Open Access Emergency Medicine : OAEM最新文献

{"title":"Reasons for Emergency Department Visit, Outcomes, and Associated Factors of Oncologic Patients at Emergency Department of Jimma University Medical Centre.","authors":"Abdata Workina,&nbsp;Asaminew Habtamu,&nbsp;Wondeson Zewdie","doi":"10.2147/OAEM.S381816","DOIUrl":"https://doi.org/10.2147/OAEM.S381816","url":null,"abstract":"<p><strong>Introduction: </strong>The number of oncologic patients visiting the emergency department (ED) is increasing and represent a challenge for the emergency team owing to they might have acute sign and symptoms of a still undiagnosed malignancy, management of treatment-related side effects, co-morbidities, and palliative care. Thus, this study was aimed to identify reasons for ED visits, management outcomes, and associated factors of oncologic patients.</p><p><strong>Patients and methods: </strong>A prospective cross-sectional study was conducted from March 11, 2021 to August 25, 2021 at the ED of Jimma University Medical Center on a total of 338 oncologic patients. Data were collected from the patient and the patient's medical record using a questionnaire developed from up-to-date similar literatures. The questionnaire was started filled out upon diagnosis of cancer and completed during discharge from the ED. The outcomes of the patients were dichotomized into died and survived then, it was analyzed using frequency and bivariate logistic regression.</p><p><strong>Results: </strong>The most common reasons for oncologic patients ED visit were neutropenic fever 79 (23.4%) followed by vomiting 38 (11.2%) and electrolyte abnormality 37 (10.9%) respectively. Among oncologic patients visited ED, 137 (40.5%) of them were admitted to ward and 126 (37.3%) of them were discharged with improvement while 64 (18.9%) of them were died. Based on multivariate logistic regression, those patients who had distant metastasis cancer (AOR 1.85; 95% CI 1.03-7.21), comorbidity (AOR 2.56; 95% CI 1.20, 6.96), and ECOG >3 (AOR 2.40; 95% CI 1.25,13.43) were more likely to die than their counterparts.</p><p><strong>Conclusion: </strong>Most of the oncologic patients visited ED due to neutropenic fever, nausea and or vomiting, and electrolyte disorder. Amongst oncologic patients who were visited ED, most of them were admitted to ward while around one-fifth of them were died. Having distant metastasis cancer, comorbidity and ECOG >3 were independent predictors of an oncologic patient's outcome at the ED.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":" ","pages":"581-590"},"PeriodicalIF":1.5,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dc/09/oaem-14-581.PMC9624217.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40465559","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":"Characteristics of Patients Presented with Complicated Appendicitis in Adama, Ethiopia: A Cross-Sectional Study.","authors":"Haset Dagne,&nbsp;Tsega-Ab Abebaw","doi":"10.2147/OAEM.S383550","DOIUrl":"https://doi.org/10.2147/OAEM.S383550","url":null,"abstract":"<p><strong>Background: </strong>Complicated appendicitis (CA) is defined as perforated appendicitis, peritonitis, peri-appendicular abscess, or appendicular mass. One-third of patients who develop appendicitis are diagnosed with CA at presentation. Studies regarding the prevalence of CA are lacking in low-income countries, and the characteristics of patients presented with CA are incoherently identified.</p><p><strong>Objective: </strong>To assess the prevalence and the significant characteristics associated with CA among patients admitted with the diagnosis of acute appendicitis at Adama Hospital Medical College.</p><p><strong>Methods: </strong>A cross-sectional study was conducted from January 1, 2018, up to December 31, 2019. From a total of 1043 patients during the study period, the charts of 431 patients were selected using a systematic random sampling technique. Data were collected by a structured checklist. Bivariate and multivariable binary logistic regression analyses were employed to assess the association of patients' characteristics with CA.</p><p><strong>Results: </strong>Out of 431 patients, 157 (36.4%) had CA. Characteristics of patients having a significant association with CA were found to be generalized abdominal tenderness (AOR: 27.48, 95% CI: 4.03, 187.24), diagnosis with peritonitis (AOR: 14.87, 95% CI: 4.05, 54.54), right lower quadrant (RLQ) abdominal mass (AOR: 7.79, 95% CI: 2.02, 29.99), shock (10.37, 95% CI: 3.18, 33.76), white blood cell (WBC) count >11,000 (AOR: 2.16, 95% CI: 1.02, 4.61), onset to visit interval of 8-14 days (AOR: 10.45, 95% CI: 2.4, 45.52) and ultrasound report of acute appendicitis (AOR: 0.33, 95% CI: 0.13, 0.85), appendiceal abscess (AOR: 5.05, 95% CI: 1.48, 17.31), and appendiceal mass (AOR: 6.04, 95% CI: 1.45, 25.14).</p><p><strong>Conclusion: </strong>The prevalence of CA was very high. Generalized abdominal tenderness, RLQ abdominal mass, shock, WBC count, onset to visit interval, abdominopelvic ultrasound report, and clinical diagnosis of peritonitis were significantly associated with CA.