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1.
Sangheon Shin Soo Hoon Lee Dong Hoon Kim Seong Chun Kim Tae Yun Kim Changwoo Kang Jin Hee Jeong Daesung Lim Yong Joo Park Sang Bong Lee 《The American journal of emergency medicine》2018,36(4):620-624
Introduction
Although consultations are essential for delivering safe, high-quality care to patients in emergency departments, they contribute to emergency department patient flow problems and overcrowding which is associated with several adverse outcomes, such as increases in patient mortality and poor quality care. This study aimed to investigate how time flow metrics including emergency department length of stay is influenced by changes to the internal medicine consultation policy.Method
This study is a pre- and post-controlled interventional study. We attempted to improve the internal medicine consultation process to be more concise. After the intervention, only attending emergency physicians consult internal medicine chief residents, clinical fellows, or junior staff of each internal medicine subspecialty who were on duty when patients required special care or an admission to internal medicine.Results
Emergency department length of stay of patients admitted to the department of internal medicine prior to and after the intervention decreased from 996.94 min to 706.62 min. The times from consultation order to admission order and admission order to emergency department departure prior to and after the intervention were decreased from 359.59 min to 180.38 min and from 481.89 min to 362.37 min, respectively. The inpatient mortality rates and Inpatient bed occupancy rates prior to and after the intervention were similar.Conclusion
The improvements in the internal medicine consultation process affected the flow time metrics. Therefore, more comprehensive and cooperative strategies need to be developed to reduce the time cycle metrics and overcrowding of all patients in the emergency department. 相似文献2.
Lucrecia María Burgos Juan Pablo Costabel Victoria Galizia Brito Alan Sigal Daniela Maymo Ana Iribarren Marcelo Trivi 《The American journal of emergency medicine》2018,36(6):911-915
Introduction
Floating right heart thrombi (FRHTS) are a rare phenomenon associated with high mortality. Immediate treatment is mandatory, but optimal therapy is controversial.Objective
To compare the clinical characteristics according to different treatment strategies and to identify predictors of mortality on patients with FRHTS.Methods
We conducted a systematic search of reported clinical cases of TTRH from 2006 to 2016.Results
207 patients were analyzed, median age was 60 years, 51.7% were men, 31.4% presented with shock. Pulmonary thromboembolism was present in 85% of the cases. The treatments administered were anticoagulation therapy in 44 patients (21.28%), surgical embolectomy in 89 patients (43%), thrombolytic therapy in 66 patients (31.8%), percutaneous thrombectomy in 3 patients (1.93%) and fibrinolytic in situ in 4 (1.45%). The overall mortality rate was 21.3%. The mortality associated with anticoagulation alone was higher than surgical embolectomy or thrombolysis (36.4 vs 18% vs 18.2%, respectively, p = 0.03), and in percutaneous thrombectomy and fibrinolytics in situ was 0%. At multivariate analysis, only anticoagulation alone (odds ratio [OR] 2.4, IC 95% 1.07–5.4, p = 0.03), and shock (OR 2.87 (IC 95% 1.3–5.9, p = 0.005) showed a statistically significant effect on mortality.Conclusion
FRHTS represent a serious form of thromboembolism that requires rapid decisions to improve the survival. Anticoagulation as the only strategy does not seem to be sufficient, while thrombolysis and surgical thrombectomy show better and similar results. A proper individualization of the risk and benefits of both techniques is necessary to choose the most appropriate strategy for our patients. 相似文献3.
