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1.
Ashley S. Mogul David M. Cline Jennifer Gabbard Casey Bryant 《The Journal of emergency medicine》2019,56(2):145-152
Background
Early integration of palliative care from the emergency department (ED) is an underutilized care modality with potential benefits, but few studies have identified who is appropriate for such care.Objective
Our hypothesis is that patients aged 65 years or older who present to the ED as level I Emergency Severity Index from a long-term care (LTC) facility have high resource utilization and mortality and may benefit from early palliative care involvement.Methods
We performed a retrospective chart review of patients aged 65 years or older who arrived in the ED of an academic suburban southeastern level I trauma center from an LTC facility and triaged as level I priority. The ED course, hospital course, and final outcomes were analyzed.Results
Of the 198 patients studied, 54% were deceased 30 days after discharge, with only 29.8% alive at 12 months. Admitted patients had a median hospital length of stay of 5 days and 73% required intensive care. Formal palliative care intervention was provided in 40.4%, occuring a median of 4 days into hospitalization and leading to 85% downgrading their advanced directive wishes, and discharge occuring a median of 1 day later. Few formal palliative care interventions occurred in the ED (9.1%).Conclusions
Elderly patients from LTC facilities presenting with severe acute illness have high mortality and seldom receive early palliative care. Introduction of palliative care has the ability to change the course of treatment in this vulnerable population and should be considered early in the hospitalization and, where available, be initiated in the ED. 相似文献2.
Vincent Gourhant Olivier Vuillot Pierre-Géraud Claret Sophie Lefebvre Roxane Schaub Alexandre Flacher Richard Dumont Mustapha Sebbane 《The American journal of emergency medicine》2019,37(1):67-72
Introduction
Obese patients with acute dyspnea may be prone to misorientation from the emergency department (ED), due to impaired gas exchange evaluation and altered basal respiratory profiles. This study aims to evaluate the prognostic value of arterial blood pH in obese ED patients with acute dyspnea in comparison to non-obese counterparts.Methods
Single-center observational study of a cohort of 400 consecutive ED patients with acute dyspnea. The primary endpoint was a composite of Intensive Care Unit admission (with critical care needs) or in ED mortality. Predictors of the primary endpoint were assessed using multivariable logistic regression and ROC curve analysis, in obese (BMI?≥?30?kg·m?2) and non-obese patients.Results
252 patients who had arterial blood gas testing were analyzed including 76 (30%) obese comparable to non-obese in terms of clinical history. 51 patients were admitted to ICU and 2 deceased before admission (20 obese (26%) vs 33 non-obese (19%); p?=?0.17). Factors associated with ICU admission were arterial blood pH (pH?<?7.36 vs pH?≥?7.36) and gender. In multivariate models adjusted for risk factors, pH remained the sole independent predictor in obese patients, with no predictive value in non-obese patients (ROC AUC: 0.74, 95% CI [0.60; 0.87], optimal threshold for pH: 7.36, odds ratio: 10.5 [95% CI 3.18; 34.68]).Conclusion
Arterial blood pH may selectively predict critical care needs in ED obese patients with acute dyspnea, in comparison to non-obese. A falsely reassuring pH?<?7.36 should be regarded as a marker of severity when assessing acute dyspnea in obese ED patients. 相似文献3.
Namkyung Jeong Kyung Su Kim Yoon Sun Jung Taegyun Kim So Mi Shin 《The American journal of emergency medicine》2019,37(2):277-280
Objectives
To determine the association between delayed (>24?h) endoscopy and hospital mortality in patients with upper gastrointestinal hemorrhage (UGIH).Methods
We retrospectively analyzed all adult patients with UGIH who underwent endoscopy in a single emergency room for 2?years. The primary exposure was defined as >24?h from the ED visit to the first endoscopy. The primary outcome was defined as all cause hospital mortality. Secondary outcomes were intensive care unit admission rate, ED length of stay, and hospital length of stay.Results
Among 1101 patients enrolled, 898 received endoscopy within 24?h (early group) and 203 received endoscopy after 24?h (delayed group). The hospital mortality of early and delayed group was 2.8% and 6.4%, respectively (unadjusted relative risk [RR] 2.30: 95% CI, 1.20–4.42, p?=?0.012). This was significant after adjusting covariates including AIMS65 and Glasgow-Blatchford score (adjusted RR 2.23: 95% CI, 1.18–4.20, p?=?0.013). Intensive care unit admission rate was not different between two groups. ED and hospital length of stay were significantly longer in delayed group.Conclusions
Endoscopy performed after 24?h was associated with increased hospital mortality in UGIH. Patients in the delayed group stayed longer in the ED and in the hospital. 相似文献4.
