RESUMEN
BACKGROUND: Coronavirus disease 2019 (COVID-19) arrived in the New York metropolitan area in early March 2020. Recommendations were made to self-quarantine within households and limit outside visits, including those to clinics and hospitals, to limit the spread of the virus. This resulted in a decrease in pediatric emergency department (ED) visits. However, it is unclear how this affected visits for some common diagnoses such as anxiety, appendicitis, asthma, headaches, seizures, and urinary tract infection (UTI). These diagnoses were chosen a priori, as they were felt to represent visits to the ED, for which the diagnoses would likely not be altered based on COVID exposure or quarantine due to their acute nature. OBJECTIVES: Our goal was to investigate the effect of COVID-19 on common pediatric diagnoses seen in the pediatric ED using a large multihospital database. METHODS: We conducted a retrospective cohort study of consecutive pediatric patients (age ≤ 21 years) between March 1 and November 30 in 2019 and 2020 in 28 hospital EDs within 150 miles of New York City. We compared the change in the number of visits from 2019 to 2020 for the following diagnoses: anxiety, appendicitis, asthma, headache, seizures, and UTI. RESULTS: Our database contained 346,230 total pediatric visits. From 2019 to 2020, total visits decreased by 61%. Decreases for specific diagnoses were 75% for asthma, 64% for headaches, 47% for UTI, 32% for anxiety, 28% for seizures, and 18% for appendicitis (p value for each comparison < 0.0001). CONCLUSIONS: We found a marked decrease in ED visits for six common pediatric diagnoses after COVID-19 arrived in our area. We suspect that this decrease was due to recommendations to quarantine and fear of contracting the virus. Further studies on other diagnoses and potential complications due to the delay in seeking care are needed.
Asunto(s)
Apendicitis , Asma , COVID-19 , Humanos , Niño , Adulto Joven , Adulto , COVID-19/diagnóstico , COVID-19/epidemiología , Estudios Retrospectivos , Apendicitis/diagnóstico , Apendicitis/epidemiología , Servicio de Urgencia en Hospital , Cefalea/etiología , Asma/diagnóstico , Asma/epidemiología , Convulsiones , Ciudad de Nueva York/epidemiologíaRESUMEN
OBJECTIVE: The Novel Coronavirus19 (COVID19) arrived in northern New Jersey (NJ) in early March 2020, peaked at the beginning of April, and then declined. Starting in March, some patients who called 911 and required advanced life support (ALS) may have decompensated more rapidly than would have been expected, possibly because of concomitant COVID19 infection and/or delays in seeking medical care because of fear of exposure to the virus, and social isolation. In this study, our goal was to determine if there was an increase in prehospital ALS pronouncements and a decrease in ED visits for potentially serious conditions such as MI and stroke during the peak of the COVID-19 pandemic in northern NJ. METHODS STUDY DESIGN: Retrospective cohort of prehospital patients pronounced dead by paramedics and patients with MI and stroke in the EDs of receiving hospitals of these paramedics. Study Setting and Population: Ten ground ALS units in northern NJ and nine receiving hospital EDs. Each ALS unit is staffed by two NJ-certified mobile intensive care paramedics and respond with a paramedic flycar in a two-tiered dispatch system. DATA ANALYSIS: We identified prehospital pronouncements using the EMSCharts electronic record (Zoll Medical, Chelmsford, Massachusetts). We tabulated the number of pronouncements by week from January 1 to June 30 in 2019 and 2020. We tabulated the combined total number of pronouncements and ED visits by month along with visits for MI and stroke and calculated the changes during the same timeframe. We used Chi-square to test for statistical significance for the monthly changes from 2019 to 2020. RESULTS: For January through June in 2019 and 2020, there were 12,210 and 13,200 ALS dispatches, and 366 and 555 prehospital pronouncements, respectively. In 2020, pronouncements rose from a weekly baseline of 13 in early March, reached a peak of 45 at the beginning of April, then returned to the baseline level by the end of May. April 2020, the month with the most pronouncements, had 183% more pronouncements than April 2019 but total ED visits and visits for MI and stroke were 49%, 46% and 42% less, respectively (p < 0.0001 for each of these changes). CONCLUSION: Following the arrival of the COVID-19 pandemic in northern NJ, we found pre-hospital ALS death pronouncements increased and ED visits for MI and stroke decreased. Although we have speculated about the reasons for these findings, further studies are needed to determine what the actual causes were.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Infarto del Miocardio/terapia , Pandemias , Accidente Cerebrovascular/terapia , Comorbilidad , Estudios de Seguimiento , Humanos , Incidencia , Infarto del Miocardio/epidemiología , New Jersey/epidemiología , Estudios Retrospectivos , Accidente Cerebrovascular/epidemiología , Factores de TiempoRESUMEN
