Trends In Emergency Department Research Articles

Benzodiazepine Discharge Prescriptions from Emergency Departments across the United States between 2012 and 2019: A National Analysis.

Benzodiazepines are commonly misused medications frequently implicated in overdose deaths. Data show that benzodiazepine prescribing is associated with increased misuse. We sought to determine national trends in benzodiazepine prescribing from the emergency department (ED). This is a retrospective review of the National Hospital Ambulatory Medical Care Survey from 2012 to 2019. Our primary outcome was to evaluate trends in ED visits where a benzodiazepine was prescribed at discharge. Secondarily, we identified commonly prescribed benzodiazepines and assessed trends over time. We examined demographic data and used descriptive statistics and Spearman rho or Pearson correlation coefficient as applicable. Between 2012 and 2019, there were 13,848,578 visits where benzodiazepines were prescribed at ED discharge. In 2012 and 2019, there were 1,407,478 visits (1.1% of all ED visits) and 1,361,372 visits (0.9%), respectively, where benzodiazepines were prescribed (mean [SD], 1,731,072 [287,623] [1.26%]), with no trend (P = 0.31). Common benzodiazepines prescribed were diazepam (5,980,279 visits, 43.2% of all prescriptions), alprazolam (3,306,549, 23.9%), and clonazepam (2,105,963, 15.2%), with no changes over time. Fifteen percent of prescriptions were for patients 65 years or older. Despite reports of increased misuse, there was no change in ED discharge benzodiazepine prescribing. Concerningly, alprazolam, a benzodiazepine with high misuse potential, was frequently prescribed despite limited ED indications, and there was a large percentage of visits where benzodiazepines were prescribed to older adults despite warnings for adverse effects in this population. Future studies should assess rational prescribing and the role of targeted interventions to curb inappropriate use.

Trends in emergency department visits during cold weather seasons among patients experiencing homelessness in Ontario, Canada: a retrospective population-based cohort study.

Recent anecdotal reports suggest increasing numbers of people experiencing homelessness are visiting emergency departments (EDs) during cold weather seasons due to inadequate shelter availability. We examined monthly ED visits among patients experiencing homelessness to determine whether there has been a significant increase in such visits in 2022/2023 compared to prior years. We used linked health administrative data to identify cohorts experiencing homelessness in Ontario between October and March of the 2018/2019 to 2022/2023years. We analyzed the monthly rate of non-urgent ED visits as a proxy measure of visits plausibly attributable to avoidance of cold exposure, examining rates among patients experiencing homelessness compared to housed patients. We excluded visits for overdose or COVID-19. We assessed level and significance of change in the 2022/2023year as compared to previous cold weather seasons using Poisson regression. We identified a total of 21,588 non-urgent ED visits across the observation period among patients experiencing homelessness in Ontario. Non-urgent ED visits increased 27% (RR 1.24 [95% CI 1.14-1.34]) in 2022/2023 compared to previous cold weather seasons. In Toronto, such visits increased by 70% (RR 1.68 [95% CI 1.57-1.80]). Among housed patients, non-urgent ED visits did not change significantly during this time period. Rates of ED visits plausibly attributable to avoidance of cold exposure by individuals experiencing homelessness increased significantly in Ontario in 2022/2023, most notably in Toronto. This increase in ED visits may be related to inadequate access to emergency shelter beds and warming services in the community.

Trends in observation stays for Medicare beneficiaries with and without Alzheimer's disease and related dementias.

