Emergency Department Visits for Pediatric Trampoline-related Injuries: An Update

Objectives: To describe the epidemiology of emergency department (ED) visits for trampoline-related injuries among U.S. children from January 1, 2000, to December 31, 2005, using the National Electronic Injury Surveillance System (NEISS) and to compare recent trampoline injury demographics and injury characteristics with those previously published for 1990–1995 using the same data source.
Methods: A stratified probability sample of U.S. hospitals providing emergency services in NEISS was utilized for 2000–2005. Nonfatal trampoline-related injury visits to the ED were analyzed for patients from 0 to 18 years of age.
Results: In 2000–2005, there was a mean of 88,563 ED visits per year for trampoline-related injuries among 0–18-year-olds, 95% of which occurred at home. This represents a significantly increased number of visits compared with 1990–1995, when there was an average of 41,600 visits per year. Primary diagnosis and principal body part affected remained similar between the two study periods.
Conclusions: ED visits for trampoline-related injuries in 2000–2005 increased in frequency by 113% over the number of visits for 1990–1995. Trampoline use at home continues to be a significant source of childhood injury morbidity.     

A Truncated E-code System for Injury Surveillance in the Emergency Department: Description and Clinometric Testing

Objectives: ED injury surveillance requires accurate information about mechanism. This study explored the clinometric properties of an E-code system specifically designed to track ED injuries.
Methods: All patients assessed in the ED had cause-of-injury information documented using a truncated E-code system. Patient records were hand-searched to determine coding compliance. A selection of 98 charts (50 injury/48 noninjury) were coded by 7 physicians, 2 nurses, and 2 nosologists. Agreements (interrater and intrarater) on the diagnosis of trauma and exact E-codes were determined (using kappa; κ).
Results: E-coding compliance was high (overall 90%: 95% CI: 85–93%), and accuracy of injury classification was 99%. Compared with an expert's coding, agreement on injury classification was excellent for physicians (κ = 0.91; 95% CI: 0.80–1.0), nurses (κ = 0.88; 95% CI: 0.75–1.0), and nosologists (κ = 0.92; 95% CI: 0.81–1.0). Agreement was substantial for the exact E-codes between physicians (κ = 0.77; 95% CI: 0.60- 0.94) and nurses (κ = 0.72; 95% CI: 0.54–0.90). Recode reliability was also excellent for physicians (κ = 0.88; 95% CI: 0.75–1.0) and nurses (κ = 0.96; 95% CI: 0.88–1.0).
Conclusions: Injury coding using a truncated E-code system can provide valid and reliable data from the ED. Differences between nurses, physicians, and nosologists in the ability to accurately code using this system were minimal, thus eliminating the need for additional staff and resources.     

Telephone Follow-up for Case Finding of Domestic Violence in an Emergency Department

Objective: To determine whether telephone follow-up of selected female patients seen in an urban ED would improve domestic violence (DV) case finding.
Methods: A prospective, cross-sectional study was conducted on consecutive female patients between the ages of 16 and 65 years treated in an urban trauma center during July and August 1995. Record review identified those patients with conditions suggesting increased risk for DV: injury; substance abuse; complaints or diagnoses related to stress, anxiety, depression, or panic attack; or complaints of headache, nonspecific abdominal pain, generalized fatigue, or numbness lasting >] week. Attempts were made to telephone all patients who had high-risk presentations within 3 days of their emergency visits. Patients were contacted by a trained interviewer regarding the circumstances of their visits.
Results: There were 142 (9%) high-risk presentations out of 1,500 ED visits by women. Of these high-risk visits, 68 patients denied DV, 19 patients did not speak English, 16 patients gave an incorrect telephone number, 18 patients could not be reached after 3 telephone calls, and 6 patients did not give a telephone number. Of the remaining 15 patients, 5 were diagnosed at the initial visit as having experienced DV, and 10 admitted on the follow-up call that the visit had been related to DV or emotional stress at home.
Conclusion: A structured interview, conducted via telephone in follow-up of released ED patients, identified an additional 10 victims out of 142 high-risk presentations and 1,500 total ED presentations. This approach is labor-intensive, with a relatively low yield. Nonetheless, prospective identification of selective high-risk cases by physicians, coupled with subsequent social service telephone contact, may be a complement in department case finding.     

