National Emergency Department Sample Research Articles

Geography of the Underserved: The Contribution of Rural Non-Trauma Hospitals to Trauma Care.

To determine the proportion and characteristics of injured rural residents treated at urban trauma centers (TCs), urban non-trauma centers (NTCs), rural TCs, and rural NTCs. Timely treatment at a designated trauma center improves outcomes for patients with serious injuries, but rural residents have limited access to designated trauma centers. Rural non-trauma centers may constitute an underrecognized source of trauma care. We used the National Emergency Department Sample to conduct a retrospective, pooled cross-sectional study of ED visits among rural residents with injury severity score (ISS) ≥ 9 (indicating at least moderate injury). Hospitals were designated as a trauma (TC) or non-trauma center (NTC) and as rural or urban. We compared management, disposition, and outcomes among hospital types. Of 748,587 injured rural residents from 2016-2020, 384,113 (51.3%) were treated in rural NTCs, 232,845 (31.1%) in urban TCs, 116,493 (15.6%) in urban NTCs, and 15,137 (2.0%) in rural TCs. Injuries treated at rural NTCs were moderate in severity (ISS 9-15) in 76.6% of visits, severe (ISS 16-25) in 15.7%, and very severe (ISS > 25) in 1.1%. Urban TCs saw the highest proportion of very severe injuries (17.3%). Rural NTCs managed 77.5% of visits definitively, discharging 72.8%. They transferred 21.9% of patients. Length of stay was longest and hospital charges highest for patients treated in urban TCs, which also performed the most procedures. Rural NTCs had the shortest length of stay and lowest mean charges. Rural non-trauma centers provided initial care for more than half of injured rural residents, including 2 in 5 of those with the most severe injuries, and managed more than 3 in 4 definitively. These hospitals may be an under-recognized component of the US trauma system.

Longitudinal changes in the US emergency department use of advanced neuroimaging in the mechanical thrombectomy era.

To describe ED neuroimaging trends across the time-period spanning the early adoption of endovascular therapy for acute stroke (2013-2018). We performed a retrospective, cross-sectional study of ED visits using the 2013-2018 National Emergency Department Sample, a 20% sample of ED encounters in the United States. Neuroimaging use was determined by Common Procedural Terminology (CPT) code for non-contrast head CT (NCCT), CT angiography head (CTA), CT perfusion (CTP), and MRI brain (MRI) in non-admitted ED patients. Data was analyzed according to sampling weights and imaging rates were calculated per 100,000 ED visits. Multivariate logistic regression analysis was performed to identify hospital-level factors associated with imaging utilization. Study population comprised 571,935,906 weighted adult ED encounters. Image utilization increased between 2013 and 2018 for all modalities studied, although more pronounced in CTA (80.24/100,000 ED visits to 448.26/100,000 ED visits (p < 0.001)) and CTP (1.75/100,000 ED visits to 28.04/100,000 ED visits p < 0.001)). Regression analysis revealed that teaching hospitals were associated with higher odds of high CTA utilization (OR 1.88 for 2018, p < 0.05), while low-volume EDs and public hospitals showed the reverse (OR 0.39 in 2018, p < 0.05). We identified substantial increases in overall neuroimaging use in a national sample of non-admitted emergency department encounters between 2013 and 2018 with variability in utilization according to both patient and hospital properties. Further investigation into the appropriateness of this imaging is required to ensure that access to acute stroke treatment is balanced against the timing and cost of over-imaging.

Epidemiology and Characteristics of Women With Facial Fractures Seeking Emergency Care in the United States: A Retrospective Cohort Study

Study Design Facial bone fractures in women are less common than in men in the United States. However, little is known about the epidemiology of women who sustain facial fractures. Objective Our aim is to describe the patient population of women seeking emergency care for facial fractures in the United States and they type and cost of care received in this setting. Methods This is a retrospective cohort study using the 2019 National Emergency Department Sample. The inclusion criterion was diagnosis of facial fracture. The primary outcome was patient characteristics. The secondary outcomes are emergency department (ED) characteristics, discharge disposition, total visit charges, and most common cause. Diagnoses and procedures were identified using ICD10-CM codes. Outcomes were compared to men. Results Thirty-seven percent of ED facial fractures were encountered in women. Both women and men were most likely adult, Caucasian, from the lowest median income quartile, sustained nasal bone fractures, and presented to a southern, metropolitan, private nonprofit, non-trauma ED. Conclusions Women were older, more likely insured by Medicare and less likely by private insurance, discharged home, and had lower ED charges than their male counterparts. However, the financial burden of emergency care for facial fractures among women was $1.6 billion.

