Frequent emergency department use in the paediatric population: A systematic literature review

2020 ◽  
Author(s):  
Theodoros V. Giannouchos ◽  
David J. Washburn ◽  
Jodie C. Gary ◽  
Margaret J. Foster
Keyword(s):  
Emergency Department ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Paediatric Population ◽  
Emergency Department Use

scholarly journals Systematic literature review of emergency department physicians’ confidence to treat dental pain and the frequency with which they prescribe pain medications: Considerations for improved outcomes.

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Sara Barna ◽  
Jean O'Donnell ◽  
Marnie Oakley
Keyword(s):  
Emergency Department ◽  
Drug Abuse ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Emergency Departments ◽  
Dental Pain ◽  
Dental Patients ◽  
Pain Medications ◽  
Prescribing Trends ◽  
Pain Patients

Opioid analgesics, when taken as prescribed, are effective therapeutic options that provide pain relief for moderate to severe pain. The use of opioids in the treatment of pain has been increasing in the U.S. at an alarming rate, possibly contributing to the simultaneous rise in opioid abuse. Emergency departments play a major role in managing patients who present in pain, with approximately 10% of all opioid analgesic prescriptions written in hospital emergency departments. It is estimated that dental pain patients represent between 0.3-4% of the overall patient emergency department workload. Yet, the literature suggests that many of these physicians may not have sufficient training in handling dentofacial emergencies. The goal of this study was to systematically review the available literature on the topics of: 1) emergency department physicians’ training related to treating dental pain patients, and 2) the frequency in which they prescribe opioid medications to these patients. Methods: A systematic literature review was conducted among publications from 1985-2014 in the databases PubMed, Ovid, and Science Citation Index. The following search terms were used in this systematic literature review in order to identify the available literature of interest: “opioid and dental and emergency departments,” “dental pain and drug abuse,” “ER physicians and dental pain,” “ER physicians and drug abuse,” and “dental pain and emergency departments.” Publications in any language or country were considered, as well as editorials and commentaries. Findings: A total of 769 publications were identified. Seventeen publications met the criteria for inclusion. Eight studies commented on the emergency department physicians’ perceived “lack of training” in handling dentofacial emergencies and found that the majority of this group did not feel comfortable in managing dental patients. Nine studies assessed the frequency in which physicians prescribe pain medications to dental patients. Within these 9 studies, 5 specifically reported that between 29.6% and 81% of dental patients treated, received an “opioid” or a “narcotic” upon discharge. The remaining 4 studies in this group instead used non-specific terms that included “prescription medications,” “analgesics,” “pain medicine,” and “pharmacotherapy” to describe their findings and did not particularly report opioid prescribing trends. Of those publications rejected, 9 addressed the topic of dental pain patients presenting to non-dental providers, but did not include data that met the criteria related to emergency department prescribing frequency or physician training. Conclusions: This review of the literature suggests that emergency department physicians’ training level in treating dentofacial pain is less than ideal. It also confirms that individuals presenting to emergency departments with dental pain are a subset of the population of patients who are prescribed opioids as an analgesic. Coupling these results with the increased use of opioids in this country, dentists are in a key position to collaborate with emergency department physicians to help positively affect change. To further justify this approach, research agendas must carefully monitor prescribing patterns for dentofacial pain in the emergency department that are specific to opioid use, carefully excluding other non-narcotic analgesics. Should comparable outcomes of data related to the same topic in other non-dental settings exist, additional areas in medicine that may benefit from this partnership may also be identified. Moving forward, this interprofessional team approach may include a presence in medical school and residency program curricula so that alternative treatment options for addressing dental pain patients can be presented that consider the increased prescribing trends of opioids.

scholarly journals Linkage-to-care Methods and Rates in U.S. Emergency Department-based HIV Testing Programs: A Systematic Literature Review Brief Report

2016 ◽  
Vol 23 (7) ◽  
pp. 835-842 ◽  
Author(s):  
Aravind A. Menon ◽  
Carolyn Nganga-Good ◽  
Mikeeo Martis ◽  
Cassie Wicken ◽  
Katie Lobner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Literature Review ◽  
Hiv Testing ◽  
Systematic Literature Review ◽  
Linkage To Care

scholarly journals A Systematic Literature Review of the Burden of Ischemic Priapism in Patients with Sickle Cell Disease

