Cause Of Emergency Admission Research Articles

Glucose and lipid assessment in patients with acute stroke.

BackgroundStroke is a major health issue in Nigeria and it is also a common cause of emergency admissions. Stroke often results in increased morbidity, mortality and reduced quality of life in people thus affected. The risk factors for stroke include metabolic abnormalities such as dyslipidaemia and diabetes mellitus (DM). The stress of an acute stroke may present with hyperglycaemia and in persons without a prior history of DM, may be a pointer to stress hyperglycaemia or undiagnosed DM.MethodologyThis was a cross sectional study carried out over a period of one year in a teaching hospital in Lagos, Nigeria. Patients with acute stroke admitted to the hospital within three days of the episode of stroke and who met other inclusion criteria for the Study were consecutively recruited. Clinically relevant data was documented and biochemical assessments were carried out within three days of hospitalization. Tests for lipid profile, glycosylated haemoglobin(HbA1c), and blood glucose at presentation were carried out. The presence of past history of DM, undiagnosed DM, stress hyperglycaemia and abnormal lipid profile were noted. Students t test and Chi square were the statistical tests employed.ResultsA total of 137 persons with stroke were recruited of which 107 (76%) met the defining criteria for ischaemic stroke. The mean age and age range of the Study subjects were 62.2 (11.7) and 26–89 years respectively. The Study subjects were classified according to their glycaemic status into the following categories viz; stress hyperglycaemia, euglycaemia, DM and previously undiagnosed DM. Stress hyperglycaemia occurred commonly in the fifth decade of life and its incidence was comparable between those with cerebral and haemorrhagic stroke. The commonly occurring lipid abnormalities were elevated LDL-C and low HDL.ConclusionsThe detection of abnormal metabolic milieu is a window of opportunity for aggressive management in persons with stroke as this will improve outcome. Routine screening for hyperglycaemia in persons with stroke using glycosylated haemoglobin tests and blood glucose may uncover previously undiagnosed DM.

Profile of Pediatric Poisoning at District Hospital Gulbarga

Introduction: Children are curious and explore their world with all their senses, including taste. As a result, the home and its surroundings can be a dangerous place when poisonous substances are inadvertently ingested. Methods: This study was done to know the profile of poisoning cases in pediatric age group in district hospital Gulbarga. It is a retrospective study of Pediatric poisoning between August 2011 and July 2013. Results: Poisoning constituted 0.73% of all Pediatric admissions. Distribution of cases among boys and girls were equal. Majority (68%) of these cases were from rural areas. Only one case of poisoning happened by inhalation / dermal absorption during farming activity, rest 36 (97%) were by oral ingestion. Most (81%) of these poisoning happened in the home environment. Out of the 7 (19%) outdoor poisoning 6 were plant poisons, which were eaten out of curiosity by children. Pesticide was the most common poison found in the study followed by lice powder and kerosene. Nonspecific gastrointestinal complaints like vomiting (75.7%), pain abdomen (40.5%) and loose stools (21.6%) were the most common symptoms with which children with poisoning presented to hospital. Conclusions: Poisoning in children remains one of the causes of emergency admissions to hospital. It is target population regarding proper storage of potential poisonous substances away from the reach of children.

P78 Impact of a pharmacist-led asthma and COPD reviews in general practice

IntroductionAsthma and COPD account for a significant burden of disease in the UK. Despite comprehensive guidelines, over a 1000 people continue to die from asthma each year and COPD accounts...

A UK feasibility study on the value of singing for people with Chronic Obstructive Pulmonary Disease (COPD) September 2011 to June 2012

Background COPD is an umbrella term for a number of specific conditions (primarily bronchitis and emphysema) leading to irreversible airflow obstruction. COPD is characterised by ‘a spiral of decline’: ‘As COPD progresses, patients fail to exercise, feel depressed, and experience low self-esteem.’ In England, approximately 835,000 people have been diagnosed with COPD, but the true prevalence is likely to be over 3 million. Exacerbation of COPD is the second most common cause of emergency admissions to hospitals in the United …

P247 Impact of Implementing COPD Self Management Plans & Rescue Medications Across 3 Hospitals

IntroductionCOPD is the second leading cause of emergency admissions in the UK. National guidelines for managing COPD advise that patients at risk of having or those who have had an...