Incidence and Characteristics of Fall-related Emergency Department Visits

Abstract. Objective: Unintentional falls are the leading cause of injury and the second most common cause of unintentional injury deaths in the United States, and place a great burden on EDs. In this study, the objective was to describe the incidence and characteristics of ED visits associated with unintentional falls in the United States.
Methods: The authors performed a secondary analysis on data from the National Center for Health Statistics' National Hospital Ambulatory Medical Care Survey for 1992–1994. An ED visit was defined as fall-related if an ICD-9-CM cause of injury code was reported as E880.0–886.9 or E888.
Results: There were an estimated 7,946,000 fall-related ED visits per year, corresponding to an annual rate of 3.1 per 100 persons (95% CI = 2.8 to 3.4). Children under 5 years of age comprised the largest proportion of visits (14%). Among those visits coded with respect to place of occurrence, the rate of visits associated with falls occurring at home (1.7/100; 95% CI = 1.6 to 1.9) was significantly higher than that associated with falls occurring in all other locations combined (1.1/100; 95% CI = 1.0 to 1.2). The mean injury severity score increased significantly with the age of the patient. Fall-related ED visits resulted in an estimated 860,000 hospitalizations, 62% of which involved individuals aged 65 years and older. An estimated $2.45 billion per year was paid for fall-related ED visits. Government sources paid all or part of 41% of visits.
Conclusions: This study reports nationally representative data describing the incidence and characteristics of fall-related ED visits. These data expand what is known about the epidemiology of falls and help to define the burden that fall injuries place on EDs in the United States. The results of this study could serve as a benchmark to evaluate the effectiveness of future fall prevention efforts.     

Predictors of Repeat Emergency Department Visits by Elders

Objective: To determine which characteristics of older patients who use a hospital ED are associated with repeat visits during the 90 days following the index visit.
Methods: The study was conducted in the ED of a 400-bed university-affiliated acute care community hospital in Montreal. Patients aged ≥75 years who visited the ED between 08:00 and and 16:00 on a convenience sample of days over an 8-week period (July and August 1994) were assessed using a questionnaire, physical and cognitive status instruments, and a functional problem checklist. The hospital's administrative database was used to identify repeat visits during the 90 days following the ED visit. The representativeness of the sample was assessed by analyses of ED visits made by 4,466 persons aged ≥65 years during a 12-month period (September 1993 to August 1994) using the hospital's administrative database.
Results: 256 patients aged ≥75 years visited the ED during the study period and 167 were assessed. Of these, 54 (32%) were admitted to the hospital. Among the 113 patients released from the ED, 27 (24%) made repeat visits during the next 90 days. In univariate analyses, repeat visits were significantly associated with the number of functional problems, cognitive impairment, and previous ED visits. In multiple logistic regression, male gender, living alone, and number of functional problems were independent predictors of repeat visits. In the administrative data analyses, nighttime arrival to the ED for the index visit was significantly associated with repeat visits.
Conclusions: Self-reported risk factors can help to identify a group of elders likely to make repeated ED visits; the development of a screening instrument incorporating questions on these problems and implementation of appropriate interventions might improve these patients' quality of life and reduce the demand for further ED care in this age group.     

Emergency Department Utilization in the United States and Ontario, Canada

Objectives: The current crisis in the emergency care system is characterized by worsening emergency department (ED) overcrowding. Lack of health insurance is widely perceived to be a major contributing factor to ED overcrowding in the United States. This study aimed to compare ED visit rates in the United States and Ontario, Canada, according to demographic and clinical characteristics.
Methods: This was a cross sectional study consisting of a nationally representative sample of 40,253 ED visits included in the 2003 National Hospital Ambulatory Medical Care Survey in the United States, and all ED visits recorded during 2003 by the National Ambulatory Care Reporting System in Ontario, Canada. The main outcome was the number of ED visits per 100 population per year.
Results: The annual ED visit rate in the United States was 39.9 visits (95% confidence interval = 37.2 to 42.6) per 100 population, virtually identical to the rate in Ontario, Canada (39.7 visits per 100 population). In both the United States and Ontario, Canada, those aged 75 years and older had the highest ED visit rate and women had a slightly higher ED visit rate than men. The most common discharge diagnosis was injury/poisoning, accounting for 25.6% of all ED visits in the United States and 24.7% in Ontario, Canada. Overall, 13.9% of ED patients in the United States were admitted to hospitals, compared with 10.5% in Ontario, Canada.
Conclusions: ED visit rates and patterns are similar in the United States and Ontario, Canada. Differences in health insurance coverage may not have a substantial impact on the overall utilization of emergency care.     

