Emergency Department Attendances Research Articles

Concordance with routine Clinical Frailty Scale screening in the frailty in European emergency departments (FEED) study.

Frailty screening determines who receive geriatric emergency medicine interventions that are of high importance for patient outcomes. However, post-implementation evaluations show around 50% older Emergency Department (ED) attenders to receive screening. Why and who are omitted from screening remains largely unstudied. This study gave opportunity to compare normal screening status to data from a targeted screening study. The parent Frailty in European Emergency Departments (FEED) study administered the Clinical Frailty Scale (CFS) to consecutive ED attenders on 04 July 2023. This present study considered a subset of sites which provided retrievable CFS data from a "normal day" two weeks prior. Symmetry and dependency of missing CFS entries with observed variables were assessed. The frailty distribution was then compared with the parent FEED study data. A minority of sites (5/62) recorded CFS in retrievable format. 55% "normal day" CFS entries were missing compared with 14% consecutive attenders during the parent FEED study. While no pattern was evident in the FEED cohort, "normal day" CFS entries were more frequently missing with non-white ethnic group (76%, vs 52% with white group), self-presentation (68%), and discharge home from ED (59%). CFS distributions differed between the routine and research day datasets (p=0.009). Our findings suggest systematic, non-random omission of CFS in normal screening practice, disproportionately affecting people with non-white ethnic group and self-presentation. This raises concern for limitations when routine CFS data are analysed and prompts study and improvement of concordance with screening.

Children exposed to family and domestic violence perpetrated against their mother are at an increased risk of emergency department attendance in childhood.

To determine the association between family and domestic violence (FDV) exposure and ED attendance in Australian children. The present study comprised a population-based retrospective cohort study using deidentified linked administrative data of children born 1987-2010, in Western Australia (n = 58 352). Multivariate Cox proportional hazards modelling was used to estimate the association of FDV exposure with ED attendance. Estimates are presented as adjusted and unadjusted hazard ratios (HR) with Wald 95% confidence intervals (CI). Children exposed to FDV had a 35% (HR = 1.35, 95% CI: 1.32-1.38) increased risk of ED attendance than non-exposed children. Following model adjustment for sociodemographic and clinical characteristics a statistically significant increased risk of 21% (HR = 1.21, 95% CI: 1.18-1.23) was observed in FDV-exposed children compared to their non-exposed counterparts. When stratified by Aboriginal status, an increased risk for ED attendance was observed in both Aboriginal and non-Aboriginal children exposed to FDV, when compared to non-exposed counterparts (aHR = 1.13, 95% CI: 1.11-1.16; aHR = 1.42, 95% CI: 1.37-1.47, respectively). Exposure to FDV is associated with an increased risk of ED attendance in childhood. The findings add to the limited literature providing further support that FDV exposure impacts children's health service utilisation and further supports that children's exposure to FDV as an area of public health concern. Attendance at the ED presents an opportunity for intervention.

Use of the Children’s Observation and Severity Tool (COAST), an Adaptation of the Paediatric Early Warning Score, in the Emergency Department as a Predictor for Hospital Admission: A Retrospective Cohort Study

Background: Paediatric Early Warning Scores (PEWS) are designed to detect the clinically unwell or deteriorating child within a hospital setting. There is a drive within the NHS to standardise this scoring system across various settings. According to the Royal College of Paediatrics and Child Health, there is currently a national review on triage tools used within emergency departments; however, evidence to date is scarce. Within the Chelsea and Westminster NHS Foundation Trust, we utilise both the Manchester Triage System (MTS) and the Children’s Observation and Severity tool (COAST), an adaption of PEWS, in our Paediatric Emergency Department (PED). Methods: This retrospective cohort study is the largest of its kind and was performed to validate COAST, compare it to MTS and determine if it is a good predictor of hospital admission. Demographic data, initial MTS scores, initial COAST scores and admission outcomes of 41,030 paediatric emergency department attendances were analysed, encompassing 27,196 unique patients. Results: Results demonstrated that high COAST scores on arrival are strongly correlated with hospital admission, with positive predictive values of 59.52% with COAST of ≥3 and 100% for with score threshold of ≥5. In comparison with the MTS, COAST is better at predicting admission. Conclusions: We conclude that COAST performs well in correlating to and thus predicting paediatric hospital admission outcome from the PED.

