Editor’s note: The Hong Kong Journal of Emergency Medicine has partnered with a small group of selected journals of international emergency medicine societies to share from each a highlighted research study, as selected monthly by their editors. Our goals are to increase awareness of our readership to research developments in the international emergency medicine literature, promote collaboration among the selected international emergency medicine journals, and support the improvement of emergency medicine worldwide, as described in the WAME statement at http://www.wame.org/about/policy-statements#Promoting%20Global%20Health. Abstracts are reproduced as published in the respective participating journals and are not peer reviewed or edited by the Hong Kong Journal of Emergency Medicine.
African Journal of Emergency Medicine
The official journal of the African Federation for Emergency Medicine, the Emergency Medicine Association of Tanzania, the Emergency Medicine Society of South Africa, the Egyptian Society of Emergency Medicine, the Libyan Emergency Medicine Association, the Ethiopian Society of Emergency Medicine Professionals, the Sudanese Emergency Medicine Society, the Society of Emergency Medicine Practitioners of Nigeria, and the Rwanda Emergency Care Association
(The print version of this article has been scheduled for July 2023)
Emergency center patients in the Democratic Republic of Congo: some epidemiological and clinical aspects at Beni General Referral Hospital
Katsioto AK, Muhesi PK, Isombi JP, Kambere PK, Sikakulya FK
Afr J Emerg Med 2023; 12(4): 307–314
https://doi.org/10.1016/j.afjem.2023.01.001
Introduction: Little information is available regarding the characteristics of patients attending the emergency center (EC) in the Democratic Republic of Congo. This study aims to provide some epidemiological and clinical aspects of patients admitted to the emergency center at Beni General Referral Hospital.
Methodology: For a year, from January to December 2021, a cross-sectional study was conducted. Data regarding patients’ characteristics, admission modality, stay duration, reason for admission, and discharge modality were anonymously collected from patients’ registers. A descriptive analysis was done with Epi-Info 7.
Result: A total of 1404 patients were admitted to the EC, with a male-to-female ratio of 1.2 to 1. The age group below 18 years accounted for 35.4%. Most of the patients (75.7%) originated from urban areas. In 83% of cases, there was no recommendation from another medical facility for EC admission. The most common reasons for admission are non-traumatic gathering on top of neuropsychiatric and non-specific symptoms. Road traffic accidents are the most frequent causes of trauma symptoms. Few patients (14.7%) spent less than 12 h in the EC. Globally, 7.3% of patients admitted to the EC were discharged after being managed, and 89% were transferred to different wards. The intra-emergency center mortality rate was 11.8% among admitted patients in the emergency room (ER) at Beni General Referral Hospital.
Conclusion: This epidemiology database underlines the need for developing globalizing and multi-sectoral interventions (diagnosis, therapeutic strategy, organization, health program, or health policies) in the perspective of bringing change and/or taking action in the Democratic Republic of Congo’s emergency medical system.
Reproduced with permission
Annals of Emergency Medicine
(The print version of this article has been scheduled for July 2023)
Frailty and neurological outcomes of patients resuscitated from non-traumatic out-of-hospital cardiac arrest: a prospective observational study
Ryo Yamamoto, Tomoyoshi Tamura, Akina Haiden, Jo Yoshizawa, Koichiro Homma, Nobuya Kitamura, Kazuhiro Sugiyama, Takashi Tagami, Hideo Yasunaga, Shotaro Aso, Munekazu Takeda, Junichi Sasaki, On Behalf of the SOS-KANTO 2017 Study Group
Study objective: To elucidate the clinical utility of the Clinical Frailty Scale score for predicting poor neurologic functions in patients resuscitated from out-of-hospital cardiac arrest (OHCA).
Methods: This was a prospective, multicenter, observational study conducted between 2019 and 2021. The study included adults with non-traumatic OHCA admitted to the intensive care unit after return of spontaneous circulation (ROSC). Pre-arrest high Clinical Frailty Scale score was defined as 5 or more. Favorable neurologic outcomes defined as a Cerebral Performance Category score of 2 or less at 30 days after admission were compared between patients with and without high Clinical Frailty Scale scores. Multivariable logistic regression analyses fitted with generalized estimating equations were performed to adjust for patient characteristics, out-of-hospital information, and resuscitation content and account for within-institution clustering.
Results: Of the 9909 patients with OHCA during the study period, 1216 were included and 317 had a pre-arrest high Clinical Frailty Scale score. Favorable neurologic outcomes were fewer among patients with high Clinical Frailty Scale scores. The high Clinical Frailty Scale score group showed a lower percentage of favorable neurologic outcomes after OHCA than the low Clinical Frailty Scale score group (6.1% vs 24.4%; adjusted odds ratio, 0.45 (95% confidence interval: 0.22–0.93)). This relationship remained in subgroups with cardiogenic OHCA, with ROSC after hospital arrival, and without a high risk of dying (Clinical Frailty Scale score of 7 or less), whereas the neurologic outcomes were comparable regardless of the pre-arrest frailty in those with noncardiogenic OHCA and with ROSC before hospital arrival.
