Browsing by Subject "Emergency"

Now showing 1 - 5 of 5
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    Association between social vulnerability index and admission urgency for transcatheter aortic valve replacement
    (Elsevier, 2024) Bolakale-Rufai, Ikeoluwapo Kendra; Shinnerl, Alexander; Knapp, Shannon M.; Johnson, Amber E.; Mohammed, Selma; Brewer, LaPrincess; Torabi, Asad; Addison, Daniel; Mazimba, Sula; Breathett, Khadijah; Medicine, School of Medicine
    Background: Transcatheter aortic valve replacement (TAVR) are not offered equitably to vulnerable population groups. Adequate levels of insurance may narrow gaps among patients with higher social vulnerability index (SVI). Among a national population of individuals with commercial or Medicare insurance, we sought to determine whether SVI was associated with urgency of receipt of TAVR for aortic stenosis. Methods and results: Using Optum's de-identified Clinformatics Data Mart Database (CDM), we identified admissions for TAVR with aortic stenosis between January 2018 and March 2022. Admission urgency was identified by CDM claims codes. SVI was cross-referenced to patient zip codes and grouped into quintiles. Generalized linear mixed effects models were used to predict the probability of a TAVR admission being urgent based on SVI quintiles, adjusting for patient and hospital-level covariates. Results: Among 6680 admissions for TAVR [median age 80 years (interquartile range 75-85), 43.9 % female], 8.5 % (n = 567) were classified as urgent. After adjusting for patient and hospital-level variables, there were no significant differences in the odds of urgent admission for TAVR according to SVI quintiles [OR 5th (greatest social vulnerability) vs 1st quintile (least social vulnerability): 1.29 (95 % CI: 0.90-1.85)]. Conclusions: Among commercial or Medicare beneficiaries with aortic stenosis, SVI was not associated with admission urgency for TAVR. To clarify whether cardiovascular care delivery is improved across SVI with higher paying beneficiaries, future investigation should identify whether relationships between SVI and TAVR urgency vary for Medicaid beneficiaries compared to commercial beneficiaries.
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    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.
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    Macroeconomic trends and practice models impacting acute care surgery
    (BMJ, 2019-04-11) Bernard, Andrew; Staudenmayer, Kristan; Minei, Joseph P.; Doucet, Jay; Haider, Adil; Scherer, Tres; Davis, Kimberly A.; Surgery, School of Medicine
    Acute care surgery (ACS) diagnoses are responsible for approximately a quarter of the costs of inpatient care in the US government, and individuals will be responsible for a larger share of the costs of this healthcare as the population ages. ACS as a specialty thus has the opportunity to meet a significant healthcare need, and by optimizing care delivery models do so in a way that improves both quality and value. ACS practice models that have maintained or added emergency general surgery (EGS) and even elective surgery have realized more operative case volume and surgeon satisfaction. However, vulnerabilities exist in the ACS model. Payer mix in a practice varies by geography and distribution of EGS, trauma, critical care, and elective surgery. Critical care codes constitute approximately 25% of all billing by acute care surgeons, so even small changes in reimbursement in critical care can have significant impact on professional revenue. Staffing an ACS practice can be challenging depending on reimbursement and due to uneven geographic distribution of available surgeons. Empowered by an understanding of economics, using team-oriented leadership inherent to trauma surgeons, and in partnership with healthcare organizations and regulatory bodies, ACS surgeons are positioned to significantly influence the future of healthcare in the USA.
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    Measles: Contemporary considerations for the emergency physician
    (Wiley, 2023-09-09) Blutinger, Erik; Schmitz, Gillian; Kang, Christopher; Comp, Geoffrey; Wagner, Emily; Finnell, John T.; Cozzi, Nicolas; Haddock, Alison; Emergency Medicine, School of Medicine
    Measles, or rubeola, is a highly contagious acute febrile viral illness. Despite the availability of an effective vaccine since 1963, measles outbreaks continue worldwide. This article seeks to provide emergency physicians with the contemporary knowledge required to rapidly diagnose potential measles cases and bolster public health measures to reduce ongoing transmission.
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    Traumatic Brain Injury as an Independent Predictor of Futility in the Early Resuscitation of Patients in Hemorrhagic Shock
    (MDPI, 2024-07-03) Al-Fadhl, Mahmoud D.; Karam, Marie Nour; Chen, Jenny; Zackariya, Sufyan K.; Lain, Morgan C.; Bales, John R.; Higgins, Alexis B.; Laing, Jordan T.; Wang, Hannah S.; Andrews, Madeline G.; Thomas, Anthony V.; Smith, Leah; Fox, Mark D.; Zackariya, Saniya K.; Thomas, Samuel J.; Tincher, Anna M.; Al-Fadhl, Hamid D.; Weston, May; Marsh, Phillip L.; Khan, Hassaan A.; Thomas, Emmanuel J.; Miller, Joseph B.; Bailey, Jason A.; Koenig, Justin J.; Waxman, Dan A.; Srikureja, Daniel; Fulkerson, Daniel H.; Fox, Sarah; Bingaman, Greg; Zimmer, Donald F.; Thompson, Mark A.; Bunch, Connor M.; Walsh, Mark M.; Futile Indicators for Stopping Transfusion in Trauma (FISTT) Collaborative Group; Pathology and Laboratory Medicine, School of Medicine
    This review explores the concept of futility timeouts and the use of traumatic brain injury (TBI) as an independent predictor of the futility of resuscitation efforts in severely bleeding trauma patients. The national blood supply shortage has been exacerbated by the lingering influence of the COVID-19 pandemic on the number of blood donors available, as well as by the adoption of balanced hemostatic resuscitation protocols (such as the increasing use of 1:1:1 packed red blood cells, plasma, and platelets) with and without early whole blood resuscitation. This has underscored the urgent need for reliable predictors of futile resuscitation (FR). As a result, clinical, radiologic, and laboratory bedside markers have emerged which can accurately predict FR in patients with severe trauma-induced hemorrhage, such as the Suspension of Transfusion and Other Procedures (STOP) criteria. However, the STOP criteria do not include markers for TBI severity or transfusion cut points despite these patients requiring large quantities of blood components in the STOP criteria validation cohort. Yet, guidelines for neuroprognosticating patients with TBI can require up to 72 h, which makes them less useful in the minutes and hours following initial presentation. We examine the impact of TBI on bleeding trauma patients, with a focus on those with coagulopathies associated with TBI. This review categorizes TBI into isolated TBI (iTBI), hemorrhagic isolated TBI (hiTBI), and polytraumatic TBI (ptTBI). Through an analysis of bedside parameters (such as the proposed STOP criteria), coagulation assays, markers for TBI severity, and transfusion cut points as markers of futilty, we suggest amendments to current guidelines and the development of more precise algorithms that incorporate prognostic indicators of severe TBI as an independent parameter for the early prediction of FR so as to optimize blood product allocation.