Emergency Admissions Of Patients Research Articles

Did the COVID-19 Pandemic Restrict Access to Emergency Urological Services: Assessment of Reorganisation Effectiveness for Hospital Treatment.

Urolithiasis derived renal colic is a common urological condition. If treated properly, the disease resolves without complications; if not treated, it causes infection and renal failure. The COVID-19 restrictions impacted hospitalised treatment of diseases. We analysed the impact of COVID-19 on renal colic treatment at a hospital in Poland. Clinical and demographic data of patients treated during the COVID-19 era were compared with those treated before this pandemic. During the COVID-19 restrictions, renal colic patient hospital admissions fell significantly. However, more patients presented with chronic renal colic symptoms and urinary tract infections. Nevertheless, the degree of hydronephrosis and the number and location of stones did not differ between the two groups. No marked changes were observed in the chosen treatment options. The observed decrease in emergency admissions of patients with acute renal colic with a simultaneous increase in the rate of infectious stones might indicate that some patients requiring urgent medical help did not report to the emergency department or came later than they would before the pandemic, reporting more serious symptoms. One plausible explanation for this may be that the reorganisation of the healthcare system restricted access to urological care. Moreover, some patients may have delayed their visit to the hospital due to the fear of contracting the SARS-CoV-2 coronavirus.

Poorer survival is associated with psychiatric emergency admission in patients with major depressive disorder

Poorer survival is associated with psychiatric emergency admission in patients with major depressive disorder

Intensive care unit requirements in patients treated with immune checkpoint inhibitors.

To determine the proportion of emergency patients treated with immune checkpoint inhibitors (ICIs) that require critical care admission and their requirements. Prospective case series. Analysis of acutely unwell patients treated with ICIs attending a tertiary UK cancer hospital between May 2018 and May 2022. The primary outcome measure was the percentage of patients treated with ICI therapy requiring ICU admission. The secondary outcome measure was whether this need was driven by an immune-mediated toxicity. Eighteen (1.2%) patients of the 1561 acutely admitted patients treated with ICI therapy required an admission to ICU. Ten (55.5%) patients were admitted due to an immune-mediated toxicity; four due to pneumonitis and four due to myasthenia gravis. Seven of 10 survived their ICU admission with 6 surviving at least 6-month post-ICU discharge. Only a small minority of emergency admissions in patients treated with ICIs require admission to ICU. This series adds further evidence that patients with organ failure due to immune-mediated toxicity may achieve good outcomes from ICU admission.

Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions.

BackgroundStudies investigating outcomes of delirium using large-scale routine data are rare. We performed a two-centre study using the 4 ‘A’s Test (4AT) delirium detection tool to analyse relationships between delirium and 30-day mortality, length of stay and home time (days at home in the year following admission).MethodsThe 4AT was performed as part of usual care. Data from emergency admissions in patients ≥65 years in Lothian, UK (n = 43,946) and Salford, UK (n = 38,824) over a period of n}{}sim3 years were analysed using logistic regression models adjusted for age and sex.Results4AT completion rates were 77% in Lothian and 49% in Salford. 4AT scores indicating delirium (≥4/12) were present in 18% of patients in Lothian, and 25% of patients in Salford. Thirty-day mortality with 4AT ≥4 was 5.5-fold greater than the 4AT 0/12 group in Lothian (adjusted odds ratio (aOR) 5.53, 95% confidence interval [CI] 4.99–6.13) and 3.4-fold greater in Salford (aOR 3.39, 95% CI 2.98–3.87). Length of stay was more than double in patients with 4AT scores of 1–3/12 (indicating cognitive impairment) or ≥ 4/12 compared with 4AT 0/12. Median home time at 1 year was reduced by 112 days (Lothian) and 61 days (Salford) in the 4AT ≥4 group (P < 0.001).ConclusionsScores on the 4AT used at scale in practice are strongly linked with 30-day mortality, length of hospital stay and home time. The findings highlight the need for better understanding of why delirium is linked with poor outcomes and also the need to improve delirium detection and treatment.

