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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 581 Research Studies DisplayedEhmann MR, Klein EY, Zhao X
Epidemiology and clinical outcomes of community-acquired acute kidney injury in the emergency department: a multisite retrospective cohort study.
This retrospective cohort study’s objective was to describe the epidemiology of community-acquired acute kidney injury (CA-AKI) in the United States and the associated clinical outcomes. CA-AKI was identified using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine (Scr)-based criteria. Outcomes for encounters resulting in hospitalization included the in-hospital trajectory of AKI severity, dialysis initiation, intensive care unit (ICU) admission, and death. Outcomes for all encounters included occurrence over 180 days of hospitalization, ICU admission, new or progressive chronic kidney disease, dialysis initiation, and death. For all encounters, 10.4% of patients met the criteria for any stage of AKI on arrival to the ED, with 16.6% of patients admitted to the hospital from the ED having CA-AKI on arrival to the ED. The likelihood of AKI recovery was inversely related to the CA-AKI stage on arrival to the ED. Among encounters for hospitalized patients, CA-AKI was associated with in-hospital dialysis initiation, ICU admission, and death compared with patients without CA-AKI. Among all encounters, CA-AKI was associated with new or progressive chronic kidney disease, dialysis initiation, subsequent hospitalization including ICU admission, and death during the subsequent 180 days.
AHRQ-funded; HS027793; HS026640.
Citation: Ehmann MR, Klein EY, Zhao X .
Epidemiology and clinical outcomes of community-acquired acute kidney injury in the emergency department: a multisite retrospective cohort study.
Am J Kidney Dis 2024 Jun; 83(6):762-71.e1. doi: 10.1053/j.ajkd.2023.10.009..
Keywords: Community-Acquired Infections, Kidney Disease and Health, Emergency Department, Outcomes
Manojlovich M, Bettencourt AP, Mangus CW
Refining a framework to enhance communication in the emergency department during the diagnostic process: an edelphi approach.
This study’s goal was to examine the entire diagnostic process in the emergency department (ED) using eDelphi methodology to achieve consensus among an expert panel of 18 clinicians, patients, family members, and other participants on a refined ED-based diagnostic decision-making framework that integrates several potential opportunities for communication to enhance diagnostic quality. The authors developed a final framework that positioned communication more prominently in the diagnostic process in the ED and enhances the original National Academies of Sciences, Engineering, and Medicine (NASEM) and ED-adapted NASEM frameworks. The process identified two specific types of communication-information exchange and shared understanding̲-as high priority for optimal outcomes. There were three categories identified for ideas for communication-focused interviews to prevent diagnosis error in the ED: patient-facing, clinician-facing, and system-facing interventions.
AHRQ-funded; HS028375.
Citation: Manojlovich M, Bettencourt AP, Mangus CW .
Refining a framework to enhance communication in the emergency department during the diagnostic process: an edelphi approach.
Jt Comm J Qual Patient Saf 2024 May; 50(5):348-56. doi: 10.1016/j.jcjq.2024.01.013..
Keywords: Emergency Department, Clinician-Patient Communication, Communication, Diagnostic Safety and Quality
Barton HJ, Maru A, Leaf MA
Academic detailing as a health information technology implementation method: supporting the design and implementation of an emergency department-based clinical decision support tool to prevent future falls.
This study investigated the effectiveness of academic detailing, a method involving personalized education sessions with clinicians, in implementing a machine learning-based clinical decision support (CDS) tool designed to prevent future falls in elderly emergency department patients. Through qualitative analysis of interviews with clinicians who had encountered the CDS tool, researchers identified several factors influencing its use, including aspects of the tool's design, clinicians' understanding of the tool and referral process, the fast-paced emergency department environment, clinicians' perception of patient fall risk, and the complexity of the referral process. Academic detailing sessions allowed for real-time clarification of misconceptions and demonstration of the tool's functionality, highlighting its potential as a valuable strategy for supporting the implementation and optimization of health information technologies. Additionally, insights gained from these sessions can inform both immediate adjustments to the implementation process and long-term redesign of the tool to better align with clinicians' needs and workflows.
