scholarly journals Common Presenting Problems for Young People Attending the Emergency Department

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Dhurgshaarna Shanmugavadivel ◽  
Rebecca Sands ◽  
Damian Wood
Keyword(s):  
Emergency Department ◽  
Young People ◽  
Clinical Pathways ◽  
University Hospital ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Presenting Problems ◽  
Self Harm ◽  
The Common ◽  
One Year

Objective. To determine the common presenting problems for young people attending the emergency department. Design. A retrospective review of electronic patient records of all young people between the ages of 13 and 17 who attended a UK University Hospital ED between 07/02/2007 and 06/02/2008 (n=10455). Results. All emergency department attendances for young people over a one-year period were studied in order to determine the common presenting problems. There were a total of 10455 attendances by 8303 young people. The presenting problem in 7505 (71.8%) was classified as injury. Of the remainder the commonest presenting problems reported for young people were abdominal pain (480, 16.3%), self-harm (314, 10.6%), fits, faints and funny turns (308, 10.4%), breathing difficulty (213, 7.2%), and intoxication (178, 6.0%). Ten presenting problems accounted for 72% of noninjury related attendances. Conclusions. Clinical guidelines and pathways developed for young people attending the emergency department should target the commonest presenting problems. In our cohort ten presenting problems account for almost three-quarters of all noninjury attendances for young people. The presenting problems are different to those described in younger children in previous studies. These results will inform the development of clinical pathways in order to improve emergency care.

scholarly journals Psychosocial and Clinical Profiles of the Cases Visiting the Emergency Department Due to Accidental Self-harm and Suicide Attempts in Doha, Qatar: A Retrospective Study

2020 ◽  
Author(s):  
Hassen Al-Amin ◽  
Rajvir Singh ◽  
Mohamad Abdulrazzak ◽  
Suhaila Ghuloum
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Suicide Attempts ◽  
Comprehensive System ◽  
Completed Suicide ◽  
Suicide Intent ◽  
Self Harm ◽  
Clinical Profiles ◽  
The Common ◽  
One Year

Abstract The aims of this study were to retrospectively assess the profiles of subjects with suicide attempts and self-harm in Doha, Qatar; and whether the available data were complete. We reviewed all the records of fatal and non-fatal suicides together with accidental self-ham cases seen in the major Emergency Department in Doha, over a one-year period. There was 37 completed suicide, mostly male expatriates in mid 30 s who died by hanging. In cases with suicide intent (N = 270), more males were admitted to Psychiatry than women. Overdose was the common method and the majority had mood disorders. In self-harm cases with no suicide intent (N = 150) the majority were not seen by Psychiatry. The profiles of suicide cases in Qatar are similar to those reported internationally. However, there is a major need to establish a comprehensive system to register and assess all self-harm patients in Qatar.

Deliberate self-harm in young people: attendance at a paediatric emergency department

2009 ◽  
Vol 26 (3) ◽  
pp. 114-118 ◽  
Author(s):  
Sophia Morgan ◽  
Sinead Byrne ◽  
Carole Boylan ◽  
Stephen McLearie ◽  
Carol Fitzpatrick
Keyword(s):  
Emergency Department ◽  
Young People ◽  
Medical Records ◽  
Risk Group ◽  
High Risk Group ◽  
Deliberate Self Harm ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Appropriate Treatment ◽  
Self Harm

AbstractObjectives: Deliberate self-harm (DSH) is the strongest predictor of suicidal behaviour. This retrospective study reviewed all DSH presentations to our Paediatric Emergency Department between 2002-2006.Method: Using database and medical records we profiled these presentations. Data was coded and statistically analysed.Results: There were 253 DSH attendances. Twenty-four percent were living in care, 15% were under 12 years and 14% presented more than once. Overdoses (61%) were more common than cutting (16%) and 56% had a psychiatric condition.Conclusions: DSH presents an ongoing challenge to child and adolescent mental health services and those working in suicide prevention. Identifying the characteristics of these young people is essential to providing appropriate treatment for this high-risk group.

scholarly journals Clinical pathways for suicidality in emergency settings: a public health priority

