Open Access Emergency Medicine : OAEM最新文献

{"title":"New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults.","authors":"Abdullah Alshibani,&nbsp;Jay Banerjee,&nbsp;Fiona Lecky,&nbsp;Timothy J Coats,&nbsp;Meshal Alharbi,&nbsp;Simon Conroy","doi":"10.2147/OAEM.S297850","DOIUrl":"https://doi.org/10.2147/OAEM.S297850","url":null,"abstract":"<p><p>Caring for older people is an important part of prehospital practice, including appropriate triage and transportation decisions. However, prehospital triage criteria are designed to predominantly assess injury severity or high-energy mechanism which is not the case for older people who often have injuries compounded by multimorbidity and frailty. This has led to high rates of under-triage in this population. This narrative review aimed to assess aspects other than triage criteria to better understand and improve prehospital triage decisions for older trauma patients. This includes integrating frailty assessment in prehospital trauma triage, which was shown to predict adverse outcomes for older trauma patients. Furthermore, determining appropriate outcome measures and the benefits of Major Trauma Centers (MTCs) for older trauma patients should be considered in order to direct accurate and more beneficial prehospital trauma triage decisions. It is still not clear what are the appropriate outcome measures that should be applied when caring for older trauma patients. There is also no strong consensus about the benefits of MTC access for older trauma patients with regards to survival, in-hospital length of stay, discharge disposition, and complications. Moreover, looking into factors other than triage criteria such as distance to MTCs, patient or relative choice, training, unfamiliarity with protocols, and possible ageism, which were shown to impact prehospital triage decisions but their impact on outcomes has not been investigated yet, should be more actively assessed and investigated for this population. Therefore, this paper aimed to discuss the available evidence around frailty assessment in prehospital care, appropriate outcome measures for older trauma patients, the benefits of MTC access for older patients, and factors other than triage criteria that could adversely impact accurate prehospital triage decisions for older trauma patients. It also provided several suggestions for the future.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":"13 ","pages":"117-135"},"PeriodicalIF":1.5,"publicationDate":"2021-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/78/b0/oaem-13-117.PMC8009532.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25557527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic and Clinical Predictors of Mortality in Patients with Acute Dyspnea.","authors":"Torgny Wessman, Rafid Tofik, Thoralph Ruge, Olle Melander","doi":"10.2147/OAEM.S277448","DOIUrl":"10.2147/OAEM.S277448","url":null,"abstract":"<p><strong>Background: </strong>Factors predicting long-term prognosis in patients with acute dyspnea may guide both acute management and follow-up. The aim of this study was to identify socioeconomic and clinical risk factors for all-cause mortality among acute dyspnea patients admitted to an Emergency Department.</p><p><strong>Methods: </strong>We included 798 patients with acute dyspnea admitted to the ED of Skåne University Hospital, Malmö, Sweden from 2013 to 2016. Exposures were living in the immigrant-dense urban part of Malmö (IDUD), country of birth, annual income, comorbidities, smoking habits, medical triage priority and severity of dyspnea. Mean follow-up time was 2.2 years. Exposures were related to risk of all-cause mortality using Cox proportional hazard model.</p><p><strong>Results: </strong>During follow-up 40% died. In models adjusted for age and gender, low annual income, previous or ongoing smoking, certain comorbidities, high medical triage priority and severe dyspnea were all significantly associated with increased mortality. After adjusting for age, gender and all significant exposures, the lowest quintile of income, ongoing or previous smoking, history of serious infection, anemia, hip fracture, high medical triage priority and severe dyspnea significantly and independently predicted mortality. In contrast, neither country of birth nor living in IDUD predicted a mortality risk.</p><p><strong>Conclusion: </strong>Apart from several clinical risk factors, low annual income predicts two-year mortality risk in patients with acute dyspnea. This is not the case for country of birth and living in IDUD. Our results underline the wide range of mortality risk factors in acute dyspnea patients. Knowledge of patients' annual income as well as certain clinical features may aid risk stratification and determining the need of follow-up both in hospital and after discharge from an ED.