AHRQ-funded; HS027735.
Citation: Barton HJ, Maru A, Leaf MA .
Academic detailing as a health information technology implementation method: supporting the design and implementation of an emergency department-based clinical decision support tool to prevent future falls.
JMIR Hum Factors 2024 Apr 18; 11:e52592. doi: 10.2196/52592..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Emergency Department, Falls, Prevention
Lu A, Armstrong M, Alexander R
Trends in pediatric prescription-opioid overdoses in U.S. emergency departments from 2008-2020: an epidemiologic study of pediatric opioid overdose ED visits.
This study looked at trends in pediatric prescription-opioid overdose visits to the emergency room from 2008 to 2020. This retrospective epidemiological study used the 2008-2020 Nationwide Emergency Department Sample. National estimates were broken down by zip code, emergency department (ED) disposition, and hospital location/teaching status. The prescription-opioid overdose ED visits for patients from 0-17 years old in the United States decreased by 22% from 2008 to 2019, then increased by 12% in 2020. Most patients were discharged to home following their ED visit, however, from 2019 to 2020 there was a 42% increase in patients admitted. The overdose rates per 100,000 children were highest in the 0 to 1 and 12 to 17 age groups, with the 12 to 17 group increasing by 27% in 2020. The West saw an increase of 58% in 2019-2020 and the Midwest increased by 20%.
AHRQ-funded; HS029183.
Citation: Lu A, Armstrong M, Alexander R .
Trends in pediatric prescription-opioid overdoses in U.S. emergency departments from 2008-2020: an epidemiologic study of pediatric opioid overdose ED visits.
PLoS One 2024 Apr 17; 19(4):e0299163. doi: 10.1371/journal.pone.0299163..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Opioids, Substance Abuse, Emergency Department, Medication, Behavioral Health
Michelson KA, Rees CA, Florin TA
Emergency department volume and delayed diagnosis of serious pediatric conditions.
The objective of this retrospective cohort study was to evaluate the association between annual pediatric volume in emergency departments (EDs) with delayed diagnosis. Subjects were children under 18 treated at 954 EDs in eight states with a first-time diagnosis of any of 23 acute, serious conditions, identified using HCUP State ED and Inpatient databases. The findings indicated that EDs with fewer pediatric encounters had more possible delayed diagnoses across all 23 conditions; there were decreased rates of possible delayed diagnosis with increasing ED volume for 21 of 23 conditions. The authors concluded that tools to support timely diagnosis in low-volume EDs are needed.
AHRQ-funded; HS026503.
Citation: Michelson KA, Rees CA, Florin TA .
Emergency department volume and delayed diagnosis of serious pediatric conditions.
JAMA Pediatr 2024 Apr; 178(4):362-68. doi: 10.1001/jamapediatrics.2023.6672..
Keywords: Children/Adolescents, Emergency Department, Diagnostic Safety and Quality
Antwi YA, Meille G, Moriya AS
AHRQ Author: Meille G, Moriya Asako S
Heterogeneous effects of the Affordable Care Act on emergency department visits and payer composition among older adults by race and ethnicity.
This AHRQ-authored paper’s goal was to estimate the impact of the Affordable Care Act (ACA) on emergency department (ED) visits and the composition of insurance coverage for White, Black, and Hispanic older adults. Their estimation strategy used changes in the discontinuity of health insurance coverage at age 65 and the variation in state decisions about Medicaid expansion under the ACA. They found that uninsured ED visits decreased for older adults in all three racial and ethnic groups in Medicaid expansion and non-expansion states. The magnitude of the decreases varied from four visits per 1,000 persons among White older adults in non-expansion states to 23 visits per 1,000 persons among Black and Hispanic older adults in expansion states. Insurance coverage gains came primarily from Medicaid in expansion states and private insurance in non-expansion states, regardless of race or ethnicity. They found suggestive evidence of increased ED visits for Black and Hispanic populations that had low insurance coverage rates before 2014.
