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  • 1
    Online Resource
    Online Resource
    Machine learning to predict in-hospital cardiac arrest from patients presenting to the emergency department
    Springer Science and Business Media LLC ; 2023
    In:  Internal and Emergency Medicine Vol. 18, No. 2 ( 2023-03), p. 595-605
    Details
    In: Internal and Emergency Medicine, Springer Science and Business Media LLC, Vol. 18, No. 2 ( 2023-03), p. 595-605
    Type of Medium: Online Resource
    ISSN: 1828-0447 , 1970-9366
    URL: Article
    DOI: 10.1007/s11739-022-03143-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2378342-4
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  • 2
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    Factors associated with a high-risk return visit to the emergency department: a case-crossover study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  European Journal of Emergency Medicine Vol. 28, No. 5 ( 2021-10), p. 394-401
    Details
    In: European Journal of Emergency Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 28, No. 5 ( 2021-10), p. 394-401
    Abstract: Although factors related to a return emergency department (ED) visit have been reported, few studies have examined ‘high-risk’ return ED visits with serious adverse outcomes. Understanding factors associated with high-risk return ED visits may help with early recognition and prevention of these catastrophic events. Objectives We aimed to (1) estimate the incidence of high-risk return ED visits, and (2) to investigate time-varying factors associated with these revisits. Design Case-crossover study. Settings and participants We used electronic clinical warehouse data from a tertiary medical center. We retrieved data from 651 815 ED visits over a 6-year period. Patient demographics and computerized triage information were extracted. Outcome measure and analysis A high-risk return ED visit was defined as a revisit within 72 h of the index visit with ICU admission, receiving emergency surgery, or with in-hospital cardiac arrest during the return ED visit. Time-varying factors associated with a return visit were identified. Main results There were 440 281 adult index visits, of which 19 675 (4.5%) return visits occurred within 72 h. Of them, 417 (0.1%) were high-risk revisits. Multivariable analysis showed that time-varying factors associated with an increased risk of high-risk revisits included the following: arrival by ambulance, dyspnea, or chest pain on ED presentation, triage level 1 or 2, acute change in levels of consciousness, tachycardia ( 〉 90/min), and high fever ( 〉 39°C). Conclusions We found a relatively small fraction of discharges (0.1%) developed serious adverse events during the return ED visits. We identified symptom-based and vital sign-based warning signs that may be used for patient self-monitoring at home, as well as new-onset signs during the return visit to alert healthcare providers for timely management of these high-risk revisits.
    Type of Medium: Online Resource
    ISSN: 0969-9546
    URL: Article
    DOI: 10.1097/MEJ.0000000000000851
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2028878-5
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  • 3
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    Social network analysis of nationwide interhospital emergency department transfers in Taiwan
    Springer Science and Business Media LLC ; 2023
    In:  Scientific Reports Vol. 13, No. 1 ( 2023-02-09)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2023-02-09)
    Abstract: Transferring patients between emergency departments (EDs) is a complex but important issue in emergency care regionalization. Social network analysis (SNA) is well-suited to characterize the ED transfer pattern. We aimed to unravel the underlying transfer network structure and to identify key network metrics for monitoring network functions. This was a retrospective cohort study using the National Electronic Referral System (NERS) database in Taiwan. All interhospital ED transfers from 2014 to 2016 were included and transfer characteristics were retrieved. Descriptive statistics and social network analysis were used to analyze the data. There were a total of 218,760 ED transfers during the 3-year study period. In the network analysis, there were a total of 199 EDs with 9516 transfer ties between EDs. The network demonstrated a multiple hub-and-spoke, regionalized pattern, with low global density (0.24), moderate centralization (0.57), and moderately high clustering of EDs (0.63). At the ED level, most transfers were one-way, with low reciprocity (0.21). Sending hospitals had a median of 5 transfer-out partners [interquartile range (IQR) 3–7), while receiving hospitals a median of 2 (IQR 1–6) transfer-in partners. A total of 16 receiving hospitals, all of which were designated base or co-base hospitals, had 15 or more transfer-in partners. Social network analysis of transfer patterns between hospitals confirmed that the network structure largely aligned with the planned regionalized transfer network in Taiwan. Understanding the network metrics helps track the structure and process aspects of regionalized care.