The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study

BackgroundHospitals in England have undergone considerable change to address the surge in demand imposed by the COVID-19 pandemic. The impact of this on emergency department (ED) attendances is unknown, especially for non-COVID-19 related emergencies.MethodsThis analysis is an observational study of ED attendances at the Imperial College Healthcare NHS Trust (ICHNT). We calibrated auto-regressive integrated moving average time-series models of ED attendances using historic (2015–2019) data. Forecasted trends were compared to present year ICHNT data for the period between March 12, 2020 (when England implemented the first COVID-19 public health measure) and May 31, 2020. We compared ICHTN trends with publicly available regional and national data. Lastly, we compared hospital admissions made via the ED and in-hospital mortality at ICHNT during the present year to the historic 5-year average.ResultsED attendances at ICHNT decreased by 35% during the period after the first lockdown was imposed on March 12, 2020 and before May 31, 2020, reflecting broader trends seen for ED attendances across all England regions, which fell by approximately 50% for the same time frame. For ICHNT, the decrease in attendances was mainly amongst those aged < 65 years and those arriving by their own means (e.g. personal or public transport) and not correlated with any of the spatial dependencies analysed such as increasing distance from postcode of residence to the hospital. Emergency admissions of patients without COVID-19 after March 12, 2020 fell by 48%; we did not observe a significant change to the crude mortality risk in patients without COVID-19 (RR 1.13, 95%CI 0.94–1.37, p = 0.19).ConclusionsOur study findings reflect broader trends seen across England and give an indication how emergency healthcare seeking has drastically changed. At ICHNT, we find that a larger proportion arrived by ambulance and that hospitalisation outcomes of patients without COVID-19 did not differ from previous years. The extent to which these findings relate to ED avoidance behaviours compared to having sought alternative emergency health services outside of hospital remains unknown. National analyses and strategies to streamline emergency services in England going forward are urgently needed.

Clinical decision-making in older adults following emergency admission to hospital. Derivation and validation of a risk stratification score: OPERA.

Objectives of the studyDemographic changes alongside medical advances have resulted in older adults accounting for an increasing proportion of emergency hospital admissions. Current measures of illness severity, limited to physiological parameters, have shortcomings in this cohort, partly due to patient complexity. This study aimed to derive and validate a risk score for acutely unwell older adults which may enhance risk stratification and support clinical decision-making.MethodsData was collected from emergency admissions in patients ≥65 years from two UK general hospitals (April 2017- April 2018). Variables underwent regression analysis for in-hospital mortality and independent predictors were used to create a risk score. Performance was assessed on external validation. Secondary outcomes included seven-day mortality and extended hospital stay.ResultsDerivation (n = 8,974) and validation (n = 8,391) cohorts were analysed. The model included the National Early Warning Score 2 (NEWS2), clinical frailty scale (CFS), acute kidney injury, age, sex, and Malnutrition Universal Screening Tool. For mortality, area under the curve for the model was 0.79 (95% CI 0.78–0.80), superior to NEWS2 0.65 (0.62–0.67) and CFS 0.76 (0.74–0.77) (P<0.0001). Risk groups predicted prolonged hospital stay: the highest risk group had an odds ratio of 9.7 (5.8–16.1) to stay >30 days.ConclusionsOur simple validated model (Older Persons’ Emergency Risk Assessment [OPERA] score) predicts in-hospital mortality and prolonged length of stay and could be easily integrated into electronic hospital systems, enabling automatic digital generation of risk stratification within hours of admission. Future studies may validate the OPERA score in external populations and consider an impact analysis.

Association between visitation restriction during the COVID-19 pandemic and delirium incidence among emergency admission patients: a single-center retrospective observational cohort study in Japan

AimThis study aimed to identify the association between total visitation restriction because of the coronavirus 2019 (COVID-19) pandemic and the incidence of delirium for emergency inpatients.MethodsThis was a single-center, retrospective, observational cohort study conducted at a tertiary critical care center in urban Kyoto, Japan. Adult emergency patients hospitalized between January 1, 2019, and June 30, 2020, were recruited. In response to the COVID-19 pandemic, the authors’ hospital began restricted visitation on March 28, 2020. This study defined before visitation restriction as January 1, 2019, through March 31, 2020, and after visitation restriction as April 1, 2020, through June 30, 2020. We did not restrict emergency services, and there were no changes in the hospital’s routine, except for visitation restrictions. The primary outcome was the incidence of delirium. The adjusted odds ratio (AOR) with 95% confidence interval (CI) for delirium incidence was calculated to compare the before and after visitation restriction periods, and the logistic model was used to adjust for seven variables: age, sex, ward type on admission, primary diagnosis, ventilator management, general anesthesia surgery, and dementia.ResultsStudy participants were 6264 patients, median age 74 years (56–83), and 3303 men (52.7%). The total delirium incidence in entire research period was 2.5% (158 of 6264 patients), comprising 1.8% (95/5251) before visitation restriction and 6.2% (63/1013) after visitation restriction. The AOR for delirium incidence was 3.79 (95% CI, 2.70–5.31) after visitation restriction versus before visitation restriction. Subgroup analysis showed no apparent interaction for delirium incidence.ConclusionVisitation restriction was associated with an increased incidence of delirium in emergency inpatients.

