scholarly journals Changing Trends in Eye-Related Complaints Presenting to the Emergency Department in Beirut, Lebanon, over 15 Years

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Haytham I. Salti ◽  
Carl-Joe Mehanna ◽  
Bachir Abiad ◽  
Nicola Ghazi ◽  
Samih Raad ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ocular Trauma ◽  
Medical Center ◽  
Third Party ◽  
Health Policies ◽  
Eye Injuries ◽  
Public Health Policies ◽  
Eye Trauma ◽  
Changing Trends ◽  
Ed Visits

Objective. To report the 15-year trend in ophthalmic presentations to the emergency department (ED) at the only medical center in Lebanon that provides 24-hour ophthalmologic care. Methods. Retrospective review of 1967 patients presenting to the ED with eye-related complaints between September 1997 and August 1998 and between September 2012 and August 2013. Diagnoses were classified into 4 categories according to the International Society of Ocular Trauma and include penetrating eye injuries, nonpenetrating eye trauma, nontraumatic ophthalmic emergencies, and nontraumatic, nonurgent ophthalmic conditions. Results. One thousand sixty eye-related presentations out of 39,158 total ED visits (2.71%) presented in 1997 compared to 907 out of 46,363 in 2012 (1.96%). Penetrating and nonpenetrating eye emergencies decreased between 1997 and 2012 (7.17% to 4.19%, p=0.003 and 52.64% to 29.00%, p<0.001, resp.) while nonurgent cases increased from 30.19% to 53.47% (p<0.001). 57% of patients were covered by third-party guarantors in 1997 versus 73% in 2012. Conclusion. Our results demonstrate a significant increase in nonurgent cases in parallel with the proportion of third-party payers, an issue to be addressed by public health policies and proper resource allocation. A detailed nationwide review is needed to make solid recommendations for the management of ophthalmologic presentations in the ED.

scholarly journals Changing trends in ocular trauma during the COVID-19 pandemic in the USA

2021 ◽  
pp. bjophthalmol-2021-319627
Author(s):  
Omar A Halawa ◽  
David S Friedman ◽  
Ana M Roldan ◽  
Nazlee Zebardast
Keyword(s):  
Emergency Department ◽  
Ocular Trauma ◽  
Multiple Comparisons ◽  
Work Environments ◽  
Annual Number ◽  
Orbital Fractures ◽  
Bonferroni Correction ◽  
Eye Injuries ◽  
Changing Trends ◽  
The Usa

Background/aimsThe COVID-19 pandemic has been associated with a decline in emergency department (ED) presentations for trauma. The purpose of this study is to compare the estimated number and characteristics of eye injuries in 2020, the year of the COVID-19 pandemic, to those in 2011–2019.MethodsA stratified probability sample of US ED-treated eye injuries was used to calculate the estimated annual number and incidence of these injuries in 2020, the year of the pandemic, and 2011–2019 (prepandemic years). Two-sample t-tests and Pearson χ2 were used to assess differences in demographics and injury characteristics. For multiple comparisons, Bonferroni correction was applied.ResultsThe estimated number of ED-treated eye injuries per year was 152 957 (95% CI 132 637 to 176 153) in 2020 and 194 142 (95% CI 191 566 to 196 401) in 2011–2019. The annual incidence of ED-treated eye injuries was lower in 2020, at 46 per 100 000 population than in 2011–2019, at 62 per 100 000 per year (p<0.001). In 2020 vs 2011–2019, there was a higher incidence of ruptured globes (0.5 per 100 000 vs 0.3 per 100 000 per year, p<0.001), hyphemas (0.6 per 100 000 vs 0.4 per 100 000 per year, p<0.001), lacerations (1.0 per 100 000 in 2020 vs 0.8 per 100 000 per year, p<0.001) and orbital fractures (0.3 per 100 000 vs 0.03).ConclusionThe estimated incidence of eye injuries presenting to the ED was significantly lower in 2020 than in 2011–2019, but there was a higher estimated incidence of severe eye injuries. Changes in living and work environments due to the COVID-19 pandemic were likely associated with the differences in ocular trauma presentations observed in this study.

scholarly journals Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

2021 ◽  
Vol 18 (2) ◽  
pp. 486
Author(s):  
Pavani Rangachari ◽  
Jie Chen ◽  
Nishtha Ahuja ◽  
Anjeli Patel ◽  
Renuka Mehta
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Childhood Asthma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Primary Research ◽  
Ed Visits ◽  
The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

scholarly journals P108: Alcohol-related emergency department visits by youth aged 12-24: trends over 4 years in one Canadian centre

