Department Chief Research Articles

Outcomes of Chengdu Pediatric Emergency Triage Criteria: A Retrospective Study of 198,628 Pediatric Patient Records.

BACKGROUND The Chengdu pediatric emergency triage criteria were developed at our hospital and consist of 4 triage levels: immediate treatment (level 1), treatment within 10 min (level 2), treatment within 30 min (level 3), and treatment within 240 min (level 4). This study aimed to evaluate outcomes from the levels 1 to 4 of this triage criteria. MATERIAL AND METHODS A self-designed survey form was used to collect pediatric Emergency Department (ED) patients' general data, including age, sex, and chief concern, and clinical data, including triage level, whether the patient had died, and whether the patient was admitted to our hospital. A total of 198,628 patient records that were triaged during January to May 2022 using Chengdu pediatric emergency triage criteria were included in this retrospective study. The numbers of patients triaged to levels 1, 2, 3, and 4 were 128, 1164, 14,560, and 182,776, respectively. RESULTS Statistically significant differences were found in waiting time for treatment, hospital admission rates, admission conversion rates, and case mix index at admission under different triage levels. The higher the triage priority level, the shorter the waiting time for ED treatment, higher the hospital admission and admission conversion rates, and higher case mix index value. CONCLUSIONS The Chengdu pediatric emergency triage criteria developed and applied within our hospital appears to be characterized by good clinical validity. Equipped with this triage criteria, triage nurses are more capable of determining the severity and emergency of the pediatric ED patients' health conditions and effectively triaging the patients.

Effective Natural Language Processing Algorithms for Early Alerts of Gout Flares from Chief Complaints

Early identification of acute gout is crucial, enabling healthcare professionals to implement targeted interventions for rapid pain relief and preventing disease progression, ensuring improved long-term joint function. In this study, we comprehensively explored the potential early detection of gout flares (GFs) based on nurses’ chief complaint notes in the Emergency Department (ED). Addressing the challenge of identifying GFs prospectively during an ED visit, where documentation is typically minimal, our research focused on employing alternative Natural Language Processing (NLP) techniques to enhance detection accuracy. We investigated GF detection algorithms using both sparse representations by traditional NLP methods and dense encodings by medical domain-specific Large Language Models (LLMs), distinguishing between generative and discriminative models. Three methods were used to alleviate the issue of severe data imbalances, including oversampling, class weights, and focal loss. Extensive empirical studies were performed on the Gout Emergency Department Chief Complaint Corpora. Sparse text representations like tf-idf proved to produce strong performances, achieving F1 scores higher than 0.75. The best deep learning models were RoBERTa-large-PM-M3-Voc and BioGPT, which had the best F1 scores for each dataset, with a 0.8 on the 2019 dataset and a 0.85 F1 score on the 2020 dataset, respectively. We concluded that although discriminative LLMs performed better for this classification task when compared to generative LLMs, a combination of using generative models as feature extractors and employing a support vector machine for classification yielded promising results comparable to those obtained with discriminative models.

Women in Neurosurgery: Turkey's Yıldız Yalçınlar

BackgroundSeveralreports have been published on the history of pioneering women pursuing neurosurgery. Women in Turkey started receiving neurosurgery specialty training later than men, as was the case in other parts of the world. However, compared to other countries, Turkey saw the admission of women in neurosurgery sooner, with Aysima Altınok who obtained her specialization in 1959. Nevertheless, Yıldız Yalçınlar, one of the pioneers, remains relatively unknown. Methods & ResultsIn this paper, we witness Yıldız Yalçınlar's journey, from her graduation from Ankara Medical Faculty in 1954 and her subsequent specialization in general surgery to her arrival in Iğdır as a young surgeon in the early 1960s, where she faced cultural challenges. We explored her transition into neurosurgery, becoming the second neurosurgeon in Turkey in 1965. We examine her complex career progression from receiving her specialization in neurosurgery to her academic journey toward becoming a department chief and her role as one of the founding members of the Turkish Neurosurgery Association. ConclusionsIn Turkey, the number of women practicing as neurosurgeons has increased consistently. Despite this upward trend, the representation of women in the field of neurosurgery remains disproportionately low. We hope that Yıldız Yalçınlar's achievements, which began in the early 60s, will encourage women today and contribute to the continuing growth of neurosurgery.