Work-related Injuries in a Rural Emergency Department Population

Objective: To describe the spectrum of work-related injury evaluated in a rural ED population. Methods: An ED-based injury surveillance system (EDBISS) was used to collect injury data for all ED patients seen over a 1-year period. A patient was classified as injured if his or her record contained an ED log injury code, an ICD-9 N-code between 800 and 995 in any diagnostic field, an E-code, or an entry in the trauma registry. An injury was considered work-related if the patient reported that the injury had occurred while at work. Results: Work-related injuries accounted for 1,539/12,321 (12.5%) of all injuries. The mean age of patients injured on the job was 33.8 years (range, 16–77 years), compared with a mean age of 27.7 years for all the injured patients. Males accounted for 1,026/1,537 (67%) of the work-related injury visits, compared with 57% of all the injury visits. The most common mechanisms of work-related injuries were: overexertion (313; 20%); cut or pierced by sharp implements (248; 16%); falls (250; 16%); struck by object (202; 13%); and transportation-related injuries (71; 5%). Sprains and strains were the most common type of injury sustained (415; 27%), followed by wounds to upper limbs (283; 18%), contusions (182; 12%), and fractures (151; 10%). Of the 1,539 patients presenting with occupational injuries, 178 (12%) presented to the ED via ambulance. Most (1,401; 91%) were treated and released from the ED, with the remainder (136; 9%) hospitalized. The mechanisms of injury that most commonly resulted in hospitalization included struck by an object (28; 21%), transportation (26; 19%), falls (27; 20%), crushing mechanism (13; 10%), and machinery (20; 15%). Of those requiring hospitalization, 132/136 (97)% were male, and the average length of stay was 4.4 days. Four of the hospitalized persons died of their work-related injuries. Known medical charges incurred by patients injured at work were as high as $62,622. The average charge for those treated and released was $273; the average charge for those who required hospitalization was $10,910. Conclusions: Occupational injuries contribute significantly to the overall incidence of injuries seen in this ED and are responsible for significant medical charges each year.     

Epidemiology of Alcohol-related Emergency Department Visits

Abstract. Objective : To examine the population and geographic patterns, patient characteristics, and clinical presentations and outcomes of alcohol-related ED visits at a national level. Methods : Cross-sectional data on a probability sample of 21,886 ED visits from the 1995 National Hospital Ambulatory Medical Care Survey were analyzed with consideration of the individual patient visit weight. The annual number and rates of alcohol-related ED visits were computed based on weighted analysis in relation to demographic characteristics and geographic region. Specific variables of alcohol-related ED visits examined included demographic and medical characteristics, patient-reported reasons for visit, and physicians' principal diagnoses. Results : Of the 96.5 million ED visits in 1995, an estimated 2.6 million (2.7%) were related to alcohol abuse. The overall annual rate of alcohol-related ED visits was 10.0 visits per 1,000 population [95% confidence interval (CI) 8.7–11.3]. Higher rates were found for men (14.7 per 1,000, 95% CI 12.5–16.9), adults aged 25 to 44 years (17.8 per 1,000, 95% CI 15.0–20.6), blacks (18.1 per 1,000, 95% CI 14.0–22.1), and residents living in the northeast region (15.2 per 1,000, 95% CI 12.1–18.2). Patients whose visits were alcohol-related were more likely than other patients to be uninsured, smokers, or depressive. Alcohol-related ED visits were 1.6 times as likely as other visits to be injury-related, and 1.8 times as likely to be rated as "urgent" or "emergent." The leading principal reasons for alcohol-related ED visits were complaints of pain, injury, and drinking problems. Alcohol abuse/dependence was the principal diagnosis for 20% of the alcohol-related visits. Conclusion : Alcohol abuse poses a major burden on the emergency medical care system. The age, gender, and geographic characteristics of alcohol-related ED visits are consistent with drinking patterns in the general population.     

