MP50: Vaping, tobacco and cannabis among patients presenting to the emergency department: a cross-sectional study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S60-S61
Author(s):  
K. Zhou ◽  
D. Junqueira ◽  
S. Couperthwaite ◽  
J. Meyer ◽  
B. Rowe
Keyword(s):  
Emergency Department ◽  
Lung Injury ◽  
Tobacco Smoking ◽  
Respiratory Symptoms ◽  
Cannabis Use ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cannabis Smoking ◽  
Lung Health ◽  
Respiratory Conditions

Introduction: Inhaled toxins from tobacco smoking, cannabis leaf smoking as well as vaping/e-cigarette products use are known causes of cardio-respiratory injury. While tobacco smoking has decreased among Canadian adults, there are now several other forms of legal inhalant products. While legal, the evidence of benefit and safety of vaping is limited. Of concern, cases of e-cigarette or vaping products use associated lung injury (EVALI) have been accumulating in the U.S. and now in Canada. Despite this, very little is known about the inhalation exposure of emergency department (ED) patients; this study was designed to explore lung health in the ED. Methods: We investigated the prevalence of exposure to vaping, tobacco and cannabis among patients presenting to a Canadian ED from July to November 2019. Ambulatory (CTAS 2 to 5), stable, adult (≥ 17 years) patients were prospectively identified and invited to complete a survey addressing factors related to lung health (previous diagnosis of respiratory conditions and respiratory symptoms at the ED presentation) and information on current exposure to vaping, tobacco and cannabis smoking. Categorical variables are reported as frequencies and percentages; continuous variables are reported as medians with interquartile range (IQR). The study was approved by the Health Research Ethics Board. Results: Overall, 1024 (71%) of 1433 eligible patients completed the survey. The median age was 43.5 (IQR: 29, 60), and 51% were female. A total of 351 (31%) participants reported having been previously diagnosed with ≥1 respiratory conditions, and 177 (17%) were visiting the ED as a result of ≥1 respiratory symptoms (e.g., cough, shortness of breath, wheezing). Daily tobacco smoking was reported by 190 (19%), and 83 (8%) reported using vaping/e-cigarette products. Cannabis use within 30 days was described by 80 (15%) respondents. Exposure to tobacco and vaping products was reported by 39 (4%) participants, 63 (6%) reported using tobacco in combination with cannabis smoking, and 3% reported combining vaping and cannabis use. Conclusion: Patients seeking care in the ED are exposed to a large quantity of inhaled toxins. Vaping products, considered the cause of the most recent epidemic of severe lung injury, are used in isolation and in combination with other smoking products in Canada. These exposures should be documented and may increase the risk of lung health injuries and exacerbations of chronic respiratory conditions.

scholarly journals P078: Impact of vaping on lung health and visits to the emergency department: a cross-sectional study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S92-S92
Author(s):  
D. Junqueira ◽  
K. Zhou ◽  
S. Couperthwaite ◽  
J. Meyer ◽  
B. Rowe
Keyword(s):  
Emergency Department ◽  
Respiratory Symptoms ◽  
Negative Impact ◽  
Positive Association ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Increased Risk ◽  
Ed Visits ◽  
Lung Health

Introduction: Despite being legal in Canada, the vaporized liquid of vaping systems contains several chemicals presenting unknown risks to lung health and little is known about their use in patients visiting the emergency department (ED). This study explores associations between exposure to inhaled products and respiratory presentations in the ED. Methods: A cross-sectional lung health survey among patients presenting to a Canadian ED was conducted, exploring the association between inhaled toxic exposures (e.g., vaping, cannabis and cigarette smoking) and visits related to respiratory symptoms. Eligible participants were ambulatory (CTAS 2 to 5), stable, adults (≥ 17 years) visiting the ED from July to November, 2019. Results are described as frequencies and percentages (categorical variables) and medians with interquartile range (IQR, continuous variables). Univariate and multivariate logistic regression models report associations as odds ratios (OR) with 95% confidence intervals (CIs). The Health Research Ethics Board approved the study. Results: From 1433 eligible patients, 1024 (71%) completed the survey. The median age was 43.5 (IQR: 29, 60), and 51% were female. Overall, 177 (17%) reported ≥1 respiratory symptoms and 83 (8%) reported using any vaping products. In a univariate regression analysis, exposure to vaping was positively associated with ED visits related to respiratory symptoms (OR 2.11, 95% CI: 1.26 to 3.54). In the multivariate model, vaping and a previous diagnosis of ≥1 respiratory conditions showed positive association with respiratory-related ED visits (OR 1.86, 95% CI: 1.03 to 3.33; and OR 2.13, 95% CI: 1.50 to 3.02, respectively). There was evidence of an additive effect of the combined exposure to cigarettes and vaping and respiratory-related ED visits (OR 3.22, 95% CI: 1.61 to 6.43). Smoking cannabis and cigarettes alone were not associated with increased risk of respiratory-related visits. Conclusion: Using vaping products increased the occurrence of respiratory-related ED visits, particularly in people with pre-existing lung conditions. A dose-response relationship exists where the risk is highest in patients inhaling a combination of toxins. Contrary to previous assumptions, the use of vaping products has a negative impact on lung health.

