Prediction of sepsis within 24 hours at the triage stage in emergency departments using machine learning

BACKGROUND:Sepsis is one of the main causes of mortality in intensive care units(ICUs).Early prediction is critical for reducing injury.As approximately 36%of sepsis occur within 24 h after emergency department(ED)admission in Medical Information Mart for Intensive Care(MIMIC-IV),a prediction system for the ED triage stage would be helpful.Previous methods such as the quick Sequential Organ Failure Assessment(qSOFA)are more suitable for screening than for prediction in the ED,and we aimed to fi nd a light-weight,convenient prediction method through machine learning.METHODS:We accessed the MIMIC-IV for sepsis patient data in the EDs.Our dataset comprised demographic information,vital signs,and synthetic features.Extreme Gradient Boosting(XGBoost)was used to predict the risk of developing sepsis within 24 h after ED admission.Additionally,SHapley Additive exPlanations(SHAP)was employed to provide a comprehensive interpretation of the model's results.Ten percent of the patients were randomly selected as the testing set,while the remaining patients were used for training with 10-fold cross-validation.RESULTS:For 10-fold cross-validation on 14,957 samples,we reached an accuracy of 84.1%±0.3%and an area under the receiver operating characteristic(ROC)curve of 0.92±0.02.The model achieved similar performance on the testing set of 1,662 patients.SHAP values showed that the fi ve most important features were acuity,arrival transportation,age,shock index,and respiratory rate.CONCLUSION:Machine learning models such as XGBoost may be used for sepsis prediction using only a small amount of data conveniently collected in the ED triage stage.This may help reduce workload in the ED and warn medical workers against the risk of sepsis in advance.

Trends in oxycodone and oxycodone-containing analgesics administration for back pain in emergency departments in the USA(2007–2018)

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period.RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in 2018.CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.

Epidemiology of shoulder dislocations presenting to United States emergency departments:An updated ten-year study

BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.

Availability and quality of procedural sedation and analgesia in emergency departments without emergency physicians: A national survey in the Netherlands

BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.

A Profile of Traumatic Brain Injury within Hospital Emergency Departments—A Retrospective Study in the Republic of Moldova

Background: Traumatic brain injury (TBI) is a critical public health and socio-economic problem throughout the world, making epidemiological monitoring of incidence, prevalence, and outcome of TBI necessary. TBI is a major cause of mortality and morbidity in adolescents, young adults, and the elderly, one of the leading causes being road traffic accidents. Methods: A retrospective study was conducted among patients with TBI within 2 medical institutions in Chisinau municipality: Emergency Medicine Institute (EMI) and Valentin Ignatenco Municipal Children’s Hospital (MCH). A questionnaire was applied, completed on the basis of medical records according to the International Classification of Diseases (ICD) 10 codes. The collection period was August 1-October 31, 2018. Data were uploaded using the existing electronic data collection tool—Red Cap and analyzed through Microsoft Excel. Data collection was performed by a resident neurosurgery and a scientific researcher. The ethics committee’s approval has been obtained. Results: There have been identified 150 patients: 57 cases (38.5%) of TBI among children and 93 cases (61.5%) among adults aged between 18 - 73 years old. A large majority (62%) of head injuries were among patients from the urban area (most in adults—60% and males—74%). The most common mechanisms of head injury were falls (53.3%) and road traffic injuries (24%), followed by assault (14.7%) and struck by/or against (8%). The distributions by place of occurrence highlighted that most injuries occurred at home (33.4%) and in transport area (25.3%). Most head injuries were registered among men 121 (81.2%) with a predominance of minor Glasgow Coma Scale (GCS) (65.1%), followed by moderate GCS (9.4%), while in women all cases with GCS minor (18.8%). Conclusion: The data obtained could be useful for the hospital administration in managing the necessary resources and for conducting information campaigns among the high-risk groups.