Matthew C. Hernandez Johnathon M. Aho Martin D. Zielinski Scott P. Zietlow Brian D. Kim David S. Morris 《The American journal of emergency medicine》2018,36(1):114-119
Background
Prehospital airway management increasingly involves supraglottic airway insertion and a paucity of data evaluates outcomes in trauma populations. We aim to describe definitive airway management in traumatically injured patients who necessitated prehospital supraglottic airway insertion.Methods
We performed a single institution retrospective review of multisystem injured patients (≥ 15 years) that received prehospital supraglottic airway insertion during 2009 to 2016. Baseline demographics, number and type of: supraglottic airway insertion attempts, definitive airway and complications were recorded. Primary outcome was need for tracheostomy. Univariate and multivariable statistics were performed.Results
56 patients met inclusion criteria and were reviewed, 78% were male. Median age [IQR] was 36 [24–56] years. Injuries comprised blunt (94%), penetrating (4%) and burns (2%). Median ISS was 26 [22–41]. Median number of prehospital endotracheal intubation (PETI) attempts was 2 [1-3]. Definitive airway management included: (n = 20, 36%, tracheostomy), (n = 10, 18%, direct laryngoscopy), (n = 6, 11%, bougie), (n = 9, 15%, Glidescope), (n = 11, 20%, bronchoscopic assistance). 24-hour mortality was 41%. Increasing number of PETI was associated with increasing facial injury. On regression, increasing cervical and facial injury patterns as well as number of PETI were associated with definitive airway control via surgical tracheostomy.Conclusions
After supraglottic airway insertion, operative or non-operative approaches can be utilized to obtain a definitive airway. Patients with increased craniofacial injuries have an increased risk for airway complications and need for tracheostomy. We used these factors to generate an evidence based algorithm that requires prospective validation.Level of evidence
Level IV – Retrospective study.Study type
Retrospective single institution study. 相似文献4.
Lindley E. Folkerson Duncan Sloan Elizabeth Davis Ryan S. Kitagawa Bryan A. Cotton John B. Holcomb Jeffrey S. Tomasek Charles E. Wade 《The American journal of emergency medicine》2018,36(1):38-42
Study hypothesis
Traumatic brain injury (TBI) is a leading cause of mortality with penetrating TBI (p-TBI) patients having worse outcomes. These patients are more likely to be coagulopathic than blunt TBI (b-TBI) patients, thus we hypothesize that coagulopathy would be an early predictor of mortality.Methods
We identified highest-level trauma activation patients who underwent an admission head CT and had ICU admission orders from August 2009–May 2013, excluding those with polytrauma and anticoagulant use. Rapid thrombelastography (rTEG) was obtained after emergency department (ED) arrival and coagulopathy was defined as follows: ACT ≥ 128 s, KT ≥ 2.5 s, angle ≤ 56°, MA ≤ 55 mm, LY-30 ≥ 3.0% or platelet count ≤ 150,000/μL. Regression modeling was used to assess the association of coagulopathy on mortality.Results
1086 patients with head CT scans performed and ICU admission orders were reviewed. After exclusion criteria were met, 347 patients with isolated TBI were analyzed-99 (29%) with p-TBI and 248 (71%) with b-TBI. Patients with p-TBI had a higher mortality (41% vs. 10%, p < 0.0001) and a greater incidence of coagulopathy (64% vs. 51%, p < 0.003). After dichotomizing p-TBI patients by mortality, patients who died were younger and were more coagulopathic. When adjusting for factors available on ED arrival, coagulopathy was found to be an early predictor of mortality (OR 3.99, 95% CI 1.37, 11.72, p-value = 0.012).Conclusions
This study demonstrates that p-TBI patients with significant coagulopathy have a poor prognosis. Coagulopathy, in conjunction with other factors, can be used to earlier identify p-TBI patients with worse outcomes and represents a possible area for intervention. 相似文献5.
6.
Jennica Siddle Peter S. Pang Christopher Weaver Elizabeth Weinstein Daniel O&#x;Donnell Thomas P. Arkins Charles Miramonti 《The American journal of emergency medicine》2018,36(5):843-845
Background
Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery.Study objective
To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization.Methods
This was a retrospective cohort analysis of a quality improvement pilot of patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care. The primary outcome compared acute care utilization (ED visits, observation stays, inpatient visits) 90 days before MIH intervention to 90 days after.Results
Of the 203 patients seen by MIH teams, inpatient utilization decreased significantly from 140 hospitalizations pre-MIH to 26 post-MIH (83% reduction, p = 0.00). ED and observation stays, however, increased numerically, but neither was significant. (ED 18 to 19 stays, p = 0.98; observation stays 95 to 106, p = 0.30) Primary care visits increased 15% (p = 0.11).Conclusion
In this pilot before/after study, MIH significantly reduces acute care hospitalizations. 相似文献7.
