Articles: emergency-services.
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Multicenter Study
Association of Gun Violence With Emergency Department Visits for Stress-Responsive Complaints.
We evaluate the association between living near a neighborhood shooting and emergency department (ED) utilization for stress-responsive complaints. ⋯ This study evaluated the relationship between objectively measured gun violence exposure and short-term health effect at a microspatial scale. Overall, this was a study with largely negative results, and we did not find any consistent dose-response pattern in time or space regarding neighborhood shootings and stress-responsive presentations to the ED. Theoretic links make this relationship plausible, however, and further investigation is needed to understand the short-term health consequences of violence exposure, and whether those vary based on the circumstances that are experienced inherently by residents of a given neighborhood.
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Multicenter Study
Acuity patterns of heart failure among emergency departments in a large health system.
The prognostic importance of Emergency Heart Failure Mortality Risk Grade (EHMRG) score in assessing short term mortality in Congestive Heart Failure (CHF) patients has been validated in the past, however, few studies have examined acuity patterns in the CHF population across healthcare settings. We aim to understand acuity patterns of CHF patients across a large health system for better resource utilization. ⋯ Academic hospitals had a higher number of Acute Heart Failure (AHF) patients, larger number of low acuity patients, higher admission rates, but less revisit rates to the ED as compared to community hospitals. We suggest acuity specific interventions will help decrease admission and revisit rates.
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The Permanente journal · May 2021
Multicenter StudyChanges in Emergency Department Patient Volume and Acuity Associated with Early Stages of the COVID-19 Pandemic in a Unique Environment.
Hospitals and emergency departments (EDs) faced profound uncertainty during the COVID-19 pandemic. Early concerns regarding demand far exceeding capacity were balanced by anecdotal reports of decreased patient visits, including those for specific high-acuity conditions. This study sought to identify changes in ED volume and acuity, within a specific managed care environment, associated with the onset of the pandemic. ⋯ Patient volume in 2 EDs dropped significantly in association with a statewide response to the COVID-19 pandemic. There was also a shift in acuity as measured by the proportion of patients admitted to the hospital, but overall admissions declined, suggesting sicker patients also did not seek care.
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Scand J Trauma Resus · Apr 2021
Multicenter Study Pragmatic Clinical TrialPoint-of-care ultrasound of the heart and lungs in patients with respiratory failure: a pragmatic randomized controlled multicenter trial.
Point-of-care ultrasound is a focus oriented tool for differentiating among cardiopulmonary diseases. Its value in the hands of emergency physicians, with various ultrasound experience, remains uncertain. We tested the hypothesis that, in emergency department patients with signs of respiratory failure, a point-of-care cardiopulmonary ultrasound along with standard clinical examination, performed by emergency physicians with various ultrasound experience would increase the proportion of patients with presumptive diagnoses in agreement with final diagnoses at four hours after admission compared to standard clinical examination alone. ⋯ Focused cardiopulmonary ultrasound added to standard clinical examination in patients with signs of respiratory failure had no impact on the diagnostic accuracy, but significantly increased the proportion of appropriate treatment prescribed and the proportion of patients who spent less than 1 day in hospital.
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Chest pain is one of the most common presentations to the emergency department (ED). The HEART-score is used to assess the 30-day risk of developing a major adverse cardiac event (MACE). The HEART-score enables clinicians to classify patients in low, intermediate, or high-risk groups though little is known as to whether this can be done reliably and reproducibly in a prehospital setting. ⋯ The moderate interobserver agreement of the HEART-score does not currently support the use of the HEART-score by ambulance nurses in a prehospital setting. Training for prehospital nurses is vital to ensure that they are able to calculate the HEART-score accurately.