University Emergency Department Research Articles

Inflammatory cytokine and C-reactive protein concentrations in dogs with systemic inflammatory response syndrome.

To evaluate C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) kinetics in dogs with a systemic inflammatory response syndrome (SIRS) presented to an emergency service. We hypothesized serum CRP concentrations would increase and vary during hospitalization, and would correlate with plasma IL-6 and TNF-α concentrations, vary in magnitude according to the underlying disease, and predict survival. Prospective, observational, clinical study. University emergency department. Sixty-nine dogs with SIRS weighing over 5 kg who could tolerate the blood sampling. Serum and plasma were collected (and stored at -80°C) at presentation (T0), after 6 (T6), 12 (T12), 24 (T24), and 72 (T72) hours, and at a follow-up visit at least 1 month after discharge (T1m). Underlying diseases were categorized as infection (I), neoplasia (N), trauma (T), gastric-dilation and volvulus (GDV), other gastrointestinal (GI), renal (R), and miscellaneous (M) disease. Serum CRP concentration was measured using a canine-specific immunoturbidimetric assay. Biologically active plasma IL-6 and TNF-α concentrations were assessed using bioassays. Forty-four dogs survived, 8 died, and 17 were euthanized. Nineteen dogs had follow-up visits. At T0, serum CRP concentration was above the reference interval in 73.1% (49/67), and was within the reference interval (0-141.9 nmol/L) throughout hospitalization in only 6% (4/67). Serum CRP concentrations were significantly higher (P < 0.0001) at T0 (882.9 ± 1082.9 nmol/L) and at all time points during hospitalization (P < 0.0001) compared to T1m, with highest concentrations observed at T24 (906. 7 ± 859.0 nmol/L). At T1m, serum CRP concentrations were within the reference interval (22.9 ± 42.9 nmol/L) in 95% (18/19) of dogs. Logarithmic concentrations of serum CRP and plasma IL-6 were significantly correlated (P < 0.001, r = 0.479). None of the measured cytokines were associated with disease category or outcome. Serum CRP concentration is increased in dogs with SIRS, and decreases during treatment and hospitalization. Serum CRP, plasma IL-6, and plasma TNF-α concentrations cannot predict outcome in dogs with SIRS.

Serum anion gap predicts lactate poorly, but may be used to identify sepsis patients at risk for death: A cohort study

Purpose(1) To test whether serum bicarbonate or anion gap can be used to predict elevated lactate or mortality in emergency department (ED) patients with sepsis, and (2) to define thresholds that may predict elevated lactate and mortality. MethodsRetrospective diagnostic-validation study of adults with sepsis treated in a 60,000-visit Midwestern university ED (2010–2015). In the derivation sample, 8 experts selected thresholds based on objective measures to optimize clinical utility. Test performance was reported using likelihood ratios (LR +/−) in the validation cohort. ResultsWe included 4159 patients. Anion gap predicted lactate>2 better than bicarbonate [ROC AUC 0.680 vs. 0.609], and anion gap predicted lactate>4 better than lactate>2 [ROC AUC 0.816 vs. 0.680]. In the validation cohort, anion gap ≥20mEq/L had LR+ for lactate>2 of 3.670 (2.630–5.122), lactate>4 of 7.019 (5.310–9.278), and mortality of 2.768 (1.922–3.986). Anion gap predicted mortality similar to lactate>2 [LR+ 2.768 vs. LR+ 2.09; LR− 0.823 vs. 0.447]. ConclusionsAnion gap and serum bicarbonate poorly predict changes in lactate and mortality. In resource-limited settings where lactate is unavailable, anion gap ≥20mEq/L may be used to further risk-stratify patients for ongoing sepsis care, but lactate remains a preferred biomarker.

Prognosis of overt disseminated intravascular coagulation in patients admitted to a medical emergency department.