INTRODUCTION: In March and April 2020 of the coronavirus disease 2019 pandemic, site clinical practice guidelines were implemented for prone positioning of patients with suspected coronavirus disease 2019 in hypoxic respiratory distress who are awake, alert, and spontaneously breathing. The purpose of this pandemic disaster practice improvement project was to measure changes in pulse oximetry associated with prone positioning of patients with coronavirus disease 2019 infection in adult acute respiratory distress or adult respiratory distress syndrome, who are awake, alert, spontaneously breathing, and nonintubated. METHODS: A retrospective chart review of patients who were coronavirus disease 2019 positive in the emergency department from March 30, 2020 to April 30, 2020 was conducted for patients with a room air pulse oximetry <90% and a preprone position pulse oximetry ≤94% who tolerated prone positioning for at least 30 minutes. The primary outcome was the change in pulse oximetry associated with prone positioning, measured on room air, with supplemental oxygen, and approximately 30 minutes after initiating prone positioning. Median and mean differences were compared with the Wilcoxon signed-rank test and paired t-test. RESULTS: Of the 440 patients with coronavirus disease 2019, 31 met inclusion criteria. Median pulse oximetry increased as 83% (interquartile range, 75%-86%) on room air, 90% (interquartile range, 89%-93%) with supplemental oxygen, and 96% (interquartile range, 94%-98%) with prone positioning (z = -4.48, P < .001). A total of 45% (n = 14) were intubated during their hospital stay, and 26% (n = 8) of the included patients died. DISCUSSION: In patients with coronavirus disease 2019 who are awake, alert, and spontaneously breathing, an initially low pulse oximetry reading improved with prone positioning. Future studies are needed to determine the association of prone positioning with subsequent endotracheal intubation and mortality.
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COVID-19/complicaciones , COVID-19/terapia , Posicionamiento del Paciente/métodos , Síndrome de Dificultad Respiratoria/complicaciones , Síndrome de Dificultad Respiratoria/terapia , Femenino , Humanos , Hipoxia/complicaciones , Hipoxia/diagnóstico , Hipoxia/terapia , Intubación Intratraqueal , Masculino , Registros Médicos , Persona de Mediana Edad , New Jersey , Oximetría , Posición Prona , Síndrome de Dificultad Respiratoria/diagnóstico , Estudios Retrospectivos , SARS-CoV-2RESUMEN
BACKGROUND: Etiologies for Bell's palsy include herpes viruses and Lyme disease, with highest incidence in the colder and warmer months, respectively. In New Jersey, a Lyme-endemic area, the months with the most Lyme disease (80% of cases) are May through October ("Lyme months"). OBJECTIVE: Our aim was to determine whether positive tests for Lyme disease and visits are greater in the Lyme months than the rest of the year for patients with Bell's palsy in New Jersey emergency departments (EDs). METHODS: We conducted a retrospective chart review from two New Jersey suburban EDs with consecutive patients from February 1, 2013 to January 31, 2018.We identified patients having Bell's palsy using the emergency physician diagnosis. We tabulated positive Lyme tests and visits for Bell's palsy by month of year. We calculated the ratio of positive tests and visits between the Lyme months and the rest of the year along with 95% confidence intervals (CIs). RESULTS: There were 442 visits for Bell's palsy, 359 (81%) of these patients were tested for Lyme disease and 57 (16%) of the tests were positive. The Lyme months had 7.1 (95% CI 3.5-14.4) times more positive tests and 1.3 (95% CI 1.1-1.4) times more Bell's palsy visits than the rest of the year. Both measures peaked in July. CONCLUSIONS: In a Lyme-endemic area, positive Lyme tests and ED visits for Bell's palsy are greatest in the Lyme months, peaking in July. This finding can help guide testing and treatment for patients in the ED with Bell's palsy during various months of the year.