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S103-S104
Author(s):  
H. Murray ◽  
L. Erlikhman ◽  
T. Graham ◽  
M. Walker
Keyword(s):  
Emergency Department ◽  
Alcohol Use ◽  
Standard Form ◽  
High Volume ◽  
Emergency Department Visits ◽  
Third Party ◽  
Mental Health Issue ◽  
Other Substances ◽  
Ed Visits ◽  
Injury Reporting

Introduction: Recent evidence shows an increase in alcohol-related emergency department (ED) visits among youth. Highly publicized collegiate rituals such as Homecoming may create a climate for problematic alcohol use. This study describes the frequency of youth alcohol-related ED visits per year and during pre-specified ritualized drinking dates in one academic centre. Methods: This was a chart review of patients aged 12-24 with alcohol-related ED presentations between Sept 2013-Aug 2017. The National Ambulatory Care Reporting System (NACRS) database was searched for visits with ICD-10 codes related to alcohol. The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) database was also searched using the keyword alcohol. Duplicate visits were removed. Visits were excluded if patients had a history of psychosis, were held in the ED for involuntary psychiatric assessment, were homeless, were inmates from a correctional institute, if alcohol use was not mentioned and for complaints of sexual assault/domestic violence. Data abstraction by two reviewers used a standard form with variables predetermined. Differences were resolved with third party adjudication. Interrater reliability of the reviewers was assessed through duplicate review of 10% of randomly selected charts. A further 10% were assessed by a 3rd reviewer for extraction accuracy. Results: A total of 3,256 ED visits were identified with 777 meeting exclusion criteria. The remaining 2,479 visits were reviewed and subclassified into injury (51.8%), acute intoxication (45.1%) and mental health issue (3.2%). Interrater agreement was high for extracted variables with Kappa scores > 0.8. Despite a decrease in the region's youth population during the study period (28,325 to 25,125), overall standardized ED visits by youth increased by 12% (66,538 to 78,129). Adjusted for population, youth alcohol-related visits increased by 86.4% from 1,557 in 2013-14 to 2,902 in 2016-17. Co-ingestion of other substances was reported in 292 (11.8%) of visits, with cannabis the most common (57%). The 17 pre-specified ritualized days saw 578 (23.3%) of ED visits. Conclusion: Alcohol-related ED visits in youth are increasing in our region. Ritualized drinking dates appear to be particularly risky for youth with high rates of observed ED utilization. Strategies to manage high volume ritual days are being piloted, including temporary diversion to an in-hospital sobriety centre.

Domestic Ocular Injuries: A Case Series

2007 ◽  
Vol 17 (4) ◽  
pp. 654-659 ◽  
Author(s):  
M. Reza Mansouri ◽  
A. Mirshahi ◽  
M. Hosseini
Keyword(s):  
Emergency Room ◽  
Ocular Trauma ◽  
Case Series ◽  
High Rate ◽  
Ocular Injury ◽  
Eye Injury ◽  
Eye Injuries ◽  
Female Ratio ◽  
Severe Visual Loss ◽  
Eye Trauma

Purpose To determine the nature and types of domestic eye injuries. Methods The authors prospectively analyzed data of 100 consecutive patients with domestic eye injury (104 eyes) referred to the emergency room of Farabi Hospital during October 2003. Standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology) was used for eye injury classification. Results Domestic ocular trauma represented 4.85% of all ocular emergencies (2061 patients) referred to the emergency room during that period. Male to female ratio was 1.13 and mean age of patients was 26±18 years (range, 1–73). Cornea was involved in 50.0% and sclera, lens, and retina each was involved in 4.8%. There was severe visual loss (best-corrected distance visual acuity <20/200 due to trauma) in 4% of the patients. The most frequent domestic ocular injury was globe injury (93.7%) including mechanical (72.1% closed and 4.8% open), chemical (14.4%), and thermal (1.9%) injuries. Conclusions Closed mechanical injuries were the most common type of domestic ocular injury in our series. Considering the high rate of domestic eye trauma among ocular emergency cases, more preventive measures should be taken at home.

scholarly journals Impact of the COVID19 Pandemic on Admissions and Emergency Department Visits of Adults with Sickle Cell Disease

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 37-38
Author(s):  
Alice J. Cohen
Keyword(s):  
Emergency Department ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Medical Center ◽  
Cell Disease ◽  
Face To Face ◽  
Outpatient Visits ◽  
Pain Medications ◽  
Time Period ◽  
Ed Visits

