US Hospital Emergency Departments Research Articles

Patient preferences for treatment of acute bacterial skin and skin structure infections in the emergency department

BackgroundLimited research has assessed patient preferences for treatment disposition and antibiotic therapy of acute bacterial skin and skin structure infection (ABSSSI) in the emergency department (ED). Understanding patient preference for the treatment of ABSSSI may influence treatment selection and improve satisfaction.MethodsA survey was conducted across 6 US hospital EDs. Patients with ABSSSI completed a baseline survey assessing preferences for antibiotic therapy (intravenous versus oral) and treatment location. A follow-up survey was conducted within 30–40 days after ED discharge to reassess preferences and determine satisfaction with care.ResultsA total of 94 patients completed both baseline and follow-up surveys. Sixty (63.8%) participants had a history of ABSSSI, and 69 (73.4%) were admitted to the hospital. Treatment at home was the most common preference reported on baseline and follow-up surveys. Patients with higher education were 82.2% less likely to prefer treatment in the hospital. Single dose intravenous therapy was the most commonly preferred antibiotic regimen on baseline and follow-up surveys (39.8 and 19.1%, respectively). Median satisfaction scores for care in the ED, hospital, home, and with overall antibiotic therapy were all 8 out of a maximum of 10.ConclusionsIn these patients, the most common preference was for outpatient care and single dose intravenous antibiotics. Patient characteristics including higher education, younger age, and current employment were associated with these preferences. Opportunities exist for improving ABSSSI care and satisfaction rates by engaging patients and offering multiple treatment choices.

Golf-related injuries treated in United States emergency departments

ObjectiveThis study investigates unintentional non-fatal golf-related injuries in the US using a nationally representative database. MethodsThis study analyzed golf-related injuries treated in US hospital emergency departments from 1990 through 2011 using the National Electronic Injury Surveillance System database. Injury rates were calculated using golf participation data. ResultsDuring 1990 through 2011, an estimated 663,471 (95% CI: 496,370–830,573) individuals ≥7years old were treated in US emergency departments for golf-related injuries, averaging 30,158 annually or 12.3 individuals per 10,000 golf participants. Patients 18–54years old accounted for 42.2% of injuries, but injury rates per 10,000 golf participants were highest among individuals 7–17years old (22.1) and ≥55years old (21.8) compared with 18–54years old (7.6). Patients ≥55years old had a hospital admission rate that was 5.01 (95% CI: 4.12–6.09) times higher than that of younger patients. Injured by a golf club (23.4%) or struck by a golf ball (16.0%) were the most common specified mechanisms of injury. The head/neck was the most frequently injured body region (36.2%), and sprain/strain (30.6%) was the most common type of injury. Most patients were treated and released (93.7%) and 5.9% required hospitalization. ConclusionsAlthough golf is a source of injury among all age groups, the frequency and rate of injury were higher at the two ends of the age spectrum. Given the higher injury and hospital admission rates of patients ≥55years, this age group merits the special attention of additional research and injury prevention efforts.

Pediatric Cotton-Tip Applicator-Related Ear Injury Treated in United States Emergency Departments, 1990-2010

To evaluate the characteristics of children with cotton-tip applicator (CTA)-related ear injuries. Data on CTA-related ear injuries among children presenting to US emergency departments (EDs) from 1990 through 2010 were obtained from the National Electronic Injury Surveillance System. Between 1990 and 2010, an estimated 263 338 children aged <18 years were treated for CTA-related ear injuries in US hospital EDs. There was a nonsignificant increase in the annual number of injuries from 1990 through 2001 (78.2%) and a significant decrease from 2001 through 2010 (26.0%). Younger children sustained the highest rate of injury (32.2 per 100 000 for age 0-3 years). Ear cleaning was the most frequently documented circumstance at the time of injury (73.2%), and patients themselves were most commonly handling the CTA (76.9%). Foreign body sensation (39.2%) and bleeding (34.8%) were commonly documented reasons for visiting the ED. The presence of a foreign body (29.7%) and tympanic membrane perforation (25.3%) were common diagnoses. Most CTA-related injuries occurred with children themselves handling CTAs while cleaning their ears. Foreign body and tympanic membrane perforation were the most common associated diagnoses. Despite warnings against the use of CTAs in the ear canal and use of CTAs by children, these injuries continued to occur. Additional injury prevention strategies through further parent/caregiver and child education are warranted.