There has been a marked rise in the use of observation care for Medicare beneficiaries visiting the emergency department (ED) in recent years. Whether trends in observation use differ for people with Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) is unknown. Using a national 20% sample of Medicare beneficiaries ages 68+ from 2012 to 2018, we compared trends in ED visits and observation stays by AD/ADRD status for beneficiaries visiting the ED. We then examined the degree to which trends differed by nursing home (NH) residency status, assigning beneficiaries to four groups: AD/ADRD residing in NH (AD/ADRD+ NH+), AD/ADRD not residing in NH (AD/ADRD+ NH-), no AD/ADRD residing in NH (AD/ADRD- NH+), and no AD/ADRD not residing in NH (AD/ADRD- NH-). Of 7,489,780 unique beneficiaries, 18.6% had an AD/ADRD diagnosis. Beneficiaries with AD/ADRD had more than double the number of ED visits per 1000 in all years compared to those without AD/ADRD and saw a faster adjusted increase over time (+26.7 vs. +8.2 visits/year; p < 0.001 for interaction). The annual increase in the adjusted proportion of ED visits ending in observation was also greater among people with AD/ADRD (+0.78%/year, 95% CI 0.77-0.80%) compared to those without AD/ADRD (+0.63%/year, 95% CI 0.59-0.66%; p < 0.001 for interaction). Observation utilization was greatest for the AD/ADRD+ NH+ population and lowest for the AD/ADRD- NH- population, but the AD/ADRD+ NH- group saw the greatest increase in observation stays over time (+15.4 stays per 1000 people per year, 95% CI 15.0-15.7). Medicare beneficiaries with AD/ADRD have seen a disproportionate increase in observation utilization in recent years, driven by both an increase in ED visits and an increase in the proportion of ED visits ending in observation.

Trends in emergency department visits for emergency care-sensitive conditions before and during the COVID-19 pandemic: a nationwide study in Korea, 2019-2021.

Emergency care systems worldwide have been significantly affected by the COVID-19 pandemic. This study investigated the trend of emergency department (ED) visits for emergency care-sensitive conditions (ECSCs) in Korea before and during the pandemic. We performed a longitudinal study using the national ED database in Korea from January 2019 to December 2021. We calculated the number and incidence rate of visits for ECSCs per 100,000 ED visits, and the incidence rate ratio of 2021 relative to the value in 2019. The selected ECSCs were intracranial injury, ischemic heart disease, stroke, and cardiac arrest. The number of ED visits for all causes decreased by about 23% during the pandemic. The number of ED visits for intracranial injuries decreased from 166,695 in 2019 to 133,226 in 2020 and then increased to 145,165 in 2021. The number of ED visits for ischemic heart disease and stroke decreased in 2020 but increased to 2019 levels in 2021. In contrast, the number of ED visits for cardiac arrest increased from 23,903 in 2019 to 24,344 in 2020 and to 27,027 in 2021. The incidence rate and incidence rate ratio of these four ECSCs increased from 2019 to 2021, suggesting increasing relative proportions of ECSCs in total ED visits. During the COVID-19 pandemic, the number of cardiac arrests seen in the EDs increased, but that of other ECSCs decreased. The decrease in ED visits for ECSCs was not as pronounced as the decrease in ED visits for all causes during the pandemic. Further studies are needed to determine clinical outcomes in patients with ECSC during the pandemic.

Trend of mortality and length of stay in the emergency department following implementation of a centralized sepsis alert system.

Sepsis alerts based on laboratory and vital sign criteria were found insufficient to improve patient outcomes. While most early sepsis alerts were implemented into smaller scale operating systems, a centralized new approach may provide more benefits, overcoming alert fatigue, improving deployment of staff and resources, and optimizing the overall management of sepsis. The objective of the study was to assess mortality and length of stay (LOS) trends in emergency department (ED) patients, following the implementation of a centralized and automated sepsis alert system. The automated sepsis alert system was implemented in 2021 as part of a hospital-wide command and control center. Administrative data from the years 2018 to 2021 were collected. Data included ED visits, in-hospital mortality, triage levels, LOS, and the Canadian Triage and Acuity Scale (CTAS). Mortality rate for patients classified as CTAS I triage level was the lowest in 2021, after the implementation of the automated sepsis alert system, compared to 2020, 2019, and 2018 (p < 0.001). The Kaplan-Meier survival curve revealed that for patients classified as CTAS I triage level, the probability of survival was the highest in 2021, after implementation of the sepsis alert algorithm, compared to previous years (Log Rank, Mantel-Cox, χ²=29.742, p < 0.001). No significant differences in survival rate were observed for other triage levels. Implementing an automated sepsis alert system as part of a command center operation significantly improves mortality rate associated with LOS in the ED for patients in the highest triage level. These findings suggest that a centralized early sepsis alert system has the potential to improve patient outcomes.

