Emergency Department Information System Database Research Articles

Incidence of overtriage and undertriage and associated factors: A cross-sectional study using a secondary data analysis.

Improving triage accuracy for accurate patient identification and appropriate resource allocation is essential. Little is known about the trend of triage accuracy, and factors associated with mistriage vary from study to study. To identify incidence and risk factors of mistriage, such as overtriage and undertriage. This is a cross-sectional study. The data came from the National Emergency Department Information System database in 2016-2020. All patients 15 years and older visiting emergency departments in Korea were assessed for eligibility, and 20,641,411 emergency patients' data were used. Multivariable logistic regressions were conducted to confirm the associated factors with overtriage and undertriage compared to expected triage. Demographic characteristics, disease-related signs and triage-related factors were independent variables. Expected triage decreased from 96.8% in 2016 to 95.7% in 2020. Overtriage (0.5%-0.7%) and undertriage (2.4%-3.3%) increased. The occupation that performed triage the most (over 85%) was nurses. Associated factors with overtriage were demographic characteristics (40-64 age group, female), disease-related signs (known disease, direct visit) and triage-related factors (regional emergency medical centre). Risk factors to undertriage were disease-related signs (systolic/diastolic blood pressure and pulse rates within normal range). While the acuity degree remained within the recommended range, the accuracy of triage decreased, and there was a gradual increase in mistriaged cases. Nurses have performed most of the triage and played a key role in expected triage. Associated factors with overtriage were demographic characteristics, disease-related signs and triage-related factors and risk factors to undertriage were disease-related signs. No patient or public contribution. Nurses should be aware of what factors are associated with mistriage and why the factors cause mistriage to improve the triage accuracy because they are responsible for the majority of the triage assessments.

Trends for Syndromic Surveillance of Norovirus in Emergency Department Data Based on Chief Complaints.

This study compared trends in norovirus cases to determine whether chief complaint-based emergency department (ED) visit data could reflect trends of norovirus in Korea. The ED visits from the National Emergency Department Information System database and the weekly reported number of noroviruses from the sentinel surveillance system were collected between August 2017 and December 2020. The correlation between weekly norovirus cases and weekly ED visits considering the chief complaint and discharge diagnosis code was estimated using a 3-week moving average. In total, 6 399 774 patients with chief complaints related to digestive system disease visited an ED. A higher correlation between reported norovirus cases and ED visit with chief complaint of vomiting and discharge diagnosis code of gastroenteritis and colitis of unspecified origin or other and unspecified gastroenteritis and colitis of infectious origin was observed (R = 0.88, P < .0001). The correlation was highest for the age group 0-4 years (R = 0.89, P < .0001). However, no correlation was observed between the reported norovirus cases and the number of ED visits with norovirus identified as a discharge diagnosis code. ED visit data considering a combination of chief complaints and discharged diagnosis code would be useful for early detection of infectious disease trends.

Association between neighborhood socioeconomic status and mechanical thrombectomy for acute ischemic stroke: A nationwide multilevel observational study.

Acute ischemic stroke is a major health burden worldwide and mechanical thrombectomy is the treatment of choice for large-vessel occlusion stroke. This study aimed to evaluate the association between neighborhood socioeconomic status (SES) and the likelihood of receiving mechanical thrombectomy in patients with acute ischemic stroke. A nationwide cross-sectional study was conducted using the National Emergency Department Information System database. Patients who were diagnosed with ischemic stroke in the emergency department (ED) within 24 h of symptom onset between 2018 and 2021 were included. The neighborhood SES index was measured at the county level using property tax per capita, education level, and the proportions of single families and single-parent households. The study population was divided into quartiles based on the neighborhood SES index. The study outcome was mechanical thrombectomy. Multilevel multivariable logistic regression was performed. An interaction analysis between mental status at the ED triage and neighborhood SES was also performed. Among the 196,007 patients, 8968 (4.6%) underwent mechanical thrombectomy. Compared with the affluent group, the deprived-middle and deprived groups were less likely to receive mechanical thrombectomy; the adjusted ORs (95% CIs) were 1.00 (0.92-1.09), 0.82 (0.74-0.91), and 0.82 (0.72-0.93) for the affluent-middle, deprived-middle, and deprived groups, respectively. Altered mental status at the ED triage strengthened the association between neighborhood SES and the likelihood of receiving mechanical thrombectomy (adjusted ORs [95% CIs] 0.85 [0.81-0.89] for the affluent-middle to deprived-middle group and 0.66 [0.65-0.66] for deprived groups, p-value for interaction < 0.05). For patients diagnosed with acute ischemic stroke at the ED, low neighborhood SES is associated with low odds of receiving mechanical thrombectomy. Public health strategies should be developed to resolve these disparities and to decrease the health care burden of acute ischemic stroke.