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Parálisis de Bell , Parálisis Facial , Enfermedad de Lyme , Parálisis de Bell/diagnóstico , Parálisis de Bell/etiología , Servicio de Urgencia en Hospital , Humanos , Enfermedad de Lyme/complicaciones , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/epidemiología , Estudios RetrospectivosRESUMEN
STUDY OBJECTIVES: Numerous studies have shown benefits of nonnarcotic treatments for emergency department (ED) migraine patients. Our goal was to determine if ED treatment of migraine patients and the rate of return within 72â¯h have changed. METHODS: Design: Multi-hospital retrospective cohort. POPULATION: Consecutive ED patients from 1-1-1999 to 9-31-2014. PROTOCOL: For determining treatments, we examined charts at the beginning (1999-2000) and end (2014) of the time period. We combined similar medications into the following groups: parenteral narcotics, oral narcotics, antihistamines and dopamine receptor antagonists prochlorperazine/metoclopramide (DRA). We calculated the percent of migraine patients given each treatment in each time period. We identified those who returned to the same ED within 72â¯h, and calculated the difference in annual return rates between 1999-2000 and 2014. RESULTS: Of the 2,824,710 total visits, 8046 (0.28%) were for migraine. We reviewed 290 charts (147 in 1999-2000 and 143 in 2014) to determine migraine treatments. The use of IV fluids, DRA, ketorolac and dexamethasone increased from 1999-2000 to 2014, whereas narcotic use and discharge prescriptions for narcotics decreased. Of the 8046 migraine patients, 624 (8%) returned within 72â¯h. The return rate decreased from 1999-2000 to 2014 from 12% to 4% (differenceâ¯=â¯8%, 95% CI 5%-11%). CONCLUSION: For ED migraine patients, the use of IV fluids, DRA, ketorolac and dexamethasone increased whereas the use of narcotics and discharge prescriptions for narcotics decreased. The return rates for migraines decreased. We speculate that the increased use of non-narcotic medications contributed to this decrease.
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Servicio de Urgencia en Hospital/tendencias , Trastornos Migrañosos/terapia , Adulto , Anciano , Antiinflamatorios no Esteroideos/normas , Antiinflamatorios no Esteroideos/uso terapéutico , Estudios de Cohortes , Dexametasona/normas , Dexametasona/uso terapéutico , Antagonistas de Dopamina/normas , Antagonistas de Dopamina/uso terapéutico , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Fluidoterapia/métodos , Fluidoterapia/normas , Humanos , Ketorolaco/normas , Ketorolaco/uso terapéutico , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/psicología , New Jersey , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pautas de la Práctica en Medicina/tendencias , Estudios RetrospectivosRESUMEN
BACKGROUND: Advances in pharmacologic therapy, non-invasive positive pressure ventilation (NIPPV) and advanced directives may have decreased the intubations of dyspneic elderly (≥65years old) patients in the emergency department (ED). OBJECTIVE: To determine if the percentage of elderly ED patients intubated has decreased in recent years. METHODS: Design: Retrospective multihospital cohort. SETTING: Consecutive ED patients in nine NJ hospitals (1/1/1999 to 9/30/2014). PROTOCOL: We identified patients intubated in the ED by CPT codes. DATA ANALYSIS: We calculated the annual percentage of patients ≥65 intubated and the percentage intubated by diagnosis along with 95% confidence intervals (CIs). RESULTS: Of the 5,693,380 total patients in the database there were 1,065,371 visits for patients≥65. Their average age was 80±8years; 54% were female. Of these, 6297 were intubated (0.59%). From 1999 to 2014 the percent intubated decreased from 0.73% to 0.52%, a relative decrease of 29% (95% CI: 17%, 38%). The specific diagnoses with >500 intubations were congestive heart failure (CHF), pneumonia and cardiac arrest, accounting for 37% of the total. Of these three, CHF was the only diagnosis with a statistically significant change from 1999 to 2014: a relative decrease of 70% (95% CI: 53%, 81%). If all diagnoses without CHF are analyzed the overall relative decrease is 14% (95% CI: 3%, 24%). CONCLUSION: Intubation rates for patients≥65 decreased from 1999 through 2014, particularly in CHF patients. We speculate that these findings reflect wider implementation of NIPPV, other therapeutic modalities and advanced directives.