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EY, et al. Early prediction of acute kidney injury in the emergency department with machine-learning methods applied to electronic health record data. Ann Emerg Med.

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Medical Care Survey (NHAMCS) were compiled and analyzed. Variables were coded to agglomerate all ICD codes which correspond to the concussion.Results: During the period studied 1,416,876 patients received the diagnosis of concussion in the ED. These patients had an average age of 30.8 years (95% CI 28.9-32.6 P<0.0001) and 55.2% were male (95% CI 51.3-59.0 P<0.0001). The most common chief complaint of patients diagnosed with concussion was head injury (35.5%, 95% CI 31.7-39.4, P<0.0001) followed by headache (15.8%, 95% CI 13.3-18.7, P<0.0001). Of these, 77.5% received a CT scan (95% CI 74.1-80.5 P<0.0001) and 1.3% received MRI (95% CI 0.7-2.4 P<0.0001). Among these patients. 5.8% admitted to the inpatient service, and 3.5% of patients returned to ED within 72 hours. During the years studied, CT use experienced a relative decrease in the use of 7.8%, while MRI experienced a relative increase of 10.0%. When compared to patients who did not receive a CT, those who did were more likely to be admitted (6.4%, 95% CI 4.7-8.6, P<0.0001).Conclusions: The majority of patients presented to ED continue to receive diagnostic tests including CT imaging. Medical professionals should continue to use the guideline, and "Choosing Wisely" approach to assess patients with concussions and relay instead on imaging-sparing approaches such as observation and close follow-ups.

OBJECTIVES/SPECIFIC AIMS: Background: Annually, 2.5 million traumatic brain injuries (TBI) occur with nearly 75% classified as mild TBI (mTBI), also known as a concussion. Mild TBI can be subtle and detection requires a high index of suspicion and a regimented evaluation process. This study was done to define the proportion of patients with a possible mTBI evaluated for concussion at a high volume urban trauma center. METHODS/STUDY POPULATION: Methods: A prospective cohort of patients was identified using a 3-question screen at the time of triage: did an injury occur; was the mechanism consistent with mTBI; was there a period of altered mental status. Patients who screened positive were thought to meet a minimum threshold for the evaluation of mTBI. Information about mTBI specific evaluation, management, and education was obtained from the patient’s charts. RESULTS/ANTICIPATED RESULTS: Results: 38,484 patients were screened over 16 weeks, of whom 453 (1.18%) screened positive for a possible mTBI and did not meet exclusion criteria. In total, 198 patients had documented loss of consciousness, 101 were diagnosed with mTBI, and 49 received mTBI discharge instructions. Overall, 32.5% of included patients had mTBI listed in the differential or as a diagnosis and 32.3% with loss of consciousness received a mTBI diagnosis. DISCUSSION/SIGNIFICANCE OF IMPACT: Conclusions: Many patients with a possible mTBI were not evaluated, managed, or educated for their potential injury. Changes in physicians’ approach to mTBI must occur to increase the proportion of patients receiving appropriate evaluation, management, and education. These results define the current reality of mTBI treatment in the Emergency Department and show the need for further experimental studies targeted at physician decision support interventions to improve mTBI care.