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":" ","pages":"573-580"},"PeriodicalIF":1.5,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/93/oaem-14-573.PMC9595057.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40652305","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":"Traumatic Injuries Following Mechanical versus Manual Chest Compression.","authors":"Safwat Saleem,&nbsp;Roman Sonkin,&nbsp;Iftach Sagy,&nbsp;Refael Strugo,&nbsp;Eli Jaffe,&nbsp;Michael Drescher,&nbsp;Shachaf Shiber","doi":"10.2147/OAEM.S374785","DOIUrl":"https://doi.org/10.2147/OAEM.S374785","url":null,"abstract":"<p><strong>Objective: </strong>Survival after out-of-hospital cardiac arrest (OHCA) depends on multiple factors, mostly quality of chest compressions. Studies comparing manual compression with a mechanical active compression-depression device (ACD) have yielded controversial results in terms of outcomes and injury. The aim of the present study was to determine whether out-of-hospital ACD cardiopulmonary resuscitation (CPR) use is associated with more skeletal fractures and/or internal injuries than manual compression, with similar duration of cardiopulmonary resuscitation (CPR) between the groups.</p><p><strong>Methods: </strong>The cohort included all patients diagnosed with out-of-hospital cardiac arrest (OHCA) at a tertiary medical center between January 2018 and June 2019 who achieved return of spontaneous circulation (ROSC). The primary outcome measure was the incidence of skeletal fractures and/or internal injuries in the two groups. Secondary outcome measures were clinical factors contributing to skeletal fracture/internal injuries and to achievement of ROSC during CPR.</p><p><strong>Results: </strong>Of 107 patients enrolled, 45 (42%) were resuscitated with manual chest compression and 62 (58%) with a piston-based ACD device (LUCAS). The duration of chest compression was 46.0 minutes vs. 48.5 minutes, respectively (p=0.82). There were no differences in rates of ROSC (53.2% vs.50.8%, p=0.84), cardiac etiology of OHCA (48.9% vs.43.5%, p=0.3), major complications (ribs/sternum fracture, pneumothorax, hemothorax, lung parenchymal damage, major bleeding), or any complication (20.5% vs.12.1%, p=0.28). On multivariate logistic regression analysis, factors with the highest predictive value for ROSC were cardiac etiology (OR 1.94;CI 2.00-12.94) and female sex (OR 1.94;CI 2.00-12.94). Type of arrhythmia had no significant effect. Use of the LUCAS was not associated with ROSC (OR 0.73;CI 0.34-2.1).</p><p><strong>Conclusion: </strong>This is the first study to compare mechanical and manual out-of-hospital chest compression of similar duration to ROSC. The LUCAS did not show added benefit in terms of ROSC rate, and its use did not lead to a higher risk of traumatic injury. ACD devices may be more useful in cases of delayed ambulance response times, or events in remote locations.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":" ","pages":"557-562"},"PeriodicalIF":1.5,"publicationDate":"2022-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/60/oaem-14-557.PMC9547590.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33498553","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":"Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study.","authors":"Abdulaziz Mohammad Al-Sharydah","doi":"10.2147/OAEM.S376819","DOIUrl":"https://doi.org/10.2147/OAEM.S376819","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the pre-procedural attributes of trauma patients to determine their suitability to undergo Percutaneous Endovascular Arterial Embolization (PEAE), and the current state of endovascular repair as an option for trauma-related injuries in traumatic abdominopelvic arterial injuries was explored.</p><p><strong>Patients and methods: </strong>We retrospectively evaluated the charts of 638 adults with traumatic abdominopelvic injuries treated from March 2011 to February 2021, extensively reviewing their pre-operative indices, pre-operative optimization requirements, and multi-modality imaging records.</p><p><strong>Results: </strong>In total, 235 patients (30.63%) were \"hemodynamically unstable\" on admission, mainly due to hypotension (n=437 [68.5%]). Additionally, laboratory-defined acquired coagulopathies and inherited bleeding disorders were found in 268 patients (42.01%). The computerized tomography bleeding protocol was performed on 408 (63.94%) patients. Percutaneous endovascular therapy by arterial embolization was performed on 146 patients. The mean number of requested pre-intervention blood units for trauma patients significantly exceeded the number of units transfused post-intervention (<i>P</i><0.0005). Apart from hemodynamics (ie heart rate, mean blood pressure); hemoglobin, and lactic acid levels were independently associated indices of PEAE outcomes (p <0.01).