To assess the prevalence, characteristics and prognosis of overt disseminated intravascular coagulation (DIC) in adult emergency department (ED) patients and identify markers of poor outcome. In a chart review study, we analysed the occurrence of overt DIC in all patients (n=1 001 727) attending the University's ED from 2003 to 2014 applying the ISTH DIC score. The primary outcome measure was 30-day mortality. Logistic regression analysis was used to determine predictors of mortality. The initial inter-rater reliability in the diagnosis of DIC was 0.85 [κ; 95% confidence interval (CI), 0.77-0.92]. The main DIC precipitators were malignancy (47%), cardiovascular diseases (CVD, 27%) and sepsis (16%). Hyperfibrinolytic DIC occurred in 27% of patients and was over-represented in those with cardiac arrest (68%). Thirty-day mortality (52%) was inversely associated with fibrinogen levels on admission [adjusted odds ratio, 0.49; 95% CI: 0.30-0.82; P=0.006]. Afibrinogenaemia implied an even 10-fold increased risk of dying (crude odds ratio, 10.0; 95% CI: 3.2-31.4; P<0.001). D-dimer and platelet count had no predictive value. Appropriate ICD-10 coding for DIC was present in only 1.8% of cases. Overt DIC is a rare but underdiagnosed event in ED patients. In this collective, cardiac arrest is a dominant cause of DIC presenting with a fibrinolytic phenotype. The degree of hypofibrinogenaemia on admission strongly and linearly predicted early death.

Safety of Risperidone for Acute Agitation and Alcohol Intoxication in Emergency Department Patients

BackgroundAcute agitation in the setting of alcohol intoxication is commonly encountered in the Emergency Department (ED). In this setting, expert consensus guidelines recommend haloperidol over second-generation antipsychotics due to their limited safety data in alcohol intoxication. ObjectiveThe primary objective was to compare vital sign changes prior to and after risperidone administration between ED patients presenting with alcohol intoxication [ETOH (+)] and without alcohol intoxication [ETOH (−)]. The secondary objective was to assess the effect of benzodiazepine co-administration with risperidone on vital signs. MethodsThis was a retrospective chart review of patients who received oral risperidone for acute agitation at two university EDs between January 1, 2012 and December 31, 2015. Vital signs (oxygen saturation, systolic and diastolic blood pressure, heart rate, and respiratory rate) were compared in patients who had ingested alcohol with those who had not. ResultsThere were 785 patients without evidence of alcohol intoxication who received risperidone in the ED, and 52 patients with alcohol intoxication who received risperidone. Overall, risperidone with and without alcohol intoxication and benzodiazepine administration had no statistically significant effect on vital signs (p = ns for all comparisons). ConclusionThis study suggests that oral risperidone may be a safe option for acute agitation in patients presenting to the ED with alcohol intoxication.

68 An Urban Fire Department's Experience With Left Ventricular Assist Devices

There has been little literature published describing the nature of out-of-hospital care of patients with implanted left ventricular assist devices (LVADs). Patients sent home from the hospital with these devices pose a unique challenge to the out-of-hospital medical provider. By describing the reasons for their presentations and interventions provided, we hope to contribute to a more understanding of complications of LVADs and which treatments are most appropriate out-of-hospital. This is a retrospective chart review of a level 1 academic center’s LVAD patients transported by the city fire agency to the academic center’s emergency department (ED) from January 2012 to December 2015. We sought to describe the frequency, 911 chief complaint, and interventions provided by the city fire agency. Medical records were queried for LVAD patients presenting to the ED during the study period. We extracted patient demographics (date of birth, sex, race, gender) and the list was then queried against the fire agency’s database to collect the out-of-hospital visits. Chief complaint, vital signs, abnormal physical exam findings, and interventions provided were obtained from the out-of-hospital database. During the study period, 95 LVAD patients presented to the academic university ED. Of these visits, ten were brought in by the fire agency. Of the ten patients, the most common chief complaint was weakness (5/10) followed by chest pain (2/10). In the patients with weakness, one patient had a battery change, another had a stroke scale performed, and all five had their glucose measured. Only 3/5 patients with weakness were documented to have a known LVAD in place. Of note, there was one patient, whom the out-of-hospital providers were unaware of the LVAD, who had shortness of breath and was found to be diaphoretic, had diminished lung sounds, and chest pain. This patient was given continuous positive airway pressure, nitroglycerin and aspirin per chest pain protocol. Another patient, with a known LVAD, received Lidocaine for a pacemaker firing issue. The crew was aware of the LVAD in 6/10 patients and the coordinator was contacted with all 6 patients. Most LVAD patients presenting to the emergency department do not present by ambulance. Of patients that do interact with out-of-hospital providers, the most common presenting symptom is weakness followed by chest pain. Given the LVAD requires coordination and consideration, a focus on how to improve out-of-hospital awareness of LVADs is key. Further research in this area is needed.

