Characteristics Of Emergency Department Patients Research Articles

Hemodynamic Resuscitation Characteristics of Emergency Department Patients with Sepsis and Hypotension who are and are not Admitted to ICU; a Prospective Cross-sectional Study.

There is an evidence-practice gap in the optimal timing and volume of intravenous fluid as well as vasopressor administration in managing patients with sepsis. This study aimed to explore current hemodynamic resuscitation practice in emergency department (ED) for patients with sepsis and hypotension. This is a sub-analysis of the prospective multicentre ARISE FLUIDS observational study, which was conducted in 70 EDs across Australia and New Zealand. Baseline characteristics, as well as ED management and outcome of sepsis patients were compared between patients who were and were not admitted to intensive care unit (ICU) or high dependency unit (HDU). A total of 587 patients with a median age of 65 years and even sex distribution (49% female) were available for analysis. Almost two-thirds of patients with sepsis (63.2%, n=371) were not admitted to ICU/HDU and were given lower intravenous (IV) fluid volumes over 24-hours, compared to those receiving critical care (4077ml vs. 5421ml, p<0.001). Patients not admitted to an ICU/HDU had a lower Acute Physiology And Chronic Health Evaluation (APACHE) II score (median 14 vs. 18, P<0.001) and serum lactate level (1.8 vs. 2.8 mmol/L, P<0.001) compared to those admitted to ICU/HDU and 5.9% received a vasopressor infusion in the first 24-hours. Females, patients aged <65 years, and those with urosepsis or sepsis of non-respiratory origin received a greater volume of IV fluids. Almost two-thirds of patients were not admitted to ICU/HDU. In patients not admitted to ICU/HDU, 1 in 17 received a vasopressor infusion during their ED or early hospital stay. Patients not admitted to ICU/HDU received less fluid in the first 24 hours than those who were. Greater resuscitation fluid volumes were independently associated with female sex, age <65 years, higher lactate levels, and urinary or non-respiratory source of sepsis.

Gender differences in clinical characteristics of emergency department patients involving illicit drugs use with analytical confirmation

To compare gender differences in socio-demographics, clinical manifestations, and laboratory test results of individuals who visited emergency departments (EDs) involving drug use. We retrospectively collected the data from 10 hospitals in Taiwan on drug-related ED visits from May 2017 to December 2020. We then examined the gender differences in their socio-demographics, clinical manifestations, urine toxicological results, and other laboratory tests results using chi-square or multivariable logistic regression. Among individuals with drug-related ED visits, there were 546 (73.7%) men and 195 (26.3%) women. The most commonly used drugs were meth/amphetamine, followed by synthetic cathinones, and ketamine and its analogs. Compared to men, women were younger (32.03±10.86 vs. 36.51±10.84 years, p<0.001) and more likely to use new psychoactive substances (NPS) (p=0.011). Men were more likely to have human immunodeficiency virus infection (p<0.001), whereas women were more likely to report psychiatric comorbidities (p=0.003). Women were less likely to have aggressive behaviors (odds ratio (OR): 0.59, 95% CI: 0.39-0.88). After adjusting for socio-demographics and drug types, women were still less likely to have aggressive behaviors than men (adjusted OR: 0.59, 95% CI: 0.38-0.93). The likelihood of rhabdomyolysis and intensive care unit admission was higher in men (p<0.001). We found considerable gender differences in clinical characteristics among ED-visiting drug users, which could offer valuable information for the future development of more tailored gender-specific drug prevention and treatment strategies.

Iterative conceptual modeling: A case study in cardiac patient survival simulation

Iterative conceptual modeling techniques were used to abstract a computer model of emergency department patient characteristics from a medical dataset. This research effort focused on unbalanced medical data then developed and defined a simulation of cardiac patient survival. The approach focused on desired real-world outcomes for the model. Specifically, iterative conceptual modeling ensured alignment between real-world needs and model development. Model validity was enhanced and the problem of unbalanced medical data was discovered and addressed through iterative prototyping. Overall, the effort approach reduced Type II Errors and improved simulation accuracy. This research yielded tangible benefits in an emergency department cardiac patient study where each improvement in accuracy can directly impact life and death decisions.

239 Characteristics of Emergency Department Patients With Agitation and Excited Delirium Syndrome

239 Characteristics of Emergency Department Patients With Agitation and Excited Delirium Syndrome

33EMF Characteristics of Emergency Department Patients With Short Intensive Care Unit Admission for Diabetic Ketoacidosis: Implications for Resource Utilization

33EMF Characteristics of Emergency Department Patients With Short Intensive Care Unit Admission for Diabetic Ketoacidosis: Implications for Resource Utilization

The Prevalence and Characteristics of Emergency Medicine Patient Use of New Media.