</p><p><strong>Conclusion: </strong>Despite the recommendations from the Society of Interventional Radiology on endovascular intervention for trauma and bleeding risk, 36.84% of study patients had hemodynamic instability and other unfeasible parameters that would limit the option of minimally invasive procedures. Early recognition and consideration of suitable treatment options is essential for optimizing patient outcomes. It is imperative that standardized algorithms and management protocols based on available resources be developed.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":" ","pages":"545-556"},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e1/6f/oaem-14-545.PMC9534156.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33496312","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":"Interprofessional On-floor Education on Oxygen Therapy in COVID-19 Patients, Cardiac Arrest, and Procedural Sedation: Perception of Health-care Workers in Emergency Setting.","authors":"Munawar Farooq,&nbsp;Shabbir Ahmad,&nbsp;Faisal K Hanjra,&nbsp;Obaidullah Zafar,&nbsp;Khalid Bashir","doi":"10.2147/OAEM.S349656","DOIUrl":"https://doi.org/10.2147/OAEM.S349656","url":null,"abstract":"<p><strong>Objective: </strong>There is paucity of evidence for interprofessional education (IPE) conducted within the working environment of emergency departments (EDs). This study demonstrates favorable perception of on-floor IPE sessions conducted in a busy emergency department.</p><p><strong>Materials and methods: </strong>Between January and December 2020, IPE was conducted in EDs using low fidelity manikins and involved nurses, doctors, respiratory therapists, and medical students already present on floor. The three key areas were, taught cardiac arrest, escalating oxygen therapy for COVID-19 patients, and procedural sedation. Each session lasted 30 min, and feedback was obtained immediately after the session in both transcribed and written forms through scannable survey monkey links.</p><p><strong>Results: </strong>Forty-seven sessions were conducted covering the three topics for 141 participants. The majority of the participants benefited from on-floor IPE and preferred this approach in the future. Both participant and faculty recommended to have some protected time to maximize the learnings.</p><p><strong>Conclusion: </strong>IPE in the clinical environment is feasible, with careful planning it can enhance collaborative learning in the ED.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":" ","pages":"535-543"},"PeriodicalIF":1.5,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/19/32/oaem-14-535.PMC9531615.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33491652","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 Correlations of Human Atrial Natriuretic Peptide on Cardiac Function and Hemodynamics in Pediatric Septic Shock.","authors":"Arina Setyaningtyas,&nbsp;Soetjipto Soetjipto,&nbsp;Anang Endaryanto,&nbsp;Antonius Hocky Pudjiadi","doi":"10.2147/OAEM.S379543","DOIUrl":"https://doi.org/10.2147/OAEM.S379543","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to determine the correlations of human Atrial Natriuretic Peptide (ANP) on cardiac function and hemodynamics in pediatric septic shock.</p><p><strong>Patients and methods: </strong>We conducted an observational and prospective study on 30 children with septic shock. Measurement of the level of human atrial natriuretic peptide was determined in the serum of patients. Cardiac power (CP) is a cardiac function parameter measured with cardiac output (cardiovascular flow) and mean arterial (intravascular) pressure. Cardiac output and mean arterial pressure were monitored using pressure recording analytical methods (PRAM). Hemodynamic status was represented by a vasoactive inotropic score.</p><p><strong>Results: </strong>Thirty pediatric septic shock patients fulfilled the eligibility criteria. The human ANP level was not significantly different in pediatric septic shock on three days of examination. Cardiac power was significantly different in pediatric septic shock on three days of examination. There was a correlation between human ANP and cardiac power on day 3 and human ANP and VIS on day 2.</p><p><strong>Conclusion: </strong>There was a significant correlation between human ANP level and cardiac power on day 3 and ANP level and VIS on day 2. The cardiac power on day 3 and VIS on 48 hours can be alternatives to evaluate the hemodynamic status and cardiac function concerning human ANP in pediatric septic shock.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":" ","pages":"525-534"},"PeriodicalIF":1.5,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/50/ac/oaem-14-525.PMC9525027.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40390105","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":"Perioperative Management for Emergency Surgery in Pediatric Patients with COVID-19: Retrospective Observational Study.","authors":"Gezy Giwangkancana,&nbsp;Ezra Oktaliansah,&nbsp;Andi Ade W Ramlan,&nbsp;Arie Utariani,&nbsp;Putu Kurniyanta,&nbsp;Hasanul Arifin,&nbsp;Yunita Widyastuti,&nbsp;Astrid Pratiwi,&nbsp;Rusmin Syukur","doi":"10.2147/OAEM.S377201","DOIUrl":"https://doi.org/10.2147/OAEM.S377201","url":null,"abstract":"<p><strong>Background: </strong>The first wave of COVID-19 in 2020 created massive challenges in providing safe surgery for pediatric patients with COVID-19. Inevitably, emergency surgery and the unknown nature of the disease place a burden on the heavily challenged surgical services for pediatrics in a developing country. Lessons from the pandemic are important for future disaster planning.