High-Pressure Injection Injuries of the Hand in Community and Industrial Settings: Incidence and Trends.

High-pressure injection injuries to the hand have been reported in both the community and industrial setting with varying levels of severity. However, there are little epidemiologic data regarding the prevalence of pressure-injection injuries. The purpose of this study is thus to describe trends in emergency department (ED) encounters associated with pressure injection injuries, thereby informing potential investments in research and education for these injuries. The National Electronic Injury Surveillance System (NEISS), a nationally representative database of all ED encounters, was queried for all high-pressure injection injuries from 2012 to 2021. Patient demographic and injury data were collected and analyzed to describe trends in incidence, patient demographics, and sequelae of hand injury associated with an ED encounter for a pressure injection-related injury. There were an estimated 15 307 (95% confidence interval: 15 051-15 562) high-pressure injection hand injuries from 2012 to 2021. Injuries were more frequent on weekends with the highest incidence on Sundays (18.9%) and Saturdays (18.0%) and during late spring and summer months (58.6%), with peak incidence occurring in May (16.8%). High-pressure paint injuries demonstrated a significantly higher rate of infection (23.7% of injuries) than pressure washer injuries (3.7%); however, pressure washer injuries were much more common overall (90% vs 10%). High-pressure injection injuries to the hand and upper extremity represent a particularly concerning injury mechanism. Prompt recognition and proper management are crucial for improving outcomes. People that utilize pressure washers for household projects should be aware of the risks associated with these machines and utilize proper safety techniques.

ED Visits for Schizophrenia Spectrum Disorders During the COVID-19 Pandemic at 5 Campus Health Systems.

Although substantial research has reported grave population-level psychiatric sequelae of the COVID-19 pandemic, evidence pertaining to temporal changes in schizophrenia spectrum disorders in the US following the pandemic remains limited. To examine the monthly patterns of emergency department (ED) visits for schizophrenia spectrum disorders after the onset of the COVID-19 pandemic. This observational cohort study used time-series analyses to examine whether monthly counts of ED visits for schizophrenia spectrum disorders across 5 University of California (UC) campus health systems increased beyond expected levels during the COVID-19 pandemic. Data included ED visits reported by the 5 UC campuses from 2016 to 2021. Participants included persons who accessed UC Health System EDs had a diagnosis of a psychiatric condition. Data analysis was performed from March to June 2023. The exposures were binary indicators of initial (March to May 2020) and extended (March to December 2020) phases of the COVID-19 pandemic. The primary outcome was monthly counts of ED visits for schizophrenia spectrum disorders. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes, categorized within Clinical Classification Software groups, were used to identify ED visits for schizophrenia spectrum disorders and all other psychiatric ED visits, from the University of California Health Data Warehouse database, from January 2016 to December 2021. Time-series analyses controlled for autocorrelation, seasonality, and concurrent trends in ED visits for all other psychiatric conditions. The study data comprised a total of 377 872 psychiatric ED visits, with 37 815 visits for schizophrenia spectrum disorders. The prepandemic monthly mean (SD) number of ED visits for schizophrenia spectrum disorders was 519.9 (38.1), which increased to 558.4 (47.6) following the onset of the COVID-19 pandemic. Results from time series analyses, controlling for monthly counts of ED visits for all other psychiatric conditions, indicated 70.5 additional ED visits (95% CI, 11.7-129.3 additional visits; P = .02) for schizophrenia spectrum disorders at 1 month and 74.9 additional visits (95% CI, 24.0-126.0 visits; P = .005) at 3 months following the initial phase of the COVID-19 pandemic in California. This study found a 15% increase in ED visits for schizophrenia spectrum disorders within 3 months after the initial phase of the pandemic in California across 5 UC campus health systems, underscoring the importance of social policies related to future emergency preparedness and the need to strengthen mental health care systems.