Swati Jha Stephen J. Walters Oscar Bortolami Simon Dixon Abualbishr Alshreef 《Physiotherapy》2018,104(1):91-97
Aims
To evaluate the clinical and cost-effectiveness of electric stimulation plus standard pelvic floor muscle training compared to standard pelvic floor muscle training alone in women with urinary incontinence and sexual dysfunction.Methods
Single centre two arm parallel group randomised controlled trial conducted in a Teaching hospital in England. Participants were women presenting with urinary incontinence and sexual dysfunction. The interventions compared were electric stimulation versus standard pelvic floor muscle training.Outcome measures
included Prolapse and Incontinence Sexual function Questionnaire (PISQ) physical function dimension at post-treatment (primary); other dimensions of PISQ, SF-36; EQ-5D, EPAQ, resource use, adverse events and cost-effectiveness (secondary outcomes).Results
114 women were randomised (Intervention n = 57; Control group n = 57). 64/114 (56%).Participants
had valid primary outcome data at follow-up (Intervention 30; Control 34). The mean PISQ-PF dimension scores at follow-up were 33.1 (SD 5.5) and 32.3 (SD 5.2) for the Intervention and Control groups respectively; with the Control group having a higher (better) score. After adjusting for baseline score, BMI, menopausal status, time from randomisation and baseline oxford scale score the mean difference was ?1.0 (95% CI: ?4.0 to 1.9; P = 0.474).There was no differences between the groups in any of the secondary outcomes at follow-up. Within this study, the use of electrical stimulation was cost-effective with very small incremental costs and quality adjusted life years (QALYs).Conclusions
In women presenting with urinary incontinence in conjunction with sexual dysfunction, physiotherapy is beneficial to improve overall sexual function. However no specific form of physiotherapy is beneficial over another.Trial registration ISRCTN09586238. 相似文献8.
Ebru Biyikli Afsin Emre Kayipmaz Cemil Kavalci 《The American journal of emergency medicine》2018,36(4):647-650
Background
Sepsis is a potentially fatal condition with high treatment costs, and is especially common among the elderly population. The emergency management of septic patients has gained importance.Objective
Herein, we investigated the effect of admission lactate levels and the platelet-lymphocyte ratio (PLR) on the 30-day mortality among patients older than 65 years who were diagnosed with sepsis and septic shock according to the qSOFA criteria at our hospital's emergency department.Methods
This observational study was conducted retrospectively. We obtained information regarding patients' demographic characteristics, comorbid conditions, hemodynamic parameters at admission, initial treatment needs at the emergency department.Results
131 patients received a diagnosis of sepsis and septic shock at our emergency department in two years. Among these, 45% (n = 59) of the patients died within 30 days of admission. Forty (30.5%) patients required mechanical ventilation. There was a significant difference between the survival and non-survival groups with regard to systolic and diastolic blood pressures (p = 0.013 and 0.045, respectively). There were significant differences between the two groups with respect to the Glasgow Coma Scale score (p < 0.001) and BUN levels (p < 0.001). The mortality status according to qSOFA scores was revealed a significant difference between the two groups (p < 0.001).Conclusion
Our results showed that the patients who died within 30 days of admission and those who did not had comparable PLR and lactate levels (p = 0.821 and 0.120, respectively). We opine that serial lactate measurements would be more useful than a single admission lactate measurement for the prediction of mortality. 相似文献9.
Di Zhang Jun Zhang Quan Gan Qiaoling Wang Nian Fan Rong Zhang Yayun Song 《Archives of Psychiatric Nursing》2018,32(1):57-61
Background
Perinatal posttraumatic stress disorder (PPTSD) is a common stress-induced mental disorder worldwide. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) is an excellent questionnaire that measures the symptoms of PPTSD, but has not been translated into Chinese yet.Objectives
The aims of this study were to develop a translated Chinese version of the (PPQ) and validate the psychometric characteristics of the PPQ in a Chinese context.Methods
After translation, back-translation, and expert discussion, 280 mothers at 1 to 18 months postpartum filled out the questionnaires through the Internet. Then the reliability and validity of the translated questionnaire were tested.Results
The Chinese version of PPQ (PPQ-C) was composed of 14 items. Cronbach's α coefficient was 0.84, test-retest reliability was 0.88, and the content validity was 0.99. Exploratory factor analysis extracted three factors (representing “arousal”, “avoidance” and “intrusion”) accounted for 53.30% of the variance. The established 3 factors model was well fitted with the collected data (χ2 = 76.40, p < 0.05).Implications for practice
The PPQ-C is a short, reliable, and valid instrument that measures the symptoms of PPTSD, and it is recommend for clinical screening.Implications for research
Further research could involve diverse participants, as well as better adapt the PPQ-C to Chinese culture. 相似文献10.