Conclusion: Pre-arrest high Clinical Frailty Scale score was associated with unfavorable neurologic functions among patients resuscitated from OHCA. The Clinical Frailty Scale score would help predict clinical consequences following intensive care after ROSC.
How to cite this article:
Yamamoto R, Tamura T, Haiden A, et al. Frailty and neurological outcomes of patients resuscitated from non-traumatic out-of-hospital cardiac arrest: a prospective observational study. Ann Emerg Med 2023. DOI: 10.1016/j.annemergmed.2023.02.009.
(The print version of this article has been scheduled for August 2023)
Clinical and laboratory predictors of dehydration severity in children with diabetic ketoacidosis
Jennifer L Trainor, Nicole S Glaser, Leah Tzimenatos, Michael J Stoner, Kathleen M Brown, Julie K McManemy, Jeffrey E Schunk, Kimberly S Quayle, Lise E Nigrovic, Arleta Rewers, Sage R Myers, Jonathan E Bennett, Maria Y Kwok, Cody S Olsen, T Charles Casper, Simona Ghetti, Nathan Kuppermann, On Behalf of the Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group
Study objective: Our primary objective was to characterize the degree of dehydration in children with diabetic ketoacidosis (DKA) and identify physical examination and biochemical factors associated with dehydration severity. Secondary objectives included describing relationships between dehydration severity and other clinical outcomes.
Methods: In this cohort study, we analyzed data from 753 children with 811 episodes of DKA in the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation Study, a randomized clinical trial of fluid resuscitation protocols for children with DKA. We used multivariable regression analyses to identify physical examination and biochemical factors associated with dehydration severity, and we described associations between dehydration severity and DKA outcomes.
Results: Mean dehydration was 5.7% (SD 3.6%). Mild (0 to <5%), moderate (5% to <10%), and severe (⩾10%) dehydration were observed in 47% (N = 379), 42% (N = 343), and 11% (N = 89) of episodes, respectively. In multivariable analyses, more severe dehydration was associated with new onset of diabetes, higher blood urea nitrogen, lower pH, higher anion gap, and diastolic hypertension. However, there was substantial overlap in these variables between dehydration groups. The mean length of hospital stay was longer for patients with moderate and severe dehydration, in both new-onset and established diabetes.
Conclusion: Most children with DKA have mild-to-moderate dehydration. Although biochemical measures were more closely associated with the severity of dehydration than clinical assessments, neither were sufficiently predictive to inform rehydration practice.
How to cite this article:
Trainor JL, Glaser NS, Tzimenatos L, et al. Clinical and laboratory predictors of dehydration severity in children with diabetic ketoacidosis. Ann Emerg Med 2023. DOI: 10.1016/j.annemergmed.2023.01.001.
Canadian Journal of Emergency Medicine
http://caep.ca/resources/cjem/
(The print version of this article has been scheduled for July 2023)
A value-based comparison of the management of respiratory diseases in walk-in clinics and emergency departments
Tania Marx, Lynne Moore, Denis Talbot, Jason R Guertin, Philippe Lachapelle, Sébastien Blais, Narcisse Singbo, David Simonyan, Jeanne Lavallée, Nawid Zada, Shaghayegh Shahrigharahkoshan, Benoit Huard, Pascale Olivier, Myriam Mallet, Mélanie Létourneau, Michel Lafrenière, Patrick M Archambault, Simon Berthelot
Cite this article:
Marx T, Moore L, Talbot D, et al. A value-based comparison of the management of respiratory diseases in walk-in clinics and emergency departments. Can J Emerg Med 2023. DOI: 10.1007/s43678-023-00481-7.
Objectives: Our aim was to compare some of the health outcomes and costs associated with value of care in emergency departments (EDs) and walk-in clinics for ambulatory patients presenting with an acute respiratory disease.
Methods: A health records review was conducted from April 2016 through March 2017 in one ED and one walk-in clinic. Inclusion criteria were (1) ambulatory patients at least 18 years old and (2) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Primary outcome was the proportion of patients returning to any ED or walk-in clinic within 3 and 7 days of the index visit. Secondary outcomes were the mean cost of care and the incidence of antibiotic prescription for URTI patients. The cost of care was estimated from the Ministry of Health’s perspectives using time-driven activity-based costing.
