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.

scholarly journals Depression among an Immigrant Black Population of African Origin resident in Canada

2021 ◽  
Author(s):  
Deborah Aluh ◽  
Osaro Aigbogun ◽  
Obinna Anyachebelu
Keyword(s):  
Depression Scale ◽  
Black Population ◽  
Health Concern ◽  
African Origin ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Black African ◽  
Mental Health Concern ◽  
Patient Health ◽  
One Year

Abstract Background Lately, there has been a surge of black African-born immigrants to Canada. It is critical to evaluate the extent to which depression has affected this vulnerable and understudied population. Methods Participants completed the Patient Health Questionnaire (PHQ-9) depression scale. Descriptive and multivariate logistic regression analyses were carried out using IBM SPPS. Results About half (51.7%, n = 91) of the participants met the criteria for depression. Female participants had a significantly higher PHQ-9 score (10.49±4.226) compared to males (8.96± 4.119). Unmarried participants had 27.979 times the odds of being depressed compared to those who were married. Those who had stayed in Canada for more than 10 years had 62.5 times higher odds of being depressed compared to those who had stayed for less than one year. Conclusions More than half of the participants exhibited significant depressive symptoms, suggesting an important mental health concern and the need for intervention.

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.

scholarly journals SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital

2021 ◽  
Vol 17 (4) ◽  
Author(s):  
Greta Barbieri ◽  
Alessandro Cipriano ◽  
Stella Carrara ◽  
Stefano Spinelli ◽  
Francesco Cinotti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Failure ◽  
Risk Stratification ◽  
Care Setting ◽  
Small Sample ◽  
Flow Chart ◽  
University Hospital ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Pandemic Wave

SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital Background: COVID-19 patients require early treatment and admission to an appropriate care setting, considering possible rapid and unpredictable to Severe Acute Respiratory Syndrome. Objective: A flow-chart was developed by a multidisciplinary team of Emergency Department (ED) clinicians, intensivists and radiologists aiming to provide tools for disease severity stratification, appropriate ventilation strategy and hospitalization setting identification. Methods: We conducted a retrospective application of our model on 313 hospitalized patients at Pisa University Hospital including 222 patients admitted to ED for respiratory failure between March and April 2020. Risk stratification score was based on respiratory and chest imaging parameters, while management strategy on comorbidities and age.  Results: Age, comorbidities, clinical respiratory and arterial blood gas parameters, semi-quantitative chest computed tomography score were significant predictors of mortality (p<0,05). Mortality rate was higher in patients treated in intensive care units (26,5%) and undergoing endo-tracheal intubation (32,7%), compared to medical area (21,3%). We verified a good concordance (81,7%) between the proposed model and actual evaluation in ED. Outcomes analysis of subgroups of patients homogeneous for baseline features allowed to verify safety of our model: in non-elderly and/or non-comorbid patients (15% mortality) our scheme overestimates the risk in 30% of cases, but it suggests non-intensive management in patients with reduced functional reserve, elderly and with comorbidities (50% mortality). Conclusion: Correct management of respiratory failure COVID-19 patients is crucial in this unexpected pandemic. Our flow-chart, despite retrospectively application in small sample, could represents a valid and safe proposal for evaluation in ED.

scholarly journals A Comparative Study on Epidemiology, Spectrum and Outcome Analysis of Physical Trauma cases Presenting to Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital and its Outreach Centers in Rural Area

2015 ◽  
Vol 11 (3) ◽  
pp. 241-246 ◽  
Author(s):  
R Shrestha ◽  
SK Shrestha ◽  
SR Kayastha ◽  
N Parajuli ◽  
D Dhoju ◽  
...  
Keyword(s):  
Emergency Department ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Outcome Evaluation ◽  
University Hospital ◽  
Mortality And Morbidity ◽  
Physical Trauma ◽  
Fall From Height ◽  
Set Up ◽  
One Year

Background Physical trauma is one of the major cause of mortality and morbidity among young and active age group and its increasing trend is of main concern. There are only few studies concerning the spectrum of physical trauma in Nepal. Objective This study aims to evaluate the epidemiological spectrum, the extent, severity of the physical trauma and the outcome evaluation of patients with physical trauma over a period of one year in the emergency department of the Kathmandu University Hospital and compare the same parameters with those patients presenting to the various outreach centers of the hospital in the community. Methods Patient treatment files from the emergency department and the reports from various outreach centers were retrieved for a period of one year (May 2011 to April 2012). Epidemiological information, mode, type and anatomic location of injuries were recorded. Outcome evaluation was assessed by number of patients discharged from emergency department of the hospital or the outreach centers after the treatment, patients admitted for inpatient management and referred to other centers for further specialty management. Result In a period of one year, total 2205 (20%) of physical trauma cases presented to the emergency department and 1994 (6.12%) in the outreach centres. Most commonly involved age group in physical trauma both in Hospital set up and in Community set up were the young adults (15 to 49 years). Fall from height was the commonest mode of injury followed by road traffic accidents among the patients coming to the hospital while significant number of trauma patients coming to outreach centers were due to fall from height. In the hospital set up, 1525 (69.2%) of the cases were discharged while 537 (24.4%) needed inpatient management and 85 (3.8%) needed referral to other centers for the specialty management. In case of outreaches, half of the patients were discharged after the primary treatment and almost another half were referred to the hospital, mainly for need of further investigations. Conclusion Fall related injuries and road traffic accidents are the most common mode of trauma in the hospital set up and fall related injuries are the single most important mode of trauma seen in the outreaches. Mostly young adults in their active period of life are involved in physical trauma so appropriate preventive measures through public health approach should be included in comprehensive trauma management for reducing mortality and morbidity rates related to physical trauma. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12513 Kathmandu Univ Med J 2013; 43(3):241-246