Global leadership in paediatric and congenital cardiac care: education and empowerment to improve outcomes in low- and middle-income countries - an interview with Krishna Kumar, MD, DM FAHA.

Dr Krishna Kumar is the focus of our sixth in a series of interviews in Cardiology in the Young entitled, "Global Leadership in Paediatric and Congenital Cardiac Care." Dr Kumar was born in Raurkela, India. He attended medical school at Maulana Azad Medical College in New Delhi, graduating in 1984. Dr Kumar then went on to complete internal medicine, emergency medicine, and adult cardiology training at All India Institute of Medical Sciences in 1988, 1989, and 1990, respectively. He then pursued paediatric cardiology training at Harvard Medical School in Boston, MA, USA. Dr Kumar began his clinical position as a paediatric cardiologist at Amrita Institute of Medical Sciences in Kochi, Kerala, India.During his impressive career, Dr Kumar has made significant contributions to educational advancement, research and innovation, public health advocacy, and clinical care. Dr Kumar is credited for distinguishing paediatric cardiology as a distinct subspecialty in India. He was a founding member of the Pediatric Cardiology Society of India and the original editor of the society's academic journal. Recognising the deficit of paediatric cardiology-trained physicians in low- and middle-income countries, Dr Kumar helped establish formal structured training programmes for paediatric cardiology in India. More recently, he established the Children's HeartLink Fellowships in paediatric cardiac sciences at Amrita Institute of Medical Sciences in Kochi and Institut Jantung Negara in Malaysia. Through educational programmes, Dr Kumar has taught countless caregivers and paediatricians, in India and neighbouring countries, the early identification and management of children with CHD. Dr Kumar has established a premier paediatric heart programme at Amrita Institute of Medical Sciences. As department Chief, he emphasises the importance of teamwork, advocacy, and continuous quality improvement. He has developed numerous low-cost strategies for the management of CHD. He has established large community-based studies on rheumatic heart disease and CHD in South India. Dr Kumar's focus on advocacy and policy change in India has made a substantial impact on early identification and treatment of CHD in the subcontinent. He has made a global impact on the care of paediatric cardiology patients through his educational programmes, research and innovation, large-scale research registries, and advocacy for public health policy changes. He is an incredibly humble and generous leader, and his patients and community are the source of his unending motivation.

Presyndromic surveillance for improved detection of emerging public health threats.

Existing public health surveillance systems that rely on predefined symptom categories, or syndromes, are effective at monitoring known illnesses, but there is a critical need for innovation in "presyndromic" surveillance that detects biothreats with rare or previously unseen symptomology. We introduce a data-driven, automated machine learning approach for presyndromic surveillance that learns newly emerging syndromes from free-text emergency department chief complaints, identifies localized case clusters among subpopulations, and incorporates practitioner feedback to automatically distinguish between relevant and irrelevant clusters, thus providing personalized, actionable decision support. Blinded evaluations by New York City's Department of Health and Mental Hygiene demonstrate that our approach identifies more events of public health interest and achieves a lower false-positive rate compared to a state-of-the-art baseline.

2.128 Psychiatric Emergency Department Chief Complaints and Wait Times in Children, Adolescents, and Young Adults During the COVID-19 Pandemic: A Retrospective Review of a Large Massachusetts Hospital System

The COVID-19 pandemic has presented an unprecedented impact on global mental health, with children, adolescents, and young adults noted to be particularly vulnerable to its effects. We aimed to evaluate COVID-19’s impact on the mental health of this population within a large Massachusetts hospital system.