Estimated Cost of Sunburn-Associated Visits to US Hospital Emergency Departments

Estimated Cost of Sunburn-Associated Visits to US Hospital Emergency Departments

Quantifying Emergency Department Visits From Sport and Recreation: Focus on the Lower Extremity and Knee, 1997-2009.

Few authors have reported nationally representative data on the number of sport and recreation (SR) injuries resulting in emergency department (ED) visitation. The existing studies have only provided 1 or 2 years of data and are not longitudinal in nature. To use a novel algorithmic approach to determine if ED visitation is due to SR, resulting in a substantially larger longitudinal dataset. Descriptive epidemiology study. Hospital. The National Hospital Ambulatory Medical Care Survey, a stratified random-sample survey of US hospital EDs was combined for years 1997-2009. There were 15 699 unweighted patient visits determined to be from SR. A custom algorithm classified SR visits based on the International Classification of Diseases, Ninth Revision, Clinical Modification E-code and pattern recognition of narrative text. Sport and recreation visits were assessed by age and categorized according to broad injury classifications. Additional quantification was performed on SR visits for lower extremity and knee-specific injuries. Sample weights were applied to provide national annual estimates. Annually, 4 243 000 ED visits resulted from SR. The largest classification of injury from SR was sprains and strains (896 000/y). Males had substantially more SR-related ED visits than females (2 929 000/y versus 1 314 000/y). For patients 10-49 years old, 1 093 000 lower extremity and 169 000 knee-specific injury visits annually were from SR. For both injury types, males had a higher rate of ED visitation; however, females had 25% and 39% greater odds of visitation for lower extremity and knee-specific injury, respectively. The burden on the health system of ED visits from SR was substantial. Males presented in the ED at a higher rate for SR injury, though females had a higher proportion of lower extremity and knee-specific injury ED visitations from SR. This longitudinal analysis of population-level data provides the information to target research on specific subpopulations to mitigate SR injury.

The Most Crowded US Hospital Emergency Departments Did Not Adopt Effective Interventions To Improve Flow, 2007-10.

Emergency department (ED) crowding adversely affects patient care and outcomes. Despite national recommendations to address crowding, it persists in most US EDs today. Using nationally representative data, we evaluated the use of interventions to address crowding in US hospitals in the period 2007-10. We examined the relationship between crowding within an ED itself, measured as longer ED lengths-of-stay, and the number of interventions adopted. In our study period the average number of interventions adopted increased from 5.2 to 6.6, and seven of the seventeen studied interventions saw a significant increase in adoption. In general, more crowded EDs adopted greater numbers of interventions than less crowded EDs. However, in the most crowded quartile of EDs, a large proportion had not adopted effective interventions: 19 percent did not use bedside registration, and 94 percent did not use surgical schedule smoothing. Thus, while adoption of strategies to reduce ED crowding is increasing, many of the nation's most crowded EDs have not adopted proven interventions.

Identifying psychiatric medications causing high numbers and rates of emergency department visits among US adults

ABSTRACT FROM: Hampton LM, Daubresse M, Chang HY, et al . Emergency department visits by adults for psychiatric medication adverse events. JAMA Psychiatry 2014;71:1006–14. More than 1 in 10 adults...

Scald burns in children under 3 years: an analysis of NEISS narratives to inform a scald burn prevention program

Background objectivesTo determine the incidence of paediatric scald burns for children under 3 years of age treated in US hospital emergency departments. To quantify injury patterns associated with scald burns...

Variation in US hospital emergency department admission rates by clinical condition.

Variation in hospitalization rates have been described for decades, yet little is known about variation in emergency department (ED) admission rates across clinical conditions. We sought to describe variation in ED risk-standardized admission rates (RSAR) and the consistency between condition-specific ED admission rates within hospitals. Cross-sectional analysis of the 2009 National Emergency Department Sample, an all-payer administrative, claims dataset. We identify the 15 most frequently admitted conditions using Clinical Classification Software. To identify conditions with the highest ED RSAR variation, we compared both the ratio of the 75th percentile to the 25th percentile hospital and coefficient of variation between conditions. We calculate Spearman correlation coefficients to assess within-hospital correlation of condition-specific ED RSARs. Of 21,885,845 adult ED visits, 4,470,105 (20%) resulted in admission. Among the 15 most frequently admitted conditions, the 5 with the highest magnitude of variation were: mood disorders (ratio of 75th:25th percentile, 6.97; coefficient of variation, 0.81), nonspecific chest pain (2.68; 0.66), skin and soft tissue infections (1.82; 0.51), urinary tract infections (1.58; 0.43), and chronic obstructive pulmonary disease (1.57; 0.33). For these 5 conditions, the within-hospital RSAR correlations between each pair of conditions were >0.4, except for mood disorders, which was poorly correlated with all other conditions (r<0.3). There is significant condition-specific variation in ED admission rates across US hospitals. This variation appears to be consistent between conditions with high variation within hospitals.