scholarly journals Clinical profiles of patients within the Mental Health Service in Qatar

2020 ◽  
Vol 5 (11) ◽  
Keyword(s):  
Emergency Department ◽  
Wide Spectrum ◽  
Language Translation ◽  
Bipolar Affective Disorder ◽  
Psychiatric Evaluation ◽  
Clinical Presentations ◽  
Common Diagnosis ◽  
Clinical Profiles ◽  
One Year ◽  
Psychiatric Problems

Aim: The aim of this study was to explore the clinical profile of patients referred to the only dedicated Psychiatry Hospital in Qatar over a one-year period in order to understand the clinical needs of these patients. Methods: We examined, retrospectively, the records of patients who presented to the Emergency Department in Hamad General Hopsital with psychiatric problems and needed psychiatric assessment in the period between 1st of June 2015 to 31st of May 2016. We reviewed the records of 870 patients within one year from both electronic records and paper records. Results: Patients from 48 different nationalities presented to the Emergency Department with a psychiatric presentation. Patients who presented spoke 22 different languages. Clinical presentations covered a wide spectrum of stress related disorders. The most common diagnosis was bipolar affective disorder, depressive disorder and schizophrenia. Conclusion: This study gives a window into the clinical profiles of those who present with acute mental illness and highlights some risk factors to be aware of in treating such patients. The variety of cultures and languages of patients is important to recognize and emphasizes the ongoing need for adequate language translation for appropriate psychiatric evaluation of these patients.

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 Reasons for Surgery Cancellation in a General Hospital: A 10-year Study

2018 ◽  
Vol 16 (1) ◽  
pp. 7 ◽  
Author(s):  
Hyun-Sun Cho ◽  
Ye Lee ◽  
Sang Lee ◽  
Ji Kim ◽  
Tae Kim
Keyword(s):  
Logistic Regression ◽  
Odds Ratio ◽  
High Probability ◽  
Patient Characteristics ◽  
University Hospital ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Chi Square ◽  
Factors Associated ◽  
Cancellation Rate

Background: This study researched related causes that make scheduled surgeries canceled not to be conducted and based on the research it is to derive issues in order to reduce surgery cancellation. Methods: We analyzed the association of surgery cancellation with patient characteristics, surgical characteristics and surgery schedule related characteristics, using electronic medical record (EMR) data on surgeries conducted at a university hospital in Korea over 10 years. Additionally, we examined the reasons for surgery cancellation based on patient and hospital characteristics. We used chi-square tests to analyze the distribution of various characteristics according to reasons for surgery cancellation. Multivariate logistic regression analyses were conducted to evaluate the factors associated with surgery cancellation. Results: Among 60,333 cases, surgery cancellation rate was 8.0%. The results of the logistic regression indicated a high probability of surgery cancellation when the patient was too old (odds ratio [OR]: 1.35, 95% confidence interval [CI]: 1.14–1.59), when it was a neurosurgery case (OR: 1.39, 95% CI: 1.21–1.59), when local anesthesia was used (OR: 1.15, 95% CI: 1.07–1.24) or when it was a planned surgery (OR: 2.45, 95% CI: 2.21–2.73). The surgery cancellation rate was lower when the patient was female (OR: 0.87, 95% CI: 0.82–0.93) or when the surgery was related to Obstetrics & Gynecology (OR: 0.53, 95% CI: 0.46–0.60) or Ophthalmology (OR: 0.66, 95% CI: 0.56–0.79). Among the canceled 4834 cases, the surgery cancellation rate for the reasons of patients was 93.2% and the surgery cancellation rate for the reasons of a hospital was 6.8%. Conclusions: This study found that there are related various causes to cancel operations, including patient characteristics, surgery related characteristics and surgery schedule related characteristics and it means that it would be possible for some reasons to be prevented. Every medical institution should consider the operation cancellation as an important issue and systematic monitoring should be needed.

scholarly journals Characteristics of Emergency Department Visits at King Abdulaziz University Hospital: A One Year Analysis