Background: The most common complication of sickle cell disease (SCD) in adults is vaso-occlusive crisis that is characterized by severe pain. These events can often be managed at home with oral analgesics, but if the pain is not controlled or the patient develops other associated problems, they seek care in an emergency department (ED). In the ED, they receive initial treatment with pain medications and are assessed for other complications such as infection and acute chest syndrome. If an individual's pain is not controlled in a short period of time, the majority of these patients are admitted to the hospital for inpatient management or placed in an observation unit (OBs) for 6-47 hours. The COVID-19 pandemic affected the Greater Newark community starting in mid March with the majority of all inpatient admissions (Ads) being COVID related through the end of May. It has been observed both at our medical center and nationally that during this time period and even afterwards, the number of ED visits and Ads had significantly fallen. The reasons for this finding may include fear of contracting COVID infection at the hospital, regular telemedicine (TM) calls to facilitate outpatient management, and an increase in the number of prescriptions of home pain medications. The purpose of this analysis was to examine patterns of ED visits, Ads, outpatient visits, prescription renewals and nurse (RN) and social worker (MSW) calls in order to determine the impact of COVID-19 infection on the local SCD community. Methodology: A retrospective review was undertaken of billing data and the EMR of all patients with SCD treated at Newark Beth Israel Medical Center (a 450 bed community-based academic tertiary care medical center) between January 2020 and June 2020. Data collected included the number of and reason for ED and OBs, Ads, the number of TM and outpatient visits, and MSW and RN telephone contacts. All patients 18 years of age and older were included. Overall, 100 adults with SCD received care between January and June. Results: Peak hospital COVID Ads, ED and OBs for all patients (SCD and non-SCD) occurred during the weeks between March 25 and May 24, 2020 with a daily inpatient census over 200 between April 7 and 24. SCD Ads at peak COVID (April-May) were significantly lower at 26±2/month compared to 64±11/month pre-COVID (January-February) (p= 0.04). ED and OBs were unchanged. During the peak of COVID, 10/93 (11%) SCD Ads (1 death) were COVID related with 80/96 (86%) for uncomplicated pain crises. MSW and RN called all patients proactively to offer support at onset of COVID pandemic. During this same time period, the number of MSW telephone contacts increased from 138±37/month pre-COVID to 372±21/month during COVID (p=0.02). RN contacts with SCD patients were stable and mostly were for pain prescription renewals. TM was initiated in March 2020 and an increase in these visits correlated with a fall in face to face physician visits: 83.5±11/month pre-COVID to 39.5±8/month peak COVID (p= 0.04), and TM 0/month pre-COVID and 31±4/month peak COVID (0.01). Conclusion: The outbreak of COVID-19 in the community reduced the number of Ads for patients with SCD without an increase in ED and OBs visits. MD face-to-face encounters were reduced but outpatient care continued with the initiation of TM, regular RN contact with maintenance of pain medication prescriptions and a greater numbers of MSW calls for psychosocial support. Further investigation and understanding of the use of Ads for SCD care, and the reduction during COVID, may have implications for current SCD management. Disclosures Cohen: GBT: Speakers Bureau.

scholarly journals Trends in emergency department visits in Lubbock from 2011-2017

2019 ◽  
Vol 7 (27) ◽  
pp. 50-54
Author(s):  
Sarah Jaroudi ◽  
Shengping Yang ◽  
Gilbert Berdine
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Emergency Department Visits ◽  
Local Data ◽  
Factors Affecting ◽  
Long Term Trends ◽  
Ed Visits ◽  
Day Of The Week ◽  
Relationship Of

To determine trends in daily emergency department (ED) visits, a preliminary retrospective study was done to analyze the relationship of long-term trends, day of week, and month of year to ED volume at University Medical Center in Lubbock, TX. Local data were collected from January 1, 2011, through December 31, 2017. An increase in ED visits from 2011 to 2014 was followed by a decrease in ED visits from 2014 to 2017. The best fit third order polynomial was “ ” with y=number of ED visits and x=cumulative day. The busiest day of the week was Monday with an average of 235.6 visits per day. Throughout the week, ED visits decreased to a minimum value of 201.9 visits per day on Saturday. The differences between each day of the week were significant (p < 0.001). Seasonal trends were present with peaks during February and September. The differences among months were significant (p < 0.001).  The total variance of the ED visit data was decreased after adjusting for the long-term trend, day of week, and month of year. These adjustments remove noises not relevant to the study goal and are necessary for further studies testing hypotheses about factors affecting ED visits that may not be uniformly distributed over time. 