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":"13 ","pages":"107-116"},"PeriodicalIF":0.0,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25538065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and Reliability of a Cardiopulmonary Resuscitation Attitudes Questionnaire Among Allied Health Profession Students.","authors":"Alaa O Oteir,&nbsp;Saddam F Kanaan,&nbsp;Mahmoud T Alwidyan,&nbsp;Khader A Almhdawi,&nbsp;Brett Williams","doi":"10.2147/OAEM.S291904","DOIUrl":"https://doi.org/10.2147/OAEM.S291904","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the structural validity and internal consistency of a cardiopulmonary resuscitation attitudes questionnaire among Allied Health Professions (AHP) university students.</p><p><strong>Methods: </strong>Structural validity of a 17-item questionnaire was tested using principal component analysis. A group of AHP university students completed the questionnaire. Internal consistency of the questionnaire was measured by Cronbach's α.</p><p><strong>Results: </strong>A total of 856 AHP students completed the questionnaire (mean age= 20.8 (±1.1) years, 74.0% were females). The analysis reduced a 17-item questionnaire to an 11-item questionnaire. The final questionnaire had three distinct factors; (1) attitudes towards mouth-to-mouth ventilation (MMV), (2) attitudes towards chest compressions (CC), and (3) the importance of cardiopulmonary resuscitation (CPR). It had factor loadings ranging from 0.629 to 0.878 and could explain 66% of the variance in the attitude. The questionnaire had acceptable internal consistency (Cronbach α=0.83; 95% CI=81.5) and was feasible with no floor or ceiling effect.</p><p><strong>Conclusion: </strong>The 11-item CPR attitude questionnaire had acceptable structural validity and internal consistency and good parsimony and unidimensionality. The questionnaire can be used to measure the university students' attitude and assess the effectiveness of CPR training activities. Future studies are required to measure the responsiveness and applicability to other cohorts.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":"13 ","pages":"83-90"},"PeriodicalIF":1.5,"publicationDate":"2021-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e0/e0/oaem-13-83.PMC7936711.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25467365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Available Criteria for Different Sepsis Scoring Systems in the Emergency Department-A Retrospective Assessment.","authors":"Sanjhai Ramdeen,&nbsp;Brandon Ferrell,&nbsp;Christopher Bonk,&nbsp;Laura Schubel,&nbsp;Robin Littlejohn,&nbsp;Muge Capan,&nbsp;Ryan Arnold,&nbsp;Kristen Miller","doi":"10.2147/OAEM.S280279","DOIUrl":"https://doi.org/10.2147/OAEM.S280279","url":null,"abstract":"<p><strong>Objective: </strong>The goal of the study was to assess the criteria availability of eight sepsis scoring methods within 6 hours of triage in the emergency department (ED).</p><p><strong>Design: </strong>Retrospective data analysis study.</p><p><strong>Setting: </strong>ED of MedStar Washington Hospital Center (MWHC), a 912-bed urban, tertiary hospital.</p><p><strong>Patients: </strong>Adult (age ≥ 18 years) patients presenting to the MWHC ED between June 1, 2017 and May 31, 2018 and admitted with a diagnosis of severe sepsis with or without shock.</p><p><strong>Main outcomes measured: </strong>Availability of sepsis scoring criteria of eight different sepsis scoring methods at three time points-0 Hours (T0), 3 Hours (T1) and 6 Hours (T2) after arrival to the ED.</p><p><strong>Results: </strong>A total of 50 charts were reviewed, which included 23 (46%) males and 27 (54%) females. Forty-eight patients (96%) were Black or African American. Glasgow Coma Scale was available for all 50 patients at T0. Vital signs, except for temperature, were readily available (>90%) at T0. The majority of laboratory values relevant for sepsis scoring criteria were available (>90%) at T1, with exception to bilirubin (66%) and creatinine (80%). NEWS, PRESEP and qSOFA had greater than 90% criteria availability at triage. SOFA and SIRS consistently had the least percent of available criteria at all time points in the ED.</p><p><strong>Conclusion: </strong>The availability of patient data at different time points in a patient's ED visit suggests that different scoring methods could be utilized to assess for sepsis as more patient information becomes available.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":"13 ","pages":"91-96"},"PeriodicalIF":1.5,"publicationDate":"2021-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/83/oaem-13-91.PMC7936926.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25467848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertensive Emergencies in the Ambulance: Characteristics, Clinical Presentations and Complications - A Prospective Cohort Study.","authors":"Dalal Alhasan,&nbsp;Ameen Yaseen","doi":"10.2147/OAEM.S293413","DOIUrl":"https://doi.org/10.2147/OAEM.S293413","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study is to describe the characteristics of hypertensive emergencies in Kuwait aiming to provide a preliminary background to update the current guidelines and improve patients' management.