A 'hot clinic' for cold limbs: the benefit of urgent clinics for patients with critical limb ischaemia.

The national reconfiguration of vascular surgery means that arterial centres serve larger populations with increased demand on resources. Emergency general surgery ambulatory clinics facilitate timely review and intervention, avoiding admission; a critical limb ischaemia (CLI) 'hot clinic' (HC) was implemented to achieve similar for vascular patients. The aim of the study was to determine HC efficacy. This was a prospective cohort study comparing HC patients with emergency admission (EA) patients between 1 May and 1 December 2017. Age, sex, comorbidities, CLI severity and smoking status were noted. HC patients were provided with satisfaction surveys. Primary outcome measures were freedom from reintervention and major amputation. Secondary outcome measures included time to procedure, length of stay, returns to theatre and 30-day readmission. A total of 147 patients (72 HC, 75 EA) were enrolled in the study. No statistical difference was found in age, sex, smoking status, severity of CLI or prevalence of comorbidities between the groups except that diabetes was more prevalent in EA patients (p=0.028). The median length of stay for the HC cohort was shorter (3 days vs 17 days, p<0.001), with no difference between time to procedure, return to theatre or 30-day readmission. HC patients were nearly 6 times more likely to experience freedom from reintervention (odds ratio: 5.824, p<0.001) and 2.5 times less likely to undergo amputation (odds ratio: 2.616, p=0.043). HC utilisation saved a total of 441 bed days. Over 90% of attendees responded with 100% positive feedback. A vascular HC facilitates urgent review and revascularisation. It provides comparable in-hospital outcomes and better long-term outcomes, with greater efficiency than hospital admission, demonstrating its value in treating CLI.

The Correlation between sST2 and Atrial Fibrillation and Its Clinical Significance

Objective: To explore the level of soluble growth-stimulated expression gene 2 (sST2) in patients with atrial fibrillation (AF) and its relationship with atrial remodeling. Methods: From December 2018 to July 2019, 86 patients were enrolled in the cardiovascular department of Jingzhou Central Hospital in Hubei Province. AF group was 60 patients with AF diagnosed according to the diagnostic criteria of electrophysiology and pacing branch of Chinese Medical Association, while the control group was 26 normal ECG patients with sinus rhythm examined by ECG and/or DCG. Clinical data, NT proBNP and birth rate of all patients were collected chemical indicators. All the patients in the groups were examined by ECG and color Doppler echocardiography. The serum level of ST2 was detected by enzyme-linked immunosorbent assay (ELISA), and the indexes related to atrial remodeling in echocardiography, left atrial diameter (LAD), were collected, compared and analyzed. Results: Serum sST2 levels and LAD and RAD values in the AF group were higher than those in the control group (P < 0.05 or P < 0.01). Serum sST2 levels were higher in the AF group than in the paroxysmal atrial fibrillation group (P = 0.031). 1) The sST2 level was positively correlated with LAD and RAD measured by cardiac ultrasound (r = 0.388, P = 0.029). Conclusion: Serum sST2 levels have early recognition value in patients with high-risk atrial fibrillation, which contributes to the stratification of risk of atrial fibrillation and the prediction of disease activity. Elevated serum sST2 levels may be associated with atrial remodeling. sST2 may be an objective biomarker that predicts the risk of emergency admission in patients with atrial fibrillation. Elevated sST2 levels may be associated with atrial fibrillation progression.

Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa.