BackgroundLittle is known about “new media” use, defined as media content created or consumed on demand on an electronic device, by patients in emergency department (ED) settings. The application of this technology has the potential to enhance health care beyond the index visit.ObjectiveThe objectives are to determine the prevalence and characteristics of ED patients’ use of new media and to then define and identify the potential of new media to transcend health care barriers and improve the public’s health.MethodsFace-to-face, cross-sectional surveys in Spanish and English were given to 5,994 patients who were sequentially enrolled from July 12 to August 30, 2012. Data were collected from across a Southern Connecticut health care system’s 3 high-volume EDs for 24 hours a day, 7 days a week for 6 weeks. The EDs were part of an urban academic teaching hospital, an urban community hospital, and an academic affiliate hospital.ResultsA total of 5,994 (89% response rate) ED patients reported identical ownership of cell phones (85%, P<.001) and smartphones (51%, P<.001) that were used for calling (99%, P<.001). The older the patient, however, the less likely it was that the patient used the phone for texting (96% vs 16%, P<.001). Income was positively associated with smartphone ownership (P<.001) and the use of health apps (P>.05) and personal health records (P<.001). Ownership of iPhones compared to Android phones were similar (44% vs 45%, P<.05). Race and ethnicity played a significant role in texting and smartphone ownership, with Hispanics reporting the highest rates of 79% and 56%, respectively, followed by black non-Hispanics at 77% and 54%, respectively, and white non-Hispanics at 65% and 42%, respectively (P<.05).ConclusionsThere is a critical mass of ED patients who use new media. Older persons are less comfortable texting and using smartphone apps. Income status has a positive relationship with smartphone ownership and use of smartphone apps. Regardless of income, however, texting and ownership of smartphones was highest for Latinos and black non-Latinos. These findings have implications for expanding health care beyond the ED visit through the use of cell phones, smartphones, texting, the Internet, and health care apps to improve the health of the public.

Trends and Characteristics of Emergency Department Patients Prescribed Novel Oral Anticoagulants

BackgroundSince 2010, several novel oral anticoagulants (NOACs) have been approved by the United States Food and Drug Administration for the use in the prevention of cerebrovascular accidents (CVAs) in nonvalvular atrial fibrillation. ObjectiveOur aim was to describe the trends and characteristics of NOAC-related emergency department (ED) visits. MethodsRetrospective review of data from an ED tracking system of all visits that had a medication reconciliation with an NOAC or warfarin to a tertiary care ED between October 2010 and August 2014. Basic demographics, admission rate, admission diagnoses, and trends were analyzed. ResultsThe rate of warfarin visits was stable at 50–60 patients per month (PPM) per 1000 ED visits, however, the rate of dabigatran visits rose to 3–5 PPM/1000 until 2012 and has stayed stable, while rivaroxaban and apixaban have been gradually increasing to 2–4 and 1–2 PPM/1000, respectively. The admission rate for warfarin was 63.7% and for NOACs was 58.1%, compared to baseline admission rate of 35.5%. The hemorrhagic diagnosis rate was similar for warfarin and the NOACs (8.8% and 8.0%, respectively). There were three significantly different admission diagnoses: there were more admission for atrial fibrillation (5.4% vs. 1.9%) and CVA/transient ischemic attack (5.3% vs. 3.0%) in the NOAC group, while there were more admissions for intracranial hemorrhage (2.7% vs. 0.8%) in the warfarin group. ConclusionsThere has been a steady increase of ED patients who are taking an NOAC. There is a nearly double admission rate for an anticoagulated patient regardless of reason for ED visit. There appears to be no difference between rates of bleeding between warfarin and NOACs, although patients taking NOACs are admitted less often for intracranial hemorrhage.

Characteristics of Emergency Department Patients With Diabetic Ketoacidosis: Assessing the Yield of Diagnostic Laboratory Testing for Identification of Episode Precipitants

Common triggers for diabetic ketoacidosis (DKA) include infection, cardiovascular events, drug use, medication non-adherence, and new-onset diabetes. The search for an underlying precipitant for a DKA episode often results in a broad and costly laboratory evaluation. The objective of this study was to evaluate the diagnostic yield of testing done to identify acute triggers for DKA episodes.