2017 ◽  
Vol 41 (2) ◽  
pp. 182 ◽  
Author(s):  
Kay Wilhelm ◽  
Viola Korczak ◽  
Tad Tietze ◽  
Prasuna Reddy
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Standard Treatment ◽  
Clinical Pathways ◽  
Health Issue ◽  
Public Health Issue ◽  
Treatment Pathways ◽  
Self Harm ◽  
Psychiatric Conditions ◽  
The Difference

Rates of self-harm in Australia are increasing and constitute a concerning public health issue. Although there are standard treatment pathways for physical complaints, such as headache, abdominal pain and chest pain, in Emergency Medicine, there is no national pathway for self-harm or other psychiatric conditions that present to the emergency department. Herein we outline the difference between clinical practice guidelines and clinical pathways, discuss pathways we have identified on self-harm in Australia and overseas and discuss their applicability to the Australian context and the next steps forward in addressing this public health issue.

scholarly journals Emergency Department Re-Presentations Following Intentional Self-Harm

2021 ◽  
Author(s):  
◽  
Silke Kuehl
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Suicide Attempts ◽  
Assessment Tool ◽  
Consumer Involvement ◽  
Mental Health Consultation ◽  
Care Needs ◽  
Admission Rates ◽  
Self Harm ◽  
One Year

<p>Repeat intentional self-harm (ISH) episodes are strongly correlated to suicide. Intentional self-harm for this thesis includes suicide attempts, deliberate self-harm and suicidal ideation. The aim was to describe what factors contribute to people re-presenting to the emergency department (ED) within one week of a previous visit for intentional self-harm. Objectives identified were to describe the people using demographic and clinical features; describe and evaluate ED management; and identify possible personal or system reasons as to why people re-present to ED within one week. A retrospective observational design was selected for a period of one year. The data was collected from electronic clinical case notes. The sample consisted of 48 people with 73 presentations and re-presentations. Descriptive and inferential analyses were undertaken using the Statistical Programme for Social Science (SPSS). Missing data limited the number of inferential analyses. Outcome measures were divided into information regarding the person and the presentation. This study made several discoveries: many representations (55%) occurred within one day; the exact number of people who represented many times to ED is unknown, but is far higher than reported in other studies; fewer support people were present for the second presentation; the documentation of triage and assessments by ED staff was often minimal, though frequently portrayed immense distress of this population; cultural input for Maori was missing; physical health complaints and psychosis were found with some intentional self-harm presentations; challenging behaviours occurred in at least a quarter of presentations; and the medical and mental health inpatient admission rates were approximately 50% higher for second presentations. Recommendations in regard to the use of a triage assessment tool, the practice of reviewing peoples' past presentations and the need for a mental health consultation liaison nurse in ED are made. Staff education, collaboration between services with consumer involvement and further research of this group are required. This study supports the need for holistic and expert care for people who present ED with intentional self-harm. Such care needs to be provided in a safe way with the intent on reducing the distress experienced by people who intentionally self-harm.</p>

scholarly journals The impact of the COVID-19 pandemic on referrals to liaison psychiatry services at University Hospital Hairmyres, NHS Lanarkshire

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S46-S47
Author(s):  
Cristina Paton ◽  
James Hills ◽  
Rekha Hegde
Keyword(s):  
Community Services ◽  
University Hospital ◽  
Direct Result ◽  
Secondary Effects ◽  
Liaison Psychiatry ◽  
Nursing Service ◽  
Self Harm ◽  
Local Emergency Department ◽  
One Year ◽  
The Impact