Prevalence and Characteristics of Emergency Department Visits by Pregnant People: An Analysis of a National Emergency Department Sample (2010-2020).

The number and characteristics of pregnant patients presenting to the emergency department (ED) has not been well described. Our objective in this study was to determine the prevalence and characteristics of pregnant patients presenting to EDs in the US between 2010-2020. We completed a retrospective, cross-sectional study of patient encounters at hospital-based EDs in the US from 2010-2020. Using the ED subsample of the National Hospital Ambulatory Medical Care Survey (NHAMCS) we identified ED visits for female patients aged 15-44years. We defined a subsample of these as visits for pregnant patients using discharge diagnosis codes specific to pregnancy. We compared this population of pregnant patient visits to those for non-pregnant patients and computed point estimates for nationally weighted values. Multivariable linear regression was used to determine factors independently associated with pregnant patient visits. The 2010-2020 NHAMCS dataset included 255,963 ED visits. Of these visits 59,080 were for female patients 15-44years old, and 6,068 of those visits were for pregnant patients. Pregnant patients accounted for 3% (95% confidence interval [CI] 2.7-3.2) of all ED visits and 8.6% (95% CI 8-9.3) of all visits among female patients 15-44years. Weighting to a national sample, this equates to 2.77 million pregnant patients presenting for ED visits annually. Pregnant patients were more likely to be Black, Hispanic, or to use public insurance. Pregnant patients make up a significant number of ED visits annually and are more likely to be people of color or publicly insured. Interventions to address the effects of changing abortion legislation on emergency medicine practice may benefit from consideration that certain populations of pregnant people are more likely to present to the ED for care.

The Burden of Burns: An Analysis of Public Health Measures.

Accurate analysis of injuries is paramount when allocating resources for prevention, research, education, and legislation. As burn mortality has improved over recent decades, the societal burden of burn injuries has grown ambiguous to the public while a scarcity of investigational funding for survivors has led to a gap in understanding lifelong sequela. We aim to compare national references reporting the incidence of burn injuries in the United States. The American Burn Association Burn Injury Summary Report (ABA-BISR), American Burn Association Fact Sheet, Centers for Disease Control and Prevention (CDC) Web-based Injury Statistics Query and Reporting (WISQARS) database, the CDC National Center for Health Statistics' National Hospital Ambulatory Medical Care Survey (NHAMCS), National Inpatient Sample (NIS), National Emergency Department Sample (NEDS), and commercially available claims databases were queried for 2020 or the most recent data available. The BISR estimated 30,135 burn admissions in 2022. The 2016 ABA Fact Sheet reported 486,000 burns presented to US emergency departments (ED). In 2020, CDC's WISQARS database reported 3,529 fatal, and 287,926 non-fatal, burn injuries. The 2020 NEDS reported 438,185 ED visits while the 2020 NIS estimated 103,235 inpatients. The NHAMCS reported 359,000 ED visits for burn injuries in the same period, and an analysis of ICD-10 burn codes demonstrated over 698,555 claims. Our study demonstrates a large variability in the reported incidence of burn injury by the ABA, CDC, national samples, and claims databases. Per our analyses, we estimate that 600,000 individuals annually suffer a burn injury which merits emergent care in the United States.

320 Emergency Department Use of Neuroimaging and Hospitalization for Transient Ischemic Attacks in the United States: A Cross-Sectional Study