</p><p><strong>Aim: </strong>To describe the characteristics of pediatric surgical patients with COVID-19 undergoing emergency surgery during the first wave and its perioperative narrative in a developing country.</p><p><strong>Methods: </strong>The study was a multicenter retrospective descriptive study in eight Indonesian government-owned referral and teaching hospitals. The authors reviewed confirmed COVID-19 pediatric patients (≤18 years old) who underwent surgery. Institutional review board clearances were acquired, and data were evaluated in proportion and percentages. The writing of this paper follows the STROBE guidelines.</p><p><strong>Results: </strong>About 7791 pediatric surgical cases were collected, 73 matched the study criteria and 24 confirmed cases were found. Cases were more common in females (58.3%), who were above 12 years old (37.5%) and who were asymptomatic (62.5%). Laparotomy (33.3%), general anesthesia (90.4%) and intubation (80.8%) were common, while use of video laryngoscopy (40%) and rapid sequence intubation (28.8%) were rare. The mean length of stay was 12 ±13.3 days, and in-hospital mortality was 8.3%.</p><p><strong>Discussions: </strong>Lockdown and school closure were successful in protecting children, hence the low incidence of pediatric surgical cases with COVID-19 during the first wave. Many hospitals were unprepared to perform surgery for a droplet or airborne infectious disease, and COVID-19 testing was not available nationally in the early pandemic, hence the use of protective protection equipment  during these early pandemic times are often not efficient.</p><p><strong>Conclusion: </strong>The incidence of COVID-19 in pediatric surgical patients is low. The rapidity and availability of preoperative testing for a new emerging disease are essential in a pandemic.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":" ","pages":"515-524"},"PeriodicalIF":1.5,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/0e/oaem-14-515.PMC9509001.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40375742","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":"Evaluation of Essential and Emergency Surgery Provide in Primary Hospitals of Gedeo Zone and Sidama Region, South, Ethiopia, 2020.","authors":"Teshome Regasa,&nbsp;Abebayehu Zemedkun,&nbsp;Derartu Neme","doi":"10.2147/OAEM.S371509","DOIUrl":"https://doi.org/10.2147/OAEM.S371509","url":null,"abstract":"<p><strong>Background: </strong>Surgical services at level referral hospitals were an essential part of overall health care. The surgical uhservice was approximated to account for 11% of the worldwide load of disease, with a large percentage of that burden being uncovered in resource-constraint settings. Even though the surgery service is significant and growing across all economic sectors, the majority of resource-limited countries have been unable to provide essential surgical services.</p><p><strong>Objective: </strong>To investigate the capacity of essential and emergency surgical services in primary hospital facilities in the Gedeo zone and Sidama region.</p><p><strong>Methodology: </strong>In the Gedeo zone and Sidama region, a cross-sectional study was undertaken in eight district hospitals. By looking at four areas of data: infrastructure, human resources, interventions available, and equipment, a World Health Organization tool for conditional analysis was used to assess a health set-up competence to perform essential surgical and anesthetic procedures. The tool looked for eight different categories of healthcare giving 35 surgical procedures, and 67 different pieces of instruments.</p><p><strong>Results: </strong>This research found that 48.57% of the 35 essential interventions counted in the test, including cesarean section, were available at all hospitals. Prior to admission, each hospital reported a total of 53 beds, with an average travel distance of 28 kilometers. There were 189 healthcare providers in the eight facilities. According to the research, basic instruments were not always present at all of the sites.</p><p><strong>Conclusion: </strong>Infrastructure, health profession, service supply, and key instruments and supplies deficiencies reveal major inadequacies in hospitals' capacity to perform EESC and efficiently treat the growing surgical load of disease and damage in primary care.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":" ","pages":"507-514"},"PeriodicalIF":1.5,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/db/d6/oaem-14-507.PMC9507455.