Potentially avoidable hospitalizations for older patients transferred from long-term care hospitals: a nationwide cross-sectional analysis of potential healthcare consequences.

Multiple chronic disorders and disabilities among older patients in long term care hospitals (LTCH) tends to increase the healthcare burden by causing overcrowding, particularly in emergency departments. Therefore, access to timely and adequate healthcare for LTCH patients is an increasingly important issue, and potentially avoidable hospitalizations (PAHs) and hospitalizations during non-office hours can result as indicators of emergency department overcrowding. The study aimed to evaluate PAHs and hospitalizations during non-office hours in emergency departments for older patients transferred from LTCH compared to patients living at home. We performed a cross-sectional study using the National Emergency Department Information System database from January 2018 to December 2019, in South Korea, with older patients (≥ 65years) who visited nationwide emergency departments. Adjusted odds ratio (aOR) and 95% confidence interval (CI) for indicators of overcrowding as PAHs and hospitalizations during non-office hours were calculated by logistic regression. Among the 2,177,663 older patients who visited the emergency departments, 98,434 patients were living in LTCH and 2,079,229 patients were living at home. The older patients living in LTCH was associated with PAHs (aOR: 1.90, 95% CI 1.87-1.94) and hospitalizations during non-office hours (aOR: 1.76, 95% CI 1.73-1.78). LTCH patients showed more hospital visits, extended stay in the emergency department, greater prevalence of chronic diseases, greater rates of transfer as well as higher admission rates and mortality as compared to the patients living at home. The LTCH older patients were associated with the indicators of emergency department overcrowding, which impacts health care quality in hospitals. Introduction of policy and training programs for LTCH staff are recommended to manage vulnerable groups in advance.

Types of cancer and outcomes in patients with cancer requiring admission from the emergency department: A nationwide, population-based study, 2016-2017.

Emergency department (ED) utilization and emergency admissions by patients with cancer have increased. The authors aimed to evaluate the characteristics of patients with cancer admitted through the ED and determine whether cancer types are related to in-hospital mortality. The National Emergency Department Information System database of patients visiting EDs in South Korea between 2016 and 2017 was analyzed. Among 6,179,088 adult patients who presented to an ED with nontraumatic medical illness, patients with cancer were identified. The primary outcome was in-hospital mortality. Patients with cancer accounted for 6.8% of ED visits, and 239,630 patients (57.0%) were admitted to the hospital (intensive care unit [ICU], 9.5%; others, 90.5%). The prevalent cancers requiring hospitalization were lung cancer (15.7%), liver cancer (14.2%), and colon cancer (11.6%). The commonest reasons for admission other than cancer-related medical problems (41.4%) were pneumonia (4.8%) and hepatobiliary infection (2.8%). Overall in-hospital mortality was 16.1% (ICU, 28.3%; general wards, 14.8%); lung cancer (22.9%), liver cancer (19.7%), and leukemia/multiple myeloma (17.8%) showed the highest mortality rates. The highest odds for mortality were for lung cancer (adjusted odds ratio [OR], 2.227; 95% confidence interval [CI], 2.124-2.335; P < .001) and liver cancer (adjusted OR, 1.839; 95% CI, 1.751-1.930; P < .001), which were referenced to genitourinary cancer by multivariable logistic regression analysis. More than half of the patients with cancer visiting EDs were admitted to the hospital with a mortality rate of 16.1%. Physicians treating patients with cancer and policymakers and planners designing health systems should understand the different prevalences and outcomes of oncological emergencies by cancer type to improve patient care.

Analysis of the Impact of the Coronavirus Disease Epidemic on the Emergency Medical System in South Korea Using the Korean Triage and Acuity Scale.