77 Results of a Novel National Emergency Department Chief Complaint Database

77 Results of a Novel National Emergency Department Chief Complaint Database

22 Efficacy of Emergency Department-Initiated 14-Day Ambulatory ECG Patch Monitors in Patients With Unexplained Syncope

Syncope is a common and costly emergency department (ED) chief complaint. Unfortunately, more than 50% of high-risk syncope patients do not follow up for further outpatient cardiac monitoring following ED or hospital discharge. Leadless and wireless ECG patch monitors are now widely available for ambulatory cardiac monitoring. We initiated a protocol in which ED physicians were given the option of discharging patients with a diagnosis of syncope with a 14-day ambulatory ECG monitor (AEM) placed by ED staff.

27 Combining Machine Learning and Network Science to Cluster Emergency Department Chief Complaints and Diagnoses

Study Objectives: Improvements to electronic health record (EHR) systems have enabled the adaptation of emergency care practice to incorporate discrete data capture of chief complaints and clinical diagnoses. However, the number of distinct data elements for complaints and diagnoses is very large. In this study, we sought to apply data science approaches (including network science and unsupervised machine learning) to identify clusters of complaints and diagnoses in the emergency department (ED).

Telerehabilitation as a Method for Achieving Competencies in Physical and Rehabilitation Medicine Residency Training in a Developing Country: A Protocol for a Pilot Mixed-Methods Study.

BackgroundIn the second year of the COVID-19 pandemic, Physical and Rehabilitation Medicine (PRM) residents in a developing country continue to face a lack of in-person clinical exposure and learning opportunities. With the unprecedented shift to virtual care, it remains uncertain whether residents can achieve PRM competencies using telerehabilitation as a method of instruction.ObjectiveTo determine the PRM residents' ability to achieve competencies through telerehabilitation, as perceived by different stakeholders (residents, chief residents, training officers, and department heads).MethodsThis will be a pilot mixed-methods study, employing concurrent triangulation, in the Department of Rehabilitation Medicine in one large private medical center and one large government hospital in Manila, Philippines. There will be two phases of online data collection upon approval by their respective research ethics board. The first phase will involve an online Likert-scale questionnaire to obtain the residents' self-perceived attainment of competencies and learning of PRM topics and skills specified by the International Society of Physical and Rehabilitation Medicine and the Philippine Board of Rehabilitation Medicine. The results of the survey will then be summarized and presented in a focus group discussion (FGD) with the department heads, training officers, and chief residents of the two institutions in an attempt to explain the residents' perceptions on their competencies achieved through virtual care. Afterwards, the qualitative data obtained from the FGD will then be thematically analyzed, and mixed methods integration will be employed to generate knowledge and recommendations.DiscussionIt is hypothesized that the majority of the residents had little to no experience with telerehabilitation pre-pandemic. Suddenly telerehabilitation was used to augment clinical training during the pandemic. It is uncertain whether telerehabilitation can help residents achieve competencies in the different domains of training, namely: patient safety and quality patient care; medical knowledge and procedural skills; interpersonal and communication skills; practice- and systems-based learning and improvement; reintegration of people with disabilities into the society; medical ethics and public health; quality assurance; policies of care and prevention for disabled people; and professionalism. The study results can provide insights on the aspects of a PRM curriculum that may have to be modified to ensure the training program is sensitive and appropriate to the changing training needs of the residents amid the pandemic and similar crises that may disrupt in-person clinical encounters in the future.

Renal Replacement Therapy for Acute Kidney Injury in French Intensive Care Units: A Nationwide Survey of Practices

