IU Indianapolis ScholarWorks :: Browsing by Author "Pettit, Nicholas"

Browsing by Author "Pettit, Nicholas"

Now showing 1 - 10 of 11

A selective review of smoking cessation interventions in the emergency department
(Springer Nature, 2022) Pettit, Nicholas; Pope, Ian; Neuner, Bruno; Lash, Rebecca; Bernstein, Steven L.; Emergency Medicine, School of Medicine
Background: Emergency department (ED) patients disproportionally smoke compared to the general population and frequently utilize the ED for routine, urgent, and emergent care. Thus, the ED is a target-rich environment for interventions aimed at increasing smoking cessation, especially among vulnerable populations. Promotion of smoking cessation in the ED has the potential to address health inequalities and reach patients that experience significant barriers to accessing preventive care and lifestyle modifications. Topics of review: This narrative review presents a concise summary of the major smoking cessation strategies studied in the ED setting for adults, children, and pregnant ED patients. Additionally, this review presents the strategies to increase the uptake of smoking cessation in the ED, as well as an international perspective of smoking cessation efforts in the ED. Past and ongoing efforts to improve smoking cessation among ED patients are discussed, and critical knowledge gaps and research opportunities are highlighted. Conclusion: Smoking cessation is both efficacious and feasible during an ED visit, with multiple options available to both adults, children, parents, and pregnant patients. Little standardization among cessation strategies among EDs has been demonstrated, despite the ED being uniquely positioned to address disparities in smoking cessation and contribute towards national smoking cessation goals. During most ED visits, any health care team member can address ongoing tobacco use, and smoking cessation can easily be related to the context of the patient’s presenting complaint. To be effective, health care systems and teams must recognize the ED as a suitable location to engage with patients regarding their knowledge and awareness of ongoing smoking use, and are well suited to provide and initiate effective smoking cessation treatments.
Disparities and Poor Outcomes for Patients Diagnosed with Lung Cancer Through the Emergency Department
(Indiana Medical Student Program for Research and Scholarship (IMPRS), 2021) Blucker, Nathaniel; Pettit, Nicholas; Emergency Medicine, School of Medicine
Background and Hypothesis: Cancer is currently the second leading cause of death in the United States, with lung cancer being the leading cause of cancer death. Approximately 40% of patients with lung cancer are diagnosed emergently, many at advanced stages, and occur despite the existence of lung cancer screening. However, local trends among Eskenazi Health patients are unknown. We hypothesize that individuals diagnosed with lung cancer through emergency presentations at Eskenazi Health will experience greater negative outcomes than individuals who are diagnosed through elective routes. Experimental Design of Project Methods: This is a retrospective chart review utilizing the Eskenazi Health electronic medical health records system. Patients with an ICD-coded lung cancer diagnosis within the five-year period between 2016 and 2021 were analyzed. We compared characteristics, health care utilization, and outcomes for adult patients who had a diagnosis of lung cancer. Our primary outcome was the number of patients diagnosed with lung cancer emergently. Results: Thus far, 74% of the cases viewed have been considered emergent diagnoses of lung cancer. Of the total cases, 54% of emergent diagnoses and 32% of non-emergent are stage IV. Mortality rates of both stage IV groups respectively are 74% and 62.5%. Overall mortality rates were 56.6%, and 45.9% for emergent and non-emergent diagnoses respectively. Amongst the diagnoses viewed, 93.8% failed to occur due to lung cancer screening. Rates of screening amongst the emergent group were lower at 6.6%, as opposed to non-emergent cases at 24%. Conclusion and Potential Impact: A significant portion of lung cancer diagnoses at Eskenazi Health are taking place due to presentation through emergent routes. The stage of these diagnoses suggests possible missed opportunities for earlier diagnosis. Additionally, a large part of the patient population currently qualifies for lung cancer screening despite low rates of screening being performed. Future work should emphasize reducing the number of patients emergently diagnosed with lung cancer.
Disparities in outcomes among patients diagnosed with cancer in proximity to an emergency department visit
(Springer, 2022-06-23) Pettit, Nicholas; Sarmiento, Elisa; Kline, Jeffrey; Emergency Medicine, School of Medicine
