Background Emergency departments (EDs) serve as an accessible gateway to healthcare system wherein numerous patients consider it a prime choice for medical complaints. Frequency of ED revisits, causes, and its burden are necessary to assess quality of care provided to patients and identify factors that leads to revisit. Patients and Methods Electronic and printed medical records of all patients who revisited ED from January to May 2016 within 72 hours of initial visit were reviewed. Patients’ cause of revisit were classified to three categories: patient-, physician- and system-related factors. Common complaints that require revisits were also collected. Descriptive analysis was performed and categorical variables were represented by the frequency; percentages and continuous variables were presented as median, and range if data did not follow normal distribution. Results Of the 79,279 patients who visited ED during the study period, 1.3% (1000) patients revisited within 72 hours; 51.3% (n=513) were males, with a mean age of 31.5 years (SD=17.7 years) where majority (57.1%) had no comorbidity recorded. The most attributed factors for revisit were as follows: patient-related causes 635 patients (63.5%), physician-related factors 167 patients (16.7%), and system-related factors 42 patients (4.2%); 15.6% were found not related to the initial visit. Recurrence of the same complaint was the highest among patient-related factors (80.5%), inadequate management and no improvement of symptoms in 71.3% among the physician-related factors. The most common ED revisit complaint was fever 29.1% (n=291). Outcomes of the revisit were mainly patient discharge 96.7% (n=967), admission 1.2% (n=12) and death in 0.2% (n=2). Conclusion Recurrence of the same complaint with no symptoms improvement and suboptimal management of physicians contributed to most of the ED revisits within 72 hours. Encouraging physicians to provide clear instructions in educating patients on discharge regarding disease progression and its red flags as to when a return to ED, might help in reducing revisit rate.

BackgroundHuman H1N1 Influenza A virus was first reported in 2009 when seasonal outbreaks consistently occurred around the world. H1N1 patients present to the emergency departments (ED) with flu-like symptoms extending up to severe respiratory symptoms that require hospital admission. Developing a prediction model for patient outcomes is important to select patients for hospital admission. To date, there is no available data to guide the hospital admission of H1N1 patients based on their initial presentation.ObjectiveThe aim of this study was to investigate the predictors of hospital admission of H1N1 patients presenting in the ED.MethodsWe conducted a retrospective review of all laboratory-confirmed H1N1 cases presenting to the ED of a tertiary university hospital in the Eastern region of Saudi Arabia within the period from November 2015 to January 2016. We retrieved data of the initial triage category, vital signs, and presenting symptoms. Multivariate logistic regression analysis was performed to evaluate risk factors for hospital admission among H1N1patients presented to the ED.ResultsWe identified 333 patients with laboratory-confirmed H1N1. Patients were classified into two groups: admitted group (n=80; 24%) and non-admitted group (n=253; 76%). Sixty patients (75%) were triaged under category IV. Triage category of level III and less were the most predictive for hospital admission. Multivariate regression analysis showed that of all vital signs, tachypnea was a significant risk factor for hospital admission (OR=1.1; 95% CI 1.02 to 1.13, p<0.01). The association between lower triage category and hospital stay was statistically significant (χ2=6.068, p=0.037). Also, patients with dyspnea were 4.5 times more likely to have longer hospital stay (OR=4.5; 95% CI 1.2 to 17.1, p=0.025).ConclusionLower triage category and increased respiratory rate predict the need for hospital admission of H1N1 infected patients; while patients with dyspnea or bronchial asthma are likely to stay longer in the hospital. Further prospective studies are needed to evaluate the accuracy of using the CTAS and other clinical parameters in predicting hospitalization of H1N1 patients during outbreaks.

Objective: The coronavirus disease (COVID-19) pandemic has disrupted healthcare systems worldwide, resulting in decreased and delayed hospital visits of patients with non-COVID-19-related acute emergencies. We evaluated the impact of the COVID-19 pandemic on the presentation and outcomes of patients with non-COVID-19-related medical and surgical emergencies. Method: All non-COVID-19-related patients hospitalized through emergency departments in three tertiary care hospitals in Saudi Arabia and Bahrain in June and July 2020 were enrolled and categorized into delayed and non-delayed groups (presentation ≥/=24 or <24 h after onset of symptom). Primary outcome was the prevalence and cause of delayed presentation; secondary outcomes included comparative 28-day clinical outcomes (i.e., 28-day mortality, intensive care unit (ICU) admission, invasive mechanical ventilation, and acute surgical interventions). Mean, median, and IQR were used to calculate the primary outcomes and inferential statistics including chi-square/Fisher exact test, t-test where appropriate were used for comparisons. Stepwise multivariate regression analysis was performed to identify the factors associated with delay in seeking medical attention. Results: In total, 24,129 patients visited emergency departments during the study period, compared to 48,734 patients in the year 2019. Of the 256 hospitalized patients with non-COVID-19-related diagnoses, 134 (52%) had delayed presentation. Fear of COVID-19 and curfew-related restrictions represented 46 (34%) and 25 (19%) of the reasons for delay. The 28-day mortality rates were significantly higher among delayed patients vs. non-delayed patients (n = 14, 10.4% vs. n = 3, 2.5%, OR: 4.628 (CI: 1.296–16.520), p = 0.038). Conclusion: More than half of hospitalized patients with non-COVID-19-related diagnoses had delayed presentation to the ED where mortality was found to be significantly higher in this group. Fear of COVID-19 and curfew restrictions were the main reasons for delaying hospital visit.

Results: 93,877 patients were in the cohort, which was 52% female. 6092 patients got tPA, for a rate of 7.6% after excluding intracranial hemorrhages. 73% were White, and 16% Black. The median age was 70, with an interquartile range of 58 to 80. 65% were Medicare. 44% were ultimately discharged home, 11% were sent to a skilled nursing facility, and 6% expired. In terms of tapestry segmentation for having a stroke, the 2 largest groups who had a stroke were 7C and 10A (8%), whereas the groups that got tPA most frequently were groups 7A and 2C (23%).Group 7C are termed "American Dreamers" and consists of 1.7 million households with a median income of 48K. Most are married couples with children of all ages or single parents; multigenerational homes are common. Most residents derive income from wages or salaries, but the rate of poverty is a bit higher in this market. Apprioxmately 63% hold only a high school diploma.Group 10A, termed "southern satellites" consists of of 3.7 million households with a median income of 44K. Their median age is 39.7. This is typically a nondiverse market, where 1/3 are mobile homes. Married couples with no children are the dominant household type, with a number of multigenerational households. 40% have a high school diploma only.Group 7A, within termed "up and coming families" is one of the 2 groups that got tPA most often consists of more than 2.5 million up and coming families, with a median income of 64K and 66% college educated.Group 2C, the other group to receive the highest rates of tPA, represents the "urban chic," consists of 1.5 million households with a median age of 42.6, median income of 98K, and 60% are college educated. Compared to 7A, this group makes higher median income and is slightly older, but the thing the groups both have in common is that they are ambitious, working hard to get ahead, and willing to take some risks to do so.Conclusions: tPA is given most often in young ethnic families as well as the urban chic. Compared to the groups in which strokes occur the most often, the groups that received tPA are better educated, have a higher employment rate, and a significantly higher income. Understanding the mapping of strokes vs. strokes that get tPA beyond simple characteristics such as sex and race may be helpful in helping to plan community based support programs for active treatment of stroke.