The disease spectrum of adult patients at a tertiary care center emergency department in Lebanon

Hitti, Eveline; Geha, Mirabelle; Hadid, Dima; Bachir, Rana

doi:10.1371/journal.pone.0216740

Cited by 2 publications

(7 citation statements)

References 16 publications

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“…On the other hand, Martin-Gill and Reiser found that mental health disorders were the most common initial visit diagnosis among HRURVs, which did not emerge in our study 8. In fact, in a study on disease spectrum of ED visits in Lebanon, mental health disorders were not among the diagnoses found in their sample 17…”

Section: Discussioncontrasting

confidence: 84%

Characteristics and determinants of high-risk unscheduled return visits to the emergency department

et al. 2019

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BackgroundHigh-risk unscheduled return visits (HRURVs), defined as return visits within 72 hours that require admission or die in the emergency department (ED) on representation, are a key quality metric in the ED. The objective of this study was to determine the incidence and describe the characteristics and predictors of HRURVs to the ED.MethodsCase–control study, conducted between 1 November 2014 and 31 October 2015. Cases included all HRURVs over the age of 18 that presented to the ED. Controls were selected from patients who were discharged from the ED during the study period and did not return in the next 72 hours. Controls were matched to cases based on gender, age (±5 years) and date of presentation.ResultsOut of 38 886 ED visits during the study period, 271 are HRURVs, giving an incidence of HRURV of 0.70% (95% CI 0.62% to 0.78%). Our final analysis includes 270 HRURV cases and 270 controls, with an in-ED mortality rate of 0.7%, intensive care unit admission of 11.1% and need for surgical intervention of 22.2%. After adjusting for other factors, HRURV cases are more likely to be discharged with a diagnosis related to digestive system or infectious disease (OR 1.64, 95% CI 1.02 to 2.65 and OR 2.81, 95% CI 1.05 to 7.51, respectively). Furthermore, presentation to the ED during off-hours is a significant predictor of HRURV (OR 1.64, 95% CI 1.11 to 2.43) as is the presence of a handover during the patient visit (OR 1.68, 95% CI 1.02 to 2.75).ConclusionHRURV is an important key quality outcome metric that reflects a subgroup of ED patients with specific characteristics and predictors. Efforts to reduce this HRURV rate should focus on interventions targeting patients discharged with digestive system, kidney and urinary tract and infectious diseases diagnosis as well as exploring the role of handover tools in reducing HRURVs.

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Section: Discussioncontrasting

confidence: 84%

Characteristics and determinants of high-risk unscheduled return visits to the emergency department

et al. 2019

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“…In 2009/2010 patients tended to present to the ED for diabetes mellitus, leukemia, and atherosclerosis, whereas in 2018/2019 infectious related diseases predominated such as pneumonia, bronchitis, and influenza. Even though reports from LMIC reported double burden of diseases in the ED, [11] our study showed that ED diagnoses are shifting from NCD towards CD. In comparison to other Middle Eastern and North African countries many NCDs, including cardiovascular diseases, chronic respiratory diseases, digestive diseases, have been mitigated except for diabetes and kidney diseases.…”

Section: Discussioncontrasting

confidence: 68%

“…The absence of those factors negatively affects policymaking, patient care, training programs, and resources allocation. [10,11] Previous studies in LMIC showed a double burden of diseases in the ED setting, including both non-communicable disease (NCD) and communicable diseases (CD). This was further studied in the ED setting at the largest hospital in Lebanon and the results confirmed that patients suffered from the double burden of NCDs and CDs.…”

Section: Introductionmentioning

confidence: 99%

“…[12] On the other hand, Lebanon has been experiencing a surge in refugees, power outages and air pollution, contributing to the increase in risk factors for CD. [11,[13][14][15] Therefore, it is crucial to understand and compare how ED visits and characteristics are changing with time as this will help design policies and training programs to meet patients' needs and direct the allocation of acute care resources. Our study aims to compare how patient and disease characteristics have changed over 10 years at the largest tertiary care center in Lebanon.…”

Section: Introductionmentioning

confidence: 99%

“…The absence of those factors negatively affects policymaking, patient care, training programs, and resources allocation. [ 10 , 11 ]…”

Section: Introductionmentioning

confidence: 99%

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Comparing emergency department visits 10-year apart at a tertiary care center in Lebanon

El Zahran,

Ghandour,

Chami

et al. 2023

Medicine

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Presentations to the emergency department (ED) are growing worldwide. With the increasing risk factors of non-communicable disease (NCD) and communicable diseases (CD) in low- and middle-income countries, it is crucial to understand how ED presentations are changing with time to meet patients’ needs and allocate acute care resources. The aim of this study is to compare the changes in patient and diseases characteristics over 2 time periods 10 year apart at the largest tertiary care center in Lebanon. This was a retrospective descriptive study of patients presenting to the ED at a large tertiary care center in 2009/2010 and 2018/2019. The discharge diagnoses were coded into Clinical Classification Software codes. We used descriptive statistics, odds ratios (OR), and non-parametric test to compare the different diagnoses. The total number of ED visits increased by 33% from 2009/2010 to 2018/2019. The highest increase rate was among patients older than 65 years (2.6%), whereas the percentage of pediatric patients decreased from 30.8% to 25.3%. ED presentations shifted from NCD to CD. A shift in the discharge diagnoses was also noted within age groups, specifically a shift in cardiovascular diseases to a younger age. Our study suggests that the role of the ED is changing and moving towards treating the aging population and CD. There is a need to invest and mitigate CD, better allocate resources to accommodate the aging population, focus on awareness campaigns targeting early detection of cardiovascular diseases and modifying its risk factors.

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The disease spectrum of adult patients at a tertiary care center emergency department in Lebanon

Cited by 2 publications

References 16 publications

Characteristics and determinants of high-risk unscheduled return visits to the emergency department

Characteristics and determinants of high-risk unscheduled return visits to the emergency department

Comparing emergency department visits 10-year apart at a tertiary care center in Lebanon

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