Romesh Nalliah

Hospital-based emergency department visits involving dental conditions: Profile and predictors of poor outcomes and resource utilization

BACKGROUND Untreated dental conditions may progress to lesions that are severe enough to necessitate emergency visits to hospitals. The authors conducted a study to investigate nationally representative trends in U.S. hospital-based emergency department (ED) visits involving dental conditions and to examine patient-related characteristics associated with ED charges. METHODS The authors used the Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality, for the years 2008 through 2010. They selected all ED visits involving patients with a diagnosis of either dental caries, pulpal or periapical lesions, gingival or periodontal conditions, or mouth cellulitis or abscess. Outcomes examined included post-ED disposition status and hospital ED charges. RESULTS During the study period, 4,049,361 ED visits involved diagnosis of a dental condition, which is about 1 percent of all ED visits occurring in the entire United States. Uninsured patients made about 40.5 percent of all dental condition-related ED visits. One hundred one patients in the study died in EDs. The mean hospital ED charge per visit was approximately

Hospital based emergency department visits attributed to dental caries in the United States in 2006.

760 (adjusted to 2010 dollars), and the total ED charges across the entire United States during the three-year study period was

Hospital Emergency Department Visits Attributed to Pulpal and Periapical Disease in the United States in 2006

2.7 billion. CONCLUSIONS Patients without insurance are a cohort at high risk of seeking dental care in hospital-based ED settings. A substantial amount of hospital resources are used to treat dental conditions in ED settings. Patients with mouth cellulitis, periodontal conditions and numerous comorbidities are likely to incur higher ED charges. PRACTICAL IMPLICATIONS Dental conditions can be treated more effectively in a dental office setting than in hospital-based settings.

Effect of occurrence of infection-related never events on length of stay and hospital charges in patients undergoing radical neck dissection for head and neck cancer.

OBJECTIVE There is a paucity of published studies presenting nationally representative estimates on hospital-based emergency department visits primarily attributed to dental caries. The objective of this study is to provide estimates of hospital-based emergency department visits attributed to dental caries in the United States. METHODS The Nationwide Emergency Department Sample, a component of the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality, was used for this study. All emergency department visits attributable to dental caries were identified using ICD-9-CM diagnoses codes and selected for analysis. Outcomes including hospital charges and length of stay in hospital were examined. Simple descriptive statistics were used to summarize the data. RESULTS This study found that in 2006, a total of 330,757 visits to hospital-based emergency departments occurred in the United States. The total charges were

Economics of facial fracture reductions in the United States over 12 months.

110 million. Approximately 45% of all visits by adults occurred among the uninsured. Medicaid was the most common payer for all visits by children, accounting for nearly 53% of all visits. About 38% of visits occurred among those residing in low-income areas. Hospitalization was required for 158 visits. CONCLUSIONS This study provides nationwide estimates of hospital-based emergency department visits attributed to dental caries in the United States. The uninsured constituted the greatest proportion of emergency department visits among adults, whereas Medicaid was the major payer for children visiting the emergency departments.

Firearm related injuries amongst children: Estimates from the nationwide emergency department sample

BACKGROUND Relatively localized conditions such as infection of the pulp or periapical tissues if left untreated could spread and require hospital care. The objectives of this study were to assess the prevalence of such hospital-based emergency department (ED) visits, to quantify hospital charges associated with those visits, and to identify characteristics of those members of the population who are likely to make such visits. METHODS The experimental design of this study involves the use of The Nationwide Emergency Department Sample for the year 2006. All discharges with a primary diagnosis code for pulpal and periapical diseases (International Classification of Disease, Clinical Modification [ICD-9-CM] code of 522) were selected for analysis. All estimates were projected to national levels using the discharge weight variables. RESULTS In the United States, during the year 2006, a total of 403,149 ED visits had a primary diagnosis code for pulp and periapical diseases. The average patient age was 32.9 years. The mean hospital charge for ED visits was

Outcomes in Patients Hospitalized for Periapical Abscess in the United States

480, and the total charges for all the ED visits in the United States was

Prevalence and impact of complications on outcomes in patients hospitalized for oral and oropharyngeal cancer treatment

163,692,957. Among the ED visits, 5,721 were admitted to the same hospital for inpatient care. The mean length of stay after hospitalization was 2.95 days. The uninsured (39.92%) constituted the largest proportion of all ED visits. CONCLUSIONS This study identifies high-risk groups that are likely to present to hospital-based EDs for the treatment of pulp and periapical diseases. This highlights the need for significant resources to treat such patients in a hospital care setting.

Emergency Department Visits With Facial Fractures Among Children and Adolescents: An Analysis of Profile and Predictors of Causes of Injuries

OBJECTIVE To estimate the impact of infection-related never events (postoperative pneumonia, Clostridium difficile infection, infection with microorganisms resistant to penicillin, postoperative infections, and decubitus ulcers) following radical neck dissections for head and neck cancers. STUDY DESIGN The 2008 Nationwide Inpatient Sample was used to select hospitalizations with HNC that underwent radical neck dissections. Predictor variables were occurrence of never events and other patient- and hospital-level factors. Outcome variables were hospitalization charges and length of stay (LOS). Regression analyses were used to measure the association between predictors and outcomes. RESULTS Among 10,660 hospitalizations, prevalence of never events ranged from 0.2% to 5.0%. Mean hospitalization charge and LOS were

Outcomes in Patients Visiting Hospital Emergency Departments in the United States Because of Periodontal Conditions

75,654 and 6.8 days, respectively. Never events were associated with 5.6-10.0 longer LOS and