Validation of a modified Birmingham Eye Trauma Terminology classification for mechanical eye injuries

Trauma ◽  
2017 ◽  
Vol 20 (3) ◽  
pp. 217-220 ◽  
Author(s):  
Mehul Shah ◽  
Shreya Shah ◽  
Rupesh Agrawal ◽  
Kashyap Patel
Keyword(s):  
Cohort Study ◽  
Foreign Body ◽  
Ocular Trauma ◽  
Eye Injuries ◽  
Eye Trauma ◽  
Globe Rupture ◽  
Wide Range ◽  
The World ◽  
Type Of Injury

Introduction Criticisms have been levelled at the widely accepted Birmingham Eye Trauma Terminology (BETT) classification of mechanical ocular trauma, as it is not specific enough. Alternative modifications to the BETT have been proposed and this study aimed to assess these newer classifications. Methods A prospective cohort study of all patients presenting to the outpatient department between January 2005 and December 2014, who were examined and categorised based on the BETT. Cases which did not comply with the BETT system were placed in additional categories, and documented for each type of injury. Results A total of 4721 eyes suffered mechanical injuries and 1060 (22.4%) could not be classified with BETT, including 368 globe injuries (7%) associated with orbital/ocular adnexa injury; 692 eyes (14.6%) with ocular surface foreign body (OSFB) or ocular wall foreign body (IWFB). There were 77 eyes (1.6%) with contusion, 9 eyes (0.19%) with lamellar laceration-associated OSFB or OWFB, 29 eyes (0.6%) with globe rupture-associated OSFB, OWFB or intraocular foreign body (IOFB) and 60 eyes (1.4%) with laceration-associated OSFB or OWFB. Conclusion The BETT needs modification to be fully applicable to the wide range of ocular trauma seen across the world.

scholarly journals Evaluation of Penicillin Allergy Prevalence and Antibiotic Prescribing Patterns for Patients within the Emergency Department

2021 ◽  
Vol 1 (S1) ◽  
pp. s38-s38
Author(s):  
Ashlyn Norris ◽  
Lindsay Daniels ◽  
Nikolaos Mavrogiorgos ◽  
Kalynn Northam ◽  
Mildred Kwan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
The United States ◽  
Penicillin Allergy ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Point Of Entry ◽  
Lactam Antibiotic ◽  
Ed Visits ◽  
Allergy Prevalence

As the point of entry into healthcare for many patients, the emergency department (ED) is an ideal setting in which to assess penicillin (PCN) allergies. An estimated 10% of the United States population has a reported PCN allergy; however, few studies have evaluated the prevalence and impact of PCN allergies on antibiotic selection within the ED. Patients with a documented PCN allergy are more likely to be exposed to costly alternative broad-spectrum antibiotics that have higher rates of adverse events, including C. difficile infections. We sought to determine the prevalence of PCN allergies within the UNC Medical Center ED. Key secondary outcomes included the percentage of patients with a documented PCN allergy who (1) received alternative antibiotics (carbapenems, aztreonam, fluoroquinolones, clindamycin, vancomycin), (2) received β-lactam antibiotics and experienced an allergic reaction during their ED visit, and/or (3) had received a β-lactam antibiotic during a past hospitalization or ED visit without their chart being appropriately updated. A retrospective evaluation included patients aged >18 years with a documented PCN allergy who were discharged from the ED between January 1, 2017, and December 31, 2019. Over the study period, there were 14,635 patient encounters with a documented PCN allergy that comprised 8,573 unique patients. The prevalence of PCN allergies was 14.3% for all ED encounters. PCN allergy–labeled patients received alternative antibiotics in 59.4% of ED encounters in which antibiotics were prescribed. Of the 454 β-lactam antibiotics (62 penicillins, 380 cephalosporins, 12 carbapenems) administered to PCN allergy-labeled patients within the ED, there were zero allergic reactions. Also, 18.6% of PCN allergy-labeled patients had received and tolerated a β-lactam antibiotic during prior hospitalizations or ED visits (1.7% penicillins, 14.4% cephalosporins, 2.6% carbapenems) without appropriate updated documentation to reflect β-lactam antibiotic tolerance. These findings confirm the utilization of non–β-lactam antibiotics in PCN allergy-labeled patients, highlighting the importance of accurate and updated allergy documentation in the electronic medical record. These findings also demonstrate the need for improved allergy documentation and protocols to proactively assess penicillin allergy labels while in the ED.Funding: NoDisclosures: None

scholarly journals P041: Patient perspectives on emergency department use for acute atrial fibrillation: a qualitative study using the theoretical domains framework