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Intubación Intratraqueal/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Utilización de Instalaciones y Servicios , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: Vertigo is a debilitating disease that is commonly encountered in the emergency department (ED). Diazepam and meclizine are oral medications that are commonly used to alleviate symptoms. OBJECTIVES: We sought to determine whether meclizine or diazepam is superior in the treatment of patients with peripheral vertigo in the ED. METHODS: We performed a double-blind clinical trial at a suburban, teaching ED. We randomized a convenience sample of adult patients with acute peripheral vertigo (APV) to diazepam 5 mg or meclizine 25 mg orally. Demographic and historical features were recorded on a standardized data form. Patients recorded their initial level (t0) of vertigo on a 100-mm visual analog scale (VAS) and after 30 min (t30) and 60 min (t60). The primary outcome parameter was the mean change in VAS score from t0 to t60. Differences between groups and 95% confidence intervals were calculated. Our a priori power calculation estimated that a sample size of 20 patients in each group was required to have an 80% power to detect a difference of 20 mm between treatment groups. RESULTS: There were 20 patients in the diazepam group and 20 in the meclizine group. The two groups were similar with respect to patient demographics and presenting signs and symptoms. At t60, the mean improvements in the diazepam and meclizine groups were 36 and 40, respectively (difference -4; 95% confidence interval -20 to 12; p = 0.60). CONCLUSION: We found no difference between oral diazepam and oral meclizine for the treatment of ED patients with acute peripheral vertigo.
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Diazepam/farmacología , Meclizina/farmacología , Resultado del Tratamiento , Vértigo/tratamiento farmacológico , Adulto , Diazepam/uso terapéutico , Método Doble Ciego , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Meclizina/uso terapéutico , Persona de Mediana Edad , Estudios ProspectivosAsunto(s)
Analgésicos Opioides/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Servicio de Urgencia en Hospital/legislación & jurisprudencia , Pautas de la Práctica en Medicina , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , New Jersey , Estudios RetrospectivosRESUMEN
OBJECTIVES: Gastroenteritis (GE) accounts for a significant number of emergency department (ED) visits in children. Several studies since the introduction of a new rotavirus vaccine in 2006 have found decreases in rotavirus illness. We sought to determine in a large multicenter ED database whether there was also a decrease in ED visits in young children for GE. DESIGN: Retrospective cohort of ED visits. SETTING: 28 EDs with annual visits between 22,000 and 82,000. POPULATION: Consecutive patients between January 1, 1996, and December 31, 2011. PROTOCOL: We identified GE visits using International Classification of Diseases 9th revision (ICD-9) codes. For each year, less than 5 years, we determined the average daily percent of total ED visits for GE. We calculated the decreases from 2005 to 2011 in the average daily percent GE visits for each year of life and their 95% confidence intervals. RESULTS: There were 7,740,823 total visits in the database, and 811,317 (10.5%) are younger than 5 years. The annual percent of GE visits rose for all years of life from 1999 to 2005 and then decreased from 2005 to 2011. The decreases from 2005 to 2011 were greatest in the earliest years of life ranging from 41% in the first year of life to 15% in the fifth year of life. CONCLUSIONS: We found a decrease in average daily ED visits for GE in each year of life for those younger than 5 years after the introduction of the rotavirus vaccine. This was most pronounced during the earliest years of life.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Gastroenteritis/epidemiología , Infecciones por Rotavirus/epidemiología , Vacunas contra Rotavirus/administración & dosificación , Preescolar , Estudios de Cohortes , Bases de Datos Factuales , Gastroenteritis/virología , Humanos , Lactante , New Jersey/epidemiología , New York/epidemiología , Estudios Retrospectivos , Infecciones por Rotavirus/prevención & control , Resultado del TratamientoRESUMEN
