Annals Update 2/4/2013

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PubMed Results

Items 1 – 30 of 30

1. Ann Emerg Med. 2013 Jan 23. pii: S0196-0644(12)01533-8. doi: 10.1016/j.annemergmed.2012.09.009. [Epub ahead of print]
The Effect of an Ambulance Diversion Ban on Emergency Department Length of Stay and Ambulance Turnaround Time.
Burke LG, Joyce N, Baker WE, Biddinger PD, Dyer KS, Friedman FD, Imperato J, King A, Maciejko TM, Pearlmutter MD, Sayah A, Zane RD, Epstein SK.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23352752 [PubMed – as supplied by publisher]
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2. Ann Emerg Med. 2013 Jan 17. pii: S0196-0644(12)01750-7. doi: 10.1016/j.annemergmed.2012.11.015. [Epub ahead of print]
Call for a Rational Approach for Testing for Urinary Tract Infection as a Source of Fever in Infants.
Shaw KN.

Department of Pediatrics, Division of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, and the Children’s Hospital of Philadelphia, Philadelphia, PA. Electronic address: [email protected].

PMID: 23332612 [PubMed – as supplied by publisher]
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3. Ann Emerg Med. 2013 Jan 17. pii: S0196-0644(12)01812-4. doi: 10.1016/j.annemergmed.2012.12.001. [Epub ahead of print]
Can the San Francisco Syncope Rule Predict Short-Term Serious Outcomes in Patients Presenting With Syncope?
Snead GR, Wilbur LG.

Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.

PMID: 23332611 [PubMed – as supplied by publisher]
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4. Ann Emerg Med. 2013 Feb;61(2):261. doi: 10.1016/j.annemergmed.2012.11.013.
Tactical emergency medicine support.
[No authors listed]
PMID: 23331660 [PubMed – in process]
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5. Ann Emerg Med. 2013 Feb;61(2):260. doi: 10.1016/j.annemergmed.2012.11.011.
Financing of graduate medical education in emergency medicine.
[No authors listed]
PMID: 23331659 [PubMed – in process]
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6. Ann Emerg Med. 2013 Feb;61(2):260-1. doi: 10.1016/j.annemergmed.2012.11.012.
Standards for measuring and reporting emergency department wait times.
[No authors listed]
PMID: 23331658 [PubMed – in process]
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7. Ann Emerg Med. 2013 Feb;61(2):257. doi: 10.1016/j.annemergmed.2012.07.130.
Independent dosing of propofol and ketamine may improve procedural sedation compared with the combination “ketofol”.
Shy BD, Strayer RJ, Howland MA.

Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY.

PMID: 23331657 [PubMed – in process]
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8. Ann Emerg Med. 2013 Feb;61(2):257-8. doi: 10.1016/j.annemergmed.2012.07.131.
In reply.
Andolfatto G.

Department of Emergency Medicine, University of British Columbia, Lions Gate Hospital, North Vancouver, British Columbia, Canada.

PMID: 23331656 [PubMed – in process]
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9. Ann Emerg Med. 2013 Feb;61(2):256-7. doi: 10.1016/j.annemergmed.2012.08.019.
In reply.
Michael GE, Jesus JE.

Department of Emergency Medicine, University of Virginia, Charlottesville, VA.

PMID: 23331655 [PubMed – in process]
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10. Ann Emerg Med. 2013 Feb;61(2):255-6. doi: 10.1016/j.annemergmed.2012.07.129.
Uncontrolled donation after circulatory determination of death protocols: ethical challenges and suggestions for improvement.
Ortega-Deballon I, Vailhen DR, Smith MJ.

Helicopter Emergency Medical Service, Madrid, Spain; Nursing School, University of Alcalá de Henares, Madrid, Spain.

PMID: 23331654 [PubMed – in process]
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11. Ann Emerg Med. 2013 Feb;61(2):254-5. doi: 10.1016/j.annemergmed.2012.08.017.
In reply.
Darracq MA, Ward NT, Tomaszewski C, Clark RF.

University of California, San Diego; Department of Emergency Medicine, Division of Medical Toxicology, UCSD Medical Center, San Diego, CA.

PMID: 23331653 [PubMed – in process]
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12. Ann Emerg Med. 2013 Feb;61(2):253-4. doi: 10.1016/j.annemergmed.2012.07.128.
In reply to evidence-based treatment of jellyfish stings in north america and hawaii.
Auerbach PS.

Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA.

PMID: 23331652 [PubMed – in process]
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13. Ann Emerg Med. 2013 Feb;61(2):253. doi: 10.1016/j.annemergmed.2012.08.016.
In reply.
Sakles JC.

Department of Emergency Medicine, University of Arizona, Tucson, AZ.

PMID: 23331651 [PubMed – in process]
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14. Ann Emerg Med. 2013 Feb;61(2):252-3. doi: 10.1016/j.annemergmed.2012.07.127.
Video laryngoscopy is a valuable adjunct in emergency airway management but is not sufficient as an exclusive method of training residents.
Wilcox SR, Brown DF, Elmer J.

Harvard Medical School, Department of Emergency Medicine, Boston, MA; Harvard Medical School, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.

PMID: 23331650 [PubMed – in process]
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15. Ann Emerg Med. 2013 Feb;61(2):251-8. doi: 10.1016/j.annemergmed.2012.06.007.
A woman with right lower quadrant pain.
Park JB, Choi HJ.

Department of Emergency Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea.

PMID: 23331649 [PubMed – in process]
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16. Ann Emerg Med. 2013 Feb;61(2):244-50. doi: 10.1016/j.annemergmed.2012.10.039.
Point-of-Care Ultrasonography in Assessing Fluid Responsiveness in Sepsis Patients: Sonographer Characteristics, Noninferential Statistics, and Study Design: Answers to the September 2012 Journal Club Questions.
Chiem A.

Olive View-University of California, Los Angeles Medical Center, Sylmar, CA.

PMID: 23331648 [PubMed – in process]
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17. Ann Emerg Med. 2013 Feb;61(2):225-43. doi: 10.1016/j.annemergmed.2012.11.005.
Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department.
This clinical policy is the result of a collaborative project of the American College of Emergency Physicians and the American Academy of Neurology.
PMID: 23331647 [PubMed – in process]
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18. Ann Emerg Med. 2013 Feb;61(2):223-4. doi: 10.1016/j.annemergmed.2012.12.010.
Commentary: what a difference a decade makes.
Al-Marshad A, Demers G, Kahn C.

Department of Emergency Medicine, University of California, San Diego, CA.

PMID: 23331646 [PubMed – in process]
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19. Ann Emerg Med. 2013 Feb;61(2):196-7. doi: 10.1016/j.annemergmed.2012.11.019.
Research or mom: listen to your mother.
Hollander JE.

Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: [email protected].

PMID: 23331645 [PubMed – in process]
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20. Ann Emerg Med. 2013 Feb;61(2):152-4. doi: 10.1016/j.annemergmed.2012.07.011.
Young man with scratches on his back.
Chen YG, Huang CF, Dai MS.

Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.

PMID: 23331644 [PubMed – in process]
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21. Ann Emerg Med. 2012 Dec;60(6):799-800.
EMS system performance-based funding and reimbursement model.
Kahn C.

Department of Emergency Medicine, University of California, San Diego, San Diego, CA, USA.

PMID: 23320268 [PubMed – in process]
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22. Ann Emerg Med. 2012 Dec;60(6):15A-17A.
Automated external defibrillator regulations threaten wider use: states grapple with disparate regulatory approaches.
Greene J.
PMID: 23320267 [PubMed – in process]
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23. Ann Emerg Med. 2012 Dec;60(6):13A-15A.
Innovations from a decade of war: soldiers’ final sacrifice has improved emergency care.
Berger E.
PMID: 23320266 [PubMed – in process]
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24. Ann Emerg Med. 2013 Jan 11. pii: S0196-0644(12)01811-2. doi: 10.1016/j.annemergmed.2012.11.021. [Epub ahead of print]
Compartment Syndrome After “Bath Salts” Use: A Case Series.
Levine M, Levitan R, Skolnik A.

Department of Emergency Medicine, University of Southern California, Los Angeles, CA; Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ. Electronic address: [email protected].

Abstract

In recent years, synthetic cathinones, often labeled as “bath salts” in an attempt to evade drug laws, have emerged as substances of abuse. Sympathomimetic drugs are well known to cause rhabdomyolysis but are rarely associated with acute compartment syndrome. In this case series, we describe 3 patients who presented with sympathomimetic signs or symptoms including hyperthermia and agitation and had confirmed synthetic cathinone use. All 3 patients had severe rhabdomyolysis with delayed development of an acute compartment syndrome. Two patients developed paraspinal compartment syndromes, whereas 1 developed bilateral forearm compartment syndromes. Management included fasciotomy in 2 patients and medical management in the third. Two of the 3 patients made a complete recovery before hospital discharge; the third patient was hemodialysis dependent at 5-month follow-up.

