Seeking Emergency Care Research Articles

National Trends In ED Visits, Hospital Admissions, And Mortality For Medicare Patients During The COVID-19 Pandemic.

Concerns about avoidance or delays in seeking emergency care during the COVID-19 pandemic are widespread, but national data on emergency department (ED) visits and subsequent rates of hospitalization and outcomes are lacking. Using data on all traditional Medicare beneficiaries in the US from October 1, 2018, to September 30, 2020, we examined trends in ED visits and rates of hospitalization and thirty-day mortality conditional on an ED visit for non-COVID-19 conditions during several stages of the pandemic and for areas that were considered COVID-19 hot spots versus those that were not. We found reductions in ED visits that were largest by the first week of April 2020 (52percent relative decrease), with volume recovering somewhat by mid-June (25percent relative decrease). These reductions were of similar magnitude in counties that were and were not designated as COVID-19 hot spots. There was an early increase in hospitalizations and in the relative risk for thirty-day mortality, starting with the first surge of the pandemic, peaking at just over a 2-percentage-point increase. These results suggest that patients were presenting with more serious illness, perhaps related to delays in seeking care.

Dental drive through model of care to reduce caries incidence

Aim or purposeAn increase in number of people seeking emergency care due to inability to access dental services for general care was seen during COVID-19. This drive through model was developed to screen, educate and prioritise, based on individual risks, patients who were otherwise unable to get dental care due to COVID-19 restrictions.MethodsOn World Oral Health Day, 2021 dental examinations were conducted for patients while they drove through an existing COVID-19 screening clinic. The ICDAS-II index (International Caries Detection and Assessment System), score two to six, was used for caries assessment and management. Patients were categorised into three groups based on number of decayed teeth (less than three, three to six or more than six). The management criteria was based on the ICDAS score of teeth under each of the three categories.ResultsA total of 247 patients were screened and educated on the day. 102 patients with ICDAS score two to four were given education and preventative treatment appointment. While 118 patients with ICDAS score five or six were identified to be at risk of dental emergency in the near future and were booked in for emergency or general treatment. Another 27 patient were given clinical priority based on their periodontal or denture related needs. Patient survey revealed a high satisfaction rate of 92%.ConclusionsThis public health initiative was a great success in providing dental care to the patients during these unprecedented times who would not have had any care otherwise due to COVID-19 restrictions.

Predictors of Hospitalization in Vitamin K Antagonist Users Presenting with Bleeding at the Emergency Department

Background Vitamin K antagonists (VKA) are indicated for the prevention of thromboembolic events and reduction of mortality in patients with atrial fibrillation and patients with valvular prostheses. However, their use is associated with bleeding complications and hospitalizations. Predictors of hospital admission for bleeding in these patients are poorly known. Objectives To define the predictors for hospitalization of VKA users who seek emergency care due to bleeding. Methods Single-center, cross-sectional study, with retrospective analysis of electronic medical records from 03/01/2012 [...]

Time to Seek Care and Hospital Length of Stay Among Older Adults With Acute Coronary Syndrome During the COVID-19 Pandemic.

The prevalence of prehospital delay is high among older adults with acute coronary syndrome (ACS). The current study aimed to examine the associated factors of prehospital delay among patients with ACS during the COVID-19 pandemic. This cross-sectional study was conducted on a convenience sample of 300 older adults with ACS admitted to the emergency department in Jordan. Data were collected from June 1 to September 1, 2020. Bivariate and multivariate analyses were used to explore the predictors of prehospital delay. Being widowed, educational level, pain intensity, the gradual onset of ACS symptoms, symptoms lasting for more than 30 minutes, patients' feeling anxious about their ACS symptoms, patients' perceiving their symptoms to be particularly dangerous, history of myocardial infarction (MI), and mode of transportation were associated with the time taken before seeking emergency care. Significant predictors of time to seek help were chief complaint of chest pain or palpitations, abrupt onset of symptoms, the associated symptom of vertigo, and a higher number of chronic illnesses; they explained about 17.9% of the variance in the time to seek care. The average time to seek care among patients with ACS during the COVID-19 pandemic was found to be longer than the average time reported by studies conducted prior the pandemic. Improved understanding of the associations between prehospital delay is crucial for optimal ACS patient outcomes under the impacts of the COVID-19 pandemic.

Emergency Department Visits by Patients with Substance Use Disorder in the United States.