AimsThe COVID-19 pandemic has led to sweeping public health restrictions with predictable impact on mental health. In Scotland, lockdown measures during the first wave of the pandemic commenced on 23rd March 2020 and only began to ease after 29th May 2020. The aim of this study was to evaluate the impact of the first wave of the COVID-19 pandemic on the number and type of referrals made to the adult psychiatric liaison nursing service (PLNS) at University Hospital Hairmyres, NHS Lanarkshire.MethodWe collated all of the archived referrals made by our local emergency department to the PLNS at University Hospital Hairmyres for adults (aged 18–65 years) during the period of the first COVID-19 national lockdown (April-July 2020) and the corresponding period one-year prior (April-July 2019) to analyse differences in referral numbers and demographics. Additionally, for referrals made during 2020, we conducted a qualitative review of electronic records to determine the reason for referral, contributory stressors to presentation, and in particular any effect from COVID-19.ResultA total of 549 referrals were made over the study period, with 320 in 2019 and 229 in 2020, a decrease of almost 30%. In 2019, referrals fell each month from April (n = 89) to July (n = 74), while this trend was reversed in 2020, rising from April (n = 45) to near-usual levels by July (n = 68). Compared to baseline, referrals in April 2020 were for a higher proportion of men (62.2%). On qualitative analysis, 26 records (11.3%) could not be found. Otherwise, the most common reasons for referral were suicidal ideation (43.3%) and/or deliberate self-harm (39.9%). Many patients presented with comorbid substance misuse (54.2%) and the majority were not known to community services (64.5%). COVID-19 was implicated in 48 referrals (23.6%), but only 2 of these arose as a direct result of infection.ConclusionWe have observed clear differences in the pattern of referrals made to the adult PLNS during the first COVID-19 national lockdown. COVID-19 was implicated in a minority of referrals, but most were related to secondary effects of lockdown restrictions rather than COVID-19 infection. Possible reasons for fewer referrals during this time could be non-presentation through fears of contracting COVID-19 or altruistic avoidance of putting “pressure on the NHS”. Further studies would be insightful; in particular, equivalent analysis of contacts with community services; and qualitative patient perspectives regarding reasons for non-presentation during this time.

scholarly journals Clinical Outcome Predictive Value of Procalcitonin in Patients Suspected with Infection in the Emergency Department

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Pierre Leroux ◽  
Sébastien De Ruffi ◽  
Laurent Ramont ◽  
Marion Gornet ◽  
Guillaume Giordano Orsini ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
University Hospital ◽  
Published Data ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Discrimination Power ◽  
Clinical Presentations ◽  
Bronchopulmonary Infection ◽  
One Year

Procalcitonin (PCT) may be useful for early risk stratification in the emergency department (ED), but the transposition of published data to routine emergency practice is sometimes limited. An observational retrospective study was conducted in the adult ED of the Reims University Hospital (France). Over one year, 852 patients suspected of infection were included, of mean age 61.7 years (SD: 22.6), and 624 (73.2%) were hospitalized following ED visit. Overall, 82 (9.6%) patients died during their hospitalization with an odds ratio (OR) of 5.10 (95% CI: 2.19–11.87) for PCT ≥ 0.5, in multivariate logistic regression analyses. Moreover, 78 (9.2%) patients were admitted to an ICU, 74 (8.7%) had attributable bacteremia, and 56 (6.6%) evolved toward septic shock with an OR of 4.37 (2.08–9.16), 6.38 (2.67–15.24), and 6.38 (2.41–16.86), respectively, for PCT ≥ 0.5. The highest discriminatory values were found for patients with age <65 years, but PCT lost its discrimination power for in-hospital mortality in patients with a bronchopulmonary infection site or a temperature ≥37.8°C and for ICU admission in patients with severe clinical presentations. PCT could be helpful in risk stratification, but several limitations must be considered, including being sometimes outperformed by a simple clinical examination.

Prevalence and presentation of patients with the chief complaint “cardiac arrhythmia” – data from a large university emergency department

2020 ◽  
Author(s):  
Julia Novotny ◽  
Matthias Klein ◽  
Manuela Thienel ◽  
Stephanie Fichtner
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Cardiac Arrhythmia ◽  
Clinical Presentation ◽  
Admission Rate ◽  
Heart Rhythm ◽  
Chief Complaint ◽  
University Hospital ◽  
One Year ◽  
Electrocardiogram Ecg

