Opioid Abuse And Poisoning: Trends In Inpatient And Emergency Department Discharges.
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ABSTRACT:
SUBMITTER: Tedesco D
PROVIDER: S-EPMC6679922 | biostudies-literature | 2017 Oct
REPOSITORIES: biostudies-literature
Publications
Opioid Abuse And Poisoning: Trends In Inpatient And Emergency Department Discharges.
Tedesco Dario D Asch Steven M SM Curtin Catherine C Hah Jennifer J McDonald Kathryn M KM Fantini Maria P MP Hernandez-Boussard Tina T
Health affairs (Project Hope) 20171001 10
Addressing the opioid epidemic is a national priority. We analyzed national trends in inpatient and emergency department (ED) discharges for opioid abuse, dependence, and poisoning using Healthcare Cost and Utilization Project data. Inpatient and ED discharge rates increased overall across the study period, but a decline was observed for prescription opioid-related discharges beginning in 2010, while a sharp increase in heroin-related discharges began in 2008. ...[more]
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Project description:ObjectiveTo report U.S. national population-based rates and trends in diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) among adults, in both the emergency department (ED) and inpatient settings.Research design and methodsWe analyzed data from 1 January 2006 through 30 September 2015 from the Nationwide Emergency Department Sample and National Inpatient Sample to characterize ED visits and inpatient admissions with DKA and HHS. We used corresponding year cross-sectional survey data from the National Health Interview Survey to estimate the number of adults ≥18 years with diagnosed diabetes to calculate population-based rates for DKA and HHS in both ED and inpatient settings. Linear trends from 2009 to 2015 were assessed using Joinpoint software.ResultsIn 2014, there were a total of 184,255 and 27,532 events for DKA and HHS, respectively. The majority of DKA events occurred in young adults aged 18-44 years (61.7%) and in adults with type 1 diabetes (70.6%), while HHS events were more prominent in middle-aged adults 45-64 years (47.5%) and in adults with type 2 diabetes (88.1%). Approximately 40% of the hyperglycemic events were in lower-income populations. Overall, event rates for DKA significantly increased from 2009 to 2015 in both ED (annual percentage change [APC] 13.5%) and inpatient settings (APC 8.3%). A similar trend was seen for HHS (APC 16.5% in ED and 6.3% in inpatient). The increase was in all age-groups and in both men and women.ConclusionsCauses of increased rates of hyperglycemic events are unknown. More detailed data are needed to investigate the etiology and determine prevention strategies.
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| S-EPMC6732253 | biostudies-literature
Project description:ObjectivesSubstance and opioid misuse are growing public health concerns. This study's objectives were to evaluate trends in substance and opioid misuse-related emergency department (ED) visits in Alberta, Canada.MethodsThis is a cross-sectional time-series analysis utilizing National Ambulatory Care Reporting System ED data from Alberta, Canada. All substance and opioid misuse-related visits made by adults (??18 years) from 2010/11 to 2014/15 were analyzed. Acuity was measured by the Canadian Triage and Acuity Scale (CTAS). Relevant visits were identified by ICD-10 diagnostic coding. Substance and opioid visits over 60 months were compared to all ED visits per 100,000 adult population using regression analysis, while controlling for temporal and seasonal variation. Trends among age and sex subgroups were also evaluated.ResultsFrom 2010/11 to 2014/15, substance and opioid misuse-related visits increased by 38.0% and 57.3% to 1119 and 118 visits per 100,000 population, respectively. Annual growth rates for substance and opioid visits were 4.4% higher (95% CI: 2.2, 6.7) and 10.6% higher (95% CI: 6.8, 14.6) than all ED visits. The 18-29 year-old category experienced the highest annual growth rate of all age groups, and the annual opioid visit growth rate was 5.6% higher among males than females. Compared to all visits, substance misuse-related visits arrived more frequently by ambulance, were higher acuity, and were hospitalized more often.ConclusionSubstance and opioid misuse-related ED visits increased significantly from 2010 to 2015, especially among younger patients. Future research should elaborate causes and evaluate interventions to curb the growth of this issue.
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Project description:The objective was to determine whether an educational intervention for health care providers would result in improved documentation of cases of possible physical child abuse in children <36 months old treated in the emergency department (ED) setting.This study had a statewide group-randomized prospective trial design. Participating EDs were randomized to one of three intervention groups: no intervention, partial intervention, or full intervention. Medical records for children <36 months of age were abstracted before, during, and after the intervention periods for specific documentation elements. The main outcome measure was the change in documentation from baseline. Generalized estimating equations (GEEs) were used to test for intervention effect.A total of 1,575 charts from 14 hospitals EDs were abstracted. Hospital and demographic characteristics were similar across intervention groups. There were 922 (59%) injury visits and 653 (41%) noninjury visits. For each specific documentation element, a GEE model gave p-values of >0.2 in independent tests, indicating no evidence of significant change in documentation after the intervention. Even among the 26 charts in which the possibility of physical abuse was noted, documentation remained variable.The educational interventions studied did not improve ED documentation of cases of possible physical child abuse. The need for improved health care provider education in child abuse identification and documentation remains. Future innovative educational studies to improve recognition of abuse are warranted.
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