PurposeSevere acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has spread worldwide. Global health systems, including emergency medical systems, are suffering from a lack of medical resources. Using a method for classifying patients visiting the emergency department (ED), we aimed to investigate trends in emergency medical system usage during the COVID-19 epidemic in Korea.Materials and MethodsThis retrospective observational study included patients who visited emergency medical institutions registered with the National Emergency Department Information System database from January 1, 2017 to May 31, 2020. The primary outcome was identification of changes in the distribution of patients visiting the ED according to the type of emergency medical institution. The secondary outcome was a detailed comparison of Korean Triage and Acuity Scale (KTAS) levels and patient distributions before and during the infectious disaster crisis period.ResultsSevere patients visited regional emergency centers (RECs) and local emergency centers (LECs) more frequently during the COVID-19 period, and disposition status warranting admission to the intensive care unit or resulting in death was more common in RECs and LECs during the COVID-19 period [RECs, before COVID-19: 300686 (6.3%), during COVID-19: 33548 (8.0%) (p<0.001); LECs, before COVID-19: 373593 (3.7%), during COVID-19: 38873 (4.5%) (p<0.001)].ConclusionDuring the COVID-19 period, severe patients were shifted to advanced emergency medical institutions, and the KTAS better reflected severe patients. Patient distribution according to the stage of emergency medical institution improved, and validation of the KTAS triage increased more in RECs.

Emergency department visits and hospitalisations for emergent asthmatic symptoms from 2014 to 2016: cross-sectional study in Korea

ObjectiveTo evaluate the characteristics of emergent patients with asthma who visited emergency departments (EDs) in Korea, and the consequences of these visits.DesignRetrospective cross-sectional study.SettingWe used data from the National Emergency...

Big Data-Driven Approach for Health Inequalities in Foreign Patients with Injuries Visiting Emergency Rooms.

ObjectivesForeign patients are more likely to receive inappropriate health service in the emergency room. This study aimed to investigate whether there is health inequality between foreigners and natives who visited emergency rooms with injuries and to examine its causes. MethodsWe analyzed clinical data from the National Emergency Department Information System database associated with patients of all age groups visiting the emergency room from 2013 to 2015. We analyzed data regarding mortality, intensive care unit admission, emergency operation, severity, area, and transfer ratio.ResultsA total of 4,464,603 cases of injured patients were included, of whom 67,683 were foreign. Injury cases per 100,000 population per year were 2,960.5 for native patients and 1,659.8 for foreign patients. Foreigners were more likely to have no insurance (3.1% vs. 32.0%, p < 0.001). Serious outcomes (intensive care unit admission, emergency operation, or death) were more frequent among foreigners. In rural areas, the difference between serious outcomes for foreigners compared to natives was greater (3.7% for natives vs. 5.0% for foreigners, p < 0.001). The adjusted odds ratio for serious outcomes for foreign nationals was 1.412 (95% confidence interval [CI], 1.336–1.492), and that for lack of insurance was 1.354 (95% CI, 1.314–1.394).ConclusionsInjured foreigners might more frequently suffer serious outcomes, and health inequality was greater in rural areas than in urban areas. Foreign nationality itself and lack of insurance could adversely affect medical outcomes.

PRS64 PATIENT CHARACTERISTICS ASSOCIATED WITH HOSPITALIZATION THROUGH EMERGENCY DEPARTMENT VISIT WITH ASTHMA EXACERBATION: ASSOCIATION RULE MINING APPROACH

To explore the patients’ characteristics associated with hospitalization through emergency department (ED) visit with asthma exacerbation by using association rule mining (ARM) A retrospective cross-sectional study was performed using ED visit cases from National Emergency Department Information System database 2016. In 2016, 9,127,979 ED visit cases collected from 410 EDs throughout the nation. We included ED visit cases with discharge diagnosis of asthma (ICD-10 code of J45/J46) as the main diagnosis. ARM was performed with Apriori algorithm to explore association rules between patients’ characteristics and hospitalization through ED visit. Hospitalization includes admissions to general ward and intensive care unit. The association rules (A=>B) meant that if a person has a feature A, a person also has a feature B (hospitalization). We used support, confidence, and lift to select interesting rules. Support was defined as the proportion of an itemset in the data. Confidence was used as a measure of reliability. Lift was used to estimate whether the occurrences of A and B were independent or not. The higher confidence, the more likely to have an interesting relation between A and B. The higher lift (lift >1), the more likely that there was a dependency between A and B. We eliminate redundant rules that have similar meanings. We included 37,350 ED visit cases for the analysis. We extracted association rules with a support ≥0.5%, a confidence ≥80% and a lift >1. After eliminating redundant rules, the rule with the highest confidence and lift was the rule ({over-80-year-old, female, comorbid with pneumonia}=>hospitalization) with confidence: 80.9% and lift: 2.94. Among patients visited the ED with asthma exacerbation, elderly, female, and comorbid with pneumonia were importantly associated with hospitalization. Cautious management is needed for patients with asthma having these characteristics.