IntroductionWe aimed to characterize emergency department (ED) utilization and clinical characteristics of patients with substance use disorder (SUD) seeking emergency care for all reasons.MethodsUsing 2016–2017 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, and clinical characteristics of patients with SUD vs those without SUD.ResultsOf all adult ED visits (N = 27,609) in the US in 2016–2017, 11.1% of patients had SUD. Among ED patients with SUD, they were mostly non-Hispanic White (62.5%) and were more likely to be male (adjusted odds ratio [aOR] 1.80 confidence interval [CI], 1.66–1.95). Emergency department patients with SUD were also more likely to return to the ED within 72 hours (aOR 1.32, CI, 1.09–1.61) and more likely to be admitted to the hospital (aOR 1.28, CI, 1.14–1.43) and intensive care unit (aOR 1.40, CI, 1.05–1.85).ConclusionPatients with SUD have specific demographic, socioeconomic, and clinical characteristics associated with their ED visits. These findings highlight the importance of recognizing co-existing SUD as risk factors for increasing morbidity in acutely ill and injured patients, and the potential role of the ED as a site for interventions aimed at reducing harm from SUD.

A motivational interviewing intervention improves the burden of physical symptoms in patients with heart failure: A secondary outcome analysis of a randomized clinical trial

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Center of Excellence for Nursing Scholarship, Rome, Italy Background. Patients with heart failure (HF) experience a variety of physical symptoms. Symptoms are perceived by patients as burdensome and, as such, negatively affect quality of life. Besides, physical symptoms are among the first reasons for seeking emergency care and hospitalization. Findings from the MOTIVATE-HF trial show that motivational interviewing (MI) leads to better self-care. However, whether MI also reduces the burden of physical symptoms is not yet known. Purpose. To evaluate the effectiveness of MI on the burden of physical symptoms in patients with HF. Methods. Secondary outcome analysis of the MOTIVATE-HF trial. The study was a three-arm, multicenter randomized controlled trial with a 12-month follow-up. Patients with HF and their informal caregivers were enrolled and randomly divided into three arms: MI performed only with patients (Arm 1); MI performed both with patients and caregivers (Arm 2); usual care (Arm 3). Patients with a diagnosis of HF in NYHA functional class II-IV were recruited in three Italian centers. Participants underwent one face-to-face MI session, followed by three phone calls within two months from enrollment. Physical symptoms were measured with the Heart Failure Somatic Perception Scale (HFSPS) with the dimensions of dyspnea, chest discomfort, early and subtle, and edema. Higher scores at the HFSPS and its dimensions indicate worse physical symptom. Data were collected at baseline, and 3 (T1), 6 (T2), 9 (T3) and 12 (T4) months after enrollment. T-test was used to compare differences in HFSPS scores in Arms 1 and 2 versus Arm 3 at each follow-up. Changes over time were analyzed with mixed linear longitudinal models. Results. A sample of 510 patients (median 74 years, 58% male) and their caregivers (median 55 years, 75.5% female) were randomized to Arm 1 (n = 155), Arm 2 (n = 177) and Arm 3 (n = 178). Chest discomfort improved in Arms 1 and 2 versus Arm 3 at T4 (mean difference(Δ): -8.13, P = .014). Dyspnea also improved in Arms 1 and 2 than Arm 3 both at T3 and T4 (Δ: -7, P = .027 and Δ: -6.78, P = .038, respectively). HFSPS total score improved in Arms 1 and 2 versus Arm 3 at T3 (Δ: -4.55, P = .048). Over the year of observation, the mixed linear longitudinal models showed a significant improvement in Chest discomfort and total HFSPS score in Arm 2 versus Arm 3 (β = -2.61, P = .002 and, β = -1.35, P = .02). Conclusions. The results of this secondary analysis indicate that MI may be effective in decreasing the burden of physical symptoms in HF patients, especially if also caregivers are involved in the intervention. Since symptom burden is among the first reasons for seeking emergency care and hospitalization in HF, MI might be a viable option to improve symptom burden via self-care.

Acceptability and uptake of HIV self-testing in emergency care settings: A systematic review and meta-analysis.