5.
Ingrid Llovera Kirsten Loscalzo Jia Gao Timmy Li Martina Brave Lance Becker Isabel Barata 《The American journal of emergency medicine》2019,37(3):486-488
Objective
We studied the impact four new urgent care centers (UCCs) had on a hospital emergency department (ED) in terms of overall census and proportion of low acuity diagnoses from 2009 to 2016. We hypothesized that low acuity medical problems frequently seen in UCCs would decrease in the ED population. Since Medicaid was not accepted at these UCCs, we also studied the Medicaid vs non-Medicaid discharged populations to see if there were some differences related to access to urgent care.Methods
We conducted a retrospective review of computerized billing data. We included all patients from 2009 to 2016 who were seen in the ED. We used the Cochran-Armitage Trend Test to examine trends over time.Results
As hypothesized, the proportion of ED patients with a diagnosis of pharyngitis decreased significantly over this time period from 1% to 0.6% (p?<?0.0001). The rate of bronchitis in the total ED population also decreased significantly (0.5% to 0.13%, p?<?0.0001).When we looked at the discharged patients with and without Medicaid, we found that significantly more Medicaid than non-Medicaid patients presented with pharyngitis to the ED with an increasing trend from 2009 to 2016: OR?=?2.33, p?<?0.0001. The overall census of the ED rose over the period 2009 to 2016 (80,478 to 85,278/year). Overall admission rates decreased significantly: 36.9% to 34.5% (p?<?0.0001).Conclusion
With the introduction of four new urgent care centers (UCCs) within 5?miles of the hospital, the ED diagnoses of pharyngitis and bronchitis, two of the most common diagnoses seen in UCCs, decreased significantly. Significantly more Medicaid discharged patients presented to the ED with pharyngitis than in the non-Medicaid discharged group, likely because Medicaid patients had no access to UCCs. 相似文献6.
Nathaniel L. Scott Lauren R. Klein Ellen Cales Brian E. Driver 《The American journal of emergency medicine》2019,37(2):209-213
Introduction
Complications associated with the emergency department (ED) management of hyperkalemia are not well characterized. The goals of this study were to describe the frequency of hypoglycemia following the use of insulin to shift potassium intracellularly and to examine the association of key variables with this complication.Methods
Adult ED patients (≥18?years old) with hyperkalemia (>5.3?mmol/L) were identified in the electronic medical record over a 5-year period at the study site. Patient characteristics, laboratory results, and treatments in the ED were captured. A generalized estimating equation (GEE) model was utilized to determine independent associations with the development of hypoglycemia.Results
1307 encounters were identified where hyperkalemia was present. Hypoglycemia (defined as a glucose <70?mg/dL) occurred in 68/409 (17%) of patients given insulin, compared to 4% of patients who did not receive insulin. Lower glucose prior to insulin (adjusted odds ratio [aOR] 0.90; 95% confidence interval [95% CI] 0.85 to 0.96), higher doses of insulin (aOR 1.07; 95% CI 1.01 to 1.15) and lower doses of D50 (aOR 0.98; 95% CI 0.97 to 0.99) were independently associated with hypoglycemia in the multivariate analysis. Age, history of diabetes, and history renal failure were not independently associated.Conclusion
Hypoglycemia is a frequent complication of treatment with IV insulin in the ED. Interventions such as standardized protocols to assist with the ED management of hyperkalemia should be developed; their efficacy and safety should be compared. 相似文献7.
8.