Development and Validation of the Japanese Version of a Job Stressor Scale for Triage Nurses in Emergency Departments

Background: With an increasing number of patients who visit emergency outpatient units, a shortage of physicians and nurses in emergency units has become an issue in Japan. Triage nurses who interview patients and their families before medical examinations feel stressed to determine the triage level in a limited time, necessitating the measures to alleviate stressors. Objective: To develop a triage nurse job stressor scale (TNJSS) for Japanese triage nurses in emergency outpatient units and to verify the reliability and validity of this scale. Methods: Anonymous, self-administered questionnaires were sent to nursing directors of 180 emergency and critical care centers randomly selected from 251 centers throughout Japan, requesting to distribute the questionnaire to nurses. Results: Based on the responses obtained from 363 nurses, the construct validity, internal consistency, and criterion-related validity were verified. A factor analysis of 44 items yielded five factors: “Lack of triage ability”, “Busy triage work”, “Patients without understanding of explanations”, “Complaints from patients waiting for treatment”, and “Lack of support to improve triage ability”. Cronbach’s α was 0.93 for the full scale and significant correlations were observed between the nurses’ stressor scores and scores for the Stress Response Scale-18 (r = 0.409;p < 0.01) and for the Nursing Job Stressor Scale (r = 0.410;p < 0.01). Conclusions: The TNJSS with a five-factor structure containing 44 items was determined to be a reliable and valid tool for evaluating Japanese triage nurse job stressors. The findings suggest the necessity to continuously educate and support triage nurses.

Evaluating the management of anaphylaxis in US emergency departments:Guidelines vs.practice

BACKGROUND:Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting.Current guidelines recommend:1) quick diagnosis using standard criteria;2) first-line treatment with epinephrine;and 3) discharge with a prescription for an epinephrine auto-injector,written instructions regarding long-term management,and a referral(preferably,allergy) for follow-up.However,studies suggest low concordance with guideline recommendations by emergency medicine(EM) providers.The study aimed to evaluate how emergency departments(EDs) in the United States(US) manage anaphylaxis in relation to guideline recommendations.METHODS:This was an online anonymous survey of a random sample of EM health providers in US EDs.RESULTS:Data analysis included 207 EM providers.For respondent EDs,approximately 9%reported using agreed-upon clinical criteria to diagnose anaphylaxis;42%reported administering epinephrine in the ED for most anaphylaxis episodes;and <50%provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge.Most provided some written materials,and follow-up with a primary care clinician was recommended.CONCLUSIONS:This is the first cross-sectional survey to provide "real-world" data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis,treatment,and follow-up of patients with anaphylaxis.The primary gaps are low(or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine.Prospective research is recommended.

Utilization of the Accident & Emergency Departments by Chinese elderly in Hong Kong

BACKGROUND: The epidemiological data on elderly patients attending Accident and Emergency Departments(AEDs) in Hong Kong is lacking. The study aimed to examine the epidemiology of geriatric patient visits to AEDs in Hong Kong, including demographic data and predictors of life-saving interventions(LSI) and admission.METHODS: A retrospective cross-sectional study of geriatric patients older than 64 years old attending three AEDs during the year 2012, with a sample of 1 200 patient visits recruited. The data were retrieved from the medical records of the respective hospitals. Descriptive characteristics of the visits were provided. Multivariate logistic regression was performed to evaluate the predictors of LSI and hospital admission.RESULTS: The mean age of the patients was 79.1 years. Totally 49.7% of the patients were male. "Diseases of the respiratory system" was the commonest diagnosis in AEDs as well as that required admission. The admission rate was 56.8%. Logistic regression demonstrated that dependent activity of daily living(ADL), arrival by ambulance, and the higher number of co-morbidities were predictors of LSI, while advanced age, dependent ADL, institutionalized patients, arrival by ambulance, and higher number of co-morbidities were predictors of hospital admission.CONCLUSIONS: Ageing population is creating an imminent burden on the emergency service in Hong Kong. Previously unavailable epidemiological information about geriatric attendance to AEDs was described. This forms the basis for development of future studies concerning the medical services on this specific group of patients.

Correlation between crowdedness in emergency departments and anxiety in Chinese patients