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-023-29554-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2615211-3
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  • 4
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    Online Resource
    Inpatient Outcomes Following a Return Visit to the Emergency Department: A Nationwide Cohort Study
    California Digital Library (CDL) ; 2021
    In:  Western Journal of Emergency Medicine Vol. 22, No. 5 ( 2021-8-30), p. 1124-1130
    Details
    In: Western Journal of Emergency Medicine, California Digital Library (CDL), Vol. 22, No. 5 ( 2021-8-30), p. 1124-1130
    Abstract: Introduction: Emergency department (ED) revisits are traditionally used to measure potential lapses in emergency care. However, recent studies on in-hospital outcomes following ED revisits have begun to challenge this notion. We aimed to examine inpatient outcomes and resource use among patients who were hospitalized following a return visit to the ED using a national database. Methods: This was a retrospective cohort study using the National Health Insurance Research Database in Taiwan. One-third of ED visits from 2012–2013 were randomly selected and their subsequent hospitalizations included. We analyzed the inpatient outcomes (mortality and intensive care unit [ICU] admission) and resource use (length of stay [LOS] and costs). Comparisons were made between patients who were hospitalized after a return visit to the ED and those who were hospitalized during the index ED visit. Results: Of the 3,019,416 index ED visits, 477,326 patients (16%) were directly admitted to the hospital. Among the 2,504,972 patients who were discharged during the index ED visit, 229,059 (9.1%) returned to the ED within three days. Of them, 37,118 (16%) were hospitalized. In multivariable analyses, the inpatient mortality rates and hospital LOS were similar between the two groups. Compared with the direct-admission group, the return-admission group had a lower ICU admission rate (adjusted odds ratio, 0.78; 95% confidence interval [CI], 0.72-0.84), and lower costs (adjusted difference, -5,198 New Taiwan dollars, 95% CI, -6,224 to -4,172). Conclusion: Patients who were hospitalized after a return visit to the ED had a lower ICU admission rate and lower costs, compared to those who were directly admitted. Our findings suggest that ED revisits do not necessarily translate to poor initial care and that subsequent inpatient outcomes should also be considered for better assessment.
    Type of Medium: Online Resource
    ISSN: 1936-900X
    URL: Issue
    URL: Journal
    URL: Article
    DOI: 10.5811/westjem.2021.9.54644
    DOI: 10.5811/westjem
    DOI: 10.5811/westjem.2021.6.52212
    Language: Unknown
    Publisher: California Digital Library (CDL)
    Publication Date: 2021
    detail.hit.zdb_id: 2375700-0
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  • 5
    Online Resource
    Online Resource
    Impact of COVID-19 pandemic on emergency department services acuity and possible collateral damage
    Elsevier BV ; 2020
    In:  Resuscitation Vol. 153 ( 2020-08), p. 185-186
    Details
    In: Resuscitation, Elsevier BV, Vol. 153 ( 2020-08), p. 185-186
    Type of Medium: Online Resource
    ISSN: 0300-9572
    URL: Article
    DOI: 10.1016/j.resuscitation.2020.06.021
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2010733-X
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  • 6
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    External validation of a triage tool for predicting cardiac arrest in the emergency department
    Springer Science and Business Media LLC ; 2022
    In:  Scientific Reports Vol. 12, No. 1 ( 2022-05-24)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-05-24)
