Emergency Department For Symptoms Research Articles

Myocardial Infarction in a Young Female Patient with Subtotal Occlusion of the Mid OM Branch: A Case Report and Review of Potential Causes

Chest pain is a common presenting symptom in emergency departments, and its evaluation and management require careful consideration of various potential causes, ranging from benign musculoskeletal pain to serious cardiac conditions. Myocardial infarction (MI) is a well-known cause of chest pain, particularly in older individuals with risk factors such as hypertension, hyperlipidemia, and smoking history. However, MI in young patients without significant risk factors is relatively uncommon and can pose diagnostic challenges. In this case report, we describe the case of a 26-year-old female with no pertinent past medical history who presented to ED with acute chest pain and was diagnosed with a subtotal occlusion of the mid obtuse marginal (OM) branch of the coronary artery requiring two drug eluting stents to be placed.

Headache as a Symptom of Carotid Web

Headache is a frequent symptom in emergency department, especially in patients with hypertension. Carotid web, also known as the variant of fibromuscular dysplasia (FMD), is a rare disorder, found in only 1- 1.2 % of patients undergoing angiography, and it should be searched for in patients with cryptogenic stroke. We present a female hyper- tensive patient presented to emergency department with headache and visual symptoms, in whom further work-up revealed carotid web. A 46 years old female patient presented to the ED with headache occurring few days before the examination. It was a constant left temporal headache accompanied with flashes in the right half of the visual field. History taking revealed well-controlled hypertension with calcium channel antagonists. The first manifestation of hypertension was eclampsia during pregnancy. In emergency department normal neurologic status was obtained, brain CT scan was normal. Neurosonological examination revealed right carotid web, confirmed by MSCT angiography.

4-Fluoroamphetamine (4-FA) intoxication results in exaggerated blood pressure effects compared to MDMA and amphetamine: A retrospective analysis.

Objective4‐Fluoroamphetamine (4‐FA) is an amphetamine‐type stimulant, with effects comparable to amphetamine and 3,4‐methylenedioxymethamphetamine (MDMA). Severe 4‐FA‐related complications, such as cardiomyopathy, myocardial infarction, and cerebral hemorrhage, have been described. The aim of this study was to explore the cardiovascular symptoms and complications in 4‐FA and compare them to MDMA and amphetamine in intoxicated patients who presented to the emergency department (ED).MethodsBetween November 2015 and March 2020, all self‐reported 4‐FA, MDMA, and amphetamine‐intoxicated adult patients that presented at the ED of an inner‐city hospital in Amsterdam, were retrospectively analyzed for cardiovascular symptoms, vital parameters, cardiovascular complications, interventions, admission rate, and Poisoning Severity Score (PSS).ResultsA total of 582 patients were included, of which 31 (5.3%) with 4‐FA intoxication (10/31 mono‐intoxications, 32.3%), 406 (69.8%) with MDMA (59/406 mono‐intoxications, 14.5%), 100 (17.2%) with amphetamine (10/100 mono‐intoxications, 10.0%), and 45 (7.7%) with a cross intoxication of these drugs. 4‐FA mono‐intoxicated patients experienced more headache (n = 8; 80.0%) compared to MDMA (n = 2; 3.3%; P < 0.001) and amphetamine mono‐intoxicated patients (n = 0; 0.0%; P < 0.001) and their systolic blood pressure was higher (164 mm Hg ± 31 vs 139 mm Hg ± 19; P = 0.031 vs 135 mm Hg ± 22; P = 0.033, respectively). Severe 4‐FA‐related cardiovascular complications included Takotsubo cardiomyopathy (n = 1; 3.2%), subarachnoid hemorrhage (n = 1; 3.2%), and hypertensive urgency (n = 2; 6.5%).Conclusions4‐FA intoxication‐related ED symptoms resemble MDMA and amphetamine complications, although patients presented more often with headache and hypertension. Severe 4‐FA‐related cardiovascular complications occurred in 40% of mono‐intoxications.