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3467-3467
Author(s):  
Dave Nellesen ◽  
Sedge Lucas ◽  
Che-Rung Liu ◽  
Menaka Bhor ◽  
Jincy Paulose ◽  
...  
Keyword(s):  
Emergency Department ◽  
Erectile Dysfunction ◽  
Sickle Cell Disease ◽  
Literature Review ◽  
Sexual Function ◽  
Sickle Cell ◽  
Systematic Literature Review ◽  
Economic Burden ◽  
Emergency Department Visits ◽  
Cell Disease

INTRODUCTION: Ischemic or low-flow priapism is a serious condition characterized by a persistent, painful erection that lasts at least 4 hours or is unrelated to sexual stimulation. Both stuttering (repeated short episodes) and fulminant (long-lasting) priapism are prevalent in men and boys with sickle cell disease (SCD). Approximately 40% of patients with SCD will experience priapism during their lifetime. The objective of this study was to conduct a systematic literature review (SLR) to identify published studies reporting the burden associated with priapism in patients with SCD. METHODS: MEDLINE, Embase, Cochrane CENTRAL/CDSR and 14 congresses were searched from May 9-16, 2019. Results were screened against predefined criteria by two independent researchers. Studies assessing the clinical, humanistic, or economic burden of human patients with SCD and priapism (N≥15) were included. Outcomes of interest included priapism-related symptoms, treatment-related complications, quality of life (QoL), and economic burden. RESULTS: The literature search identified 1236 articles; 62 full-text studies were reviewed in detail and 34 studies were included in the analysis. Most studies were retrospective observational (21), others were prospective (7 observational, 6 interventional). Study size varied widely (range: 15-10,788 patients). Of 27 studies that reported mean or median patient age, the age statistic for patients with SCD and priapism ranged from 10 to 32. Overall, 19 studies reported at least one aspect of clinical burden. Thirteen reported the rate of erectile dysfunction or impotence, ranging from 0% to 56%. Eight reported treatment-related complications, including perceived penile scarring/deformity (19.4%) and small intrapenile hematoma (13.3%). Nineteen studies reported QoL outcomes. Eight reported physical outcomes, including a negative impact of SCD-related priapism on sleep quality and worse scores on periodic limb movement and apnea hypopnea indices. Seven reported measures of sexual function, including low rates of satisfactory sexual intercourse. One study reported a diminished Sexual Health Inventory for Men score in patients with active priapism, and another found a statistically significant relationship between stuttering priapism and premature ejaculation. Three studies reported measures of mental function, one of which outlined increased cognitive fatigue and impaired emotional functioning among children with priapism and another reported that 36% of patients had substantial to very extreme worry regarding episodes of priapism. Use of validated measures for QoL were limited: 3 studies assessed patients with the International Index of Erectile Function (IIEF) and 1 with the Priapism Impact Profile (PIP). No studies measuring the burden to caregivers of pediatric patients with priapism were identified. Eight studies reported the economic burden of priapism in patients with SCD, including rates of emergency department visits (4 studies: 56.5% sought hospital treatment - 26/46; 49.8% admission to the hospital out of emergency department visits - 5371/10,788; 50.4% admitted at the emergency department - 930/1844; 26% vs. 11% readmission vs no readmission - p <0.001) and hospital length of stay (4 studies: mean 3.38 days; mean 3.8 days; median 2 days; median 5 days in patients who received an exchange transfusion as a treatment for priapism.). Three studies reported direct treatment costs, ranging from a mean of $4496 (2015 USD) for patients who did not undergo penile operations to a mean of $19,670 (2013 USD) total adjusted hospital costs for patients receiving both transfusions and urologic procedures. CONCLUSIONS: This SLR identified 34 studies reporting the burden of priapism in patients with SCD. No RCTs were identified. The use of comprehensive or validated measures of humanistic burden was limited. Manifestations of priapism are wide-ranging, including painful treatment-related complications, impaired sleep, and diminished physical, mental and sexual function. Patients with priapism and SCD are more likely to visit the emergency department and experience longer hospital stays compared to SCD patients without priapism. Together, the evidence identified in this SLR indicates that priapism not only can result in erectile dysfunction, but can impair multiple dimensions of a patient's physical and mental health. Disclosures Nellesen: Analysis Group, Inc.: Consultancy. Lucas:Analysis Group, Inc.: Consultancy. Liu:Analysis Group, Inc.: Consultancy. Bhor:Novartis: Employment, Equity Ownership. Paulose:Novartis Pharmaceuticals Corporation: Employment.

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