Brian J. Yun Robert M. Rodriguez Anand M. Prabhakar David A. Peak DaMarcus E. Baymon Ali S. Raja 《The American journal of emergency medicine》2019,37(5):909-912
Introduction
Increased use of computed tomography (CT) during injury-related Emergency Department (ED) visits has been reported, despite increased awareness of CT radiation exposure risks. We investigated national trends in the use of chest CT during injury-related ED visits between 2012 and 2015.Methods
Analyzing injury-related ED visits from the 2012–2015 United States (U.S.) National Hospital Ambulatory Medical Care Survey (NHAMCS), we determined the percentage of visits that had a chest CT and the diagnostic yield of these chest CTs for clinically-significant findings. We used survey-weighted multivariable logistic regression to determine which patient and visit characteristics were associated with chest CT use.Results
Injury-related visits accounted for 30% of the 135 million yearly ED visits represented in NHAMCS. Of these visits, 817,480 (2%) received a chest CT over the study period. The diagnostic yield was 3.88%. Chest CT utilization did not change significantly from a rate of 1.73% in 2012 to a rate of 2.31% in 2015 (p?=?0.14). Multivariate logistic regression demonstrated increased odds of chest CT for patients seen by residents versus by attendings (adjusted odds ratio [AOR] 2.08, 95% confidence interval [CI] 1.41–3.08). Patients aged 18–59 and 60+ had higher AORs (5.75, CI 3.44–9.61 and 9.81, CI 5.90–16.33, respectively) than those <18?years of receiving chest CT.Conclusions
Overall chest CT utilization showed an increased trend from 2012 to 2015, but the results were not statistically significant. 相似文献9.
Kristin L. Rising Shannon K. Doyle Rhea E. Powell Amanda M.B. Doty Marianna LaNoue Angela M. Gerolamo 《Journal of emergency nursing》2019,45(1):46-53
Introduction
Prior research suggests that uncertainty related to symptoms is a driver of emergency department (ED) use, and that patients often leave the ED with uncertainty not being addressed. Our objective was to engage patients to identify domains that contribute to feelings of uncertainty and decisions to use the ED.Methods
We used Group Concept Mapping, a quasi-qualitative/quasi-quantitative method, to elicit patients’ views on how uncertainty related to experiencing symptoms contributes to decisions to access the ED. Purposive sampling was used to recruit participants who either sought treatment at the ED twice within a 30-day period, or visited both the ED and a primary care provider at least once within the past year.Results
Thirty-four participants engaged in two rounds of Group Concept Mapping during which participants participated in structured brainstorming of ideas, followed by ranking and clustering of ideas into domains. The first round generated 47 idea statements reflecting uncertainty about consequences, severity, emergency room services, primary care options, finances, and psychologic concerns. The second round generated 52 idea statements reflecting uncertainty about self-management, causation, diagnosis and treatment plan, trust in the provider and institution, accessibility, and alternative care options.Discussion
Factors that contribute to uncertainty and decision-making about ED use are both intrinsic (ie, cause, symptom severity) and extrinsic (ie, finances, accessibility). These domains can inform approaches to measure the uncertainty that patients experience, and to design and test interventions for nurses and other providers to help manage patient uncertainty during acute illness. 相似文献10.
Troy Madsen Rocky Jedick Troy Teeples Margaret Carlson Jacob Steenblik 《The American journal of emergency medicine》2019,37(2):281-285
Background
The Pulmonary Embolism Rule-out Criteria (PERC) defines hypoxia as an oxygen saturation (O2 sat)?<?95%. Utilizing this threshold for hypoxia at a significant elevation above sea level may lead to an inflated number of PERC-positive patients and unnecessary testing. The aim of this study was to determine the effect of an altitude-adjusted O2 sat on PERC's sensitivity and the potential impact on testing rates.Methods
At the University of Utah Emergency Department (ED) (elevation: 4980?ft/1518?m), we prospectively enrolled a convenience sample of patients presenting with chest pain and/or shortness of breath. We calculated PERC utilizing triage vital signs and baseline clinical variables and noted the diagnosis of acute PE during the ED visit. We adjusted the PERC O2 sat threshold to <90% to account for altitude to determine the potential impact on outcomes and decision tool performance.Results
Of 3024 study patients, 1.9% received the diagnosis of an acute PE in the ED, resulting in a sensitivity of 96.6% for the traditional PERC (95% CI: 88.1%–99.6%). Utilizing a definition of hypoxia of <90%, the sensitivity of the altitude-adjusted PERC rule was 94.8% (95% CI: 85.6%–98.9%). Assuming that imaging would not have been pursued for PERC-negative patients, the altitude-adjusted PERC rule would have reduced the overall rate of advanced imaging by 2.7% (95% CI: 1.8%–4.1%).Conclusion
Adjusting the PERC O2 sat threshold for altitude may result in decreased rates of advanced imaging for PE without a substantial change in the sensitivity of the PERC rule. 相似文献11.
12.