Emergency departments (ED) interface with large numbers of patients that are often missed by conventional HIV testing approaches. ED-based HIV self-testing (HIVST) is an innovative engagement approach which has potential for testing gains among populations that have failed to be reached. This systematic review and meta-analysis evaluated acceptability and uptake of HIVST, as compared to standard provider-delivered testing approaches, among patients seeking care in ED settings. Six electronic databases were systematically searched (Dates: January 1990-May 2021). Reports with data on HIVST acceptability and/or testing uptake in ED settings were included. Two reviewers identified eligible records (κ=0.84); quality was assessed using formalized criteria. Acceptability and testing uptake metrics were summarized, and pooled estimates were calculated using random-effects models with assessments of heterogeneity. Of 5773 records identified, seven met inclusion criteria. The cumulative sample was 1942 subjects, drawn from three randomized control trials (RCTs) and four cross-sectional studies. Four reports assessed HIVST acceptability. Pooled acceptability of self-testing was 92.6% (95% confidence interval [CI]: 88.0%-97.1%). Data from two RCTs demonstrated that HIVST significantly increased testing uptake as compared to standard programs (risk ratio [RR]=4.41, 95% CI: 1.95-10.10, I2 =25.8%). Overall, the quality of evidence was low (42.9%) or very low (42.9%), with one report of moderate quality (14.2%). Available data indicate that HIVST may be acceptable and may increase testing among patients seeking emergency care, suggesting that expanding ED-based HIVST programs could enhance HIV diagnosis. However, given the limitations of the reports, additional research is needed to better inform the evidence base.

The Impact of COVID-19 Lockdown on Injuries in Saudi Arabia: Results From a Level-I Trauma Center.

Background: The COVID-19 pandemic has placed an enormous strain on global health. Due to precautionary measures, the epidemiology of health conditions may have been affected. Saudi Arabia imposed a lockdown order on March 25, 2020. This study investigated the impact of the pandemic lockdown on injuries in a level-I trauma center in King Abdulaziz Medical City, Riyadh, Saudi Arabia.Methods: This retrospective study identified all injured patients seeking emergency care during the lockdown period (March 25–June 21, 2020) and a similar period in two previous year (March 25–June 21) 2018 and 2019. The collected data included patients' demographics, injury types, mechanisms, and health outcomes.Results: Two hundred sixty nine injured patients sought emergency care during the lockdown, while 626 and 696 patients were treated in the same period of 2018 and 2019, respectively. There was a significant reduction in motor vehicle crashes (OR: 0.47; 95% CI: 0.31–0.73) and burns (OR: 0.24; 95% CI: 0.08–0.66), coupled with a significant increase in assault injuries (OR: 2.20; 95% CI: 1.30–3.74) in the lockdown period compared to 2019. Apart from the intensive care unit (ICU) admission and hospital length of stay, there were no differences between the two periods in the health outcomes. ICU admission was significantly reduced by 57% during the lockdown period (OR: 0.43; 95% CI: 0.22–0.83). Mechanisms of injuries were not significant predictors of deaths or ICU admission or both in the lockdown period.Conclusion: The COVID-19 lockdown had a clear impact on the volume and mechanisms of injuries. The findings highlight that injury risk factors are modifiable and emphasize the importance of public health measures for preventing injuries and the significance of maintaining trauma services capacity during pandemics.

Impact of a Novel Emergency Department Forward Treatment Area During the New York City COVID-19 Surge.

IntroductionCoronavirus disease 2019 (COVID-19) caused a disproportionate number of patients to seek emergency care at hospitals in New York City (NYC) during the initial crisis. Our urban emergency department (ED), a member of the NYC public hospital system had to process the increased volume while also differentiating our patients’ critical needs. We established a forward treatment area (FTA) directly in front of the ED to accomplish these goals from March 23–April 16, 2020.MethodsA clinical greeter evaluated patients 18 years and older who presented to the walk-in entrance of the ED where they were screened for COVID-19-like complaints. If they did not appear critically ill and could ambulate they were directed into the FTA. Clinical and non-clinical staff worked in concert to register, evaluate, and process patients with either a disposition of directly home or into the ED for further care.ResultsA total of 634 patients were seen in the FTA from March 23–April 16, 2020. Of the 634 patients evaluated, 135 (21%) were referred into the ED for further evaluation, of whom 81 (12.7% of the total) were admitted. These patients were disproportionately male (91 into the ED and 63 admitted) and tended to have a higher heart rate (105.4 vs 93.7), a higher respiratory rate (21.5 vs 18.1), and lower oxygen saturation (93.9% vs 97.8%).ConclusionA forward treatment area is an effective method to rapidly screen and process an increased volume of COVID-19 patients when resources are limited. This treatment area helped decompress the ED by being rapidly deployable and effectively screening patients for safe discharge home.

