Articles: emergency-department.
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Leaving before medically advised (BMA) is a significant issue in the US healthcare system, leading to adverse health outcomes and increased costs. Despite previous research, multi-year studies using up-to-date nationwide emergency department (ED) data, are limited. This study examines factors associated with leaving BMA from EDs and trends over time, before and during the COVID-19 pandemic. ⋯ In this study, several demographics, socio-economic, and clinical characteristics were associated with higher incidences of leaving ED BMA. The COVID-19 pandemic also exacerbated BMA rates. These findings highlight the need for targeted interventions to improve patient-provider communication and ED triage efficiency, especially in resource-constrained facilities serving lower-income individuals.
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Pediatric emergency care · Dec 2024
Missed Opportunity for Initial Diagnosis in Children With Complex Appendicitis.
Delayed diagnosis of acute appendicitis in children may result in complex appendicitis with appendiceal perforation. Delayed diagnosis can result from missed opportunity for initial diagnosis (MOID) despite medical attention. Studies report MOID of less than 5% in pediatric emergency departments (EDs), but we hypothesized that many MOID occurs outside tertiary care facilities. Our goals were to determine the MOID rate in all presenting facilities in children with complex appendicitis and to identify associated risk factors. ⋯ Missed opportunity for initial diagnosis of complex appendicitis occurs in nontertiary care facilities, is more common in younger children and non-English/Spanish speakers, and is associated with worse outcomes, highlighting the need for interpreters and algorithmic evaluation in nontertiary care facilities.
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Eur. J. Intern. Med. · Dec 2024
Prevalence and impact of multidrug resistance in a cohort of patients admitted to emergency department for urinary tract-infections: The UTILY study, a prospective multicentre study.
The aim of the present study was to evaluate the prevalence and to identify the independent predictors of multi-drug resistance among a cohort of patients admitted to emergency department for urinary tract infections (UTI), and to assess the impact of antimicrobial resistance on the clinical outcomes. ⋯ Our study has reported a 39.1 % prevalence of MDR pathogens in patients admitted to emergency departments for UTI, with a 21 % prevalence among patients without any known risk factor.
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Pediatric emergency care · Dec 2024
Accuracy of ICD-10 Codes for Suicidal Ideation and Action in Pediatric Emergency Department Encounters.
According to the ideation-to-action framework of suicidality, suicidal ideation and suicidal action arise via distinct trajectories. Studying suicidality under this framework requires accurate identification of both ideation and action. We sought to assess the accuracy of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for suicidal ideation and action in emergency department encounters. ⋯ Many cases of suicidality may be missed by relying on only ICD-10-CM codes. Accuracy of ICD-10-CM codes is high for suicidal ideation but low for action. To scale the ideation-to-action model for use in large populations, better data sources are needed to identify cases of suicidal action.
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Pediatric emergency care · Dec 2024
Changes in Emergency Department Practices After Implementation of a Standardized Heavy Menstrual Bleeding Guideline.
The aim of the study is to assess the effect of an emergency department (ED) standardized clinical guideline for adolescent heavy menstrual bleeding on the rate of return ED visits and ED provider history-taking and management of this condition. ⋯ Implementation of a clinical guideline pathway improved provider documentation and history taking, increased referrals to specialist care, and significantly decreased return ED visits within 3 weeks for heavy menstrual bleeding complaints.