AHRQ-authored.
Citation: Antwi YA, Meille G, Moriya AS .
Heterogeneous effects of the Affordable Care Act on emergency department visits and payer composition among older adults by race and ethnicity.
American Journal of Health Economics 2024 Spring; 10(2):272-99. doi: 10.1086/728787..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Emergency Department, Policy, Racial and Ethnic Minorities, Healthcare Utilization
Scott HF, Lindberg DM, Brackman S
Pediatric sepsis in general emergency departments: association between pediatric sepsis case volume, care quality, and outcome.
The purpose of this study was to evaluate whether a general emergency department's (ED) annual pediatric sepsis volume increases the odds of delivering care aligned with Surviving Sepsis pediatric guidelines. The researchers included 1,527 ED encounters between January 1, 2015, and September 30, 2021. The study found that care was aligned with the guidelines in 41.1% of encounters, and annual pediatric sepsis volume was minimally related with the probability of guideline-concordant care. Care concordance increased from 23.1% in 2015 to 52.8% in 2021.
AHRQ-funded; HS025696.
Citation: Scott HF, Lindberg DM, Brackman S .
Pediatric sepsis in general emergency departments: association between pediatric sepsis case volume, care quality, and outcome.
Ann Emerg Med 2024 Apr; 83(4):318-26. doi: 10.1016/j.annemergmed.2023.10.011..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Quality of Care, Guidelines, Evidence-Based Practice
Friend R, Hash D, Rivera-Sepulveda A
Utility of serum amylase in children with abdominal pain in the pediatric emergency department.
A retrospective analysis of pediatric emergency department (PED) visits in 2019 evaluated the diagnostic utility of amylase and lipase tests in children presenting with abdominal pain. Researchers found that while both tests were frequently ordered, abnormal levels were relatively uncommon (4.6% for amylase, 5.6% for lipase). Amylase demonstrated higher sensitivity (30%) but lower specificity (92%) compared to lipase (7.5% sensitivity, 94.5% specificity). Elevating the threshold to three times the normal level improved specificity for both tests, but at the cost of reduced sensitivity. Notably, combining amylase and lipase testing did not significantly improve diagnostic yield compared to lipase alone. These findings suggest that while amylase and lipase can be useful screening tools for abdominal pain, their combined use may not offer additional clinical value.
AHRQ-funded; HS026393.
Citation: Friend R, Hash D, Rivera-Sepulveda A .
Utility of serum amylase in children with abdominal pain in the pediatric emergency department.
Pediatr Emerg Care 2024 Apr; 40(4):297-301. doi: 10.1097/pec.0000000000003032..
Keywords: Children/Adolescents, Emergency Department
Achola EM, Griffith KN, Wrenn JO
Injuries from legal interventions involving conducted energy devices.
This cross-sectional study evaluated emergency department (ED) visits for physical injuries from use of conducted energy devices (CEDs) such as TASERs by police departments. The authors evaluated sociodemographic and clinical characteristics of patients presenting with law enforcement-related CED injuries. They sampled US ED visits from the Nationwide Emergency Department Sample, which provided a 20% stratified sample of all EDs and weights to allow calculation of national representative estimates for all ED visits. They identified 1276 visits with the ICD-10 Y35.83X codes for CED injuries. Patients included 1186 males and 91 females with a mean age of 32.9 years residing in zip codes below the 50th percentile for median household income (67.5%). Most presented to teaching hospitals (70.8%) in metropolitan areas (86.1%) and were Asian or Pacific Islander (1.4%), Black (35.7%), Hispanic (17.6%), Native American (1.8%), White (39.2%), or other (4.3%) race and ethnicity. Among patients with serious injuries (70.8%), most (61.1%) were minor, 25.4% were moderate, 2.9% were severe, and 1.6% were critical injuries. The most common area of injury was extremities (36.9%), followed by chest (27.4%), head and neck (25.6%), abdomen (24.2%), and face (8.7%). Patients with lower income were more likely to receive serious, severe, or critical injuries, but these differences were not statistically significant.