Effect of coronavirus disease 2019 on febrile children’s visits to the emergency department of a tertiary hospital

Purpose During the coronavirus disease 2019 pandemic, many countries have reported sharp drops in the numbers of patients, especially children, seeking emergency care unrelated to the disease. The author investigated the patterns of febrile children’s visits to the emergency department (ED) of a tertiary hospital from 2017 through 2020. Methods We compared the data of febrile children aged 15 years or younger who visited the ED in 2017-2019 and in 2020 (February through August, each year). Information on the children’s baseline characteristics, the Korean Triage and Acuity Scale 1-2 indicating a high severity, and ED disposition, such as hospitalization, were collected. In addition, we determined the number of children who underwent cancellation, defined as the leave of children without treatment, and the rates of respiratory virus polymerase chain reaction performance and its positivity. Results In 2020, we noted decreases in the median monthly fever-related ED visits (2017-2019, 326 [interquartile range, 292-425] vs. 2020, 149 [132-182]; P < 0.001) with a shorter median fever duration (2017-2019, 11 [3-27] days vs. 2020, 9 [2-23] days; P < 0.001). However, in the same year, we noted increases in rates of the Korean Triage and Acuity Scale 1-2 (2017-2019, 5.7% vs. 2020, 16.4%; P < 0.001) and hospitalization (2017-2019, 23.5% vs. 2020, 35.7%; P < 0.001). We also noted increases in the number of cancellation and the rate of respiratory virus polymerase chain reaction performance rate, along with a decrease in its positive rate in 2020. Conclusion During the pandemic, the febrile children’s visits to the ED decreased in number. However, the severity remarkably increased, requiring more medical attention. Key Words: Child; COVID-19; Emergency Service, Hospital; Fever; Retrospective Studies; Tertiary Care Centers

The impact of peer influencing on adolescent suicidal ideation and suicide attempts

ObjectiveThe purpose of this study was to examine the role of peer influence on adolescent suicidal ideation and attempts within youth seeking emergency care or outpatient mental health services. We examined whether affiliation with peers reporting suicidal thoughts/behaviors was associated with an adolescent's own suicidal ideation and/or suicide attempt beyond individual risk factors. MethodsOne hundred and eighteen adolescents, ages 13–18, were recruited from the emergency department and outpatient mental health clinics at a large, metropolitan children's hospital. Adolescents with suicidal ideation in the past six months (ideators, n=19) and with a suicide attempt in the past year (attempters, n=40) were matched with controls with no history of ideation or attempt on age (±1 year), sex, and race. Adolescents and parents completed semi-structured interviews and self-report questionnaires to examine individual and peer associated risk factors. ResultsBoth ideators and attempters were more likely to affiliate with peers with suicidal behavior compared to their matched controls. However, affiliation with suicidal peers was only associated with attempter group status after controlling for individual risk factors. ConclusionAffiliation with peers reporting suicidal thoughts/behaviors was linked to an adolescent's own history of suicide attempt. Through understanding peer affiliation, peers may be an important resource for both identifying and preventing youth suicidal behavior. Evidence-based programs that focus and utilize peer influence may be invaluable for prevention efforts.

Ingested Foreign Bodies and Toxic Materials: Who Needs to be Scoped and When?