Comparison of Diagnostic Accuracy of CT scan and USG in Right Upper Quadrant Pain: A Review Analysis

Purpose: Acute right upper quadrant (RUQ) pain is a common presenting symptom in emergency departments and outpatient medical practices, and is most commonly attributable to biliary and hepatic pathology. The main objective of the study is to systematically analyse the comparison of diagnostic accuracy of ultrasound and computed tomography in right upper quadrant pain. Material and methods: This study was conducted using a systematic search on Google scholar, Pubmed and Web of science published until 20th June 2020. The cited references of retrieved articles and previous reviews were also manually checked to identify any additional eligible studies with indexed search terms for cholecystitis, US, cholescintigraphy, CT, and MR imaging. Results: After excluding duplicates and articles that did not meet the inclusion criteria, we obtained 30 articles with full-texts which were read for further evaluation, where another 60 were excluded as irrelevant. Overall, we included 30 articles that directly match on the inclusion criteria. Conclusion: It is concluded that RUQ pain were not as good as sensitivities reported in prior studies. CT was statistically significantly better for the diagnosis of RUQ pain than US, most likely because of an unclear clinical picture, the patient population, and a high proportion of poor-quality US examinations. However, US is still our first test of choice if RUQ pain is suspected clinically, whereas CT is performed when the clinical picture is unclear.

Additive value of bioclinical risk scores to high sensitivity troponins-only strategy in acute coronary syndrome

BackgroundDischarging patients home as quickly as possible, or gaining the ability to eliminate a serious event is a goal requested by clinicians in the emergency department (ED). For this, risk scores, taking into account co-morbidities, have been established. The aim of our study consists to evaluate in patients with chest pain admitted in ED the risk stratification obtained with clinico-biological risk scores (CCS, GRACE score, TIMI score and HEART score) using Ortho hs-cTnI assay (Ortho Clinical Diagnostics, Illkirch, France) on the Vitros 3600® instrument or Roche hs-cTnT assay on the Cobas8000/e801® module (Roche diagnostics, Meylan, France), with comparison to hs-cTn-only strategy. Prognostic performances were evaluated according to AMI with or without STEMI, and deaths during hospitalization. MethodsPatients admitted to the ED presenting chest pain or symptoms suggesting of acute coronary syndrome (ACS) were included. Hs-cTnT was performed on a Roche hs-cTnT assay on the Cobas8000/e801® module using a fifth-generation assay and was used for the clinical diagnosis. In addition, hs-cTnI was tested using Ortho hs-cTnI assay on the Vitros 3600® analyzer. Retrospectively, we collected the variables needed for each score in clinical records. Our endpoint were occurrence of AMI in patients with chest pain after presentation to the ED and all cause death during the hospitalization. ResultsWe enrolled 160 patients with suspected ACS. The adjudicated diagnosis was AMI in 37 patients (with 9 STEMI and 28 NSTEMI), cardiac pathologies in 57 patients and other causes in 66 patients. The majority of patients were classified at high risk for each risk scores (from 42% to 68%) whatever the considered hs-cTn assay, except for TIMI score. Cohen’s kappa agreements with GRACE, TIMI and HEART scores were excellent between Roche hs-cTnT vs Ortho hs-cTnI. The AUC of the HEART score was highest for both hs-cTn to predict AMI, NSTEMI or death, with no statistical difference according to the hs-cTn (p = NS) assay used. NRI analysis confirmed the interest of HEART score which improved individual risk prediction for AMI (or NSTEMI) and death. ConclusionIn view of our results, the decision aids using only biological variables (hs-cTn-only strategy and CCS) would seem more effective for rule-out AMI whereas bioclinical risk scores could better identify patients at low and high risk for mortality. In consequence, risk scores taking in account comorbidities, appear necessary to determine the outcome and thus to adapt the therapeutic options. It is interesting to note that the HEART score could be useful for the rule out AMI but also for the risk prediction as confirmed by the NRI.