Venous thromboembolism (VTE) is a common complication during and after hospitalisation, and is regarded as the most common cause of preventable death in hospitalised patients worldwide. Despite its importance, there are few data on VTE risk and adherence to prophylaxis prescription guidelines in surgical patients from the South African (SA) public sector, especially from low-resource environments such as Eastern Cape Province. To evaluate the risk and prescription of VTE prophylaxis to surgical patients at a tertiary government hospital in the Eastern Cape. A cross-sectional clinical audit of general surgical inpatients was performed on two dates during July and August 2017. Patients' VTE risk was calculated by using the Caprini risk assessment model (RAM) and thromboprophylaxis prescription evaluated accordingly. A total of 179 patients were included in the study, of whom 56% were male and 44% female. The average age was 45 (range 18 - 83) years. Of the total number of participants, 33% were elective cases and 67% were emergency admissions. With application of RAM, 77% of patients were at risk of VTE (Caprini score ≥2), with 81% of elective and 74% of emergency patients being at risk. The most prevalent risk factors for VTE were major surgery (34%), age 41 - 60 years (30%), age 61 - 74 years (20%) and sepsis during the previous month (27%). A contraindication to chemoprophylaxis was recorded in 30% of patients, with the most prevalent being renal dysfunction (40%), peptic ulcer disease (34%), active bleeding (17%), liver dysfunction (17%), coagulopathy (6%) and recent cerebral haemorrhage (6%). With regard to VTE risk profile and contraindications to chemoprophylaxis, the correct thromboprophylactic treatment was prescribed to 26% of at-risk patients, with 21% of elective and 27% of emergency admission patients receiving the correct therapy. Despite a high proportion of patients being at risk of VTE, the rate of adequate thromboprophylaxis prescription for surgical inpatients at Frere Hospital, East London, SA is very low. Increased availability of mechanical prophylaxis, as well as interventions to improve the rate of adequate prophylaxis prescription, needs to be evaluated for feasibility and effect in this hospital and other SA public hospitals.

Pulmonary Rehabilitation Reduces Emergency Admission and Hospitalization Rates of Patients with Chronic Respiratory Diseases.

Chronic respiratory diseases exert a global health burden with high health care costs, morbidity, and mortality. The aim of the present study was to investigate the effect of pulmonary rehabilitation (PR) on emergency admission and hospitalization rates of patients with chronic respiratory disease. In this retrospective cohort study, hospitalization rates and emergency admissions of patients before (December 2014-December 2015) and after PR (January 2015-December 2016) were investigated. Patients with chronic respiratory diseases were included. Chronic obstructive pulmonary disease (COPD) patients were classified based on the Global Initiative Chronic Obstructive Pulmonary Disease assessment scheme. PR was applied by three physiotherapists over 8 weeks (2 days/week). Data on patient demographics, clinical and anthropometric data, spirometry, exercise capacity, and quality of life before and after PR were acquired. This study evaluated 51 patients, of whom 76% were men. A total of 37 (73%) COPD patients and 14 (27%) non-COPD patients (7 bronchiectasis, 4 interstitial lung disease, and 3 kyphoscoliosis) were included. The patients exhibited significantly improved incremental shuttle walk test (ISWT) and endurance test scores (p<0.05) after PR. Similar to exercise capacity, the patients exhibited significantly improved Modified Medical Research Council (mMRC) score, St. George's Respiratory Questionnaire (SGRQ), anxiety and depression scores (p<0.05) after PR. In COPD patients, differences in pre- and post-PR ISWT, COPD assessment test, mMRC, and SGRQ scores were statistically significant (p=0.001). The number of emergency admissions and hospitalizations significantly decreased after PR (p=0.001; p=0.001). The post-PR FEV1% of COPD significantly increased (p=0.029). Pulmonary rehabilitation leads to an increase in exercise capacity as well as improved quality of life, resulting in a decrease in emergency admissions and hospitalization rates. Considering the cost of hospitalization, it is important to add PR to the management of patients with chronic respiratory diseases, in addition to medical therapy.

Reduced risk of emergency admission for colorectal cancer associated with the introduction of bowel cancer screening across England: a retrospective national cohort study.

