Dataset Information

Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices.

ABSTRACT:

Background

In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance.

Methods

This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17). After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER): Follow-up and final examination in the hospital's emergency unit. Group B (GP): Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment.

Results

Female and male patients were equally represented in both groups. The age of the patients ranged from 16 - 64 years, with a mean age of 34 years (ER) and 35 years (GP). 98% (n = 98) of all patients were satisfied with their treatment, and 93% (n = 93) were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively). 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc.) on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669).

Conclusion

Patients who first present at the ER with a lateral ankle ligament injury grade I-II can be referred to a general practitioner for follow-up treatment without affecting patient satisfaction regarding treatment and treatment outcome.

SUBMITTER: Schwab PR

PROVIDER: S-EPMC2631016 | biostudies-literature | 2008 Dec

REPOSITORIES: biostudies-literature

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Publications

Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices.

Schwab Patrik R PR Benneker Lorin M LM Eggli Stefan S Zimmermann Heinz H Exadaktylos Aristomenis K AK

BMC family practice 20081223

<h4>Background</h4>In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influe ...[more]

PMID: 19105803

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Project description:BackgroundAnkle sprains account for a large proportion of injuries presenting to both United States (US) emergency departments (EDs) as well as high school (HS) and collegiate school athletic training settings. The epidemiologic differences across these settings by both sport and diagnosis have not been well differentiated. Ankle injury data from 3 national surveillance datasets. Athletic training setting data from the National High School Sports-Related Injury Surveillance System and the National Collegiate Athletic Association Injury Surveillance Program was from academic years 2009/10 through 2013/14 and the US Consumer Product Safety Commission's National Electronic Injury Surveillance System (ED setting) data was from calendar years 2009 through 2013. Data was analyzed for patients 14-22 years old participating in 12 sports (male football, baseball, basketball, lacrosse, soccer, and wrestling, and female softball, basketball, lacrosse, soccer, volleyball, and field hockey). We calculated sport-specific injury rates, proportions, and rate ratios (RRs) with 95% confidence intervals (CI).ResultsDuring the study period, the surveillance systems captured 20,261 ankle injuries presenting to EDs plus 5546 HS and 2725 collegiate injuries presenting to school athletic training settings. Rates were higher in collegiate compared to HS athletes presenting in the athletic training setting. Football accounted for the largest proportion of ankle injuries presenting to HS (31.2%) and college (41.0%) athletic training settings; male basketball accounted for the largest proportion presenting to EDs among both HS (41.0%) and college (65.8%) aged patients. Sprains/strains accounted for over 80% of injuries in all three settings. Fractures accounted for a larger proportion of ankle injuries presenting to EDs (9.5%) compared to HS (3.8%) and college (0.8%) athletic training settings. There was no change in injury rates during the study period across the three settings.ConclusionsInjury rates and patterns varied by sport and presentation setting, with athletic trainers evaluating more ankle injuries overall in the collegiate setting compared to the high school setting. Ankle injuries presenting to EDs were more commonly fractures, suggesting that more severe injuries present to this setting. Understanding the epidemiology of such patterns will help readers interpret differences in publications reporting data from varied clinical settings.

Project description:BackgroundAnkle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments.HypothesisThere will be a higher incidence of ankle sprains among younger populations (?25 years old) and in female patients. Complications and procedures will differ between ankle sprain types. Lateral ankle sprains will have lower health care charges relative to medial and high ankle sprains.Study designDescriptive epidemiological study.Level of evidenceLevel 3.MethodsA cross-sectional study of the 2010 Nationwide Emergency Department Sample was conducted. Outcomes such as charges, complications, and procedures were compared using propensity score matching between lateral and medial as well as lateral and high ankle sprains.ResultsThe sample contained 225,114 ankle sprains. Female patients sustained more lateral ankle sprains (57%). After propensity score adjustment, lateral sprains incurred greater charges than medial ankle sprains (median [interquartile range], $1008 [$702-$1408] vs $914 [$741-$1108]; P < 0.01). Among complications, pain in the limb (1.92% vs 0.52%, P = 0.03), sprain of the foot (2.96% vs 0.70%, P < 0.01), and abrasion of the hip/leg (1.57% vs 0.35%, P = 0.03) were more common in lateral than medial ankle sprain events. Among procedures, medial ankle sprains were more likely to include diagnostic radiology (97.91% vs 83.62%, P < 0.01) and less likely to include medications than lateral ankle sprains (0.87% vs 2.79%, P < 0.01). Hospitalizations were more common following high ankle sprains than lateral ankle sprains (24 [6.06%] vs 1 [0.25%], P < 0.01).ConclusionAnkle sprain emergency department visits account for significant health care charges in the United States. Age- and sex-related differences persist among the types of ankle sprains.Clinical relevanceThe health care charges associated with ankle sprains indicate the need for additional preventive measures. There are age- and sex-related differences in the prevalence of ankle sprains that suggest these demographics may be risk factors for ankle sprains.