Chest physiotherapy during an acute exacerbation of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a slowly progressive, irreversible constriction of the airways causing breathlessness, cough and respiratory distress. The primary cause is repeated exposure to cigarette smoke, although occupational exposures may contribute towards its development. The prevalence of COPD is estimated between 2% and 4%, representing approximately one to two million people in England. Acute exacerbations occur when there is rapid and prolonged worsening of symptoms, which may include increased secretions and cough, and one in eight unplanned hospital stays concern COPD, making it the second largest cause of emergency admissions in the United Kingdom. Across Europe, admission rates vary in Nordic countries; rates have been estimated to be between 360 and 460 per 100,000 per year, and in 1994, COPD admissions are numbered 125,508 in Germany, 45,624 in Spain and 40,190 in Italy. This places a considerable financial burden on health care services, representing a condition for which economic evaluation of therapeutic interventions is particularly relevant. The National Institute for Health and Clinical Excellence (NICE) estimates the direct cost of COPD to the National Health Services (NHS), which exceeds £491m per year (expenditure based on 2001–2002 activity). More than half of this relates to hospital care with more than one million inpatient ‘bed days’ per year attributable to the disease. The estimates of cost are US$88 to US$7757 per exacerbation in the United States, and across Europe, inpatient costs account for approximately Eur2.9b annually. COPD is a heterogeneous condition. Individuals commonly experience dyspnoea, but a smaller proportion may experience excessive secretions, particularly during an exacerbation. Removing these secretions may or may not be beneficial to these individuals, and this may be an individual preference. Manual chest physiotherapy (MCP) involves external manipulation of the thorax using the techniques of percussion and vibration, and recent systematic reviews have identified a limited role for MCP during an acute exacerbation of COPD. NICE guidelines recommend that all the patients are taught to use positive expiratory pressure and instructed in active cycle of breathing technique. These guidelines are based on the best evidence that is currently available. However, physiotherapy research is a growing discipline and much of the earlier evidence regarding chest physiotherapy is fundamentally flawed by small sample sizes and a lack of homogeneity within the sample studied. These studies measure short-term outcomes and in essence, consider efficacy, that is to say the effects, both positive and negative, of these techniques. In 2001, a comprehensive review of the literature regarding manual physiotherapy techniques was undertaken. This focused on patients with compromised respiratory function and impaired mucociliary clearance, who were not being mechanically ventilated. It aimed to identify studies of acceptable quality, designed to evaluate the use and the mode of manual techniques, so as to compile clear and concise clinical practice guidelines. This proved impossible to achieve, owing to the lack of suitable evidence. Whilst eight articles report designs that evaluate a specific manual technique, using secretion clearance

Comparison of emergency hospital admissions for drug poisoning and major diseases: a retrospective observational study using a nationwide administrative discharge database

ObjectiveTo compare the clinical and procedural characteristics of emergency hospital admissions for drug poisoning and major diseases.DesignRetrospective observational study.SettingDischarged patients from 855 acute care hospitals from 1 July to 31...

P223a Increasing the quality of COPD case finding, diagnosis and management through a primary care financial incentive scheme in inner London

Introduction and ObjectivesCOPD is a major cause of mortality/morbidity in high smoking prevalence Primary Care Trusts (PCTs). Our PCT expected COPD prevalence (3.7%) is therefore high but recorded prevalence (2009/2010)...

Nursing documentation prior to emergency admissions to the intensive care unit

Early identification of prodromal signs of acute deterioration of patients is essential in high quality care. Rigorous monitoring of patients is facilitated by risk assessment tools, e.g. the Modified Early Warning Score (MEWS). The purpose of the study was to estimate the accuracy of nursing documentation according to parameters that comprise MEWS in patients prior to emergency admission to the intensive care unit (ICU). The research design was retrospective and descriptive. Data was collected from medical records of in-patients who presented as emergency admission to two ICUs at a university hospital between 1 October and 31 December 2006. Data was collected from 65 patients' records over the 3-month period. Most admissions occurred between the hours of 8 a.m. and 4 p.m. Respiratory failure was the primary reason for admission, followed by septic shock. Respiratory rate was documented for 14% of patients (n = 9) prior to ICU admission, which was the least documented observation. Urine output and fluid balance were documented for 40% of the patients, level of consciousness in 48% of patients (n = 31), temperature for 69% (n = 45) and oxygen saturation for 80% of the patients (n = 53). Respiratory failure was the primary cause of emergency admission of in-patients to the ICUs with respiratory rate the least documented vital sign. Nursing documentation according to the MEWS was insufficient. CONCLUSIONS/RELEVANCE TO CLINICAL PRACTICE: Nurses need to be alerted to the necessity of documenting early signs of deterioration of patients, particularly the respiratory rate. With better monitoring and documentation of physiological parameters, emergency admission to the ICU might be avoided.