Automated identification of patients with syncope in the textual health record – a feasibility study using machine learning and natural language processing

Abstract Background Syncope is a commonly occurring presenting symptom in emergency departments. While the majority of episodes are benign, syncope is associated with worse prognosis in hypertrophic cardiomyopathy, arrhythmia syndromes, heart failure, aortic stenosis and coronary heart disease. Flagging documented syncope in these patients may be crucial to management decisions. Previous studies show that the International Classification of Diseases (ICD) codes for syncope have a sensitivity of around 0.63, leading to a large number of false negatives if patient identification is based on administrative codes. Thus, in order to provide data-driven, clinical decision support, and to improve identification of patient cohorts for research, better tools are needed. A recent study manually annotated more than 30.000 patient records in order to develop a natural language processing (NLP) tool, which achieved a sensitivity of 92.2%. Since access to medical records and annotation resources is limited, we aimed to investigate whether an unsupervised machine learning and NLP approach with no manual input could achieve similar performance. Methods Our data was admission notes for adult patients admitted between 2005 and 2016 at a large university hospital in Norway. 500 records from patients with, and 500 without a “R55 Syncope” ICD code at discharge were drawn at random. R55 code was considered “ground truth”. Headers containing information about tentative diagnoses were removed from the notes, when present, using regular expressions. The dataset was divided into 70%/15%/15% subsets for training, validation and testing. Baseline identification was calculated by a simple lexical matching using the term “synkope”. We evaluated two linear classifiers, a Support Vector Machine (SVM) and a Linear Regression (LR) model, with a term frequency–inverse document frequency vectorizer, using a bag-of-words approach. In addition, we evaluated a simple convolutional neural network (CNN) consisting of a convolutional layer concatenating filter sizes of 3–5, max pooling and a dropout of 0.5 with randomly initialised word embeddings of 300 dimensions. Results Even a baseline regular expression model achieved a sensitivity of 78% and a specificity of 91% when classifying admission notes as belonging to the syncope class or not. The SVM model and the LR model achieved a sensitivity of 91% and 89%, respectively, and a specificity of 89% and 91%. The CNN model had a sensitivity of 95% and a specificity of 84%. Conclusion With a limited non-English dataset, common NLP and machine learning approaches were able to achieve approximately 90–95% sensitivity for the identification of admission notes related to syncope. Linear classifiers outperformed a CNN model in terms of specificity, as expected in this small dataset. The study demonstrates the feasibility of training document classifiers based on diagnostic codes in order to detect important clinical events. ROC curves for SVM and LR models Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Research Council of Norway

Patients with syncope remaining unexplained after a structured work-up share the characteristics of patients with neurally mediated syncope

Syncope is a common symptom in emergency department visits and, despite extensive evaluation, still remains unexplained in a significant number of cases.The findings of this study support the concept that patients with SUA suffer from some form of neurally mediated syncope.

Ignorance of pre-ED healthcare setting is a factor leading to inappropriate initial antibiotic treatment of sepsis in ED and poor outcomes in ICU.

Appropriate initial antibiotic therapy is critical for successfully treating sepsis. In the emergency department (ED), clinicians often rely on septic symptoms to guide empirical therapy. The aim of this study was to investigate whether history of contacting pre-ED healthcare setting is easy to be neglected and whether the patients received more inappropriate initial antibiotic therapy and developed poorer outcomes. Septic patients (n=453) admitted from ED to the intensive care unit (ICU) between 2014 and 2017 were retrospectively selected. Appropriate antibiotic treatment or not was determined by checking whether the selected antibiotics can effectively eradicate the bacteria identified. Various indexes were compared between patients with appropriate and inappropriate initial antibiotic treatments, including septic symptoms (qSOFA scores) in ED, septic-severity change in ICU (SOFA-score ratios), and septic outcomes (APACHE II scores, stay length, 30-day survival probability). These indexes were also compared between pre-ED healthcare and pre-ED community patients. In comparison with pre-ED community patients, pre-ED healthcare patients received more inappropriate initial antibiotic treatment in ED, showing poorer outcomes in ICU, including septic severity, stay-lengths in ICU and 30-day survival probabilities. Pre-ED settings is more significant than qSOFA scores to predict the inappropriate initial antibiotic treatment. Pre-ED healthcare settings, which are indexes for infection with antibiotic resistant pathogens, are easy to be neglected in the first hour in ED. We suggested that standard operating procedure for getting enough information of pre-ED settings should be incorporated to the 1h bundle of sepsis guideline.