Steven G. Schauer Jason F. Naylor Joshua J. Oliver Joseph K. Maddry Michael D. April 《The American journal of emergency medicine》2019,37(1):94-99
Background
During the past 17?years of conflict the deployed US military health care system has found new and innovative ways to reduce combat mortality down to the lowest case fatality rate in US history. There is currently a data dearth of emergency department (ED) care delivered in this setting. We seek to describe ED interventions in this setting.Methods
We used a series of ED procedure codes to identify subjects within the Department of Defense Trauma Registry from January 2007 to August 2016.Results
During this time, 28,222 met inclusion criteria. The median age of causalities in this dataset was 25?years and most (96.9%) were male, US military (41.3%), and part of Operation Enduring Freedom (66.9%). The majority survived to hospital discharge (95.5%). Most subjects sustained injuries by explosives (55.3%) and gunshot wound (GSW). The majority of subjects had an injury severity score that was considered minor (74.1%), while the preponderance of critically injured casualties sustained injuries by explosive (0.7%). Based on AIS, the most frequently seriously injured body region was the extremities (23.9%). The bulk of administered blood products were packed red blood cells (PRBC, 26.4%). Endotracheal intubation was the most commonly performed critical procedure (11.9%). X-ray (79.9%) was the most frequently performed imaging study.Conclusions
US military personnel comprised the largest proportion of combat casualties and most were injured by explosive. Within this dataset, ED providers most frequently performed endotracheal intubation, administered blood products, and obtained diagnostic imaging studies. 相似文献13.
Christopher L. Hunter Salvatore Silvestri Amanda Stone Anne Shaughnessy Stacie Miller Alexa Rodriguez Linda Papa 《The American journal of emergency medicine》2019,37(1):114-117
Objective
To determine if prehospital identification of sepsis will affect time to Centers for Medicare and Medicaid services (CMS) sepsis core measures and improve clinical outcomes.Methods
We conducted a retrospective cohort study among septic patients who were identified as “sepsis alerts” in the emergency department (ED). Metrics including time from ED registration to fluid resuscitation, blood cultures, serum lactate draws, and antibiotics administration were compared between those who had pre-arrival notification by EMS versus those that did not. Additionally, outcomes such as mortality and intensive care unit (ICU) admission were recorded.Results
Of the 272 total patients, 162 had pre-arrival notification (prehospital sepsis alerts) and 110 did not. The prehospital sepsis alert group had significantly lower times to intravenous fluid administration (6?min 95%CI 4–9?min vs 41?min 95%CI 24–58?min, p?<?0.001), blood cultures drawn (12?min 95%CI 10–14?min vs 34?min 95%CI 20–48?min, p?=?0.003), lactate levels drawn (12?min 95%CI 10–15?min vs 34?min 95%CI 20–49?min, p?=?0.003), and administration of antibiotics (33?min 95%CI 26–40?min vs 61?min 95%CI 44–78?min, p?=?0.004). Patients with prehospital sepsis alerts also had a higher admission rate (100% vs 95%, p?=?0.006), and a lower ICU admission rate (33% vs 52%, p?=?0.003). There was no difference in mortality (11% vs 14%, p?=?0.565) between groups.Conclusions
Prehospital sepsis alert notification may decrease time to specific metrics shown to improve outcomes in sepsis. 相似文献14.
Objectives
Diagnostic tests are widely used for patients with syncope in the emergency department (ED). This study aimed to determine the diagnostic yield of neuroimaging in patients with syncope without high-risk symptoms.Methods
Adult patients who presented to the ED with syncope in 2016 were screened retrospectively. Patients who suffered from mild head trauma due to syncope were also included. Patients with neurological examination findings (confusion, amnesia, focal neurological deficit, severe headache, dizziness, nausea and vomiting), patients on anticoagulants, patients with known intracranial malignancies and those whose loss of consciousness was attributed to reasons other than syncope were excluded from the study.Results
A total of 1114 patients were included in the study. The median age was 48?years (IQR?=?34–66?years) and 576 (51.7%) of the patients were male. The neuroimaging tests performed were cranial computerized tomography (CT) in 694 (62.3%) cases and magnetic resonance imaging (MRI) in 114 (10.2%) cases. Mild head trauma due to syncope was observed in 116 (10.4%) patients. None of the neuroimaging studies revealed any clinically significant findings.Conclusion
Neuroimaging is not beneficial in patients whose medical history and physical examination do not indicate neurogenic syncope, even if the patient has mild head trauma. 相似文献15.