2018 ◽  
Vol 25 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Jameel T. Abualenain
Keyword(s):  
Emergency Department ◽  
Arrival Rate ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Operational Parameters ◽  
Waiting Room ◽  
Admission Rates ◽  
King Abdulaziz University ◽  
One Year ◽  
Saudi Patients

This study seeks to report the frequencies of the Emergency Department visits at King Abdulaziz University Hospital, as well as an analysis of its operational parameters. This is a retrospective analysis of all emergency visits over one year. In 2017, 69,522 patients were triaged, 62.55% adults, 20.12% pediatrics, and 17.33% OB/GYN. Ineligible patients (lower acuity stable non-Saudi patients who hold health insurance through their sponsors) were 12.84% of triaged patients, they were advised to go to another hospital. Females were 57.11%, and 40.92% were between 24 and 43 years, 18.49% younger than 14 years, and 9.22% older than 64 years. Saudi patients were 64.76%. Only 0.40% arrived by ambulance. Full management was provided for 73.83% of registered patients, whereas 26.17% left the waiting room after triage and initial evaluation by a physician without being treated due to bed unavailability; 97.22% were lower acuity and stable. Admission rates were 23.44%. The overall emergency department mortality rate was 0.52%, and death on arrival rate was 0.25%. Most registered patients (86.18%) were lower acuity and stable. All cases in which the patient needed resuscitation were treated immediately. Emergency department use by patients with low acuity conditions that are potentially treatable in other settings must be addressed.  

scholarly journals Exploring biomarkers of age in routine diagnostics for the risk stratification of older patients in the emergency department

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Bahrmann ◽  
A L Kunz ◽  
A Schoenstein ◽  
E Giannitsis ◽  
H.-W Wahl ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Older Patients ◽  
University Hospital ◽  
Biological Aging ◽  
Kaplan Meier ◽  
Age Related ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Objectives To estimate the association of the routinely applied biological age-related biomarkers hs-TnT, CRP and Hemoglobin (Hb) with mortality for the purpose of older patient's risk stratification in the emergency department (ED). Design Exploratory, prospective cohort study with a follow-up at 2.5 years after recruitment start. Setting and participants A cardiological emergency department (ED), chest pain unit, of our University Hospital. N=256 cardiological ED patients with a minimum age of 70 years and with an expected life-expectancy above 24h. Methods Data from the hospital files were supplemented by a questionnaire. Patients were followed-up for mortality by requesting registry office information. Results Among N=256 patients 63 died over the follow-up period. Positive results in each of the three biomarkers alone as well as the combination were associated with increased all-cause mortality at follow-up. The number of positive age-related biomarkers appeared to be strongly indicative of the risk of mortality, even when controlled for major confounders (age, sex, BMI, creatinine clearance, and comorbidity). Conclusion and implications In older ED patients, biomarkers explicitly related to biological aging processes such as hs-TnT, CRP and Hb were independently of each other as well as combined associated with an increased risk of all-cause mortality. Thus, they may have the potential to be used to supplement the general risk stratification of older patients in the ED. Validation of the results in a large dataset is needed. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Robert Bosch Foundation, Stuttgart, Germany Kaplan-Meier curves with 95% CI Kaplan-Meier curves for patients grouped

scholarly journals Emergency Department Mean Physician Time per Patient and Workload Predictors ED-MPTPP

2020 ◽  
Vol 9 (11) ◽  
pp. 3725
Author(s):  
Julian Wrede ◽  
Helge Wrede ◽  
Wilhelm Behringer
Keyword(s):  
Emergency Department ◽  
Prediction Model ◽  
Univariate Analysis ◽  
Prospective Trial ◽  
Severity Index ◽  
University Hospital ◽  
Treatment Area ◽  
Physician Time ◽  
One Year ◽  
Triage Level

One key element for emergency department (ED) staff calculation is the mean physician time per patient (MPTPP) and its influencing factors. The aims of this study were measuring the MPTPP, identifying factors with significant influence on the MPTPP, and developing a model to predict the MPTPP. This study was a prospective trial conducted at the ED of a university hospital in Germany. The MPTPP was measured with a specifically developed app. The influence of different factors on MPTPP were first tested in univariate analysis. Then, all significant factors were used in a multivariant regression model to minimize collinearities and to develop a prediction model. In total, 202 patients treated by 32 different physicians were observed within one year. The MPTPP was 47 min (standard deviation: 34 min). Relevant factors influencing the MPTPP were treatment area, Emergency Severity Index (ESI) triage level, guiding symptom category, and physician level (all p < 0.001). This model predicted 45% of the variance in the MPTPP (p < 0.001), which corresponds to a large effect size. We developed an effective prediction model for ED MPTPP, resulting in an MPTPP of 47 min. Future studies are needed to validate our model, which could serve as a benchmark for other EDs where the MPTPP is not available.

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