Emergency Department Visit Rates by Selected Characteristics: United States, 2021.

In 2021, 140 million emergency department (ED) visits occurred in the United States (1). During that year, about 4% of children had two or more ED visits in the past 12 months, and 18% of adults had visited the ED in the past 12 months (2,3). This report presents characteristics of ED visits by age group, sex, race and ethnicity, insurance, and mentions of COVID-19, using data from the 2021 National Hospital Ambulatory Medical Care Survey (NHAMCS) (4).

Emergency Department Visits Among Children Aged 0-17 by Selected Characteristics: United States, 2019-2020.

With the disruptions to access and use of care caused by the COVID-19 pandemic, emergency department (ED) visit rates decreased from 2019 to 2020 among children and adolescents (1). The ED visit rate for children under age 1 year in 2020 was nearly one-half of the rate in 2019, and the rate for those aged 1-17 years decreased over the same period (2). This report uses data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) (3,4) to compare ED visits for children aged 0-17 from 2019 to 2020, by age group, sex, and race and ethnicity, and to assess changes in wait time at ED visits.

Emergency Department Visit Rates for Motor Vehicle Crashes by Selected Characteristics: United States, 2019-2020.

For 2019-2020, an average of 3.8 million emergency department (ED) visits for motor vehicle crash injuries occurred annually (1,2). Most injuries from motor vehicle crashes (90.4%) are unintentional and occur among vehicle occupants, and these types of injuries are a leading cause of all injury in the United States (1-3). This report presents ED visit rates for injuries related to all types of motor vehicle crashes by age, race and ethnicity, health insurance status, and region. Data for this report are from the National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual nationally representative survey of nonfederal, general, and short-stay hospitals (1,2).

Emergency Department Visits With Suicidal Ideation: United States, 2016- 2020.

Before the COVID-19 pandemic in the United States, suicide was the 10th highest cause of death overall and the 2nd highest cause for the 10-34 age group (1,2). Suicidal ideation is defined as thinking about, considering, or planning suicide; is predictive of suicide deaths; and may result in injury and hospitalization (3). An estimated 4.0% to 4.8% of adults aged 18 and over have suicidal ideation each year (4,5). The lifetime prevalence of suicidal ideation in the United States is 15.6% (6). This report uses data from the 2016-2020 National Hospital Ambulatory Medical Care Survey to present the annual average emergency department (ED) visit rate per 10,000 people for patients with suicidal ideation.

Emergency Department Visit Rates by Selected Characteristics: United States, 2020.

In 2020, an estimated 131 million emergency department (ED) visits occurred in the United States, with 19.0% of adults reporting a visit and 4.7% of children reporting two or more visits in the past 12 months (1-3). In that time, over 20 million cases of COVID-19 caused a disruption in access to and use of care (4). This report presents characteristics of ED visits, including those with mentions of COVID-19, by age group, sex, race and ethnicity, and primary expected source of payment, using data from the 2020 National Hospital Ambulatory Medical Care Survey (NHAMCS)(5).

Experiences Related to the COVID-19 Pandemic Among U.S. Physicians in Office-based Settings, 2020-2021.

Objective-To assess final estimates of physician experiences related to COVID-19 and to compare preliminary estimates used in NCHS early-release dashboards with final estimates in this report.

Emergency Department Visit Rates by Selected Characteristics: United States, 2019.

In 2019, an estimated 151 million emergency department (ED) visits occurred in the United States and about 22% of adults aged 18 and over had visited the ED in the past 12 months (1,2). This report presents ED visit rates by selected characteristics, including metropolitan statistical area (MSA) status, age, sex, race and ethnicity, and health insurance status. Data for this report are from the National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual nationally representative survey of nonfederal, general, and short-stay hospitals (3,4).

Emergency Department Visit Rates for Motor Vehicle Crashes by Selected Characteristics: United States, 2017-2018.

In 2017-2018, an average of 3.4 million emergency department (ED) visits for motor vehicle crash injuries occurred annually (1,2). Most persons injured or killed in motor vehicle crashes are occupants (3). Medical care costs and productivity losses associated with crash injuries and deaths exceeded $75 billion in 2017 (4). This report presents ED visit rates for motor vehicle crashes by age, race and ethnicity, health insurance status, and census region. Data for this report are from the National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual nationally representative survey of nonfederal, general, and short-stay hospitals (1,2).

Emergency Department Visit Rates by Selected Characteristics: United States, 2018.

In 2018, there were an estimated 130 million emergency department (ED) visits in the United States (1). In 2019, approximately 22% of adults aged 18 and over had visited the ED in the past 12 months (2). This report presents ED visit rates by selected characteristics, including metropolitan statistical area (MSA), age, sex, race and ethnicity, and health insurance status. Data for this report are from the National Hospital Ambulatory Medical Care Survey (NHAMCS) (3,4).

