Abstract
Background
Respiratory tract infections are common, often seasonal, and caused by multiple pathogens. We assessed whether seasonal respiratory illness patterns changed during the COVID-19 ...pandemic.
Methods
We categorized emergency department (ED) visits reported to the National Syndromic Surveillance Program according to chief complaints and diagnosis codes, excluding visits with diagnosed SARS-CoV-2 infections. For each week during 1 March 2020 through 26 December 2020 (“pandemic period”), we compared the proportion of ED visits in each respiratory category with the proportion of visits in that category during the corresponding weeks of 2017–2019 (“pre–pandemic period”). We analyzed positivity of respiratory viral tests from 2 independent clinical laboratories.
Results
During March 2020, cough, shortness of breath, and influenza-like illness accounted for twice as many ED visits compared with the pre–pandemic period. During the last 4 months of 2020, all respiratory conditions, except shortness of breath, accounted for a smaller proportion of ED visits than during the pre–pandemic period. Percent positivity for influenza virus, respiratory syncytial virus, human parainfluenza virus, adenoviruses, and human metapneumovirus was lower in 2020 than 2019. Although test volume decreased, percent positivity was higher for rhinovirus/enterovirus during the final weeks of 2020 compared with 2019, with ED visits similar to the pre–pandemic period.
Conclusions
Broad reductions in respiratory test positivity and respiratory ED visits (excluding COVID-19) occurred during 2020. Interventions for mitigating spread of SARS-CoV-2 likely also reduced transmission of other pathogens. Timely surveillance is needed to understand community health threats, particularly when current trends deviate from seasonal norms.
Introduction: Given the importance of the subject and the knowledge gap, we decided to perform this survey. Methods: In this descriptive cross-sectional study, the knowledge levels of patients’ ...companions about the concept and application of hospital triage were evaluated in 202 subjects. The research population included patient companions referred to the emergency department (ED). The exclusion criterion was the failure to complete the questionnaire. Convenience sampling was done. Questionnaires were delivered to the companions of the patients. In this study, the data gathering tool was a questionnaire consisting of two parts. The final questionnaire included 13 questions, 10 and 3 of which were closed (multiple choice) and open questions, respectively. Finally, the age, level of education, and gender were also asked from participants. The level of patient triage was also determined in this research. Results: 202 questionnaires were completed by companions of patients admitted to the ED. The mean age of those who completed the questionnaire was 39.95±17.92 years, and 192 individuals expressed their gender, of which 123 (64.1%) and 69 (35.9%) persons were male and female, respectively. The level of education was also reported in 180 people. Moreover, diploma and postgraduate diplomas, bachelor’s degrees, and postgraduate or doctoral degrees were observed in 59 (32.77%), 90 (50%), and 31 (17.22%) patients’ companions respectively. Conclusion: According to the results, it seems that the knowledge about the concept of triage among ordinary people of the society is lower than the desired level.
BACKGROUND:Research on frequent emergency department (ED) use shows that a subgroup of patients visits multiple EDs. This study characterizes these individuals.
OBJECTIVE:The objective of this study ...was to determine how many frequent ED users seek care at multiple EDs and to identify sociodemographic, clinical, and contextual factors associated with such behavior.
RESEARCH DESIGN:We used the 2011–2014 Healthcare Cost and Utilization Project State Emergency Department Databases data on all outpatient ED visits in New York, Massachusetts, and Florida. We studied all adult ED users with ≥5 visits in a year and defined multisite use as visits to ≥3 different sites. We estimated predictors of multisite use with multivariate logistic regressions.
RESULTS:Across all 3 states, 1,033,626 frequent users accounted for 7,613,077 ED visits. Of frequent users, 25% were multisite users, accounting for 30% of the visits studied. Frequent users with at least 1 visit for mental health or substance use-related diagnosis were more likely to use multiple sites. Uninsured frequent users and those with public insurance were associated with less use of multiple EDs than those with private coverage while lacking consistent coverage by the same insurance within each year were associated with using multiple sites.
CONCLUSIONS:Health policy interventions to reduce duplicative or unnecessary ED use should apply a population health perspective and engage multiple hospitals. Community-level preventive approaches and a stronger infrastructure for mental health and substance use are essential to mitigate multisite ED use.
Trauma-informed care has been posited as a framework to optimize patient care and engagement, but there is a paucity of data on patient-level outcomes after trauma-informed care training in health ...care settings. We sought to measure patient-level outcomes after a painful procedure after implementation of trauma-informed care training for ED staff.
As part of a quality improvement initiative, we trained 110 ED providers in trauma-informed care. Next, we prospectively recruited patients who had undergone a painful procedure to complete a survey to assess several patient-level outcomes, such as anxiety reduction and overall experience of care. We compared differences in patient outcomes for those who were treated by providers in the trauma-informed care intervention group with those who were treated by providers who did not complete the training (usual care).
One-hundred forty-seven adult patients completed survey measures (n = 76 trauma-informed care intervention group; n = 71 usual care group) over a 1-month period. Most patients offered the highest rating for all ED staff-related questions. We found no significant differences in assessment of patient-reported outcomes based on intervention versus usual care.
Our trauma-informed care training did not seem to have a significant effect on our selected patient outcomes. This may be caused by the training itself or the challenges in measurement of the patient-level impact of trauma-informed care training owing to the study design, setting, and lack of standardized tools. Recommendations for future study of trauma-informed care training and measuring its direct impact on patients in the ED setting are discussed.
In 2017 the Northern Territory (NT) government re-introduced the Banned Drinker Register (BDR) to address the high rates of alcohol related harm. This paper aims to evaluate whether trends in ...assault, maltreatment and sentinel injuries in children and adolescents were associated with the re-introduction of the BDR, in the context of other local interventions such as police officers stationed in bottle shops being partially removed, Police Auxiliary Liquor Inspectors, and the introduction of a minimum unit price of alcohol.