BACKGROUND: Although oral corticosteroids are commonly given to emergency department (ED) patients with musculoskeletal low back pain (LBP), there is little evidence of benefit. OBJECTIVE: To determine if a short course of oral corticosteroids benefits LBP ED patients. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Suburban New Jersey ED with 80,000 annual visits. PARTICIPANTS: 18-55-year-olds with moderately severe musculoskeletal LBP from a bending or twisting injury ≤ 2 days prior to presentation. Exclusion criteria were suspected nonmusculoskeletal etiology, direct trauma, motor deficits, and local occupational medicine program visits. PROTOCOL: At ED discharge, patients were randomized to either 50 mg prednisone daily for 5 days or identical-appearing placebo. Patients were contacted after 5 days to assess pain on a 0-3 scale (none, mild, moderate, severe) as well as functional status. RESULTS: The prednisone and placebo groups had similar demographics and initial and discharge ED pain scales. Of the 79 patients enrolled, 12 (15%) were lost to follow-up, leaving 32 and 35 patients in the prednisone and placebo arms, respectively. At follow-up, the two arms had similar pain on the 0-3 scale (absolute difference 0.2, 95% confidence interval [CI] -0.2, 0.6) and no statistically significant differences in resuming normal activities, returning to work, or days lost from work. More patients in the prednisone than in the placebo group sought additional medical treatment (40% vs. 18%, respectively, difference 22%, 95% CI 0, 43%). CONCLUSION: We detected no benefit from oral corticosteroids in our ED patients with musculoskeletal LBP.
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Antiinflamatorios/uso terapéutico , Dolor de la Región Lumbar/tratamiento farmacológico , Dolor Musculoesquelético/tratamiento farmacológico , Prednisona/uso terapéutico , Administración Oral , Adulto , Antiinflamatorios/administración & dosificación , Método Doble Ciego , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Prednisona/administración & dosificación , Estudios ProspectivosRESUMEN
OBJECTIVE: A study published in December 2000 showed that 5% of patients presenting with transient ischemic attacks (TIAs) developed a stroke within 48 hours. This finding has been corroborated in several other studies. We hypothesize that, influenced by this, emergency department (ED) physicians have been more reluctant to discharge TIA patients resulting in an increase in the percentage of TIA patients admitted. METHODS: This is a retrospective cohort of consecutive ED visits. This study is conducted in 6 New Jersey EDs with annual ED visits from 25000 to 65000. Consecutive patients seen by ED physicians between January 1, 2000, and December 31, 2010, were included. We identified TIA visits using the International Classification of Diseases, Ninth Revision, code. We analyzed the admission rates for TIA testing for significant differences using the Student t test and calculated 95% confidence intervals. RESULTS: Of the 2622659 visits in the database, 8216 (0.3%) were for TIA. Females comprised 57%. There was a statistically significant increase in the annual admission rates for TIA patients from 2000 to 2010, from 70% to 91%, respectively (difference, 22%; 95% confidence interval, 18%-26% [P < .001]). Separate analysis by sex showed similar increased admission rates for females and males. CONCLUSIONS: We found that the admission rate for TIAs increased significantly from 2001 to 2010. This change in physicians' practice may be due to the body of evidence that TIA patients have a significant short-term risk of stroke.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Ataque Isquémico Transitorio/epidemiología , Admisión del Paciente/estadística & datos numéricos , Anciano , Femenino , Humanos , Ataque Isquémico Transitorio/terapia , Masculino , New Jersey/epidemiología , Alta del Paciente/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
OBJECTIVE: Many advances have been made recently in the treatment of congestive heart failure (CHF). We hypothesize that this should have resulted in fewer CHF patients presenting to the emergency department (ED) and fewer being intubated. DESIGN: Retrospective cohort. SETTING: consecutive patients seen by ED physicians in 4 suburban hospitals in New Jersey and New York from 1996 to 2008. PROTOCOL: We classified patients as having CHF based on International Classification of Diseases, Ninth Revision, codes. For each year of the study, we determined CHF visit rates (as a percentage of total ED visits) and calculated the percentage of CHF patients intubated. We used the Student t test, calculated 95% confidence intervals (CIs), and performed regression analyses. RESULTS: Of the 2,374,428 ED visits, 32,036 (1.3%) were for CHF. The mean age of the CHF patients was 76 ± 14 years, and 57% were female. Congestive heart failure visits declined from 1.6% of all ED visits in 1996 to 1.2% in 2008, a 26% relative decrease (95% CI: 21%-30%, P < .001, correlation coefficient R(2) = 0.94, P < .001). Of the CHF patients, 778 (2.4%) were intubated. Intubation rates declined from 3.6% in 1996 to 1.7% in 2008, a 53% (95% CI: 31%-68%, P < .001, R(2) = 0.83, P < .001) relative decrease. CONCLUSION: The rates of annual ED visits for CHF and intubation rates declined from 1996 to 2008. These decreases are most likely due to better CHF treatments.