</p><p><strong>Methods: </strong>This is a prospective analysis of hypertensive emergency cases retrieved from emergency medical services (EMS) archived data between 1 January - 30 June 2020. Collected variables included patient characteristics, clinical presentations, vital signs, interventions, and complications. Outcome variable collected was: en route complications.</p><p><strong>Results: </strong>Hypertensive emergency prevalence in Kuwait is 4.75 per 100,000. Most were non-Kuwaiti (62%) males (59%) with a mean age of 57 ±14 years. Most hypertensive emergency cases occurred at home (62%). The hypertensive emergency BP threshold was; SBP 182 (SD=31) and diastolic BP (DBP) 108 (SD=18). 36% of hypertensive emergency cases had silent hypertension. 67% of hypertensive emergencies were verified using ambulance verification tools. Nitroglycerin was administered to only hypertensive emergencies suspected to have acute coronary syndrome or acute heart failure (50%). Complications were seen in 9.5% of hypertensive emergency cases.</p><p><strong>Conclusion: </strong>Hypertensive emergency is rare in the ambulance but can progress into a serious situation. One in every 10 hypertensive emergency cases will require en route resuscitation. Hypertensive emergencies should be recognized and managed within their clinical context. The most common clinical presentation of hypertensive emergency is cardiac chest pain. Some pre-hospital verification tools confirm acute HMOD. Further research is required to establish hypertension emergency recognition and management guidelines in the prehospital setting.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":"13 ","pages":"75-81"},"PeriodicalIF":1.5,"publicationDate":"2021-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/60/oaem-13-75.PMC7924252.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25432481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Thrombolysis During Cardiac Arrest Due to Pulmonary Thromboembolism: Our Experience Over 6 Years.","authors":"David de Paz,&nbsp;Julio Diez,&nbsp;Fredy Ariza,&nbsp;Diego Fernando Scarpetta,&nbsp;Jaime A Quintero,&nbsp;Sandra Milena Carvajal","doi":"10.2147/OAEM.S275767","DOIUrl":"https://doi.org/10.2147/OAEM.S275767","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac arrest (CA) is one of the leading causes of death worldwide. Among patients with CA, pulmonary embolism (PE) accounts for approximately 10% of all cases.</p><p><strong>Objective: </strong>To compare the outcomes after cardiopulmonary-cerebral resuscitation (CCPR) with and without thrombolytic therapy (TT) in patients with CA secondary to PE.</p><p><strong>Methods: </strong>We included patients older than 17 years admitted to our hospital between 2013 and 2017 with a diagnosis of CA with confirmed or highly suspected PE who received CCPR with or without TT. Measures of central tendency were used to depict the data.</p><p><strong>Results: </strong>The study comprised 16 patients, 8 of whom received CCPR and thrombolysis with alteplase, whereas the remaining patients received CCPR without TT. The most frequent rhythm of CA in both groups was pulseless electrical activity. Return of spontaneous circulation (ROSC) occurred in 100% of patients who received TT and in 88% of non-thrombolysed patients. The mortality rate of patients who received TT and non-thrombolysed patients at 24 hours was 25% and 50%, respectively. However, at the time of hospital discharge, the mortality was the same in both groups (62%). In patients who received TT, mortality was related to sepsis and hemorrhage whereas in non-thrombolysed patients, mortality was due to myocardial dysfunction.</p><p><strong>Conclusion: </strong>Intra-arrest thrombolysis resulted in a higher likelihood of ROSC and a higher 24-hour survival in adults with CA secondary to acute PE. Overall, the survival at hospital discharge was the same in the two groups.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":"13 ","pages":"67-73"},"PeriodicalIF":1.5,"publicationDate":"2021-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ac/e3/oaem-13-67.PMC7910090.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25422722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"USER Protocol as a Guide to Resuscitation of the Patient with Septic Shock in the Emergency Department.","authors":"German Devia Jaramillo,&nbsp;Salvador Menendez Ramirez","doi":"10.2147/OAEM.S289148","DOIUrl":"https://doi.org/10.2147/OAEM.S289148","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis is a disease that is still associated with high mortality, in which timely interventions are related to better results.