 led to a rapid reduction in total emergency department (ED) visits and hospital admissions for other diseases. Whether this represented a transient “lockdown and fear” phenomenon, or a more persisting trend, is unknown. We divided acute from post-wave changes in ED flows, diagnoses, and hospital admissions, in an Italian city experiencing a FW peak followed by nadir. This multicenter, retrospective, cross-sectional study involved five general EDs of a large Italian city (January–August 2020). Percent changes were calculated versus 2019, using four 14-day periods (FW peak, early/mid/late post-wave). ED visits were 147,446 in 2020, versus 214,868 in 2019. During the FW peak, visits were reduced by 66.4% (P < 0.001). The drop was maximum during daytime (69.8%) and for pediatric patients (89.4%). Critical triage codes were unchanged. Reductions were found for all non-COVID-19 diagnoses. Non-COVID-19 hospital admissions were reduced by 39.5% (P < 0.001), involving all conditions except hematologic, metabolic/endocrine, respiratory diseases, and traumas. In the early, mid, and late post-wave periods, visits were reduced by 25.4%, 25.3% and 23.5% (all P < 0.001) respectively. In the late period, reduction was greater for female (27.9%) and pediatric patients (44.6%). Most critical triage codes were unchanged. Oncological, metabolic/endocrine, and hematological diagnoses were unchanged, while other diagnoses had persistent reductions. Non-COVID-19 hospital admissions were reduced by 12.8% (P = 0.001), 6.3% (P = 0.1) and 12.2% (P = 0.001), respectively. Reductions in ED flows, led by non-critical codes, persisted throughout the summer nadir of COVID-19. Hospital admissions for non-COVID-19 diseases had transient changes.

scholarly journals Emergency department visits and hospitalisations for emergent asthmatic symptoms from 2014 to 2016: cross-sectional study in Korea

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e036237
Author(s):  
Kyungseon Choi ◽  
Sola Han ◽  
Hae Sun Suh
Keyword(s):  
Emergency Department ◽  
Age Groups ◽  
International Classification Of Diseases ◽  
Cross Sectional Study ◽  
Emergency Department Visits ◽  
Resource Utilisation ◽  
Main Diagnosis ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ed Visits

ObjectiveTo evaluate the characteristics of emergent patients with asthma who visited emergency departments (EDs) in Korea, and the consequences of these visits.DesignRetrospective cross-sectional study.SettingWe used data from the National Emergency Department Information System database from 2014 to 2016. The data included reports collected from 408 EDs in Korea.ParticipantsWe analysed the ED cases for asthma-related emergent symptoms that met the following inclusion criteria: (1) had a main diagnosis code of asthma (International Classification of Diseases 10th Revision code: J45/J46), and (2) recorded as an emergent symptom in the EDs.ResultsDuring 2014–2016, there were 58 713 ED visits related to an asthma diagnosis with emergent symptoms. Following an ED visit, 31.69% were hospitalised, of which 89.88% were admitted to the general wards, and 10.12% to the intensive care units (ICUs). More than 50% of the hospitalised cases included in the group ≥70 years of age. The incidence of death during hospitalisation generally increased with age and the proportion of death in ICU exceeded 10% among the group ≥70 years. The ratio of ICU/general ward admission at the arrival time of 0–03:00, in the ≥60 years age group was the highest compared with other times of the day and age groups.ConclusionsWe found that among all age groups, ED visits by older patients resulted in more ICU admissions. Our results can help in providing a better understanding of medical resource utilisation by emergent patients with asthma.

Visits to the Emergency Department during the 2020 COVID-19 Outbreak in Thailand

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S1-S4
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Emergency Departments ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Patient Age ◽  
Cross Sectional ◽  
Front Door ◽  
The Past ◽  
Ed Visits

Background: The emergency department (ED) can be thought of as the “front door” to the 2019 coronavirus (COVID-19) pandemic. However, there have yet been no studies conducted examining ED patients in this situation. Objective: To determine the numbers of ED visits by level urgency during the COVID-19 pandemic. Materials and Methods: This was a cross-sectional study. The sample consisted of patients who presented at the Srinagarind Hospital ED from January 13 to April 21, 2020 (the date of the first confirmed case of COVID-19 in Thailand according to the Ministry of Public Health and day 100). We compared these data with those from the same period over the past three years. Results: In 2020, the total number of ED visits was 13,263, with a mean patient age of 50.14+6.40 years. Over half of these patients (56.2%; n = 7,467) were female. Most visits (50.6%) occurred between 4.00 PM to 0.00 AM (afternoon shift). The majority of were walk-ins (84.2%) and ESI 3 (non-urgent; 79.9%). The average numbers of ESI 3 patients who visited the ED over the same period in 2017 to 2020 were 152.3, 171.5, 153.0 and 105.9 per day, respectively (p<0.001). Conclusion: During the COVID-19 pandemic, the number of ED visits, specifically those of ESI 3 patients, was significantly lower than during the same period in previous years. Keywords: COVID-19, Emergency departments, Pandemics, Triage

scholarly journals Development and Validation of a Trigger Tool for Identifying Drug-Related Emergency Department Visits

2021 ◽  
Vol 18 (16) ◽  
pp. 8572
Author(s):  
Sung-Hee Hwang ◽  
Young-Mi Ah ◽  
Kwang-Hee Jun ◽  
Jae-Woo Jung ◽  
Min-Gyu Kang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Drug Events ◽  
Group Discussion ◽  
Cross Sectional Study ◽  
Emergency Department Visits ◽  
Cross Sectional ◽  
Trigger Tool ◽  
Three Phase ◽  
Ed Visits ◽  
Development And Validation

There are various trigger tools for detecting adverse drug events (ADEs), however, a drug-related emergency department (ED) visit trigger tool (DrEDTT) has not yet been developed. We aimed to develop and validate a DrEDTT with a multi-center cohort. In this cross-sectional study, we developed the DrEDTT consisting of 28 triggers through a comprehensive literature review and three phase expert group discussion. Next, we evaluated the performance of the DrEDTT by applying it to relevant medical records retrieved from four hospitals from January 2016 to June 2016. Two experts performed an in-depth chart review of a 25% of random sample of trigger flagged and unflagged ED visits and a true ADE was determined through causality assessment. Among 66,564 patients who visited the ED for reasons other than traffic accident and trauma during the study period, at least one trigger was found in 21,268 (32.0%) patients. A total of 959 true ADE cases (5.8%) were identified from a randomly selected 25% of ED visit cases. The overall positive predictive value was 14.0% (range: 8.3–66.7%). Sensitivity and specificity of DrEDTT were 77.7% and 70.4%, respectively. In conclusion, this newly developed trigger tool might be helpful to detect ADE-related ED visits.

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