scholarly journals Risk for Repeat Emergency Department Visits for Violent Injuries in Youth Firearm Victims

2008 ◽  
Vol 2 ◽  
pp. CMTIM.S2141 ◽  
Author(s):  
Hyun Ja Lim ◽  
Michael McCart ◽  
W Hobart Davies ◽  
Alice Calhoun ◽  
Marlene D. Melzer-Lange
Keyword(s):  
Emergency Department ◽  
Social Worker ◽  
Significant Risk ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Prior History ◽  
P Value ◽  
Violent Injury ◽  
Police Custody ◽  
Ed Visits

Objective To identify significant risk factors associated with repeat emergency department (ED). Visits for violent injuries in youth firearm victims. Methods The study subjects of this retrospective cohort study were firearm victims aged 18 and younger presenting to a Pediatric Emergency Department/Trauma Center at Children's Hospital of Wisconsin between 1990 and 1995. The primary outcome was subsequent Emergency Department visits (REDV) at any emergency department in Milwaukee for a violent injury. Results A total of 495 subjects were eligible for the present study in the pediatric firearm victim's ED visit database. Eighty-five percent (n = 420) were males and 82% were African-Americans. Mean age was 15 years old (s.d = ±3.6). A majority of them had a single-parent family. Eighty-eight subjects (17.8%) had a prior history of ED visit due to violence. During the study time, 201 subjects had at least one REDV. In the multivariable model, a subject without a social worker consulting at the hospital were more likely to have REDV compared to subjects with a social worker consulting (O.R = 1.749; p-value = 0.047), controlling for guardian and disposition. Subjects disposed to detention center or police custody were more likely to have REDV compared to subjects disposed to home or a hospital (O.R = 5.351; p-value = 0.003). Conclusion Our analysis indicates that individuals with guardians, those who did not receive social worker intervention on their initial visit, and those discharged in police custody were associated with increased repeat ED visits due to a violent injury.

scholarly journals Adjacent Primary Care May Reduce Less Urgent Pediatric Emergency Department Visits

2020 ◽  
Vol 11 ◽  
pp. 215013272092627
Author(s):  
Julia Ellbrant ◽  
Jonas Åkeson ◽  
Helena Sletten ◽  
Jenny Eckner ◽  
Pia Karlsland Åkeson
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Patient Characteristics ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Pediatric Emergency Department ◽  
Hospital Data ◽  
Cross Sectional ◽  
Ed Visits

Aims: Pediatric emergency department (ED) overcrowding is a challenge. This study was designed to evaluate if a hospital-integrated primary care unit (HPCU) reduces less urgent visits at a pediatric ED. Methods: This retrospective cross-sectional study was carried out at a university hospital in Sweden, where the HPCU, open outside office hours, had been integrated next to the ED. Children seeking ED care during 4-week high- and low-load study periods before (2012) and after (2015) implementation of the HPCU were included. Information on patient characteristics, ED management, and length of ED stay was obtained from hospital data registers. Results: In total, 3216 and 3074 ED patient visits were recorded in 2012 and 2015, respectively. During opening hours of the HPCU, the proportions of pediatric ED visits (28% lower; P < .001), visits in the lowest triage group (36% lower; P < .001), patients presenting with fever ( P = .001) or ear pain ( P < .001), and nonadmitted ED patients ( P = .033), were significantly lower in 2015 than in 2012, whereas the proportion of infants ≤3 months was higher in 2015 ( P < .001). Conclusions: By enabling adjacent management of less urgent pediatric patients at adequate lower levels of medical care, implementation of a HPCU outside office hours may contribute to fewer and more appropriate pediatric ED visits.

Emergency Department Visits in the Year Prior to Total Shoulder Arthroplasty as a Risk Factor for Postoperative Emergency Department Visits

2021 ◽  
pp. 155633162199577
Author(s):  
Brian C. Werner ◽  
Francis P. Bustos ◽  
Richard P. Gean ◽  
Matthew J. Deasey
Keyword(s):  
Emergency Department ◽  
Risk Factor ◽  
Lower Extremity ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Significant Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Emergency Department Visits ◽  
Ed Visits ◽  
Increasing Risk