BACKGROUND Emergency department(ED)overcrowding is a severe health care concern,while anxiety and depression rates among ED patients have been reported to be substantially higher compared to the general population.We hypothesized that anxiety due to over crowdedness may lead to adverse events in EDs.AIM To investigate correlations between crowdedness in EDs and anxiety of patients and nurses,and to identify factors affecting their anxiety.METHODS In this prospective observational study,a total 43 nurses and 389 emergency patients from two tier III hospitals located in Beijing were included from January 2016 to August 2017.Patients were grouped into inpatients when they were hospitalized after diagnoses,or into outpatients when they were discharged after treatments.The State Trait Anxiety Inventory(STAI Form Y)questionnaire was used to investigate patient and nurse anxieties,while crowdedness of EDs was evaluated with the National Emergency Department Over Crowding Score.RESULTS The present results revealed that state anxiety scores(49.50±6.00 vs 50.80±2.80,P=0.005)and trait anxiety scores(45.40±5.70 vs 46.80±2.70,P=0.002)between inpatients(n=173)and outpatients(n=216)were significantly different,while the state anxiety of nurses(44.70±5.80)was different from those of both patient groups.Generalized linear regression analysis demonstrated that multiple factors,including crowdedness in the ED,were associated with state and trait anxieties for both inpatients and outpatients.In addition,there was an interaction between state anxiety and trait anxieties.However,multivariable regression analysis showed that while overcrowding in the ED did not directly correlate with patients’and nurses’anxiety levels,the factors that did correlate with state and trait anxieties of inpatients were related to crowdedness.These factors included waiting time in the ED,the number of patients treated,and the number of nurses in the ED,whereas for nurses,only state and trait anxieties correlated significantly with each other.CONCLUSION Waiting time,the number of patients treated,and the number of nurses present in the ED correlate with patient anxiety in EDs,but crowdedness has no effect on nurse or patient anxiety.

Infected aortic and iliac aneurysms:Clinical manifestations in the emergency departments of two hospitals in southern Taiwan,China

BACKGROUND: Accurate diagnosis of infected aortic and iliac aneurysms is often delayed, hampering timely treatment and potentially resulting in a fatal consequence. The aim of this study was to discover useful clinical features that can help physicians to identify these patients.METHODS: We reviewed the discharge notes from two hospitals and identifi ed all patients who had a diagnosis of infected aneurysms of the thoracoabdominal aorta and iliac arteries between July 2009 and December 2013. Eighteen patients, aged from 41 to 93, were reviewed. Only 6 patients were diagnosed accurately in their fi rst visit to our ED.RESULTS: Most patients had at least one underlying illness, and it took 1 to 30(9.9±6.5) days for physicians to diagnose their infected aneurysm. Localized pain and fever were the two most commonly presented symptoms. The majority(92%) of isolated microorganisms were gram-negative bacilli, including Salmonella spp, Klebsiella pneumoniae, and Escherichia coli. Two of the 3 patients who underwent non-operative therapy died, and all of the patients who underwent a combination of medical and operative therapies survived.CONCLUSION: We suggest that physicians liberally use computed tomography scans on patients with unknown causes of pain and inflammatory processes. A combination of surgical and medical treatments is indicated for all patients with infected aortic and iliac aneurysms.

Language affects length of stay in emergency departments in Queensland public hospitals

BACKGROUND:A long length of stay(LOS) in the emergency department(ED) associated with overcrowding has been found to adversely affect the quality of ED care.The objective of this study is to determine whether patients who speak a language other than English at home have a longer LOS in EDs compared to those whose speak only English at home.METHODS:A secondary data analysis of a Queensland state-wide hospital EDs dataset(Emergency Department Information System) was conducted for the period,1 January 2008 to 31 December 2010.RESULTS:The interpreter requirement was the highest among Vietnamese speakers(23.1%)followed by Chinese(19.8%) and Arabic speakers(18.7%).There were significant differences in the distributions of the departure statuses among the language groups(Chi-squared=3236.88,P<0.001).Compared with English speakers,the Beta coefficient for the LOS in the EDs measured in minutes was among Vietnamese,26.3(95%Cl:22.1-30.5);Arabic,10.3(95%Cl:7.3-13.2);Spanish,9.4(95%CI:7.1-11.7);Chinese,8.6(95%Cl:2.6-14.6);Hindi,4.0(95%Cl:2.2-5.7);Italian,3.5(95%Cl:1.6-5.4);and German,2.7(95%Cl:1.0-4.4).The final regression model explained 17%of the variability in LOS.CONCLUSION:There is a close relationship between the language spoken at home and the LOS at EDs,indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding in EDs in Queensland's public hospitals.