We wanted to find out if roll-out of the bowel cancer screening programme (BCSP) across England was associated with a reduced risk of emergency hospital admission for people presenting with colorectal cancer (CRC) during this period. This is a retrospective cohort study of 27763 incident cases of CRC over a 1-year period during the roll-out of screening across parts of England. The primary outcome was the number of emergency (unplanned) hospital admissions during the diagnostic pathway. The primary exposure was to those living in an area where the BCSP was active at the time of diagnosis. Patients were categorized into three exposure groups: BCSP not active (reference group), BCSP active <6months or BCSP active ≥6months. The risk of emergency admission for CRC in England was associated with increasing age, female gender, comorbidity and social deprivation. After adjusting for these factors in logistic regression, the odds ratio (OR) for emergency admission in patients diagnosed ≥6months after the start-up of local screening was 0.83 (CI 0.76-0.90). The magnitude of risk reduction was greatest for cases of screening age (OR 0.75; CI 0.63-0.90) but this effect was apparent also for cases outside the 60-69-year age group (OR 0.85; CI 0.77-0.94). Living in an area with active BCSP conferred no reduction in risk of emergency admission for people diagnosed with oesophagogastric cancer during the same period. The start-up of bowel cancer screening in England was associated with a substantial reduction in the risk of emergency admission for CRC in people of all ages. This suggests that the roll-out of the programme had indirect benefits beyond those related directly to participation in screening.

Use of medical emergency call data as a marker of quality of emergency department care in the post-National Emergency Access Target era.

Objectives Any new model of care should always be accompanied by rigorous monitoring to ensure that there are no negative consequences, especially any that impact upon patient safety. In 2013, 'THERMoSTAT' (Two- Hour Evaluation and Referral Model for Shorter Turnaround Times), an emergency department model of care developed by Royal Brisbane and Women's Hospital staff was launched to gain efficiencies and improve hospital National Emergency Access Target (NEAT) compliance. The aim of this study was to trial the use of medical emergency call data as a novel marker of the quality of care delivered by our emergency department. Methods Incidence of medical emergency calls for hospital emergency admission patients for the 2 years pre- and 1 year post-THERMoSTAT were compared after standardising for overall hospital activity. Results During the study period, hospital activity increased 10%, and the emergency department experienced a total of 222645 presentations, 68000 (30.5%) of which converted into an admission. THERMoSTAT improved NEAT compliance by 17% (from 57.7% to 74.9%) with no change in any patient-safety indicators. A total of 8432 medical emergency calls were made on 5930 patients, 2831 of whom were emergency admissions. After adjusting for hospital activity, there was no change in the average number of patients per week who triggered a medical emergency call after the introduction of THERMoSTAT. These results were reproduced when data was analysed for: total number of inpatients triggering calls; emergency admission patients; and emergency admission patients within the first 24h or first 4h of admission. Conclusions This is the first report to investigate the correlation between inpatient medical emergency call incidence and emergency department model of care. Medical emergency call data showed significant promise as a measure of morbidity and as a more direct, objective, simple, quantitative and meaningful measure of patient safety. What is known about the topic? It is well established that extended emergency department lengths of stay are associated with poorer patient outcomes. The corollary of this is not always true however; shorter emergency department length of stay does not automatically translate into better care. Although the underlying philosophy of NEAT is to enhance patient care, there is a risk of negative consequences if NEAT is seen as an end in itself. Many of the commonly used emergency department key performance indicators focus on the timeliness of care and there is a scarcity of easily quantifiable markers that reliably reflect the quality of that care. What does this paper add? This study builds on the concept of medical emergency call incidence as a marker of safety and quality. It explores the utility of using the number of medical emergency calls made in the first few hours of an emergency admission as an indicator of the quality of care delivered by the emergency department. This is significant because it introduces a measure that has a focus that embraces more than the timeliness of care only. What are the implications for practitioners? If medical emergency call incidence in early emergency admissions can be proven to accurately reflect emergency department quality of care then it would provide an easily monitored, objective, quantitative and prompt measure that evaluates dimensions other than timeliness.

111 Can early introduction of specialized palliative care limit intensive care, emergency and hospital admissions in patients with severe and very severe COPD? A pilot randomized study