P5676Implementing a syncope pathway

Abstract Background Syncope is a common presenting symptom in emergency departments (0.8–2.4%) and is associated with high health care costs. In up to 40% of cases, etiology remains unidentified after initial evaluation. Purpose To assess the increase in diagnostic yield and the time to diagnosis by implementing a structured pathway in syncope evaluation according ESC- Guidelines in a secondary hospital. Methods In the study, we compared 2 groups of patients with T-LOC. We evaluated the diagnostic yield and the time to diagnosis. The first group comprised all patients with T-LOC referred to the emergency department (ED) of the hospital from January to March 2016. The work-up was done according to existing clinical practice. After implementation of a structured pathway in syncope evaluation according to ESC-Guidelines, we reevaluated the diagnostic yield and the time to diagnosis in all patients referred to ED with T-LOC from July to September 2017. The implementation consisted of an initial evaluation (careful history taking with a checklist, physical examination, ECG, orthostatic challenge test carried out by nurses), risk assessment and instructing the medical staff. Results There were 169 vs. 85 patients presenting with suspected T-LOC in the ED. 130 (77%) vs. 65 (76.5%) were classified as having a syncope. The diagnostic yield in the syncope patients was 60% vs. 80% (p=0.013). The rate of correct diagnosis within 14 days increased from 55 to 80%. Conclusion By implementing a structured pathway and educating the staff, we succeeded in increasing diagnostic yield from 60 to 80%. This could be achieved in a reduced referral to diagnosis time.

Frequency, aetiology, and impact of vestibular symptoms in the emergency department: a neglected red flag.

We aimed to determine the incidence of all vestibular symptoms in a large interdisciplinary tertiary emergency department (ED) and to assess stroke prevalence, and frequency of other life-threatening aetiologies. In this 1-year retrospective study, we manually screened all medical records of 23,608 ED visits for descriptions of vestibular symptoms. Symptoms were classified according to the International Classification of Vestibular Disorders of the Bárány Society. We evaluated all patients older than 16years in whom vestibular symptoms were the main or accompanying complaint. We extracted clinical, radiological, and laboratory findings as well as aetiologies from medical records. We identified a total of 2596 visits by 2464 patients (11% of ED visits) who reported at least one vestibular symptom. In 1677/2596 visits (64.6%), vestibular symptoms were the main reason for the ED consultation. Vestibular symptoms were classified as dizziness (43.8%), vertigo (33.9%), postural symptoms (6.5%), or more than one symptom (15.8%). In 324/2596 visits (12.5%), cerebrovascular events were the aetiology of vestibular symptoms, and in 355/2596 visits (13.7%), no diagnosis could be established. In 23.8% of visits with vestibular symptoms as the main complaint, the underlying condition was life-threatening. Frequency and impact of vestibular symptoms in patients visiting the ED were higher than previously reported, and life-threatening aetiologies such as strokes are common. Therefore, awareness among physicians regarding the importance of vestibular symptoms has to be improved.