Preventative tele-health supported services for early stage chronic obstructive pulmonary disease: a protocol for a pragmatic randomized controlled trial pilot.

BackgroundChronic Obstructive Pulmonary Disease (COPD) is a prevalent debilitating long term condition. It is the second most common cause of emergency admission to hospital in the UK and remains one of the most costly conditions to treat through acute care.Tele-health monitoring offers potential to reduce the rates of re-hospitalisation and emergency department visits and improve quality of life for people with COPD. However, the current evidence base to support technology adoption and implementation is limited and the resource implications for implementing tele-health in practice can be very high. This trial will employ tele-health monitoring in a preventative capacity for patients diagnosed with early stage COPD following discharge from hospital to determine whether it reduces their need for additional health service support or hospital admission and improves their quality of life.Methods/DesignWe describe a pilot study for a two arm, one site randomized controlled trial (RCT) to determine the effect of tele-health monitoring on self-management, quality of life and patient satisfaction. Sixty patients who have been discharged from one acute trust with a primary diagnosis of COPD and who have agreed to receive community clinical support following discharge from acute care will be randomly assigned to one of two groups: (a) Tele-health supported Community COPD Service; or (b) Usual Care. The tele-health supported service involves the patient receiving two home visits with a specialist COPD clinician (nurse or physiotherapist) then participating in daily tele-monitoring over an eight week period. Usual care consists of six home visits to the patient by specialist COPD clinicians again over eight successive weeks. Health status and quality of life data for all participants will be measured at baseline, on discharge from the service and at six months post discharge from the service.DiscussionThe tele-health service under study is a complex service delivered through a collaboration between local authority and health care partners. The implementation of this service demanded significant changes to established working patterns and has been a challenging process requiring considerable planning - a challenge that many providers are likely to face in the future.Trial registrationCurrent Controlled Trials ISRCTN68856013

An audit of appendicitis and appendicectomy in Kumasi, Ghana

Acute appendicitis is a leading cause of emergency admission into our hospital. A report on 638 surgical abdominal explorations following emergency admissions for suspected acute appendicitis is presented. The study was conducted at the Komfo Anokye Teaching Hospital between January 1998 and December 2004. During the 7-year period, all consecutive adult patients admitted to our hospital emergency department with suspected appendicitis and who subsequently had an operation done provided the material for the study. Patients whose symptoms settled without operation were excluded. A special proforma was designed to record patient demographic details, clinical features, laboratory data, operative findings and outcome of treatment. Six hundred and thirty-eight patients were studied. These were 408 men and 230 women; a male to female ratio of 1.7:1. The mean age was 32.4 +/- 15.0 S.D years. All patients were admitted with abdominal pains that were initially located at the umbilicus in 38.0% and diffused in 31.8%. Vomiting 85.7%, fever 73.0% and anorexia 49.0% were the most frequent associated symptoms. The mean duration of illness was 74 hours. Right iliac fossa pain and tenderness were present in 612 patients (89.22 %). The total white cell count was significantly raised (p = 0.05). Six hundred and thirty-eight appendicectomies were performed. Thirty-nine percent (249/638) of the appendices were perforated at operation and 25.9% (56/216) of the removed appendices had no histological evidence of inflammation. The complication rate was 43.1% and wound infection (41.5%) was the most common. The average stay in hospital was 7 days. There were 12 deaths--a mortality rate of 1.9%--mostly elderly patients. The diagnosis of appendicitis in our environment is clinical and based mainly on the combination of abdominal pains, signs of peritoneal irritation, and a raised total white cell count with neutrophilia. This mode of presentation is similar to that seen in other communities. The treatment of appendicitis in our hospital is appendicectomy. The negative appendicectomy rate of 25.9% falls within the range reported in other studies. More than a third of the appendices were perforated. The considerable morbidity and appreciable mortality from acute appendicitis in our community are due mainly to the late presentation of our patients.