Trends in the incidence and outcomes of bicycle-related injury in the emergency department: A nationwide population-based study in South Korea, 2012-2014.

ObjectiveThis study aimed to examine trends in the incidence and outcomes of bicycle-related injuries in emergency departments (ED) in South Korea.MethodsWe analysed data from the National Emergency Department Information System database for adult patients (≥20 years) with bicycle-related injuries presenting to EDs in South Korea between January 2012 and December 2014. Riders and bicycle passengers whose injuries were associated with bicycle use were included. Serious outcomes were defined as death at the ED, need for emergency operation, or intensive care unit admission.ResultsThe number of people who commute to work by bicycle increased by 36% from 205,100 in 2005 to 279,544 in 2015. Of 529,278 traffic-related trauma cases, 58,352 (11.0%) were bicycle-related, which increased from 7,894 (10.2%) in the first half of 2012 to 12,882 (12.2%) in the second half of 2014 (p < 0.001). However, the proportion of serious outcomes decreased from 5.0% to 4.2% during the study period (p < 0.001). Serious outcomes were most frequent in the elderly (65–74 years) and older elderly (≥75 years) groups and decreased for all but the elderly age group from 10.3% to 9.8% (p = 0.204). The helmet use rate increased from 14.2% to 20.3% (p < 0.001) but was the lowest in the older elderly group (3.6%) without change during the study period (from 4.7% to 3.7%, p = 0.656). A lack of helmet use was significantly associated with serious outcomes (odds ratio, 1.811; 95% confidence interval, 1.576–2.082).ConclusionsAlthough the incidence of bicycle-related injuries increased, the proportion of serious outcomes decreased, possibly due to increased helmet use. Public education on safety equipment use is required, especially in elderly populations.

Impact of Middle East respiratory syndrome outbreak on the use of emergency medical resources in febrile patients

ObjectiveOutbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources.MethodsAn ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea.ResultsFollowing the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attendances. This effect was more prominent in the children under five years. The duration of the chief complaint before ED arrival and the length of ED stay were significantly increased among younger pediatric patients. Decreased body temperature on arrival was observed in younger pediatric patients.ConclusionMERS outbreak appears to have had a significant effects on ED use by febrile patients. The use of emergency care services by pediatric patients makes them more vulnerable to an outbreak of a transmissable disease. An effective strategy to control emergency center visits by non-urgent febrile patients and provide proper medical services is urgently needed.

Current management practices for patients presenting with low back pain to a large emergency department in Canada

BackgroundLow back pain (LBP) is one of the leading causes of disability. Presentations to the emergency department (ED) are common and consume significant healthcare resources. However, treatment of patients with LBP is variable and highly physician dependent. Our study objective was to describe the demographic and clinical characteristics of patients presenting to the ED with LBP, the diagnostic strategies employed by ED physicians, and the subsequent management.MethodsWe conducted a retrospective study using clinical and electronic health data at the Queen Elizabeth II Health Science Center’s Charles V. Keating Emergency and Trauma Centre. We selected a simple random sample of 325 adult participants who presented to the ED with non-urgent LBP over a six-year period. Data for all participants, including demographic characteristics, diagnostic testing, and interventions received, was retrieved from the Emergency Department Information System database and from patient charts.ResultsParticipants had a median age of 43 years and 55% were female. The majority (92.9%) were acute presentations of LBP (less than 4 weeks of duration), with an assigned Canadian Triage Acuity Scale score of 3-4 (92.4%). A range of pain intensity scores were reported, mostly without associated neurological symptoms (81%) or sciatica (68%). At triage, pain score was most commonly reported as moderate intensity (57.6%), followed by severe (32.6%) and mild (9.9%). Documentation of pain rating during assessment was similar (moderate 68.6%; severe 25.9%; mild 5.6%). Laboratory investigations were conducted on 22.5% of participants and 30% received an imaging study. Medications were delivered to 59.4% of participants during their stay in the ED. Of the medications administered, ibuprofen (28.3%), hydromorphone (24.9%), and acetaminophen (21.5%) were the most frequent. Almost all (94%) had a record of having a primary care provider in EDIS and referrals back to the participant’s family physician were recorded for 41.2% of non-urgent LBP encounters.ConclusionsWe presented a complete description of patient characteristics, LBP descriptors, and health service use for a random sample of non-urgent LBP patients presenting to the ED. This has allowed for a better understanding of patients who seek care in the ED for their non-urgent LBP.