Impact of a government triple zero awareness campaign on emergency department patient characteristics

To evaluate the impact of a government triple zero community awareness campaign on the characteristics of patients attending an ED. A study using Emergency Department Information System data was conducted in an adult metropolitan tertiary-referral teaching hospital in Brisbane. The three outcomes measured in the 3 month post-campaign period were arrival mode, Australasian Triage Scale and departure status. These measures reflect ambulance usage, clinical urgency and illness severity, respectively. They were compared with those in the 3 month pre-campaign period. Multivariate logistic regression models were used to investigate the impacts of the campaign on each of the three outcome measures after controlling for age, sex, day and time of arrival, and daily minimum temperature. There were 17,920 visits in the pre- and 17,793 visits in the post-campaign period. After the campaign, fewer patients arrived at the ED by road ambulance (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.80-1.00), although the impact of the campaign on the arrival mode was only close to statistical significance (Wald χ(2) -test, P= 0.055); and patients were significantly less likely to have higher clinical urgency (OR 0.86, 95% CI 0.79-0.94), while more likely to be admitted (OR 1.68, 95% CI 1.38-2.05) or complete treatment in the ED (OR 1.46, 95% CI 1.23-1.73) instead of leaving without waiting to be seen. The campaign had no significant impact on the arrival mode of the patients. After the campaign, the illness acuity of the patients decreased, whereas the illness severity of the patients increased.

353 “Frequent Flyers:” Characteristics of Emergency Department Patients With 6 or More Visits in a Single Year

353 “Frequent Flyers:” Characteristics of Emergency Department Patients With 6 or More Visits in a Single Year

A Case Series and Review of Takotsubo Cardiomyopathy: Does Stress Really Cause the Stress Cardiomyopathy?

Objective: We sought to describe clinical characteristics of emergency department patients ultimately diagnosed with Takotsubo Cardiomyopathy (TCM) and to explore the causal role that stress may play in its pathogenesis. Methods: We performed a retrospective chart review analyzing all myocardial infarction patients with non-obstructive coronary artery disease on cardiac catheterization to assess for the presence of TCM. Various clinical data, including the pres-ence of stressors, from emergency department records were reported. We also analyzed factors from several studies (including ours) to assess the true causality of stress in the development of TCM. Results: Twelve ED patients out of 2,179 charts reviewed were identified as having TCM. Most were female, post-menopausal, and had chest pain, but only half had a specific stressful event identified in the ED. One-third of patients had no stressful event identified during their hospital stay. Several other studies suggest that stressful events are associated with increased diagnoses of TCM, but we found that causality of stress cannot be substantiated. Conclusion: Stressful events are often not identified in emergency department patients ultimately diagnosed with TCM. The causative nature of stress in the development of TCM cannot be firmly established from any existing data.

International variations in the clinical, diagnostic, and treatment characteristics of emergency department patients with acute heart failure syndromes

Results from investigations in one area of the world may not translate to another if patient characteristics and practices differ. We examine differences in the presentation and management of emergency department (ED) patients with dyspnoea from acute heart failure syndromes (AHFS) between the USA, Western Europe, and Eastern Europe. The URGENT Dyspnoea study was a multinational prospective observational study of dyspnoeic ED patients with AHFS from 18 countries. Acute heart failure syndrome patients from the USA and Western and Eastern Europe underwent dyspnoea assessments within 1 h of the first physician evaluation. Patient characteristics, evaluation, and treatments were compared between geographical regions using analysis of variance and χ(2) tests. Four hundred and ninety-three patients with AHFS met the inclusion criteria. Participants in the USA were more frequently non-white, younger, on chronic beta-blocker therapy, and with an ejection fraction ≤40% when compared with Eastern and Western Europe. Patients from Eastern Europe were more likely to present with de novo heart failure and have ischaemic electrocardiogram changes. Pulmonary oedema was more common on chest radiograph in Western Europe, but natriuretic peptide levels were elevated in all three regions. Diuretic use was similar across all the regions. Intravenous nitroglycerin was used more frequently in Eastern (32.8%) and Western Europe (24.4%) compared with the USA (2.5%). International differences in AHFS presentations and management between regions suggest results from clinical trials in one region may not translate directly to another. These differences should be considered when designing trials and interpreting the results from clinical investigations.