OBJECTIVES/GOALS: A TIA is a transient episode of symptoms attributed to a cerebrovascular cause, and associated with an increased risk of stroke. Care of these patients often requires substantial resources in the Emergency Department (ED). We therefore described neuroimaging and hospitalization use for TIA within a nationally representative sample of US ED visits. METHODS/STUDY POPULATION: Retrospective cross-sectional analysis using TIA encounters in the 2018 National Emergency Department Sample (NEDS), an AHRQ dataset consisting of a weighted sample of 20% of all US ED encounters. Non-contrast Head CT, CTA Head, Carotid Ultrasound, MRI and CT Perfusion imaging utilization was determined based on Common Procedural Terminology (CPT) codes in the non-admitted encounters. The study population includes all adult patients with a discharge diagnosis of TIA as determined by ICD-10 codes (H34.0, G45.0-3, G45.8 G45.9) in any diagnosis position. The percentage of patients receiving each neuroimaging test was reported with the corresponding 95% confidence interval (CI). We utilized survey sample weights to generate reliable national estimates. RESULTS/ANTICIPATED RESULTS: The study population consisted of 80,803 ED encounters with a discharge diagnosis of TIA, representing 326,802 weighted ED visits nationally. Among this group, 46.8% of patients were discharged and 41.8% were admitted to the same hospital, 7% of patients were transferred to another facility, and the remaining 5% left AMA, were dispositioned to home health, died in the ED, or had an unknown disposition. Because discharged encounters retain their more precise CPT coding of procedural information, imaging analysis was conducted in discharged TIA encounters only. Of these encounters, 73% (95% CI, 70.7-76.5) received a noncontrast head CT, 20.9% (95% CI, 19.1-22.7) a CTA Head, 22.5% (95% CI, 20.6-24.4) a carotid ultrasound, and 31.5% (95% CI, 29.3-33.7) an MRI brain without contrast. DISCUSSION/SIGNIFICANCE: The discharge rate of just under 50% of patients is consistent with other published data, and represents a gradual trend over the past decade of decreased admissions for TIA. The fact that for many of these patients, the entire episode of care occurs in the ED setting suggests that the ED may be a rich target for future innovations in care for TIA.

Abstract WP66: Increases in Emergency Department Utilization of CT Angiography Brain and CT Perfusion in the Transferred Patient Population Across the Endovascular Therapy Era

Background: With the advent of endovascular therapy as a treatment modality for LVO stroke, the importance of stroke networks has become increasingly clear. We sought to understand the way advanced neuroimaging is utilized in transferred emergency department (ED) encounters using a large national dataset. Methods: Retrospective cohort study of adult ED encounters, comparing ED transfers (to other acute care hospitals) to discharged patients. Data from the 2013-2018 National Emergency Department Sample (NEDS), an AHRQ dataset containing a weighted 20% sample of US ED encounters were analyzed. CTA Head, CTP, MRI Brain, and Non-contrast CT Head imaging use was determined from Common Procedural Terminology (CPT) codes. ICD10 Codes I60-I69 were used to indicate cerebrovascular disease. Statistical comparisons used 95% CI for rate per 100,000 ED visits. Results: ED utilization of advanced neuroimaging was higher in transferred patients than discharged patients in all years studied (Fig). Between 2013 and 2018, utilization of CTA and CTP increased 8-fold and 20-fold, respectively in the transferred population. Noncontrast head CT and MRI were relatively stable but more frequent in transferred encounters. Between 2013 and 2018, encounters associated with a transfer came disproportionately from smaller hospitals (45% from hospitals with &lt;=20,000 ED visits per year, and 24% from ED visits at hospitals with between 20,000 and 40,000 ED visits per year). In 2018 transferred encounters with a CTA Head or CTP, 75% (72-77) and 76%(70-83), respectively had a diagnosis code associated with cerebrovascular disease. Conclusions: Utilization of CTA and CTP increased substantially between 2013-2018 in the ED transfer population, and most of these encounters are associated with a cerebrovascular disease diagnosis. Detailed diagnosis and hospital demographic data to be presented. These results have implications for the design and optimization of stroke systems of care.

Cost of U.S emergency department and inpatient visits for fall injuries in older adults

BackgroundFalls are a leading cause of injury and hospital readmissions in older adults. Understanding the distribution of acute treatment costs across inpatient and emergency department settings is critical for informed investment and evaluation of fall prevention efforts. MethodsThis study used the 2016–2018 National Inpatient Sample and National Emergency Department Sample. Annual treatment cost of fall injury among adults 65 years and older was estimated from charges, applying cost-to-charge and professional fee ratios. Weighted multivariable generalized linear models were used to separately estimate cost for inpatient and emergency department (ED) setting by injury type and individual demographic and health characteristics after adjusting for payer and hospital level characteristics. ResultsOlder adults incurred an estimated 922,428 inpatient and 2.3 million ED visits annually due to falls with combined annual costs of $19.8 billion. Over half of inpatient visits for fall injury were for fracture. Notably, 23% of inpatient visits were for fractures other than hip fracture and 14% of inpatient visits were for multiple fractures with costs totaling $3.4 billion and $2.5 billion, respectively. Annual ED costs were driven by superficial injury totaling $1.5 billion. Cost of ED visits were higher for adults 85 years and older (adjusted cost ratio (aCR): 1.11, 95% Confidence Interval (CI)I: 1.11–1.12) and those with dementia (aCR: 1.14, 95% CI: 1.13–1.15). Higher inpatient and ED visit cost was also associated with high-energy falls and discharge to post-acute care. ConclusionThe study found that more than 3 million older adults in the United States seek hospital care for fall injuries annually, a major concern given increasing capacity strain on hospitals and EDs. The $20 billion in annual acute treatment costs attributed to fall injury indicate an urgent need to implement evidence-based fall prevention interventions and underscores the importance of newly launched ED-based fall prevention efforts and investments in geriatric emergency departments.

