Allison Tadros

A Comparison of National Emergency Department Use by Homeless versus Non-Homeless People in the United States

Background. A single-site study described differences between homeless and non-homeless patient utilization of the emergency department (ED). No prior study has examined ED use by the homeless on a national level. Objective.To analyze national ED utilization by homeless patients. Methods. Data were extracted from the 2005 National Hospital Ambulatory Medical Care Survey. SAS callable SUDAAN was used to produce national estimates. Results. Of the 115 million visits to national EDs in 2005, 472,922 were made by homeless patients. In comparison with the non-homeless, these patients were more likely to arrive by ambulance and to be uninsured. Both groups had similar admission rates and triage urgency, with a trend toward increased diagnostic testing for homeless patients. Conclusion. Homeless patients who visited EDs in 2005 were more likely to arrive by ambulance despite similar triage urgency and admission rates compared with the non-homeless, and were less likely to be insured.

Predictors of Stroke During 9-1-1 Calls: Opportunities for Improving EMS Response

Objective. Only 31%–52% of stroke calls are accurately identified by 9-1-1 dispatchers according to prior studies. Recognizing the time-dependent nature of acute stroke, better identification of stroke patients at the time of their 9-1-1 calls may allow an improved prehospital response. We sought to identify any words/phrases that 9-1-1 dispatchers could use to identify more stroke calls. Methods. Potential stroke calls were identified from emergency medical services run sheets, andthe discharge diagnosis for each of these patients was obtained. The emergency medical services tapes were independently reviewed by two listeners who were blinded to the final diagnosis. Words/phrases previously associated with 9-1-1 stroke calls mentioned by the caller were recorded. Other pertinent words/phrases were also recorded. Using the final diagnosis of stroke as the gold standard, the sensitivity, specificity, andpositive likelihood ratio of each word andphrase were calculated. Cohens κ was calculated to assess interrater agreement. Data were collected for runs from October 2003 to July 2004. Results. A total of 176 tapes were reviewed (40 strokes, 136 nonstrokes). The presence of at least one of four criteria predicted 80% of all stroke calls: the word “stroke,” facial droop, weakness/fall, andimpaired communication. All criterion elements had very good interrater agreement (κ > 0.7). The word “stroke” was highly predictive of actual stroke (positive likelihood ratio, 2.27). Conclusions. The majority of stroke patients in this study could be identified by 9-1-1 dispatchers if the caller reported any one of the following four complaints: stroke, facial droop, weakness/fall, or impaired communication.

Emergency Medical Services-Based Community Stroke Education Pilot Results From a Novel Approach

Background and Purpose— Although previous studies using mass media have demonstrated successful public stroke awareness campaigns, they may have been too costly for smaller communities to implement. The goal of this study was to investigate if a novel emergency medical services (EMS) -sponsored community awareness campaign could increase public stroke awareness. Methods— This was a pre- and postintervention study with 2 phases conducted between August 2005 and July 2007. During Phase I, strategic placement of stroke education media by EMS personnel was implemented in one county over a 2-year period. Five random-digit, standardized phone surveys measuring stroke awareness were conducted with county residents to assess the campaign’s impact. In Phase II, EMS interventions and random-digit measurements were conducted in 4 additional counties with 4 counties randomly selected as controls. Results— A pattern of increasing stroke knowledge after exposure to the EMS intervention followed by declines in the absence of the intervention was observed during Phase I. EMS interventions also demonstrated a positive effect on the stroke knowledge of residents who lived in counties exposed to the intervention during Phase II with a statistically significant (P<0.05) increase observed in the proportion of respondents that named 2 stroke risk factors and 3 symptoms in comparison to either no changes or declines in the control counties. No evidence of a positive impact on knowledge of calling 911 for stroke was observed. Conclusion— Results of this study suggest that the public’s knowledge of stroke signs and symptoms was increased using communitywide EMS-based programs. Additional studies are needed to determine optimal methods for educating the public regarding the need to call 911 for stroke and to confirm these results in other locales.

National healthline responses to a stroke scenario: implications for early intervention.