Interrupted time series analysis was used to assess monthly trends in emergency department presentations and inpatient hospital admissions for assault, maltreatment and sentinel injuries between January 2014 and December 2019 in the regions of Greater Darwin, Alice Springs, and Katherine.
A significant step increase after the introduction of the BDR in emergency department presentations for assault and maltreatment was present when examining the three regions combined (β = 7.65, 95 % CI = 2.15, 13.16). However, this was not present at the individual community level. Results across a range of other models pointed towards null effects of the BDR introduction.
The current study found that the re-introduction of the BDR had minimal impact on rates of assault, maltreatment, or sentinel injuries in children and adolescents. To ensure long-term harm mitigation from alcohol use, a combination of evidence informed alcohol policies that address the price and availability of alcohol in a comprehensive framework, along with measures which address the underlying social determinants of unregulated drinking and health more broadly will assist in reducing alcohol related harm in both children and adults.
It is important that policy makers, health administrators, and emergency physicians have up-to-date statistics on the most common diagnoses of patients seen in the emergency department (ED).
We ...sought to describe the changes that occurred in ED visits from 2010 through 2014 and to describe the frequency of different ED diagnoses.
This is a retrospective analysis of ED visit data from the National Emergency Department Sample from 2010 through 2014. Visits were stratified by age, sex, insurance status, disposition, diagnosis, and diagnostic category. We calculated the total annual ED visits and the ED visit rates by diagnoses and diagnostic categories.
Between 2010 and 2014, the number of U.S. ED visits increased from 128.9 million to 137.8 million. The rate of ED Visits per 1000 persons increased from 416.92 (95% confidence interval CI 399.47–434.37) in 2010 to 432.51 (95% CI 411.51–453.61) in 2014 (p = 0.0136). ED visits grew twice as quickly (1.7%) as the overall population (0.7%). The most common reason for an ED visit was abdominal pain (11.75% 95% CI 11.61–11.89). This was followed by mental health problems (4.45% 95% CI 4.19–4.72).
The number of ED visits in the United States continues to increase faster than the rate of population growth. Abdominal problems and mental health issues, including substance abuse, were the most common reasons for an ED visit in 2014.
Fever is a common presenting complaint to the pediatric emergency department (PED), especially among oncology patients. While bacteremia has been extensively studied in this population, pneumonia has ...not. Some studies suggest that chest X-ray (CXR) does not have a role in the investigation of neutropenic fever in the absence of respiratory symptoms, yet non-neutropenic pediatric oncology patients were excluded from these studies.
We aimed to determine the incidence of CXRs ordered for febrile pediatric oncology patients, irrespective of their absolute neutrophil count (ANC), and to evaluate the rates of radiographic pneumonia as well as predictors of the latter in this group.
This study was conducted in the PED at the American University of Beirut Medical Center (AUBMC), an Eastern Mediterranean tertiary-care hospital. We conducted a retrospective cohort study of acutely febrile pediatric cancer patients, younger than 18 years, presenting to a tertiary center from 2014 to 2018. We included one randomly selected febrile visit per patient. Fever was defined as a single oral temperature ≥38 °C within 24 h of presentation. We collected data on patient characteristics and outcomes. Our primary outcome was radiographic pneumonia; our secondary outcome was whether a CXR was done or not. We defined radiographic pneumonia as a consolidation, pleural effusion, infiltrate, pneumonia, “infiltrate vs. atelectasis,” or possible pneumonia mentioned by the radiologist. SPSS was used for the statistical analysis.
We reviewed a total of 664 medical charts and included data from 342 febrile pediatric patients in our analysis. Of these, 64 (18.7%) had a CXR performed. Overall, 16 (25%) had radiographic pneumonia while 48 (75%) did not. Patients were significantly more likely to have a CXR performed if they presented with upper respiratory tract symptoms, cough (p < 0.001 for both), or abnormal lung auscultation at the bedside (p = 0.004). Patients were also less likely to have a CXR done if they were asymptomatic upon admission to the PED (p < 0.001). However, neither cough nor shortness of breath nor abnormal lung examinations were significant predictors of a positive CXR (p = 0.17, 0.43, and 0.669, respectively). Patients with radiographic pneumonia were found to be significantly younger (4.29 vs. 6 years, p = 0.03), with a longer time since their last chemotherapy (15 vs. 7 days, p = 0.005), and were given intravenous (IV) bolus in the PED (87.5% vs. 56.3%, p = 0.02). Interestingly, patients with higher white blood cell (WBC) counts were more likely to have radiographic pneumonia (4850 vs. 1750, p = 0.01). Having a cough and an abnormal lung examination on presentation increased the odds of having a CXR (adjusted odds ratio aOR: 6.6; 95% confidence interval CI: 3.4–12.8 and aOR: 4.5; 95% CI: 1.1–18.3, respectively). Returning to the PED for the same complaint within 2 weeks was associated with lower odds of a CXR at the index visit (aOR: 0.3; 95% CI: 0.1–0.6). For every year the child is older, the odds of having radiographic pneumonia decreased by 0.8 (95% CI: 0.6–0.98). However, for every day since the last chemotherapy session, the odds increased by 1.1 (95% CI: 1.01–1.12).
In our sample, CXR was not commonly performed in the initial assessment of febrile cancer patients in the PED, unless respiratory symptoms or an abnormal lung examination was noted. However, these were not significant predictors of radiographic pneumonia. Further studies are needed to identify better predictors of pneumonia in this high-risk population.
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