Results: The ED group included 170 patients and the walk-in clinic group 326 patients. The return visit incidences at 3 and 7 days were, respectively, 25.9% and 38.2% in the ED versus 4.9% and 14.7% in the walk-in clinic (adjusted relative risk (aRR) of 4.7 (95% confidence interval [CI]: 2.6–8.6) and 2.7 (1.9–3.9)). The mean cost ($Cdn) of the index visit care was 116.0 (106.3–125.7) in the ED versus 62.5 (57.7–67.3) in the walk-in clinic (mean difference of 56.4 (45.7–67.1)). Antibiotic prescription for URTI was 5.6% in the ED versus 24.7% in the walk-in clinic (ARR: 0.2, 0.01–0.6).
Conclusion: This study is the first in a larger research program to compare the value of care between walk-in clinics and the ED. The potential advantages of walk-in clinics over EDs (lower costs, lower incidence of return visits) for ambulatory patients with respiratory diseases should be considered in healthcare planning.
Keywords: Value of care, health outcomes, respiratory diseases, outpatient visit, emergency department
Emergencias
(The print version of this article has been scheduled for July 2023)
Safety and efficiency of discharge to home hospitalization of patients with acute heart failure directly after emergency department care
Carolina Sánchez Marcos, Begoña Espinosa Emmanuel Coloma, David San Inocencio, Sonja Pilarcikova, Sergio Guzmán Martínez, Mariona Ramon, Alejandro Carratalá Ballesta, Omar Saavedra, Nicole Ivars Obermeier, Ernest Bragulat, Adriana Gil-Rodrigo, Ainoa Ugarte, Pere Llorens, Òscar Miró
Cited: Sánchez Marcos C, Espinosa B, Coloma E, et al. Safety and efficiency of discharge to home hospitalization of patients with acute heart failure directly after emergency department care. Emergencias. DOI: 891.
http://emergencias.portalsemes.org/descargar/anlisis-de-seguridad-y-eficiencia-de-la-hospitalizacin-a-domicilio-directamente-desde-urgencias-en-pacientes-con-insuficiencia-cardiaca-aguda/
Objectives: To analyze whether discharge to home hospitalization (HHosp) directly from emergency departments (EDs) after care for acute heart failure (AHF) is efficient and whether there are short-term differences in outcomes between patients in HHosp versus those admitted to a conventional hospital ward (CHosp).
Methods: Secondary analysis of cases from the EAHFE registry (Epidemiology of Acute Heart Failure in Emergency Departments). The EAHFE is a multicenter, multipurpose, analytical, non-interventionist registry of consecutive AHF patients after treatment in EDs. Cases were included retrospectively and registered to facilitate prospective follow-up. Included were all patients diagnosed with AHF and discharged to HHosp from two EDs between March 2016 and February 2019 (3 years). Cases from 6 months were analyzed in three periods: March–April 2016 (corresponding to EAHFE-5), January–February 2018 (EAHFE-6), and January–February 2019 (EAHFE-7). The findings were adjusted for characteristics at baseline and during the AHF decompensation episode.
Results: A total of 370 patients were discharged to HHosp and 646 to CHosp. Patients in the HHosp group were older and had more comorbidities and worse baseline functional status. However, the decompensation episode was less severe, triggered more often by anemia and less often by a hypertensive crisis or acute coronary syndrome. The HHosp patients were in care longer (median [interquartile range], 9 [7–14] days vs 7 [5–11] days for CHosp patients, p < 0.001), but there were no differences in mortality during hospital care (7.0% vs 8.0%, p = 0.56), 30-day adverse events after discharge from the ED (30.9% vs 32.9%, p = .31), or 1-year mortality (41.6% vs 41.4%, p = 0.84). Risks associated with HHosp care did not differ from those of CHosp. The odds ratios (ORs) were as follows: mortality while in hospital care, OR = 0.90 (95% CI, 0.41–1.97); adverse events within 30 days of ED discharge, OR = 0.88 (95% CI, 0.62–1.26); and 1-year mortality, OR = 1.03 (95% CI, 0.76–1.39). Direct costs of HHosp and CHosp averaged €1309 and €5433, respectively.
Conclusion: After ED treatment of AHF, discharge to HHosp requires longer care than CHosp, but short- and long-term outcomes are the same and at a lower cost.