Predictors of specialist care referrals (SCR) following emergency department review or hospital admission in adults with previous acute COVID-19: a prospective UK cohort study

BackgroundLong-COVID research to date focuses on outcomes in non-hospitalised vs. hospitalised survivors. However Emergency Department attendees (post-ED) presenting with acute COVID-19 may experience less supported recovery compared to people admitted and discharged from hospital (post-hospitalised group, PH).ObjectiveWe evaluated outcomes and predictors of specialty care referrals (SCR) in those with ongoing symptomatic Long-COVID, comparing post-ED and PH adults.MethodsThis prospective observational cohort study evaluates 800 PH and 484 post-ED adults from a single hospital in London, United Kingdom. Participants had either confirmed laboratory-positive SARS-CoV-2 infection or clinically suspected acute COVID-19 and were offered post-COVID clinical follow-up at approximately six weeks after their ED attendance or inpatient discharge, to assess ongoing symptoms and support recovery. Multiple logistic regression determined associations with specialist care referrals (SCR) to respiratory, cardiology, physiotherapy (including chest physiotherapy), and mental health services.ResultsPresence of at least one Long-COVID symptom was lower in adults attending ED services with acute COVID-19 compared to those hospitalised (70.1% post-ED vs. 79.5% PH adults, p < 0.001). Total number of Long-COVID symptoms was associated with increased SCR in all patients (adjusted odds ratio (aOR) = 1.26, 95%CI:1.16, 1.36, p < 0.001), with post-ED adults more likely to need a SCR overall (aOR = 1.82, 95%CI:1.19, 2.79, p = 0.006). Post-ED adults had higher SCR to both physiotherapy (aOR = 2.59, 95%CI:1.35, 4.96, p = 0.004) and mental health services (aOR = 3.84, 95%CI:2.00, 7.37, p < 0.001), with pre-existing mental illness linked to the latter (aOR = 4.08, 95%CI:1.07, 15.6, p = 0.04).ConclusionsWe demonstrate greater specialist care referrals to mental health and physiotherapy services in patients attending the ED and discharged with acute COVID-19, compared to those admitted, despite lower ongoing COVID-19 symptom burden. Total number of symptoms, pre-existing co-morbidity such as smoking status, cardiac co-morbidities, and mental health illnesses may predict those requiring healthcare input. This information may enable better post-COVID support for ED attendees, a distinct group who should not be neglected when preparing for future pandemics.Trial registrationThis study had HRA approval (20/HRA/4928).

N38 Exploring the role of the IBD surgical link nurse in a tertiary referral centre

Abstract Background An inflammatory bowel disease (IBD) surgical link nurse (SLN) role was introduced during the Covid -19 pandemic to improve monitoring and safety netting for IBD patients awaiting surgery. Objectives include maintaining a database and working with the MDT and scheduling team to prioritise and manage operating lists, and avoid patients being removed form waiting lists inappropriately. Bi-weekly meetings facilitate MDT review with surgical, nursing, and dietetic input allowing for timely therapeutic optimisation of advanced therapies, facilitate preoperative optimisation and coordinate care among the MDT and scheduling team, often including primary and secondary care outside of our trust as appropriate. The IBD SLN also undertakes virtual clinics and provides advice line support for patients awaiting surgery providing monitoring, reassurance, education, and empowerment. We wanted to capture clinical activity and outcomes from the SLN role, including utilisation of service, by reviewing the IBD surgical monitoring database for the previous 12 months. Methods Three referral systems for entering the patient to the IBD surgical link nurse monitoring database were reviewed. Direct referral from colorectal surgeons, patient-initiated referrals via the existing IBD advice line service, and the IBD email service acting as a referral system for primary care, other secondary care centres, multi-disciplinary team, and advanced therapy service to highlight to the IBD SLN patients who there are concerns about. All referrals are assessed and categorised by the IBD SLN and added to the IBD surgical monitoring database. Results Between October 2023 to September 2024, 208 referrals were received. The majority of referrals came from colorectal surgeons. 131 virtual support sessions have been conducted for pre-operative support and education. 74 patients underwent colorectal surgeries and 4 patients declined surgery. Currently, 122 patients are on the IBD surgical monitoring database for active monitoring. Patient feedback is being collected regarding their experiences of the service. Conclusion The IBD SLN role supports patients while awaiting surgery. The IBD SLN acts as a support and point of access for patients and family to discuss surgery and related issues. This role has improved communication between primary care and within the MDT. The IBD surgical monitoring database strengthens safety netting and avoids unnecessary delay or cancellation in surgeries. This comprehensive monitoring system and the SLN role helps provide timely surgical care, optimises waiting lists, facilitates efficient and equitable utilisation of theatre lists, and helps to avoid unnecessary outpatient and emergency department attendance.

