Abstract P123: Accuracy Of Hypertensive Emergency Diagnosis Code In Administrative Database: Insights From National Inpatient Sample 2017

Background: Hypertensive emergency (HTNE) diagnostic code was introduced, in the US, in October 2016 to improve identification of patients with end-organ damage due to high blood pressure but its impact is unclear. Objective: To assess the accuracy of HTNE code using administrative data. Methods: We used National Inpatient Sample 2017 to identify adult patients, age ≥18 years, with International Classification of Disease-10th Clinical modification (ICD-10-CM) code of I16.1. We used the presence of end-organ damage diagnostic codes to identify true HTNE. Results: A total of 194,495 patients had a diagnosis of HTNE. Of these only 144,070 (74.1%) had a concomitant diagnosis of end-organ damage. Baseline characteristics of entire cohort stratified by presence of target organ damage (Table 1A) and frequency of end-organ damage in true HTNE patients (Table 1B) are shown. Patients with true HTNE were likely to be older and male with higher co-morbidity burden. There was also significant difference in outcomes between two groups with a higher proportion of true HTNE patients experiencing longer length of stay and increased mortality which is in-line with previous studies. Conclusions: The accuracy of hypertensive emergency diagnosis code is low with positive predictive value of 74.1% and caution is advised when using with administrative data. Further studies, using individual patient discharge records, are required to validate HTNE code.

POISONING OBSERVATION AND ASSESSMENT

<p>Records of 360 poisoning patients were evolved with observation by trained experts for 6 months on a structured taxonomy sheet (STS) on first entry to a selected poisoning ward. Observations made were about the patients’ appearance, facial expressions, vocal signs, social interaction and other observable signs. It was assumed that (STS) could help to distinguish between self, accidental and pretended poisoning behaviors as a quick measure as compared with existing hospital emergency diagnosis procedures. (STS) records were compared with emergency diagnosis. Comparison revealed (STS) capacity to report otherness in three poisoning types with workable similarity. Importance of observational methods emerged in high emergency for diagnosis/ assessment that could be utilized in areas having less advanced facilities for diagnosis. Methodology suitability emerged as objective diagnosis/ assessment possibility in other kinds of emergency situations in less developed areas. More cross cultural comparison would highlight utility in developing cultures?</p>

POISONING OBSERVATION AND ASSESSMENT

<p>Records of 360 poisoning patients were evolved with observation by trained experts for 6 months on a structured taxonomy sheet (STS) on first entry to a selected poisoning ward. Observations made were about the patients’ appearance, facial expressions, vocal signs, social interaction and other observable signs. It was assumed that (STS) could help to distinguish between self, accidental and pretended poisoning behaviors as a quick measure as compared with existing hospital emergency diagnosis procedures. (STS) records were compared with emergency diagnosis. Comparison revealed (STS) capacity to report otherness in three poisoning types with workable similarity. Importance of observational methods emerged in high emergency for diagnosis/ assessment that could be utilized in areas having less advanced facilities for diagnosis. Methodology suitability emerged as objective diagnosis/ assessment possibility in other kinds of emergency situations in less developed areas. More cross cultural comparison would highlight utility in developing cultures?</p>

Inflammatory Biomarkers and Clinical Judgment in the Emergency Diagnosis of Urgent Abdominal Pain

BACKGROUND The early diagnosis of urgent abdominal pain (UAP) is challenging. Most causes of UAP are associated with extensive inflammation. Therefore, we hypothesized that quantifying inflammation using interleukin-6 and/or procalcitonin would provide incremental value in the emergency diagnosis of UAP. METHODS This was an investigator-initiated prospective, multicenter diagnostic study enrolling patients presenting to the emergency department (ED) with acute abdominal pain. Clinical judgment of the treating physician regarding the presence of UAP was quantified using a visual analog scale after initial clinical and physician-directed laboratory assessment, and again after imaging. Two independent specialists adjudicated the final diagnosis and the classification as UAP (life-threatening, needing urgent surgery and/or hospitalization for acute medical reasons) using all information including histology and follow-up. Interleukin-6 and procalcitonin were measured blinded in a central laboratory. RESULTS UAP was adjudicated in 376 of 1038 (36%) patients. Diagnostic accuracy for UAP was higher for interleukin-6 [area under the ROC curve (AUC), 0.80; 95% CI, 0.77–0.82] vs procalcitonin (AUC, 0.65; 95% CI, 0.62–0.68) and clinical judgment (AUC, 0.69; 95% CI, 0.65–0.72; both P &lt; 0.001). Combined assessment of interleukin-6 and clinical judgment increased the AUC at presentation to 0.83 (95% CI, 0.80–0.85) and after imaging to 0.87 (95% CI, 0.84–0.89) and improved the correct identification of patients with and without UAP (net improvement in mean predicted probability: presentation, +19%; after imaging, +15%; P &lt; 0.001). Decision curve analysis documented incremental value across the full range of pretest probabilities. A clinical judgment/interleukin-6 algorithm ruled out UAP with a sensitivity of 97% and ruled in UAP with a specificity of 93%. CONCLUSIONS Interleukin-6 significantly improves the early diagnosis of UAP in the ED.