Yuan Zhang Kai Sun Yuling Wang Yafei Qin Hui Li 《The American journal of emergency medicine》2018,36(8):1410-1417
Background
Patients suffered from craniocerebral trauma with extermities fracture is one of the most common multiple injuries.Actually there is no comparative study demonstrating advantages of early or delayed treatment of skeletal injuries.Purposes
To conduct a meta-analysis with studies published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of early fracture fixation(EFF) and late fracture fixation(LFF) for patients with severe head and orthopedic injuries to provide the predictive diagnosis for clinic.Patients and methods
Literature search was performed in PubMed, Embase, Web of Science and Cochrane Library for information from the earliest date of data collection to October 2017. Studies comparing the perioperative, postoperative outcomes of EFF with those of LFF patients with severe head and orthopedic injuries were included. Statistical heterogeneity was quantitatively evaluated by ×2 test with the significance set P < 0.10 or I2 > 50%.Results
Thirteen papers consisting of 2941 patients were included (1224EFF patients; 1717 LFF patients). The results showed that EFF was related to a greater increase in blood loss, intraoperative blood infusion, crystalloid, hypotension, hypoxia, length of surgery, non-neurologic complications and mortality(P < 0.1). No differences in ICU days, hospital days, neurologic complications and GCS on discharge scores (P > 0.1).Conclusions
Compared with LFF patients, EFF patients demonstrated an increased risk of perioperative and postoperative complications and clear difference about complications between EFF and LFF about patients with severe head and orthopedic injuries.Level of evidence
Level IV, therapeutic study. 相似文献11.
Qing-quan Lv Xiao-hua Gu Qi-hong Chen Jiang-quan Yu Rui-qiang Zheng 《The American journal of emergency medicine》2017,35(12):1810-1814
Background
Physiologic dose hydrocortisone is part of the suggested adjuvant therapies for patients with septic shock. However, the association between the corticosteroid therapy and mortality in patients with septic shock is still not clear. Some authors considered that the mortality is related to the time frame between development of septic shock and start of low dose hydrocortisone. Thus we designed a placebo-controlled, randomized clinical trial to assess the importance of early initiation of low dose hydrocortisone for the final outcome.Methods
A total of 118 patients with septic shock were recruited in the study. All eligible patients were randomized to receive hydrocortisone (n = 58) or normal saline (n = 60). The study medication (hydrocortisone and normal saline) was initiated simultaneously with vasopressors. The primary end-point was 28-day mortality. The secondary end-points were the reversal of shock, in-hospital mortality and the duration of ICU and hospital stay.Results
The proportion of patients with reversal of shock was similar in the two groups (P = 0.602); There were no significant differences in 28-day or hospital all-cause mortality; length of stay in the ICU or hospital between patients treated with hydrocortisone or normal saline.Conclusion
The early initiation of low-dose of hydrocortisone did not decrease the risk of mortality, and the length of stay in the ICU or hospital in adults with septic shock.Trial registration: www.clinicaltrials.govNCT02580240. 相似文献12.
Ulla A. Botha Marise Coetzee Liezl Koen Dana J.H. Niehaus 《Archives of Psychiatric Nursing》2018,32(3):384-389
Introduction
Pressure on inpatient beds often results in premature discharges, which may precipitate early readmission. This has prompted an increased interest in transitional care interventions to bridge the gap between in- and outpatient care to reduce such readmissions. Our study aimed to assess the effect of a Transitional Care Service (TCS) on readmission rates in a high pressure inpatient service which utilizes a premature discharge policy to address bed pressures.Methods
Sixty male patients identified for crisis discharge were offered a TCS for the first ninety days after discharge. Patients received a structured intervention consisting of four phone calls and one home visit, focusing on maintaining adherence, appointment reminders and psychoeducation. The TCS patients were retrospectively compared to a matched control group in terms of readmission after 90 days. Data was collected on adherence to medication, attendance of appointments and incidence of substance use.Results
There was no significant difference in readmission rates. Prevalence of substance use was very high (90%), especially methamphetamine use (48%). Adherence dropped from 45% (n = 27) at one week post-discharge to 25% (n = 15) at 90 days.Conclusion
Structured telephone-based transitional interventions have no effect on readmission rates in this setting. Prematurely discharged patients require more comprehensive support with focus on comorbid substance use. 相似文献13.