Serum lithium levels and suicide attempts: a case-controlled comparison in lithium therapy-naive individuals.

Several epidemiological studies have shown the inverse association of lithium levels in drinking water and suicide rates; however, it is necessary to perform a clinical study dealing with individual patients. We analyzed 199 patients including 31 patients with suicide attempts, 21 patients with self-harm, and 147 control patients. All were transferred to a university emergency department suffering from intoxication or injury, were aged 20 or more years, and were alive at the start of the study. The exclusion criteria consisted of suffering from schizophrenia and a past or present history of lithium therapy. These exclusions were applied because it is difficult to determine whether their suicide attempt was induced by the intent to end their life or by psychotic symptoms such as auditory hallucinations, and if the patient had received lithium therapy, the association between the small amount of lithium taken from drinking water and food and serum lithium levels cannot be detected. There was a significant difference (p=0.043) between the three groups whereby patients with suicide attempts had significantly lower lithium levels than control patients (p=0.012) in males but not females. Multivariate logistic regression analysis with adjustment for age and gender revealed that patients with suicide attempts had significantly lower lithium levels than control patients (p=0.032, odds ratio 0.228, 95% CI 0.059-0.883). The limitations of the present study are the nature of observational research which cannot reveal a causal relationship and the relatively small number of subjects. The present findings suggest that higher serum lithium levels may be protective against suicide attempts in lithium therapy-naive individuals.

72 h returns: A trigger tool for diagnostic error

BackgroundPatients who return to the Emergency Department (ED) within 72h of discharge are often used for ED Quality Assurance efforts, however little is known about the yield of this kind of review and the types of errors it identifies. Our objective was to identify the prevalence, types and severity of errors in these cases. MethodsRetrospective review of patients who presented to an urban, university affiliated ED between 10/1/2012–9/30/2015 who returned within 72 h requiring hospital admission. ResultsThere were 413,167 ED visits during the study period with 2001 (0.48%) patients who returned within 72h and were admitted to the hospital. An event requiring further investigation was identified in 59 (2.95%) of these patients and 50 (2.49%) of them were deemed to represent a deviation from optimal care. Of these, 48 (96%) represented diagnostic error. When a standard diagnostic process of care framework was applied to these, the majority of cases represented failures in the initial diagnostic pathway (29 cases, 60.4%). When Error Severity Codes were applied, 16 (32%) resulted in minor harm and 34 (68%) resulted in major harm or death. ConclusionScreening of 72h ED returns has low yield in identifying suboptimal care, with less than 3% of cases representing deviations from standard care. Of these, the majority represent cognitive errors in the diagnostic pathway. These reviews may be useful as a tool for Ongoing Professional Practice Evaluation of individual clinicians, however likely serve less value in identifying systems issues contributing to unsafe care.

A "Patch" to the NYU Emergency Department Visit Algorithm.

To document erosion in the New York University Emergency Department (ED) visit algorithm's capability to classify ED visits and to provide a "patch" to the algorithm. The Nationwide Emergency Department Sample. We used bivariate models to assess whether the percentage of visits unclassifiable by the algorithm increased due to annual changes to ICD-9 diagnosis codes. We updated the algorithm with ICD-9 and ICD-10 codes added since 2001. The percentage of unclassifiable visits increased from 11.2 percent in 2006 to 15.5 percent in 2012 (p<.01), because of new diagnosis codes. Our update improves the classification rate by 43 percent in 2012 (p<.01). Our patch significantly improves the precision and usefulness of the most commonly used ED visit classification system in health services research.