Background: The frequency of acute kidney injury (AKI) can be as high as 50% in the intensive care unit (ICU). Despite the publication of national guidelines in France in 2015 for the use of RRT, there are no data describing the implementation of these recommendations in real-life. Methods: We performed a nationwide survey of practices from November 15, 2019, to January 24, 2020, in France. An electronic questionnaire based on the items recommended in the national guidelines was sent using an online survey platform, to the chiefs of all ICUs in France. The questionnaire comprised a section for the Department Chief about local organization and facilities, and a second section destined for individual physicians about their personal practices. Results: We contacted the Department Chief in 356 eligible ICUs, of whom 88 (24.7%) responded regarding their ICU organization. From these 88 ICUs, 232/285 physicians (82%) completed the questionnaire regarding individual practices. The practices reported by respondent physicians were as follows: intermittent RRT was first-line choice in >75% in a patient with single organ (kidney) failure at the acute phase, whereas continuous RRT was predominant (>75%) in patients with septic shock or multi-organ failure. Blood and dialysate flow for intermittent RRT were 200–300 mL/min and 400–600 mL/min, respectively. The dose of dialysis for continuous RRT was 25–35 mL/kg/h (65%). Insertion of the dialysis catheter was mainly performed by the resident under echographic guidance, in the right internal jugular vein. The most commonly used catheter lock was citrate (53%). The most frequently cited criterion for weaning from RRT was diuresis, followed by a drop in urinary markers (urea and creatinine). Conclusion: This study shows a satisfactory level of reported compliance with French guidelines and recent scientific evidence among ICU physicians regarding initiation of RRT for AKI in the ICU.

COVID-19 Impact on Resident Mental Health and Well-Being.

Columbia University's Papper Symposium, a virtual event held on March 20, 2021, was dedicated to the coronavirus disease-2019 (COVID-19) pandemic. This article summarizes a lecture by Dr. Roberta Hines, Nicholas M. Greene Professor of Anesthesiology and Department Chair and Chief of Anesthesiology at Yale-New Haven Hospital titled "The impact of COVID-19 on trainees: lessons learned and unanticipated opportunities," in addition draws from experiences at Columbia University Irving Medical Center and a focused review of the literature on the toll of the pandemic on trainee well-being and mental health. Early research has demonstrated that rates of burnout and acute stress were higher among health care providers who cared for COVID-19 patients than those who did not and that COVID-19 frontline health care providers are at high risk for common psychological disorders, including depression, anxiety, and post-traumatic stress disorder. Trainees working on the frontlines may be at particularly high risk for these mental health disorders and are less likely to access resources available to them. Program directors and hospital graduate medical education leaders should be aware of the threats to physiological and psychological safety and take action to prevent further detrimental effects. The rates of burnout and mental health disorders among trainees are expected to rise as a result of the pandemic, making screening programs and increased access to mental health treatment an essential feature of all residency and fellowship programs.

The Impact of COVID-19 on Trainees: Lessons Learned and Unanticipated Opportunities.

Dr. Emanuel Martin Papper was a Professor and Department Chair at Columbia University whose top passion was training the next generation of anesthesiologists. As such, a fitting topic for discussion at Columbia University Department of Anesthesiology's Papper Symposium was the "The Impact of the COVID-19 Pandemic on Trainees: Lessons Learned and Unanticipated Opportunities," presented by Dr. Roberta L. Hines, Nicholas M. Greene Professor of Anesthesiology and Department Chair and Chief of Anesthesiology at Yale-New Haven Hospital. The pandemic led to abrupt changes at the national, hospital, and training program levels, all of which impacted trainees in anesthesiology and other disciplines. Nationally, there were sweeping regulatory changes that helped to shape the coronavirus disease-2019 response by medical front line workers. At each individual hospital, coronavirus disease-2019 units were created and teams were restructured to keep up with patient care demands. Educational programs adapted their curricula and trainees lost valuable clinical and academic opportunities. The innovative educational responses, including a pivot to virtual learning and virtual recruitment, provided a silver lining to the health care crisis. Another bright spot was that anesthesiology as a specialty rose to the forefront of patient care. Anesthesiologists displayed impactful leadership during the pandemic, paving the way for future growth and broadened reach of our specialty.