1. Yasemin Cagil, MD* 2. Jenna Diaz, MD† 3. Seth Iskowitz, MD‡ 4. Alisa J. Muniz Crim, MD§ 1. *Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA 2. †Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Washington University School of Medicine in St Louis, St Louis, MO 3. ‡Division of Pediatric Gastroenterology, Hepatology, and Nutrition, C.S. Mott Children’s Hospital Michigan Medicine, Ann Arbor, MI 4. §Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nicklaus Children’s Hospital, Miami, FL Providers should be able to identify the signs and symptoms of foreign body and toxic material ingestion in children, select the proper diagnostic tests needed to confirm the diagnosis, and describe adequate treatment modalities for the described ingestions. After completing this article, readers should be able to: 1. Understand the common types of foreign body and toxic material ingestions. 2. Recognize the presenting symptoms of the described ingestions. 3. Recognize which patients warrant emergency endoscopic intervention. 4. Recognize which patients warrant nonemergency endoscopic intervention. 5. Recognize which patients warrant noninvasive medical management. 6. Review the role of prevention. Foreign body and toxic substance ingestions are a common reason for families to seek emergency care. Often, the pediatric patient is unable to describe the nature of the ingestion and/or the timing of the event. This can pose significant barriers to both caregivers and the medical team. Coins, button batteries, magnets, pointed and/or large objects, food, absorptive substances, alcohol, acidic and alkaline substances, detergent pods, and hydrocarbons are all frequently reported ingestions. Each ingested object or substance requires an individualized approach to management. The most common site for foreign bodies to become entrapped is in the proximal esophagus at the site of the cricopharyngeus muscle. Other common locations include the midesophagus, at the site of compression from the aortic arch, and at the lower esophageal sphincter. Most foreign bodies that are ingested by children pass spontaneously without complications; however, endoscopic removal may be necessary in some situations. Parameters that must be considered regarding the need for endoscopic removal of ingested foreign bodies include the child’s age, weight, clinical presentation, time since ingestion, type and size of the foreign body, location in the gastrointestinal tract, and underlying intestinal abnormalities. This section describes the most commonly ingested foreign bodies and their management. (1) ### Coins Coins remain the most commonly ingested …

Worse Cardiac Arrest Outcomes During The COVID-19 Pandemic In Boston Can Be Attributed To Patient Reluctance To Seek Care.

Delays in seeking emergency care stemming from patient reluctance may explain the rise in cases of out-of-hospital cardiac arrest and associated poor health outcomes during the COVID-19 pandemic. In this study we used emergency medical services (EMS) call data from the Boston, Massachusetts, area to describe the association between patients' reluctance to call EMS for cardiac-related care and both excess out-of-hospital cardiac arrest incidence and related outcomes during the pandemic. During the initial COVID-19 wave, cardiac-related EMS calls decreased (-27.2percent), calls with hospital transportation refusal increased (+32.5percent), and out-of-hospital cardiac arrest incidence increased (+35.5percent) compared with historical baselines. After the initial wave, although cardiac-related calls remained lower (-17.2percent), out-of-hospital cardiac arrest incidence remained elevated (+24.8percent) despite fewer COVID-19 infections and relaxed public health advisories. Throughout Boston's fourteen neighborhoods, out-of-hospital cardiac arrest incidence was significantly associated with decreased cardiac-related calls, but not with COVID-19 infection rates. These findings suggest that patients were reluctant to obtain emergency care. Efforts are needed to ensure that patients seek timely care both during and after the pandemic to reduce potentially avoidable excess cardiovascular disease deaths.

Thyrotoxic Periodic Paralysis: A Rare Presentation of Graves’ Disease

Abstract Background: Thyrotoxic periodic paralysis (TPP) is a rare but serious thyroid emergency characterized by hypokalemia, acute onset flaccid paralysis &amp; thyrotoxicosis. Typically, seen in an Asian male with untreated hyperthyroidism symptoms, who awakens at night or in the early morning with flaccid ascending paralysis. This is precipitated by exercise, alcohol or carbohydrate rich meal. TPP is widely reported &amp; studied in Asian population. Its prevalence is about 2 % in Asian hyperthyroid patients. However, incidence is 0.1-0.2% in non-Asian hyperthyroid patients. Clinical Case: 33-year-old Caucasian male with celiac disease and no thyroid disease sought emergency care for complaints of sudden onset severe weakness in all extremities. He reported 20-pound unintentional weight loss, intermittent palpitations and low-grade fever. He noticed leg cramps with numbness and unable to move his extremities. At initial evaluation, he had acute flaccid paralysis and tachycardia. Initial laboratory studies showed potassium at 1.9 mmol/l, Magnesium at 1.8, suppressed TSH &amp;lt;0.005 uIU/ml with elevations in free T4 at 2.43 ng/dl and total T3 at 1.9 ng/ml. CT and MRI head were normal. Patient’s aldosterone level was normal. The patient’s paralysis and hypokalemia resolved after potassium replacement. Thyroid stimulating immunoglobulin was elevated and increased vascularity suggestive of Grave’s disease noted on thyroid Ultrasound. Methimazole and propranolol were initiated. His neurological workup was negative. After resolution of paralysis and hypokalemia he was discharged home. Since our patient presented with severe hypokalemia, flaccid paralysis and hyperthyroidism, that resolved promptly with potassium replacement, hence likely diagnosis of thyrotoxic periodic paralysis. Discussion: Thyrotoxic periodic paralysis is potentially reversible and mostly seen with Graves’ disease among Asian population. Early diagnosis &amp; treatment prevents life threatening complications. Differential diagnosis of TPP includes familial periodic paralysis, Guillain-Barre Syndrome &amp; acute intermittent porphyria. Diagnosis is based on family history, characteristic presentation, hyperthyroidism with low serum potassium level. Possible mechanism is increased sodium-potassium ATPase activity in the skeletal muscle membrane leading to intracellular shift of potassium causing hypokalemia and muscle inexcitability. Treatment includes potassium replacement, nonselective beta-blocker and definitive treatment of hyperthyroidism, to prevent further episodes.