The Potential of Using Billing Data for Emergency Department Injury Surveillance

Objective: To determine the availability of and sample statewide ED injury information obtained from hospital billing data for the purpose of demonstrating the feasibility of information acquisition for subsequent data linkage.
Methods: A retrospective, database investigation was conducted to obtain data describing a statewide stratified sample of ED patients. The aim was to collect a computerized billing summary record for each injured ED patient seen at each sampled hospital over a 1-year period. All 215 Pennsylvania acute care hospitals in 1991 were eligible for sample selection. Data collection for the project was conducted in 1993. Participants included directors of hospital medical records and billing departments.
Results: Twenty-four hospitals contributed data sets from the original target goal of 31 strata. The final combined data set contained 187,404 records with injury diagnoses from approximately 616,000 ED patient visits, representing a 12% sample of all annual statewide ED visits. Age, sex, date of visit, and primary diagnosis fields were completed from the retrieved data >99% of the time. More than two-thirds of the sampled records had a social security number, and total charges were recorded >90% of the time. Other variables such as name and address were contained in <50% of the records submitted. E-codes were usually not available.
Conclusions: Retrospective compilation of multihospital ED billing data to create a statewide ED data sample—with the potential for injury research and probabilistic database linkage—can be accomplished; there are, however, important limitations.     

Injuries in Youth Football: National Emergency Department Visits during 2001–2005 for Young and Adolescent Players

Objectives:  Limited research exists describing youth football injuries, and many of these are confined to specific regions or communities. The authors describe U.S. pediatric football injury patterns receiving emergency department (ED) evaluation and compare injury patterns between the younger and older youth football participants.
Methods:  A retrospective analysis of ED data on football injuries was performed using the National Electronic Injury Surveillance System–All Injury Program. Injury risk estimates were calculated over a 5-year period (2001–2005) using participation data from the National Sporting Goods Association. Injury types are described for young (7–11 years) and adolescent (12–17 years) male football participants.
Results:  There were an estimated total of 1,060,823 visits to U.S. EDs for males with football-related injuries. The most common diagnoses in the younger group (7–11 years) were fracture/dislocation (29%), sprain/strain (27%), and contusion (27%). In the older group (ages 12–17 years), diagnoses included sprain/strain (31%), fracture/dislocation (29%), and contusion (23%). Older participants had a significantly higher injury risk of injury over the 5-year study period: 11.0 (95% confidence interval [CI] = 9.2 to 12.8) versus 6.1 (95% CI = 4.8 to 7.3) per 1,000 participants/year. Older participants had a higher injury risk across all categories, with the greatest disparity being with traumatic brain injury (TBI), 0.8 (95% CI = 0.6 to 1.0) versus 0.3 (95% CI = 0.2 to 0.4) per 1,000 participants/year.
Conclusions:  National youth football injury patterns are similar to those previously reported in community and cohort studies. Older participants have a significantly higher injury risk, especially with TBI.     

Detection of Electrolyte Abnormalities in Children Presenting to the Emergency Department: A Multicenter, Prospective Analysis

Objective : To prospectively derive high-yield criteria for the detection of clinically significant electrolyte abnormalities (CSEAs) in children presenting to the ED.
Methods : A prospective, multicenter, observational study was performed at the EDs of 2 urban teaching hospitals, a university medical center, and a children's hospital with a combined census of >275,000 patient visits/year (100,000 visits for children <13 years old). All children <13 years old who had electrolyte panels obtained were eligible for analysis. A data form containing potential predictor variables for a CSEA was completed by the clinician prior to receipt of electrolyte results. A CSEA was any abnormal electrolyte value that 1) stimulated constructive assessment of the patient's condition (monitoring, reevaluation of nonspurious laboratory values, or admission), 2) led to further diagnostic studies, 3) led to a new diagnosis, or 4) affected therapy, χ² recursive partitioning was used to derive a decision rule for ordering electrolytes.
Results : Of 715 eligible patient visits, 488 (68%) electrolyte panels contained a laboratory abnormality, with 182 (25%) CSEAs. A decision rule requiring 1 of 6 clinical criteria was 100% sensitive (95% CI 98–100%) and 24% specific (95% CI 21–28%) in detecting CSEAs with positive and negative predictive values of 31% (95% CI 28–34%) and 100% (95% CI 97–100%), respectively. If these criteria had been used to screen patients for whom electrolyte panels were ordered, 128 patients (18%) would not have had electrolyte panels obtained and no CSEAs would have been missed.
Conclusion : A set of clinical criteria was derived that may be useful for limiting electrolyte panels ordering in children. This criterion set requires prospective validation in a separate patient population.     