Indoor tanning-related injuries treated in a national sample of US hospital emergency departments.

Indoor tanning exposes users to intense UV radiation, which is a known carcinogen.1 However, little is known about the more immediate adverse outcomes of indoor tanning. To our knowledge, this study provides the first national estimates of indoor tanning–related injuries treated in US hospital emergency departments (EDs).

Prevalence of Clostridium difficile infection presenting to US EDs

ObjectiveThe objective of the study is to determine the prevalence of Clostridium difficile infection (CDI) presenting to emergency departments (EDs) in the United States. Secondary objectives included defining the burden of CDI. MethodsThis is a retrospective, observational cohort study of 2006-2010 Nationwide Emergency Department Sample database of 980 US hospital EDs in 29 states. Prevalence, mortality rate, length of stay, hospital charges, and endemicity were measured. ResultsA total of 474513 patients with CDI-related ED visits were identified. From 2006 to 2010, the prevalence of CDI increased from 26.2 to 33.1 per 100000 population (P < .001). The number of CDI-related ED cases increased 26.1% (P < .001) over the study period: 18.6% from 2006 to 2007 (P < .001), 4.3% from 2007 to 2008 (P = .46), 1.8% from 2008 to 2009 (P = .73), and 0.13% from 2009 to 2010 (P = .95). Emergency department visits occurred more frequently with individuals 85 years or older (relative risk [RR], 13.74; P < .001), females (RR, 1.77; P < .001) and in the northeast United States (RR, 1.42; P < .001). From 2009 to 2010, the mortality rate decreased 17.9% (P = .01). ConclusionsThe prevalence of CDI presenting to EDs increased each year from 2006 to 2010; however, the rate of increase slowed from each year to the next. The mortality rate increased from 2006 to 2009 and decreased significantly from 2009 to 2010. C difficile infection visits presenting to EDs occurred more frequently with older individuals, females, and in the northeast.

Non-fatal work-related traumatic brain injuries treated in US hospital emergency departments, 1998–2007

PurposeLittle is known about work-related traumatic brain injuries (WRTBI). This study describes non-fatal WRTBIs treated in US emergency departments (ED) from 1998 through 2007.MethodsNon-fatal WRTBIs were identified from the National...

National Estimates of Noncanine Bite and Sting Injuries Treated in US Hospital Emergency Departments, 2001–2010

Injuries resulting from contact with animals and insects are a significant public health concern. This study quantifies nonfatal bite and sting injuries by noncanine sources using data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). The NEISS-AIP is an ongoing nationally representative surveillance system used to monitor all types and causes of injuries treated in US hospital emergency departments (EDs). Cases were coded by trained hospital coders using information from medical records on animal and insect sources of bite and sting injuries being treated. Data were weighted to produce national annualized estimates, percentages, and rates based on the US population. From 2001 to 2010 an estimated 10.1 million people visited EDs for noncanine bite and sting injuries, based on an unweighted case count of 169,010. This translates to a rate of 340.1 per 100,000 people (95% CI, 232.9-447.3). Insects accounted for 67.5% (95% CI, 45.8-89.2) of bite and sting injuries, followed by arachnids 20.8% (95% CI, 13.8-27.9). The estimated number of ED visits for bedbug bite injuries increased more than 7-fold-from 2156 visits in 2007 to 15,945 visits in 2010. This study provides an update of national estimates of noncanine bite and sting injuries and describes the diversity of animal exposures based on a national sample of EDs. Treatment of nonfatal bite and sting injuries are costly to society. Direct medical and work time lost translates to an estimated $7.5 billion annually.