Background: Recent research has found a high rate of emergency department (ED) use after lower extremity arthroplasty; one study found a risk factor for ED presentation after lower extremity arthroplasty was presentation to the ED in the year prior to surgery. It is not known whether a similar association exists for total shoulder arthroplasty (TSA). Questions/Purposes: The goal of this study was to investigate the relationship between preoperative ED visits and postoperative ED visits after anatomic TSA. Methods: The 100% Medicare database was queried for patients who underwent anatomic TSA from 2005 to 2014. Emergency department visits within the year prior to the date of TSA were identified. Patients were additionally stratified by the number and timing of preoperative ED visits. The primary outcome measure was one or more postoperative ED visits within 90 days. A multivariate logistic regression analysis was used to control for patient demographics and comorbidities. Results: Of the 144,338 patients identified, 32,948 (22.8%) had an ED visit in the year prior to surgery. Patients with at least 1 ED visit in the year before surgery presented to the ED at a significantly higher rate than patients without preoperative ED visits (16% versus 6%). An ED visit in the year prior to TSA was the most significant risk factor for postoperative ED visits (in the multivariate analysis). The number of preoperative ED visits in the year prior to surgery demonstrated a significant dose-response relationship with increasing risk of postoperative ED visits. Conclusions: Postoperative ED visits occurred in nearly 10% of Medicare patients who underwent TSA in the period studied. More frequent presentation to the ED in the year prior to anatomic TSA was associated with increasing risk of postoperative ED visits. Future studies are needed to investigate the reasons for preoperative ED visits and if any modifiable risk factors are present to improve the ability to risk stratify and optimize patients for elective TSA.

scholarly journals National Trends in Leukemia Related Emergency Department Visits, Health Care Burden and Disposition Rate in the United States, 2010-2014

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4695-4695
Author(s):  
Mohamed Mokhtar Bakr ◽  
Umar Zahid ◽  
Pavan Tenneti ◽  
Alsadiq Waleed Al-Hillan ◽  
Faiz Anwer
Keyword(s):  
United States ◽  
Health Care ◽  
Emergency Department ◽  
Hospital Admission ◽  
The United States ◽  
Emergency Department Visits ◽  
P Value ◽  
Health Care Burden ◽  
Ed Visits ◽  
National Trends

Abstract National Trends in Leukemia Related Emergency Department Visits, Health Care Burden and Disposition Rate in the United States, 2010-2014. Background: Recently emergency department (ED) utilization has been increasing for the management of acute conditions. Utilization of ED healthcare services by hematology and oncology patients have been documented previously. Cancer patients frequently visit the EDs with acute symptoms, that may require further assessment, management, and even hospitalization. Whether the incidence of leukemia related ED visits has altered is unknown. The aim of this study was to analyze the trend of leukemia related ED visits, healthcare cost associated with the visit and the discharge disposition from ED. Methods: We utilized Nationwide Emergency Department Sample (NEDS) dataset for this study. NEDS is a part of the Healthcare Cost and Utilization Project (HCUP) database and contains the information of more than 950 United States (US) hospitals that is weighted to the national estimates. We used five years of data from 2010 to 2014 to examine the trends in prevalence and rates of ED visits, cost, and disposition (such as admission, discharge and death in ED). We defined patients with leukemia (acute myeloid, chronic myeloid, acute lymphocytic, and chronic lymphocytic leukemias) by using the international classification of disease, 9th revision, clinical modification (ICD-9-CM) codes. Cochrane-Armitage test was used to assess the trend of leukemia ER visits over five years. We used estimated US census population to calculate the rate of leukemia related ED visits. Furthermore, we assessed the predictors of hospital admission by using multivariable logistic regression model. Results: Between 2010 to 2014, a nationally weighted estimate of 771,510 patients visited ED with leukemia. The frequency of leukemia related ED visits increased 21.7% from 138,038 to 167,935 during this period that accounted for 0.12% of all ED visits. The rate of leukemia related ED visits increased 20.5% from 44 to 53 per 100,000 census population, which was statistically significant (p=0.04) on a trend test. The total national cost of leukemia related visit increased by 81% from $544 million in 2010 to $984 million in 2014 (p-value<0.001). While the mean cost of each leukemia related ED visit increased 50.7% from $2367 in 2010 to $3566 in 2014 (p-value <0.001). Rate of discharge to home from ED for leukemia related visits increased 31.6% (from 22.88% in 2010 to 30.12% in 2014) (p<0.05). Similarly, the rate of in hospital admission decreased 9% from 2010 to 2014. The rate of death in a leukemia related visit remained same (0.17%) from 2010 to 2013 but in 2014 death rate increased from 0.17% to 0.23% (p-value >0.05). In an adjusted multivariable logistic regression analysis, increasing age (OR 1.02 95% CI 1.024, 1.027), male gender (OR 1.15, 95% CI 1.114, 1.188), patient location in metropolitan area (OR 2.08, 95% CI 1.88, 2.22) and northeast location (OR 1.16, 95% CI 1.03, 1.32) were found to be significantly associated with the higher odds of in hospital admission following leukemia related ED visits. While few other variables like residents of higher income quartile and those holding Medicaid, insurance were also found to be positively associated with the hospitalization but were not statistically significant (OR>1.00, p>0.05). Conclusions: There is an increasing trend of leukemia related ED utilization and associated total and mean/median costs over time, while the rate of hospitalization for leukemia associated visit from ED have decreased. Oncology providers need to plan care accordingly to reduce ER visits and hospital admission for patients with leukemia. Disclosures No relevant conflicts of interest to declare.

