Comparison of substance-use prevalence among Rhode Island and The Miriam Hospital Emergency Department patients to state and national general population prevalence estimates.
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ABSTRACT:
SUBMITTER: Bernardino VL
PROVIDER: S-EPMC4932856 | biostudies-literature | 2014 Apr
REPOSITORIES: biostudies-literature
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Comparison of substance-use prevalence among Rhode Island and The Miriam Hospital Emergency Department patients to state and national general population prevalence estimates.
Bernardino Vera L VL Baird Janette R JR Liu Tao T Merchant Roland C RC
Rhode Island medical journal (2013) 20140401 4
<h4>Objectives</h4>Compare the prevalence of recent alcohol, tobacco, and drug use among patients from two Rhode Island emergency departments (EDs) to Rhode Island state and United States national general population estimates between 2010 and 2012.<h4>Methods</h4>Secondary analysis of ED patient data and the National Survey of Drug Use and Health.<h4>Results</h4>Alcohol was the most commonly reported substance, and prevalence of its use was higher among ED patients than those in the national, bu ...[more]
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Project description:BackgroundAcute healthcare utilization attributed to alcohol use disorders (AUD) and other substance use disorders (SUD) is rising.ObjectiveTo describe the prevalence and characteristics of emergency department (ED) visits and hospitalizations made by adults with AUD or SUD.Design, setting, and participantsObservational study with retrospective analysis of the National Hospital Ambulatory Medical Care Survey (2014 to 2018), a nationally representative survey of acute care visits with information on the presence of AUD or SUD abstracted from the medical chart.Main measuresOutcome measured as the presence of AUD or SUD.Key resultsFrom 2014 to 2018, the annual average prevalence of AUD or SUD was 9.4% of ED visits (9.3 million visits) and 11.9% hospitalizations (1.4 million hospitalizations). Both estimates increased over time (30% and 57% relative increase for ED visits and hospitalizations, respectively, from 2014 to 2018). ED visits and hospitalizations from individuals with AUD or SUD, compared to individuals with neither AUD nor SUD, had higher percentages of Medicaid insurance (ED visits: AUD: 33.1%, SUD: 35.0%, neither: 24.4%; hospitalizations: AUD: 30.7%, SUD: 36.3%, neither: 14.8%); homelessness (ED visits: AUD: 6.2%, SUD 4.4%, neither 0.4%; hospitalizations: AUD: 5.9%, SUD 7.3%, neither: 0.4%); coexisting depression (ED visits: AUD: 26.3%, SUD 24.7%, neither 10.5%; hospitalizations: AUD: 33.5%, SUD 35.3%, neither: 13.9%); and injury/trauma (ED visits: AUD: 51.3%, SUD 36.3%, neither: 26.4%; hospitalizations: AUD: 31.8%, SUD: 23.8%, neither: 15.0%).ConclusionsIn this nationally representative study, 1 in 11 ED visits and 1 in 9 hospitalizations were made by adults with AUD or SUD, and both increased over time. These estimates are higher or similar than previous national estimates using claims data. This highlights the importance of identifying opportunities to address AUD and SUD in acute care settings in tandem with other medical concerns, particularly among visits presenting with injury, trauma, or coexisting depression.