A suspected diagnosis of cancer in the emergency department (ED) may be associated with poor outcomes, related to health disparities, however data are limited. This is a retrospective observational cohort of the Indiana State Department of Health Cancer Registry, and the Indiana Network for Patient Care. First time cancer diagnoses appearing in the registry between January 2013 and December 2017 were included. Cases identified as patients who had an ED visit in the 6 months before their cancer diagnosis; controls had no preceding ED visits. The primary outcome was mortality, comparing ED-associated mortality to non-ED-associated. 134,761 first-time cancer patients were identified, including 15,432 (11.5%) cases. The mean age was same at 65, more of the cases were Black than the controls (12.4% vs 7.4%, P < .0001) and more were low income (36.4%. vs 29.3%). The top 3 ED-associated cancer diagnoses were lung (18.4%), breast (8.9%), and colorectal cancers (8.9%), whereas the controls were breast (17%), lung (14.9%), and prostate cancers (10.1%). Cases observed an over three-fold higher mortality, with cumulative death rate of 32.9% for cases vs 9.0% for controls (P < .0001). Regression analysis predicting mortality, controlling for many confounders produced an odds ratio of 4.12 (95% CI 3.72–4.56 for cases). This study found that an ED visit within 6 months prior to the first time of ICD-coded cancer is associated with Black race, low income and an overall three-fold increased adjusted risk of death. The mortality rates for ED-associated cancers are uniformly worse for all cancer types. These data suggest that additional work is needed to reduce disparities among ED-associated cancer diagnoses.
Emergency department associated lung cancer diagnosis: Case series demonstrating poor outcomes and opportunities to improve cancer care
(Elsevier, 2021) Pettit, Nicholas; Al-Hader, Ahmad; Thompson, Caroline A.; Emergency Medicine, School of Medicine
The diagnosis of cancer through an emergency presentation of an undiagnosed malignancy constitutes around 20–50% of first-time cancer diagnoses. There is a paucity of evidence on the emergency presentations of undiagnosed malignancy with only a few epidemiological studies of large administrative databases. Limited administrative data has shown patients diagnosed with cancer after an emergency presentation suffer poorer clinical outcomes as compared to those diagnosed with cancer through elective routes. Further those diagnosed emergently are commonly among vulnerable populations, such as based on socioeconomic status and racial/ethnic groups. Lung cancer is the most common cancer diagnosed emergently, and while one of the most preventable and treatable, often presents to an emergency department in extremis. This case study of six patients seeks to augment administrative database research by adding detailed clinical information as to demonstrate the issues with diagnosing lung cancer through an emergency presentation. We found that patients diagnosed emergently have complex care pathways including delayed biopsies, delayed treatments, and poor outcomes. Research is needed to elucidate the optimal path on how to manage suspected lung cancer diagnoses from the emergency department.
Emergency department involvement in the diagnosis of cancer among older adults: a SEER-Medicare study
(Oxford University Press, 2024) Thompson, Caroline A.; Sheridan, Paige; Metwally, Eman; Peacock Hinton, Sharon; Mullins, Megan A.; Dillon, Ellis C.; Thompson, Matthew; Pettit, Nicholas; Kurian, Allison W.; Pruitt, Sandi L.; Lyratzopoulos, Georgios; Emergency Medicine, School of Medicine
Background: Internationally, 20% to 50% of cancer is diagnosed through emergency presentation, which is associated with lower survival, poor patient experience, and socioeconomic disparities, but population-based evidence about emergency diagnosis in the United States is limited. We estimated emergency department (ED) involvement in the diagnosis of cancer in a nationally representative population of older US adults, and its association with sociodemographic, clinical, and tumor characteristics. Methods: We analyzed Surveillance, Epidemiology, and End Results Program-Medicare data for Medicare beneficiaries (≥66 years old) with a diagnosis of female breast, colorectal, lung, and prostate cancers (2008-2017), defining their earliest cancer-related claim as their index date, and patients who visited the ED 0 to 30 days before their index date to have "ED involvement" in their diagnosis, with stratification as 0 to 7 or 8 to 30 days. We estimated covariate-adjusted associations of patient age, sex, race and ethnicity, marital status, comorbidity score, tumor stage, year of diagnosis, rurality, and census-tract poverty with ED involvement using modified Poisson regression. Results: Among 614 748 patients, 23% had ED involvement, with 18% visiting the ED in the 0 to 7 days before their index date. This rate varied greatly by tumor site, with breast cancer at 8%, colorectal cancer at 39%, lung cancer at 40%, and prostate cancer at 7%. In adjusted models, older age, female sex, non-Hispanic Black and Native Hawaiian or Other Pacific Islander race, being unmarried, recent year of diagnosis, later-stage disease, comorbidities, and poverty were associated with ED involvement. Conclusions: The ED may be involved in the initial identification of cancer for 1 in 5 patients. Earlier, system-level identification of cancer in non-ED settings should be prioritized, especially among underserved populations.
Low Rates of Lung and Colorectal Cancer Screening Uptake Among a Safety-net Emergency Department Population
(Department of Emergency Medicine, School of Medicine, University of California, Irvine, 2022-08-11) Pettit, Nicholas; Ceppa, DuyKhanh; Monahan, Patrick; Emergency Medicine, School of Medicine