AHRQ-funded; HS026395.
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Citation: Achola EM, Griffith KN, Wrenn JO .
Injuries from legal interventions involving conducted energy devices.
JAMA Intern Med 2024 Apr; 184(4):440-43. doi: 10.1001/jamainternmed.2023.8012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Injuries and Wounds, Emergency Department
Carey K, Cole MB
Mental health care provision in community health centers and hospital emergency department utilization.
This study examined whether community health centers (CHCs) are effective in offsetting mental health emergency department (ED) visits. The study used the HRSA Uniform Data System and the HCUP State ED Databases for Florida patients during 2012-2019. The authors identified CHC-year-specific service areas using patient origin zip codes, and then estimated panel data models for number of ED mental health visits per capita in a CHC's service area. During 2012-2019, CHC mental health utilization increased 100%. There were small reductions in ED mental health utilization associated with increased CHC mental health provision. An annual increase of 1000 CHC mental health care visits (5%) was associated with 0.44% fewer ED mental health care visits, and an increase of 1000 CHC mental health care patients (15%) with 1.9% fewer ED mental health care visits. An increase of 1 annual mental health visit per patient was associated with 16% fewer ED mental health care visits.
AHRQ-funded; HS028054.
Citation: Carey K, Cole MB .
Mental health care provision in community health centers and hospital emergency department utilization.
Health Serv Res 2024 Apr; 59(2):e14283. doi: 10.1111/1475-6773.14283..
Keywords: Healthcare Cost and Utilization Project (HCUP), Community-Based Practice, Behavioral Health, Emergency Department, Healthcare Utilization
Mazurenko O, Hirsh AT, Harle CA
Health-related social needs information in the emergency department: clinician and patient perspectives on availability and use.
The purpose of this qualitative study was to assess what health-related social needs (HRSN) information is available to emergency department (ED) physicians and staff, and how HRSN-related clinical actions align with patient expectations. Researchers conducted in-depth semi-structured interviews guided by HRSN literature, the 5 Rights of Clinical Decision Support (CDS) framework, and the Contextual Information Model. Participants were ED providers, staff, and patients from a health system in the mid-Western U.S. Three themes were identified: HRSN availability, means of collection, and usage. Patients and ED providers and staff differed in their perspectives on how HSRNs should be collected and acted upon. The researchers concluded that accounting for differences in clinical and administrative decisions will be critical for patient acceptance and effective usage of HSRN information.
AHRQ-funded; HS028008.
Citation: Mazurenko O, Hirsh AT, Harle CA .
Health-related social needs information in the emergency department: clinician and patient perspectives on availability and use.
BMC Emerg Med 2024 Mar 18; 24(1):45. doi: 10.1186/s12873-024-00959-2..
Keywords: Emergency Department, Healthcare Delivery, Care Coordination
Aghaei P, Bayramzadeh S
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
This study’s objective was to investigate how trauma team members perceive technological equipment and tools in the trauma room (TR) environment and to identify how the technological equipment could be optimized in relation to the TR’s space. The authors conducted a total of 21 focus group sessions with 69 trauma team members, all of whom worked in Level I TRs from six teaching hospitals in the USA. Findings were analyzed and categorized into three parent themes: imaging equipment, assistive devices, and room features. The results suggest that trauma team members place high importance on the availability and versatility of the technological equipment in the TR environment. CT-scanners were not usually optimized for easy access to the TR. Other suggestions included the implementation of cameras and screens to accommodate situation awareness, and the rapid sharing of data such as imaging results. This study will inform health-care designers with the knowledge they need to make informed decisions when designing TRs. It covers key considerations such as room layout, equipment selection, lighting and controls.
AHRQ-funded; HS027261.
Citation: Aghaei P, Bayramzadeh S .