Background
Acute kidney injury (AKI) is a common complication in septic patients, imposing a heavy burden of illness in terms of morbidity and mortality. Serum lactate is a widely used marker predicting the severity of sepsis. A paucity of research has investigated septic AKI in emergency departments (EDs) and its correlation with initial serum lactate level. This study aimed at identifying risk factors for septic AKI and clarifying the link between initial serum lactate level and septic AKI in ED patients.Methods
A retrospective cohort study was conducted at a single tertiary referral medical center. The medical records of all adult ED patients with measurement of serum lactate and creatinine between January 2012 and December 2016 were reviewed. A total of 696 septic patients were stratified into AKI and non-AKI groups according to Acute Kidney Injury Network (AKIN) criteria for further statistical analysis.Results
Ninety-nine septic patients (14.2%) had AKI, with AKIN-I, AKIN-II, and AKIN-III in 71.7%, 11.1%, and 17.2% of patients, respectively. Compared with the non-AKI group, the AKI group had a significantly higher mortality rate (71.7% vs. 21.3%, p?<?0.001). Independent risk factors for septic AKI included liver disease (adjusted odds ratio [AOR]?=?2.02, 95% confidence interval [CI]?=?1.16–3.52), diabetes mellitus (AOR?=?1.73, 95% CI?=?1.11–2.69), chronic kidney disease (AOR?=?1.68, 95% CI?=?1.06–2.66), and initial serum lactate (AOR?=?1.08, 95% CI?=?1.02–1.14).Conclusions
Patients with septic AKI had an overwhelmingly higher mortality rate. The comorbidities of liver disease, diabetes mellitus, and chronic kidney disease were correlated with septic AKI and in combination with an elevated initial serum lactate level had predictive regarding AKI and further mortality in ED septic patients. 相似文献16.
Alexander D. Bode Mallika Singh James R. Andrews Amado A. Baez 《The American journal of emergency medicine》2019,37(1):53-55
Background
Barriers to EMS care can result in suboptimal outcomes and preventable morbidity and mortality. Large EMS databases such as the National Emergency Medical Services Information System (NEMSIS) dataset provide valuable data on the relative incidence of such barriers to care.Methods
A retrospective cross-sectional analysis was performed using the NEMSIS database. Cases of violent trauma were collected based on gender and racial group. Each group was analyzed for the ratio of cases that involved an EMS barrier to care. Chi-square testing was used to assess associations, and the relative risk was used as the measure of strength of association. For all tests, statistical significance was set at the 0.05 level.Results
719,812 cases of violent trauma were analyzed using the NEMSIS dataset. EMS encountered barriers to care for white and non-white patients was found to be 4.9% and 4.0% respectively. The difference between groups was found to be 0.9% (95% CI [0.7%, 1.1%] p?<?0.0001). RR was 1.23 for white patients (95% CI [1.19, 1.26]), and 0.82 (95% CI [0.79, 0.84]) for non-white. EMS barriers to care for male and female patients was found to be 6.03% and 3.34%, respectively. The difference between groups was found to be 2.7% (95% CI [2.6%, 2.8%] p?<?0.0001). RR for male patients was 1.80 (95% Cl [1.76, 1.84]) while RR for female patients was 0.55 (95% CI [0.54, 0.57]).Conclusions
Racially white patients and male patients have a statistically significant higher risk of encountering an EMS barrier to care in cases of violent trauma. 相似文献17.
Cody McIlvain Galadima Hadiza Theodore J. Tzavaras Gregory S. Weingart 《The American journal of emergency medicine》2019,37(3):472-477
Introduction
Hoverboards have become popular since they became available in 2015. We seek to provide an estimate of the number of injuries in the United States for 2015 and 2016, and to evaluate differences between adult and pediatric injury complexes.Methods
We performed a retrospective analysis of the National Electronic Injury Surveillance System (NEISS) from January 1, 2015 to December 31, 2016. Using the weighted design of the NEISS, a nationally representative sample could be determined.Results
During the 2?year period, there were 24,650 hoverboard related injuries (95% confidence interval [Cl], 17,635–31,664) in the US. The average age was 20.9?years old. There were 15,134 pediatric injuries (95%CI 9980–20,287) and 9515 adult injuries (95%CI 7185–11,845). Female patients compromised 51.2% of the sample. The upper extremity was the most common region injured [13,080 (95% CI 8848–17,311)] and fracture was the most common type of injury [10,074 (95% CI 6934–13,213)]. Hoverboard injuries increased from 2416 (95% CL 575–4245) in 2015 to 22,234 (95% CI 16,446–28,020) in 2016. Pediatric patients were more likely to be injured in the upper and lower extremity when compared to their adult cohort (p?=?0.0031). Six percent of the cohort [1575 (95% CI 665–2485)] sustained critical injuries with pediatric patients being at 1.46 times higher risk for life threatening injuries.Conclusion
Emergency department (ED) visits for hoverboard related injuries appear to be increasing. Pediatric patients are more at risk for hoverboard related injuries than adults and almost 6% of ED visits involved critical injuries, highlighting that hoverboards may be more dangerous than previously recognized. 相似文献18.