Emergency department patient characteristics: potential impact on emergency medicine residency programs in the Netherlands

We set out to study emergency department patient characteristics at a busy level-2 trauma center, to gain insight into the practise of emergency medicine, which is not yet recognized as a specialty in the Netherlands. From May 27 to July 4 2001, the following data were recorded from the charts of all patients presenting to the emergency department: age, time and form of presentation, diagnostics, treatment, disposition and the single best diagnosis (International Classification of Disease-10 classification). The majority (84%) of the 5234 patients (134/day) patients seen were self-referred and treated by the emergency department physician. The remaining 16% were referred, usually by their general practitioner, directly to a specialty service, which saw them in the emergency department. Self-referred patients tended to be younger (average 33 years), with minor trauma, and infrequently required diagnostics (37%), treatment (49%) or admission (4%). The referred patients were older (average 50 years), with 41% needing admission. Only 16% of all patients were under 16 years of age. In all, there were five deaths (referred patients), 12 resuscitations, seven intubations, seven chest tube insertions and no lumbar punctures performed during the study period. The acuity of self-referred patients seen by the emergency physicians is low, with little diagnostic testing and few interventions and resuscitations, even in a busy center. This has both training and practise implications and it may be inappropriate to take an emergency medicine practise model or curriculum from another country based on its emergency department population.

Dutch emergency department patient characteristics: implications for an emergency medicine residency program

Dutch emergency department patient characteristics: implications for an emergency medicine residency program

Abstract 282 Dutch emergency department patient characteristics: implications for an emergency medicine residency program

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Dutch Emergency Department Patient Characteristics: Implications for an Emergency Medicine Residency Program

Study Objectives: Emergency medicine (EM) does not yet exist as a specialty in the Netherlands, and there is no consensus on the scope of practice for future emergency physicians, nor a defined EM curriculum. We set out to study ED patient characteristics at a busy level 2 trauma center in Amsterdam in order to gain insight into the practice of EM and determine any implications for EM training in the Netherlands.

Nonurgent Emergency Department Patient Characteristics and Barriers to Primary Care

Nonurgent (NU) emergency department (ED) use is at the forefront of medico-political agendas, and diversion of NU patients has been entertained as a management strategy. Before policy changes are implemented, this population should be better understood with respect to their characteristics and reasons for not presenting to primary care providers (PCPs) instead of EDs. This study compares NU with urgent and semiurgent (USU) patients and describes the NU patients' reasons for not seeking care with a PCP before presenting to the ED. This was a secondary analysis from a cross-sectional study with sequential sampling in the EDs of five Quebec tertiary care hospitals (October 19, 1999, to May 26, 2000). Data on medical history, social support, awareness and utilization of health care, ED visits, referrals, activities of daily living, and sociodemographics were obtained. The NU group included patients with triage code 5 and the USU group included patients with triage codes 2, 3, and 4 using the Canadian Triage and Acuity Scale. Patient characteristics were structured into the Andersen behavioral model for health care utilization. Of 2,348 patients approached, 1,783 patients (77%) were eligible and agreed to participate. NU patients (n = 454) were younger than USU patients (n = 1,329) (mean age, 43 [SD +/- 18.1] vs. 49 [SD +/- 20.1] years). Patients in the NU group had better health (number of prior conditions, 3.1 vs. 3.9), were less likely to arrive by ambulance (5% vs. 22%), and were less often admitted from the ED (4% vs. 24%). While 70% of NU compared with 75% of USU patients were followed up by a PCP, only 22% of NU and 27% of USU patients sought PCP care before presenting to the ED. The reasons given by NU patients for not seeking PCP care were accessibility (32%), perception of need (22%), referral/follow-up to the ED (20%), familiarity with the ED (11%), trust of the ED (7%), and no reason (7%). NU ED patients are different from USU patients and have multiple reasons for not seeking primary care before going to the ED. This may help explain why various diversion strategies have been unsuccessful and indicate that a multifaceted approach may be better suited to this group of patients. The design of new interventions, however, will benefit from further research that clarifies the impact of NU patients on the health care system.

Nonurgent Emergency Department Patient Characteristics and Barriers to Primary Care

Nonurgent Emergency Department Patient Characteristics and Barriers to Primary Care

Prevalence and Characteristics of Emergency Department Patients with Harmful and Hazardous Drinking

Prevalence and Characteristics of Emergency Department Patients with Harmful and Hazardous Drinking

Historical, physical, and laboratory characteristics of emergency department patients with positive cervical chlamydia and gonorrhea cultures

Historical, physical, and laboratory characteristics of emergency department patients with positive cervical chlamydia and gonorrhea cultures