Consumer experiences of emergency department pre-triage waiting period: A mixed-methods study.

Emergency department pre-triage waiting periods have received limited attention. We aimed to explore the pre-triage experiences and perspectives of consumers attending emergency departments. This mixed-methods cross-sectional study included 92 participants (patients, carers, and guardians) who attended one of three public hospital emergency departments in metropolitan Melbourne (Victoria, Australia). Quantitative self-report outcomes were waiting time (minutes) and number of previous emergency department visits. Qualitative outcomes (explored through content analysis) were consumer experiences and perspectives of emergency departments in general and the pre-triage waiting period specifically. Participants reported a median (IQR) waiting time since triage of 45 (100) minutes and 65 % (n = 60) experienced a pre-triage waiting time of 3-90 minutes. The most common perception of the pre-triage waiting period was an expectation to wait (n = 16, 17 %), yet 46 % (n = 42) reported difficulties during this period, such as other patients cutting in queue (n = 6, 6.5 %). Few positives were associated with the pre-triage waiting period and suggestions to improve this period tended to focus on facilitating a queuing system (n = 18, 20 %). Consumers expected and understood triage, yet reported various difficulties and few positives during the pre-triage waiting period and suggested improvements to the current system, warranting investigation of interventions to improve queuing.

Case management in Emergency Care: Impact Evaluation of the CARED Program.

Hospitals face mounting pressure to reduce unplanned utilization amid rising healthcare demands from an aging population. The Case management for At-Risk patients in the Emergency Department (CARED) program is among the first ED transitional care strategies to focus on both frail older adults and Emergency Department (ED) re-attenders to reduce acute hospital utilization. This study aims to evaluate the effectiveness of the CARED program in reducing hospital (re)admissions and ED re-attendances within 30- and 60-days post-discharge. A retrospective, propensity-matched study was conducted from April 2022 to July 2023 in the ED of Ng Teng Fong General Hospital in Singapore. The CARED program identifies and enrols at-risk patients i.e., frail older adults and patients who re-attend the ED within 30 days of hospital discharge, for a geriatric assessment. This is followed by multidisciplinary team care, discharge planning and right siting of care from the ED to community-based services by ED case managers. The primary outcomes were hospital (re)admissions and ED re-attendances within 30- and 60-days post-discharge. Secondary outcomes were cost avoidance and bed occupancy days from reduced acute hospital usage. Nearest-neighbour 1:1 propensity score matching matched 1,615 intervention group to 1,615 control group. Baseline characteristics of the intervention and control groups did not differ significantly. Difference-in-differences (DID) analyses showed significantly lower 30-day (3.96%; 95% CI 2.71% to 5.23%) and 60-day (6.69%; 95% CI 5.47% to 7.91%) hospital admissions, as well as 30-day (4.89%; 95% CI 3.83% to 5.95%) and 60-day (6.50%; 95% CI 5.28% to 7.72%) ED re-attendances in the intervention group compared to the control group. Additionally, the reduced admission and ED re-attendance rates resulted in 30-day and 60-day inpatient admission costs avoidance ($1,553,548.96 (69.86%); 95% CI $1,525,827.76 to $1,581,270.15; P = 0.006; and $1,400,047.07 (32.56%); 95% CI $1,365,484.79 to $1,434,609.37; P = 0.048 respectively), ED attendance costs avoidance ($25,849.92 (23.70%); 95% CI $25,091.93 to $26,607.89; P = 0.096; and $37,538.39 (18.09%); 95% CI $36,470.27 to $38,606.53; P = 0.086 respectively) and bed occupancy days saved (1,212 days; 95% CI 1,191.80 days to 1,232.20 days; P = 0.003; and 1,267 days; 95% CI 1,242.58 days to 1,291.42 days; P = 0.011 respectively). CARED program effectively reduced unplanned hospital use within 30- and 60-days post-ED discharge for at-risk patients. It also significantly lowered inpatient admission and ED attendance costs and hospital bed occupancy days, highlighting its potential to improve patient outcomes and reduce healthcare expenses.