Factors Associated with Discharge against Medical Advice among Acute Stroke Patients: Analysis of the Nationwide Emergency Department Sample

Introduction: Patients discharged against medical advice have been shown to have worse outcomes across a host of different conditions. However, risk factors related to increased odds of discharge against medical advice remain understudied in patients who suffer from acute cerebral infarction. Methods: We retrospectively examined the 2019 National Emergency Department Sample Database for stroke patients. Multivariable logistic regression was used to estimate associations between patient- and hospital-level factors and the outcome of discharge against medical advice. Results: Of the 603,623 encounters for acute ischemic stroke, 8,858 (1.5%) were discharged against medical advice. Predictors of discharge against medical advice were lower income quartile and having either Medicaid insurance (odds ratio [OR] 1.32, 95% confidence interval [CI]: 1.10–1.58) or being uninsured (OR 1.28, 95% CI: 1.03–1.58). Vascular comorbidities associated with discharge against medical advice included prior tobacco use (OR 1.60, 95% CI: 1.45–1.78) and coronary artery disease (OR 1.19, 95% CI: 1.04–1.35). Treatment with thrombectomy (OR 0.33, 95% CI: 0.13–0.78) or systemic thrombolysis (OR 0.39, 95% CI: 0.23–0.66) was inversely associated with discharge against medical advice. A high modified Charlson comorbidity index (3+ vs. 0, OR 0.49, 95% CI: 0.42–0.56) was also associated with a lower odds of discharge against medical advice. Presenting to a Northeastern hospital had the highest rate of discharge against medical advice, when compared to other regions (p < 0.05). Conclusions: Certain patient-level, socioeconomic, and regional factors were associated with discharge against medical advice following acute stroke. These patient- and systems-level factors warrant heightened attention in order to optimize acute care and secondary prevention strategies.

Pediatric cancer patient emergency department visits and disposition by sociodemographic and economic characteristics.

Limited research has been conducted on cancer-related emergency department (ED) patterns among pediatric cancer patients, including whether there are differences in the characteristics of individuals who seek ED care for cancer complications. The objectives of this study were to determine whether rates and disposition of cancer-related ED visits and hospital admissions in childhood cancer patients differ by sociodemographic factors. A cross-sectional analysis of ED encounters with a cancer diagnosis code among patients aged 0-19years from the 2019 National Emergency Department Sample (NEDS) was conducted. Weighted logistic regression models were utilized to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for a primary cancer-related encounter, and hospital admission overall and by subgroup characteristics. Of the unweighted 6,801,711 ED encounters in children aged 0-19years, 10,793 were classified as visits by cancer patients. ED encounters of Hispanic versus non-Hispanic White pediatric cancer patients had higher odds of having a cancer-related primary diagnosis (OR=1.15, 95% CI: 1.04-1.27). ED encounters of non-Hispanic Black pediatric patients and those in the lowest zip code income quartile had higher odds of hospital admission (OR=1.28, 95% CI: 1.08-1.53; OR=1.30, 95% CI: 1.15-1.46), while rurality was associated with lower odds of hospital admission (OR=0.69, 95% CI: 0.57-0.83). These results suggest that pediatric cancer patients from certain under-resourced communities are more likely to use the ED for cancer treatment complications, and their encounters are more likely to result in admission to the hospital.

Injuries Due to Law Enforcement Use of Force in the United States, 2006-2015: Trends in Severity and by Race.