170 Emergency Department Chief Complaints Among Older Adults With and Without Alzheimer’s Disease or Related Dementias in Years Before and After Diagnosis

The Emergency Department (ED) is a common site of care for older adults including those with Alzheimer’s disease and Related Dementias (ADRD). Chief complaints may provide valuable early information to hasten triage, diagnostic workup, and care; however, studies have been limited in ADRD. We characterized chief complaints of patients with and without ADRD presenting to the ED in the years prior to and after diagnosis. This was a retrospective observational analysis of the chief complaints of Medicare beneficiaries who received care within the ED at two large healthcare systems in New York, NY and Chicago, IL over a six-year period (2010-2015). ED visit encounter data from electronic health records (EHRs) of both healthcare systems were linked to beneficiary Medicare Fee-for-service claims. Chief complaints were abstracted from EHRs and grouped into 82 different categories. We identified diagnosis of ADRD through ICD diagnoses in inpatient and outpatient claims and ADRD-related prescriptions. We report the prevalence of each chief complaint category among beneficiaries with ADRD, before and after ADRD diagnosis, and at each ED location. We identified 57,204 Medicare beneficiaries who had a total of 151,053 ED visits across the two hospital systems over the 6-year period. One in four patients (N=14,991; 25.3%) had a diagnosis of ADRD or received ADRD-related prescription during the observation period. These patients accounted for 31.8% of all ED visits (12.4% prior to diagnosis; 19.4% after ADRD diagnosis). Among the top 10 chief complaints, altered mental status (4.3% vs. 1.3%), fall (6.4% vs. 4.7%), psychiatric disturbance (2.89% vs. 1.69%), and weakness (4.3% vs. 3.1%) were more common among patients with ADRD compared to beneficiaries without ADRD. On the contrary, chief complaints of any pain (9.9% vs. 7.1%), chest pain (7.7% vs. 4.6%), abdominal related (6.1% vs. 4.4%), and dizziness (2.9% vs. 2.0%) were more common among non-ADRD patients. These differences were observed up to 2 years prior to diagnosis with an increase in number and percentage of ED visits with chief complaints of alerted mental status, falls, and weakness in the 6 months prior to diagnosis of ADRD. These patterns were consistent across sites. Patients with ADRD and cognitive impairment encompass a significant portion of older adults presenting to the ED. Chief complaints of patients with ADRD are more likely to present with geriatric syndromes and altered mental status, even before diagnosis is documented. Chief complaints may be a feasible way to recognize and triage older adults to geriatric and ADRD services needed to foster higher quality ED and post-ED care.

Identifying Areas of Improvement for Care of Hospice-Enrolled Patients Presenting to the Emergency Department (QI720)

1.Describe the current framework for management of hospice-enrolled patients presenting to the Emergency Department.2.Identify how many patients enrolled in a large hospice organization present to the Emergency Department over a 2-month period and most common chief complaints.3.Describe a potential intervention to assist hospice-enrolled patients experiencing perceived emergencies at home or in congregate settings. While there are some emergencies that require hospice-enrolled patients to present to the Emergency Department (ED) (such as lacerations or equipment malfunction), some hospice-related and predictable emergencies may be equally or superiorly treated at home or inpatient hospice (such as shortness of breath or pain). Although Emergency Medicine and Hospice and Palliative Medicine physicians have opinions on why hospice-enrolled physicians present to the Emergency Department, there is little research on the most common reasons leading hospice-enrolled patients presentation to the ED. To identify the most common reasons hospice-enrolled patients in a large hospice organization present to the Emergency Department and design chief complaint-focused interventions to avoid undesired and unnecessary ED visits. Using triage notes and input from hospice nurses and physicians, I identified hospice-enrolled patients who presented to the ED over between January 1, 2020 and February 28, 2020. Over a 2-month period, 44 hospice-enrolled patients presented to the ED. The most common hospice diagnoses were cancer, cardiovascular disease, COPD, Alzheimer’s disease and cirrhosis. 26 patients came from home and 18 came from a nursing facility. 18 out of the 44 patients presented after a fall. The other presentations were for respiratory issues (7), gastrointestinal issues (6), equipment malfunction (4), agitation or altered mental status (4), pain (3), and rash (2). ED presentation was relatively common over a 2-month period among our hospice-enrolled patients. Falls were by far the most common reasons for presentation. This was not a commonly identified emergency in the literature related to hospice-enrolled patients presenting to the ED. In response to this, I created an Emergency Plan sheet related to falls. In the future, this will be given to patients upon enrollment.