Disposition of emergency department patients presenting with angiotensin-converting enzyme inhibitor-induced angioedema

BackgroundAngiotensin-converting enzyme inhibitors (ACEI) are the most common cause of drug-induced angioedema in the United States. Our primary objective was to provide descriptive evidence regarding emergency department (ED) disposition of ACEI-induced angioedema patients. Our secondary objective was to evaluate unique patterns in those with ACEI-induced angioedema at a tertiary referral center, including demographics, details of those requiring intubation, length of inpatient stay, and allergy documentation.MethodsThis was a retrospective study evaluating all cases of ACEI-induced angioedema at a large, regional academic medical center. We performed a medical record review to identify patients with ACEI-induced angioedema who presented to the ED from January 1, 2016, to December 31, 2022. A structured data abstraction process was utilized to select patients of interest, followed by descriptive statistics, chi-square tests and odds ratios for categorical data, and Kruskal Wallis tests for continuous data.ResultsA total of 637 unique patient encounters met potential inclusion. After a substantial, standardized review, 94 patients met inclusion. During the study period, there were 94 patients presenting to the ED who were diagnosed as having angioedema secondary to an ACEI (90 patients) or angiotensin receptor blocker (ARB) (4 patients). Overall, 53 patients (56.38%) improved during their ED stay, and of those, 32 patients (60.38%) were discharged home. None of the 12 patients that worsened were sent home from the ED. Those who were discharged from the ED with a median stay of 4 h had no increased risk of return to the ED versus those who were admitted. The only treatment found to have statistical association with disposition was intramuscular epinephrine. Only 13 of 43 ED discharged patients (23.64%) had their ACEI/ARB documented in their allergy listings compared to 42 of 51 patients (76.36%) of admitted patients, odds ratio of failure to document was 0.0929 (95% CI, 0.0352 to 0.24512). Only one patient out of the total 94 returned to the ED due to recurrent angioedema symptoms during our study period and was subsequently discharged.ConclusionOur results indicated that at a large, tertiary care referral center, patients with ACEI-angioedema who did not exhibit severe symptoms were safely discharged home with low risk of early return visit to the ED. Severe symptoms were found to be any throat symptoms, voice change, drooling, worsening swelling, or complaints of dyspnea. Further, among those admitted, patients in our study had a short inpatient stay and were safely discharged with no documented early return visit to the ED.

Clinical decision instruments for predicting mortality in patients with cirrhosis seeking emergency department care.