Cannabis Associated “High” Cardiovascular Morbidity and Mortality: Marijuana Smoke Like Tobacco Smoke? A Déjà Vu/Déjà Vécu Story?

2019 ◽  
Vol 19 (11) ◽  
pp. 870-879 ◽  
Author(s):  
Theodora A. Manolis ◽  
Antonis A. Manolis ◽  
Antonis S. Manolis
Keyword(s):  
Health Effects ◽  
Tobacco Use ◽  
Tobacco Smoking ◽  
English Literature ◽  
The Body ◽  
Cannabis Use ◽  
Cardiovascular Morbidity And Mortality ◽  
Cannabis Smoking ◽  
Deja Vu ◽  
Déjà Vu

Background: Cannabis use has increased over the past several years as some countries have legalized its use for the treatment of certain medical conditions and/or for recreational use. Thus, concerns have risen about potential adverse health effects. Increasing number of reports have associated cannabis use with serious cardiovascular (CV) complications. Furthermore, there appears to be a likeness in the harmful health effects, especially on the CV and respiratory systems, of cannabis smoking to those of tobacco smoking. Objective: To review the CV effects of cannabis use and compare them with those of tobacco use. Methods: Articles were reviewed that were published in English literature reporting on cannabis and cannabinoid pharmacology and their effects on the CV system and their consequences. Emphasis was also placed on articles reporting on cannabis use in adolescents, exposure to secondhand smoke, its effect on exercise and finally its inter-relationship and similarities with tobacco use. Results: With growing cannabis use, an increasing number of reports have emerged associating marijuana use with serious and life-threatening CV complications, including acute coronary syndromes, potentially lethal cardiac arrhythmias and ischemic strokes. There are certain similarities of the deleterious CV and respiratory effects of cannabis smoking with those of tobacco smoking. Despite the difference in the active ingredients (tetrahydrocannabinol vs. nicotine), each substance produces a plethora of chemicals when smoked and these are largely identical; furthermore, due to different modes of smoking, cannabis chemicals are retained in the body for a longer time. Of course, concomitant tobacco and cannabis smoking is a perplexing factor in isolating damages specifically pertaining to cannabis use, while the health risk is additive. Although the mechanisms producing CV harm may be somewhat different between these two substances, the outcome appears similar, or even worse, as the effects may emerge at a younger age. Conclusion: There is an increasing concern that, apart from the mental health problem with cannabis smoking, societies may be facing another wave of a déjà vu/déjà vécu phenomenon similar to the tobacco smoking story.

scholarly journals Preventing SARS-CoV-2 transmission in the emergency department by implementing a separate pathway for patients with respiratory conditions

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Fulwah Alqahtani ◽  
Marzouqah Alanazi ◽  
Wajdan Alassaf ◽  
Fadilah Sfouq Aleanizy ◽  
Muna Aljahany ◽  
...  
Keyword(s):  
Emergency Department ◽  
Longitudinal Study ◽  
Healthcare Workers ◽  
Respiratory Symptoms ◽  
Control Measures ◽  
University Hospital ◽  
Respiratory Pathway ◽  
Infection Control Measures ◽  
Separate Pathway ◽  
Respiratory Conditions