| S-EPMC8436853 | biostudies-literature
Project description:INTRODUCTION:Hookah (also known as waterpipe) smoking is associated with acute adverse health effects such as vomiting and fainting, symptoms related to carbon monoxide poisoning, and decreased pulmonary function, however, national estimates of hookah-related acute injuries are not currently available in the scientific literature. This study provides national estimates of United States hospital emergency department visits due to hookah-related acute injuries. METHODS:We analyzed 2011-2019 data from the National Electronic Injury Surveillance System to calculate national estimates of emergency department visits due to hookah-related acute injuries. National Electronic Injury Surveillance System data were gathered from approximately 100 United States hospitals selected as a probability sample of approximately 5000 hospitals with emergency departments. Each case contains information abstracted from all emergency department records involving injuries associated with consumer products. All individuals admitted to emergency departments who sustained hookah-related acute injuries were included in the study. RESULTS:During 2011-2019, an estimated 1371 (95% confidence interval: 505-2283) United States hospital emergency department visits were related to hookah-related acute injuries. The most common injuries were sustained from dizziness/light-headedness and syncopal episodes (54.8%), followed by burns (41.5%). Young adults aged 18-24?years accounted for 66.8% of hookah-related acute injuries admitted to United States emergency departments. CONCLUSIONS:This study provides national estimates of hospital emergency department visits due to hookah-related acute injuries. We found that hookah smoking related AIs mostly occurred among young adults. Study findings may inform public health policy and educational intervention efforts to prevent these events and complement other acute injury surveillance systems, such as the National Poison Data System.
| S-EPMC7416403 | biostudies-literature
Project description:The Emergency Department (ED) appears to be an ideal place to conduct hepatitis C virus (HCV) screening. We aimed to estimate the prevalence of prior HCV test positivity among adult (18-64 year-old) patients at The Miriam Hospital and Rhode Island Hospital EDs, as well as the undiagnosed HCV antibody seroprevalence among patients with any self-reported injection or non-injection drug use who agreed to undergo rapid HCV antibody testing. The prevalence of prior HCV test positivity among 8,500 adult ED patients was approximately 4.6%, and the previously undiagnosed HCV antibody seroprevalence among 621 drug-using adult ED patients was 1.6%. Among the ten ED patients with a positive rapid HCV antibody test not previously diagnosed, eight were born after 1965 and six never had injected drugs. If current HCV screening recommendations were followed exclusively in this setting, this practice would have missed half of those with a positive rapid HCV antibody test.
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Project description:The objectives of this study were to estimate the incidence and identify the temporal patterns of visits to Rhode Island emergency departments (EDs) by adults who were sexually assaulted. Visits to all Rhode Island EDs from January 1995-June 2001 by adults who were sexually assaulted were identified using International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9) codes. Medical records of these visits were reviewed. Frequency distributions of the assault characteristics and patient demographics were generated. Incidence rates (IRs) of ED visits after sexual assault were estimated using 2000 US Census data. Analyses of the temporal patterns of the ED visits after sexual assault were conducted. Of the 823 ED visits, 796 (96.7%) were by females and 27 (3.3%) were by males. The median age for females was 25 years (range, 18-96 years) and was 28 years (range, 18-87 years) for males. Among the female patients, 76.6% sustained a vaginal/anal assault. Among the male patients, 59.3% sustained an anal assault. The average annual IR of ED visits after sexual assault was 30.3/100,000/year for females and 1.2/100,000/year for males, which is a 25-fold greater incidence of these visits for females than males. ED visits after adult sexual assault were more frequent during warmer months and around 5 P.M. There was a gradual 43% increase in the IRs of ED visits after sexual assault over the 6.5-year period. These findings should help direct EDs to maximize supportive services when they are needed most often.