Assessing appropriateness of pediatric emergency department visits: is it even possible?

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 661-664
Author(s):  
Jessica E. Paul ◽  
Katie Y. Zhu ◽  
Garth D. Meckler ◽  
David K. Park ◽  
Quynh Doan
Keyword(s):  
Emergency Department ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Pediatric Emergency ◽  
Risk Tolerance ◽  
Emergency Department Visits ◽  
Ed Overcrowding ◽  
Ed Visits ◽  
Return Visits ◽  
Clinician Judgment

ABSTRACTObjectivesNumerous studies reported on the frequency of, and factors associated with inappropriate or unnecessary emergency department (ED) visits using clinician judgment as the gold standard of appropriateness. This study evaluated the reliability of clinician judgment for assessing appropriateness of pediatric ED visit.MethodsWe conducted a retrospective cohort study comparing 3 clinicians’ determination of ED visit appropriateness with and without guidance from a three-question structured algorithm. We used a cohort of scheduled ED return visits deemed appropriate by the index treating clinician between May 1, 2012, and April 30, 2013. We measured the level of agreement among three clinician investigators with and without use of the structured algorithm.ResultsA total of 207 scheduled ED return visits were reviewed by the primary clinician reviewer who agreed with the index treating clinician for 79/207 visits (38.2%). Among a random subset of 90 return visits reviewed by all three clinicians, agreement was 67% with a Fleiss’ Kappa of 0.30 (0.17–0.44). Using a three-question algorithm based on objective criteria, agreement with the index treating provider increased to 115/207 (55.6%).ConclusionsAlthough an important contributor to pediatric ED overcrowding, unnecessary or inappropriate visits are difficult to identify. We demonstrated poor reliability of clinician judgment to determine appropriateness of ED return visits, likely due to variability in clinical decision-making and risk-tolerance, social and systems factors impacting access and use of health care. We recommend that future studies evaluating the appropriateness of ED use standardized, objective criteria rather than clinician judgment alone.

scholarly journals Level of Acuity in Pediatric Patients with Recurrent Emergency Department Visits

2012 ◽  
Vol 1 (2) ◽  
pp. 1
Author(s):  
Ilene Claudius ◽  
Chun Nok Lam
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Pediatric Emergency Department ◽  
Group Comparison ◽  
Intravenous Fluid Therapy ◽  
Ed Visits ◽  
And Performance ◽  
Critical Intervention

Introduction: Recurrent ED utilizers account for a substantial proportion of ED visits, yet little data exists on children with multiple visits. The objective of this study was to compare the need for interventions and triage acuity of recurrent utilizers of a pediatric emergency department to that of non-recurrent utilizers. Methods: This is a retrospective analysis of children presenting to a pediatric emergency department. Children were classified as recurrent utilizers if they had 4 or more visits to the ED per year and non-recurrent utilizers if they had less than 4 visits. Data was collected and inter-group comparison performed on critical interventions received (admission, consultation, intravenous fluid therapy, observation, and performance of procedures), all interventions received (including critical interventions as well as laboratories, radiographs, and medications), and triage acuity for the index visit. Results: Two-hundred thirty patients were included, of whom, 15% were classified as recurrent utilizers. This group had significantly lower rates of requiring a critical intervention (8.6% vs. 51.4%, p=.001), lower rates of any intervention (51.4% vs. 74.4%, p=.007), and less urgent triage acuity (3.3 vs. 3.1, p=.029). Conclusions: Recurrent utilizers of the pediatric emergency department had significantly lower need for intervention and less urgent mean triage acuity when compared with non-recurrent utilizers.

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value &lt; 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P &lt; 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

scholarly journals Predictors of Urgent Cancer Care Clinic and Emergency Department Visits for Individuals Diagnosed with Cancer

2021 ◽  
Vol 28 (3) ◽  
pp. 1773-1789
Author(s):  
Kathleen Decker ◽  
Pascal Lambert ◽  
Katie Galloway ◽  
Oliver Bucher ◽  
Marshall Pitz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mixed Models ◽  
Cancer Care ◽  
Median Number ◽  
Emergency Department Visits ◽  
Planning Service ◽  
Care Clinic ◽  
Future Studies ◽  
Acute Complications ◽  
Ed Visits