Abstract Objectives This study aimed to describe the development and implementation of a separated pathway to check and treat patients with a suspected/confirmed coronavirus disease 2019 (COVID-19) in the emergency department (ED) at King Abdullah bin Abdulaziz University Hospital in Riyadh. Methods We conducted a retrospective, descriptive longitudinal study from March to July 2020 by analyzing data of all confirmed cases of COVID-19 among ED visitors and healthcare workers in King Abdullah bin Abdulaziz University Hospital. Results During the study period, a total of 1,182 swab samples were collected for testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), of which 285 (24.1%) tested positive. Of the 285 cases of confirmed SARS-CoV-2 infection, 18 were healthcare workers and 267 were patients. As a result of using the respiratory pathway for COVID-19 patients, the hospital managed to limit transmission of SARS-CoV-2 not only between patients but also between patients and healthcare workers, while also containing the pandemic. There were no cases of nosocomial SARS-CoV-2 infection recorded among the patients who visited the ED or the flu clinic. All confirmed cases were community acquired and patients were cared for under constrained measures. Conclusions Implementing infection control measures and restricting those with respiratory symptoms to the ED pathway prevented nosocomial spread of SARS-CoV-2 infection in the ED.

scholarly journals P047: Emergency department practice patterns of UTI investigation among the delirious elderly: a retrospective chart review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S81-S81
Author(s):  
R. Pinnell ◽  
P. Joo
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Urinary Symptoms ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Indwelling Catheter ◽  
Exact Test

Introduction: Delirium is a common emergency department (ED) presentation in elderly patients. Urinary tract infection (UTI) investigation and treatment are often initiated in delirious patients in the absence of specific urinary symptoms, despite a paucity of evidence to support this practice. The purpose of this study is to describe the prevalence of UTI investigation, diagnosis and treatment in delirious elderly patients in the ED. Methods: We performed a retrospective chart review of elderly patients presenting to the ED at The Ottawa Hospital between January 15-July 30, 2018 with a chief complaint of confusion or similar. Exclusion criteria were pre-existing and current UTI diagnosis, Glasgow Coma Scale <13, current indwelling catheter or nephrostomy tube, transfers between hospitals, and leaving without being seen. The primary outcome was the proportion of patients for whom urine tests (urinalysis or culture) or antibiotic treatment were ordered. Secondary outcomes were associations between patient characteristics, rates of UTI investigation, and patient outcomes. Descriptive values were reported as proportions with exact binomial confidence intervals for categorical variables and means with standard deviations for continuous variables. Comparisons were conducted with Fischer's exact test for categorical variables and t-tests for continuous variables. Results: After analysis of 1039 encounters with 961 distinct patients, 499 encounters were included. Urine tests were conducted in 324 patients (64.9% [60.6-69.1]) and antibiotics were prescribed to 176 (35.2% [31.1-39.6]). Overall 57 patients (11.4% [8.8-14.5]) were diagnosed with UTI, of which only 12 (21.1% [11.4-33.9]) had any specific urinary symptom. For those patients who had no urinary symptoms or other obvious indication for antibiotics (n = 342), 199 (58.2% [52.8-63.5]) received urine tests and 62 (18.1% [14.2-22.6]) received antibiotics. Patients who received urine tests were older (82.4 ± 8.8 vs. 78.3 ± 8.4 years, p < 0.001) but did not differ in sex distribution from those than those who did not. Additionally, patients who received antibiotics were more likely to be admitted (OR = 2.6 [1.48-4.73]) and had higher mortality at 30 days (OR = 4.2 [1.35-12.91]) and 6 months (OR = 3.2 [1.33-7.84]) than those who did not. Conclusion: Delirious patient without urinary symptoms in the ED were frequently investigated and treated for UTI despite a lack of evidence regarding whether this practice is beneficial.

Emergency Department Management of Children with Sickle Cell Disease.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1660-1660
Author(s):  
Melissa J. Frei-Jones ◽  
Amy L. Baxter ◽  
Charles T. Quinn ◽  
George R. Buchanan
Keyword(s):  
Emergency Department ◽  
Steady State ◽  
Sickle Cell Disease ◽  
Hospital Admission ◽  
Sickle Cell ◽  
Admission Rate ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cell Disease ◽  
Ed Visits