Efficient Model for Emergency Departments:Real Case Study

There are several challenges that hospitals are facing according to the emergency department(ED).Themain two issues are department capacity and lead time.However,the lack of consensus on performance criteria to evaluateEDincreases the complication of this process.Thus,this study aims to evaluate the efficiency of the emergency department in 20 Egyptian hospitals(12 private and 8 general hospitals)based on 13 performance metrics.This research suggests an integrated evaluation model assess ED under a framework of plithogenic theory.The proposed framework addressed uncertainty and ambiguity in information with an efficient manner via presenting the evaluation expression by plithogenic numbers.Data Envelopment Analysis(DEA)technique is used in order to measure the efficiency of the emergency department of 20 hospitals according to the number of treated patients and effect on patient’s life quality based on 11 factors.Using the Analytic Hierarchy Process(AHP),the weight of efficiency factors will be measured based on neutrosophic linguistic scale pairwise comparison.Plithogenic operations provide more accurate aggregation result according to contradiction degree between criteria values.The results show that ten of the hospitals are providing efficient service in their emergency department,while the other ten are less efficient.The analysis of the results shows that 58%of private hospitals emergency department is operating efficiently,while the efficient general hospitals represent 38%.

Immigrants and the utilization of hospital emergency departments

BACKGROUND：Immigrants with language barriers are at high risk of having poor access to health care services. However, several studies have indicated that immigrants tend to use emergency departments （EDs） as their primary source of care at the expense of primary care. This may place an additional burden on already overcrowded EDs and lead to a low level of patient satisfaction with ED care. The study was to review if immigrants utilize ED care differently from host populations and to assess immigrants＇ satisfaction with ED care. METHODS：Studies about immigrants＇ utilization of EDs in Australia and worldwide were reviewed.RESULTS：There are conflicting results in the literature about the pattern of ED care use among immigrants. Some studies have shown higher utilization by immigrants compared to host populations and others have shown lower utilization. Overall, immigrants use ED care heavily, make inappropriate visits to EDs, have a longer length of stay in EDs, and are less satisfied with ED care as compared to host populations.CONCLUSION：Immigrants might use ED care differently from host populations due to language and cultural barriers. There is sparse Australian literature regarding immigrants＇ access to health care including ED care. To ensure equity, further research is needed to inform policy when planning health care provision to immigrants.

A GIS Tool That Provides Intelligent Solutions in Emergency Departments during COVID-19

The response to the COVID-19 pandemic has led to a revolution in open geographic information system (GIS) sources and Web GIS, which have grown considerably. Patient handover and crowding are critical issues to address during the COVID-19 pandemic. Saudi Arabia’s Vision 2030 aims to optimise quality and resource utilisation in emergency departments (EDs). GIS technology has been used to clarify the state of COVID-19 at the country level, however, the potential of GIS technology requires ongoing investigation to support Saudi Arabia’s Vision 2030. During a pandemic, great pressure is placed on EDs, with patients waiting long periods for treatment, which can lead to great health risks. This paper aims to illustrate the rule of GIS in providing intelligent solutions in emergency services during the COVID-19 pandemic. A satisfaction questionnaire was distributed to over 180 patients who were selected randomly from the nine emergency rooms of Jeddah governorate hospitals from different priority levels. Fifteen factors are determined and grouped into five domains to reflect patients’ satisfaction: emergency department environment, emergency department staff, physician care satisfaction, and wait time satisfaction. The critical values reveal in wait time were 84% of patients from the second to the fourth level of priority had waited a long or extremely. Most of the respondents (87%) wanted to know ER wait times before arrival hospital. The website was the most preferred choice for publishing wait times outside the ER for 56.7% of them. An online ArcGIS dashboard was developed to monitor hospital wait times in Jeddah City. This dashboard can be useful to the public to guide them in determining which hospital is the most suitable regarding a minimum waiting time and can also help in considering the travel distance.

Referrals to Emergency Departments—— The Processes and Factors That Influence Decision-Making among Community Nurses

The aim of the study was to describe the basis on which municipal care registered nurses (RN) make decisions and their experiences when referring older persons from nursing homes to emergency departments (EDs). RNs in the community are to ensure that older adults receive good care quality in nursing home. This study used a descriptive design with a qualitative content analysis. The analysis of the data from the 13 interviews revealed one theme “Shared responsibilities in the best interests of the older person reduce feelings of insufficiency”. The content was formulated, which revealed the RNs’ feelings, reasoning and factors influencing them and their actions in the decision-making situation, before the patients were referred to an emergency department. Complex illnesses, non-adapted organizations, considerations about what was good and right in order to meet the older person’s needs, taking account of her/his life-world, health, well-being and best interests were reported. Co-worker competencies and open dialogues in the “inner circle” were crucial for the nurses’ confidence in the decision. Hesitation to refer was associated with previous negative reactions from ED professionals. The RN sometimes express that they lacked medical knowledge and were uncertain how to judge the acute illness or changes. Access to the “outer circle”, i.e. physicians and hospital colleagues, was necessary to counteract feelings of insecurity about referrals. When difficult decisions have to be made, not only medical facts but also relationships are of importance. To strengthen the RNs’ and staff members’ competence by means of education seems to be important for avoiding unnecessary referrals. Guidelines and work routine need to be more transparent and referrals due to the lack of resources are not only wasteful but can worsen the older persons’ health.

Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department

BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong.The primary outcome was sepsis(Sepsis-3 definition)within 48 h of ED presentation.Using c-statistics and the DeLong test,we compared 11 EWSs,including the National Early Warning Score 2(NEWS2),Modified Early Warning Score,and Worthing Physiological Scoring System(WPS),etc.,and three shock indices(the shock index[SI],modified shock index[MSI],and diastolic shock index[DSI]),with Systemic Inflammatory Response Syndrome(SIRS)and quick Sequential Organ Failure Assessment(qSOFA)in predicting the primary outcome,intensive care unit admission,and mortality at different time points.RESULTS:We analyzed 601 patients,of whom 166(27.6%)developed sepsis.NEWS2 had the highest point estimate(area under the receiver operating characteristic curve[AUROC]0.75,95%CI 0.70-0.79)and was significantly better than SIRS,qSOFA,other EWSs and shock indices,except WPS,at predicting the primary outcome.However,the pooled sensitivity and specificity of NEWS2≥5 for the prediction of sepsis were 0.45(95%CI 0.37-0.52)and 0.88(95%CI 0.85-0.91),respectively.The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point.CONCLUSION:NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.

Innovative pathways allow safe discharge of mild acute pancreatitis from the emergency room

Acute pancreatitis(AP)is a leading cause of gastrointestinal-related hospitalizations in the United States,resulting in 300000 admissions per year with an estimated cost of over$2.6 billion annually.The severity of AP is determined by the presence of pancreatic complications and end-organ damage.While moderate/severe pancreatitis can be associated with significant morbidity and mortality,the majority of patients have a mild presentation with an uncomplicated course and mortality rate of less than 2%.Despite favorable outcomes,the majority of mild AP patients are admitted,contributing to healthcare cost and burden.In this Editorial we review the performance of an emergency department(ED)pathway for patients with mild AP at a tertiary care center with the goal of reducing hospitalizations,resource utilization,and costs after several years of implementation of the pathway.We discuss the clinical course and outcomes of mild AP patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital,and identify predictors of successful ED discharge to select patients who can potentially be triaged to the pathway.We conclude that by implementing innovative clinical pathways which are established and reproducible,selected AP patients can be safely discharged from the ED,reducing hospitalizations and healthcare costs,without compromising clinical outcomes.We also identify a subset of patients most likely to succeed in this pathway.

Short-term effects of low-level PM2.5,PM10,O3,and tropical meteorological conditions on emergency department visits for respiratory diseases in Haikou,China

Objective:To assess the correlation between atmospheric pollutants,meteorological factors,and emergency department visits for respiratory diseases in Haikou City.Methods:Daily data on atmospheric pollutants,meteorological factors,and emergency department visits for respiratory diseases in Haikou City from 2018 to 2021 were collected.The Spearman rank correlation test was used to analyze the correlation,and a distributed lag non-linear model was employed to analyze the health effects and lag impacts of environmental factors.Subgroup analyses were conducted based on sex and age.Results:According to the criteria of International Classification of Diseases(ICD-10:J00-J99),a total of 221913 cases were included,accounting for 21.3%of the total emergency department visits in Haikou City.For every 1℃increase in temperature,the risk of emergency department visits increased by 1.029%(95%CI 1.016%-1.042%).Relative humidity greater than 80%reduced the risk of visits,while higher atmospheric pressure(>1010 hpa)also decreased the likelihood of daily emergency department visits.Higher concentrations of PM2.5(30-50μg/m^(3)),PM10(>60μg/m^(3)),and O_(3)(75-125μg/m^(3))were associated with increased visits.Higher temperatures(>25℃)have a greater impact on females and children aged 0-14 years,while males are more sensitive to low atmospheric pressure.Individuals aged 65 and above exhibited increased sensitivity to O_(3)concentration,and the effects of PM2.5,PM10,and O_(3)are more pronounced in individuals over 14 years old.Conclusions:Short-term exposure to high temperatures,particulate matter pollutants(PM_(2.5)and PM_(10)),and ozone(O_(3))is associated with increased emergency department visits for respiratory diseases.