A practical system that enables physicians to respond expeditiously to significant unexpected findings (SUFs) in radiological reports.

To demonstrate effectiveness of our present radiological report check flowchart enabling physicians to respond to significant unexpected findings (SUFs), by comparing the response periods from the examination date to the action date on untreated SUFs between the previous and present versions of our flowchart. In the flowchart's previous version used February-October 2019, SUFs, which were notified by email, were audited every month. The physician received a phone call and was asked to act on the untreated SUF. In the flowchart's present version used from November 2019 to May 2020, SUFs were audited every 2weeks. The physician and his/her chief were asked to return a written response to the untreated SUF. We evaluated the difference in the response periods between the previous and present versions of the flowchart. With the previous flowchart's use, untreated SUFs were 43 of 229 SUFs (18.8%) with the present flowchart untreated SUFs were 22 of 130 SUFs (16.9%). All SUFs in both periods were eventually responded. The present flowchart (median/range, 25/11-70days) significantly had shorter response periods than the previous flowchart (70/16-290days) (p < 0.0001). The present flowchart employing a shortened primary audit interval, a written response, and the department chief's intervention, helped reduce the response periods.

Scoring systems for the triage and assessment of short-term cardiovascular risk in patients with acute chest pain.

Acute chest pain is a common emergency department (ED) chief complaint. Evaluating patients for acute coronary syndrome is challenging because missing the diagnosis carries substantial morbidity, mortality, and medicolegal consequences. However, over-testing is associated with increased cost, overcrowding, and possible iatrogenic harm. Over the past two decades, multiple risk scoring systems have been developed to help emergency providers evaluate patients with acute chest pain. The ideal risk score balances safety by achieving high sensitivity and negative predictive value for major adverse cardiovascular events while also being effective in identifying a large proportion of patients for early discharge from the ED. This review examines contemporary risk scores used to risk stratify patients with acute chest pain.

Confederate Citadel: Richmond and Its People at War by Mary A. DeCredico

Reviewed by: Confederate Citadel: Richmond and Its People at War by Mary A. DeCredico Wendy Venet (bio) Confederate Citadel: Richmond and Its People at War. By Mary A. DeCredico. (Lexington: University Press of Kentucky, 2020. Pp. 209. Cloth, $50.00.) In Confederate Citadel, Mary A. DeCredico joins a growing list of scholars who examine the Confederacy’s capital city during the period 1861–65, a list that includes Emory M. Thomas, Ernest B. Furgurson, and Stephen V. Ash. DeCredico’s book is slim (151 pages of text) but covers a broad range of topics, including secession, the growth and importance of Richmond as [End Page 437] capital city, deteriorating conditions in the wake of military defeat, and the city’s capture in April 1865. The breadth of coverage, range of sources consulted, and concise writing style make DeCredico’s book a good candidate for classroom use. DeCredico characterizes Richmond as a “vibrant commercial, urban, and industrial complex” at the start of the war (2). As the author of a previous work about Georgia’s wartime industrialists,1 she understandably gives special attention to Richmond as industrial powerhouse. Home to the Tredegar Iron Works, along with other factories and railroads, Richmond earned its reputation as an industrial center and prompted Confederate leaders to select it as capital. Confederate Citadel follows a chronological format, with chapters devoted to Richmond replacing Montgomery, Alabama, as Confederate capital, Federal efforts to seize the city in 1862, increasing civilian hardship in 1863, the struggling city in 1864, and Richmond’s fall to the Union army in 1865. DeCredico does a good job of weaving the Confederate military narrative with the civilian story, especially in her chapter devoted to the “the campaigns of 1862,” when residents of Richmond feared their city would be captured by Major General George McClellan’s army. In addition to photographs, several nice maps are included in the book, depicting the city center, the Battle of the Seven Days in 1862, and the Richmond-Petersburg theater of war in 1865. DeCredico provides an in-depth discussion of Richmond’s evolution from a Unionist city that voted for moderate John Bell in the presidential election of 1860 to a secessionist enclave after the fall of Fort Sumter. She considers the role of local newspaper editors in fanning the flames of secessionism, notably John Moncure Daniel of the Richmond Examiner. Her discussion of Richmond as Confederate capital is very solid, including the growth of hospitals, prisons, female benevolent groups, and the problems posed by infectious disease, crime, food shortages, and inflation, along with the city council’s sincere efforts to mitigate these problems. By 1864, DeCredico writes, Richmond’s population had reached at least 100,000 residents, possibly 130,000, and a widening gap existed between elites who held elegant parties and the city’s increasingly destitute under-class, a situation that drew the attention of both journalists and private citizens. In addition to newspapers, DeCredico cites a variety of archival sources and quotes prominent residents, including diarist Mary Chesnut and Confederate Ordnance Department chief Josiah Gorgas, nurses Phoebe Pember and Sallie Tompkins, and Union spy Elizabeth Van Lew. She also includes less well known chroniclers such as Sallie Brock Putnam and [End Page 438] John B. Jones, wartime residents who published books about Richmond after the war. DeCredico might have done more to pull material from some of her sources. Putnam is cited as an authority on changing wartime conditions but not on family relationships, a topic DeCredico does not treat with significant depth. Similarly, Jones, a Confederate civil servant, is cited frequently in discussions about deteriorating conditions but not used effectively as a source of information about the working lives of War Department clerks. DeCredico focuses on Jefferson Davis, his family, and their relationship with the city, with less discussion of Robert E. Lee’s family, although Mary Custis Lee is quoted at the end of the book, complaining about “Lincoln’s triumphal entry into Richmond. He was surrounded by a crowd of blacks, whooping & cheering like so many demons” (145). DeCredico reminds us that Richmond was a city with a diverse population, including immigrant communities of Germans, Irish, and Jews, and free...