Characterising emergency centre encounters in Mbour, Senegal as emergent-emergency care, emergent-primary care or non-emergent.

IntroductionEmergency medicine is a relatively new specialty in Africa, with the first emergency medicine training programme only started in South Africa in 2004. Continued emergency centre development and preparedness relies on a better understanding of the quantity and category of emergency centre encounters within the various African regions.MethodsThis study was conducted over four, consecutive months in 2014 using a retrospective chart review, aimed to examine the types of visits made to one emergency centre at the Grande Mbour Hospital in Mbour, Senegal. The New York University Emergency Department Algorithm was used to classify emergency centre encounters. Each diagnosis included in this study was classified per the algorithm as non-emergent; emergent but primary care treatable; emergent with emergency centre care needed but avoidable/preventable; and emergent with emergency centre care needed and not avoidable/preventable. The algorithm also categorised diagnoses of injury, mental health problems, alcohol, or substance abuse.ResultsThis study included 1268 diagnoses from the emergency centre. The most common presentations in Mbour, Senegal were injuries, with 302 cases (33%), and from the category: emergent but primary care treatable, with 303 cases (33%). In total, 174 cases (19%) were classified as: non-emergent. While only 93 cases (10%) were considered: emergency care needed/preventable or avoidable, a substantial number (n = 218, 24%) were categorised as: emergent with emergency centre care needed and not avoidable/preventable.ConclusionThis study provides the first description of patients presenting for care in the emergency centre of Mbour’s hospital and demonstrates the wide range of illnesses and types of trauma that the emergency centre must accommodate while contending with the limited resources available in the area. Understanding the burden of disease will help prioritise resources appropriately.

GYM score: 30-day mortality predictive model in elderly patients attended in the emergency department with infection.

To determine the validity of the classic sepsis criteria or systemic inflammatory response syndrome (heart rate, respiratory rate, temperature, and leukocyte count) and the modified sepsis criteria (systemic inflammatory response syndrome criteria plus glycemia and altered mental status), and the validity of each of these variables individually to predict 30-day mortality, as well as develop a predictive model of 30-day mortality in elderly patients attended for infection in emergency departments (ED). A prospective cohort study including patients at least 75 years old attended in three Spanish university ED for infection during 2013 was carried out. Demographic variables and data on comorbidities, functional status, hemodynamic sepsis diagnosis variables, site of infection, and 30-day mortality were collected. A total of 293 patients were finally included, mean age 84.0 (SD 5.5) years, and 158 (53.9%) were men. Overall, 185 patients (64%) fulfilled the classic sepsis criteria and 224 patients (76.5%) fulfilled the modified sepsis criteria. The all-cause 30-day mortality was 13.0%. The area under the curve of the classic sepsis criteria was 0.585 [95% confidence interval (CI) 0.488-0.681; P=0.106], 0.594 for modified sepsis criteria (95% CI: 0.502-0.685; P=0.075), and 0.751 (95% CI: 0.660-0.841; P<0.001) for the GYM score (Glasgow <15; tachYpnea>20 bpm; Morbidity-Charlson index ≥3) to predict 30-day mortality, with statistically significant differences (P=0.004 and P<0.001, respectively). The GYM score showed good calibration after bootstrap correction, with an area under the curve of 0.710 (95% CI: 0.605-0.815). The GYM score showed better capacity than the classic and the modified sepsis criteria to predict 30-day mortality in elderly patients attended for infection in the ED.

Pattern of Injuries from Road Traffic Accidents Presented at a Rural Teaching Institution of Karachi.