Ovarian conservation in adnexal torsion-a report of six cases

Adnexal torsion is an uncommon but important cause of emergency admission to the gynaecologist. Treatment of adnexal torsion has traditionally involved surgical excision of the affected structure, usually via laparotomy. A more conservative surgical approach of untwisting the torsion has been widely reported in paediatric cases. Despite reports of the successful treatment of torsion with this approach in the adult population, many UK surgeons remain reluctant to attempt ovarian conserving surgery, particularly via the laparoscopic route.We report six cases of conservative surgery for adnexal torsion. After initial success via laparotomy, the subsequent five cases were managed laparoscopically. We discuss the advantages and disadvantages of this management approach.

Mapping of Atrial Arrhythmias in Complex Congenital Heart Disease

Advances in the treatment of complex congenital heart disease over the past 20 years have led to a dramatic improvement in long-term survival.1 However, the incidence of cardiac arrhythmias as a sequel of palliative heart surgery has also increased significantly in adolescent and adult survivors of congenital heart disease surgery.1,2 Cardiac arrhythmias are the leading cause of emergency admissions in adult congenital heart disease patients with or without surgical intervention.3

Pneumonia presenting with acute abdominal pain in children.

Abstract Abdominal pain is a common cause of emergency admission in children. Although often due to appendicitis and other intra-abdominal causes, extra-abdominal conditions, especially pneumonia, can simulate an acute abdominal catastrophe. Accurate and prompt diagnosis is essential, not only to avoid general anaesthesia and a negative laparotomy in the presence of pneumonia but also to start antibiotic therapy early so as to prevent the complications of pneumonia.

Abdominal emergencies in a tropical African population.

A decade ago intestinal obstruction was the commonest cause of general surgical abdominal emergency admissions in many tropical African countries. Recently there has been a change in this pattern and acute appendicitis has become the major cause of emergency admissions. Most cases of intestinal obstruction are due to obstructed (strangulated or incarcerated) groin hernia. Intestinal ascariasis is a declining cause of intestinal obstruction while colorectal cancer is now an important differential diagnosis. Trauma due to road traffic accidents is increasing in frequency. Gallbladder disease is not a major problem; symptoms suggestive of acute gallbladder disease are more likely to be due to an amoebic abscess in the West African environment.

Ventilation Imaging: a New Emphasis on Chest Imaging

Imaging of the chest is almost as old as the discovery of X-rays. Traditionally, imaging of the chest and lungs relied on projection imaging (with use of a fluorescent screen and radiographs). Since the introduction of body computed tomography (CT) in the 1970s, the lungs have been imaged using both standard and high-resolution CT. It has been shown that CT is much more sensitive for detection of lung diseases (1, 2). Although this has led to significant improvements in the diagnosis of lung diseases, the imaging was (and to a large extent remains) predominantly static and aimed at morphology rather than function. However, even CT is increasingly being applied to gain more information on functional parameters, such as ventilation and perfusion (and their interaction), as will be described in some of the other articles in this volume. Why is the focus returning to lung imaging, and the use of imaging to improve functional analysis? First, we would have to look at the epidemiology of lung diseases. Currently, chronic obstructive lung diseases are one of the four leading causes of morbidity and mortality and outpacing heart diseases and cancer in increasing prevalence (3). Recent data show that between 5 and 15% of adults in industrialized countries suffer from respiratory disorders, which are characterized by a gradually progressive reduction of maximum expiratory flow and delayed emptying of the lungs as a result of a combination of airways disease and parenchymal destruction (emphysema) (4). And it is not just COPD that is causing problems. A recent statistical report from the British Thoracic Society showed that lung disease now kills one in four people, which is more than coronary heart disease (5). It is also the most common cause of emergency admissions and costs the NHS more than any other disease (5). Many of these diseases are either related to smoking (as are emphysema and lung cancer) or are industry/environmental in aetiology (such as lung fibrosis, asthma and asbestosis). Another issue is how lung diseases are diagnosed and managed. Most commonly, lung diseases are diagnosed based on spirometry and, in a subgroup of patients, with the addition of (high-resolution) CT. However, both methods have their limitations. Spirometry is dependent on a number of factors, such as the cooperation of the patient, training and motivation of personnel and is only capable of giving an overall picture of the entire ventilatory system. Thus, it lacks spatial resolution and carries significant intraand inter-patient diversity. Computed tomography overcomes the issue of spatial resolution, but is virtually incapable of yielding functional information. he management of most lung diseases relies almost exclusively on spirometry, which has been used for many years and has resulted in a certain sense of understanding by respiratory physicians. Most recently, this has been emphasized in the GOLD guidelines (6). Thus, bronchodilators and immunosuppression have remained the mainstay of treatment for most lung diseases, such as COPD and asthma. Novel insights in drug delivery may have a significant role to play in the near future. For instance, the lungs are increasingly recognized as a potentially interesting route of drug delivery, such as inhaled insulin, because it avoids the hepatic metabolic pathway and may better simulate the physiological response to a food bolus. This could lead to a reduction in required dose to achieve similar effects, while the doses also become independent of liver metabolism, which may be changeable and is a source of drug interactions (enzyme induction). Furthermore, individualized drug delivery is another source requiring novel insights and assessment of lung ventilation. So how can ventilation be imaged? Several methods have been tested, and these will be discussed in this issue. Lung scintigraphy with a variety of agents has been possible for over 25 years. Aerosols with labelled compounds, such as 99m Technetium DTPA, have been used extensively. They have proven to be safe, albeit that the droplets have a propensity for central airway accumulation in patients with a significant inflammatory (mucus production) component. This problem was overcome by the M R I 0 2 8 B Dispatch: 26.10.04 Journal: MRI CE: Hari