The purpose of the study was to assess incidence and severity of hospital reported injuries related to law enforcement Use of Force (UoF) in the US over time, and by race. Data from the National Emergency Department Sample from the Healthcare Cost and Utilization Project and the National Electronic Injury Surveillance System (NEISS-AIP) from US Consumer Product Safety Commission were queried to identify UoF injuries. Regression analysis, t-tests, and chi-square tests were used in the analysis. Between 2006-15, there were 529,259 emergency department admissions for UoF injury in the NEDS, and 870,779 admissions in the NEISS-AIP. In a model adjusting for year, sex, and age, the Injury Severity Score increased by 1.1% annually (p<0.0001). Black people were 6 times as likely to be admitted to the ED as White people or Native Americans/Alaska Natives, and 25 times as likely as Asians/Pacific Islanders. Black patients were 4 times as likely as White patients to be admitted as inpatients. Per arrest rate by race using FBI uniform crime reporting data, Black arrestees were 2.5-3.1 times as likely as any other race to be hospitalized for UoF injury. The results of the study demonstrate that US law enforcement are injuring civilians more frequently and severely over time, and that Black people are disproportionately affected.

Alcohol Use Disorder Visits and Suicide Ideation Diagnosis: Racial/Ethnic Differences at Emergency Departments

Nationally, suicide ideation prevalence is comparable among White, American Indian/Alaska Native, Black, and Hispanic adults experiencing alcohol use disorder. This study examines whether such comparability extends to the probability of receiving a suicide ideation diagnosis when presenting with alcohol use disorder at emergency departments. The probability of hospitalization following such diagnosis is examined as well. National Emergency Department Sample (2019) data were used. Logistic and multilevel logistic regression analyses were performed in 2022-2023 with suicide ideation diagnosis and subsequent hospitalization as the outcome variables. Control variables included demographics, payor, alcohol use disorder level, comorbidities, and emergency department facility. Adjusted probabilities were computed. Age-adjusted probabilities of suicide ideation diagnoses for American Indian/Alaska Native, Black, and Hispanic patients with alcohol use disorder were 5.4%, 6.7%, and 4.9% (95% CIs=3.7, 7.1; 6.0, 7.4; 4.4, 5.4), respectively; all less than that for White counterparts (8.7%; 95% CI=8.2, 9.2). Among patients with alcohol use disorder plus suicide ideation diagnoses, the age-adjusted probability of hospitalization for American Indians/Alaska Natives (32.4%; 95% CI=20.9, 44.0) was less than that for Whites, Blacks, and Hispanics (49.8%, 52.3%, and 49.9%; 95% CIs=46.7, 52.8; 47.1, 57.5; and 43.9, 55.8, respectively). In regressions with multiple control variables, the racial/ethnic differences remained statistically significant (p<0.05). Diagnosis of suicide ideation, a key step in emergency department suicide prevention care, occurred significantly less often for patients of color with alcohol use disorder than for White counterparts. American Indians/Alaska Natives, the racial/ethnic group known to have the nation's highest suicide rate, had the lowest probability of being hospitalized after a diagnosis of alcohol use disorder plus suicide ideation.

Predictive Modeling and Analyses of National Emergency Department Data for Improving Patient Outcomes of Nephrolithiasis.

Nephrolithiasis, or kidney stones, imposes a significant burden of disease in the United States and comes with considerable costs, pain, and morbidity.The exact cause of stone formation is undefined, but the formation is a process. Risk factors include environmental, diabetes, obesity, metabolic syndromes, low fluid intake, dehydration, diet, inflammatory bowel disorders, irritable bowel syndrome (IBS), and genetics.Laboratory testing and appropriate diagnostic imaging studies are two key components of assessment and prevention. This is a retrospective, quantitative study utilizing the Healthcare Cost and Utilization Project's (HCUP) National Emergency Department Sample (NEDS)'s existing databases from 2012 to 2014 to classify outcomes for nephrolithiasis patients.International Classification of Diseases, Ninth Revision (ICD-9-CM)billing codes related to nephrolithiasis, relevant medical imaging exams, and procedural and surgical billing codes for interventions and procedures were selected. Descriptive statistical analyses as well as multiple regression modelswere used to analyze frequencies and percentages of variables and the relationship of the data, identify co-linearity amongvariables, and predict outcomes. Results: The study sample includes a total of 509,192 emergency department (ED) visits for nephrolithiasis from 2012 to 2014 and reveals that IBS patients are two times more likely to require intervention. Stepwise regression models yield P-values of 0.004 for gender, 0.017 and 0.018 for minor diagnostic procedures, 0.006 and 0.001 for minor therapeutic procedures, and 0.000 and 0.001 for major therapeutic procedures when predicting total cost of care, and have a statistically significant impact on patient outcomes of nephrolithiasis. This research offers an investigation of the prevalence of nephrolithiasis based on age, gender, and co-morbidity, specifically IBS, and is the first to report on patient outcomes. This analysis also provides clinicians with recommendations to utilize for a comprehensive assessment of nephrolithiasis patients in the ED.