351 The Diagnosis of Carotid and Vertebral Artery Dissections by Emergency Physicians is Rare

Carotid and vertebral artery dissections are rare events. The most frequent symptoms are head and neck pain and neurological deficits, but these are common emergency department (ED) chief complaints and other diseases causing these occur much more often. Furthermore, about one-third of patients have no headache, one-third have no neck pain and over 10% have no neurologic deficits. For these reasons, diagnosing dissections is challenging. We wished to quantify the magnitude of this problem in a large ED database. Our goal was to determine the number of total ED visits for every carotid and vertebral artery dissection diagnosed by ED physicians. Design: Multicenter retrospective cohort. Setting: 27 suburban and urban New York and New Jersey EDs with annual visits between 20,000 and 119,000. Participants: Patients seen by ED physicians in the four-year period from 11-1-2015 through 10-31-2019. Observations: We identified carotid and vertebral artery dissections using ICD-10 codes. We then calculated the number of ED visits for every carotid and vertebral artery dissection, along with 95% confidence intervals (CIs). From a database of 6,223,499 ED visits, we identified 115 carotid artery dissections and 97 vertebral artery dissections. The median ages (with interquartile ranges) and percent female of carotid and vertebral artery dissection patients were 54 years (41, 64), 47 years (38, 63), 55% and 51%, respectively. Of the total ED visits there was one carotid artery dissection for every 54,117 (95% CI 45,089 to 64,953) visits and one vertebral artery dissection for every 64,160 (95% CI 52,599 to 78,261) visits. The diagnosis of carotid and vertebral artery dissections by ED physicians is rare. An ED physician seeing 3,000-4000 patients a year would diagnose one carotid artery dissection every 13 to18 years and one vertebral artery dissection every 16 to 21 years.Tabled 1Row LabelsCount of Billed ICD DescriptionNumber of visits for each diagnosisDissection of carotid artery11554117.38Dissection of renal artery23111750Dissection of vertebral artery9764159.78Extradural and subdural abscess, unspecified7286437.49Intraspinal abscess and granuloma12649392.85total visits622349927 hospitals Open table in a new tab

COVID-19 and the Radiology Match: A Residency Program's Survival Guide to the Virtual Interview Season

COVID-19 and the Radiology Match: A Residency Program's Survival Guide to the Virtual Interview Season