Treatment and outcome variation in out-of-hospital cardiac arrest among four urban hospitals in Detroit.

AIMS: To determine whether out-of-hospital cardiac arrest (OHCA) post-resuscitation management and outcomes differ between four Detroit hospitals. INTRODUCTION: Significant variation exists in treatment/outcomes from OHCA. Disparities between hospitals serving a similar population is not well known. METHODS: Retrospective OHCA data was collected from the Detroit-Cardiac Arrest Registry (DCAR) between January 2014 to December 2019. Four hospitals were compared on two treatments (angiography, do not resuscitate (DNR)) and two outcomes (cerebral performance category (CPC) ≤ 2, in-hospital death). Models for death and CPC were tested with and without coronary angiography and DNR status. RESULTS: 999 patients at hospitals A - D differed (p < 0.05) before multivariable adjustment by age, race, witnessed arrest, dispatch-emergency department (ED) time, TTM, coronary angiography, DNR order, and in-hospital death. Rates of death and CPC ≤ 2 were worse in Hospital A (82.8%, 10%, respectively) compared to others (69.1%, 14.1%). After multivariable adjustment, Hospital A performed angiography less compared to B (OR = 0.17) and was more likely to initiate new DNR status than B (OR = 2.9), C (OR = 16.1), or D (OR = 3.6). CPC ≤ 2 were worse in Hospital A compared to B (OR = 0.27) and D (OR = 0.35). After sensitivity analysis, CPC ≤ 2 odds did not differ for A versus B (OR = 0.58, adjusted for angiography) or D (OR = 0.65, adjusted for DNR). Odds of death, despite angiography and DNR differences, were worse in Hospital A compared to B (OR = 1.87) and D (OR = 1.81). CONCLUSION: Differing rates of DNR and coronary angiography was associated with observed disparities in favorable neurologic outcome, but not death, between four Detroit hospitals.

Are Digital Oral Thermometer Readings Accurate in Adult Emergency Department Patients?

Background Inaccurate vital signs may lead to inadequate treatment and skew the differential diagnosis in patients presenting to the emergency department (ED), and thus could cause a delay in diagnosis and treatment. Our study sought to evaluate and compare oral and rectal temperatures in patients with medical conditions that may have fever as part of their presentation to the ED. Objectives To determine if oral and rectal temperatures correlate in patients with medical conditions who have a fever, dry mucous membranes, and are warm to the touch on exam. To identify which patient presentations are more likely to have incongruous temperatures. Our hypothesis is that digital oral thermometers are inaccurate and understate the temperature in patients who present with dry mucous membranes and tactile warmth. Methods A prospective cohort of adult patients in the ED was asked to consent to the comparison of rectal temperature if they presented with a medical condition that could result in a fever. Oral and rectal (core) temperatures were obtained, along with demographic data, chief complaint, current medications, recent ingestion of warm or cold liquids, use of antipyretics, and the treating physician's assessment of mucous membrane dryness and tactile warmth. Results A total of 111 patients were enrolled in the study. 55.8% of patients were male, and the mean age was 61 years. The most common presenting complaint was lower respiratory tract related; 87% had dry mucous membranes, and 85.5% were warm to the touch. Fever or hypothermia was missed in 55 patients (49.5%) if only oral temperatures were obtained. Patients were more likely to consent if their doctor was concerned about a fever and requested a rectal temperature as part of their workup. Conclusions This is one of the first studies to evaluate the difference between oral and rectal routes of obtaining body temperature in the ED in adult patients. Our data reveal that many fevers are "missed" if only oral temperatures are used in medical decision-making in patients with dry mouths and with tactile warmth. Our study is limited by the small sample size and the potential for selection bias.

The Impact of COVID-19 on Patient Presentations to the Emergency Department.

Introduction As the coronavirus disease 2019 (COVID-19) pandemic continues, it may be useful to elucidate its impact on services in the emergency department (ED). This research project aims to identify and analyze changes in patient presentations and disease severity within the ED at Hurley Medical Center (HMC) in Flint, Michigan, due to the COVID-19 pandemic. Methods The study is a retrospective chart review focusing on adults 18 years and above who presented to HMC's ED. The data collected for the study was obtained from patient charts from February 1, 2019, to July 31, 2019, and from February 1, 2020, to July 31, 2020. Data from the years 2019 and 2020 were analyzed using a combination of independent t-test, chi-square analysis, and regression modeling. Results There were a total of 59,345 visits analyzed within the study; 33,648 ED visits within the study were in 2019 compared to 25,697 visits in 2020. There was a significant difference in patient sex between 2019 and 2020 with a larger percentage of males presenting in 2020 versus 2019 (p<0.001). Dispositions also significantly differed in 2020 compared to 2019 with more patients being admitted or dying in the ED (p<0.001). Patients who presented to the ED often presented with more severe illness in 2020 as reflected in increased length of stay in 2020 (p=0.01) and increased case mix index (p<0.001). Conclusion The COVID-19 pandemic significantly reduced the total number of ED visits to HMC in Flint, Michigan, in 2020 than in 2019. Notably, patients were more likely to have a longer length of stay, present with more severe illness, and be admitted or die in the ED when compared to 2019. The results from this study can be used for future planning for the next public health emergency.