The American journal of emergency medicine
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To examine whether and how avoidable emergency department (ED) utilization is associated with ambulatory or primary care (APC) utilization, insurance, and interaction effects. ⋯ The association between APC utilization and avoidable ED utilization varied based on segments of the distribution of ED score and differed significantly by insurance type.
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Upper gastrointestinal bleeding (UGIB) is an important health problem with a potentially life threatening course. Measurement of immature granulocytes percentage (IG %), reflecting the fraction of circulating immature granulocyte (IG), is associated with increased mortality in patients with systemic inflammation, or distress. The aim of this study was to evaluate whether the IG% is an effective predictive marker for estimating the in-hospital mortality for patients with UGIB admitting to the emergency department (ED). ⋯ This study included 149 patients, 94 of whom were men. The mean age of the patients was 64.5 ± 14.2. Twenty patients died during hospitalization and 129 were discharged. IG% was significantly higher in patients who died compared with patients who discharged. In the receiver operating characteristic (ROC) curves analysis to determine the in-hospital mortality, the cut-off value (>1%) for IG% level was found specificity (93.8%), sensitivity (100%), positive predictive value (PPV = 71.43%), negative predictive value (NPV = 100.00%) and area under curve (AUC = 0.98). Univariate logistic regression analysis showed that IG% was predicting in-hospital mortality (odds ratio, OR = 65.6, confidence interval, CI = 2.00-2152.6). CONCLUSıONS: High IG% levels may be used as a predictor of in-hospital mortality in patients with UGIB.
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Chronic nitrous oxide abuse is a known cause of myeloneuropathy. Nitrous oxide irreversibly inactivates vitamin B12 causing demyelination of the dorsal spinal columns, clinically indistinguishable from that which is caused by vitamin B12 deficiency. ⋯ The patient reported daily use in excess of 500 nitrous oxide cartridges, also known as "whippits". Nitrous oxide myeloneuropathy should be included in the differential diagnoses for emergency medicine physicians when evaluating a patient with bilateral neurologic deficits and ataxia.