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Insuficiencia Cardíaca/terapia , Intubación Intratraqueal/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Progresión de la Enfermedad , Servicio de Urgencia en Hospital/tendencias , Femenino , Humanos , Intubación Intratraqueal/tendencias , Masculino , Persona de Mediana Edad , New Jersey , New York , Estudios RetrospectivosRESUMEN
OBJECTIVE: Renal colic has been considered predominantly a disease of adults with only occasional cases occurring in the pediatric population. A recent report from a single hospital showed a rise in the number of children with renal colic. Our objective was to examine this in a much larger multihospital database of emergency department (ED) visits. METHODS: This study has a retrospective cohort design. It was conducted on consecutive pediatric patients (age <18 years) with a diagnosis of "renal colic, calculus kidney, calculus ureter, urinary calculus, or urethral calculus" according to the International Classification of Diseases, Ninth Revision, as seen by ED physicians in 29 urban, suburban, and rural EDs in New Jersey and New York between January 1, 1999, and December 31, 2008. We analyzed the number of renal colic visits as a percent of total ED pediatric visits in yearly intervals using the Student t test and performed a regression analysis. The α was set at 0.05. RESULTS: The database contained 6,497,458 total ED visits, of which 1,312,487 (20%) were pediatric visits. Of these, 1005 (0.077%) were for renal colic. The median age of these pediatric patients was 16 years (interquartile range, 13-17 years) and 61% were female. The percentage of ED pediatric visits for renal colic increased from 0.048% in 1999 to 0.089% in 2008, an increase of 86% (95% confidence interval, 36%-154%; P < 0.001). The correlation coefficient for this upward trend was R2 = 0.69 (P = 0.003). CONCLUSIONS: We found a marked increase in ED pediatric visits for renal colic over the past decade. This may reflect a real increase in the incidence of renal colic in the pediatric population or an increased use of imaging modalities for abdominal and flank pain.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Cólico Renal/epidemiología , Cálculos Urinarios/epidemiología , Adolescente , Niño , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , New Jersey/epidemiología , New York/epidemiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: Some would advocate against routine use of prereduction x-rays for shoulder dislocations. Our objective was to examine the percent of dislocations that also had fractures as a function of age to determine whether there are some decades of life with a sufficiently low risk of fracture to avoid routine prereduction x-rays. METHODS: This was a retrospective cohort study in 19 New Jersey and New York emergency departments. We used The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9) codes to identify patients with shoulder dislocations and, among these, those who also had fractures. A priori, we chose to group the patients by decade of life. For patients with dislocations in each age group, we calculated the percent that also had fractures. RESULTS: Of the total 5,408,837 visits in the database, there were 7209 patients with dislocations, of which 465 (6.5%) had fractures. We found the lowest percent of fractures in the 2nd and 3rd decades of life (0.7% [95% confidence interval, 0.3%-1.2%] and 0.8% [0.4%-1.3%]). In the 4th and 5th decades of life, the percents were 2.6% (1.7%-3.5%) and 4.6% (3.2-6.0%), respectively, and they steadily increased to 19% or greater in the 8th to 10th decades of life. Omitting the prereduction x-rays for patients in the 2nd and 3rd decades of life would reduce the total number of prereduction x-rays by 40%. CONCLUSION: In the second and third decades of life, less than 1% of patients with shoulder dislocations also had fractures. Because these patients have a sufficiently low risk of fracture, routine prereduction x-rays may not be necessary for them.