Trends by Acuity for Emergency Department Visits and Hospital Admissions in California, 2012 to 2022

This cohort study investigates trends in emergency department (ED) visits and hospital admissions from EDs in California by visit acuity from 2012 to 2022.

Gender and Age Influence on Emergency Department Visits for Non-Suicidal Self-Injuries in School Aged Children in Italy: An 11Years Retrospective Cross-Sectional Study.

Objectives: Non-suicidal self-injury (NSSI) poses a threat in developmental ages, yet there is a scarcity of studies on NSSI trends, especially those in emergency departments (ED). Methods: The aim of this cross-sectional study is to describe trends in ED visits for NSSI among young people aged between 5 and 19years in Italy from 2011 to 2021 in Piedmont. From the ministerial ED discharge information system, all occurring NSSIs were identified by medical report and/or ICD9CM code and reported as a population rate and a visit rate on all ED requests. Results: The general rate of ED visits remained stable, with around 210,000 (55% males) visits each year, along the whole period from 2011 to 2019, then halved during 2020 and 2021. The NSSI population and visits rates increased from 2013, peaking in 2019 at a rate of around 25 and 23 NSSI visits (girls) and 76 and 69 NSSI (boys) per 100,000 ED visits. In 2020 and 2021, the rate of NSSI visits increased, particularly in girls and among older adolescents. Conclusion: The gradual increase of NSSI over the last decade is a rising public health issue, which deserves wider attention to ensure early detection and prevention.

Epidemiologic trends of patients who visited nationwide emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

: This study analyzed trends in emergency department (ED) visits in South Korea using the National Emergency Department Information System (NEDIS) data from 2018 to 2022. : This was a retrospective observational study using data from the NEDIS database from 2018 to 2022. Age- and sex-standardized ED visits per 100,000 population, as well as age- and sex-standardized rates for mortality, admission, and transfer, were calculated. : The standardized ED visits per 100,000 population was approximately 20,000 from 2018 to 2019 and decreased to about 18,000 in 2022. The standardized mortality rate ranged from 1.4% to 1.7%. The admission rate (18.4%-19.4%) and the transfer rates (1.6%-1.8%) were similar during the study period. Approximately 5.5% of patients were triaged as Korean Triage and Acuity Scale score 1 or 2. About 91% of patients visited the ED directly and 21.7% of patients visited the ED with an ambulance. The ED length of stay was less than 6 hours in 90.3% of patients and the ED mortality rate was 0.6%. Acute gastroenteritis was the most common diagnosis. Respiratory virus symptoms, such as fever and sore throat, were also common chief complaints. : ED visits decreased during the 5-year period, while admission, transfer, and death rates remained relatively stable.

Opioid and Benzodiazepine Co-Prescribing Trends from the Emergency Department from 2012 to 2019: A National Analysis

BackgroundIn 2016, the U.S. Food and Drug Administration (FDA) issued its strongest safety warning (“Black Box Warning”) for concomitant use of prescription opioids and benzodiazepines due to overdose deaths. ObjectiveOur objective was to look at trends of opioid and benzodiazepine co-prescribing in the emergency department (ED) using national data, because recent data are sparse. MethodsThis is a retrospective review of data collected by the National Hospital Ambulatory Medical Care Survey between 2012 and 2019. Our primary outcome was to determine whether there was a trend in ED visits when opioids and benzodiazepines were co-prescribed at discharge. We also compared the rate of visits when co-prescribing occurred before (2012–2015) and after (2017–2019) the 2016 FDA warning. We identified commonly co-prescribed benzodiazepines and opioids, and the rate of naloxone co-prescribing. We used descriptive statistics and bivariate tests to describe data. ResultsBetween 2012 and 2019, there were 4,489,613 ED visits (0.41% of ED visits) when benzodiazepines and opioids were co-prescribed. There was no trend in the rate of co-prescribing overall, but a decrease in visits after the 2016 FDA Black Box Warning (2012–2015: mean 0.49%; 2017–2019: mean 0.29%; p < 0.0001). There were 7980 ED visits (0.18%) when naloxone was co-prescribed for these visits within this time frame and an increase over time (p < 0.001). ConclusionsOur study found that between 2012 and 2019, there was no overall reduction in co-prescribing of opioids and benzodiazepines across EDs nationwide, but a decrease after the 2016 Black Box Warning.