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
Facilities 2024 Mar 12. 2024/02/14..
Keywords: Workflow, Teams, Emergency Department, Trauma
Hoffmann JA, Kshetrapal A, Pergjika A
A qualitative assessment of barriers and proposed interventions to improve acute agitation management for children with mental and behavioral health conditions in the emergency department.
This study is a qualitative assessment of barriers and proposed strategies for providing high-quality care to children who experience acute agitation in the emergency department (ED). The authors conducted semistructured interviews with 6 ED physicians, 6 ED nurses, 6 parents, and 6 adolescents at high risk for developing agitation. They asked participants about their experiences with acute agitation care in the ED, barriers and facilitators to providing high-quality care, and proposed interventions. The participants discussed identifying risk factors for acute agitation, worrying about safety and the risk of injury, feeling moral distress, and shifting the culture toward patient-centered, trauma-informed care. Barriers and facilitators discussed included using a standardized care pathway, identifying environmental barriers and allocating resources, partnering with the family and child, and communicating among team members. They proposed nine interventions: opening a behavioral observation unit with dedicated staff and space, asking screening questions to identify risk of agitation, creating personalized care plans in the electronic health record, using a standardized agitation severity scale, implementing a behavioral response team, providing safe activities and environmental modifications, improving the handoff process, educating staff, and addressing bias and inequities.
AHRQ-funded; HS026385.
Citation: Hoffmann JA, Kshetrapal A, Pergjika A .
A qualitative assessment of barriers and proposed interventions to improve acute agitation management for children with mental and behavioral health conditions in the emergency department.
J Acad Consult Liaison Psychiatry 2024 Mar-Apr; 65(2):167-77. doi: 10.1016/j.jaclp.2023.12.001..
Keywords: Children/Adolescents, Emergency Department, Behavioral Health
Iantorno SE, Scaife JH, Bryce JR
Emergency department utilization for pediatric gastrostomy tubes across the United States.
This study investigated the number and nature of emergency department (ED) visits to community hospitals for pediatric gastrostomy tube complication. The authors used the 2019 Nationwide Emergency Department Sample to perform a retrospective cross-sectional analysis of pediatric patients (<18 y) with a primary diagnosis of gastrostomy tube complication. Their primary outcome was a potentially preventable ED visit, defined as an encounter that did not result in any imaging, procedures, or an inpatient admission. They observed 32,036 ED visits at 535 hospitals and 15,165 (47.3%) were potentially preventable. Median age was 2 years, and 17,707 (55%) were male. Compared to White patients, patients with higher odds of potentially preventable visits were Black and Hispanic. Patients with residential zip codes in the first, second, and third median household income quartiles had higher odds of potentially preventable visits compared to the highest.
AHRQ-funded; HS025776.
Citation: Iantorno SE, Scaife JH, Bryce JR .
Emergency department utilization for pediatric gastrostomy tubes across the United States.
J Surg Res 2024 Mar; 295:820-26. doi: 10.1016/j.jss.2023.11.028.
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Healthcare Utilization, Surgery, Adverse Events
Bui LN, Knox M, Miller-Rosales C
Hospital capabilities associated with behavioral health integration within emergency departments.
The objective of this study was to identify hospital capabilities associated with behavioral health processes in emergency departments. Responses to the National Survey of Healthcare Organizations and Systems were linked American Hospital Association Annual Survey data. Most hospitals reported screening for behavioral health conditions and provided direct referrals to community-based clinicians. Approximately half the hospitals used team approaches to behavioral health. Hospitals that reported more barriers to care delivery innovations also reported less screening and usage of a team approach. The authors concluded that research and interventions which focus on removing barriers or adding processes to disseminate best practices offer a path to accelerate behavioral health integration in emergency departments.
AHRQ-funded; HS024075.
Citation: Bui LN, Knox M, Miller-Rosales C .
Hospital capabilities associated with behavioral health integration within emergency departments.
Med Care 2024 Mar; 62(3):170-74. doi: 10.1097/mlr.0000000000001973.