Copyright © 2013. Published by Mosby, Inc.

PMID: 23318022 [PubMed – as supplied by publisher]
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25. Ann Emerg Med. 2013 Jan 3. pii: S0196-0644(12)01703-9. doi: 10.1016/j.annemergmed.2012.10.030. [Epub ahead of print]
“Patients Who Can’t Get an Appointment Go to the ER”: Access to Specialty Care for Publicly Insured Children.
Rhodes KV, Bisgaier J, Lawson CC, Soglin D, Krug S, Van Haitsma M.

Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA. Electronic address: [email protected].

Abstract
STUDY OBJECTIVE:

Emergency departments (EDs) frequently refer patients for needed outpatient specialty care, but little is known about the dynamics of these referrals when patients are publicly insured. Hence, we explored factors, including the role of ED referrals, associated with specialists’ willingness to accept patients covered by Medicaid and the Children’s Health Insurance Program (CHIP).

METHODS:

We conducted semistructured qualitative interviews with a purposive sample of 26 specialists and 14 primary care physicians in Cook County, Illinois, from April to September 2009, until theme saturation was reached. Transcripts and notes were entered into ATLAS.ti and analyzed using an iterative coding process to identify patterns of responses, ensure reliability, examine discrepancies, and achieve consensus through content analysis.

RESULTS:

Themes that emerged indicate that primary care physicians face considerable barriers getting publicly insured patients into outpatient specialty care and use the ED to facilitate this process. Specialty physicians reported that decisions to refuse or limit the number of patients with Medicaid/CHIP are due to economic strain or direct pressure from their institutions. Factors associated with specialist acceptance of patients with Medicaid/CHIP included high acuity or complexity, personal request from or an informal economic relationship with the primary care physician, geography, and patient hardship. Referral through the ED was a common and expected mechanism for publicly insured patients to access specialty care.

CONCLUSION:

These exploratory findings suggest that specialists are willing to see children with Medicaid/CHIP if they are referred from an ED. As health systems restructure, EDs have the potential to play a role in improving care coordination and access to outpatient specialty care.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23312670 [PubMed – as supplied by publisher]
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26. Ann Emerg Med. 2013 Jan 3. pii: S0196-0644(12)01707-6. doi: 10.1016/j.annemergmed.2012.10.034. [Epub ahead of print]
Pediatric Urinary Tract Infection: Does the Evidence Support Aggressively Pursuing the Diagnosis?
Newman DH, Shreves AE, Runde DP.

Mount Sinai School of Medicine, New York, NY. Electronic address: [email protected].

Abstract

The epidemiology of pediatric fever has changed considerably during the past 2 decades with the development of vaccines against the most common bacterial pathogens causing bacteremia and meningitis. The decreasing incidence of these 2 conditions among vaccinated children has led to an emphasis on urinary tract infection as a remaining source of potentially hidden infections in febrile children. Emerging literature, however, has led to questions about both the degree and nature of the danger posed by urinary tract infection in nonverbal children, whereas the aggressive pursuit of the diagnosis consumes resources and leads to patient discomfort, medical risks, and potential overdiagnosis. We review both early and emerging literature to examine the utility and efficacy of early identification and treatment of urinary tract infection in children younger than 24 months. We conclude that in well children of this age, it may be reasonable to withhold or delay testing for urinary tract infection if signs of other sources are apparent or if the fever has been present for fewer than 4 to 5 days.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23312370 [PubMed – as supplied by publisher]
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27. Ann Emerg Med. 2013 Jan 7. pii: S0196-0644(12)01712-X. doi: 10.1016/j.annemergmed.2012.10.038. [Epub ahead of print]
Videographic Analysis of Glottic View With Increasing Cricoid Pressure Force.
Oh J, Lim T, Chee Y, Kang H, Cho Y, Lee J, Kim D, Jeong M.

Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea.

Abstract
STUDY OBJECTIVE:

Cricoid pressure may negatively affect laryngeal view and compromise airway patency, according to previous studies of direct laryngoscopy, endoscopy, and radiologic imaging. In this study, we assess the effect of cricoid pressure on laryngeal view with a video laryngoscope, the Pentax-AWS.