Emergency Department Visits,Related Hospitalizations,and Reasons for Emergency Department Utilization After Traumatic Spinal Cord Injury

ObjectiveTo identify the self-reported frequency of emergency department (ED) visits, ED-related hospitalizations, and reasons for ED visits among people with traumatic spinal cord injury (SCI) and compare them with general population data from the same geographic area.DesignCross-sectional.SettingA specialty hospital in the Southeastern United States.ParticipantsThe participants (N=648) were community-dwelling adults (18 years and older) with a traumatic SCI, who were at least 1 year postinjury. A comparison group of 9728 individuals from the general population was retrieved from the 2017 National Health Interview Survey (NHIS).InterventionsNot applicable.Main Outcome MeasuresParticipants completed self-report assessments on ED visits, ED hospitalizations, and reasons for ED visits in the past 12 months using items from the NHIS.ResultsA total of 37% of participants with SCI reported at least 1 ED visit, and 18% reported at least 1 ED hospitalization in the past 12 months. Among those having at least 1 ED visit, 49% were admitted to hospitals. After controlling for sex, age, and race/ethnicity, participants with SCI were 151% more likely to visit the ED (odds ratio [OR], 2.51) and 249% more likely to have at least 1 ED hospitalization than the NHIS sample (OR, 3.49). Persons with SCI had a higher percentage of ED visits because of severe health conditions, reported an ED was the closest provider, and were more likely to arrive by ambulance. NHIS participants were more likely to visit the ED because no other option was available.ConclusionsCompared with those in the general population, individuals with SCI have substantially higher rates of ED visits, yet ED visits are not regularly assessed within the SCI Model Systems. ED visits may indicate the need for intervention beyond the acute condition leading directly to the ED visits and an opportunity to link individuals with resources needed to maintain function in the community.     

Subsequent Suicide Mortality among Emergency Department Patients Seen for Suicidal Behavior

Objectives: To determine whether suicide mortality rates for a cohort of patients seen and subsequently discharged from the ED for a suicide-related complaint were higher than for ED comparison groups.
Methods: This was a nonconcurrent cohort study set at a university-affiliated urban ED and Level 1 trauma center. All ED patients 10 years and older, with at least one ED visit between February 1994 and November 2004, were eligible. ED visit characteristics defined the cohort exposure. Patients with visits for suicide attempt or ideation, self-harm, or overdose (exposed) were compared with patients without these visits (unexposed). Exposure classification was determined from billing diagnoses, E-codes (E950–E959), and free-text searching of the ED tracking system data for suicide, overdose , and spelling variants. Emergency department patient data were probabilistically linked to state mortality records. The principal outcome was suicide death. Suicide mortality rates were calculated by using person-year (py) analyses. Relative rates (RR) and 95% confidence intervals (95% CIs) were calculated from Cox proportional hazards models.
Results: Among the 218,304 patients, the average follow-up was 6.0 years; there were 408 suicide deaths (incidence rate [IR]: 31.2 per 100,000 py). Males (IR: 48.3) had a higher rate than females (IR: 13.5; RR: 3.6; 95% CI = 2.8 to 4.6). A single ED visit for overdose (RR: 5.7; 95% CI = 4.5 to 7.4), suicidal ideation (RR: 6.7; 95% CI = 5.0 to 9.1), or self-harm (RR: 5.8; 95% CI = 5.1 to 10.6) was strongly associated with increased suicide risk, relative to other patients.
Conclusions: The suicide rate among these ED patients is higher than population-based estimates. Rates among patients with suicidal ideation, overdose, or self-harm are especially high, supporting policies that mandate psychiatric interventions in all cases.     

U.S. Emergency Department Visits for Supraventricular Tachycardia, 1993–2003

Background: Supraventricular tachycardia (SVT) is often described as a recurrent condition that leads to emergency department (ED) visits. However, the epidemiology of ED visits for SVT is unknown.
Objectives: To define the frequency of SVT in U.S. EDs and to analyze patient characteristics, ED management, and disposition for such visits.
Methods: The authors analyzed data from the National Hospital Ambulatory Medical Care Survey, 1993–2003. SVT cases were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes 426.7 or 427.0 in any of the three diagnostic fields.
Results: Of the 1.1 billion ED visits over the 11-year study period, an estimated 555,000 (0.05%; 95% confidence interval [CI] = 0.04% to 0.06%) were related to SVT. The annual frequency and population rate appear stable between 1993 and 2003 (p for trend = 0.35). Compared with non-SVT visits, those with SVT were more likely to be older than 65 years of age (26% vs. 15%, p < 0.01) and female (70% vs. 53%, p < 0.01). Electrocardiograms were documented for most visits (91%; 95% CI = 85% to 96%). Approximately half of the patients (51%; 95% CI = 40% to 61%) received an atrioventricular nodal blocking medication, most frequently adenosine (26%; 95% CI = 17% to 36%). SVT visits ended in hospital admission for 24% (95% CI = 15% to 34%). At the other extreme, 44% (95% CI = 32% to 56%) were discharged without planned follow-up.
Conclusions: Supraventricular tachycardia accounts for approximately 50,000 ED visits each year. Higher visit rates in older adults and female patients are consistent with prior studies of SVT in the general population. This study provides an epidemiologic foundation that will enable future research to assess and improve clinical management strategies of SVT in the ED.     