Clinical decision instruments (CDIs) could be useful to aid risk stratification and disposition of emergency department (ED) patients with cirrhosis. Our primary objective was to derive and internally validate a novel Cirrhosis Risk Instrument for Stratifying Post-Emergency department mortality (CRISPE) for the outcomes of 14- and 30-day post-ED mortality. Secondarily, we externally validated the existing Model for End-Stage Liver Disease (MELD) scores for explicit use in ED patients and prediction of the same outcomes. A cohort of 2093 adults with cirrhosis, at 16 sites in a statewide health system, was analyzed for 119 candidate variables available at ED disposition. LASSO with 10-fold cross-validation was used in variable selection for 14-day (CRISPE-14) and 30-day (CRISPE-30) logistic regression models. Area under the receiver operating characteristic curve (AUROC) was calculated for each variant of the CRISPE and MELD scores and compared via Delong's test. Predictions were compared to actual ED disposition for predictive value and reclassification statistics. Median (interquartile range [IQR]) characteristics of the cohort were age 62 (53-70) years and MELD 3.0 13.0 (8.0-20.0). Mortality was 4.3% and 8.5% at 14 and 30 days, respectively. CRISPE-14 and CRISPE-30 outperformed each MELD variant, achieving AUROC of 0.824 (95% CI: 0.781-0.866) and 0.829 (0.796-0.861), respectively. MELD 3.0 AUROCs were 0.724 (0.667-0.781) and 0.715 (0.672-0.781), respectively. Compared to ED disposition, CRISPE-14, CRISPE-30, and MELD 3.0 significantly improved positive and negative predictive value and net reclassification index at multiple cutoffs. Applying CRISPE-30 (cutoff 4.5) favorably reclassified one net ED disposition for mortality for every 12 patients, while MELD 3.0 net reclassified one disposition per 84 patients. CDIs may be useful in risk-stratifying ED patients with cirrhosis and aiding disposition decision making. The novel CRISPE CDI showed powerful performance and requires external validation, while the existing MELD 3.0 score has moderate performance and is now externally-validated in an ED population for short-term mortality.

The impact of an All-Hazard mass casualty event on emergency department operations: A retrospective study.

Mass Casualty Events (MCI) which have a direct and persisting impact on the safety and well-being of an emergency department (ED) and its staff, secondary to specific targeting of the healthcare setting, represent a distinct and complex operational challenge. ED physicians may be faced with the prospect of providing ongoing patient care while simultaneously experiencing direct threats to their own health or physical safety. In our study we considered the unique operational challenges encountered, and management strategies adopted, by the ED staff and its leadership to an all-hazard MCI impacting an academic urban emergency department. We conducted a retrospective, observational study of data from a tertiary academic medical center of patients arriving to the ED during a protracted MCI lasting from May 11th to May 21st, 2021. No arriving patients were excluded from analysis. Patient demographics, ED resource utilization, throughput, disposition and other pertinent data were considered. Analysis was done of three distinct patient populations including the event-group (EG), a non-event-group (NEG) and a control group (CG). Descriptive statistics were used to evaluating observational findings. We reviewed the records of 8527 total patients presenting to the Shamir Medical Center ED during the event and control periods. Of those, 283 patients were identified as an EG consisting of casualties from the MCI. 3563 patients were identified as the NEG presenting with complaints not related to the event. Our CG consisted of the 4681 patients who presented in the two weeks prior to the MCI. EG patients were noted to have important characteristics including higher relative numbers of men n=173 (61.6%), higher CTAS triage acuities [n=10 (3.8%), classified as CTAS 1], and an increase utilization of specialty consultation and admission consistent with observed injury patterns, most notably for the orthopedic services [orthopedic consultations: n=126 (44.5%) / orthopedic admissions: n=13 (4.6%)]. Findings from our observational study suggested that in the absence of larger public health interventions a manmade MCI, with direct threats to an ED and its staff, could force EDs to concurrently address the unique clinical needs of two distinct patient populations while simultaneously needing to take measures to protect hospital staff. Additionally, a higher burden of patient volumes and clinical acuity are likely to be encountered by select specialty consultation services. Further studies could focus on quantitative analysis to better understand the operational impact of these types of events on both patients and staff.

Comparative analysis of injuries related to self-harm, assault, and intimate partner violence: insights from U.S. Emergency Departments (2005–2021)

BackgroundEmergency departments are on the front lines of non-fatal self-harm injury (SHI). This study identifies patterns in patients presenting to emergency departments with SHI compared with patients presenting with assault...

