BackgroundAlcohol or other drug (AOD) intoxication in minors is a public health challenge. We characterized underage patients admitted to an emergency department (ED) with acute, recreational AOD intoxication.MethodsWe conducted a 5‐year (2012 to 2016) analysis of minors admitted to the only hospital‐based pediatric ED in an urban area. Episodes of AOD intoxication were selected using ICD‐9‐CM diagnostic codes. Sociodemographics, substance use and clinical characteristics, laboratory parameters, and discharge dispositions were collected through the revision of clinical charts.ResultsA total of 266 admissions related to recreational AOD intoxication in 258 patients occurred during the study period. Among the 258 patients, 127 (49.2%) were men, median age 16 years [IQR: 15 to 17 years], and 234 (90.7%) of episodes were alcohol‐related. At admission, 202/256 (78.9%) patients had a Glasgow Coma Scale ≥ 13 points, the median systolic and diastolic blood pressure was 109 mmHg (IQR: 101 to 118 mmHg) and 67 mmHg (IQR: 60 to 73 mmHg), respectively, and the median blood glucose level was 112 mg/dl (IQR: 99 to 127 mg/dl). Only 72/258 (27.9%) patients underwent urine screening (22/72 (30.5%) were positive for cannabis), and only 30/258 (11.6%) were tested for blood ethanol (median: 185 mg/dl, IQR: 163 to 240 mg/dl). There was a trend in admissions occurring early in the morning of weekend days, and 249 (96.5%) patients were discharged home the day of admission.ConclusionsThough the severity of AOD intoxication seems to be mild to moderate, assessment of substance exposure is low and may underestimate polydrug use in underage populations.

In the United States, an estimated 6.5 million adults greater than 20 years of age have congestive heart failure (CHF). CHF is projected to affect up to 8 million people by 2030. The total health care costs were estimated to be $30.7 billion dollars and will increase to $69.7 billion by 2030. 1 Frequently, patients with CHF decompensate resulting in pulmonary edema, one of the causes of an alveolar interstitial syndrome pattern, requiring emergency department (ED) evaluation or hospital admission. Despite advances in care, around half of patients discharged with CHF are readmitted within 6 months. 2 Although decompensated CHF is increasingly prevalent it still remains a difficult diagnosis to make accurately, and there is no criterion standard diagnostic tool. 3 Physical examination findings are neither sensitive nor specific. 4 Despite laboratory tests (e.g., B-natriuretic peptide) and imaging studies (e.g., chest radiograph), the diagnosis and degree of decompensated CHF are classified as

Study Objective: Atrial fibrillation (AF) is a potentially serious condition that can lead to thromboembolic complications. Current guidelines recommend oral anticoagulation (OAC) to reduce the risk of stroke in high-risk AF candidates but US emergency department (ED) OAC prescribing rates and 30-day clinical outcomes after an AF diagnosis are unknown. We determined OAC prescribing practices and 30-day clinical outcomes after ED diagnosis of new AF. Methods: This was a population-based, retrospective cohort of Medicare fee-forservice beneficiaries from 2011 to 2012. The cohort included beneficiaries age 65, without prior OAC filled in 90 days, who were discharged from the ED with a new diagnosis of AF. We calculated proportions of patients filling an OAC prescription within 10 days of an ED AF diagnosis. Adverse events within 30 days of the ED visit were identified via ICD-9 codes from inpatient and outpatient ED claims data. We performed descriptive statistics and bivariate analyses to assess associations between filling an OAC and patient/hospital characteristics and clinical outcomes. We stratified analyses by risk for stroke (CHA 2 DS 2-VASc) and bleeding (HAS-BLED). Results: Of those discharged from the ED with a diagnosis of AF (n¼9,147), 91.4% (n¼8,363) were intermediate to high-risk (CHA 2 DS 2-VASc1 in males and CHA 2 DS 2-VASc 2 in females) for stroke. Of those eligible for stroke prophylaxis [high-stroke risk with low-moderate bleeding risk (n¼3,968)], 74.5% (n¼2,958) did not fill an OAC prescription within 10 days. Of those prescribed, 71.4% were prescribed by an ED provider. Warfarin was the most common OAC ED prescription (64.6%), followed by dabigatran (21.0%), enoxaparin (8.0%), and rivaroxaban (6.4%). In high stroke risk patients, ischemic strokes occurred in 3.1% (40/1302) of those with OACs filled vs. 2.1% (132/6219) of those unfilled (p<0.01). Bleeding events occurred in less than 10 patients in this cohort of OAC filled, and in 1.4% (44/3247) of those without an OAC filled. Conclusions: In ED patients with a new diagnosis of AF and at high stroke risk, only a minority are prescribed an OAC within 10 days. Among these patients, OAC prescribing could potentially avoid ischemic events in up to 2.1% of patients with AF. These data indicate a practice gap in appropriate OAC prescribing.

Introduction: There is growing popularity in social media use among physicians and health care practitioners for data collection and health promotion among cardiovascular disease. However, there is little knowledge regarding the ongoing dialogue, and who are communicating. Hypothesis: This is an exploratory study to capture the users and contents of tweets related to heart failure. Methods: We searched Twitter for these hash users and the hashtags #chf #congestiveheartfailure and #heartfailure between the dates of January 2017-March 2017. We we categorized the type of user and content of each tweet. For any discrepancies for categorization, another reviewer would examine the tweet. For the hashtag #heartfailure as there were more than 2500 tweets per month, we randomly selected 5% of tweets to hand code. Results: During this time period, users infrequently used #congestiveheartfailure and #chf, with only 37 and 222 tweets respectively, while #heartfailure was more commonly used. Within our random sample of coded tweets, 29.4% (204/693) of tweets were from patients, caretakers, or advocacy groups, while 35.2% (244/693) were from physicians, academic journals, medical groups, and industry. The most common content areas were medical education (such as journal articles) (34.6%, 240/693), disease awareness and advocacy (18.76%, 130/ 693), and personal experience (16.3%, 113/693). There was little overlap between discussions from patients and academic discussions, and lack of patient and academic engagement. There were few tweets of patients sharing journal articles (2 tweets), and by the lack of retweets between patients and physicians. Conclusions: Twitter, a social media platform, is used by both health care providers and patients. However, conversations are significantly siloed, and engagement between laypersons/advocacy groups and professionals were not observed.

commonly documented in those not readmitted (82.6 vs. 56.3%, P = .04). A clear discussion in the DS that the patient had achieved euvolemia was similarly documented between those readmitted and those not (17.6 vs. 18.4%, P = .93). In the DS assessment section, no markers of volume status to justify discharge reached statistical significance except dyspnea resolution, which was more commonly cited in those not readmitted (40.8 vs. 23.5%, P = .06). These differences remained significant if HF was the primary readmission diagnosis. Conclusions: The presence or absence of clinical euvolemia as measured by DS physical exam and heart failure assessment was not associated with readmission rate. This long-term outcome possibly reflects long-term disease severity rather than the management practices during a singular admission.