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33483438","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":"MONitoring Knockbacks in EmergencY (MONKEY) - An Audit of Disposition Outcomes in Emergency Patients with Rejected Admission Requests.","authors":"Wendell Zhang,&nbsp;Lee Yung Wong,&nbsp;Jasmine Liu,&nbsp;Soham Sarkar","doi":"10.2147/OAEM.S376419","DOIUrl":"https://doi.org/10.2147/OAEM.S376419","url":null,"abstract":"<p><strong>Background: </strong>Emergency Department (ED) clinicians commonly experience difficulties in referring patients to inpatient teams for hospital admission. There is limited literature reporting on patient outcomes following these complicated referrals, where ED requests for inpatient admission are rejected - which study investigators termed a \"knockback\".</p><p><strong>Purpose: </strong>To identify disposition outcomes and referral accuracy in ED patients whose admission referral was initially rejected. Secondary objectives were to identify additional patient, clinician and systemic factors associated with knockbacks.</p><p><strong>Selection and methodology: </strong>Emergency clinicians prospectively nominated a convenience sample of patients identified as having knockbacks over two time periods (Jan-Feb 2020 and Aug 2020 to Jan 2021) at a tertiary Australian ED. Data were analyzed with a mixed-methods approach and subsequent descriptive and thematic analyses were performed.</p><p><strong>Results: </strong>A total of 109 patients were identified as knockbacks. The referrals were warranted, with 89.0% of cases (n = 97) ultimately requiring a hospital admission. In 60.6% (n = 66) of the admissions, patients were admitted under the inpatient team initially referred to by the ED, suggesting referrals were generally accurate. The number of in-hospital units involved in the admission process and ED length of stay were positively correlated (0.409, p < 0.001). Patient factors associated with knockbacks include pre-existing chronic medical conditions and presenting acutely unwell. Analysis of clinicians' perspectives yielded recurring themes of disagreements over admission destination and diagnostic uncertainty.</p><p><strong>Conclusion: </strong>In this patient sample, emergency referrals for admission were mostly warranted and accurate. Knockbacks increase ED length of stay and may adversely affect patient care. Further focused discussion and clearer referral guidelines between ED clinicians and their inpatient colleagues are required.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":" ","pages":"481-490"},"PeriodicalIF":1.5,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9b/a6/oaem-14-481.PMC9448349.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33454887","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":"Do Non-COVID-19 Patients' Behaviour Towards Emergency Changed During the COVID-19 Outbreak? A Severity-Based Approach.","authors":"Julien Flament,&nbsp;Frederic Clarembeau,&nbsp;Charlotte Hayden,&nbsp;Nathan Scius,&nbsp;Maxime Regnier,&nbsp;Henri Thonon","doi":"10.2147/OAEM.S368254","DOIUrl":"https://doi.org/10.2147/OAEM.S368254","url":null,"abstract":"<p><strong>Objective: </strong>During the COVID-19 pandemic, the number of patients presenting to the emergency department (ED) declined. The main goal of this study was to compare and describe the non-COVID-19 patient's disease severity presentation during the pandemic with its pre-pandemic severity.</p><p><strong>Methods: </strong>We conducted a retrospective observational study. We selected two samples of visits: one during the first COVID-19 wave of 2020 (pandemic period, PP) and the other during the same months of 2019 (control period, CP). The primary endpoints were the comparison of severity and distribution of the Emergency Severity Index (ESI). Secondary endpoints were comparisons of specific patient characteristics (age, sex, length of the symptoms before the visits, spontaneous visits or not, return home or not).</p><p><strong>Results: </strong>The mean ESI of the visits during the PP (3.19) was statistically significantly lower (<i>P</i> = 0.001) than it was in the CP (3.43). These changes were more pronounced during the months of March (3.03 versus 3.33, <i>P</i> = 0.037) and April (2.96 versus 3.48, <i>P</i> < 0.001). The change in ESI was mainly due to an increase in the proportion of visits by patients with an ESI score of 3 (42% versus 28%, <i>P</i> < 0.001). There were no differences in the characteristics of patients except a decline in patients whose symptoms had a duration of more than 30 days (2% during PP versus 4% during CP, <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>The COVID-19 pandemic caused a change in the pattern of non-COVID-19 visits, with proportionally more severe presentations based on the ESI. To our knowledge, this is the first description of changes in behaviour in ED visits by specifically non-COVID-19 patients.</p>","PeriodicalId":503614,"journal":{"name":"Open Access Emergency Medicine : OAEM","volume":" ","pages":"473-479"},"PeriodicalIF":1.5,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/59/4b/oaem-14-473.PMC9419907.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33446479","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}