Did COVID-19 impact national trends of hospitalization and outcomes for neutropenic fever in adults with cancer?

e18799 Background: Neutropenic fever (FN) is an oncologic emergency associated with significant morbidity and mortality. Patients on chemotherapy are at a higher risk of COVID-19-related complications. During the initial phase of the pandemic, healthcare systems were overwhelmed, resulting in shortage of resources and rationing of care. We aimed to assess the impact of the COVID-19 on trends of hospitalization and outcomes in adult emergency department (ED) visits for cancer-related FN in the US between 2019 and 2020. Methods: In this retrospective observational study using the National Emergency Department Sample of adults presenting to ED for cancer-related FN as primary diagnosis (using ICD-10-CM codes), we compared the outcomes between patients presenting in 2019 (pre-pandemic) and 2020. The primary outcome was mortality. Secondary outcomes were incidence of shock, discharge disposition, and length of stay (LOS). A propensity score matching was performed to estimate the effect of COVID-19 on outcomes. Results: There were a total of 95,163 visits to the ED for FN in 2019 and 2020. Both groups had similar demographics, with mainly White (68.1% vs 69.3%) patients presenting to large metropolitan areas (57.6% vs 58.6%) and mostly metropolitan teaching hospitals (74.5% vs 77.2%). More patients presenting in 2020 had a higher Elixhauser comorbidity index (66.6% vs 70.2% for comorbidity of ≥3; p = 0.0002). Although the number of patients who got admitted or died in the ED was similar in 2019 and 2020 (88.4% vs 87.8% for admission and 0.1% for death, p = 0.83), higher number died during their hospitalization (3.4% vs 4.4%, p = 0.002), and were likely to develop shock (6.0 vs 7.1%, p = 0.005) in 2020. More patients were discharged home with services (21.9% vs 17.1%, p &lt; 0.001), while fewer patients went to nursing homes (7.9% vs 8.5%, p &lt; 0.001) in 2020. There were no significant differences in LOS or cost of hospitalization. A propensity score matching was performed to estimate the effect of COVID-19 on outcomes showing higher mortality during hospitalization (13.7% vs 4.6%, p = 0.006) and increased LOS (6 days vs 5 days, p = 0.02) for patients with concurrent COVID-19. Conclusions: Overall, mortality related to FN was higher during the pandemic and more so among patients with concurrent COVID-19. While patients developing shock was higher in 2020, this was not attributable to COVID. Fewer patients were discharged to nursing homes, and more patients went home with services during the pandemic highlighting the constraints imposed on resources during the pandemic. [Table: see text]

Trends in Thrombectomy Utilization in Stroke: Basilar Artery versus ICA/MCA (P7-5.003)

<h3>Objective:</h3> In the current analysis, we compared the annual utilization of thrombectomy for Basilar Artery Occlusion (BAO) with internal carotid and middle cerebral artery (ICA/MCA) occlusion strokes. <h3>Background:</h3> Although the BAOCHE and ATTENTION trials have only recently demonstrated the effectiveness of thrombectomy for BAO stroke, the poor prognosis of acute BAO has encouraged providers to aggressively treat BAO in the absence of randomized trial data. <h3>Design/Methods:</h3> Stroke patients who presented to the emergency department between 2015 and 2019 were identified using the National Emergency Department Sample database. Patients were grouped by primary diagnosis of BAO or ICA/MCA to assess for thrombectomy likelihoods. Odds of thrombectomy were determined by multivariate logistic regression to account for hospital type, geographic location, and patient demographics. <h3>Results:</h3> Between 2015–2019 we identified a total of 1,721,207 stroke patients, of whom 12,620 patients had a BAO and 137,118 had ICA/MCA occlusions. Of the included patients 15.7% of BAO patients (95%CI 13.6%–17.9%) and 14.5% (95%CI 12.9%–16.1%) of ICA/MCA occlusions were treated with a thrombectomy. Within this time frame, thrombectomy usage increased from 1.5% (95% CI: 1.2%–1.9%) to 2.5% (95% CI: 2.1%–3.0%) for all stroke types. There was no difference in odds of thrombectomy between stroke types (OR: 0.86, 95% CI:0.70–1.06). <h3>Conclusions:</h3> Despite a lack of clinical trial data supporting thrombectomy in BAO, it is used just as frequently in US patients with BAO as patients with ICA/MCA occlusion stroke. These data suggest a lack of perceived equipoise in randomizing patients with BAO to thrombectomy in the US, and may be helpful in the design of future randomized trials in this population. <b>Disclosure:</b> Karan Patel has nothing to disclose. Mr. Taneja has nothing to disclose. Mr. Diaz has nothing to disclose. Mr. Mohamed has nothing to disclose. Mr. Batchu has nothing to disclose. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Focus group participant with Alexion. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AstraZeneca.