Delayed emergency healthcare seeking behaviour by Dutch emergency department visitors during the first COVID-19 wave: a mixed methods retrospective observational study

BackgroundEmergency department (ED) visits due to non-coronavirus disease 2019 (COVID-19) conditions have drastically decreased since the outbreak of the COVID-19 pandemic. This study aimed to identify the magnitude, characteristics and underlying motivations of ED visitors with delayed healthcare seeking behaviour during the first wave of the pandemic.MethodsBetween March 9 and July 92,020, adults visiting the ED of an academic hospital in the East of the Netherlands received an online questionnaire to collect self-reported data on delay in seeking emergency care and subsequent motivations for this delay. Telephone interviews were held with a subsample of respondents to better understand the motivations for delay as described in the questionnaire. Quantitative data were analysed using descriptive statistics. Qualitative data were thematically analysed.ResultsOne thousand three hundred thirty-eight questionnaires were returned (34.0% response). One in five respondents reported a delay in seeking emergency care. Almost half of these respondents (n = 126; 45.4%) reported that the pandemic influenced the delay. Respondents reporting delay were mainly older adults (mean 61.6; ±13.1 years), referred to the ED by the general practitioner (GP; 35.1%) or a medical specialist (34.7%), visiting the ED with cardiac problems (39.7%). The estimated median time of delay in receiving ED care was 3 days (inter quartile range 8 days). Respectively 46 (16.5%) and 26 (9.4%) respondents reported that their complaints would be either less severe or preventable if they had sought for emergency care earlier. Delayed care seeking behaviour was frequently motivated by: fear of contamination, not wanting to burden professionals, perceiving own complaints less urgent relative to COVID-19 patients, limited access to services, and by stay home instructions from referring professionals.ConclusionsA relatively large proportion of ED visitors reported delay in seeking emergency care during the first wave. Delay was often driven by misperceptions of the accessibility of services and the legitimacy for seeking emergency care. Public messaging and close collaboration between the ED and referring professionals could help reduce delayed care for acute needs during future COVID-19 infection waves.

Access to Optimal Emergency Care for Children.

Every year, millions of pediatric patients seek emergency care. Significant barriers limit access to optimal emergency services for large numbers of children. The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association have a strong commitment to identifying these barriers, working to overcome them, and encouraging, through education and system changes, improved access to emergency care for all children.

Social determinants of seeking emergency and routine dental care in Saudi Arabia during the COVID-19 pandemic

BackgroundBetween March and June 2020, closing dental clinics during the COVID-19 pandemic except for emergency dental care was recommended. It is documented that health-seeking behaviors change during pandemics. The objective of this study was to examine social determinants associated with decisions to seek dental care in Saudi Arabia during the COVID-19 pandemic.MethodsA total of 4372 participants were invited to this cross-sectional web-based survey distributed from April 21 to June 20, 2020. The survey included a list of emergency, urgent, and routine dental procedures. Participants were asked if they would seek dental care for these conditions during the pandemic, and what pain severity would make them seek dental treatment. Logistic regression models were performed for predicting variables that explain the decision to go or not to go to the dental clinic during the pandemic for each dental condition.ResultsA total of 3443 responded to this survey. The emergency dental situation participants were most willing to go to the dental clinic for was trauma involving facial bones compromising the airway (94.5%). Only 65.8% were willing to seek care for facial cellulitis compromising the airway. On average 35.2% reported seeking teleconsultation as the first step. Eighteen percent of participants were still willing to go to the dental clinic during the pandemic for routine dental procedures. Multiple logistic regression showed that females (Odds Ratio (OR): 1.6, OR 95% CI 1.3, 1.9), people who had never visited a dentist (OR: 1.8, OR 95% CI 1.3, 2.5), and people living in metropolitan regions (OR: 1.8, OR 95%: 1.4, 2.3) had higher odds for not seeking emergency dental care during this pandemic. The pain threshold for seeking dental care during the pandemic was 7 out of 10. Female, those who never visited a dentist, and those from urban regions reported higher pain threshold before seeking dental care (P value < 0.001).ConclusionSocial disparities were found in emergency dental care seeking decision-making in Saudi Arabia during the COVID-19 pandemic. It was alarming that some people were afraid to seek dental care for life-threatening dental emergencies as cellulitis during this pandemic. This reflects the importance of increasing public health awareness and governmental regulations.