An interrupted time series analysis of trends in opioid-related emergency department visits from pre-COVID-19 pandemic to pandemic, from the Canadian Hospitals Injury Reporting and Prevention Program

BackgroundOpioid-related emergency department (ED) visits in Canada increased during the COVID-19 pandemic, but how trends in volume and case severity changed from pre-pandemic times through the pandemic is not known. Trends in ED visits related to specific types of opioids also remain unclear. Our objective was to describe pre-pandemic trends and how they changed with the onset of COVID-19 and thereafter.MethodsBased on data from the Canadian Hospitals Injury Reporting and Prevention Program, we identified opioid-related ED visits and constructed a time series from March 12, 2018 through March 7, 2021—two pre-COVID periods and one COVID period. We used an interrupted time series (ITS) analysis to examine trends in volume and case severity. We compared medians and means of monthly counts and percentages of severe cases between the periods, by sex, age, and opioid type.ResultsBefore the pandemic, there was an increasing trend in fentanyl-related visits for males, females and 25- to 64-year-olds, and a decreasing trend in heroin-related visits for males and 18- to 64-year-olds. Fentanyl-related visits for 18- to 24-year-olds showed an immediate increase at the start of the pandemic and a decreasing trend during the pandemic. Heroin-related visits for 12- to 17-year-olds had an immediate increase at the start of the pandemic; for 18- to 24-year-olds and 45- to 64-year-olds, the prior decreasing pre-pandemic trend ceased. For pooled opioid-related visits, no significant trend in the percentage of severe cases was observed throughout the entire study period.ConclusionThis study shows that an ITS approach in trend analysis is a valuable supplement to comparisons of before and after measures (with or without controlling seasonal effects). The findings provide evidence on how ED presentations for opioid use evolved in Canada from 2018 to 2021. The results can inform policies designed to reduce opioid-related harm in the context of a public health emergency.

Diagnostic Imaging Utilization in the Emergency Department: Recent Trends in Volume and Radiology Work Relative Value Units

PurposeThe aim of this study was to quantify and characterize the recent trend in emergency department (ED) imaging volumes and radiology work relative value units (wRVUs) at level I and level III trauma centers. MethodsTotal annual diagnostic radiology imaging volumes and wRVUs were obtained from level I and level III trauma centers from January 2014 to December 2021. Imaging volumes were analyzed by modality type, examination code, and location. Total annual patient ED encounters (EDEs), annual weighted Emergency Severity Index, and patient admissions from the ED were obtained. Data were analyzed using annual imaging volume or wRVUs per EDE, and percentage change was calculated. ResultsAt the level I trauma center, imaging volumes per EDE increased for chest radiography (5.5%), CT (35.5%), and MRI (56.3%) and decreased for ultrasound (−5.9%) from 2014 to 2021. Imaging volumes per EDE increased for ultrasound (10.4%), CT (74.6%), and MRI (2.0%) and decreased for chest radiography (−4.4%) at the level III trauma center over the same 8-year period. Total wRVUs per EDE increased at both the level I (34.9%) and level III (76.6%) trauma centers over the study period. ConclusionsED imaging utilization increased over the 8-year study period at both level I and level III trauma centers, with an increase in total wRVUs per EDE. There was a disproportionate increased utilization of advanced imaging, such as CT, over time. ED utilization trends suggest that there will be a continued increase in demand for advanced imaging interpretation, including at lower acuity hospitals, so radiology departments should prepare for this increased work demand.