Data in brief: Factors associated with in-patient admission among stroke patients (P1-5.024)

<h3>Objective:</h3> To estimate the probability of admission among patients with stroke evaluated in the emergency department. <h3>Background:</h3> Misuse of inpatient resources is a central problem to the healthcare system. Elucidating certain trends behind inpatient admission in patients with a cerebral infarction may reveal opportunities to improve safe and effective stroke triage and throughput. <h3>Design/Methods:</h3> We retrospectively queried the 2019 National Emergency Department Sample Database for patients who had a cerebral infarction. Disposition from the emergency department was classified into one of several categories: routine discharge, discharge against medical advice, transfer to short term hospital, home care, death, and admission to the inpatient setting. The primary endpoint was inpatient admission versus all other dispositions and was assessed using multivariable logistic regression after adjustment for key patient characteristics, hospital teaching and trauma status, geographic regions, insurance status. <h3>Results:</h3> Of the 598,818 patients diagnosed with acute cerebral infarction, 471,464 (78.7%) were admitted to an inpatient acute care facility. Patients with private insurance (OR 0.85, 95%CI 0.78–0.93) or self-pay (OR 0.80, 95%CI 0.70–0.91) had lower odds of being admitted, compared to Medicare patients. Compared to Metropolitan Non-Teaching hospitals, Metropolitan teaching hospitals (OR 1.59, 95%CI 1.27–1.97) had a higher odds of admission, whereas non-metropolitan hospitals (OR 0.35, 95%CI 0.27–0.44) had a lower odds of admission. Additionally, compared to non-trauma hospitals, patients evaluated at level 1 trauma centers (OR 3.17, 95%CI 2.48–4.05) had higher odds of admission. In addition, hyperlipidemia (OR 2.25, 95%CI 2.09–2.42), overweight (OR 2.15, 95%CI 1.90–2.42), and hypertension (OR 1.55, 95%CI 1.47–1.63) were independently associated with a higher odds of admission. <h3>Conclusions:</h3> Optimization of certain high-risk comorbidities may not only reduce stroke incidence, but they may reduce inpatient utilization. Further, differences in admission based on patient-level socioeconomic factors warrant greater exploration to minimize disparities in access to acute care. <b>Disclosure:</b> Mr. Wolfe has nothing to disclose. Karan Patel has nothing to disclose. Mr. Taneja has nothing to disclose. Mr. Oak has nothing to disclose. The institution of Dr. Favilla has received research support from National Institutes of Health. The institution of Dr. Favilla has received research support from American Heart Association. The institution of Dr. Favilla has received research support from OpenWater, Inc.. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Focus group participant with Alexion. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AstraZeneca.

Thrombectomy versus tPA in Basilar Artery Occlusion Stroke (P7-5.012)