In 2013, CancerCare Manitoba (CCMB) launched an urgent cancer care clinic (UCC) to meet the needs of individuals diagnosed with cancer experiencing acute complications of cancer or its treatment. This retrospective cohort study compared the characteristics of individuals diagnosed with cancer that visited the UCC to those who visited an emergency department (ED) and determined predictors of use. Multivariable logistic mixed models were run to predict an individual’s likelihood of visiting the UCC or an ED. Scaled Brier scores were calculated to determine how greatly each predictor impacted UCC or ED use. We found that UCC visits increased up to 4 months after eligibility to visit and then decreased. ED visits were highest immediately after eligibility and then decreased. The median number of hours between triage and discharge was 2 h for UCC visits and 9 h for ED visits. Chemotherapy had the strongest association with UCC visits, whereas ED visits prior to diagnosis had the strongest association with ED visits. Variables related to socioeconomic status were less strongly associated with UCC or ED visits. Future studies would be beneficial to planning service delivery and improving clinical outcomes and patient satisfaction.

scholarly journals Internet search and medicaid prescription drug data as predictors of opioid emergency department visits

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Sean D. Young ◽  
Qingpeng Zhang ◽  
Jiandong Zhou ◽  
Rosalie Liccardo Pacula
Keyword(s):  
Emergency Department ◽  
Prescription Drug ◽  
Drug Utilization ◽  
Prediction Models ◽  
Emergency Department Visits ◽  
Treatment Preferences ◽  
Internet Search ◽  
Utilization Data ◽  
Ed Visits ◽  
Medicaid Prescription

AbstractThe primary contributors to the opioid crisis continue to rapidly evolve both geographically and temporally, hampering the ability to halt the growing epidemic. To address this issue, we evaluated whether integration of near real-time social/behavioral (i.e., Google Trends) and traditional health care (i.e., Medicaid prescription drug utilization) data might predict geographic and longitudinal trends in opioid-related Emergency Department (ED) visits. From January 2005 through December 2015, we collected quarterly State Drug Utilization Data; opioid-related internet search terms/phrases; and opioid-related ED visit data. Modeling was conducted using least absolute shrinkage and selection operator (LASSO) regression prediction. Models combining Google and Medicaid variables were a better fit and more accurate (R2 values from 0.913 to 0.960, across states) than models using either data source alone. The combined model predicted sharp and state-specific changes in ED visits during the post 2013 transition from heroin to fentanyl. Models integrating internet search and drug utilization data might inform policy efforts about regional medical treatment preferences and needs.

scholarly journals Influence of Indoor Temperature Exposure on Emergency Department Visits Due to Infectious and Non-Infectious Respiratory Diseases for Older People

2021 ◽  
Vol 18 (10) ◽  
pp. 5273
Author(s):  
Chien-Cheng Jung ◽  
Nai-Tzu Chen ◽  
Ying-Fang Hsia ◽  
Nai-Yun Hsu ◽  
Huey-Jen Su
Keyword(s):  
Emergency Department ◽  
Respiratory Diseases ◽  
Significant Risk ◽  
Cumulative Effect ◽  
Emergency Department Visits ◽  
Heating Season ◽  
Indoor Temperature ◽  
Distributed Lag ◽  
Poisson Function ◽  
Temperature Exposure

Previous studies have demonstrated that outdoor temperature exposure was an important risk factor for respiratory diseases. However, no study investigates the effect of indoor temperature exposure on respiratory diseases and further assesses cumulative effect. The objective of this study is to study the cumulative effect of indoor temperature exposure on emergency department visits due to infectious (IRD) and non-infectious (NIRD) respiratory diseases among older adults. Subjects were collected from the Longitudinal Health Insurance Database in Taiwan. The cumulative degree hours (CDHs) was used to assess the cumulative effect of indoor temperature exposure. A distributed lag nonlinear model with quasi-Poisson function was used to analyze the association between CDHs and emergency department visits due to IRD and NIRD. For IRD, there was a significant risk at 27, 28, 29, 30, and 31 °C when the CDHs exceeded 69, 40, 14, 5, and 1 during the cooling season (May to October), respectively, and at 19, 20, 21, 22, and 23 °C when the CDHs exceeded 8, 1, 1, 35, and 62 during the heating season (November to April), respectively. For NIRD, there was a significant risk at 19, 20, 21, 22, and 23 °C when the CDHs exceeded 1, 1, 16, 36, and 52 during the heating season, respectively; the CDHs at 1 was only associated with the NIRD at 31 °C during the cooling season. Our data also indicated that the CDHs was lower among men than women. We conclude that the cumulative effects of indoor temperature exposure should be considered to reduce IRD risk in both cooling and heating seasons and NIRD risk in heating season and the cumulative effect on different gender.

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

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