Abstract Vaso-occlusive crises (VOC) are a common cause of emergency department (ED) visits for children with sickle cell disease (SCD). To better understand our patient population and compare with reports from other centers, we sought to describe the presentation, management, and disposition of children with VOC at our center’s ED. We also aimed to identify predictors of hospital admission. We retrospectively reviewed hospital records of all patients with SCD, age 8–19 years, who presented to our urban pediatric ED in 2003 with a chief complaint of pain. We identified all subjects diagnosed with VOC and not another cause of pain. We obtained the following data for each: SCD genotype; duration of VOC and treatment prior to ED presentation; the nature of analgesia and use of intravenous fluids (IVF) in the ED; hemoglobin (Hgb) concentration; and disposition (admitted, discharged, discharged with subsequent ED visit for same crisis). Categorical variables were evaluated by the χ2 and Fisher exact tests and continuous variables by the t-test. Odds ratios (OR) and 95% confidence intervals (CI) were calculated where appropriate. In 2003, there were 320 ED visits for patients with SCD and pain. Among these, there were 279 diagnoses of VOC in 105 individual patients: 45 had one visit, 25 two visits, and 16 ≥5 visits. Mean number of visits per patient was 2.7; 23 (22%) patients accounted for 145 (55%) visits. Homozygous sickle cell anemia (Hgb SS) was present in 73/105 patients, accounting for 222 (79%) ED visits. Overall admission rate was 179/279 (64%), with 167/179 admitted on their first visit and 12 on their return visit. Subjects with Hgb SS accounted for 147/179 (82%) admissions. Among those discharged who later returned to the ED during the same VOC, the admission rate was 86% (5 returned in 24 hours, 5 in 48 hours, 3 in 72 hours, and one 4 days later). Pre-ED home opioid use was reported in 75% of visits and was associated with increased likelihood of discharge (OR 1.63, CI 0.94–2.84, p=0.082). Duration of VOC before presentation did not significantly affect admission rate and averaged 53.2 hours for admitted patients and 49.7 hours for those discharged (p=0.689). Patients who received IVF in the ED (219/279; 79%) were less likely to be admitted (31% vs 56%, p<0.001). Hgb concentration was increased in 61%, decreased in 36% and unchanged in 3% of patients from steady-state values and was not associated with admission. After receiving 2 doses of morphine, 31 patients were discharged from the ED, while only 5 patients were discharged after receiving 3 or 4 doses of morphine. A departmental VOC protocol was followed for 25.4% of patients, with no impact on admission rate (p=0.290). In this retrospective analysis of a large series of pediatric sickle cell ED visits, patients presented later in their VOC, and admission rate was higher than previously reported. A small proportion of older patients with SCD accounted for most ED visits and hospitalizations. Hgb variation from steady-state was neither clinically significant nor predictive of admission or discharge. In contrast to previous studies, receiving IVF in the ED was associated with a greater likelihood of discharge. Home opioids prior to ED presentation seemed to decrease hospital admission. Adherence to our center’s VOC protocol did not appear to influence disposition from the ED.

scholarly journals Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan

2020 ◽  
Vol 36 (6) ◽  
Author(s):  
Noman Ali ◽  
Nadeem Ullah Khan ◽  
Shahid Waheed ◽  
Syed Mustahsan
Keyword(s):  
Emergency Department ◽  
Enteric Fever ◽  
Care Center ◽  
Tertiary Care ◽  
Practical Importance ◽  
University Hospital ◽  
Categorical Variables ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Continuous Variables

Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital. Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever. Results: A total of one hundred and fifty five patients were included. Out of these 97 (62.6%) were males and 58 (37.4%) were females. Most patients (25.2%, n= 39) were diagnosed as malaria followed closely by dengue fever (n=33, 21.3%) and then enteric fever (n= 10, 6.5%). while 41.9% (n=65) were diagnosed as suspected viral fever based on clinical judgment and inconclusive laboratory results. Conclusion: Malaria was found to be the most common confirmed cause of acute undifferentiated fever followed by dengue and enteric fever. The provision of accurate epidemiological data will enable resources to be directed towards key areas and will be of practical importance to clinicians. doi: https://doi.org/10.12669/pjms.36.6.2334 How to cite this:Ali N, Khan NU, Waheed S, Mustahsan S. Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2334 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Impact of Tobacco Smoking Status on Morbidity and Mortality in Patients Hospitalized with COVID-19 Pneumonia: Observational study

2020 ◽  
Author(s):  
Gustavo Fernandez Romero ◽  
Eduardo Dominguez-Castillo ◽  
Matthew Zheng ◽  
Ibraheem Yousef ◽  
Melinda Darnell ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tobacco Smoking ◽  
Smoking Status ◽  
Respiratory Support ◽  
Categorical Variables ◽  
Nasopharyngeal Swab ◽  
Continuous Variables ◽  
Non Invasive ◽  
Former Smokers ◽  
The Impact