Is endoscopic injection hemostasis of bleeding gastrointestinal ulcers obsolete in 1995?

Bleeding non-neoplastic lesions of the upper gastrointestinal tract, not due to portal hypertension, are a frequent cause of emergency admission. In the present paper we report our retrospective experience in hemostatic injection treatment of these lesions. From May 1990 to May 1994, 164 patients were admitted to our institution for a bleeding gastrointestinal lesion. In 124 cases an ulcer classified according Forrest's criteria was detected. Four patients underwent immediate surgery. The second group of 86 patients (FIIa/FIIb/FIII) were treated conservatively. The third group of 34 patients (FIa/FIb/FIIa) underwent perilesional injection of adrenaline 1:10,000 and polidocanol 1% saline solution during endoscopic examination; 29% (25 pts) of the second group re-bled during the first 72 h vs 8.8% (3 pts) of the third group. The postoperative morbidity in the rebleeding patients was higher in the second group: 38.4% vs 0%. The importance of immediate, inexpensive, and simple hemostatic treatment extended to Forrest IIa lesions is emphasized.

Pharmacological prevention of suicidal behaviour

The number of hospital admissions following an episode of deliberate self harm has been increasing steadily over the past two decades and hospitals in England and Wales now provide care for some 100,000 cases of deliberate non-fatal self-poisoning per year. Indeed in younger women self-poisoning is the commonest cause of emergency admission to a medical ward. The rate of actual suicide has not changed very much although the unreliable nature of suicide statistics and reporting bias make it difficult to make categorical statements. Those with a history of suicidal behaviour contribute substantially to the suicide rates. In this group subsequent suicidal behaviour is reported in 20% within one year (Kreitman 1977). Estimates of the subsequent suicide rate in this group range from 1 to 2% per annum which is between a hundred and two hundred times the expected rate for the general population. Whether they die or not these patients with suicidal behaviour are an at risk group associated with considerable suffering both for themselves and their friends and family. A strong association between suicide and depression has been assumed largely on the basis of retrospective analysis, which is subject to the bias inherent in even the most carefully conducted investigations. Prospective surveys of the prevalence of psychiatric illness in patients admitted to hospital following an episode of deliberate self harm vary but there is agreement that it appears to account for no more than around 40% of such admissions. In the Edinburgh survey depressive illness was a common diagnosis but accounted for only 28% of the men and 40% of the women. By far the largest category were patients with personality disorders. It is likely that any investigation of suicidal behaviour will need to look at the phenomenon in personality disorders separately from depressed patients.

Self-poisoning with drugs: the past 20 years in Sheffield.

In Sheffield there are now over 1000 admissions to hospital each year because of self-poisoning, an increase of twentyfold over the past two decades. The city is representative of the Trent Region, and it can be confidently estimated that there are at least 100 000 cases of self-poisoning in the United Kingdom each year. Most patients are in their late teens and early twenties, and in young women self-poisoning is the most common cause of emergency admission to a medical ward. Although the drugs are usually prescribed by a doctor, patients, especially the young, are showing an increasing tendency to misappropriate drugs prescribed for others. The choice of drug is a matter of simple availability, and national trends in prescribing are reflected in the overdose figures. Barbiturates and paracetamol are responsible for the most deaths. Residence in densely populated areas may be a predisposing factor.