Jonathan D. Auten John H. Naheedy Nicole D. Hurst Andrew T. Pennock Kathryn A. Hollenbach John T. Kanegaye 《The American journal of emergency medicine》2019,37(5):832-838
Objective
Emergency department (ED) reduction of pediatric fractures occurs most commonly in the forearm and can be challenging if fluoroscopy is not available. We sought to assess the ability of point of-care ultrasonography (POCUS) to predict adequacy of reduction by fluoroscopy.Methods
We prospectively enrolled ED patients 0–17?years of age with radial and/or ulnar fractures requiring reduction under fluoroscopic guidance. Post-reduction POCUS (probe dorsal, volar, and coronal) and fluoroscopic (AP and lateral) fracture images were recorded. Fracture angles were compared between blinded POCUS and fluoroscopic measurements and between POCUS measurements by a blinded emergency physician and a blinded radiologist, reporting mean differences and 95% confidence intervals. We calculated sensitivity, specificity, and likelihood ratios of POCUS in the prediction of fluoroscopically detected post-reduction malalignment, as interpreted by a blinded pediatric orthopaedist.Results
The 58 patients were 7.9?±?3.5?years of age and had 21 radial (36%), 1 ulnar (2%), and 36 radioulnar (62%) fractures. Fluoroscopy and POCUS angles were within a mean of 0.1°–3.2°, depending on the site and surface measured. Radiologist- and emergency physician-interpreted POCUS measurements were within a mean of 1° in all dimensions. POCUS identified inadequate reductions with 100% sensitivity and 92–93% specificity.Conclusions
Blinded emergency medicine and radiology interpretations of post-reduction POCUS fracture images agree closely. Post-reduction POCUS measurements are comparable to those obtained by fluoroscopy and accurately predict adequacy of reduction. POCUS can be used to guide pediatric fracture reduction when bedside fluoroscopy is not available in the ED. 相似文献19.
Tae Han Kim Ki Jeong Hong Sang Do Shin Gwan Jin Park Sungwan Kim Nhayoung Hong 《The American journal of emergency medicine》2019,37(2):183-188
Background
Monitoring and detecting sudden outbreaks of respiratory infectious disease is important. Emergency Department (ED)-based syndromic surveillance systems have been introduced for early detection of infectious outbreaks. The aim of this study was to develop and validate a forecasting model of respiratory infectious disease outbreaks based on a nationwide ED syndromic surveillance using daily number of emergency department visits with fever.Methods
We measured the number of daily ED visits with body temperature?≥?38.0?°C and daily number of patients diagnosed as respiratory illness by the ICD-10 codes from the National Emergency Department Information System (NEDIS) database of Seoul, Korea. We developed a forecast model according to the Autoregressive Integrated Moving Average (ARIMA) method using the NEDIS data from 2013 to 2014 and validated it using the data from 2015. We defined alarming criteria for extreme numbers of ED febrile visits that exceed the forecasted number. Finally, the predictive performance of the alarm generated by the forecast model was estimated.Results
From 2013 to 2015, data of 4,080,766 ED visits were collected. 303,469 (7.4%) were ED visits with fever, and 388,943 patients (9.5%) were diagnosed with respiratory infectious disease. The ARIMA (7.0.7) model was the most suitable model for predicting febrile ED visits the next day. The number of patients with respiratory infectious disease spiked concurrently with the alarms generated by the forecast model.Conclusions
A forecast model using syndromic surveillance based on the number of ED visits was feasible for early detection of ED respiratory infectious disease outbreak. 相似文献20.
James R. Langabeer Tiffany Champagne-Langabeer Raymond Fowler Timothy Henry 《The American journal of emergency medicine》2019,37(2):179-182