Assessment of Satisfaction in the Reception and Emergency Department of a Health Center

Introduction The main objective of any healthcare establishment must be to ensure the quality of patient care and customer satisfaction. It is necessary to regularly assess patient satisfaction. The aim of this study was to assess the level of satisfaction of customers aged over 18 years attending the emergency department of the health center. Methodology This was a descriptive and analytical cross-sectional study of patients aged 18 years and over, who attended the Samu Municipal emergency department between 02 and 30 May 2023. The satisfaction index was determined using the adapted 2009 SAPHORA-MCO questionnaire and the Likert satisfaction scale. Results A total of 400 patients were surveyed. The average age was 35 years, with a standard deviation of 14.7. Of those surveyed, 51% were women, 87% were educated, 50% lived in Grand Yoff and 59.5% were unemployed. Satisfaction levels linked to perception of the cost of care (72%), waiting time (64.3%), information given to patients (69.1%) and pain management (74 .5%) are fair. On the other hand, the levels of satisfaction linked to administrative procedures (82.5%), staff attitudes towards patients (84%), staff availability (86.4%), patient privacy (89.2%), general atmosphere (87.2%), staff competence (87.3%), and the effectiveness of care (89.4%) were satisfactory. The average waiting time was 38 minutes. However, 32% of patients waited less than 30 minutes and 92% less than an hour. The satisfaction index linked to administration and reception was 72.9% and 79.85%, respectively. The satisfaction index linked to the administration and technical quality of care is equal to 85.8% and 83.7%, respectively. The overall satisfaction index is equal to 80.6%;the level of satisfaction of users of the health structure is satisfactory. Conclusion Patient satisfaction is an essential part of quality care. Patient satisfaction must be based on effective communication from the healthcare team and the creation of a patient-caregiver relationship.

Epidemiology of Hand Injuries That Presented to the Emergency Department of a Tertiary Care Facility in Suburban Mumbai, India: A Study Including 489 Patients

Background: Hand injuries are very common and responsible for a significant number of emergency department (ED) visits, most of which are not to hand specialists [1]. The functionality and outcome of hand injuries can vary significantly depending on the mechanism and pattern of injuries, which is why it is imperative for emergency physicians to recognize the complexities, and the potential repercussion of missed injuries in such cases. Objective: The aim of this study is to provide epidemiological information on hand injuries and their patterns. The objective is 1) to assess whether most hand injuries are superficial (simple), or involve underlying deeper structures (complex) and 2) to assess whether most hand injuries presented to the emergency department were managed by the emergency physician or plastic/orthopaedic surgeon. Methods: This retrospective single-centre observational study conducted at an emergency department in a tertiary care hospital in Mumbai, India collected data from hand trauma patients using a standardized documentation form. Demographic data, trauma-related data, and disposition plans were analysed. Results: A total of 489 cases sustained hand injuries over a period of one year. The patients were predominantly males in the 20 - 30 year age group and injuries were mainly sustained over the right hand. Most of the injuries were sustained at home (42%). The most common mechanism (34%) was sharp object injury (including needle-stick and other sharps in hospital), followed by blunt injury (30%). Among grievous hand injuries, door jamb was a mechanism noted in 11% of patients, accounting for 50% of all crush injuries. Lacerations were the most common pattern (24.7%) noticed, followed closely by fractures (23.3%). Digits II - IV were injured most commonly (54%), followed by carpals (14%) and the thumb (10%). Nearly 80% of the hand injuries were managed by emergency physicians alone, with 61% of cases involving superficial structures. Though 14% of the cases required plastic surgery intervention, the initial evaluation of all these patients was performed by the emergency physician. Conclusions: Our study highlights the burden of hand injuries on the emergency physician, as well as the odds of missed injuries, directly indicating the necessity of a thorough anatomical knowledge of the structures of the hand, and in turn, a proper physical examination. A dedicated registry for hand trauma would help quantify the mechanism and pattern of injuries, and formulate preventive strategies.