Background and Purpose— Acute stroke is a time-dependent emergency in which patients often arrive outside of the therapeutic treatment windows. To determine the role that healthlines may have in promoting early presentation, this study evaluated patterns of healthline triage of potential stroke patients. Methods— Phone numbers of healthlines at 82 United States hospitals with neurology residencies were acquired. Each healthline was called and the operator was presented with a standardized scripted stroke patient scenario. The operator was asked to choose 1 of 4 responses that could be given to the patient (wait for symptom resolution, contact a primary care physician, drive to a local urgent care center, call 911 for ambulance transport). The operator was then asked to name common signs and symptoms of stroke. If the operator transferred the call, the process was repeated. Results— Forty-six healthlines participated, with 22% recommending that the patient contact a primary care physician. The remaining 78% recommended calling 911. Calls were transferred at least once in 18 cases, and 24% of the operators could not name 1 sign or symptom of stroke. Conclusions— Nearly one-quarter of potential stroke patients were routed away from emergent treatment for the described scenario. By diverting patients away from emergency therapy, patients are in jeopardy of “falling” out of the windows for therapy. Improved stroke education for healthline personnel may result in stroke patients arriving at an emergency department more urgently.

Emergency Visits for Prescription Opioid Poisonings

BACKGROUND Prescription opioid abuse and overdose has steadily increased in the United States (US) over the past two decades, and current research has shown a dramatic increase in hospitalizations resulting from opioid poisonings. Still, much is unknown about the clinical and demographic features of patients presenting to emergency departments (EDs) for poisoning from prescription drugs. OBJECTIVE We sought to evaluate ED visits by adults for prescription opioids. METHODS This was a retrospective cohort study utilizing 2006-2011 data from the Nationwide Emergency Department Sample. Total number of admissions (weighted), disposition, gender, age, expected payer, income, geographic region, charges, and procedures performed were examined. RESULTS From 2006 through 2010, there were 259,093 ED visits by adults for poisoning by opioids, and 53.50% of these were unintentional. The overall mean age of patients was 45.5 years, with more visits made by females (52.37%). Patients who unintentionally overdosed were more likely to have Medicare (36.54%), whereas those who intentionally overdosed had private insurance (29.41%). The majority of patients resided in the South (40.93%) and came from lower-income neighborhoods. Approximately 108,504 patients were discharged, and 140,395 were admitted. CONCLUSIONS There were over 250,000 visits to US EDs from 2006 through 2011 with a primary diagnosis of poisoning by a prescription opioid. Females made the majority of visits, and over half were admitted to the hospital, resulting in over

Emergency department visits by pediatric patients for poisoning by prescription opioids.

4 billion in charges. Future studies should examine preventative measures, optimal screening, and intervention programs for these patients.

Pediatric visits to United States Emergency Departments for alcohol-related disorders.

ABSTRACT Background: Prescription medication abuse is an increasingly recognized problem in the United States. As more opioids are being prescribed and abused by adults, there is an increased risk of both accidental and intentional exposure to children and adolescents. The impact of pediatric exposures to prescription pain pills has not been well studied. Objectives: We sought to evaluate emergency department (ED) visits for poisoning by prescription opioids in pediatric patients. Methods: This retrospective study looked at clinical and demographic data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2012. Results: There were 21,928 pediatric ED visits for prescription opioid poisonings and more than half were unintentional. There was a bimodal age distribution of patients, with slightly more than half occurring in females. The majority of patients were discharged from the ED. More visits in the younger age group (0–5 years) were unintentional, while the majority of visits in the adolescent age group (15–17 years) were intentional. Mean charge per discharge was

A 5-year comparison of ED visits by homeless and nonhomeless patients

1,840 and

Hospitalizations of Older Patients with Human Immunodeficiency Virus in the United States

14,235 for admissions and surmounted to over

Emergency department visits by pediatric patients sustained as a passenger on a motorcycle

81 million in total charges. Conclusion: Poisonings by prescription opioids largely impact both young children and adolescents. These findings can be used to help target this population for future preventive efforts.