Keywords: Behavioral Health, Emergency Department, Hospitals, Substance Abuse, Teams, Telehealth, Health Information Technology (HIT)
Wust KL, Carayon P, Werner NE
Older adult patients and care partners as knowledge brokers in fragmented health care.
This study explores the knowledge broker roles of older adult patients and their care partners during emergency department (ED) visits. The research concludes that patients and care partners serve as information liaisons between fragmented care systems, providing details on diagnostic testing, medications, health history, and care accommodations. They engage in proactive and reactive knowledge brokering within and across ED work systems, aiding in communication and care coordination to mitigate healthcare fragmentation.
AHRQ-funded; HS026624.
Citation: Wust KL, Carayon P, Werner NE .
Older adult patients and care partners as knowledge brokers in fragmented health care.
Hum Factors 2024 Mar; 66(3):701-13. doi: 10.1177/00187208221092847.
Keywords: Elderly, Emergency Department, Caregiving, Clinician-Patient Communication, Communication
Salwei ME, Hoonakker P, Carayon P
Usability of a human factors-based clinical decision support in the emergency department: lessons learned for design and implementation.
A human-centered design process was followed to assess the usability and adoption of human factors (HF)-based clinical decision support (CDS) in the emergency department (ED). A CDS was developed to aid in pulmonary embolism (PE) diagnosis, showing high usability in testing. However, despite positive perceptions, actual CDS usage remained low due to integration issues with clinician workflow. The findings highlight the need for ongoing refinement of CDS design to align with clinical workflows and enhance usability.
AHRQ-funded; HS026395; HS024558; HS022086. NIH 142099
Citation: Salwei ME, Hoonakker P, Carayon P .
Usability of a human factors-based clinical decision support in the emergency department: lessons learned for design and implementation.
Hum Factors 2024 Mar; 66(3):647-57. doi: 10.1177/00187208221078625.
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Emergency Department, Implementation
Patel MD, Lin P, Cheng Q
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
The purpose of this multi-site retrospective study was to assess differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, factoring in age, clinical factors, and ED operating conditions. The study assessed differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, accounting for age, clinical factors, and ED operating conditions. For the study outcome, ESI levels were grouped into three categories: 1-2 (highest acuity), 3, and 4-5 (lowest acuity). The researchers analyzed patient-level data from three EDs affiliated with a large Southeastern United States health system. The study found 186,840 eligible ED visits with 56,417 from an academic ED, 69,698 from a metropolitan community ED, and 60,725 from a rural community ED. The majority of patients were assigned ESI 3 in the academic and metropolitan community EDs (61% and 62%, respectively) whereas 47% were assigned ESI 3 in the rural community ED. In adjusted analyses, White females had a lower likelihood of being assigned ESI 1-2 compared to White males although both groups were roughly comparable in the assignment of ESI 4-5. Non-White and Hispanic females were generally least likely to be assigned ESI 1-2 in all EDs. Interactions between ED wait time and race/ethnicity-sex were not statistically significant.
AHRQ-funded; HS029078.
Citation: Patel MD, Lin P, Cheng Q .
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
Am J Emerg Med 2024 Feb; 76:29-35. doi: 10.1016/j.ajem.2023.11.008..
Keywords: Emergency Department, Disparities, Racial and Ethnic Minorities
Gyftopoulos S, Simon E, Swartz JL
Efficacy and impact of a multimodal intervention on CT pulmonary angiography ordering behavior in the emergency department.
The objective of this study was to evaluate the efficacy of a multimodal intervention to reduce overutilization of computed tomography pulmonary angiography (CTPA) for suspected pulmonary embolism in the emergency department. Results indicated that guideline concordance increased significantly after intervention. The authors concluded that their success in increasing guideline concordance demonstrated the efficacy of a mixed-methods, human-centered approach to behavior change; however, given that neither of the secondary outcomes improved, the results may demonstrate potential limitations to the guidelines directing the ordering of CTPA studies.