    Abstract: Early recognition and prevention comprise the first ring of the Chain of Survival for in-hospital cardiac arrest (IHCA). We previously developed and internally validated an emergency department (ED) triage tool, Emergency Department In-hospital Cardiac Arrest Score (EDICAS), for predicting ED-based IHCA. We aimed to externally validate this novel tool in another ED population. This retrospective cohort study used electronic clinical warehouse data from a tertiary medical center with approximately 130,000 ED visits per year. We retrieved data from 268,208 ED visits over a 2-year period. We selected one ED visit per person and excluded out-of-hospital cardiac arrest or children. Patient demographics and computerized triage information were retrieved, and the EDICAS was calculated to predict the ED-based IHCA. A total of 145,557 adult ED patients were included. Of them, 240 (0.16%) developed IHCA. The EDICAS showed excellent discrimination with an area under the receiver operating characteristic (AUROC) of 0.88. The AUROC of the EDICAS outperformed those of other early warning scores (0.80 for Modified Early Warning Score [MEWS] and 0.83 for Rapid Emergency Medicine Score [REMS]) in the same ED population. An EDICAS of 6 or above (i.e., high-risk patients) corresponded to a sensitivity of 33%, a specificity of 97%, and a positive likelihood ratio of 12.2. In conclusion, we externally validated a tool for predicting imminent IHCA in the ED and demonstrated its superior performance over other early warning scores. The real-world impact of the EDICAS warning system with appropriate interventions would require a future prospective study.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-022-12781-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2615211-3
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  • 7
    Online Resource
    Online Resource
    Pain trajectories in the emergency department: Patient characteristics and clinical outcomes
    Elsevier BV ; 2022
    In:  The American Journal of Emergency Medicine Vol. 55 ( 2022-05), p. 111-116
    Details
    In: The American Journal of Emergency Medicine, Elsevier BV, Vol. 55 ( 2022-05), p. 111-116
    Type of Medium: Online Resource
    ISSN: 0735-6757
    URL: Article
    DOI: 10.1016/j.ajem.2021.09.087
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2041648-9
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  • 8
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    Development and Validation of a Novel Triage Tool for Predicting Cardiac Arrest in the Emergency Department
    California Digital Library (CDL) ; 2022
    In:  Western Journal of Emergency Medicine Vol. 23, No. 2 ( 2022-2-23), p. 258-267
    Details
    In: Western Journal of Emergency Medicine, California Digital Library (CDL), Vol. 23, No. 2 ( 2022-2-23), p. 258-267
    Abstract: Background: Early recognition and prevention of in-hospital cardiac arrest (IHCA) have played an increasingly important role in the chain of survival. However, clinical tools for predicting IHCA are scarce, particularly in the emergency department (ED). We sought to estimate the incidence of ED-based IHCA and to develop and validate a novel triage tool, the Emergency Department In-hospital Cardiac Arrest Score (EDICAS), for predicting ED-based IHCA. Methods: In this retrospective cohort study we used electronic clinical warehouse data from a tertiary medical center with approximately 100,000 ED visits per year. We extracted data from 733,398 ED visits over a seven-year period. We selected one ED visit per person and excluded out-of-hospital cardiac arrest or children. Patient demographics and computerized triage information were included as potential predictors. Results: A total of 325,502 adult ED patients were included. Of these patients, 623 (0.2%) developed ED-based IHCA. The EDICAS, which includes age and arrival mode and categorizes vital signs with simple cut-offs, showed excellent discrimination (area under the receiver operating characteristic [AUROC] curve, 0.87) and maintained its discriminatory ability (AUROC, 0.86) in cross-validation. Previously developed early warning scores showed lower AUROC (0.77 for the Modified Early Warning Score and 0.83 for the National Early Warning Score) when applied to our ED population. Conclusion: In-hospital cardiac arrest in the ED is relatively uncommon. We developed and internally validated a novel tool for predicting imminent IHCA in the ED. Future studies are warranted to determine whether this tool could gain lead time to identify high-risk patients and potentially reduce ED-based IHCA.
