scholarly journals Predicting Appropriate Hospital Admission of Emergency Department Patients with Bronchiolitis: Secondary Analysis

10.2196/12591 ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. e12591 ◽  
Author(s):  
Gang Luo ◽  
Bryan L Stone ◽  
Flory L Nkoy ◽  
Shan He ◽  
Michael D Johnson
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Secondary Analysis ◽  
Emergency Department Patients

Examining the relationship between triage acuity and frailty to inform the care of older emergency department patients: Findings from a large Canadian multisite cohort study

CJEM ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 74-81 ◽  
Author(s):  
Fabrice Mowbray ◽  
Audrey-Anne Brousseau ◽  
Eric Mercier ◽  
Don Melady ◽  
Marcel Émond ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Frailty Index ◽  
Secondary Analysis ◽  
Binary Logistic Regression ◽  
Hospital Length ◽  
Study Data ◽  
Hospital Length Of Stay ◽  
Emergency Department Patients ◽  
The Relationship

ABSTRACTBackgroundThe 2016 Canadian Triage and Acuity Scale (CTAS) updates introduced frailty screening within triage to more accurately code frail patients who may deteriorate waiting for care. The relationship between triage acuity and frailty is not well understood, but may help inform which supplemental geriatric assessments are beneficial to support care in the emergency department (ED). Our objectives were to investigate the relationship between triage acuity and frailty, and to compare their associations with a series of patient outcomes.MethodsWe conducted a secondary analysis of the Canadian cohort from a multinational prospective study. Data were collected on ED patients 75 years of age and older from eight ED sites across Canada between November 2009 and April 2012. Triage acuity was assigned using the CTAS, whereas frailty was measured using an ED frailty index. Spearman rank and binary logistic regression were used to examine associations.ResultsA total of 2,153 ED patients were analyzed. No association was found between the CTAS and ED frailty index scores assigned to patients (r = .001; p = 0.99). The ED frailty index was associated with hospital admission (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.4–1.6), hospital length of stay (OR = 1.4; 95% CI = 1.2–1.6), future hospitalization (OR = 1.1; 95% CI = 1.05–1.2), and ED recidivism (OR = 1.1; 95% CI = 1.04–1.2). The CTAS was associated with hospital admission (e.g., CTAS 2 v. 5; OR = 6; 95% CI = 3.3–11.4).ConclusionOur findings demonstrate that frailty and triage acuity are independent but complementary measures. EDs may benefit from comprehensive frailty screening post-triage, as frailty and its associated geriatric syndromes drive outcomes separate from traditional measures of acuity.

scholarly journals Appropriateness of Hospital Admission for Emergency Department Patients with Bronchiolitis: Secondary Analysis

10.2196/10498 ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. e10498 ◽  
Author(s):  
Gang Luo ◽  
Michael D Johnson ◽  
Flory L Nkoy ◽  
Shan He ◽  
Bryan L Stone
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Secondary Analysis ◽  
Emergency Department Patients

Diagnostic and prognostic value of the D-dimer test in emergency department patients: secondary analysis of an observational study

2019 ◽  
Vol 57 (11) ◽  
pp. 1730-1736 ◽  
Author(s):  
Alaadin Vögeli ◽  
Mohammad Ghasemi ◽  
Claudia Gregoriano ◽  
Angelika Hammerer ◽  
Sebastian Haubitz ◽  
...  
Keyword(s):  
Emergency Department ◽  
False Positive ◽  
Prognostic Value ◽  
Secondary Analysis ◽  
Area Under The Curve ◽  
Thromboembolic Disease ◽  
Predictive Values ◽  
Emergency Department Patients ◽  
D Dimer ◽  
Rule Out

Abstract Background D-dimer measurement improves the rule-out of thromboembolic disease. However, little is known about the risk of false positive results for the diagnosis of thromboembolic disease and its prognostic value. Herein, we investigated factors influencing the accuracy of D-dimer and its prognostic value in a large cohort of emergency department (ED) patients. Methods This is a secondary analysis of a prospective observational single center, cohort study. Consecutive patients, for whom a D-dimer test was requested by the treating physician, were included. Associations of clinical parameters on admission with false positive D-dimer results for the diagnosis of thromboembolic disease were investigated with logistic regression analysis. Results A total of 3301 patients were included, of which 203 (6.1%) had confirmed thromboembolic disease. The negative and positive predictive values of the D-dimer test at the 0.5 mg/L cut-off were 99.9% and 11.4%, respectively. Several factors were associated with positive D-dimer results potentially falsely indicating thromboembolic disease in multivariate analysis including advanced age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.04–1.05, p < 0.001), congestive heart failure (CHF) (OR 2.79, 95% CI 1.77–4.4, p < 0.01), renal failure (OR 2.00, 95% CI 1.23–3.24, p = 0.005), history of malignancy (OR 2.6, 95% CI 1.57–4.31, p < 0.001), C-reactive protein (CRP) (OR 1.02, 95% CI 1.01–1.02, p < 0.001) and glomerular filtration rate (GFR) (OR 0.99, 95% CI 0.99–1.00, p = 0.003). Regarding its prognostic value, D-dimer was associated with a 30-day mortality (adjusted OR 1.05, 95% CI 1.02–1.09, p = 0.003) with an area under the curve (AUC) of 0.79. Conclusions While D-dimer allows an accurate rule-out of thromboembolic disease, its positive predictive value in routine ED patients is limited and largely influenced by age, comorbidities and acute disease factors. The strong prognostic value of D-dimer in this population warrants further investigation.

Does nonmedical hospital admission staff accurately triage emergency department patients?

2009 ◽  
Vol 16 (4) ◽  
pp. 172-176 ◽  
Author(s):  
Jonas Quitt ◽  
Daniel Ryser ◽  
Thomas Dieterle ◽  
Urs Lüscher ◽  
Benedict Martina ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Emergency Department Patients
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