Factors influencing choice of pre-hospital transportation of patients with potential acute coronary syndrome: An observational study.

To determine factors associated with ambulance use in patients with confirmed and potential acute coronary syndrome presenting to the ED. A convenience sample of patients (n = 247) presenting to the ED from April 2014 to January 2015 with suspected acute coronary syndrome were included in the study. Data on mode of transport and patient demographics were collected from the Emergency Department Information System database. Clinical data were collected from chart records and information systems. A questionnaire assessed reasons for using a chosen method of transport, symptom timing and characteristics, acute coronary syndrome knowledge, and awareness of the National Heart Foundation Early Warning Symptoms campaign. Approximately half the patients (49.4%) assessed with symptoms of potential acute coronary syndrome used ambulance transport to the ED. Patients who arrived by ambulance were older than those not arriving by ambulance (mean 56.7 years vs 51.7 years, P = 0.01). Risk factors were not associated with ambulance use. Dizziness (P < 0.01), sweating (P = 0.03), nausea (P = 0.03) and vomiting (P = 0.04) were associated with increased ambulance use. Mean systolic blood pressure was lower in the ambulance group (136 mmHg, standard deviation [SD] = 19.8) than in the non-ambulance group (143 mmHg, SD = 25.9). Awareness of the National Heart Foundation Heart Attack Warning Signs campaign was not associated with ambulance use. Patients with possible ischaemic symptoms who are at a high risk of cardiac disease do not utilise ambulance services more than low risk patients. In general, transport to hospital using ambulance services by patients with symptoms of possible acute coronary syndrome is low despite community campaigns.

P1.01-032 Emergency Department Visits by Lung Cancer Patients in Korea

Although lung cancer patients frequently require emergency medical care due to acute unbearable symptoms and life-threatening conditions, there are limited data on them at the emergency departments (ED). National Emergency Department Information System Database (NEDIS) collects information about ED visits in Korean population. We aimed to determine the frequency and main causes of emergency consultations and the predicting factors for hospital admissions and deaths. In this retrospective observational study, we reviewed all the cases of ED visit for six months, from July 2014 to December 2014, in three university hospitals: Hanyang University Hospital and Chung-Ang University Hospital in Seoul, and Chungbuk National University Hospital in Cheongju. By reviewing all the medical records including NEDIS database, we identified cases with lung cancer and performed descriptive statistics and logistic regressions analysis. Of all 62,369 ED visits, there were 292 ED visit (0.5%) by 216 patients with lung cancer. Among them, 76.4% had only one ED visit in study period. The main reasons for consultation were respiratory symptoms (36.8%) and fatigue/alteration of the general state (12.7%), and pain (12.4%). ED visit leads to hospital admission in 74.9% and hospital death in 25.1% of lung cancer patients. In multivariate analysis, the main independent predictor factors of hospitalization are diagnostic phase of lung cancer (odd ratio 9.3) and the transfer from another hospital (odd ratio 4.9). The palliative phase with best supportive care alone (odd ratio 5.2) and abnormal heart rate at the time of ED visit (odd ratio 2.4) are statistically associated with death during hospitalization. Our study shows that ED visit is a frequent but clinically important event for patients with lung cancer. We might consider certain risk factors indicating hospitalization and death in lung cancer patients visiting ED to improve delivery of quality cancer care.

Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia

Hospital emergency department (ED) use by patients from residential aged care facilities (RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home (HiNH) program. RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics. In both hospitals, most RACF residents presenting to EDs were aged between 75-94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio (95%CI): 0.09 (0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio (95%CI): 0.22 (0.07, 0.66); P=0.007]. The HiNH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.

Adolescent presentations with alcohol intoxication to the emergency department at Joondalup Health Campus in 2013.

To document the number of adolescents aged 16 years and under presenting to the ED at Joondalup Health Campus (JHC) with problems related primarily to alcohol intoxication, and document information about these presentations. Presentations of adolescents were sourced from the Emergency Department Information System database at JHC. The patient's notes were interrogated for data on presentation and discharge times, means of arrival to the ED, age, gender, arrival Glasgow Coma Score (GCS), location from where the adolescent was brought and blood alcohol levels (BALs), if done. These were analysed, and descriptive statistics was reported. Fifty-six adolescents (61% girls) were brought in to JHC ED with alcohol intoxication in 2013. The majority (76.8%) arrived between 21.00 hours and 05.00 hours, most often by ambulance or police (58.9%). Most adolescents had BALs performed (80.4%) and of those, nearly seven in eight (86.7%) had a BAL >0.1 g/L, with a mean of 0.161 g/L (SD 0.066). Girls had a lower mean BAL, but 26.5% presented with a GCS <14. Most 16 year olds were brought from organised parties, whereas other age groups were more likely drinking at a friend's house or with friends. Few (12.5%) were drinking at home. Adolescents requiring review in an ED for alcohol intoxication are most often brought in by ambulance or police in the late evening or early morning. They are most likely to have high BALs and a significant proportion will have a GCS <14.

Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 Emergency Departments in Korea.

PurposeCroup is a common pediatric respiratory illness with symptoms of varying severity. Moreover, epiglottitis is a rare disease that can rapidly progress to life-threatening airway obstruction. Although the clinical course and treatments differ between croup and epiglottitis, they are difficult to differentiate on presentation. We aimed to compare the clinical characteristics of croup and epiglottitis in Emergency Department patients.MethodsThe 2012 National Emergency Department Information System database of 146 Korean Emergency Departments was used to investigate patients aged ≤18 years presenting with croup or epiglottitis.ResultsWe analyzed 19,374 croup patients and 236 epiglottitis patients. The male:female sex ratios were 1.9:1 and 2.3:1 and mean ages were 2.2±2.0 and 5.6±5.8 years, respectively. The peak incidence of croup was observed in July and that of epiglottitis was observed in May. The hospitalization rate was lower in croup than in epiglottitis patients, and the proportion of patients treated in the intensive care unit was lower among croup patients. The 3 most common chief complaints in both croup and epiglottitis patients were cough, fever, and dyspnea. Epiglottitis patients experienced dyspnea, sore throat, and vomiting more often than croup patients (P<0.05).ConclusionBoth groups had similar sex ratios, arrival times, 3 most common chief complaints, and 5 most common comorbidities. Epiglottitis patients had a lower incidence rate, higher mean age of onset, and higher hospitalization rate and experienced dyspnea, sore throat, and vomiting more often than croup patients. Our results may help in the differential diagnosis of croup and epiglottitis.

Can the characteristics of emergency department attendances predict poor hospital outcomes in patients with sepsis?

The emergency department (ED) is often the initial site of identification of patients with sepsis. We aimed to determine the characteristics of ED attendances that predict poor hospital outcomes. We conducted a retrospective cohort study of adult patients in eight metropolitan EDs in Perth, Western Australia, from 2001 to 2006. Patients diagnosed with sepsis in the ED were identified using the International Classification of Diseases, 10th Revision-Australian Modification code in the Emergency Department Information System (EDIS) database. The EDIS database was subsequently linked to mortality and hospital morbidity records. The following characteristics were examined: triage category, mode of arrival, source of referral and hospital of presentation. Multivariate logistic regression was performed to identify predictors of hospital mortality, prolonged length of stay, and admission to the intensive care unit (ICU). In the 1,311 patients diagnosed with sepsis in the ED, the hospital mortality and ICU admission rates were 19.5% and 18.5%, respectively. The mean hospital length of stay was 12 ± 15 days. Acute triage categories predicted both hospital mortality and ICU admissions, while mode of arrival by ambulance was a predictor of all poor hospital outcomes (p < 0.001). Patients who presented to non-teaching hospitals had similar hospital outcomes as patients who presented to teaching hospitals. The source of referrals was not a predictor of poor hospital outcomes (p > 0.05). Mode of arrival and triage score, which are characteristics unique to the ED, may predict poor hospital outcomes in patients with sepsis.