Abstract Background: Determine the impact of tobacco smoking status on patients hospitalized with COVID-19 pneumonia in the need for ICU care, mechanical ventilation and mortality. Methods: We performed a retrospective cohort study, that involved chart review. All adults 18 years or older with a diagnosis of COVID-19 pneumonia hospitalized from March 15th, 2020 to May 06th, 2020 with a positive reverse transcription polymerase chain reaction (RT-PCR) nasopharyngeal swab for COVID-19. We used chi-squared test for categorical variables and student t-tests or Wilcoxon rank sum tests for continuous variables. We further used adjusted and unadjusted logistic regression to assess risk factors for mortality and intubation.Results: Among 577 patients hospitalized with COVID-19 pneumonia, 268 (46.4%) had a history of smoking including 187 former and 81 active smokers. The former smokers when compared with non-smokers were predominantly older with more comorbidities. Also, when compared with never smokers D Dimer levels were elevated in active (p=0.05) and former smokers (p<0.01). The former smokers versus non-smokers required increased need for advanced non-invasive respiratory support on admission (p<0.05), ICU care (p<0.05) and had higher mortality [1.99 (CI 95% 1.03-3.85, p<0.05)]. Active smokers versus non-smokers received more mechanical ventilation [OR 2.11 (CI 95% 1.06-4.19, p<0.05)].Conclusions: In our cohort of hospitalized patients with COVID-19 pneumonia, former smokers had higher need for non-invasive respiratory support on admission, ICU care, and mortality compared to non-smokers. Also, active smokers versus non-smokers needed more mechanical ventilation.

Improving cancer pain management in the emergency department: An EMR-based solution.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12110-12110
Author(s):  
Christopher John Coyne ◽  
Ellen Kettler ◽  
Kelly Dong ◽  
James Killeen
Keyword(s):  
Emergency Department ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Chief Complaint ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Opioid Dose ◽  
Patients With Cancer

12110 Background: Pain is common reason for patients with cancer to seek care in the emergency department (ED). Unfortunately, these patients frequently receive inadequate doses of pain medication, partially due to opioid reduction efforts in the ED, as well as opioid tolerance among those with chronic cancer pain. The purpose of this study was to investigate the effectiveness of an electronic medical record (EMR) based best practice advisory (BPA) at improving analgesic dosing for cancer patients in the ED. Methods: We performed a retrospective cohort study on cancer pain at two academic medical centers from 05/18/20 to 10/27/20. The BPA algorithm identified ED patients with cancer that were taking prescription opioids with a morphine equivalent daily dose (MEDD) of at least 100, as calculated by the EMR. If the ED provider ordered opioids for these patients, a BPA alert appeared with a recommended opioid dose based on the patient’s individual MEDD. This alert also included pre-set safety orders for O2 and end tidal CO2 monitoring as well as naloxone. We compared outcomes based on whether an ED provider accepted or cancelled the BPA recommendation. These outcomes included the change in opioid dose and ED disposition. Continuous variables were compared using the students t-test, while categorical variables were compared with the chi-squared test with an alpha of 0.05. Results: Our BPA identified 92 patients that met our criteria, representing 143 BPA alerts. The mean age was 52, 43.5% were female, 54.3% had metastatic disease, and 56.5% presented with a painful chief complaint. Of the ED providers that accepted the BPA, 57.5% increased their dose of opioid medication. BPA usage led to a 33.3% mean increase in medication dosage (p <.001). Patients that presented with a painful chief complaint, whose providers utilized the BPA were admitted at a rate of 60.5%, verses a 77.8% admission rate among those whose providers did not utilize the BPA (p <.01). No patients required an opioid reversal agent. Conclusions: Among cancer patients on chronic opioids presenting to the ED, use of an EMR-based BPA led to more appropriate opioid dosing without the need for opioid reversal agents, and was associated with an overall decrease in hospital admissions.

scholarly journals Causes and Characteristics of Children Unintentional Injuries in Emergency Department and Its Implications for Prevention

2021 ◽  
Vol 9 ◽  
Author(s):  
Hairong Gong ◽  
Guoping Lu ◽  
Jian Ma ◽  
Jicui Zheng ◽  
Fei Hu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Age Groups ◽  
Unintentional Injury ◽  
Sports Injury ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Unintentional Injuries ◽  
Cross Sectional ◽  
Fall Injury