METHODS:

This cross-sectional survey involved 50 American Society of Anesthesiologists status I and II patients who were scheduled to undergo elective surgery. The force measurement sensor for cricoid pressure and the video recording system using a Pentax-AWS video laryngoscope were newly developed by the authors. After force and video were recorded simultaneously, 11 still images were selected per 5-N (Newton; 1 N = 1 kg·m·s(-2)) increments, from 0 N to 50 N for each patient. The effect of cricoid pressure was assessed by relative percentage compared with the number of pixels on an image at 0 N.

RESULTS:

Compared with zero cricoid pressure, the median percentage of glottic view visible was 89.5% (interquartile range [IQR] 64.2% to 117.1%) at 10 N, 83.2% (IQR 44.2% to 113.7%) at 20 N, 76.4% (IQR 34.1% to 109.1%) at 30 N, 51.0% (IQR 21.8% to 104.2%) at 40 N, and 47.6% (IQR 15.2% to 107.4%) at 50 N. The number of subjects who showed unworsened views was 20 (40%) at 10 N, 17 (34%) at 20 and 30 N, and 13 (26%) at 40 and 50 N.

CONCLUSION:

Cricoid pressure application with increasing force resulted in a worse glottic view, as examined with the Pentax-AWS Video laryngoscope. There is much individual difference in the degree of change, even with the same force. Clinicians should be aware that cricoid pressure affects laryngeal view with the Pentax-AWS and likely other video laryngoscopes.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23306455 [PubMed – as supplied by publisher]
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28. Ann Emerg Med. 2013 Jan 3. pii: S0196-0644(12)01645-9. doi: 10.1016/j.annemergmed.2012.10.022. [Epub ahead of print]
Prognostic Value of Plasma Lactate Levels Among Patients With Acute Pulmonary Embolism: The Thrombo-Embolism Lactate Outcome Study.
Vanni S, Viviani G, Baioni M, Pepe G, Nazerian P, Socci F, Bartolucci M, Bartolini M, Grifoni S.

Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: [email protected].

Abstract
STUDY OBJECTIVE:

We investigate the prognostic value of plasma lactate levels in patients with acute pulmonary embolism.

METHODS:

We studied adult patients with symptomatic, objectively confirmed pulmonary embolism presenting to a single emergency department. Plasma lactate and troponin I levels were tested at presentation. We considered lactate values greater than or equal to 2 mmol/L and troponin I values greater than or equal to 0.10 ng/mL to be abnormal. Right-sided ventricular dysfunction was assessed by echocardiography. Primary endpoint was all-cause death occurring on or before 30 days after presentation. Secondary endpoints were the composite of all-cause death and clinical deterioration (defined as progression to shock, mechanical ventilation, or cardiopulmonary resuscitation) and death caused by pulmonary embolism. We tested the association between lactate level greater than or equal to 2 mmol/L and the endpoints using Cox proportional hazards regression analysis.

RESULTS:

Of the 270 patients included in the study, the mean age was 73 years (SD 12.7 years) and 151 (55.9%) were women. Twelve patients (4.4%) showed shock or hypotension (shock or systolic arterial pressure <100 mm Hg) at presentation, 109 (40.4%) had right-sided ventricular dysfunction, 93 (34.4%) showed troponin I level greater than or equal to 0.10 ng/mL, and 81 (30%) showed lactate level greater than or equal to 2 mmol/L. Seventeen patients (6.3%) died, 12 (4.4%) because of pulmonary embolism, and 37 (13.7%) reached the composite endpoint. Patients with lactate level greater than or equal to 2 mmol/L showed higher mortality (17.3%; 95% confidence interval [CI] 11.9% to 20%) than patients with a lower level (1.6%; 95% CI 0.8% to 1.9%). Plasma lactate level was associated with all-cause death (hazard ratio 11.67; 95% CI 3.32 to 41.03) and the composite endpoint (hazard ratio 8.14; 95% CI 3.83 to 17.34) independent of shock or hypotension, right-sided ventricular dysfunction, or elevation of troponin I values.

CONCLUSION:

Patients with pulmonary embolism and elevated plasma lactate level are at high risk of death and adverse outcome, independent of shock or hypotension, or right-sided ventricular dysfunction or injury markers.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23306454 [PubMed – as supplied by publisher]
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29. Ann Emerg Med. 2013 Jan 3. pii: S0196-0644(12)01704-0. doi: 10.1016/j.annemergmed.2012.10.031. [Epub ahead of print]
Comparison of Enhanced Targeted Rapid HIV Screening Using the Denver HIV Risk Score to Nontargeted Rapid HIV Screening in the Emergency Department.
Haukoos JS, Hopkins E, Bender B, Sasson C, Al-Tayyib AA, Thrun MW; Denver Emergency Department HIV Testing Research Consortium.

Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, Aurora, CO. Electronic address: [email protected].

Abstract
STUDY OBJECTIVE:

A clinical prediction tool, the Denver HIV Risk Score, was recently developed to help identify patients with increased probability of undiagnosed HIV infection. Our goal was to compare targeted rapid HIV screening using the Denver HIV Risk Score to nontargeted rapid HIV screening in an urban emergency department (ED) and urgent care.

METHODS:

We used a prospective, before-after design at an urban medical center with an approximate annual census of 110,000 visits. Patients aged 13 years or older were eligible for screening. Targeted HIV screening of patients identified as high-risk by nurses using the Denver HIV Risk Score during medical screening was compared to nontargeted HIV screening offered by medical screening nurses during 2 separate 4-month time periods. The primary outcome was newly diagnosed HIV-infected patients.

RESULTS:

28,506 patients presented during the targeted phase, 1,718 were identified as high-risk, and 551 completed HIV testing. Of these, 7 (1.3%, 95% confidence interval [CI] 0.5% to 2.6%) were newly diagnosed with HIV infection. 29,510 patients presented during the nontargeted phase and 3,591 completed HIV testing. Of these, 7 (0.2%, 95% CI 0.1% to 0.4%) were newly diagnosed with HIV infection. Targeted HIV screening was significantly associated with identification of newly diagnosed HIV infection when compared to nontargeted screening, adjusting for patient demographics and payer status (relative risk [RR] 10.4, 95% CI 3.4 to 32.0).

CONCLUSION:

Targeted HIV screening using the Denver HIV Risk Score was strongly associated with new HIV diagnoses when compared to nontargeted screening. Although both HIV screening methods identified the same absolute number of newly diagnosed patients, significantly fewer tests were required during the targeted phase to achieve the same effect.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23290527 [PubMed – as supplied by publisher]
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30. Ann Emerg Med. 2013 Jan 3. pii: S0196-0644(12)01617-4. doi: 10.1016/j.annemergmed.2012.10.010. [Epub ahead of print]
Do Patient-Reported Symptoms Predict Emergency Department Visits in Cancer Patients? A Population-Based Analysis.
Barbera L, Atzema C, Sutradhar R, Seow H, Howell D, Husain A, Sussman J, Earle C, Liu Y, Dudgeon D.

Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: [email protected].

Abstract
STUDY OBJECTIVE:

Since 2007 in Ontario, Canada, the Edmonton Symptom Assessment System has been routinely used for cancer outpatients. The purpose of this study is to determine the relationship between individual patient symptoms and symptom severity, with the likelihood of an emergency department (ED) visit.

METHODS:

The cohort included all cancer patients in Ontario who completed an Edmonton Symptom Assessment System between January 2007 and March 2009. Using multiple linked provincial health databases, we examined the adjusted association between symptom scores and the likelihood of an ED visit within 7 days of assessment.

RESULTS:

The cohort included 45,118 patients whose first assessment contributed to the study, of whom 3.8% made a subsequent ED visit. A severe well-being score was associated with the highest odds of a subsequent ED visit (adjusted odds ratio [OR] 1.9; 95% confidence interval 1.5 to 2.4). Nausea, drowsiness, and shortness of breath with moderate or severe scores were associated with ED visits (adjusted OR 1.2 to 1.5), whereas pain, tiredness, poor appetite, and well-being had a significant association for mild scores (adjusted OR 1.2, 1.3, 1.2, and 1.3, respectively), moderate scores (adjusted OR 1.3, 1.5, 1.5, and 1.7, respectively), and severe scores (adjusted OR 1.4, 1.7, 1.7, and 1.9, respectively). Anxiety and depression were not associated with ED visits.

CONCLUSION:

Worsening symptoms contribute to emergency visits in cancer patients. Specific symptoms such as pain are obvious management targets, but constitutional symptoms were associated with even higher odds of ED usage and therefore warrant detailed assessment to optimize both patient outcomes and resource use.

Copyright © 2012. Published by Mosby, Inc.

PMID: 23290526 [PubMed – as supplied by publisher]
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