Michael D. April Chase Donaldson Lloyd I. Tannenbaum Tyler Moore Jose Aguirre Alexander Pingree James H. Lantry 《The American journal of emergency medicine》2017,35(10):1474-1479
Background
Our objective was to compare in-hospital mortality among emergency department (ED) patients meeting trial-based criteria for septic shock based upon whether presenting with refractory hypotension (systolic blood pressure < 90 mm Hg after 1 L intravenous fluid bolus) versus hyperlactatemia (initial lactate ≥ 4 mmol/L).Methods
We conducted a retrospective cohort analysis by chart review of ED patients admitted to an intensive care unit with suspected infection during 1 August 2012–28 February 2015. We included all patients with body fluid cultures sampled either during their ED stay without antibiotic administration or within 24 h of antibiotic administration in the ED. We excluded patients not meeting criteria for either refractory hypotension or hyperlactatemia. Trained chart abstractors blinded to the study hypothesis double entered data from each patient's record including demographics, clinical data, treatments, and in-hospital mortality. We compared in-hospital mortality among patients with isolated refractory hypotension, isolated hyperlactatemia, or both. We also calculated odds ratios (ORs) via logistic regression for in-hospital mortality based on presence of refractory hypotension or hyperlactatemia.Results
Of 202 patients included in the analysis, 38 (18.8%) died during hospitalization. Mortality was 10.9% among 101 patients with isolated refractory hypotension, 24.4% among 41 patients with isolated hyperlactatemia, and 28.3% among 60 patients with both (p = 0.01). Logistic regression analyses yielded in-hospital mortality OR for refractory hypotension of 1.3 (95% CI 0.5–3.8) versus OR for hyperlactatemia of 2.9 (95% CI 1.2–7.4).Conclusions
Hyperlactatemia appears associated with higher in-hospital mortality compared to refractory hypotension among ED patients with septic shock. 相似文献14.
Adam R. Aluisio Stephanie Garbern Tess Wiskel Zeta A. Mutabazi Olivier Umuhire Chin Chin Ch&#x;ng Kristina E. Rudd Jeanne D&#x;Arc Nyinawankusi Jean Claude Byiringiro Adam C. Levine 《The American journal of emergency medicine》2018,36(11):2010-2019
Objective
To evaluate the utility of the quick Sepsis-related Organ Failure Assessment (qSOFA) score to predict risks for emergency department (ED) and hospital mortality among patients in a sub-Saharan Africa (SSA) setting.Methods
This retrospective cohort study was carried out at a tertiary-care hospital, in Kigali, Rwanda and included patients ≥15 years, presenting for ED care during 2013 with an infectious disease (ID). ED and overall hospital mortality were evaluated using multivariable regression, with qSOFA scores as the primary predictor (reference: qSOFA = 0), to yield adjusted relative risks (aRR) with 95% confidence intervals (CI). Analyses were performed for the overall population and stratified by HIV status.Results
Among 15,748 cases, 760 met inclusion (HIV infected 197). The most common diagnoses were malaria and intra-abdominal infections. Prevalence of ED and hospital mortality were 12.5% and 25.4% respectively. In the overall population, ED mortality aRR was 4.8 (95% CI 1.9–12.0) for qSOFA scores equal to 1 and 7.8 (95% CI 3.1–19.7) for qSOFA scores ≥2. The aRR for hospital mortality in the overall cohort was 2.6 (95% 1.6–4.1) for qSOFA scores equal to 1 and 3.8 (95% 2.4–6.0) for qSOFA scores ≥2. For HIV infected cases, although proportional mortality increased with greater qSOFA score, statistically significant risk differences were not identified.Conclusion
The qSOFA score provided risk stratification for both ED and hospital mortality outcomes in the setting studied, indicating utility in sepsis care in SSA, however, further prospective study in high-burden HIV populations is needed. 相似文献15.