AHRQ-funded; HS024376.
Citation: Gyftopoulos S, Simon E, Swartz JL .
Efficacy and impact of a multimodal intervention on CT pulmonary angiography ordering behavior in the emergency department.
J Am Coll Radiol 2024 Feb; 21(2):309-18. doi: 10.1016/j.jacr.2023.02.033.
Keywords: Emergency Department, Respiratory Conditions, Imaging, Diagnostic Safety and Quality, Blood Clots
Khalaf N, Ali B, Liu Y
Emergency presentations predict worse outcomes among patients with pancreatic cancer.
This study evaluated the association between pancreatic emergency presentation (EP) and cancer stage, treatment, and survival. The authors conducted a retrospective cohort study among patients with pancreatic adenocarcinoma diagnosed from 2007 to 2019 at a tertiary-care Veterans Affairs medical center. They used electronic health records to identify EP cases, defined as a new pancreatic cancer diagnosis made within 30 days of an ED visit where cancer was suspected. Of 243 identified pancreatic cancer patients, 66.7% had EPs. Although there was no difference in stage by EP status, patients diagnosed through EPs were 72% less likely to receive cancer treatment compared to non-emergency presenters. Patients with EPs also had a 73% higher mortality risk. This difference in mortality remained statistically significant after adjusting for cancer stage and receipt of cancer treatment.
AHRQ-funded; HS029347; HS028595.
Citation: Khalaf N, Ali B, Liu Y .
Emergency presentations predict worse outcomes among patients with pancreatic cancer.
Dig Dis Sci 2024 Feb; 69(2):603-14. doi: 10.1007/s10620-023-08207-6.
Keywords: Cancer, Emergency Department, Outcomes
Pang PS, Berger DA, Mahler SA
Short-stay units vs routine admission from the emergency department in patients with acute heart failure: the SSU-AHF randomized clinical trial.
The purpose of this study was to compare the effectiveness of short-stay units (SSU) care vs hospitalization in lower-risk patients with acute heart failure (AHF). The researchers designed the study to detect at least 1-day superiority for a primary outcome of days alive and out of hospital (DAOOH) at 30-day follow-up for 534 participants. Enrollment was stopped at 194 participants due to the COVID-19 pandemic, with 1 participant found ineligible after randomization. Of the 193 patients enrolled, the mean (SD) KCCQ-12 summary score between the SSU and hospitalization arms at 30 days was 51.3 vs 45.8 points, respectively. Participants in the SSU arm had 1.6 more DAOOH at 30-day follow-up than those in the hospitalization arm, 26.9 vs 25.4. Adverse events were uncommon and similar in both arms.
AHRQ-funded; HS025411.
Citation: Pang PS, Berger DA, Mahler SA .
Short-stay units vs routine admission from the emergency department in patients with acute heart failure: the SSU-AHF randomized clinical trial.
JAMA Netw Open 2024 Jan; 7(1):e2350511. doi: 10.1001/jamanetworkopen.2023.50511..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Emergency Department, Hospitalization
Haimovich AD, Shah MN, Southerland LT
Automating risk stratification for geriatric syndromes in the emergency department.
This study discussed using automated risk stratification to implement screening programs for geriatric syndromes in the emergency department (ED). This method would reduce significant workloads at a time of record-breaking ED patient volumes, staff shortages, and hospital boarding crises. The authors defined the concept of automated risk stratification and screening using existing electronic health record (EHR) data. They discussed progress made in three potential use cases in the ED: falls, cognitive impairment, and end-of-life and palliative care; emphasizing the importance of linking automated screening with systems of healthcare delivery. They found that research progress and operational deployment vary by use case, ranging from deployed solutions in falls screening to algorithmic validation in cognitive impairment and end-of-life care, but should still be considered a potential solution.
AHRQ-funded; HS027735.
Citation: Haimovich AD, Shah MN, Southerland LT .
Automating risk stratification for geriatric syndromes in the emergency department.