<h3>Objective:</h3> To evaluate the effectiveness of thrombectomy compared to medical management for patients with a basilar artery occlusion (BAO). <h3>Background:</h3> The effectiveness of thrombectomy to treat a BAO stroke has only recently been established. The BAOCHE trial and ATTENTION trial reported improvement in functional outcomes in Chinese patients with BAO treated with thrombectomy as compared to conventional medical management. These findings warrant validation in other populations before any definitive conclusions can be drawn about the effectiveness of thrombectomy for BAO. <h3>Design/Methods:</h3> Using the National Emergency Department Sample Database (NEDS), we retrospectively queried patients with a BAO between 2006–2019 in the United States. Patients were stratified into groups reflecting treatment with intravenous tissue plasminogen activator (tPA) alone, thrombectomy alone, or both tPA and thrombectomy. Multivariable logistic regression was performed to evaluate likelihood of death and length of hospital stay within all treatment groups. <h3>Results:</h3> Of the 2,998,237 stroke patients identified, 17,346 had a BAO, of whom 1,508 were treated only with thrombectomy, 1,697 were treated with tPA only, and 704 were treated with both thrombectomy and tPA. Patients treated with either dual therapy (OR: 2.88, 95% CI: 1.34–6.17) or thrombectomy-only (OR:1.95, 95% CI:1.64–2.33) had a higher death risk than those treated with tPA-only. Compared to patients treated with tPA-only, patients treated with dual therapy (b=4.02, 95% CI: 1.08–6.96) or thrombectomy-only (b=3.25, 95% CI: 2.60–3.90) had longer hospital stays. There was no difference in length of stay between those treated with dual therapy or thrombectomy-only. <h3>Conclusions:</h3> The present analysis did not find any associated mortality or length of stay benefits in patients treated with thrombectmoy compared to those treated with tPA. However, the nonrandomized allocation of treatment groups and lack of clinical severity indices limit the findings of this population-based analysis. <b>Disclosure:</b> Karan Patel has nothing to disclose. Mr. Taneja has nothing to disclose. Mr. Diaz has nothing to disclose. Mr. Mohamed has nothing to disclose. Mr. Batchu has nothing to disclose. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Focus group participant with Alexion. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AstraZeneca.

Impact of Season on Incidence of Sinusitis-related Orbital Cellulitis.

To explore the impact of season on the incidence of presentation to emergency departments with sinusitis-related orbital cellulitis in the United States. The National Emergency Department Sample was queried to identify cases of patients with sinusitis-related orbital cellulitis. Patient's age, location, and the month of presentation were recorded. Statistical correlations were analyzed via a dedicated software package. A total of 439 patients with sinusitis-related orbital cellulitis were identified. The overall incidence was higher during the winter months ( p < 0.05); while children were more likely to develop this disease during the winter ( p < 0.05), season was not statistically correlated with its incidence among adults ( p = 0.16). The incidence of orbital cellulitis was higher during the winter in the midwest and south regions of the United States ( p < 0.05 for each region), although this correlation did not apply in the northeast and west ( p = 0.60 and 0.99, respectively). While sinusitis incidence increases during the winter, the relationship between season and orbital cellulitis is complex and varies by age and geographic location. These findings may help to facilitate screening protocols for this disease and to define staffing issues for emergent ophthalmic care.

Abstract No. 59 Temporal Trends in Cystostomy Exchanges and Placements: A 2000–2014 Analysis of the National Inpatient Sample (NIS) and National Emergency Department Sample (NEDS) of the Healthcare Cost and Utilization Project

Abstract No. 59 Temporal Trends in Cystostomy Exchanges and Placements: A 2000–2014 Analysis of the National Inpatient Sample (NIS) and National Emergency Department Sample (NEDS) of the Healthcare Cost and Utilization Project

Can accurate demographic information about people who use prescription medications nonmedically be derived from Twitter?

Traditional substance use (SU) surveillance methods, such as surveys, incur substantial lags. Due to the continuously evolving trends in SU, insights obtained via such methods are often outdated. Social media-based sources have been proposed for obtaining timely insights, but methods leveraging such data cannot typically provide fine-grained statistics about subpopulations, unlike traditional approaches. We address this gap by developing methods for automatically characterizing a large Twitter nonmedical prescription medication use (NPMU) cohort (n = 288,562) in terms of age-group, race, and gender. Our natural language processing and machine learning methods for automated cohort characterization achieved 0.88 precision (95% CI:0.84 to 0.92) for age-group, 0.90 (95% CI: 0.85 to 0.95) for race, and 94% accuracy (95% CI: 92 to 97) for gender, when evaluated against manually annotated gold-standard data. We compared automatically derived statistics for NPMU of tranquilizers, stimulants, and opioids from Twitter with statistics reported in the National Survey on Drug Use and Health (NSDUH) and the National Emergency Department Sample (NEDS). Distributions automatically estimated from Twitter were mostly consistent with the NSDUH [Spearman r: race: 0.98 (P< 0.005); age-group: 0.67 (P< 0.005); gender: 0.66 (P= 0.27)] and NEDS, with 34/65 (52.3%) of the Twitter-based estimates lying within 95% CIs of estimates from the traditional sources. Explainable differences (e.g., overrepresentation of younger people) were found for age-group-related statistics. Our study demonstrates that accurate subpopulation-specific estimates about SU, particularly NPMU, may be automatically derived from Twitter to obtain earlier insights about targeted subpopulations compared to traditional surveillance approaches.