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Project description:ObjectivesTo determine the diagnostic value of ultrasonography for complete discontinuity of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the anterior inferior tibiofibular ligament (AITFL).MethodsAll acute ankle injuries in adult athletes (> 18 years old) presenting to the outpatient department of a specialised Orthopaedic and Sports Medicine Hospital within 7 days post-injury were assessed for eligibility. Using ultrasonography, one musculoskeletal radiologist assessed the ATFL, CFL and AITFL for complete discontinuity. Dynamic ultrasound measurements of the tibiofibular distance (mm) in both ankles (injured and contralateral) were acquired in the neutral position (N), during maximal external rotation (Max ER), and maximal internal rotation (Max IR). MR imaging was used as a reference standard.ResultsBetween October 2017 and July 2019, 92 acute ankle injuries were included. Ultrasound diagnosed complete discontinuity of the ATFL with 87% (CI 74-95%) sensitivity and 69% (CI 53-82%) specificity. Discontinuity of the CFL was diagnosed with 29% (CI 10-56%) sensitivity and 92% (CI 83-97%) specificity. Ultrasound diagnosed discontinuity of the AITFL with 100% (CI 74-100%) sensitivity and 100% (CI 95-100%) specificity. Of the dynamic measurements, the side-to-side difference in external rotation had the highest diagnostic value for complete discontinuity of the AITFL (sensitivity 82%, specificity 86%; cut-off 0.93 mm).ConclusionsUltrasound has a good to excellent diagnostic value for complete discontinuity of the ATFL and AITFL. Therefore, ultrasound can be used to screen for injury of the ATFL and AITFL. Compared with ultrasound, dynamic ultrasound has inferior diagnostic value for complete discontinuity of the AITFL.Key points• Ultrasound has a good to excellent diagnostic value for complete discontinuity of the anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament (AITFL). • Ultrasound can be used to screen for injury of the ATFL and AITFL. • Compared with ultrasound, dynamic ultrasound has inferior diagnostic value for complete discontinuity of the AITFL.

Project description:BackgroundDifferences between hospital-presenting sepsis (HPS) and emergency department-presenting sepsis (EDPS) are not well described.ObjectivesWe aimed to (1) quantify the prevalence of HPS versus EDPS cases and outcomes; (2) compare HPS versus EDPS characteristics at presentation; (3) compare HPS versus EDPS in process and patient outcomes; and (4) estimate risk differences in patient outcomes attributable to initial resuscitation disparities.DesignRetrospective consecutive-sample cohort.SettingNine hospitals from October 1, 2014, to March 31, 2016.PatientsAll hospitalized patients with sepsis or septic shock, as defined by simultaneous (1) infection, (2) ?2 Systemic Inflammatory Response Syndrome (SIRS) criteria, and (3) ?1 acute organ dysfunction criterion. EDPS met inclusion criteria while physically in the emergency department (ED). HPS met the criteria after leaving the ED.MeasurementsWe assessed overall HPS versus EDPS contributions to case prevalence and outcomes, and then compared group differences. Process outcomes included 3-hour bundle compliance and discrete bundle elements (eg, time to antibiotics). The primary patient outcome was hospital mortality.ResultsOf 11,182 sepsis hospitalizations, 2,509 (22.4%) were hospital-presenting. HPS contributed 785 (35%) sepsis mortalities. HPS had more frequent heart failure (OR: 1.31, CI: 1.18-1.47), renal failure (OR: 1.62, CI: 1.38-1.91), gastrointestinal source of infection (OR: 1.84, CI: 1.48-2.29), euthermia (OR: 1.45, CI: 1.10-1.92), hypotension (OR: 1.85, CI: 1.65-2.08), or impaired gas exchange (OR: 2.46, CI: 1.43-4.24). HPS were admitted less often from skilled nursing facilities (OR: 0.44, CI: 0.32-0.60), had chronic obstructive pulmonary disease (OR: 0.53, CI: 0.36-0.78), tachypnea (OR: 0.76, CI: 0.58-0.98), or acute kidney injury (OR: 0.82, CI: 0.68-0.97). In a propensity-matched cohort (n = 3,844), HPS patients had less than half the odds of 3-hour bundle compliant care (17.0% vs 30.3%, OR: 0.47, CI: 0.40-0.57) or antibiotics within three hours (66.2% vs 83.8%, OR: 0.38, CI: 0.32-0.44) vs EDPS. HPS was associated with higher mortality (31.2% vs 19.3%, OR: 1.90, CI: 1.64-2.20); 23.3% of this association was attributable to differences in initial resuscitation (resuscitation-adjusted OR: 1.69, CI: 1.43-2.00).ConclusionsHPS differed from EDPS by admission source, comorbidities, and clinical presentation. These patients received markedly less timely initial resuscitation; this disparity explained a moderate proportion of mortality differences.

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Dataset Information

Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices.

Background

Methods

Results

Conclusion

Publications

Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices.

Similar Datasets

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