Introduction: A suspected diagnosis of cancer through an emergency department (ED) visit is associated with poor clinical outcomes. The purpose of this study was to explore the rate at which ED patients attend cancer screenings for lung, colorectal (CRC), and breast cancers based on national guidelines set forth by the United States Preventive Services Task Force (USPSTF). Methods: This was a prospective cohort study. Patients were randomly approached in the Eskenazi Hospital ED between August 2019-February 2020 and were surveyed to determine whether they would be eligible and had attended lung, CRC, and breast cancer screenings, as well as their awareness of lung cancer screening with low-dose computed tomography (LDCT). Patients who were English-speaking and ≥18 years old, and who were not critically ill or intoxicated or being seen for acute decompensated psychiatric illness were offered enrollment. Enrolled subjects were surveyed to determine eligibility for lung, colorectal, and breast cancer screenings based on guidelines set by the USPSTF. No cancer screenings were actually done during the ED visit. Results: A total of 500 patients were enrolled in this study. More participants were female (54.4%), and a majority were Black (53.0%). Most participants had both insurance (80.2%) and access to primary care (62.8%). Among the entire cohort, 63.0% identified as smokers, and 62.2% (140/225) of the 50- to 80-year-old participants qualified for lung cancer screening. No patients were screened for lung cancer in this cohort (0/225). Only 0.6% (3/500) were aware that LDCT was the preferred method for screening. Based on pack years, 35.5% (32/90) of the patients who were 40-49 years old and 6.7% (6/90) of those 30-39 years old would eventually qualify for screening. Regarding CRC screening, 43.6% (218/500) of the entire cohort was eligible. However, of those patients only 54% (118/218) had been screened. Comparatively, 77.7% (87/112) of the eligible females had been screened for breast cancer, but only 54.5% (61/112) had been screened in the prior two years. Conclusion: Many ED patients are not screened for lung/colorectal/breast cancers even though many are eligible and have reported access to primary care. This study demonstrates an opportunity and a need to address cancer screening in the ED.
Man with productive cough
(Wiley, 2020-06-12) Pettit, Nicholas; Al‐Hader, Ahmad; Emergency Medicine, School of Medicine
Multisystem inflammatory syndrome in adults: A case in a previously healthy adult
(Wiley, 2021-10) Motzkus, Christine A.; Whitaker, Nash; Lommel, Jennifer; Pettit, Nicholas; Emergency Medicine, School of Medicine
A 25-year-old previously healthy female presented to the emergency department (ED) with 5 days of rash, fevers, shortness of breath, and generalized weakness. She had presented to another ED 4 days previously and noted that her rash had improved, but her other symptoms were worsening. She had recovered from COVID-19, confirmed by positive antigen test 5 weeks prior. On ED arrival, she was afebrile and persistently tachycardic to a rate of 120 beats per minute, despite aggressive fluid resuscitation with 3L of IV crystalloid. She was found to have a troponin elevated to 0.06 ng/mL in addition to a d-dimer elevated to 1.42 mcg/mL FEU. She was admitted to the hospital where she developed hypotension requiring vasopressor support and was admitted to the intensive care unit (ICU). A transthoracic echocardiogram revealed a newly reduced ejection fraction of 31%. She was diagnosed with multisystem inflammatory syndrome in adults (MIS-A). The patient received intravenous immunoglobulin and methylprednisolone 60 mg Q12 hours while admitted. She was discharged on hospital day 3 with a prednisone taper and is currently doing well at her most recent follow-up with infectious disease.
Novel referral pathway for patients with new solid tumors discharged from the emergency department: A pilot study
(Wiley, 2021) Pettit, Nicholas; Al‐Hader, Ahmad; Emergency Medicine, School of Medicine
Recognizing the emergency department's role in oncologic care: a review of the literature on unplanned acute care
(BMC, 2021) Lash, Rebecca S.; Hong, Arthur S.; Bell, Janice F.; Reed, Sarah C.; Pettit, Nicholas; School of Nursing
Background: The global prevalence of cancer is rapidly increasing and will increase the acute care needs of patients with cancer, including emergency department (ED) care. Patients with cancer present to the ED across the cancer care continuum from diagnosis through treatment, survivorship, and end-of-life. This article describes the characteristics and determinants of ED visits, as well as challenges in the effort to define preventable ED visits in this population. Findings: The most recent population-based estimates suggest 4% of all ED visits are cancer-related and roughly two thirds of these ED visits result in hospitalization-a 4-fold higher ED hospitalization rate than the general population. Approximately 44% of cancer patients visit the ED within 1 year of diagnosis, and more often have repeat ED visits within a short time frame, though there is substantial variability across cancer types. Similar patterns of cancer-related ED use are observed internationally across a range of different national payment and health system settings. ED use for patients with cancer likely reflects a complex interaction of individual and contextual factors-including provider behavior, health system characteristics, and health policies-that warrants greater attention in the literature. Conclusions: Given the amount and complexity of cancer care delivered in the emergency setting, future research is recommended to examine specific symptoms associated with cancer-related ED visits, the contextual determinants of ED use, and definitions of preventable ED use specific to patients with cancer.

Browsing by Author "Pettit, Nicholas"

Results Per Page

Sort Options