Longer Total Interhospital Transfer Times for Rural Sepsis Patients Not Associated with Increased Mortality

ABSTRACT OBJECTIVES Sepsis is a time-sensitive condition, and many rural emergency department (ED) sepsis patients are transferred to tertiary hospitals. The objective of this study was to determine whether longer transport times during interhospital transfer are associated with higher sepsis mortality or increased hospital length-of-stay (LOS). METHODS A cohort of rural adult (age ≥ 18y) sepsis patients transferred between hospitals were identified in the TELEmedicine as a Virtual Intervention for Sepsis Care in Emergency Departments (TELEVISED) parent study. We collected data on the time spent between triage and disposition at the rural ED (ED LOS), time from rural ED disposition to arrival at the destination hospital (transport duration), and overall time from rural ED triage to arrival at the destination hospital (total transfer time). We used a zero inflated negative binomial model with log link for the primary outcome (28-day hospital-free days), and a logit model for secondary outcomes of Surviving Sepsis Campaign (SSC) bundle adherence and in-hospital mortality. We included clinical and demographic covariates in model development. RESULTS We included 359 transferred rural sepsis patients. There was no association between ED LOS (aRR: 1.00; 95% CI: 0.98-1.02), transport duration (aRR: 1.03; 95% CI: 0.99-1.07), or total transfer time (aRR: 1.01; 95% CI: 0.99-1.03) and 28-day hospital free days. Similarly, we found no association between ED LOS, transport duration, and total transfer time with secondary outcomes. CONCLUSIONS Longer total transfer time showed no association with 28-day hospital free days in rural sepsis patients. Future work will seek to better understand how rural ED sepsis care can be optimized to maximize outcomes in transferred patients.

Coming in hot: a qualitative investigation into perceptions of parents and doctors of reasons for the presentation of children with fever to the emergency department in England.

Paediatric emergency department (ED) attendances and admissions in England are increasing. Fever is a common presenting problem for these attendances. Anxiety and misperceptions surrounding appropriate management of fever persist among parents. Little evidence exists on the pathways to ED for fever, and doctors' perceptions of why parents present their child to the ED. To understand perceptions of parents and doctors of the reasons for ED presentation for children (0-18 years) with fever in England. This forms the first part of a qualitative study, using reflective thematic analysis. 15 parents (12 mothers and 3 fathers) who had taken their febrile child to hospital (2015-2023), and 5 ED doctors (4 consultants and 1 resident doctor) who had experienced treating a febrile child in an ED in England. Semistructured remote (Zoom) interviews were conducted (2022-2023). Reflexive thematic analysis facilitated investigation into current parental concerns regarding fever and decision-making leading to ED attendance. The overarching theme 'factors influencing unscheduled care' comprised four key themes that reflected the complex interplay between factors influencing parental decision-making to seek emergency care, at the individual and wider structural level. These were parental proficiency and experience; social networks and access to services; fever phobia, uncertainty and anxiety; and reassurance. Doctors also acknowledged the importance of these factors, such as reassurance and showing compassion and further indicated a persistent educational gap surrounding fever between doctors and parents. We widen the evidence base of why parents attend ED for paediatric fever and their perceptions of other health services. Parents face challenges when seeking care and perceived ED as a last resort. Interventions to support parental decision-making and management of fever could help to alleviate these challenges, as well as potentially reducing the demand for emergency care.

Frequency, demographics, diagnoses and consultation patterns associated with low-acuity attendances in German emergency departments: a retrospective routine healthcare data analysis from the INDEED project

ObjectiveEvidence suggests interventions targeting low-acuity attendances have been hampered by insufficient characterisation of potential target groups. This study aimed to estimate the frequency of low-acuity emergency department (ED) attendances and...

Characterizing Emergency Department Disposition Conversations for Persons Living With Dementia: Protocol for an Ethnographic Study.

Almost 40% of persons living with dementia make an emergency department (ED) visit each year. One of the most impactful and costly elements of their ED care is the decision to discharge or admit them to the hospital-the "disposition" decision. When more than one reasonable option exists regarding a health care decision, such as the decision to admit or not, it often requires a complex conversation between patients, care partners, and ED providers, ideally involving shared decision-making. However, little is known about how these conversations are conducted and the real-world context in which they take place. Best practices in ED communication and shared decision-making for persons living with dementia and their care partners are limited. This study aims to characterize current practices in ED disposition conversations for persons living with dementia and their care partners, informed by perspectives from patient and care partner participants. This study will use an ethnographic design, including direct observation methods with a semistructured data collection tool to capture the ED encounter for up to 20 patient and care partner dyads, including all discussions about dispositions. Follow-up qualitative, semistructured interviews will be conducted with persons living with dementia and their care partners to explore specific observations made during their ED encounter, and to gain insight into their perspective on their role and elements of decision support used during that conversation. Data collection was initiated in October 2023, with 13 dyads recruited and observed as of July 2024. This study is expected to be completed by December 2024. Novel methods can offer novel insights. By combining direct observation and follow-up interviews about an ED visit, our study design will provide insights into how ED disposition occurs in real-world settings for persons living with dementia. Findings can inform more patient-centered interventions for disposition decision-making. DERR1-10.2196/65043.