MP55: Characteristics associated with biphasic reactions in an adult population

Introduction: Biphasic anaphylactic reactions are a concern in emergency medicine. Risk factors associated with this type of reaction remain ill-defined. The aim of this study was to investigate elements associated with biphasic anaphylactic reactions and to determine the impact of anaphylaxis treatments on biphasic reactions. Methods: From the multicenter Cross-Canada Anaphylaxis Registry prospective cohort, we selected adults (≥18 years) with a visit to the emergency department (ED) of Sacré-Cœur Hospital, an urban tertiary-care hospital. Then, a structured chart review was done to collect additional information on types and timing of treatments for the initial anaphylactic reaction, presence and treatment of biphasic reactions during the initial ED visit or upon patients’ return. Biphasic reactions were defined by the recurrence of any anaphylaxis symptoms within 72 hours of a resolved anaphylaxis episode. Potential factors associated with biphasic reactions were studied using Chi-Square and Mann-Whitney tests. Results: Patients with anaphylaxis were enrolled between April 2014 and February 2018. From the cohort, 401 adult patients were identified. We found 37 patients who developed a biphasic reaction. Amongst them, 33 received treatments and 9 required more than one dose of intramuscular epinephrine. None of the biphasic reaction patients required intravenous epinephrine, other vasopressors, ICU admission, or endotracheal intubation. Biphasic reactions appeared in a median time of 13.3h after the initial reaction ranging from 1.1h to 69.6h (IQR 30.2). There was no difference in age or gender of patients who developed a biphasic reaction compared those who did not. Pertinent past medical history, daily medications, mean of arrival to the ED, allergen type, ingestion route, or initial symptoms during the anaphylaxis episode were not significantly different in the two groups. Treatment with corticosteroids was similar in the two groups (9.0% vs. 8.1% p = 0.82). Treatment, dose and route of administration of epinephrine was not different in the two groups but longer delays before treatment with the first dose of epinephrine was more frequent in biphasic reaction patients (median delay of 64 minutes, p = 0.015). Conclusion: No patient characteristic, allergen, route of ingestion, symptom, nor treatment with corticosteroids has shown to be significantly different in patients with and without biphasic reactions. Delayed treatment with epinephrine is significantly associated with biphasic reactions.

Diagnosis of Concussion in the Pediatric Emergency Department

Pediatric visits to the Emergency Department (ED) for concussion are common and increasing. ED clinicians evaluating children with concussion should first ensure the absence of more serious injuries requiring immediate intervention, such as intracranial hemorrhage or cervical spine injury. In the ED setting, signs and symptoms of concussion are sometime subtle and often overlooked. A thorough physical exam is warranted but may be normal. Imaging and laboratory studies have no role in concussion diagnosis and should be reserved for cases where an injury requiring immediate intervention is suspected. Symptom management may include avoiding symptom-triggers (such as bright lights triggering headaches) and/or specific treatments such as nonsteroidal anti-inflammatories or antiemetics. Discharge instructions should include a recommendation for a brief period of rest, followed by outpatient management for return-to-activity decisions in conjunction with a primary care provider.

The broad symptoms with genetically identified episodic ataxia type 2 in a family

Background: Episodic ataxia type 2 (EA2) is an autosomal dominant calcium channelopathy caused by a mutation in CACNA1. Spells are characterized by ataxia, which may be accompanied by vertigo, dysarthria, This disease is very rare and the prevalence is estimated at less than 1 in 100,000 population. However, we may encountered these symptoms in emergency department.

Cannabis-induced psychotic disorders and THC use among patients with psychotic symptoms

IntroductionCausality between THC and psychotic symptoms has been outlined in several studies and a potential role for THC in the development of Schizophrenia remains to be assessed.MethodsRetrospective study undertaken in a sample of 124 patients assessed in an Emergency Department (ED) due to psychotic symptoms. Medical records were reviewed to obtain clinical and sociodemographic variables.Objectives(1) To analyse the prevalence of THC consumption among psychotic patients in ED; (2) to establish the prevalence of cannabis-induced psychotic disorder; (3) to underpin the socio-demographic and clinical variables associated with cannabis-induced psychosis.ResultsPersonal history of cannabis use 31.5% (6.5% as a single drug.) Accumulated time interval of cannabis use prior to the first psychotic episode: 0 – 5 years 15% (3.9% developed psychosis during the first year of cannabis use), 5 – 10 years 9.2%, more than 10 years 20.8%. Cannabis-induced psychotic disorder (F12.5) was diagnosed in 3.3% of the sample. The prevalence of this diagnosis was the same among male and female patients. The highest prevalence of cannabis-induced psychosis was found among 36–50 years old patients (50%). All patients with a diagnosis of Cannabis-induced psychotic disorder had a personal history of THC use and urine tests had been positive for THC in 75% of the cases. Habitat: 75% urban, 25% rural. Marital status: 50% single, 50% married.ConclusionsCannabis use is highly prevalent among patients who present with psychotic symptoms in ED and THC is correlated with psychotic episodes. The prevalence of cannabis-induced psychosis has also increased. Further studies comprising larger samples are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Reducing the time to disposition of patients with abdominal pain admitted to the Male Urgent Area ED-HGH