Background: COPD is a progressive lung disorder with rates of mortality between 36–50%, within 2 years after admission for an acute exacerbation. While treatment with inhaled bronchodilators and steroids may partially relieve symptoms and oxygen therapy may prolong life, for many patients the course of the disease is one of inexorable decline. Very few palliative care intervention studies are available for this population. This trial seeks to determine the effectiveness of the introduction of specialized palliative care on hospital, intensive care unit and emergency admissions of patients with severe and very severe COPD. Methods/Design: The study is a three year single centre, randomized controlled trial using a 2 arms parallel groups design conducted in a tertiary center (University Hospitals; Geneva). For the intervention group, an early palliative care consultation is added to standard care; the control group benefits from standard care only. Patients with COPD defined according to GOLD criteria with a stage III or IV disease and/or long term treatment with domiciliary oxygen and/or home mechanical ventilation and/or one or more hospital admissions in the previous year for an acute exacerbation are eligible to participate. Allocation concealment is achieved using randomisation by sealed envelopes. Our sample size of 90 patients/group gives the study a 80% power to detect a 20% decrease in intensive care unit and emergency admissions – the primary endpoint. All data regarding participants will be analysed by a researcher blinded to treatment allocation, according to the “Intention to treat” principle. Discussion: Given the trends toward aggressive and costly care near end-of-life among patients with COPD, a timely introduction of palliative care may limit unnecessary and burdensome personal and societal costs, and invasive approaches. The results of this study may provide directions for future palliative care interventions in this particular population. Trial registration: This trial has been registered at clinicaltrials.gov under NCT02223780

Hospital-based study on emergency admission of patients with Parkinson's disease.

ObjectiveParkinson's disease (PD) is a progressive neurodegenerative disease. As the severity of disease worsens, patients have lower tolerance for treatments and occasionally need to be hospitalized. This study focuses on characteristics of patients with PD who were emergently admitted to our hospital and evaluates their prognosis during hospitalization.MethodsHospital-based study on emergency admission was conducted in a consecutive series of patients with PD between April 2009 and March 2015.ResultsA total of 164 admissions involving 136 patients with PD with available medical records were identified. Among these, 40 admissions involving 38 patients were emergency admissions. The most common cause of hospitalization was aspiration pneumonia (n = 17) followed by parkinsonism hyperpyrexia syndrome (n = 6), cerebrovascular disease (n = 2), dehydration (n = 2), and others (n = 13). The mean Hoehn and Yahr stage at admission and discharge were 3.5 and 4.2, respectively, with significant differences between time points (p < 0.001). All patients except one presented with either postural instability gait difficulty phenotype (PIGD) or mixed phenotype with PIGD and tremor. All 17 patients with aspiration pneumonia had various combinations of three components: abnormalities seen on videofluoroscopy swallowing study, cognitive impairment, and history of psychiatric symptoms.ConclusionAspiration pneumonia was the most common reason for emergency admission in patients afflicted with PD for more than five years. Abnormalities seen in videofluoroscopy, PIGD and mixed phenotypes, cognitive impairment, and history of psychiatric symptoms could potentially be predictors for aspiration pneumonia in patients with PD.

Lung cancer diagnosed following an emergency admission: Mixed methods study of the management, outcomes and needs and experiences of patients and carers

BackgroundIn the UK, although 40% of patients with lung cancer are diagnosed following an emergency admission (EA), data is limited on their needs and experiences as they progress through diagnostic and treatment pathways. MethodsProspective data collection using medical records, questionnaires and in-depth interviews. Multivariate logistic regression explored associations between diagnosis following EA and aspects of interest. Questionnaire responses with 95% confidence intervals were compared with local and national datasets. A grounded theory approach identified patient and carer themes. ResultsOf 401 patients, 154 (38%) were diagnosed following EA; 37 patients and six carers completed questionnaires and 13 patients and 10 carers were interviewed. Compared to those diagnosed electively, EA patients adjusted results found no difference in treatment recommendation, treatment intent or place of death. Time to diagnosis, review, or treatment was 7–14 days quicker but fewer EA patients had a lung cancer nurse present at diagnosis (37% vs. 62%). Palliative care needs were high (median [IQR] 21 [13–25] distressing or bothersome symptoms/issues) and various information and support needs unmet. Interviews highlighted in particular, perceived delays in obtaining investigations/specialist referral and factors influencing success or failure of the cough campaign. ConclusionsPresentation as an EA does not appear to confer any inherent disadvantage regarding progress through lung cancer diagnostic and treatment pathways. However, given the frequent combination of advanced disease, poor performance status and prognosis, together with the high level of need and reported short-fall in care, we suggest that a specialist palliative care assessment is routinely offered.

Hospital-based study on emergency admission in patients with Parkinson's disease

Hospital-based study on emergency admission in patients with Parkinson's disease

PTU-266 Does participation in bowel cancer screening programme (BCSP) affect emergency admission in patients with bowel cancer?