Respiratory Illness Emergency Department Visits in the National Hospital Care Survey and the National Hospital Ambulatory Medical Care Survey.

Purpose-This report compares emergency department (ED) visits for respiratory illness between the 2014 National Hospital Care Survey (NHCS) and the 2014 National Hospital Ambulatory Medical Care Survey (NHAMCS) to determine the potential of researching respiratory illness in EDs with non-nationally representative NHCS data. The 2014 NHCS data linked to records in the 2014-2015 National Death Index (NDI) are also described to provide results on mortality after ED visits for respiratory illness. Methods-For both surveys, encounters with respiratory illness were identified using diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Weighted NHAMCS percentage estimates and their 95% confidence intervals (CIs) are shown for all demographic characteristics. Unweighted NHCS percentages are presented for all demographic and health care characteristics and are compared with weighted NHAMCS percentage estimates and used to report NHCS-only results. Standard errors and CIs are also presented for the NHCS unweighted percentages as a measure of variability. Results-The percentage of NHCS ED visits for respiratory illness fell within NHAMCS measures of statistical variation for overall and specific respiratory illnesses. Additionally, respiratory illness by sex, older age groups, older men, and female patients of all ages fell within these measures. Compared with NHAMCS, NHCS had a higher percentage of ED visits for respiratory illness for both infants (under 1 year) and children (1-17 years) but a lower percentage for adults aged 18-44. NHCS data show that 15.2% of patients with ED visits for respiratory illness were hospitalized and of those hospitalized, 6.6% died within 90 days post-discharge. However, 11.1% of patients admitted to the intensive care unit died within 90 days. Conclusion-Although the 2014 NHCS data are not nationally representative, the data may be used for exploratory analyses and have analytical capabilities that are not available in other hospital surveys.

Trends in Electronic Health Record Use Among Residential Care Communities: United States, 2012, 2014, and 2016.

Introduction-This report presents a trend analysis of electronic health record (EHR) use and health information exchange capability among residential care communities. EHR systems and health information exchange have the potential to improve communication and facilitate care coordination, especially during care transitions. Methods-Data in this report are from the residential care community survey component of the 2012, 2014, and 2016 waves of the biennial National Study of Long-Term Care Providers (NSLTCP), which is conducted by the National Center for Health Statistics. For the EHR use measure, respondents were asked if, for other than accounting or billing purposes, they used EHRs. Among those who indicated they did use EHRs, health information exchange capability was also measured using items that asked residential care communities if their computerized system supported electronic health information exchange with physicians or pharmacies. A weighted least-squares regression was used to test the significance of trends across the 2012, 2014, and 2016 NSLTCP waves by several residential care community characteristics, including bed size, ownership status, chain affiliation, U.S. Census division, and metropolitan statistical area (MSA) status. Results-The percentage of residential care communities that used EHRs increased between 2012 and 2016 overall (20% to 26%), for all bed size categories, profit and nonprofit ownership, chain and nonchain affiliation, six out of nine census divisions, and MSA and non-MSA status. Among residential care communities reporting EHR use, computerized support for health information exchange with physicians or pharmacies also increased between 2012 and 2016 overall (47.2% to 55.0%) and among communities that had more than 100 beds, were for profit, chain affiliated, located in the East North and East South Central census divisions, and in both MSAs and non-MSAs.

Molecular epidemiology of Marek's disease virus in central Pennsylvania, USA.

The evolution of Marek's disease virus (MDV, Gallid herpesvirus 2) has threatened the sustainability of poultry farming in the past and its continued evolution remains a concern. Genetic diversity is key to understanding evolution, yet little is known about the diversity of MDV in the poultry industry. Here, we investigate the diversity of MDV on 19 Pennsylvanian poultry farms over a 3-year period. Using eight polymorphic markers, we found that at least twelve MDV haplotypes were co-circulating within a radius of 40 km. MDV diversity showed no obvious spatial clustering nor any apparent clustering by bird line: all of the virus haplotypes identified on the commercial farms could be found within a single, commonly reared bird line. On some farms, a single virus haplotype dominated for an extended period of time, while on other farms the observed haplotypes changed over time. In some instances, multiple haplotypes were found simultaneously on a farm, and even within a single dust sample. On one farm, co-occurring haplotypes clustered into phylogenetically distinct clades, putatively assigned as high and low virulence pathotypes. Although the vast majority of our samples came from commercial poultry farms, we found the most haplotype diversity on a noncommercial backyard farm experiencing an outbreak of clinical Marek's disease. Future work to explore the evolutionary potential of MDV might therefore direct efforts toward farms that harbor multiple virus haplotypes, including both backyard farms and farms experiencing clinical Marek's disease.

Industry-Wide Surveillance of Marek's Disease Virus on Commercial Poultry Farms.