Stove-related injuries treated in EDs in the United States, 1990-2010

BackgroundHousehold stoves are a common source of injury in the United States. PurposeTo investigate the epidemiology of stove-related injuries. MethodsThe National Electronic Injury Surveillance System database was used to analyze cases of nonfatal stove-related injuries treated in US hospital emergency departments (EDs) from 1990 through 2010. ResultsAn estimated 910696 (95% CI, 789279-1032113) individuals were treated for stove-related injuries during the 21-year study period, yielding an average of 43366 injured persons annually or 5 injuries every hour. The number (m = −252.85; P = .033) and rate (m = −0.026; P < .001) of injured individuals significantly decreased during the study. Injuries were highest in 1991 (50656 cases; 2.0 per 10000) and lowest in 2005 (38669 cases; 1.31 per 10000), although there was an increase in 2010 (48990 cases; 1.58 per 10000). Patients ≤19 years experienced 41.3% of stove-related injuries. The primary mechanism of injury was contact with stove parts (37.5%). The body region most commonly injured was the hand (44.6%), and a thermal burn was the most common diagnosis (51.8%). The majority (94.4%) of patients were treated and released from the ED. Patients >60 years of age were 3.85 (95% CI, 2.97-4.98) times more likely to be admitted to the hospital than younger patients. ConclusionsThis is the first comprehensive study of stove-related injuries in the United States using a nationally representative sample. Strategies to prevent stove-related injuries should address the multiple mechanisms of injury.

US‐based emergency department visits for fluoroquinolone‐associated hypersensitivity reactions

To estimate the rate of hypersensitivity reactions per 100,000 prescription dispensings of fluoroquinolones based on care rendered in a nationally representative sample of US hospital emergency departments (ED). We analyzed the frequency of fluoroquinolone-associated hypersensitivity reactions using the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance system (2004-2010) in conjunction with US retail outpatient prescription data from IMS Health (2004-2010). We further categorized reaction severity into three subgroups (mild, moderate, and severe). Based on 1422 cases of fluoroquinolone-associated hypersensitivity reactions and national drug utilization projections, we estimated risk of hypersensitivity reactions for moxifloxacin, ciprofloxacin, and levofloxacin. The absolute risk of a fluoroquinolone-related hypersensitivity reaction of any severity was low (44.0 (95% CI 34.8-53.3) ED visits/100,000 prescriptions); however, we identified a statistically significant difference in the relative risk (rate ratios) of seeking care in an ED attributed to moxifloxacin hypersensitivity compared to either levofloxacin or ciprofloxacin. For all reaction severities, the estimated ED visits/100,000 prescriptions were 141.3 (95% CI 99.9-182.7) for moxifloxacin, 40.8 (95% CI 31.5-50.0) for levofloxacin, and 26.3 (95% CI 20.8-31.9) for ciprofloxacin. When the rates were stratified by reaction severity category (mild or moderate-severe), moxifloxacin continued to be implicated in more ED visits per 100,000 prescriptions dispensed than either levofloxacin or ciprofloxacin. Fluoroquinolones may cause hypersensitivity reactions requiring care in an ED, and relative to use, the rate of moxifloxacin-related hypersensitivity reactions is higher compared to levofloxacin or ciprofloxacin.

Nonfatal Choking on Food Among Children 14 Years or Younger in the United States, 2001–2009

The objective of this study was to investigate the epidemiology of nonfatal choking on food among US children. Using a nationally representative sample, nonfatal pediatric choking-related emergency department (ED) visits involving food for 2001 through 2009 were analyzed by using data from the National Electronic Injury Surveillance System-All Injury Program. Narratives abstracted from the medical record were reviewed to identify choking cases and the types of food involved. An estimated 111,914 (95% confidence interval: 83,975-139,854) children ages 0 to 14 years were treated in US hospital EDs from 2001 through 2009 for nonfatal food-related choking, yielding an average of 12,435 children annually and a rate of 20.4 (95% confidence interval: 15.4-25.3) visits per 100,000 population. The mean age of children treated for nonfatal food-related choking was 4.5 years. Children aged ≤ 1 year accounted for 37.8% of cases, and male children accounted for more than one-half (55.4%) of cases. Of all food types, hard candy was most frequently (15.5% [16,168 cases]) associated with choking, followed by other candy (12.8% [13,324]), meat (12.2% [12,671]), and bone (12.0% [12,496]). Most patients (87.3% [97,509]) were treated and released, but 10.0% (11,218) were hospitalized, and 2.6% (2911) left against medical advice. This is the first nationally representative study to focus solely on nonfatal pediatric food-related choking treated in US EDs over a multiyear period. Improved surveillance, food labeling and redesign, and public education are strategies that can help reduce pediatric choking on food.

