Trends in US Emergency Department Visits

Kirkegaard, Margaret

doi:10.1001/jama.2010.1580

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…Our study found an acute coma event rate of 4.23 visits per 1,000 ED visits, consistent with the Schmidt et al (2019) ED cohort study 28 . However, our results differ from another study that reported 0.29-0.40 cases of coma per 1,000 ED visits 33 . Based on the ICD code approach, studies suggested that acute coma is about 0.93-5% of all ED visits 27 34 .…”

Section: Incidencecontrasting

confidence: 99%

Incidence, Etiology, and Clinical Outcomes of Acute Coma

Lin,

Tsai,

Liang

et al. 2024

Preprint

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Objectives To investigate the clinical nature of acute coma, which will serve as a reference for subsequent clinical decision-making Methods and analysis This observational study utilized Taiwan National Health Insurance Database to identify cases of acute coma from 2000 to 2017 based on ED discharge diagnoses. Clinical Classification Software (CCS) was employed to categorize the causes of acute coma. We examined the characteristics of acute coma cases, age-specific incidence rates, underlying causes, and clinical outcomes such as reversible coma, hospitalization, and 30-day mortality. Additionally, we assessed functional outcomes at a one-year follow-up. Long-term factors influencing mortality were ascertained using Cox regression. Results Among 99,217,322 ED visits between 2000 and 2017, 419,480 acute coma events were identified, with an event rate of 4.23 per 1,000 ED visits and an incidence rate of 0.93 per 1,000 person-years. We analyzed 205,747 first-ever acute coma cases, predominantly male (58.90%), aged 58.27 years (SD 23.04). Infection and CNS causes were predominant. CNS and drug-related causes contributed to increased 30-day mortality, while psychiatric, alcohol, women's health and perinatal care, and seizure are causes linked to reversible coma. Patients needed intensive care (26.54%), life-sustaining treatments (41.09%), or disability (6.57%). Generalized estimating equations revealed that CNS (aOR, 0.68; 95% CI, 0.62 to 0.74; p < .0001) and drug-related causes (aOR, 0.72; 95% CI, 0.65 to 0.81; p < .0001) were less likely to result in reversible coma, suggesting higher 30-day mortality risk factors. Cox regression showed drugs (aHR, 1.30, 95% CI 1.20 to 1.41, p < .001), neoplasm (aHR, 1.18, 95% CI 1.11 to 1.25, p < .001), and symptoms (aHR, 1.44, 95% CI 1.24 to 1.67, p < .001) elevated the long-term death risk. Conclusion Our study demonstrates the use of ICD codes aggregation to CCS in acute coma clinical study, providing insights into its clinical nature.

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Section: Incidencecontrasting

confidence: 99%

Incidence, Etiology, and Clinical Outcomes of Acute Coma

Lin,

Tsai,

Liang

et al. 2024

Preprint

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“…In Australia there has been an increase in the ED patient presentation rate from 321 per 1000 to 339 per 1000 between 2017-18 and 2021 − 22 1 . Similar trends have been reported in other countries [2][3][4][5][6] .…”

Section: Introductionsupporting

confidence: 90%

Emergency department staff opinion on newly introduced phlebotomy services in the department. A cross-sectional study incorporating reflexive thematic analysis.

Osman,

Yeak,

Ben-Meir

et al. 2024

Preprint

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Introduction The demand for Emergency Department (ED) services, both in terms of patient numbers and complexity has risen over the past decades. According to reports, there has been an increase in the ED patient presentation rate from 321 per 1000 to 339 per 1000 between 2017-18 and 2021-22. Consequently, new care models have been introduced to address this surge in demand, mitigate associated risks, and improve overall safety. Among these models is the concept of "front loading" clinical care, involving the initiation of interventions at the point of arrival. This study evaluates the impact of introducing phlebotomists at triage. Method We conducted a cross-sectional survey using purposive sampling and employed quantitative analysis, complemented by reflexive thematic analysis. Results The response rate for the questionnaire was 61% (n = 207) with good representation from all ED craft groups. Nearly all the staff (99.5%) reported being aware of the presence of phlebotomists in the ED, while only 57% of the staff reported working in triage (p = 0.048, 0.0001599 to 0.043073). ‘Valuable/vital resource’ featured as a common response. Early decision making, patient safety, staff and patient satisfaction emerged as consistent themes. Conclusion Emergency Departments continue to introduce new models of care to address increasing demand for services. We present a model that utilises an existing workforce, relocating them from the ambulatory and outpatient setting to the ED and increasing their scope to complement triage needs, including COVID-19 PCR testing, ECG and venous blood gas analysis. Our staff have identified these tasks, and the concierge role provided by the phlebotomists as contributions to enhanced patient care and safety.

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“…The present study indicates that the MSK system is a common distinct source of chest pain presentations to EDs, worthy of further attention. Risk stratification of cardiac chest pain is the focus of early ED care, importantly however, the findings re‐iterate that a majority (79%) of patients presenting to ED will ultimately be diagnosed with noncardiac or undifferentiated chest pain in line with findings elsewhere 3,16,17 …”

Section: Discussionmentioning

confidence: 79%

Musculoskeletal chest pain prevalence in emergency department presentations: A retrospective case notes review

Dacombe‐Bird,

Dassanayake,

Beck

et al. 2023

Emerg Medicine Australasia

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ObjectiveMusculoskeletal (MSK) causes of chest pain are considered common in emergency care, yet management is limited, reported outcomes are poor and prevalence data in New Zealand are lacking. The present study aims to estimate the prevalence of MSK chest pain in New Zealand EDs and describe the characteristics of MSK chest pain cases.MethodsA retrospective chart review was conducted based on de‐identified clinical notes extracted from four hospitals within the South Island of New Zealand from 3 months spanning 1 March to 31 May 2021. Individual cases were categorised to the single best‐fitting cause of chest pain using systems‐based categorisation, based primarily on the doctors' documented final impression.ResultsA total of 1344 cases were categorised in the present study. MSK chest pain had a prevalence of 15% (range 11–31%) of chest pain presentations across all study sites. This represented the second most common system responsible for chest pain, after the cardiovascular system. The mean age of MSK chest pain cases was 46.9 (standard deviation [SD] 19.1) years, compared to 55.5 (SD 19.7) years in all cases. Age and gender‐specific data, data from rural hospitals and MSK sub‐type data are presented.ConclusionsThese data provide a conservative estimate of MSK chest pain prevalence in EDs within the South Island of New Zealand. The findings highlight MSK chest pain as common in emergency care, providing a basis and justification for further research to improve management and outcomes for people with MSK chest pain.

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Trends in US Emergency Department Visits

Cited by 4 publications

References 6 publications

Incidence, Etiology, and Clinical Outcomes of Acute Coma

Incidence, Etiology, and Clinical Outcomes of Acute Coma

Emergency department staff opinion on newly introduced phlebotomy services in the department. A cross-sectional study incorporating reflexive thematic analysis.

Musculoskeletal chest pain prevalence in emergency department presentations: A retrospective case notes review

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