</p><p><strong>Objective: </strong>To determine if there is a difference in in-hospital mortality, fluid balances, norepinephrine initiation and recovery time of blood pressure, when comparing the resuscitation of the patient who is admitted to the emergency room in septic shock by applying the ultrasound protocol (USER) versus the standard of care.</p><p><strong>Patients and methods: </strong>This is a prospective, cohort study conducted in the emergency room of a highly complex hospital of patients with septic shock.</p><p><strong>Results: </strong>83 patients recruited in total. The groups were comparable in demographics, mean baseline blood pressure, disease severity given by the SOFA value, and arterial lactate. A statistically significant difference was documented in the fluid balances at 4 hours, median 1325mL (IQR:451-2455mL) in Group C versus 900mL (IQR:440-1292) in Group U (p=0.048) and at 6 hours, median 1658mL (IQR:610-2925mL) versus 1107mL (IQR:600-1500mL), p=0.026, as well as in the total fluid balance of hospital stay, median 14,564mL (IQR:8660-18,705mL) versus 8660mL (IQR:5309-16,974mL), p=0.049. On the other hand, in the USER Group, the mean blood pressure ≥ 65mmHg was achieved in 97.4% of the patients 4 hours after the start of the protocol versus 50% in Group C (p=<0.001). Mortality with the use of the protocol compared with conventional therapy was (56.4% vs 61.36%, p=0.647).</p><p><strong>Conclusion: </strong>The use of the USER protocol in patients with septic shock in the emergency room showed lower fluid balances at 4 and 6 hours, and of the total hospital stay, as well as earlier initiation of norepinephrine and statistically significant faster improvement in blood pressure. Although a statistically significant difference was not found in the days of ICU stay, hospitalization and in-hospital mortality, a trend was observed in the reduction of these parameters.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":"13 ","pages":"33-43"},"PeriodicalIF":1.5,"publicationDate":"2021-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c2/6d/oaem-13-33.PMC7886247.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25387184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurses' Supplemental Oxygen Therapy Knowledge and Practice in Debre Tabor General Hospital: A Cross-Sectional Study.","authors":"Shegaw Zeleke,&nbsp;Demewoz Kefale","doi":"10.2147/OAEM.S299139","DOIUrl":"https://doi.org/10.2147/OAEM.S299139","url":null,"abstract":"<p><strong>Background: </strong>Oxygen therapy is a medical treatment and prescribed to prevent or treat hypoxemia. Based on a WHO report every year at least 1.4 million deaths occur due to the lack of supplemental oxygen therapy and inappropriate administration of oxygen.</p><p><strong>Objective: </strong>To assess the knowledge and practice of nurses on supplemental oxygen therapy in Debre Tabor General Hospital, 2019.</p><p><strong>Methods: </strong>Data was collected using structured questionnaires that measure nurses' knowledge and practice regarding supplemental oxygen therapy. Data were entered using Epi Data version 3.1 and analyzed using SPSS version 23. Bivariate and multivariate analyses were conducted to examine the association between independent and outcome variables.</p><p><strong>Results: </strong>Only one-third of nurses had a good practice on supplemental oxygen administration. Nurses who had good knowledge of supplemental oxygen administration were 12-times (AOR=12.25, 95% CI=6.48-32.93) more likely to have a good practice of supplemental oxygen administration than those who had poor knowledge of supplemental oxygen administration.</p><p><strong>Conclusion: </strong>There is a clear knowledge and practice gap among nurses working in Debre Tabor General Hospital. The knowledge and practice level of nurses in the study area is low compared with others. The possible factors were identified; such as lack of supplemental oxygen therapy training, absence of supplemental oxygen administration standard guidelines, workload, and inadequate supply of oxygen and delivery devices.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":"13 ","pages":"51-56"},"PeriodicalIF":1.5,"publicationDate":"2021-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fc/f5/oaem-13-51.PMC7886231.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25387186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Three-Year Study on Acute Poisoning Cases Brought for Medico-Legal Autopsy in a North-Eastern City of India.","authors":"Oli Goswami,&nbsp;Putul Mahanta,&nbsp;Deepjyoti Kalita,&nbsp;Ranjumoni Konwar,&nbsp;Dhirendra Singh Yadav","doi":"10.2147/OAEM.S297083","DOIUrl":"https://doi.org/10.2147/OAEM.S297083","url":null,"abstract":"<p><strong>Purpose: </strong>Death due to acute poisoning is one of the significant health challenges to cope-up. It is imperative to know the death victims' pattern due to acute poisoning to prepare the relevant preventive and remedial measures. Therefore, the present study aimed to assess the pattern of the dead victims of acute poisoning in a tertiary care centre.