Abstract Background Cardiac arrhythmias (CA) are a common chief complaint that leads to presentation at the emergency department (ED). However, data on the underlying diagnoses in patients with CA is not well studied. Our objective was to analyse the prevalence and clinical presentation of CA in the setting of an interdisciplinary ED.Methods In this retrospective study, we included all patients admitted to our ED in the Ludwig-Maximilian University Hospital in Munich within one year with the chief complaint “cardiac arrhythmia”. Subsequently cardiac rhythm in the 12-lead electrocardiogram (ECG), clinical presentation, therapy performed in the ED and in-hospital care were analyzed.Results A total of 558 out of 36.798 visitors of the ED presented with the chief complaint of CA. 42.3% of these patients indeed showed a pathologic heart rhythm on the initial ECG. The most abundant pathological ECG diagnosis was atrial fibrillation. In the pathological ECG group 60.6% and in the sinus rhythm (SR) group 39.4% of patients had to be admitted to hospital, and 34.7% with pathological ECG underwent invasive investigations (16.8% in the SR group). Conclusion Over half of our patients showed no arrhythmia on the ED ECG. The most abundant arrhythmia was atrial fibrillation. Most of the patients were stable. However, with 49.5% admission rate was quite high. This fact illustrates the need for better outpatient management of these patients. Further chief complaint CA in the ED must not be mistaken as disease specific.

Pattern of acute adult poisoning at Tikur Anbessa specialized teaching hospital, a retrospective study, Ethiopia

2010 ◽  
Vol 30 (7) ◽  
pp. 523-527 ◽  
Author(s):  
Mekonnen Desalew ◽  
Azaje Aklilu ◽  
Amare Amanuel ◽  
Melkie Addisu ◽  
Tesfaye Ethiopia
Keyword(s):  
Medical Records ◽  
Epigastric Pain ◽  
Case Fatality ◽  
Public Health Problem ◽  
Acute Poisoning ◽  
University Hospital ◽  
Important Public Health Problem ◽  
Self Harm ◽  
The Common ◽  
Suicidal Patients

Acute poisoning continues to be an important public health problem. Medical records of 116 adult patients presented to Tikur Anbessa Specialized University Hospital from January 2007 to December 2008 were reviewed retrospectively. Females outnumbered males. Mean age was 21 years. Most (96.5%) were intentional self-harm poisonings. Household cleansing agents were the leading causes of poisoning (43.1%) followed by organophosphate (21.6%) and phenobarbitone (10.3%). Loss of consciousness, vomiting and epigastric pain were the common presenting features accounting 46.2%, 23.8% and 22.5%, respectively. A total of 13(11.2%) patients had already known mental illness and 12 of them poisoned by using their own medications. Among 65 patients who reported their reason of poisoning, temporary quarrel (57%) and emotional disturbance (26%) were frequently cited. The case fatality rate was 8.6%. Death was most occurred by organophosphate (5/25) and phenobarbitone poisoning (3/12). Awareness on proper handling of chemicals and prescribed agents should be forwarded to users of these agents. Majority of patients poisoned for intentional self-harm purposes so that linkage of suicidal patients to appropriate mental health service is recommended. The availability of psychiatry consultation in the hospital is also recommended.

Punch injury self-harm in young people

2016 ◽  
Vol 22 (2) ◽  
pp. 318-325
Author(s):  
Cristal Oxley ◽  
Jane E Roberts ◽  
Sebastian Kraemer ◽  
Giles Armstrong
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
High Risk ◽  
Young People ◽  
Medical Records ◽  
Substance Misuse ◽  
Total Group ◽  
Effective Interventions ◽  
Male Preponderance ◽  
Self Harm

Punch injuries are a form of self-harm characterised by the intentional act of striking an object with a closed fist. We aimed to describe the characteristics and trends in young people presenting with injuries sustained via the punch mechanism. A comprehensive retrospective review of medical records was completed of all young people aged 10–18 years presenting to our Central London Emergency Department over a 12-month period. A subset of the total group was identified as the punch injury subgroup. A total of 78 punch injury presentations were identified. In this subgroup, the male:female ratio is 4.57:1; 37.18% of presentations were associated with a fracture ( n = 29) and 35.90% ( n = 28) of patients re-presented following another punch injury, as a victim of violence, or by other psychiatric presentation. In conclusion, a male preponderance was observed, with frequent re-presentations, often in high-risk circumstances. An opportunity for screening, including mental health, social and substance misuse, was identified. Further research is needed to enable targeted effective interventions in this group.

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