Keywords: Acute heart failure, mortality, emergency health services, home hospitalization
(The print version of this article has been scheduled for August 2023)
Impact of emergency department management of isolated superficial vein thrombosis of the lower limbs: a secondary analysis of data from the ALTAMIRA study
Fahd Beddar Chaib, Sònia Jiménez Hernández, José María Pedrajas Navas, Ramón Lecumberri, Leticia Guirado Torrecillas, Héctor Alonso Valle, Susana Diego Roza, Vanesa Sendín Martín, Maria Angélica Rivera Núñez, Jorge Pedraza García, Daniel Sánchez Díaz-Canel, Pedro Ruiz Artacho, en representación del Grupo de Enfermedad Tromboembólica Venosa de la Sociedad Española de Medicina de Urgencias y Emergencias (ETV-SEMES)
Cited: Beddar Chaib F, Jiménez Hernández S, Pedrajas Navas JM, et al. Impact of emergency department management of isolated superficial vean thrombosis of the lower limbs: a secondary analysis of data from the ALTAMIRA study. Emergencias 2023;35:109–16.
http://emergencias.portalsemes.org/descargar/impacto-del-manejo-en-urgencias-en-la-evolucin-de-los-pacientes-con-trombosis-venosa-superficial-aislada-de-miembros-inferiores-subanlisis-del-estudio-altamira/
Objectives: To describe the management of superficial vein thrombosis (SVT) of the lower limbs in patients treated in Spanish hospital emergency departments (EDs). To evaluate the impact of ED management of venous thromboembolic complications on outcomes and to determine the characteristics of patients who develop complications.
Methods: The retrospective multicenter ALTAMIRA study (Spanish acronym for risk factors, complications, and assessment of Spanish ED management of SVT) used recorded data for consecutive patients with a diagnosis of isolated SVT treated in 18 EDs. We gathered data on symptomatic venous thromboembolic disease (deep vein thrombosis, pulmonary embolism, or the extension or recurrence of SVT), clinically significant bleeding, and 180-day mortality. Cox regression analysis was used to explore variables associated with complications.
Results: A total of 703 patients were included. Anticoagulation was prescribed for 84.1% of the patients for a median of 30 days (interquartile range, 15–42 days), and 81.3% were treated with low-molecular-weight heparin. A prophylactic dose was prescribed for 48% and an intermediate therapeutic dose for 52%. Sixty-four patients (9.2%) developed symptomatic thromboembolic disease within 180 days, 12 (1.7%) experienced clinically significant bleeding, and 4 (0.6%) died. Complications developed later in patients receiving anticoagulant therapy than in those not taking an anticoagulant (66 vs 11 days, p = 0.009), and 76.6% of those developing complications were not on anticoagulant when symptoms appeared. A history of thromboembolic disease was associated with developing complications (adjusted hazard ratio, 2.20; 95% confidence interval, 1.34–3.62).
Conclusion: ED treatment of SVT varies and is often suboptimal. The incidence of thromboembolic complications after SVT is high. Starting anticoagulation in the ED delays the development of complications. Patients with a history of thromboembolic disease are more at risk of complications.
Keywords: Venous thrombosis, superficial, venous thromboembolic disease, emergency department
Emergency Medicine Journal
(The print version of this article has been scheduled for July 2023)
Evaluating the impact of a pulse oximetry remote monitoring program on mortality and healthcare utilization in patients with COVID-19 assessed in emergency departments in England: a retrospective matched cohort study
Beaney T, Clarke J, Alboksmaty A, Flott K, Fowler A, Benger J, Aylin PP, Elkin S, Darzi A, Neves AL
Background: To identify the impact of enrollment on a national pulse oximetry remote monitoring program for COVID-19 (COVID-19 Oximetry @home; CO@h) on health service use and mortality in patients attending emergency departments (EDs).
Methods: We conducted a retrospective matched cohort study of patients enrolled onto the CO@h pathway from EDs in England. We included all patients with a positive COVID-19 test from 1 October 2020 to 3 May 2021 who attended ED from 3 days before to 10 days after the date of the test. All patients who were admitted or died on the same or following day to the first ED attendance within the time window were excluded. In the primary analysis, participants enrolled onto CO@h were matched using demographic and clinical criteria to participants who were not enrolled. Five outcome measures were examined within 28 days of first ED attendance: (1) death from any cause; (2) any subsequent ED attendance; (3) any emergency hospital admission; (4) critical care admission; and (5);ength of stay.
Results: In all, 15,621 participants were included in the primary analysis, of whom 639 were enrolled onto CO@h and 14,982 were controls. Odds of death were 52% lower in those enrolled (95% confidence interval (CI), 7%–75%) compared with those not enrolled onto CO@h. Odds of any ED attendance or admission were 37% (95% CI, 16%–63%) and 59% (95% CI, 32%–91%) higher, respectively, in those enrolled. Of those admitted, those enrolled had 53% (95% CI, 7%–76%) lower odds of critical care admission. There was no significant impact on length of stay.
Conclusion: These findings indicate that for patients assessed in ED, pulse oximetry remote monitoring may be a clinically effective and safe model for early detection of hypoxia and escalation. However, possible selection biases might limit the generalizability to other populations.