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Selección de Paciente , Luxación del Hombro/diagnóstico por imagen , Fracturas del Hombro/diagnóstico por imagen , Adolescente , Adulto , Servicio de Urgencia en Hospital , Femenino , Humanos , Clasificación Internacional de Enfermedades , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Luxación del Hombro/terapia , Fracturas del Hombro/terapiaRESUMEN
BACKGROUND: Recurrence of migraine headache after treatment in the emergency department (ED) is common. Conflicting evidence exists regarding the utility of steroids in preventing migraine headache recurrence at 24-48 h. OBJECTIVE: To determine if steroids decrease the headache recurrence in patients treated for migraine headaches in the ED. METHODS: Double-blind placebo-controlled, two-tailed randomized trial. Patients aged >17 years with a moderately severe migraine headache diagnosed by treating Emergency Physician were approached for participation. Enrollees received either dexamethasone (10 mg i.v.) if intravenous access was utilized or prednisone (40 mg by mouth × 2 days) if no intravenous access was obtained. Each medication was matched with an identical-appearing placebo. Patients were contacted 24-72 h after the ED visit to assess headache recurrence. RESULTS: A total of 181 patients were enrolled. Eight were lost to follow-up, 6 in the dexamethasone group and 2 in the prednisone arm. Participants had a mean age of 37 years (±10 years), with 86% female. Eighty-six percent met the International Headache Society Criteria for migraine headache. Of the 173 patients with completed follow-up, 20/91 (22%) (95% confidence interval [CI] 13.5-30.5) in the steroid arm and 26/82 (32%) (95% CI 21.9-42.1) in the placebo arm had recurrent headaches (p = 0.21). CONCLUSION: We did not find a statistically significant decrease in headache recurrence in patients treated with steroids for migraine headaches.
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Dexametasona/uso terapéutico , Glucocorticoides/uso terapéutico , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/prevención & control , Prednisona/uso terapéutico , Adulto , Distribución de Chi-Cuadrado , Método Doble Ciego , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Prevención Secundaria , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
OBJECTIVE: Previous studies of the seasonality of testicular torsion have yielded conflicting results. Our goal was to examine this issue in a large emergency department (ED) database. We also hypothesized that seasonal patterns would be similar in younger and older patients. METHODS: This was a retrospective cohort of ED visits. This study was performed on 20 New Jersey and New York EDs. The subjects are consecutive patients seen by ED physicians from January 1, 1996, to December 31, 2009. The authors identified visits with testicular torsion using International Classification of Disease, Ninth Revision codes. We then determined the number of testicular torsion visits by month, correcting for the total number of days over the study period in each month. We compared the corrected number of visits for the winter (December-February) compared with the summer (June-August) using the Student t test, with α set at 0.05. We also calculated these visits for the older and younger half of the patients. Finally, we determined the correlation between mean monthly testicular torsion visits and ambient temperatures. RESULTS: Of the 8,545,979 visits in the database, 768 (0.009%) had an ED diagnosis of testicular torsion. The median age was 15.5 years (interquartile range, 11.7-20.8 years). We found that testicular torsion visits were 39% (95% confidence interval, 24%-57%) more likely in the winter compared with the summer, and this was similar when the older and younger half of the patients were analyzed separately. The correlation coefficient between mean monthly testicular torsion visits and ambient temperature was r = 0.54 (P = 0.006). CONCLUSIONS: Testicular torsion visits are more frequent in the winter than in the summer months.
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Estaciones del Año , Torsión del Cordón Espermático/epidemiología , Temperatura , Adolescente , Factores de Edad , Niño , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Masculino , New Jersey/epidemiología , New York/epidemiología , Torsión del Cordón Espermático/etiología , Adulto JovenRESUMEN
INTRODUCTION: The ngram classifier is created by using text fragments to measure associations between chief complaints (CC) and a syndromic grouping of ICD-9-CM codes. OBJECTIVES: For gastrointestinal (GI) syndrome to determine: (1) ngram CC classifier sensitivity/specificity. (2) Daily volumes for ngram CC and ICD-9-CM classifiers. DESIGN: Retrospective cohort. SETTING: 19 Emergency Departments. PARTICIPANTS: Consecutive visits (1/1/2000-12/31/2005). PROTOCOL: (1) Used an existing ICD-9-CM filter for "lower GI" to create the ngram CC classifier from a training set and then measured sensitivity/specificity in a test set using an ICD-9-CM classifier as criterion. (2) Compare daily volumes based on ICD-9-CM with that predicted by the ngram classifier. RESULTS: For a specificity of 0.96, sensitivity was 0.70. The daily volume correlation for ngram vs. ICD-9-CM was R=0.92. CONCLUSION: The ngram CC classifier performed similarly to manually developed CC classifiers and has advantages of rapid automated creation and updating, and may be used independent of language or dialect.