Pediatric Emergency Department Utilization and Reliance by Insurance Coverage in the United States

Objectives

For many children, the emergency department (ED) serves as the main destination for health care, whether it be for emergent or nonurgent reasons. Through examination of repeat utilization and ED reliance (EDR), in addition to overall ED utilization, we can identify subpopulations dependent on the ED as their primary source of health care.

Methods

Nationally representative data from the 2010 to 2014 Medical Expenditure Panel Survey were used to examine the annual ED utilization of children age 0 to 17 years by insurance coverage. Overall utilization, repeat utilization (two or more ED visits), and EDR (percentage of all health care visits that occur in the ED) were examined using multivariate models, accounting for weighting and the complex survey design. High EDR was defined as having > 33% of outpatient visits in a year being ED visits.

Results

A total of 47,926 children were included in the study. Approximately 12% of children visited an ED within a 1‐year period. A greater number of children with public insurance (15.2%) visited an ED at least once, compared to privately insured (10.1%) and uninsured (6.4%) children. Controlling for covariates, children with public insurance were more likely to visit the ED (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.40–1.73) than children with private insurance, whereas uninsured children were less likely (aOR = 0.64, 95% CI = 0.51–0.81). Children age 3 and under were significantly more likely to visit the ED than children age 15 to 17, whereas female children and Hispanic and non‐Hispanic other race children were significantly less likely to visit the ED than male children and non‐Hispanic white children. Among children with ED visits, 21% had two or more visits to the ED in a 1‐year period. Children with public insurance were more likely to have two or more visits to the ED (aOR = 1.53, 95% CI = 1.19–1.98) than children with private insurance whereas there was no significant difference in repeat ED utilization for uninsured children. Publicly insured (aOR = 1.70, 95% CI = 1.47–1.97) and uninsured children (aOR = 1.90, 95% CI = 1.49–2.42) were more likely to be reliant on the ED than children with private insurance.

Conclusions

Health insurance coverage was associated with overall ED utilization, repeat ED utilization, and EDR. Demographic characteristics, including sex, age, income, and race/ethnicity were important predictors of ED utilization and reliance.

     

Emergency Department Visits for Sledding Injuries in Children in the United States in 2001/2002

Objectives: To describe the characteristics of nonfatal sledding-related injuries in U.S. children resulting in emergency department (ED) visits in 2001/2002 and to explore the implications of these findings for injury prevention efforts.
Methods: A stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System–All Injury Program was utilized for 2001/2002. ED visits resulting from injuries involving sleds, snow discs, snow tubes, and toboggans were analyzed for patients 19 years of age or younger.
Results: In 2001/2002, there were an estimated 57,866 ED visits for sledding-related injuries in the United States for all age groups. Of these, 41,272 (71%) occurred in patients 19 years of age or younger, 58% of whom were male. The highest number of injuries occurred in children between five and 14 years of age (74%), and the injuries were most often caused by falls or collisions (75%). The head or neck was the most frequently injured body region among those 0–9 years of age, while the extremities were injured most commonly among those 10–19 years of age. Head and neck injuries occurred in 56% (95% confidence interval [CI] = 32% to 81%) of children 0–4 years of age versus 19% (95% CI = 9% to 29%) of patients 15–19 years of age. Nine percent (95% CI = 6% to 12%) of patients sustained a traumatic brain injury. Three percent (95% CI = 1% to 5%) of patients required admission to the hospital.
Conclusions: Sledding injuries resulting in ED visits predominantly affect children and are a source of measurable morbidity in this population. An increase in injury prevention efforts for this activity is warranted.     