Background: Abdominal pain is one of the most common presenting symptoms in Emergency Department. During a recent audit, it was found that Patients presenting to HGH emergency room with a chief complaint of abdominal pain are the most common patient's category to be delayed to disposition. Currently 62% of patients with abdominal pain admitted to Male Urgent Area in Emergency Department HGH were delayed to Disposition for more than 6 hrs. Aim: To decrease the percentage of patients with abdominal pain delayed in Male Urgent Area ED, HGH for more than 6 hrs from 62% to 50% by May 2015 Project Scope; Project period: February 10th to 24th May 2015; Place: Male Urgent Area, Emergency HGH; Population: Male patients Expected Benefits of the project; Improve Patient Flow; Improve Patient safety; Improve patient Satisfaction. Intervention: All abdominal pain patients must first be reviewed by the consultant of the See &amp; Treat before transfer to male urgent area. Dedicated bed for reassessment of abdominal pain in Male Urgent Area. Flagging of patients when ready for reassessment. Results: Post-intervention length of Stay Male Urgent Area has reduced by 2.28 hrs. Conclusions: Early senior involvement has an impact on decreasing the Length of Stay in abdominal pain patients. Flagging patients for reassessment had an impact on the Length of Stay. It was very challenging to implement the changes and reach out to every staff being a big department. Next steps: Quarterly Audit _ Publication of the Audit _ Continuous Education &amp; Implementing to other Areas of the ED.

Association of social support during emergency department evaluation for acute coronary syndrome with subsequent posttraumatic stress symptoms.

We examined the associations of different aspects of social support during emergency department (ED) evaluation for an acute cardiac event with perceptions of threat in the ED and subsequent posttraumatic stress symptoms (PSS) in 484 patients. Participants were enrolled in the ED where they reported on theirperceptions of threat in the ED. Social support in the ED and PSS were assessed at inpatient bedside or by telephone a median of 3days later. Positive aspects of social support were not associated with subsequent PSS. Anxiety-provoking social support was significantly associated with increased PSS at follow-up. Greater ED threat perception partially mediated that relationship.

Approach to Headache in Emergency Department

Headache remains a frequently encountered neurological symptom in Emergency department. Secondary causes of headache outnumber the primary entities such as migraine. Most of the secondary headaches have benign etiologies. The goal of emergent evaluation is to detect those with serious or life threatening causes. Identifying the pattern of headache helps in narrowing down the possible etiological diagnosis. A single episode of acute headache usually results from an acute infection ranging from viral URI to acute meningitis. Acute recurrent headaches are typically a feature of migraine. Chronic progressive headaches often indicate a serious underlying pathology such as a brain tumor and warrant a detailed neurological examination for signs of raised intracranial pressure (ICP) and focal deficits. Children with abnormal neurological findings require a neuroimaging. CT scan usually detects most of the abnormalities. Initial stabilization and management of raised ICP takes precedence in sick children. While simple analgesics like paracetamol and ibuprofen are used for symptomatic therapy, identification and appropriate treatment of underlying conditions is necessary for complete resolution of headache.

