Emergency Department Visits after Kidney Transplantation

Background and objectives

In 2011, there were approximately 131 million visits to an emergency department in the United States. Emergency department visits have increased over time, far outpacing growth of the general population. There is a paucity of data evaluating emergency department visits among kidney transplant recipients. We sought to evaluate the incidence and risk factors for emergency department visits after initial hospital discharge after transplantation in the United States.

Design, setting, participants, & measurements

We identified 10,533 kidney transplant recipients from California, New York, and Florida between 2009 and 2012 using the State Inpatient and Emergency Department Databases included in the Healthcare Cost and Utilization Project. We used multivariable Poisson and Cox proportional hazard models to evaluate adjusted incidence rates and time to emergency department visits after transplantation.

Results

There were 17,575 emergency department visits over 13,845 follow-up years (overall rate =126.9/100 patient-years; 95% confidence interval, 125.1 to 128.8). The cumulative incidences of emergency department visits at 1, 12, and 24 months were 12%, 40%, and 57%, respectively, with median time =19 months; 48% of emergency department visits led to hospital admission. Risk factors for higher emergency department rates included younger age, women, black and Hispanic race/ethnicity, public insurance, depression, diabetes, peripheral vascular disease, and emergency department use before transplant. There was wide variation in emergency department visits by individual transplant center (10th percentile =70.0/100 patient-years; median =124.6/100 patient-years; and 90th percentile =187.4/100 patient-years).

Conclusions

The majority of kidney transplant recipients will visit an emergency department in the first 2 years post-transplantation, with significant variation by patient characteristics and individual centers. As such, coordination of care through the emergency department is a critical component of post-transplant management, and specific acumen of transplant-related care is needed among emergency department providers. Additional research assessing best processes of care for post-transplant management and health care expenditures and outcomes associated with emergency department visits for transplant recipients are warranted.     

无脑部外伤与骨科相关的意识障碍分析与处理

目的 探讨无脑部外伤与骨科相关的意识障碍原因、鉴别诊断和治疗方法.方法 回顾性分析自2003-01-2014-01诊治的77例无脑部外伤骨科患者出现意识障碍的临床资料.结果 本组68例获得随访6～128个月,平均67.6个月.其中脂肪栓塞综合征(FES)33例中死亡2例,植物状态1例,13例昏迷2～10周,17例表现为较轻的意识障碍,24例目前意识均恢复正常.肺栓塞(PE)21例中死亡9例,植物状态2例,4例昏迷2～5 d,6例出现短暂的意识丧失,8例目前意识恢复正常.脑梗死(CI)9例中死亡3例,植物状态1例,4例遗留部分后遗症.重度低钠血症(SHN)7例,意识均恢复正常.重症肺炎(SP)5例中死亡4例,1例意识恢复正常.颅内感染(ICI)2例,均死亡.结论 无脑部外伤的骨科患者出现的意识障碍要充分认识,辨明病因,积极防治,减少死亡率和病残率.     

低频脉冲电位治疗骨科卧床患者便秘的疗效分析

目的：：对低频脉冲电位治疗骨科卧床患者便秘的疗效进行分析和探讨。方法：以我院2011年1月至2014年1月收治的100例骨科卧床合并便秘患者为研究对象,随机分为观察组与对照组,各50例。对照组给予常规便秘护理;观察组在对照组的基础上,给予低频脉冲电位治疗。观察指标：总有效率、使用开塞露率、排便频率、排便时间和粪便性状。结果：治疗1周后,观察组总效率为98.0%,显著高于对照组80.0%,差异有统计学意义(字2=6.553, P=0.034);观察组使用开塞露率为12.0%,显著低于对照组34.0%,差异有统计学意义(字2=6.0623, P=0.042);观察组排便频率、排便时间及粪便性状开始改善时间也显著快于对照组,差异有统计学意义(P<0.01)。结论：低频脉冲电位治疗骨科卧床患者便秘,疗效显著。可明显降低患者使用开塞露的比率,加强排便反射活动,提高排便频率,改善粪便性状,利于患者临床康复,值得在临床广泛推广应用。     

Inappropriate emergency department visits

Guidelines adopted in 1982 by the American College of Emergency Physicians were used to determine appropriate and inappropriate emergency department (ED) utilization patterns at three community hospitals during a two-week period in August 1983. In all, 3,130 visits were examined. There was an overall inappropriate visit rate of 10.8%, although considerable variation was observed among the three hospitals. Subgroups with the highest inappropriate visit rates included the following: 1) persons with Medicaid as the primary payment source (17.3%); 2) children aged 5 years or younger (15.2%); 3) those unable to identify a personal physician (14.1%); 4) unemployed persons (13.1%); 5) patients making visits during regular office hours (12.6%); and 6) those failing to attempt to contact their personal physicians (12.4%). These variations in inappropriate usage were all statistically significant at the P less than .05 level or better. Inability to identify a personal physician emerged as the most pervasive influence on inappropriate ED visit rates (P less than .001).