    Type of Medium: Online Resource
    ISSN: 1936-900X
    URL: Issue
    URL: Journal
    URL: Article
    DOI: 10.5811/westjem.2022.3.56639
    DOI: 10.5811/westjem
    DOI: 10.5811/westjem.2021.8.53063
    Language: Unknown
    Publisher: California Digital Library (CDL)
    Publication Date: 2022
    detail.hit.zdb_id: 2375700-0
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  • 9
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    Online Resource
    Serum Lactate for Predicting Cardiac Arrest in the Emergency Department
    MDPI AG ; 2022
    In:  Journal of Clinical Medicine Vol. 11, No. 2 ( 2022-01-13), p. 403-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 2 ( 2022-01-13), p. 403-
    Abstract: Objectives: Early recognition and prevention of in-hospital cardiac arrest (IHCA) play an increasingly important role in the Chain of Survival. However, clinical tools for predicting IHCA in the emergency department (ED) are scanty. We sought to evaluate the role of serum lactate in predicting ED-based IHCA. Methods: Data were retrieved from 733,398 ED visits over a 7-year period in a tertiary medical centre. We selected one ED visit per person and excluded out-of-hospital cardiac arrest, children, or those without lactate measurements. Patient demographics, computerised triage information, and serum lactate levels were extracted. The initial serum lactate levels were grouped into normal (≤2 mmol/L), moderately elevated (2 〈 lactate ≤ 4), and highly elevated ( 〉 4 mmol/L) categories. The primary outcome was ED-based IHCA. Results: A total of 17,392 adult patients were included. Of them, 342 (2%) developed IHCA. About 50% of the lactate levels were normal, 30% were moderately elevated, and 20% were highly elevated. In multivariable analysis, the group with highly elevated lactate had an 18-fold increased risk of IHCA (adjusted odds ratio [OR], 18.0; 95% confidence interval [CI] , 11.5–28.2), compared with the normal lactate group. In subgroup analysis, the poor lactate-clearance group ( 〈 2.5%/h) was associated with a 7.5-fold higher risk of IHCA (adjusted OR, 7.5; 95%CI, 3.7–15.1) compared with the normal clearance group. Conclusions: Elevated lactate levels and poor lactate clearance were strongly associated with a higher risk of ED-based IHCA. Clinicians may consider a more liberal sampling of lactate in patients at higher risk of IHCA with follow-up of abnormal levels.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm11020403
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662592-1
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  • 10
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    High-risk Return Visits to United States Emergency Departments, 2010–2018
    California Digital Library (CDL) ; 2022
    In:  Western Journal of Emergency Medicine Vol. 23, No. 6 ( 2022-10-18)
    Details
    In: Western Journal of Emergency Medicine, California Digital Library (CDL), Vol. 23, No. 6 ( 2022-10-18)
    Abstract: Introduction: Although factors related to a return visit to the emergency department (ED) have been reported, only a few studies have examined “high-risk” ED revisits with serious adverse outcomes. In this study we aimed to describe the incidence and trend of high-risk ED revisits in United States EDs and to investigate factors associated with these revisits. Methods: We obtained data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 2010–2018. Adult ED revisits within 72 hours of a previous discharge were identified using a mark on the patient record form. We defined high-risk revisits as revisits with serious adverse outcomes, including intensive care unit admissions, emergency surgery, cardiac catheterization, or cardiopulmonary resuscitation (CPR) during the return visit. We performed analyses using descriptive statistics and multivariable logistic regression, accounting for NHAMCS’s complex survey design. Results: Over the nine-year study period, there were an estimated 37,700,000 revisits, and the proportion of revisits in the entire ED population decreased slightly from 5.1% in 2010 to 4.5% in 2018 (P for trend = 0.02). By contrast, there were an estimated 827,000 high-risk ED revisits, and the proportion of high-risk revisits in the entire ED population remained stable at approximately 0.1%. The mean age of these high-risk revisit patients was 57 years, and 43% were men. Approximately 6% of the patients were intubated, and 13% received CPR. Most of them were hospitalized, and 2% died in the ED. Multivariable analysis showed that older age (65+ years), Hispanic ethnicity, daytime visits, and arrival by ambulance during the revisit were independent predictors of high-risk revisits. Conclusion: High-risk revisits accounted for a relatively small fraction (0.1%) of ED visits. Over the period of the NHAMCS survey between 2010-2018, this fraction remained stable. We identified factors during the return visit that could be used to label high-risk revisits for timely intervention.
    Type of Medium: Online Resource
    ISSN: 1936-900X
    URL: Issue
    URL: Journal
    URL: Article
    DOI: 10.5811/westjem.2022.8.59370
    DOI: 10.5811/westjem
    DOI: 10.5811/westjem.2022.7.57028
    Language: Unknown
    Publisher: California Digital Library (CDL)
    Publication Date: 2022
    detail.hit.zdb_id: 2375700-0
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