Giancarlo Cicolini Carlo Della Pelle Valentina Simonetti Dania Comparcini Gianna Sepede Francesco Cipollone 《Archives of Psychiatric Nursing》2018,32(2):305-309
Purpose
To investigate the role of psychiatric dimensions, behavioral or substance addictions and demographical variables as determinants of pathological gambling among nursing students.Design
Multicenter cross-sectional study.Methods
From June to October 2015 a survey was carried out among Italian Nursing students. Data were collected using a six-section tool.Findings
Nursing students who completed the survey numbered 1083, 902 (83.3%) had some problems with gambling and 29 (2.7%) showed pathological gambling. Percentage of pathological gambling was significantly associate with illicit drug/alcohol use (65.5%; p = 0.001) and with male gender (58.6%) comparing to student nurse with non-pathological gambling (20%) and those with some problem (24.2%). Significant main effect was observed for IAT score (Beta = 0.119, t = 3.28, p = 0.001): higher IAT scores were associated with higher SOGS scores.Conclusions
Italian nursing students have some problems with gambling and pathological gambling problem, and males are those who have more problems. Results might be useful for faculties of health professionals to identify students at risk in an early stage, to direct prevention tailored interventions.Clinical relevance
Nursing faculties should be aware of the prevalence of Gambling among students.Prevention interventions should be planned to minimize the risk of gambling behavior in the future nurses' health care workers. 相似文献16.
Chun Tat Lui Oi Fung Wong Kwok Leung Tsui Chak Wah Kam Siu Man Li Mina Cheng Ka Kit Gilberto Leung 《The American journal of emergency medicine》2018,36(8):1444-1450
Background
Currently existing predictive models for massive blood transfusion in major trauma patients had limitations for sequential evaluation of patients and lack of dynamic parameters.Objective
To establish a predictive model for predicting the need of massive blood transfusion major trauma patients, integrating dynamic parameters.Design
Multi-center retrospective cohort study.Setting
Four designated trauma centers in Hong Kong.Methods
Trauma patients aged > 12 years were recruited from the trauma registries from 2005 to 2012. MBT was defined as delivery of ≥ 10 units of packed red cells within 24 h. Split sampling method was adopted for model building and validation. Multivariate logistic regression was adopted for model building, with weight assigned based on logarithmic of adjusted odds ratios. The performance of the dynamic MBT score (DMBT) was compared with the PWH score and the Trauma Associated Severe Hemorrhage (TASH) score in the validation data set.Results
4991 patients were included in the study. The DMBT was established with 8 parameters: systolic blood pressure, heart rate, hemoglobin, hemoglobin drop within the first 2 h, INR, base deficit, unstable pelvic fracture and hemoperitoneum in radiological imaging. At cut-off score of 6 the DMBT achieved sensitivity of 78.2% and specificity of 89.2%. In the validation set, the AUCs of the DMBT, PWH score, and TASH score were 0.907, 0.844, and 0.867 respectively.Conclusions
The DMBT score allows both snapshot and sequential activation along the trauma care pathway and has better performance than the PWH score and TASH score. 相似文献17.