The etiology and prognostic significance of cardiac troponin I elevation in unselected emergency department patients

Background: Burns are a common cause of injury presenting to the Emergency Department (ED). Several reports state that admission for and mortality from burn injury are declining. Total visits to the ED, however, have increased. Objectives: The objective of this study was to determine the number and trends over time of patients presenting to the ED for burn injury. Methods: The study was a retrospective analysis of National Hospital Ambulatory Medical Care Survey databases for 1996–2005 available from the Centers for Disease Control and Prevention. Subjects were patients with a first diagnosis of a burn. Patient weights in the database were used to obtain estimated national values. Measures used were estimated total numbers and percentages of patients by year. Trends from 1996 through 2005 were examined overall and by demographic factors and injury characteristics. Linear regression was used to evaluate trends. Results: There was a significantly decreasing trend in ED burn visits from 1996 to 2000 (614,745 to 433,681 visits), but no apparent trend for the years 2000 to 2005. Annually, about 60% of ED burn patients were male, and about half were between the ages of 19 and 44 years. Less than 5% of burns were third degree or full thickness injuries. Admissions per year were stable at 5%. The most common causes of burn injury were contact with a hot liquid and contact with a hot object, and the most common body region affected was the upper extremities (40% each year), followed by burns to the head/face/neck. Use of medications showed no trends over time. Conclusions: ED visits for burn injuries have been decreasing; however, patterns of cause, admission, and treatment show no consistent temporal change.     

National differences between ED and ambulatory visits for suicidal ideation and attempts and depression

Background

Many suicidal and depressed patients are seen in emergency departments (EDs), whereas outpatient visits for depression remain high.

Study objective

The primary objective of the study is to determine a relationship between the incidence of suicidal and depressed patients presenting to EDs and the incidence of depressed patients presenting to outpatient clinics. The secondary objective is to analyze trends among suicidal patients.

Methods

The National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey were screened to provide a sampling of ED and outpatient visits, respectively. Suicidal and depressed patients presenting to EDs were compared with depressed patients presenting to outpatient clinics. Subgroup analyses included age, sex, race/ethnicity, method of payment, regional variation, and urban verses rural distribution.

Results

Emergency department visits for depression (1.16% of visits in 2002) and suicide attempts (0.51% of visits in 2002) remained stable over the years. Office visits for depression decreased from 3.14% of visits in 2002 to 2.65% of visits in 2008. Non-Latino whites had a higher percentage of ED visits for depression and suicide attempt and office visits for depression than other groups. The percentage of ED visits for suicide attempt resulting in hospital admission decreased by 2.06% per year.

Conclusion

From 2002 to 2008, the percentage of outpatient visits for depression decreased, whereas ED visits for depression and suicide remained stable. When examined in the context of a decreasing prevalence of depression among adults, we conclude that an increasing percentage of the total patients with depression are being evaluated in the ED, vs outpatient clinics.     

Frequent Users of the Emergency Department: Can We Intervene?

Objective: To determine whether the use of individualized patient care plans and multidisciplinary case management would decrease ED utilization by frequent ED users.
Methods: The authors performed a prospective, randomized clinical trial of the impact of a care plan on ED use by adults with frequent ED visits. Patients with >10 ED visits to a university hospital in 1993 were identified. Patients were matched for age, sex, and number of visits and then randomized into 2 groups. The control group received standard emergency care. The treatment group was managed by a multidisciplinary team and treated in the ED according to individualized care plans. ED use was tracked at the university hospital and at the other 5 community hospitals in the city.
Results: Of the 70 enrolled patients, 25 of 37 control patients and 27 of 33 treatment patients made visits to the university hospital during the 1-year study period. Only those patients with follow-up visits were included in the data analysis. Patients remaining in the control group made 247 total visits (range 1–65) to the university hospital and 179 total visits (range 0–38) to the community hospitals during the study period. Patients in the treatment group made 320 total visits (range 1–72) to the university hospital and 254 total visits (range 0–135) to the community hospitals during the study period. There was no significant difference in the median number of visits made to either the university hospital or the community hospitals by the patients in the control group and those in the treatment group.
Conclusions: The use of individualized care plans and case management did not significantly decrease ED utilization by frequent ED users. However, the impact of individualized care plans and case management on other quality-of-care measures (e.g., patient satisfaction, ED length of stay, hospitalizations, primary care visits, and health care costs) remains to be determined.