Intendedness of pregnancies and preconception contraceptive use in women of Swedish and non-European origins seeking emergency care in early pregnancy

IntroductionUnintended pregnancies in Europe have been estimated to constitute 43% of all pregnancies, with the proportion in Sweden being unknown. In striving for equitable healthcare, increased knowledge about unintended pregnancies...

Predictors of depression amongst older adults with acute coronary syndrome seeking emergency care

Psychological and traumatic events may cause disruption to daily life for patients, in particular, older adult patients with acute coronary syndrome (ACS). The present study aimed to identify the prevalence of depression and explore its predictors amongst older adults with ACS seeking emergency care. Secondary data analysis of cross-sectional data, using a convenience sample of 300 older adult patients with ACS seeking emergency care, was used in this study. Bivariate and multivariate analyses, including linear regression models, were conducted. The prevalence of depression amongst older adult patients with ACS seeking emergency care was 65.7%. The predictors of depression amongst this cohort of patients were age (t = 3.06, P = .003), frailty (t = 5.77, P < .001), troponin (t = 2.98, P = .003), and hemoglobin alpha 1C (HBA1C) (t = 3.18, P = .002). The model of these predictors explained 56.6% of the variation in the outcome (depression) (Adjusted R2 = 0.566, P = .017). Depression had a significant positive correlation with each intensive care unit (ICU) length of stay (LOS) (rho = 0.31, P < .001), hospital LOS (rho = 0.36, P < .001), and frailty (rho = 0.69). Depression rate is high amongst those patients, so healthcare providers (HCPs) should assess those patients for depression and be prepared to intervene accordingly. Depression amongst older adult patients with ACS seeking emergency care necessitates emergency management protocol by HCPs to manage depression amongst this cohort of at-risk patients.

Health Care Needs in the Aftermath of Hurricane Maria in Puerto Rico: A Perspective from Federal Medical Shelter Manatí.

On September 20, 2017, Hurricane Maria, a Category 4 hurricane, swept across Puerto Rico (PR), wreaking devastation to PR's power, water, and health care infrastructure. To address the imminent humanitarian crisis, the US government mobilized Federal Medical Shelters (FMS) to serve the needs of hurricane victims. This study's objective was to provide a description of the patients seeking emergency care at FMS and the changes in their needs over time. This retrospective, cross-sectional study included all patients presenting to the FMS Manatí from October 6, two weeks after Hurricane Maria's landfall, to November 2, 2017. Categories were created to catalogue the nature of new acute medical issues by patients presenting to the Shelter. Descriptive, graphical analyses were performed to assess changes to presenting complaints over time, and by age groups defined as infant (age ≤1 years), child (1 year < age ≤10 years), adolescent (10 years < age ≤ 25 years), and adult (age > 25 years). Over the 30-day period, 5,268 patients were seen in the FMS seeking medical care (average 188.1 patients per day), spending less than five hours in the facility. The distribution of patients' age was bimodal: the first peak at one year and the second at age 50. The most common patient complaint was infection (38.8%), then musculoskeletal (MSK) complaints (11.8%) and management of chronic medical conditions (11.8%). The proportion of patients presenting with chronic disease complaints declined over the course of the period of observation (21.4% on Day 4 to 8.0% on Day 30) while the proportion of patients presenting with infection increased (31.0% on Day 4 to 48.6% on Day 30). Infection complaints were highest in all age groups, but most in infxants (80.2%), while MSK and chronic disease complaints were highest in adults (14.9% and 14.9%, respectively). Infection treatment and chronic disease management were important medical needs facing patients seeking care at FMS Manatí after Hurricane Maria. These findings suggest that basic needs related to sanitation and shelter remained important weeks after the hurricane, and a focus on access to medications, infection control, and injury prevention/management after a disaster needs to be prioritized during disaster response.