Mauro Giordano Tiziana Ciarambino Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Luca Rinaldi Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(5):749-752
Study objective
We investigated seasonal prevalence of hyponatremia in the emergency department (ED).Design
A cross-sectional study using clinical chart review.Setting
University Hospital ED, with approximately 28 000 patient visits a year.Type of participants
We reviewed 15 049 patients, subdivided in 2 groups: the adult group consisting of 9822 patients aged between 18 and 64 years old and the elderly group consisting of 5227 patients aged over 65 years presenting to the ED between January 1st, 2014 and December 31st, 2015.Intervention
Emergency patients were evaluated for the presence of hyponatremia by clinical chart review.Measurements and main results
Hyponatremia was defined as a serum sodium level < 135 mmol/l. Mean monthly prevalence of hyponatremia was of 3.74 ± 0.5% in the adult group and it was significantly increased to 10.3 ± 0.7% in the elderly group (p < 0.05 vs adults). During the summer, hyponatremia prevalence was of 4.14 ± 0.2% in adult and markedly increased to 12.52 ± 0.7% (zenith) in elderly patients (p < 0.01 vs adult group; p < 0.05 vs other seasons in elderly group). In the elderly group, we reported a significant correlation between weather temperature and hyponatremia prevalence (r: 0.491; p < 0.05).Conclusion
We observed a major influence of climate on the prevalence of hyponatremia in the elderly in the ED. Decline in renal function, salt loss, reduced salt intake and increased water ingestion could all contribute to developing hyponatremia in elderly patients during the summer. These data could be useful for emergency physicians to prevent hot weather-induced hyponatremia in the elderly. 相似文献18.
Kito Lord Vivek Parwani Andrew Ulrich Emily B. Finn Craig Rothenberg Beth Emerson Alana Rosenberg Arjun K. Venkatesh 《The American journal of emergency medicine》2018,36(7):1246-1248
Objective
Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality.Method
We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015. This study was conducted in an urban, academic hospital with an annual adult ED census over 90,000. We defined boarding as patients with greater than 4 h from ED bed order to ED departure to hospital ward. The primary outcome was a composite of adverse outcomes in the first 24 h of admission, including RRT activation, care escalation to intensive care, or in-hospital mortality.Results
A total of 31,426 patient encounters were included of which 3978 (12.7%) boarded in the ED for 4 h or more. Adverse outcomes occurred in 1.92% of all encounters. Comparing boarded vs. non-boarded patients, 41 (1.03%) vs. 244 (0.90%) patients experienced a RRT activation, 53 (1.33%) vs. 387 (1.42%) experienced a care escalation, and 1 (0.03%) vs.12 (0.04%) experienced unanticipated in-hospital death, within 24 h of ED admission. In unadjusted analysis, there was no difference in the composite outcome between boarding and non-boarding patients (1.91% vs. 1.91%, p = 0.994). Regression analysis adjusted for patient demographics, acuity, and comorbidities also showed no association between boarding and the primary outcome. A sensitivity analysis showed an association between ED boarding and the composite outcome inclusive of the entire inpatient hospital stay (5.8% vs. 4.7%, p = 0.003).Conclusion
Within the first 24 h of hospital admission to a general medicine service, adverse hospitalization outcomes are rare and not associated with ED boarding. 相似文献19.
Jun Liu Lian-Lian Sun Jue Wang Guang Ji 《The American journal of emergency medicine》2018,36(5):741-744
Background and purpose
Fibrinogen plays an important role in hemostasis and thrombosis and is proven to have prognostic significance in patients with cardiovascular disease. We examined the utility of fibrinogen as a prognostic indicator for patients with type A acute aortic dissection (AAD).Methods
This study was performed in consecutive patients with type A AAD admitted to our hospital within 24 hours after onset of symptoms. Fibrinogen levels were measured on admission. Baseline clinical characteristics and laboratory test results were collected. The endpoint was in-hospital mortality.Results
A total of 143 patients with type A AAD were enrolled. Compared with the survivors, the nonsurvivors had significant lower fibrinogen levels (1.95(1.37, 2.38) vs. 2.37(1.85, 3.15) g/L, p = 0.001). The cutoff level of fibrinogen determined by ROC curve analysis was 2.17 g/L, with a sensitivity, specificity of 71.9%, 60.4% respectively, and the area under the ROC curve was 0.686 (95% CI, 0.585–0.768; p = 0.001). After controlling for potentially relevant confounding variables, we found an admission fibrinogen level less than 2.17 g/L was associated with an increased risk of in-hospital mortality (odds ratio, 5.527; 95% CI, 1.660–18.401; p = 0.005) compared with those with fibrinogen greater than 2.17 g/L.Conclusion
Low fibrinogen level on admission is an independent predictor of in-hospital mortality in patients with type A AAD. 相似文献20.
Ki Ok Ahn Sang Chul Kim Ju Ok Park Sang Do Shin Kyoung Jun Song Ki Jeong Hong 《The American journal of emergency medicine》2018,36(2):257-261
