Referral patterns from emergency department to otolaryngology clinic

Garneau, Jonathan; Wasserman, Isaac; Konuthula, Neeraja; Malkin, Benjamin D.

doi:10.1002/lary.26868

Cited by 14 publications

(14 citation statements)

References 22 publications

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“…Other studies have reported that the cause of the highest number of referrals from the ED to the otolaryngology clinic was peripheral vertigo, and that the most frequent referral diagnosis was nonspecific vertigo [20]. In such cases, otolaryngologists make a specific diagnosis upon examination.…”

Section: Discussionmentioning

confidence: 99%

Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey

Numata¹,

Shiga

Omura

et al. 2019

PLoS ONE

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Acute vertigo is a common problem in emergency departments. However, clinical strategies of acute vertigo care vary among care providers. The aim of the study was to investigate differences in diagnosis [Dix-Hallpike test, the head impulse, nystagmus, and the test of skew (HINTS) procedure, and imaging modalities] and treatment (pharmacological treatments and the Epley maneuver) by otolaryngologists and non-otolaryngologists in emergency medicine settings. We used a multicenter case-based survey for the study. Four clinical vignettes of acute vertigo (posterior canal benign paroxysmal positional vertigo, vestibular neuritis, Meniere disease, and nonspecific vertigo) were used. Total 151 physicians from all study sites participated in the study. There were 84 non-otolaryngologists (48 emergency physicians and 36 internists) and 67 otolaryngologists. The multivariate analysis indicated that otolaryngologists ordered fewer CT scans (odds ratio (OR), 0.20; 95% confidence interval (CI), 0.07–0.53) and performed fewer HINTS procedures (OR, 0.17; 95% CI, 0.06–0.46), but used the Dix-Hallpike method more often (OR, 2.36; 95% CI, 1.01–5.52) for diagnosis compared to non-otolaryngologists. For treatment, otolaryngologists were less likely to use the Epley method (OR, 0.19; 95% CI, 0.07–0.53) and metoclopramide (OR, 0.09; 95% CI, 0.01–0.97) and more likely to use sodium bicarbonate (OR, 20.50; 95% CI, 6.85–61.40) compared to non-otolaryngologists. We found significant differences in the acute vertigo care provided by non-otolaryngologists and otolaryngologists from a vignette-based research. To improve acute vertigo care, educational systems focusing on acute vertigo are needed.

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Section: Discussionmentioning

confidence: 99%

Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey

Numata¹,

Shiga

Omura

et al. 2019

PLoS ONE

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“…

Epistaxis is the most common emergency in otolaryngology, 1,2 accounting for up to one third of all emergencies. 3,4 The treatment is discomforting and has a huge socio-economic impact. 5,6 Up to one third of all epistaxis patients in inpatient treatment are taking oral anticoagulants (OAC).

…”

mentioning

confidence: 99%

Direct oral anticoagulants versus vitamin K antagonists in epistaxis patients: A systematic review and meta‐analysis

Stankovic

Hoch

Rudhart

et al. 2021

Clinical Otolaryngology

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Objective Epistaxis is the most common otolaryngological emergency and up to one third of patients in treated on an inpatient basis take oral anticoagulants (OAC). Direct oral anticoagulants (DOAC), an OAC subgroup, have been on the market since 2010 and are being increasingly prescribed due to the cardiological and haematological guidelines that favour them over vitamin K antagonists (VKA), the older of the OAC subgroups. The present study aims to investigate which subgroup of epistaxis patients taking OACs has a more favourable outcome. Design/setting A systematic review and meta‐analysis were performed according to the PRISMA 2020 statement using the PubMed and Cochrane Library databases. Continuous data were analysed and standardised mean difference (SMD) was calculated according to Hedges' g. Dichotomous data were analysed, and the Mantel‐Haenszel method was applied to establish the odds ratio (OR). Heterogeneity was assessed according to the I2 statistics. Main outcome/results A total of eight reports covering 1390 patients were included in the final synthesis. The pooled analysis demonstrated significantly shorter hospital stays in the DOAC group (SMD = −0.22, 95% CI−0.42 to −0.02, p = .03) and a significantly higher rate of posterior bleeding in the VKA group (OR = .39, 95% CI 0.23 to 0.68, p = .001). No statistically significant differences with regard to recurrence rates, admission rates, the need for transfusion or surgical intervention (p = .57, .12, .57 and .38 respectively) were found. Conclusion According to this meta‐analysis, epistaxis patients taking DOACs have a more favourable outcome than patients taking VKAs.

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“…In addition, a high number of them actually do not need to be evaluated in an emergency care unit by an ENT specialist but may necessitate an ENT outpatient clinic visit. [5] The number of patients in our study is a good example of this. We found that over 10,000 patients were seen in a 1-year period in our ENT clinic.…”

Section: Discussionmentioning

confidence: 86%

“…In a study, it was found that the most common diagnoses made were vertigo, external otitis, and nasal fractures, and they concluded that their study was similar to other published hospital audits and epidemiologic studies. [5,6] In another study including 1,067 patients, the most common diseases during the study period were the URTI, acute rhinosinusitis, and tonsillitis. [3] In a study aiming to identify the utilization of EDs by patients with primary otological complaints, the authors found that the most common diagnoses made were otitis media, external otitis, and otalgia.…”

Section: Discussionmentioning

confidence: 99%

Distribution of Patient Profile Referred from Emergency Department to Otolaryngology Clinic

Evman¹

2018

South Clin Ist Euras

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Objective: Emergency departments (EDs) are overcrowded with patients having ear, nose, and throat (ENT) complaints. A large proportion of patients are not true emergencies. Therefore, understanding patient demographics and referral patterns are important to reduce the number of ED visits. Understanding these will highlight the areas for the improvement of care, cost effectiveness, and education. Methods: Patients who were referred to the adult ED and consulted the ENT clinic between January 2016 and February 2017 were reviewed retrospectively. Age, gender, and diagnosis made at that time were analyzed. Results: A total of 10, 110 patients were admitted to the adult ED and referred to the ENT clinic. Of those, 5,919 (58%) were men and 4,217 (42%) women, with an average age of 44.9 (range, 18-90 years). The most common three diagnoses made during the study period were (in the descending order): epistaxis (n=3,101; 31%), nasal fractures (n=1,620; 16%), and nasal foreign bodies (n=927; 9%). Conclusion: Learning about the most common referral diagnosis made for ENT patients in the ED will enable institutions to find new ways to decrease the number of ED referrals and to conduct non-urgent cases to ENT outpatient clinics. Also, the education process of health employees will be more efficient. Thus, the quality of health care will increase, and costs will decrease.

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Referral patterns from emergency department to otolaryngology clinic

Abstract: 4. Laryngoscope, 128:1062-1067, 2018.

Cited by 14 publications

References 22 publications

Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey

Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey

Direct oral anticoagulants versus vitamin K antagonists in epistaxis patients: A systematic review and meta‐analysis

Distribution of Patient Profile Referred from Emergency Department to Otolaryngology Clinic

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