</p><p><strong>Materials and methods: </strong>It is a hospital record-based study and conducted in a tertiary care centre. Descriptive statistics to study the distribution of the cases among different age groups, sex, type of poison compounds was computed and analysed using SPSS software version 20.</p><p><strong>Results: </strong>The present study detected poisonous substances in 244 (41.8%) cases out of 584 death cases of suspected acute poisoning with the male preponderance of 62.29%. A higher incidence of acute poisoning was noticed among the young age group 21-30 years (33.6%) with 48 (31.6%) cases among males and 34 (36.9%) cases of the female. The Organophosphates (OP) was the main compound found in 151 (61.9%) fatal cases, followed by Carbamate in 45 (18.4%) cases. We also observed a maximum, 76 (36.2%) cases of suicidal victims in the age group of 21-30 years. Children and lower age group were more vulnerable to accidental poisoning as 26.5% cases of accidental death were reported in both the age group of 0-10 and 11-20 years respectively, gradually declining and practically found nil in above 60 years group. These differences of frequencies were found statistically significant (p < 0.0001), <i>χ</i> ² = 55.1.</p><p><strong>Conclusion: </strong>The results suggest due consideration to the young adolescents' groups without any sexual discrimination to define guidelines for appropriate handling, storage and transportation of the poisonous compounds. Organophosphate's involvement as the most preferred agent in acute poisoning is to be remembered to help manage poisoning cases.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":"13 ","pages":"45-50"},"PeriodicalIF":1.5,"publicationDate":"2021-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f1/92/oaem-13-45.PMC7886380.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25387185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Predictors of Abnormal Calcium, Magnesium and Phosphorus Blood Levels in the Emergency Department: A Retrospective Cohort Study.","authors":"Antoine Lapointe,&nbsp;Nikyel Royer Moreau,&nbsp;David Simonyan,&nbsp;François Rousseau,&nbsp;Viviane Mallette,&nbsp;Frédérique Préfontaine-Racine,&nbsp;Caroline Paquette,&nbsp;Myriam Mallet,&nbsp;Annie St-Pierre,&nbsp;Simon Berthelot","doi":"10.2147/OAEM.S289748","DOIUrl":"https://doi.org/10.2147/OAEM.S289748","url":null,"abstract":"<p><strong>Purpose: </strong>With rising healthcare costs limiting access to care, the judicious use of diagnostic tests has become a critical issue for many jurisdictions. Calcium, magnesium and phosphorus serum levels are regularly performed tests in the emergency department, but their clinical relevance have come into question. Authors sought to determine risk factors that could predict abnormal calcium, magnesium and phosphorus serum levels, as well as identify patients who may need corrective interventions.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in two academic hospitals in Québec City. Demographic and clinical characteristics of 1008 patients who had serum calcium and/or magnesium and/or phosphorus levels drawn by an emergency physician were collected. Multivariate logistic regression models were fitted to obtain adjusted odds ratios for each risk factor for abnormal calcium or magnesium or phosphorus blood levels, and for a required intervention.</p><p><strong>Results: </strong>Among patients for whom calcium, magnesium and phosphorus were tested in the Emergency Department, the most significant risk factors (OR>2) for electrolytic abnormality were as follows: hypocalcemia - respiratory distress, diuretics (excluding loop and thiazide), anti-neoplastic medication, long QTc, chronic kidney disease (CKD); hypercalcemia - bone pain, vitamin D, hallucinations; hypomagnesemia - diabetes, corticosteroids; hypermagnesemia - poor extremity perfusion, CKD, furosemide; hypophosphatemia - seizure; hyperphosphatemia - phosphate-binders, CKD, peripheral vascular atherosclerotic disease. Of all patients tested, 3.4% received a corrective intervention initiated by the emergency physician. Predictors of intervention on an electrolyte abnormality include poor peripheral perfusion, nausea and chronic obstructive pulmonary disease (COPD).</p><p><strong>Conclusion: </strong>Emergency physicians can potentially reduce the unnecessary testing of calcium, magnesium and phosphorus blood levels by targeting patients with high-acuity conditions or chronic comorbidities such as CKD, diabetes and COPD.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":"13 ","pages":"13-21"},"PeriodicalIF":1.5,"publicationDate":"2021-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/94/aa/oaem-13-13.PMC7823096.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38798475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}