The aim of the study is to study the pattern of injuries from road traffic accidents presented at the emergency department of a rural teaching institution in Karachi. This descriptive case series was conducted prospectively in the Emergency Department of Fatima Hospital and Baqai Medical University from 1 January 2012 to 21 March 2013. There were 385 patients in the series. All of the patients with recent injuries from road traffic accidents were included. Cases with injuries more than 72h old were excluded. The majority of patients had lower limb injuries 172 (44.7%), followed by head and neck injuries 107 (27.8%), multiple injuries 62 (16.1%), upper limb injuries 22 (5.7%), abdominoperineal injuries 19 (5%), and chest injuries 3 (0.8%). Majority (229, 59.5%) of patients were given first aid treatment and discharged, while 151 (39.3%) patients were either admitted or referred to better equipped hospitals. Three patients were brought dead, and two patients left against medical advice. The lower limb injuries were the commonest road traffic accidental injuries, followed by head and neck injuries, multiple injuries, upper limb injuries, abdominoperineal injuries, and chest injuries.

Comparison of ultrasound-guided interscalene block versus procedural sedation for closed shoulder reduction in a swiss university emergency department

Abstract Background: To facilitate shoulder reduction and shorten time from shoulder dislocation to reduction, we started in 2014 a protocol for ultrasound-guided interscalene block (UGIB) in pure shoulder dislocation

Bronchial Hyperresponsiveness Among Patients Presented to the University Emergency Departments in Ahvaz, Iran: Impact of Ecosystem on Human Life?

SESSION TITLE: Occupational and Environmental Lung Disease SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Previous studies demonstrated more severe bronchospasm during seasonal thunderstorms (thunderstorm asthma). Ahvaz, a metropolitan city located in Southwest of Iran, was named the World’s worst air polluted city by the World Health Organization (WHO) in 2011. Drastic changes in the ecosystem resulted in more thunder- and sand-storms. This is believed to be due to substantial ecologic changes in the Southern part of Iraq & Iran after decades of wars and industrialization. Evidence is lacking on spirometric changes after thunderstorms. In the current study, we aimed to examine the difference of spirometric indices among patients presented to the Ahvaz Jundishapur Medical University (AJMU) emergency departments (ED) with symptoms of thunderstorm-asthma during seasonal thunderstorms compared to those presented during other times. METHODS: In a cross-sectional case control study, we reviewed all patients presented to the AJMU’s nine hospital emergency departments in November 2013 (peak incidence of regional thunderstorms) with patients presented during seasons other than Fall. Overall, 585 patients were randomly selected, all of which underwent spirometry. If spirometry did not show evidence of obstruction, then patient underwent methacholine challenge test (MCT). All studies were conducted 3 weeks after resolution of acute symptoms. Primary outcome was spirometric indices and MCT results. Patients with history of COPD, pregnant women, those with hemoptysis or nonacceptable spirometry and chest pain were excluded. Using Chi-square and student’s t-test, we compared the characteristics and spirometric indices between two groups. RESULTS: Overall, 284 patients were enrolled during the thunderstorm period (cases) and 267 from other time-periods (controls). Cases and controlled were age and sex matched. Higher rate of history of asthma and smoking were noted among control (35.2% vs. 26.1%, p-value <0.001) and (20% vs. 13.7%, p-value 0.02), respectively. Despite insignificant difference between two groups in rate of obstructive pattern (30.6% vs. 33.3% among cases and controls, respectively), the severity of obstructive pattern and positive MCT were substantially higher among cases. CONCLUSIONS: The results of the current study showed more severe bronchial hyperresponsiveness during seasonal thunderstorms. CLINICAL IMPLICATIONS: Our results underscore the impact of ecosystem changes on people’s daily life. Further studies on the material and molecular characteristics of the regional thunderstorms are warranted. DISCLOSURE: The following authors have nothing to disclose: Maryam Haddadzadeh Shoushtari, Seyed Ali Mousavi, Hanieh Raji, Arash Foroozan, Seied Hamid Borsi, Esmail Eidani, Sakineh Afrakhteh, Mohammad-Ali Assarehzadegan, Kamran Masoumi, Roozbeh Sharif No Product/Research Disclosure Information

Safety of deferred CT imaging of intoxicated patients presenting with possible traumatic brain injury