| S-EPMC2629515 | biostudies-other
Project description:OBJECTIVES:The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. DESIGN:Analysis of data from the National Hospital Ambulatory Medical Care Survey. SETTING:U.S. emergency department visits, 2009-2011. PATIENTS:Adult (age, ? 18 yr) emergency department sepsis patients. We defined serious infection as an emergency department diagnosis of a serious infection or a triage temperature greater than 38°C or less than 36°C. We defined three emergency department sepsis classifications: 1) original emergency department sepsis-serious infection plus emergency department diagnosis of organ dysfunction, endotracheal intubation, or systolic blood pressure less than or equal to 90?mm Hg or explicit sepsis emergency department diagnoses; 2) quick Sequential Organ Failure Assessment emergency department sepsis-serious infection plus presence of at least two "quick" Sequential Organ Failure Assessment criteria (Glasgow Coma Scale ? 14, respiratory rate ? 22 breaths/min, or systolic blood pressure ? 100?mm Hg); and 3) revised emergency department sepsis-original or quick Sequential Organ Failure Assessment emergency department sepsis. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:We used survey design and weighting variables to produce national estimates of annual adult emergency department visits using updated sepsis classifications. Over 2009-2011, there were 103,257,516 annual adult emergency department visits. The estimated number of emergency department sepsis visits were as follows: 1) original emergency department sepsis 665,319 (0.64%; 95% CI, 0.57-0.73); 2) quick Sequential Organ Failure Assessment emergency department sepsis 318,832 (0.31%; 95% CI, 0.26-0.37); and 3) revised emergency department sepsis 847,868 (0.82%; 95% CI, 0.74-0.91). CONCLUSIONS:Sepsis continues to present a major burden to U.S. emergency departments, affecting up to nearly 850,000 emergency department visits annually. Updated sepsis classifications may impact national estimates of emergency department sepsis epidemiology.
| S-EPMC5609499 | biostudies-literature
Project description:IntroductionAmong adult emergency department (ED) patients, we sought to examine how estimates of substance use prevalence and the need for interventions can differ, based on the type of screening and assessment strategies employed.MethodsWe estimated the prevalence of substance use and the need for interventions using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in a secondary analysis of data from two cross-sectional studies using random samples of English- or Spanish-speaking 18-64-year-old ED patients. In addition, the test performance characteristics of three simplified screening strategies consisting of selected questions from the ASSIST (lifetime use, past three-month use, and past three-month frequency of use) to identify patients in need of a possible intervention were compared against using the full ASSIST.ResultsOf 6,432 adult ED patients, the median age was 37 years-old, 56.6% were female, and 61.6% were white. Estimated substance use prevalence among this population differed by how it was measured (lifetime use, past three-month use, past three-month frequency of use, or need for interventions). As compared to using the full ASSIST, the predictive value and accuracy to identify patients in need of any intervention was best for a simplified strategy asking about past three-month substance use. A strategy asking about daily/near-daily use was better in identifying patients needing intensive interventions. However, some patients needing interventions were missed when using these simplified strategies.ConclusionSubstance use prevalence estimates and identification of ED patients needing interventions differ by screening strategies used. EDs should carefully select strategies to identify patients in need of substance use interventions.
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Project description:Objective. We sought to determine the characteristics of children presenting to United States (US) Emergency Departments (ED) with severe sepsis. Study design. Cross-sectional analysis using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Using triage vital signs and ED diagnoses (defined by the International Classification of Diseases, Ninth Revision codes), we identified children <18 years old presenting with both infection (triage fever or ICD-9 infection) and organ dysfunction (triage hypotension or ICD-9 organ dysfunction). Results. Of 28.2 million pediatric patients presenting to US EDs each year, severe sepsis was present in 95,055 (0.34%; 95% CI: 0.29-0.39%). Fever and respiratory infection were the most common indicators of an infection. Hypotension and respiratory failure were the most common indicators of organ dysfunction. Most severe sepsis occurred in children ages 31 days-1 year old (32.1%). Most visits for pediatric severe sepsis occurred during winter months (37.4%), and only 11.1% of patients arrived at the ED by ambulance. Over half of severe sepsis cases were self-pay or insured by Medicaid. A large portion (44.1%) of pediatric severe sepsis ED visits occurred in the South census region. ED length of stay was over 3 h, and 16.5% were admitted to the hospital. Conclusion. Nearly 100,000 children annually present to US EDs with severe sepsis. The findings of this study highlight the unique characteristics of children treated in the ED for severe sepsis.