Emergency department crowding and older patients: a nationwide retrospective cohort study.

Emergency department (ED) crowding is a worldwide problem and one of the main causes internationally is an increase in presentations by older patients with complex and chronic care needs. Although there has been a 4,3% reduction in total ED visits from 2016-2019 in the Netherlands, the EDs still experience crowding. National crowding research has not focused on the older group in detail, hence their possible role remains ill defined. The primary aim of this study was to map the trend in ED visits by older patients in the Netherlands. The secondary aim was to identify healthcare utilization 30 days before/after ED visit. We conducted a nationwide retrospective cohort study, using longitudinal health insurance claims data (2016-2019). The data encompasses all Dutch patients of 70 years or older who visited the ED. The number of older patients who visited the ED followed by admission, increased from 231,223 patients (2016), to 234,817 (2019). The number without admission also increased from 244,814 patients, to 274,984. There were 696,005 total visits by older patients (2016) increasing to 730,358 visits (2019). The slight rise in older patients at the ED is consistent with overall population growth of older people in the Netherlands. These results indicate that Dutch ED crowding cannot be explained by mere numbers of older patients. More research is needed with data on patient level, to study other contributing factors, such as complexity of care needs within the ageing population.

Postpartum Emergency Department Visits and Risk Factors for Readmission [ID: 1363150

INTRODUCTION: Postpartum emergency department (ED) visits complicate 12% of births. We aimed to characterize trends in ED visits and risk factors for readmission. METHODS: This was a retrospective cohort study on postpartum ED visits within 42 days of delivery at a tertiary care center over 1 year. Readmitted patients were compared to those who remained outpatient as appropriate. IRB #14-001098. RESULTS: Of 3,084 deliveries, 138 (4.5%) patients presented to the ED for total 157 encounters. 17 (12.3%) patients presented more than once. 55 (35%) ED visits resulted in readmission, with 4 patients readmitted twice. Public insurance rates in the cohort were significantly higher than baseline (16.7% versus 8.5%, P=.001). Postpartum hypertension (HTN) was the most common reason for ED visits (40%) and had four times higher likelihood of being readmitted (adjusted odds ratio [aOR] 4.076, 95% CI 2.04–8.15, P&lt;.001). Black women were six times more likely to be readmitted compared to other groups (aOR 6.53, 95% CI 1.26–33.88, P=.026). Coexistent psychiatric disease had lower likelihood of readmission (aOR 0.43, 95% CI 0.19–0.95, P=.037). Having more than one ED visit led to fivefold higher odds of readmission (aOR 5.05, 95% CI 1.66–15.32, P=.004). Median days from delivery to ED visit were 8 (interquartile range [IQR]: 5, 15). CONCLUSION: Seventy-three percent of presentations to the ED were within 2 weeks of delivery, and postpartum HTN was the leading cause. Black patients were more likely to be readmitted. Further studies are needed to evaluate whether earlier postpartum visits for high-risk groups may reduce ED visits and readmissions.

Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures

Emergency department visits and hospitalizations for unsupervised medication exposures among young children increased in the early 2000s. Prevention efforts were initiated in response. Nationally representative data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project collected from 2009 to 2020 were analyzed in 2022 to assess overall and medication-specific trends in emergency department visits for unsupervised exposures among children aged ≤5 years. From 2009 to 2020, there were an estimated 677,968 (95% CI=550,089, 805,846) emergency department visits for unsupervised medication exposures among children aged ≤5 years in the U.S. Most visits involved children aged 1-2 years (2009-2012 [70.3%], 2017-2020 [67.4%]), and nearly one half involved prescription solid medications (2009-2012 [49.4%], 2017-2020 [48.1%]). The largest declines in estimated numbers of annual visits from 2009-2012 to 2017-2020 were for exposures involving prescription solid benzodiazepines (-2,636 visits, -72.0%) and opioids (-2,596 visits, -53.6%) and over-the-counter liquid cough and cold medications (-1,954 visits, -71.6%) and acetaminophen (-1,418 visits, -53.4%). The estimated number of annual visits increased for exposures involving over-the-counter solid herbal/alternative remedies (+1,028 visits, +65.6%), with the largest increase for melatonin exposures (+1,440 visits, +421.1%). Overall, the estimated number of visits for unsupervised medication exposures decreased from 66,416 in 2009 to 36,564 in 2020 (annual percentage change= -6.0%). Emergent hospitalizations for unsupervised exposures also declined (annual percentage change= -4.5%). Declines in estimated emergency department visits and hospitalizations for unsupervised medication exposures from 2009 to 2020 coincided with renewed prevention efforts. Targeted approaches may be needed to achieve continued declines in unsupervised medication exposures among young children.