BackgroundPatients presenting to the emergency department (ED) with altered mental status and alcohol intoxication can clinically resemble patients with an intracranial hemorrhage. Although intracranial hemorrhage is quickly excluded with a head computed tomographic (CT) scan, it is common practice to defer imaging and allow the patient to metabolize to spare ED resources and minimize radiation exposure to the patient. Although this reduces unnecessary scans, it may delay treatment in patients with occult intracranial hemorrhage, which some fear may increase morbidity and mortality. We sought to evaluate the safety of deferred CT imaging in these patients by evaluating whether time to scan significantly affects the rate of neurosurgical intervention. MethodsIn this retrospective medical record review, all clinically alcohol-intoxicated patients presenting to 2 university EDs were included. Time to order CT imaging, findings on imaging, and outcomes of these patients were determined. Patients were assessed in 3 groups: CT ordered within 1 hour of triage, CT ordered 1-3 hours from triage, and CT ordered 3 or more hours from triage. ResultsDuring the study period, 5943 patients were included in the study. Of these, 0 patients scanned in less than 3 hours had intracranial findings on imaging requiring neurosurgery, whereas 1 patient with a deferred CT scan required a neurosurgical intervention; however, it was not emergently performed. ConclusionRoutine CT scanning of alcohol-intoxicated patients with altered mental status is of low clinical value. Deferring CT imaging while monitoring improving clinical status appears to be a safe practice.

Ethanol Values During College Football Season: University Policy Change and Emergency Department Blood Ethanol Values From 2006 Through 2014.

Tailgating is popular at many college football games. However, it is known to contribute to binge drinking and alcohol intoxication, which are common public health challenges. To use laboratory data to measure changes in plasma ethanol levels observed in a large state university emergency department after a series of reforms were enacted to reduce binge drinking. We performed a retrospective chart review on all serum ethanol levels measured at the University of Iowa Hospitals and Clinics on weekends from 2006 through 2014. Data were analyzed by multivariable logistic regression after controlling for significant covariates. A total of 5437 patients had ethanol levels recorded on weekends. After the implementation of policy changes, there was a significant reduction in the adjusted odds ratio (AOR) of ethanol values reported in the severe intoxication range (≥240 mg/dL; AOR = 0.77; 95% confidence interval [CI], 0.64-0.92). The policy changes implemented in 2009 in an attempt to reduce binge drinking are associated with a decreased likelihood of an ethanol result being in the severe intoxication range.

Comparison of Ultrasound-guided interscalene block vs. analgosedation for shoulder reduction in a Swiss University Emergency Department

Comparison of Ultrasound-guided interscalene block vs. analgosedation for shoulder reduction in a Swiss University Emergency Department

The efficacy of transcutaneous cardiac pacing in ED

IntroductionTranscutaneous cardiac pacing (TCP) is a rapid, time-saving, and noninvasive ventricular stimulation that is tolerated by conscious patients despite the painful intervention for treatment of symptomatic bradycardias. The goal of this study was to determine the efficacy of TCP in unstable bradycardia patients in emergency department (ED). MethodsThis single-central, observational clinical study was conducted on patients older than 18 years who presented with acute unstable bradycardia to the tertiary care university ED. Primary outcome measure was to determine the efficacy of TCP in unstable bradycardia patients in the emergency settings. Efficacy of TCP was to determine changes of clinically significant vital signs and electrocardiography. ResultsOf 349 patients who visited the ED presenting with bradycardia, 89 patients who met the criteria were included in the study. There was a statistically significant difference between before and after the first administration TCP in mean systolic (71.2 [64.8-77.6] and 105.3 [97.6-112.9 mm Hg]) and diastolic blood pressure (42.9 [38.8-47.0] and 61.0 [56.4-65.5] mm Hg) and median heart rate (40 [39-42] and 74 [71-78] beats/min, P< .0001). ConclusionTranscutaneous cardiac pacing is a clinically effective treatment modality in patients with atropine-resistant unstable bradycardia.