Introduction The aim of the BCSP is the detection of early colorectal cancer in order to improve overall prognosis. In this study, we looked at the impact of participation in the BCSP on emergency admissions related to colorectal cancer (CRC). Method A retrospective analysis of all patients presenting with a confirmed diagnosis of CRC and were eligible for Faecal Occult Blood testing (FOBt) between 2009 and 2014 at Hillingdon Hospital was carried out (n = 174). The response to FOBt was obtained from the national screening hub. The mode of admission was determined by accessing discharge summaries, the MDT database and the patient assessment service. A responder was defined as a patient who sent a FOBt sample back at any point, and a non-responder as any patient who failed to send back a sample. Results Of the 174 patients, we had 64 (37%) responders and 110 (63%) non-responders. 24 patients presented as emergencies, of which 75% (n = 18) were non-responders, in comparison to 25% (n = 6) responders. 32 patients had incurable disease, of which 23 (72%) were non-responders in comparison to 9 (28%) responders. Conclusion Patients who did not participate in the BCSP had a threefold increase in risk of presenting with a colorectal cancer related emergency, and they were also two and half times more likely to have incurable disease. Although our numbers are small the difference between the responders and non-responders is evident. Disclosure of interest None Declared.

Can early introduction of specialized palliative care limit intensive care, emergency and hospital admissions in patients with severe and very severe COPD? a randomized study.

BackgroundCOPD is a progressive lung disorder with rates of mortality between 36–50%, within 2 years after admission for an acute exacerbation. While treatment with inhaled bronchodilators and steroids may partially relieve symptoms and oxygen therapy may prolong life, for many patients the course of the disease is one of inexorable decline. Very few palliative care intervention studies are available for this population. This trial seeks to determine the effectiveness of the introduction of specialized palliative care on hospital, intensive care unit and emergency admissions of patients with severe and very severe COPD.Methods/DesignThe study is a three year single centre, randomized controlled trial using a 2 arms parallel groups design conducted in a tertiary center (University Hospitals; Geneva). For the intervention group, an early palliative care consultation is added to standard care; the control group benefits from standard care only. Patients with COPD defined according to GOLD criteria with a stage III or IV disease and/or long term treatment with domiciliary oxygen and/or home mechanical ventilation and/or one or more hospital admissions in the previous year for an acute exacerbation are eligible to participate. Allocation concealment is achieved using randomisation by sealed envelopes. Our sample size of 90 patients/group gives the study a 80% power to detect a 20% decrease in intensive care unit and emergency admissions – the primary endpoint. All data regarding participants will be analysed by a researcher blinded to treatment allocation, according to the "Intention to treat" principle.DiscussionGiven the trends toward aggressive and costly care near end-of-life among patients with COPD, a timely introduction of palliative care may limit unnecessary and burdensome personal and societal costs, and invasive approaches. The results of this study may provide directions for future palliative care interventions in this particular population.Trial registrationThis trial has been registered at clinicaltrials.gov under NCT02223780

Analysis of NT-proBNP detection guided treatment of elderly patients with dyspnea （ affiliated 146 cases）

Objective To explore the clinical value of N-terminal pro-brain natriuretic peptide （NT-proBNP） in elderly patients with acute dyspnea. Methods Retrospective analysis of 146 cases of patients with emergency admissions of patients （age ≥ 60 years）with dyspnea from January 2012 - December 2013, patients in 2012 with conventional treatment group; patients in 2013 were under the guidance of NT-proBNP treatment group; properties according to the test results of the NT-proBNP clinical reference standard and NT-proBNP to the evaluation of dyspnea and guide rescue, rescue success rate of patients in 2 groups were analyzed and compared. Results 67 cases （ 15 cases were markedly effective,37 cases were effective,ll cases were invalid,4 cases of death） were rescued in 2012, 79 cases （27 cases were markedly effective,44 cases were effective,6 cases were invalid,2 cases of death） were rescued in 2013. Elderly patients with Dyspnea under the guidance of emergency NT-proBNP levels in 2013 （89.87%） , the rescue success rate was higher than that in the 2012 traditional treatment group （77.61%） （x^2 = 4. 11, P 〈 0. 05 ）. Conclusion Rapid determination of NT-proBNP level of elderly patients with dyspnea has high clinical value in emergency rescue. Key words: Dyspnea; N-terminal pro-brain natriuretic peptide; Aged