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S71-S71 ◽  
Author(s):  
D. Eagles ◽  
W.J. Cheung ◽  
E. Lee ◽  
T. Tang ◽  
I.G. Stiell
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Hospital Admissions ◽  
Theoretical Domains Framework ◽  
Patient Perspectives ◽  
Third Party ◽  
Structured Interviews ◽  
Management Options ◽  
Ed Visits ◽  
Belief Statements

Introduction: Acute atrial fibrillation (AAF) is the most common arrhythmia managed in the Emergency Department (ED). Direct costs of AAF are primarily attributed to ED visits and subsequent admission to hospital. A better understanding of patients attitudes regarding ED attendance is necessary to develop strategies to improve the patient care experience while simultaneously reducing ED presentation and inappropriate hospital admissions. This study aims to describe patient perspectives on ED use for AAF using in-depth qualitative interviews. Methods: An interview template designed to explore why patients attend the ED for AAF was constructed based on the Theoretical Domains Framework, a theory-informed approach that utilizes 14 domains to describe influencers of behavior. We conducted audio-recorded, semi-structured interviews of patients following their presentation to the ED for management of AAF. Interviews were anonymized, transcribed and imported into NVivo for coding and analysis. Two independent reviewers used a direct approach to code participant statements. Discrepancies were resolved by a third party. Belief statements were generated and relevant domains identified based on high frequency scores, conflicting belief statements or evidence of strong influencing beliefs. Results: 12 patient interviews, mean age 63.1 years, 91.7% male, 75.0% recurrent AAF, were completed. Patients stated that they attended the ED because: 1) symptom severity; 2) they were instructed by physicians to attend the ED should their AAF recur; and 3) they were encouraged by family members to attend. Their primary goal was to have relief of their symptoms. There was no expectation of specialist consultation or admission to hospital. Even though most patients stated they were open to managing these episodes independently, they reported that they did not have the knowledge or tools to do so. Conclusion: Patients with AAF present to the ED because of their symptom burden, social influences (physician and family) and lack of other management options. This study demonstrates the need for development of patient self-management strategies which will empower patients in their disease management and may decrease future ED visits.

scholarly journals P005: Consultations in the emergency department: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S79
Author(s):  
C. Alexiu ◽  
L. Gaudet ◽  
B.H. Rowe
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Literature Search ◽  
Third Party ◽  
Measure Data ◽  
Common Component ◽  
Median Proportion ◽  
Care Consultation ◽  
Ed Visits ◽  
Ed Crowding

Introduction: Consultation in the emergency department (ED) is a common component of emergency health care. Consultation is defined as a case in which an ED physician (EP) requests the services of another physician (consultant) for an ED patient to assist, advise, and/or transfer care when the care required is beyond the expertise of the EP’s practice. While consultation is generally considered required and beneficial for patient care, consultation can also have a negative impact by incurring delays in patient flow and disposition. These delays contribute to ED crowding, patient dissatisfaction and, in some cases, worse health outcomes. Using an a priori protocol and accepted methodology, the aim of this systematic review was to update a previous review on the same topic and determine the proportion of 1) ED visits that involve consultation and 2) consultation cases that result in admission. PROPSPERO registration number: CRD42017054054. Methods: Literature search involved multiple electronic databases (e.g., MEDLINE and EMBASE) and grey literature (e.g., Google Scholar and conference abstracts). Study selection was conducted independently by two reviewers and determined by consensus among the two reviewers with disagreements resolved by a third party. Data extraction was conducted independently by two reviewers and determined by consensus among the two reviewers with disagreements resolved by a third party. A descriptive analysis was conducted. Outcome measure data were aggregated and reported with suitable descriptive statistics such as raw or weighted mean, median, or proportion with 95% confidence interval. Results: Literature search yielded 1,584 studies, of which 65 were included. Two-thirds of studies were conducted in USA or Canada. Of the 65, 54 were focused on a particular patient group or consulting specialty (e.g., psychiatry) while 11 considered the general ED population. Of these 11, the median proportion of ED visits involving consultation was 26%. The median proportion of cases with consultation that resulted in admission was 60%. Conclusion: Consultations in the ED are quite common and many of these cases result in admission. Given their frequency of occurrence and increasing ED crowding, efforts to reduce consult delays and expedite disposition appear warranted.

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