Trends in emergency department visits for suicide attempts before and during the COVID-19 pandemic in Korea: A nationwide study, 2016–2021

There is increasing concern that the effects of the COVID-19 pandemic will result in excess suicides by increasing known risk factors, such as suicide attempts. However, evidence on the long-term impacts of COVID-19 on suicide attempts is lacking. We aimed to assess the short- and long-term effects of the COVID-19 pandemic on patients with suicide attempts in emergency departments (EDs) and to evaluate age- and sex-specific differences. We conducted nationwide cross-sectional study among patients with suicide attempts in the ED from 2016 to 2021. The trend test were used to determine whether study subjects were affected by changes in ED visits for suicide attempts. We estimated the average annual percentage change (APC) stratified by sex and age groups. The number of ED visits related to suicide attempts increased from 27,581 in 2016 to 37,719 in 2021. In particular, it decreased immediately after the COVID-19 pandemic but increased again in 2021. We identified that the average APC increased by 6.8 % overall, 1.6 % among males, and 10.8 % among females. Moreover, the APC of trend sharply increased in patients aged 10s and 20s. The in-hospital mortality was 3.6 % for females, compared to 9.5 % for males, which showed sex differences. Other information such as severity of injury, interpersonal relationships were not available. This study was limited to confirming causal relationship based on a descriptive study. The incidence of suicide attempts in ED has increased in Korea. In particular, there was a sharp increase among women, adolescents and young adults. Patient-tailored treatment and preventive medical system for suicide attempts is important.

Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

An initial step to reducing emergency department (ED) visits among patients with cancer is to identify the characteristics of patients visiting the ED and examine which of those visits could be prevented. To explore nationwide trends and characteristics of ED visits and examine factors associated with potentially preventable ED visits and unplanned hospitalizations among patients with cancer in the US. This cross-sectional study used data on ED visits from the National Hospital Ambulatory Medical Care Survey from January 1, 2012, to December 31, 2019; US Cancer Statistics reports were used to estimate new cancer cases each year. Frequencies and trends among 35 510 014 ED visits by adult patients (aged ≥18 years) with cancer were calculated. The primary outcome was potentially preventable ED visits, and secondary outcomes were unplanned hospitalizations and the immediacy of the ED visits. Potentially preventable ED visits were identified using the Centers for Medicare & Medicaid Services definition. The Emergency Severity Index, a triage algorithm that ranks patients based on the urgency of their health care condition, was used to measure the immediacy of ED visits (immediate [most urgent], emergent, urgent, less urgent, and nonurgent), with the categories of immediate and emergent classified as high acuity. The Wilcoxon rank sum test was used to calculate trends in ED visits among patients with cancer over time. Multivariable logistic regression analyses were performed to examine the associations of patient, hospital, and temporal factors with potentially preventable ED use and ED use resulting in hospitalization. Among 854 911 106 ED visits, 35 510 014 (4.2%) were made by patients with cancer (mean [SD] age, 66.2 [16.2] years); of those, 55.2% of visits were among women, 73.2% were among non-Hispanic White individuals, 89.8% were among patients living in a private residence, and 54.3% were among Medicare enrollees. A total of 18 316 373 ED visits (51.6%) were identified as potentially preventable, and 5 770 571 visits (21.3%) were classified as high acuity. From 2012 to 2019, potentially preventable ED visits increased from 1 851 692 to 3 214 276. Pain (36.9%) was the most common reason for potentially preventable ED visits. The number of patients who visited an ED because of pain increased from 1 192 197 in 2012 to 2 405 849 in 2019 (a 101.8% increase). Overall, 28.9% of ED visits resulted in unplanned hospitalizations, which did not change significantly over time (from 32.2% in 2012 to 26.6% in 2019; P = .78 for trend). Factors such as residence in a nursing home (odds ratio, 1.73; 95% CI, 1.25-2.41) were positively associated with having a potentially preventable ED visit, and factors such as the presence of more than 1 comorbidity (odds ratio, 1.82; 95% CI, 1.43-2.32) were positively associated with having an unplanned hospitalization. In this study, 51.6% of ED visits among patients with cancer were identified as potentially preventable, and the absolute number of potentially preventable ED visits increased substantially between 2012 and 2019. These findings highlight the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.