Marek's disease virus is a herpesvirus of chickens that costs the worldwide poultry industry more than US$1 billion annually. Two generations of Marek's disease vaccines have shown reduced efficacy over the last half century due to evolution of the virus. Understanding where the virus is present may give insight into whether continued reductions in efficacy are likely. We conducted a 3-yr surveillance study to assess the prevalence of Marek's disease virus on commercial poultry farms, determine the effect of various factors on virus prevalence, and document virus dynamics in broiler chicken houses over short (weeks) and long (years) timescales. We extracted DNA from dust samples collected from commercial chicken and egg production facilities in Pennsylvania, USA. Quantitative PCR was used to assess wild-type virus detectability and concentration. Using data from 1018 dust samples with Bayesian generalized linear mixed effects models, we determined the factors that correlated with virus prevalence across farms. Maximum likelihood and autocorrelation function estimation on 3727 additional dust samples were used to document and characterize virus concentrations within houses over time. Overall, wild-type virus was detectable at least once on 36 of 104 farms at rates that varied substantially between farms. Virus was detected in one of three broiler-breeder operations (companies), four of five broiler operations, and three of five egg layer operations. Marek's disease virus detectability differed by production type, bird age, day of the year, operation (company), farm, house, flock, and sample. Operation (company) was the most important factor, accounting for between 12% and 63.4% of the variation in virus detectability. Within individual houses, virus concentration often dropped below detectable levels and reemerged later. These data characterize Marek's disease virus dynamics, which are potentially important to the evolution of the virus.

Restrictive versus liberal transfusion strategies for older mechanically ventilated critically ill patients: a randomized pilot trial.

OBJECTIVES: To compare hemoglobin concentration (Hb), RBC use, and patient outcomes when restrictive or liberal blood transfusion strategies are used to treat anemic (Hb≤90 g/L) critically ill patients of age≥55 years requiring≥4 days of mechanical ventilation in ICU. DESIGN: Parallel-group randomized multicenter pilot trial. SETTING: Six ICUs in the United Kingdom participated between August 2009 and December 2010. PATIENTS: One hundred patients (51 restrictive and 49 liberal groups). INTERVENTIONS: Patients were randomized to a restrictive (Hb trigger, 70 g/L; target, 71-90 g/L) or liberal (90 g/L; target, 91-110 g/L) transfusion strategy for 14 days or the remainder of ICU stay, whichever was longest. MEASUREMENTS AND MAIN RESULTS: Baseline comorbidity rates and illness severity were high, notably for ischemic heart disease (32%). The Hb difference among groups was 13.8 g/L (95% CI, 11.5-16.0 g/L); p<0.0001); mean Hb during intervention was 81.9 (SD, 5.1) versus 95.7 (6.3) g/L; 21.6% fewer patients in the restrictive group were transfused postrandomization (p<0.001) and received a median 1 (95% CI, 1-2; p=0.002) fewer RBC units. Protocol compliance was high. No major differences in organ dysfunction, duration of ventilation, infections, or cardiovascular complications were observed during intensive care and hospital follow-up. Mortality at 180 days postrandomization trended toward higher rates in the liberal group (55%) than in the restrictive group (37%); relative risk was 0.68 (95% CI, 0.44-1.05; p=0.073). This trend remained in a survival model adjusted for age, gender, ischemic heart disease, Acute Physiology and Chronic Health Evaluation II score, and total non-neurologic Sequential Organ Failure Assessment score at baseline (hazard ratio, 0.54 [95% CI, 0.28-1.03]; p=0.061). CONCLUSIONS: A large trial of transfusion strategies in older mechanically ventilated patients is feasible. This pilot trial found a nonsignificant trend toward lower mortality with restrictive transfusion practice.

Life-threatening hyperkalaemia following therapeutic barbiturate coma.

OBJECTIVE: To report the occurrence of life-threatening hyperkalaemia following treatment with therapeutic thiopentone coma. SETTING: The neurosurgical intensive care units of Royal North Shore Hospital and Liverpool Hospital, Sydney, Australia. PATIENTS: Three patients treated with theraputic thiopentone coma. One patient with raised intracranial pressure secondary to a severe traumatic brain injury and two patients with refractory vasospasm secondary to subarachnoid haemorrhage. Two of the three patients developed hypokalaemia on starting thiopentone, which was resistant to potassium supplementation. All three patients developed severe hyperkalaemia during the recovery phase of coma. This was life-threatening in all three patients and fatal in one. CONCLUSIONS: Severe hypokalaemia refractory to potassium therapy may occur during therapeutic thiopentone coma. Severe rebound hyperkalaemia may occur after cessation of thiopentone infusion. Protocols for the management of patients with therapeutic barbiturate coma should recognise this potentially serious complication.