J Am Geriatr Soc 2024 Jan; 72(1):258-67. doi: 10.1111/jgs.18594..
Keywords: Elderly, Emergency Department, Risk, Health Information Technology (HIT)
Jurlina A, Maul T, Hunsaker P
Changes in bronchiolitis characteristics during the COVID-19 pandemic: a description of pediatric emergency department visits in a community hospital, 2019-2021.
The purpose of this retrospective, cross-sectional study was to describe changes in bronchiolitis characteristics in pediatric emergency department patients in a community hospital during the COVID-19 pandemic. The researchers conducted the study with children with bronchiolitis aged 1 to 24 months during an ED visit between 2019 and 2021. The study found that bronchiolitis cases decreased by 75% from 2019 to 2020 and rose back to prepandemic levels by 2021. Radiographs, steroids, and bronchodilators decreased during the study period. Laboratory studies, viral testing, antibiotic use, and respiratory support were unchanged. The decrease in steroids and bronchodilators was related to a clinical pathway that discouraged their use. Respiratory support remained unchanged.
AHRQ-funded; HS026393.
Citation: Jurlina A, Maul T, Hunsaker P .
Changes in bronchiolitis characteristics during the COVID-19 pandemic: a description of pediatric emergency department visits in a community hospital, 2019-2021.
Clin Pediatr 2024 Jan; 63(1):73-79. doi: 10.1177/00099228231208941..
Keywords: COVID-19, Respiratory Conditions, Children/Adolescents, Emergency Department
Scaife JH, Bryce JR, Iantorno SE
Secondary undertriage of pediatric trauma patients across the United States emergency departments.
The term “Undertriage” refers to the treatment of patients at facilities lacking in the equipment needed to treat the patient's injuries appropriately. The purpose of this retrospective cohort study was to assess the relationship between patient and hospital characteristics and secondary undertriage in children after major trauma. The researchers utilized the 2019 Nationwide Emergency Department Sample and included patients aged less than 18 years of age if they presented to a Level 3 or non-trauma center (NTC) and were diagnosed with a traumatic injury with an injury severity score of greater than 15 based on International Classification of Diseases 10 codes. The study found that of 6,572 weighted patients, 15% were undertriaged. Undertriage was significantly associated with older age, metropolitan location, and major abdominal injuries. After multivariable adjustment, secondary undertriage was significantly associated with patients aged 6-10 years of age compared to patients aged 15-17 years, penetrating injury, major chest injury, and presentation at a teaching hospital.
AHRQ-funded; HS025776.
Citation: Scaife JH, Bryce JR, Iantorno SE .
Secondary undertriage of pediatric trauma patients across the United States emergency departments.
J Surg Res 2024 Jan; 293:37-45. doi: 10.1016/j.jss.2023.07.054..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Trauma, Injuries and Wounds
Teeple S, Smith A, Toerper M
Exploring the impact of missingness on racial disparities in predictive performance of a machine learning model for emergency department triage.
The purpose of this study was to examine how missing data in the patient problem list may affect racial disparities in the predictive performance of an emergency department (ED) triage machine learning (ML) model. The researchers utilized an ML model that predicts patients’ risk for adverse events to produce triage-level recommendations and compared the model’s predictive performance on sets of observed versus manipulated test data. Differences were compared between Black and non-Hispanic White patient groups using multiple performance measures relevant to health equity. The study found there were modest, but significant, changes in predictive performance comparing the observed to manipulated models across both Black and non-Hispanic White patient groups. Problem list missingness affected model performance for both patient groups.
AHRQ-funded; HS02664002.
Citation: Teeple S, Smith A, Toerper M .
Exploring the impact of missingness on racial disparities in predictive performance of a machine learning model for emergency department triage.
JAMIA Open 2023 Dec; 6(4):ooad107. doi: 10.1093/jamiaopen/ooad107..
Keywords: Racial and Ethnic Minorities, Disparities, Emergency Department, Health Information Technology (HIT)