Trends in emergency department visits associated with cannabis use among older adults in California, 2005-2019.

The use of cannabis among older adults is increasing in the United States. While cannabis use has been suggested to help alleviate chronic symptoms experienced by older adults, its potential adverse effects may lead to unintended consequences, including increased acute healthcare utilization related to its use. The objective of this study was to examine trends in cannabis-related emergency department (ED) visits in California. Using data from the Department of Healthcare Access and Information, we conducted a trend analysis of cannabis-related ED visits from all acute care hospitals in California from 2005 to 2019. For each calendar year, we determined the cannabis-related ED visit rate per 100,000 ED visits for adults aged ≥65 utilizing primary or secondary diagnosis codes. We estimated the absolute and relative changes in overall cannabis-related visit rates during the study period and by subgroup, including age (65-74, 75-84, ≥85), race/ethnicity, sex, payer/insurance, Charlson comorbidity index score, and cannabis-related diagnosis code. The cannabis-related ED visit rate increased significantly for adults aged ≥65 and all subgroups (p < 0.001). The overall rate increased from 20.7 per 100,000 visits in 2005 to 395.0 per 100,000 ED visits in 2019, a 1804% relative increase. By race/ethnicity, older Black adults had the highest ED visit rate in 2019 and the largest absolute increase while older males had a higher ED visit rate in 2019 and a greater absolute increase than older women. Older adults with a higher Charlson score had a higher ED visit rate in 2019 and a larger absolute increase during the study period. Cannabis-related ED visits are increasing among older adults in California and are an adverse effect of cannabis use. Asking about cannabis use and providing education about its use should be a part of routine medical care for older adults.

Temporal Trends and Characteristics of Adult Patients in Emergency Department Related to Suicide Attempt or Self-Harm in Korea, 2016-2020.

The implementation of an effective suicide prevention program requires the identification and monitoring of subpopulations with elevated risks for suicide in consideration of demographic characteristics, to facilitate the development of tailored countermeasures for tackling the risk factors of suicide. We examined the annual trends in emergency department (ED) visits for suicide attempts (SAs) or self-harm and investigated the sex- and age-specific characteristics of individuals who visited the ED for SA and self-harm. Data on ED visits for SAs or self-harm in Korea from 2016 to 2020 were extracted from the National Emergency Department Information System and assessed. We evaluated the age-standardized incidence rate of ED visits for SAs or self-harm, and hospital mortality among individuals who visited the ED for SAs or self-harm. In addition, the characteristics of the individuals were compared according to sex and age. We identified 145,963 ED visits for SAs or self-harm (0.42% of the total ED visits) during the study period. The rate of ED visits increased in the youngest age group (19-29 years old), and was more prominent among women (increased by an annual average of 22.5%), despite the coronavirus disease pandemic. The middle-aged group (45-64 years old) had a higher rate of mortality than other age groups, and the highest proportion of individuals on Medical Aid. It is necessary to plan age- and gender-specific suicide prevention programs that focus on improving the limited public mental health resources for the vulnerable populations.