Victim of Carbon Monoxide Poisoning Identified by Carbon Monoxide Oximetry

Carbon monoxide (CO) is known as a leading cause of unintentional poisoning death in many countries. Diagnosis is usually made by measuring carboxyhemoglobin (COHb), but due to the non-specific symptoms, the crucial step is considering CO poisoning. A possible solution might be screening emergency department (ED) patients. A cutaneous sensor that measures oxygen and CO saturation simultaneously could accomplish that. We report a case in which CO-oximetry screening helped to identify CO poisoning in a patient with otherwise non-specific complaints presenting to a busy university hospital ED. A 53-year-old woman presented to our ED, reporting non-specific but common symptoms including emesis and diarrhea, one-sided headache, paresthesia, and palpitations. Whereas conventional pulse oximetry showed normal results, a COHb level of 28% was measured using a CO-oximeter. This allowed a diagnosis of CO poisoning to be made at admission. The patient was treated with 100% oxygen continuous positive airway pressure ventilation, and CO washout was monitored continuously and non-invasively. In the meantime, the local fire department was alerted and found a malfunctioning water heater as the source of CO in the patient's residence. As COHb fell to normal levels and the patient reported feeling well, she was discharged the next day. CO-oximetry served as a powerful tool in both identifying and monitoring a CO-poisoned patient in a busy ED. Future studies should address possible sources of error using this method on a long-term basis and its level of acceptance by ED staff.

A comparison of emergency department utilization by elderly and younger adult patients presenting to three hospitals in Hong Kong

BackgroundThe elderly population is increasing in absolute and relative terms in most developed countries, and this is protected to have a major impact on the delivery of health care, particularly acute and emergency services. The aim of this study is to describe the pattern of utilization of emergency department (ED) services in Hong Kong by the elderly and to compare it to the utilization by younger adults.MethodsData on ED visits to three acute hospitals in the eastern New Territories were retrieved from a central computerized database of ED attendances. Data on all adult patients (aged ≥15 years) who attended the three EDs in 2006 were analyzed retrospectively. Patients aged 15 to 64 years were defined as younger adults; patients aged ≥65 years were defined as elderly. The attendance rate, ED consultation process, hospital admission rate and disease pattern of the two age groups were compared.ResultsElderly patients required significantly more emergency care resources than younger adults. Elderly ED patients were brought to hospital more frequently by ambulance (42.8% vs. 14.8%, p < 0.0001) and required hospital admission more often (45.0% vs. 15.5%, p < 0.0001) than younger adults. A significantly higher proportion of elderly patients were triaged as being in the critical, emergency or urgent categories compared to younger adults (44.4% vs. 18.2%, p < 0.0001). Laboratory tests, radiography and CT scanning were performed on elderly patients more frequently than on younger adults (p < 0.0001), and their lengths of stay in EDs and emergency wards were significantly longer (p < 0.0001). Neurological symptoms and chest pain were the most common presenting symptoms in elderly ED patients.ConclusionWith the foreseeable rapid growth of the elderly population, ED utilization by the elderly will increase. Health service delivery, including that in the ED, needs to take account of the specific features and requirements of the elderly population in each locale.

Management of pain in a surgical emergency unit—Underlying factors affecting its delivery

Pain is an important symptom in emergency departments. The purpose of this study was to evaluate possible obstacles to pain management in a surgical emergency department. All patients arriving in the ED (N = 100) during the time period were asked to participate in an interview. Information about medication, patient history, and documented pain intensity were extracted from patient records. In addition, a questionnaire with six demographic and 31 pain-related items was distributed to 50 physicians and 82 nurses. Pain was the most important symptom of 60.3% (N = 46) of the respondents. Severe pain was reported by 45.8% of the patients. Analgesics were administered to 46.6% of the respondents (N = 34). None of the patients received nonsteroidal anti-inflammatoric analgesics (NSAIDs). Male gender, lower educational level and high age correlated with reluctance to accept analgesics. Experience of pain and the healthcare system correlated with unwillingness to talk about pain. The nurses were more positive towards measurement of pain (p < 0.05) and encouragement (p < 0.001) than the physicians. The physicians were less concerned about problems with analgesics than the nurses (p < 0.01). The patients should be encouraged to talk about their pain. The emergency department personnel needs education about measurement of pain and pain medication.