An analysis of e-scooter-related trauma in Ireland: an update.

Electronic (E)-scooters have become increasingly common in Ireland. Our group was the first to publish an analysis of injuries related to these devices in Ireland in 2021. Since then, the use of e-scooters has increased significantly. The primary aim of this study was to re-analyse the trend in scooter-related trauma 4 years later. We conducted a retrospective analysis over the same time period as our previous study (13 months). Seventy-six patients with e-scooter-related trauma in our emergency department (ED) were identified between June 2023 and July 2024. Medical records and patient imaging were reviewed. Injury severity score (ISS) was calculated, and results were compared to our previous study. There was an increase from 22 to 76 patients presenting to our ED with an e-scooter-related injury over a 13-month period. The number of patients presenting with fractures has risen from 15 to 34 (45%). Twenty-four per cent of ED attendees required hospital admission, and 13 patients underwent surgical intervention. The average ISS was 4.3, and helmet use has decreased significantly from 40% to 8%. E-scooters remain to be a key contributor to emergency department presentations and complex orthopaedic injuries. The majority of patients require radiological investigation and specialist follow-up, with many needing surgical fixation. The effects of such injuries can have severe long-term consequences for patients and place financial constraints on our health system. With the rollout of e-scooter rental schemes and infrequent helmet use, one can expect the resulting trauma will continue to rise.

Emergency Departments in Contemporary Healthcare: Are They Still for Emergencies? An Analysis of over 1 Million Attendances.

Over the past few decades, emergency departments (EDs) have experienced an increasing workload. However, the variation in the types of patient accesses to these departments remains poorly understood. To evaluate the 5-year temporal trend in the volume of patients attending EDs based on the urgency of their conditions. This multicenter observational retrospective study was conducted from 1 January 2019, to 31 December 2023, across seven Italian EDs located within the same province. All patients accessing the EDs during the study period were included, totaling 1,282,735 patients. The triage code was used as an urgency index; non-urgent patients were defined as those who received a code 4 or 5 in triage, while urgent patients were defined as those who received a code 3, 2, or 1 in triage. Temporal analyses of admissions were conducted, also evaluating individual age groups to understand behavior over time. From 2019 to 2023, there was a significant 10% increase in ED attendances by non-urgent patients. This increase was observed during both daytime and nighttime shifts. Notably, all age groups showed an increase in non-urgent patients, except for pediatric patients aged 0 to 14. Over the past 5 years, there has been a consistent upward trend in ED attendances by non-urgent patients. Healthcare policies should consider implementing strategies to manage or mitigate the overload in EDs, particularly related to non-urgent patient accesses.

Changes in emergency healthcare use following intervention by Navigator, an emergency department social support programme: a multi-centre retrospective before-and-after study.