Assessing the extent of provision of comprehensive medical care management for female sexual assault patients in US hospital emergency departments

ObjectiveTo describe medical services provided to sexual assault patients in US emergency departments and to identify the percentage of hospitals always providing the 10 elements of comprehensive medical care management (CMCM). MethodsA cross-sectional study was conducted in a national sample of US hospitals. A 26-item telephone survey assessed provision of services to sexual assault survivors in accordance with CMCM. Management included acute medical care comprising history and physical examination; acute and long-term rape crisis counseling; STI testing and prophylaxis; emergency contraception counseling and provision; and HIV testing and prophylaxis. The primary outcome was extent of provision of these elements. ResultsOverall, 582 emergency departments responded to the survey. The following components of CMCM were provided: acute medical care (582 [100.0%]); rape crisis counseling (234 [40.2%]); STI management (448 [77.0%]); emergency contraception (351 [60.3%]); and HIV management (380 [65.3%]). Only 101 (17.4%) hospitals provided all 10 elements of CMCM. ConclusionLess than one-fifth of US hospitals provide comprehensive services to sexual assault patients. A national program incorporating clinical guidelines, checklists, and funding for sexual assault forensic/nurse examiner programs could improve the standard of care provided in emergency departments—the primary point of contact for acute care of sexual assault survivors.

US Pediatric Injuries Involving Amusement Rides, 1990-2010

This study investigates pediatric injuries involving amusement rides treated in US emergency departments by retrospectively analyzing data from the National Electronic Injury Surveillance System. From 1990 to 2010, an estimated 92 885 children ≤17 years sought treatment in US hospital emergency departments for injuries involving amusement rides, yielding an annual average of 4423 injuries. The average annual injury rate was 6.24 injuries per 100 000 US children, and the mean patient age was 8.73 years. The head and neck was the most commonly injured body region (28.0%), and the most common type of injury was a soft tissue injury (29.4%). Falling in, on, off, or against the ride was the most frequent mechanism of injury (31.7%). Only 1.5% of injuries resulted in hospitalization. An improved national system for monitoring injuries involving amusement rides is needed. There are opportunities to improve the safety of amusement rides for children, especially to prevent injuries from falls.

Microwave oven-related injuries treated in hospital EDs in the United States, 1990 to 2010

BackgroundThe widespread availability of microwave ovens has sparked interest in injuries resulting from their use. MethodsUsing a retrospective cohort design, the objective of this study is to investigate the epidemiology of microwave oven-related injuries treated in United States emergency departments (EDs) from 1990 through 2010 by analyzing data from the National Electronic Injury Surveillance System. ResultsAn estimated 155959 (95% confidence interval [CI], 133515-178402) individuals with microwave oven-related injuries were treated in US hospital EDs from 1990 through 2010, which equals an average of 21 individuals per day; 60.7% were female; 63.3% were adults (≥18 years); 98.1% of injury events occurred at home; and 3.9% of patients were hospitalized. During the 21-year study period, the number and rate of microwave oven-related injuries increased significantly by 93.3% and 50.0%, respectively. The most common mechanism of injury was a spill (31.3%), and the most common body region injured was the hand and fingers (32.4%). Patients younger than 18 years were more likely to sustain an injury to their head and neck (relative risk: 1.65; 95% CI, 1.39-1.96) than adults. ConclusionsTo our knowledge, this is the first study to investigate microwave oven-related injuries on a national scale. Microwave ovens are an important source of injury in the home in the United States. The large increases in the number and rate of these injuries underscore the need for increased prevention efforts, especially among young children.

Swimming injuries treated in US EDs: 1990 to 2008

ObjectiveSwimming is one of the most popular recreational activities in the United States. The objective of this study was to investigate the epidemiology of the complete spectrum of injuries associated with swimming and swimming pools treated in US hospital emergency departments. MethodsData from the National Electronic Injury Surveillance System from 1990 to 2008 were analyzed. Injury rates were calculated using US census swimming participation data. ResultsAn estimated 1688924 swimming injuries occurred during the 19-year study, averaging 1 injury every 6 minutes. During the study period, the number of injuries and rate of injury among individuals 7 years or older significantly increased. Within this trend, injuries peaked in 1999 and significantly decreased during the last 10 years but still showed an overall increase of 18.6% in number and 29.3% in rate from 1900 to 2008. Patients 17 years or younger accounted for 60.5% of injuries, and patients 7 to 17 years of age had a greater mean annual swimming injury rate (18.78 per 10000 participants) than patients older than 17 years (9.15). Most injuries occurred in or around a swimming pool (87.0%), and most were soft tissue injuries (54.7%), followed by strains/sprains (16.4%), fractures/dislocations (11.3%), and submersion (4.9%). Injuries to patients younger than 7 years, submersion injuries, and injuries occurring at home were more likely to result in hospital admission or fatality. ConclusionsThe observed increase in injuries among individuals older than 7 years underscores the need for increased prevention efforts, including education about safe swimming practices, supervision, and environmental modifications.