Implementing Triage Standing Orders in the Emergency Department Leads to Reduced Physician-to-Disposition Times

Emergency departments (EDs) throughout USA have improvised various processes to curb the “national epidemic” termed ED “crowding.” Standing orders (SOs), one such process, are medical orders approved by the medical director and entered by nurses when patients cannot be seen expeditiously, expediting medical decision-making and decreasing length of stay (LOS) and time to disposition. This retrospective cohort study evaluates the impact of SOs on ED LOS and disposition time at a large university ED. Results indicate that SOs significantly improve ED throughput by reducing disposition time by up to 16.9% (p=0.04), which is especially significant in busy ED settings. SOs by themselves are not sufficient for a complete diagnostic assessment. Strategies such as having a provider in the waiting area may help make key decisions earlier.

Experience With a New Process—Condition T—for Uncontrolled Donation After Circulatory Determination of Death in a University Emergency Department

In the United States, organ donation after circulatory death (DCD) determination is increasing among those who are removed from life-sustaining therapy but is rare when death is unexpected. We created a program for uncontrolled DCD (uDCD). A comprehensive program was created to train personnel to identify and respond quickly to potential donors after unexpected death. The process termed Condition T was implemented in the emergency department (ED) of 2 academic medical centers. All ED deaths were screened for uDCD potential. Eligible donors included patients with preexisting donor designation who received cardiopulmonary resuscitation, failed to respond, and were pronounced dead. Over 350 nurses, physicians, perfusionists, organ procurement personnel, and administrators were trained. From February 2009 to June 2010, a total of 18 patients were potential Condition T candidates. Six Condition T responses were triggered. Three donors underwent cannulation, and 4 organs were recovered (3 kidney and 1 liver) from 2 donors. Time from Condition T trigger to perfusion with organ preservation solution ranged from 14 to 22.3 minutes. Perfusion duration was 197 and 221 minutes. No recovered organs were transplanted because biopsies showed prolonged warm ischemia. It is feasible to create a process to rapidly intervene in the ED for uDCD. However, no organ transplants resulted. The utility and sustainability of an uDCD program in this particular setting are questionable.

Trends in Urgency of Emergency Department Visits among Those with and without Multiple Chronic Conditions

Objectives: The objective of this study was to examine overall trends in Emergency Department (ED) visits among adults with and without multiple chronic conditions (MCC) by urgency of visit (nonurgent, urgent, primary care sensitive) and across relevant population subgroups. Methods: Using data from the Nationwide Emergency Department Sample (NEDS) for 2007-2012 maintained by the Healthcare Cost and Utilization Project (HCUP), we examined trends in ED visits among adults who were diagnosed as having no chronic conditions (0CC), one chronic condition (1CC), and MCC based on the Clinical Classification Software codes. Separate trend analyses were conducted for ED visits that were classified as urgent, nonurgent, and primary care sensitive (PCS) based on the New York University (NYU) ED Algorithm. Trend analyses were also conducted for several population subgroups: age, sex, metropolitan hospital status, Census Region, insurance status, and median income quartiles by ZIP code. Results: Between 2007 and 2012, the overall percentage change in nonurgent ED visits made by adults with 0CC, 1CC and MCC were 8.05%, 22.50% and 35.36% respectively (p<0.001 for all categories). Primary Care Sensitive (PCS) ED visits among adults with 0CC, 1CC and MCC increased by 6.53%, 15.49% and 16.53%, respectively, from 2007-2012 (p<0.001 for all categories). Among adults with 0CC, 1CC and MCC, different patterns of growth trends were found for urgent, nonurgent, and PCS ED visits across analyzed population subgroups. Conclusion: The results show that chronic conditions, especially multiple chronic conditions, played a role in the long-term growth of ED visits in general and in nonurgent and primary care sensitive (PCS) ED visits. The increases in nonurgent and PCS visits highlight the importance, as well as opportunities, to reduce potentially avoidable ED visits and unnecessary health care costs, especially as the MCC population is expected to grow in the years ahead.