Patients living with social deprivation, and those with experiences of violence, substance misuse, mental ill-health and homelessness are known to use emergency departments (EDs) more often. It is not known whether a programme of social support initiated during ED attendance may lead to a reduction in healthcare use. The objective of this study is to determine the change in emergency, inpatient and outpatient healthcare use following a social support programme, Navigator, initiated during an ED attendance. Retrospective before-and-after study. Adult patients ≥16 years, attending EDs in the West of Scotland from 14th September 2016 to 10th March 2023, with a Navigator programme encounter. The Navigator social support programme, delivered by trained support workers, initiated during ED attendance, and targeting patients affected by issues including violence, substance misuse, mental ill-health, domestic abuse and homelessness. Healthcare use rates in the 365 days following intervention, as change compared to those in the 365 days prior to the intervention. The primary outcome was the number of ED attendances in the year following intervention compared with the year prior to intervention. Secondary outcomes included inpatient admissions, inpatient bed days, outpatient appointments and outpatient appointments where the patient did not attend. Changes in use rates were analysed with negative binomial regression and reported as incidence rate ratios for interpretation as percentage change. Analysis was repeated for a subgroup of frequent attenders to the ED. Of 1421 Navigator programme encounters, 1056 were included for analysis. Median attendance in the year prior to intervention was 3 [interquartile range (IQR) 1-5], and in the year following intervention was 2 (IQR 0-4). Negative binomial regression demonstrated that in the year following Navigator intervention, there was a 29% (95% confidence interval: 24-33%) reduction in ED attendances. The Navigator programme was associated with reduced emergency and acute healthcare use in the year following intervention, with increased scheduled outpatient care. There is the potential for a social support programme, delivered from the ED, to change patterns of healthcare use, and future work should consider prospectively assessing the impact of such an intervention.

Modified Hospital Frailty Risk Score (mHFRS) as a Tool to Identify and Predict Outcomes for Hospitalised Older Adults at Risk of Frailty.

This study aims to determine whether modified Hospital Frailty Risk Score (mHFRS) can identify frail hospitalised older adults by comparing mHFRS to HFRS and Clinical Frailty Scale (CFS). A retrospective review was undertaken in patients =>65 years hospitalised following an Emergency Department attendance between 1st July 2022 and 31st March 2023. Predictive models were evaluated with correlation and measure of agreement between frailty risk scores, CFS and HFRS, CFS and modified HFRS (mHFRS) using the Spearman's rank correlation and Cohen's kappa (κ). Of 3042 patients, CFS categorised 1635 (53.7%) patients as non-frail (CFS 1-4) and 1407 (46.3%) as frail (CFS 5-9,p<0.001). Frail patients were more likely to be female (55.9%), older (81.8 years, SD 8.41 vs 75.3 years, SD 7.20, p<0.001), with longer LOS (52.5% % vs 31.5%, p<0.001), higher 30-day emergency re-admission (18.5% vs 9.9%, p<0.001) and higher mortality at all time points. We could compute mHFRS for 1623 (53.4%) patients, of whom, 37.5% were low risk, 40.5% intermediate risk and 22.1% high frailty risk. mHFRS showed significant correlation with CFS (p<0.001) and HFRS (p<0.001), respectively and achieved comparable association with clinical outcomes. mHFRS was better at identifying non-frail patients and provides a novel, standardised and comparable frailty risk stratification tool for screening older hospitalised patients.

Retrospective validation of the STUMBL score in a Level 1 trauma centre.

A single-centre retrospective validation study was undertaken using information from all patients with an Emergency Department (ED) attendance for isolated blunt chest trauma at a major trauma centre in Australia from 2018. The performance of the STUMBL score was measured including the cut-off score which best predicted 1) the discharge disposition from ED (ward or intensive care unit [ICU]), 2) the development of pulmonary complications, 3) an extended length of stay (LOS) (7 days or more) and 4) any complication (pulmonary, extended LOS, in hospital mortality). The performance measures included sensitivity, specificity, negative and positive predictive values as well discrimination and calibration. There were 300 patients admitted between 1st January 2018 and 31st December 2018 with a median age of 60 years (IQR 44-75) and 65 % were male. The risk prediction cut-off score for our patient cohort ranged from 18.5 for LOS 7 days or more to 11.5 for ward admission from ED. The positive predictive value (PPV) ranged from 56.7 % for ward admission from ED to 21.1 % for pulmonary complications. The negative predictive value (NPV) and sensitivity was highest for ICU admission from ED (96.5 % and 80.6 %) and the specificity ranged from 78 % for all complication prediction to 65.3 % for LOS of 7 or more days. The C statistic ranged from 0.82 for ICU admission to 0.65 for pulmonary morbidity. The performance measures of the STUMBL score are suboptimal in our population. The best performing measure was the ability to predict ICU admission. Further validation work that includes additional factors may improve the positive predictive value and clinical utility of the score in our cohort.