Mortality of interhospital transfers originating from an Emergency Department in Perth, Western Australia

Interhospital transfer (IHT) is an integral part of emergency practice and required to access specialist care. To identify factors that predict in-hospital mortality for IHT originating from an Emergency Department (ED). A retrospective cohort study utilising linked health data from the ED Information System database, Death Register and the Hospital Morbidity Data examined all IHTs originating from a public hospital ED and transferred to a tertiary hospital ED (ED-ED IHT), January 1st 2002-December 31st 2006. There were 27,776 ED-ED IHTs. In-hospital mortality was 2.1% (95% CI 1.9-2.3%). Age, male sex, clinical deterioration by one or ≥2 levels on the Australasian Triage Scale (ATS) and circulatory or respiratory disease increased risk of mortality. Clinical improvement by one level on the ATS, injury or poisoning, digestive disease, transfer from 2004 to 2006 and exposure to access block reduced risk of mortality. Other than year of transfer, injury or poisoning, digestive and respiratory disease, these factors were also predictive of mortality within 1-day of transfer. Multiple factors influence mortality following IHT from an ED. Awareness of these factors helps to optimise risk reduction. The limited infrastructure and resourcing available in non-tertiary hospitals are important considerations.

122 The Effect of Implementing High-Sensitivity Troponin Testing on Operational Efficiency in Three Large Urban Emergency Departments

New highly sensitive cardiac Troponin T (hsTnT) assays are becoming widely adopted in Canadian hospitals, raising the possibility of improved throughput times for emergency department (ED) assessment. Few studies have addressed the effects of introducing the hsTnT assay on ED and hospital resource consumption. In this study, we evaluate the impact of hsTnT implementation on ED length of stay (LOS), consultation and admission rates for patients with suspected AMI. This time-series analysis involved a cohort of all patients presenting to three Calgary adult EDs evaluated using hsTnT or its predecessor, conventional TnT (cTnT). The hsTnT assay was implemented on January 31, 2012. An educational intervention for ordering physicians and nurses preceded the implementation of hsTnT testing. The cutoff value used for diagnosis of AMI was 50 ng/ml. Data was collected for February 12, 2011-April 22, 2011: control period one year prior to hsTnT implementation (Ctrl1yrPre); November 20, 2011-January 28, 2012: immediately pre-hsTnT implementation (Immed-pre); February 12, 2012- April 21, 2012: immediately post-hsTnT implementation (Post). Subjects included all ED patients, excluding physician-confirmed STEMIs, who had at least one cTnT or hsTnT drawn as a marker for symptoms suspicious of AMI. The ED information system database was used to collect outcome data. Categorical variables were analyzed using Pearson's Chi-squared test. The Mann-Whitney U test was used to compare median values between the three study periods. We analyzed data from 6742 patients Ctrl1yrPre, 6952 Immed-pre and 5822 Post; demographic characteristics between the groups were similar. A smaller proportion of patients had troponin assays performed in the Post period, compared to the Ctrl1yrPre and Immed-pre periods (12.5% Post vs. 15.8% Ctrl1yrPre and 15.4% Immed-pre). A significant reduction in median ED LOS was observed following hsTnT implementation: 6.53 hours (h) in Ctrl1yrPre, 6.52 h in Immed-pre, and 6.04 h in Post (p<0.001). The proportion of patients with third troponins ordered decreased from 7.9% in Ctrl1yrpre and 7.2% in Immed-pre to 5.9% in Post (p<0.001). There was no statistically significant change in the number of Cardiology consultations or admissions following hsTnT implementation. Implementing hsTnT testing at three centers with an equivalent cutoff value and a change in nurse-initiated TnT ordering resulted in a decreased ED LOS for patients with suspected AMI and no increase in cardiology resource utilization. This finding may be attributable to a carefully considered hsTnT assay implementation strategy that reduced the number of unnecessary TnT assays performed.