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Brotes de Enfermedades/estadística & datos numéricos , Métodos Epidemiológicos , Informática Médica/métodos , Procesamiento de Lenguaje Natural , Vigilancia de la Población/métodos , Estudios de Cohortes , Diagnóstico , Brotes de Enfermedades/prevención & control , Servicio de Urgencia en Hospital , Enfermedades Gastrointestinales , Humanos , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
PURPOSE: A previous study showed that pulmonary edema patients presenting between noon and 4 pm have the highest rates of myocardial infarction and death. We hypothesized that the highest intubation rates would also occur at these times. BASIC PROCEDURES: We performed a retrospective cohort study of consecutive patients seen by emergency department physicians in 15 hospital emergency departments (1996-2003). MAIN FINDINGS: Of 3.6 million visits in the database, 39,795 (1.1%) patients had congestive heart failure. We found statistically significant circadian variations in intubation rates. Patients arriving between midnight and 4 am had the highest intubation rates (4.1%), and those arriving between noon and 4 pm had the lowest (1.2%) (difference, 2.9%; 95% confidence interval, 2.4%-3.4%; P < .0001). CONCLUSION: We found significant circadian variation in intubation rates, with a marked increase around midnight. Pathological mechanisms causing patients with congestive heart failure to require intubation may differ from those resulting in myocardial infarction or death.
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Ritmo Circadiano , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Intubación Intratraqueal , Anciano , Urgencias Médicas , Femenino , Humanos , Incidencia , Masculino , New Jersey/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Frequently it is difficult to determine illness severity in hypothermic patients. Our goal was to determine if there are factors associated with illness severity of hypothermic emergency department (ED) patients. METHODS: Multi-hospital retrospective cohort. Consecutive patients in 24 EDs (1-1-2012 to 4-30-2015). Hypothermic patients (≤35 °C) were identified using ICD codes. We used hospital admission as marker of illness severity. Student's t-test was used for differences between mean age and temperature for admitted and discharged patients. We calculated the percent of patients admitted by factor, the difference from overall admission rate and 95% confidence interval (CI) of difference. RESULTS: There were 2094 visits with hypothermia ICD code. Of these, 132 patients had initial rectal temperatures ≤35 °C. Females comprised 42%; the mean age was 55 ± 23 years, and overall admission rate was 62%. The percent of patients with alcohol, trauma and found indoors were 39%, 27% and 27%, respectively. For admitted and discharged patients the mean ages were 60 and 48 years, respectively (p = 0.01), and initial mean temperature 32.3 °C vs. 33 °C, respectively (p = 0.07). Found indoors was associated with an 86% admission rate, a 22% increase (95% CI, 3%-34%) compared to overall admission rate. There was no statistically significant difference in admission rates from overall admission rate based on gender, alcohol or trauma. CONCLUSIONS: For hypothermic ED patients increased severity of illness was associated with older age and found indoors but not associated with initial temperature, gender, alcohol or trauma. These findings may assist physicians in treatment and disposition decisions.
RESUMEN
The purpose of this study was to examine the effect of September 11, 2001 on anxiety-related visits to selected Emergency Departments (EDs). We performed a retrospective analysis of consecutive patients seen by emergency physicians in 15 New Jersey EDs located within a 50-mile radius of the World Trade Center from July 11 through December 11 in each of 6 years, 1996--2001. We chose by consensus all ICD-9 (International Classification of Diseases, 9th revision) codes related to anxiety. We used graphical methods, Box-Jenkins modeling, and time series regression to determine the effect of September 11 to 14 on daily rates of anxiety-related visits. We found that the daily rate of anxiety-related visits just after September 11th was 93% higher (p < 0.0001) than the average for the remaining 150 days for 2001. This represents, on average, one additional daily visit for anxiety at each ED. We concluded that there was an increase in anxiety-related ED visits after September 11, 2001.