Background: Child unintentional injuries have become a hot topic worldwide, and substantial regional disparities existed in causes and characteristics. To date, limited data are available to investigate the causes and characteristics of child unintentional injuries from hospitals for children in China.Methods: A cross-sectional study was conducted between January 2017 and December 2018 in Shanghai, China. Patients aged &lt;18 years with an unintentional injury presented to the emergency department were enrolled. Demographic information, Pediatric Risk for Mortality III score, and outcome variables were retrieved from electronic health records (EHRs). Frequencies and proportions of categorical variables and means and SDs of continuous variables are presented. Chi-square test and Student's t-test were used for the comparison between groups, as appropriate. Logistic regression analysis was used to estimate potential risk factors for admission to the hospital.Results: A total of 29,597 cases with unintentional injuries were identified between January 2017 and December 2018, with boys vs. girls ratio of 1.75. Preschool children account for approximately two-thirds of unintentional injuries in the emergency department. A distinctive pattern of mechanisms of unintentional injuries between gender was documented, and sports injury was significantly higher in boys than in girls (10.2 vs. 7.8%). Compared with Canadian Emergency Department Triage and Acuity Scale (CTAS) Grade 3 patients, Grade 2 [odds ratio (OR) = 2.99, 95% CI = 1.93–4.63, P &lt; 0.001] and Grade 1 (OR = 74.85, 95% CI = 12.93–433.14, P &lt; 0.001) patients had higher risk of inhospital admission. For causes of injuries, compared with falling, foreign body and poison had a lower risk of inhospital admission, while transport injury (OR = 1.31, 95% CI = 1.07–1.59, P = 0.008) and high fall injury (OR = 2.58. 95% CI =1.48–4.49, P &lt; 0.001) had a significantly higher risk of admission.Conclusions: There was a significant relationship between age-groups and unintentional injuries between gender, with decreased injuries among girls growing up older. Preventive measures should be taken to reduce transport injury and high fall injury, which had a significantly higher risk of admission.

scholarly journals P051: Interventions to improve emergency department consultation processes: a systematic review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S81
Author(s):  
L. Gaudet ◽  
S. Kirkland ◽  
D. Keto-Lambert ◽  
B. Rowe
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Clinical Pathways ◽  
Grey Literature ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Arrival Times ◽  
Specialized Care ◽  
Study Characteristics ◽  
Ed Crowding

Introduction: Emergency Department (ED) consultations are often necessary for safe and effective patient care. Delays in throughput related to ED consultations can increase a patient's ED length of stay (LOS) and contribute to ED crowding. This review aimed to characterize and evaluate interventions to improve consultation metrics. Methods: Eight primary literature databases and the grey literature were comprehensively searched. Comparative studies of interventions to improve ED consultation metrics were included. Unique citations were screened for relevance and the full-texts of relevant articles were reviewed by two independent reviewers. Data on study characteristics and outcomes were extracted in duplicate onto standardized forms. Disagreements were resolved through consensus. Categorical variables are reported as proportions. Continuous variables are reported as the median of the means and total range. Results: After screening 2632 unique citations and 19 from the grey literature items, 24 studies were included. Seventeen interventions targeted specific conditions or speciality services, while the remainder targeted all ED presentations. Interventions fell into three broad categories: strategies to expedite patient care, including clinical pathways (42%); interventions to improve consultant responsiveness (33%); and addition of a specialized care team to the ED (25%). Overall, eight studies reported on the overall proportion of consults in the ED, of which six reported an increase in the consultation proportion (median: +0.6%, range: −11.3% to +49.6%). Six studies reported the proportion of consulted patients who were admitted, of which four reported an increase (median: +1.1%, range: −5.9% to +3.5%). On the other hand, six of seven studies reporting on time from request to consult arrival reported a decrease (median: −25 minutes, range: −66 to +3.8 minutes). Similarly, overall ED LOS was reported to be lower in 17/19 studies reporting this metric (median: −47.6 minutes, range: −600 minutes to +59 minutes). Conclusion: A variety of strategies have been employed to improve ED consultation processes and outcomes. Neither the proportion of consulted patients in the ED nor the proportion of admissions were improved; however, interventions appeared successful at improving consultant arrival times and overall ED LOS. Improvements in consultation processes may be an effective strategy to improve ED throughput and thereby reduce ED crowding.

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