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Project description:ImportanceDetailed, nationally representative data describing high-risk populations and circumstances involved in insulin-related hypoglycemia and errors (IHEs) can inform approaches to individualizing glycemic targets.ObjectiveTo describe the US burden, rates, and characteristics of emergency department (ED) visits and emergency hospitalizations for IHEs.Design, setting, and participantsNationally representative public health surveillance of adverse drug events among insulin-treated patients seeking ED care (National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project) and a national household survey of insulin use (the National Health Interview Survey) were used to obtain data from January 1, 2007, through December 31, 2011.Main outcomes and measuresEstimated annual numbers and estimated annual rates of ED visits and hospitalizations for IHEs among insulin-treated patients with diabetes mellitus.ResultsBased on 8100 National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance cases, an estimated 97,648 (95% CI, 64,410-130,887) ED visits for IHEs occurred annually; almost one-third (29.3%; 95% CI, 21.8%-36.8%) resulted in hospitalization. Severe neurologic sequelae were documented in an estimated 60.6% (95% CI, 51.3%-69.9%) of ED visits for IHEs, and blood glucose levels of 50 mg/dL (to convert to millimoles per liter, multiply by 0.0555) or less were recorded in more than half of cases (53.4%). Insulin-treated patients 80 years or older were more than twice as likely to visit the ED (rate ratio, 2.5; 95% CI, 1.5-4.3) and nearly 5 times as likely to be subsequently hospitalized (rate ratio, 4.9; 95% CI, 2.6-9.1) for IHEs than those 45 to 64 years. The most commonly identified IHE precipitants were reduced food intake and administration of the wrong insulin product.Conclusions and relevanceRates of ED visits and subsequent hospitalizations for IHEs were highest in patients 80 years or older; the risks of hypoglycemic sequelae in this age group should be considered in decisions to prescribe and intensify insulin. Meal-planning misadventures and insulin product mix-ups are important targets for hypoglycemia prevention efforts.
| S-EPMC4631022 | biostudies-literature
Project description:BackgroundBlunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department.MethodsChildren presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts.ResultsThe preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation.ConclusionThe series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.
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Project description:In hospital settings, depression is an underdetected, undertreated, but prevalent and interfering illness that is associated with significant disability, morbidity, and mortality. A general hospital emergency department (ED) setting may be well suited to identify individuals with clinically significant depressive symptoms, facilitating their referral and treatment.Cross-sectional data of adult ED patients in a general hospital enrolling in a human immunodeficiency virus (HIV) screening study between February 2007 and March 2008 were analyzed. Data included demographic factors, the Center for Epidemiologic Studies Depression Scale (CES-D), alcohol and substance use history, sexual risk taking, and brief medical history. The primary outcome was a dichotomous measure of self-reported clinically significant depressive symptoms. Patients who scored >/= 16 on the CES-D were considered to screen positive for depressive symptoms.Of the 3,262 patients enrolled in the screening trial, 2,588 (79%) completed the survey between February 2007 and March 2008. Among these, 1,945 (75%) completed the psychosocial assessment battery; 596 (31%) survey completers screened positive for clinically significant depressive symptoms. In a multivariable model, female sex (RR = 1.36; 95% CI, 1.16-1.57), being unemployed (RR = 1.61; 95% CI, 1.32-1.93), and lower annual income (RR from 1.73 to 2.24) were associated with increased rates of clinically significant depressive symptoms (CES-D score >/= 16). Clinically significant depressive symptoms were more often present in patients who screened positive for alcohol dependence (RR = 1.48; 95% CI, 1.19-1.78), individuals reporting current smoking (RR = 1.39; 95% CI, 1.17-1.62), those with a prior psychiatric disorder diagnosis (RR = 2.20; 95% CI, 1.80-2.57) or history of hypertension (RR = 1.47; 95% CI, 1.18-1.79), and those who reported ever having sex with an HIV-infected partner (RR = 1.58; 95% CI, 1.08-2.09).This study identified a high frequency of undiagnosed clinically significant depressive symptoms among ED patients and highlights several new demographic and clinical correlates of such symptoms. Screening for and diagnosis of clinical depression in the ED setting introduces important opportunities for acute care providers and for the health care system as a whole.
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