Most Opioid Overdose Patients Can Be Discharged After Brief ER Visit

MedicalResearch.com Interview with:

Frank Scheuermeyer MD MHSc Clinical Associate Professor Department of Emergency Medicine St Paul’s Hospital and the University of British Columbia

Dr. Scheuermeyer

Frank Scheuermeyer MD MHSc
Clinical Associate Professor
Department of Emergency Medicine
St Paul’s Hospital and the University of British Columbia 

MedicalResearch.com: What is the background for this study?

Response: Mortality from the opioid epidemic is dramatically increasing and a main culprit appears to be illicit fentanyl. Current research states that patients with presumed fentanyl overdoses are at high risk of deterioration and death, and require prolonged emergency department stays or hospital admission to ensure a safe outcome.

Our inner-city hospital adopted a protocol initially developed for patients with heroin overdose, modified it to account for the greater potency of fentanyl, and studied 1009 consecutive patients who arrived with an overdose.

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Urgent/Emergent TAVR Feasible But Mortality Higher Than When Performed Electively

MedicalResearch.com Interview with:

Dawn Abbott, MD, FACC, FSCAI Associate Chief, Faculty Development and Academic Advancement Director, Interventional Cardiology and Structural Fellowship Programs Associate Professor of Medicine Warren Alpert Medical School, Brown Providence, RI 02903

Dr. Abbott

Dawn Abbott, MD, FACC, FSCAI
Associate Chief, Faculty Development and Academic Advancement
Director, Interventional Cardiology and Structural Fellowship Programs
Associate Professor of Medicine
Warren Alpert Medical School, Brown
Providence, RI 02903 

MedicalResearch.com: What is the background for this study?

Response: Approximately 35,000 transcatheter aortic valve replacement (TAVR) procedures are now performed annually in the United States (US). TAVR is usually performed as an elective procedure in hemodynamically stable patients. Approximately 1 in 5 hospitalizations for severe aortic stenosis (AS) are emergent with acute decompensation. Balloon aortic valvuloplasty (BAV) is a therapeutic option in patients with acute decompensated AS; however, long-term survival after BAV remains poor with a high incidence of valvular re-stenosis. Data on the outcomes of urgent/emergent TAVR as a rescue therapy in patients with acute decompensated severe AS are extremely limited.

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Heart Attacks Rarely Misdiagnosed in Emergency Rooms

MedicalResearch.com Interview with:
Daniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, CaliforniaDaniel A. Waxman, MD, PhD
Department of Emergency Medicine
David Geffen School of Medicine
University of California, Los Angeles
RAND Corporation Santa Monica, California 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: When people talk about medical error, they are usually referring to treatment error—giving the wrong medication, operating on the wrong side of the body, etc.  But many believe that diagnostic error—the failure to diagnose a condition when a patient seeks care—is at least as widespread and consequential a problem.  However, diagnostic errors are intrinsically difficult to measure, since one can rarely prove that a condition was present at the time it was not diagnosed.

In this study, we introduce a novel method for measuring how often patients who come to the emergency room with symptoms of an imminent cardiovascular emergency such as acute myocardial infarction (heart attack) are discharged home without a diagnosis.

We find that among Medicare patients whose ER visits were attributable to symptoms of an imminent infarction, only about 2.3% were discharged home, and that the figure was under 5% for each of the other four conditions we studied.    However, we also found that these relatively low rates did not improve between 2007 and 2014.

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Distance to Trauma Center & Prehospital Care Influence Outcomes from Injuries

MedicalResearch.com Interview with:

Dr. Molly Jarman PhD Postdoctoral Research Fellow at Brigham and Womens Hospital 

Dr. Jarman

Dr. Molly Jarman PhD
Postdoctoral Research Fellow at
Brigham and Womens Hospital 

MedicalResearch.com: What is the background for this study?

Response: Injuries are a leading cause of death and disability in the US, and there are well documented disparities in injury incidence and outcomes. Certain populations (i.e. rural, low income, people of color) experience more injury than others, and are more likely to die following and injury.

Past studies focused on individual health and socioeconomic characteristics as the primary driving force behind these disparities, along with variation in the time required to transport an injured patient to the hospital. We wondered if geographic features of an injury incident location contributed to variation in injury mortality that was not explained by differences in individual patient characteristics.

In other words, we know that who you are contributes to injury mortality, and we wanted to know if it also matters where you are when an injury occurs.

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Study Finds Patients Equally Likely To Fill Paper vs Electronic Prescriptions

MedicalResearch.com Interview with:

Shannon Toohey, MD, MAEd Associate Residency Director, Emergency Medicine Assistant Clinical Professor, Emergency Medicine University of California, Irvine Editor-in-Chief Journal of Education and Teaching in Emergency Medicine

Dr. Toohey

Shannon Toohey, MD, MAEd
Associate Residency Director, Emergency Medicine
Assistant Clinical Professor, Emergency Medicine
University of California, Irvine
Editor-in-Chief
Journal of Education and Teaching in Emergency Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Electronic prescriptions (e-prescriptions) are now the predominant form of prescription used in the US. Concern has been raised that this form of prescription may be more difficult for emergency department (ED) patients to utilize than traditional printed prescriptions, given the unplanned nature of most ED visits at all times of day.

While there are disincentives for physicians who choose not to use them, many emergency physicians are still concerned that it could decrease compliance in their patients.
This study evaluated prescription compliance in insured patients at a single center. In our studied population, we found that patients were as equally likely to fill paper and e-Prescriptions.

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Study Finds Pulmonary Embolus Rarely the Cause of Syncope

MedicalResearch.com Interview with:
Giorgio Costantino MD

Dipartimento di Medicina Interna
Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda
Ospedale Maggiore Policlinico
Università degli Studi di Milano
Milan, Italy

MedicalResearch.com: What is the background for this study?

Response: Syncope is a common symptom that occurs in one in four people during their lifetime. Pulmonary embolism (PE) has long been recognized as an important and serious cause of syncope. PE has always been estimated a rare cause of syncope, present in less than 1.5% of patients. A recent study (PESIT), aiming at evaluating PE prevalence using a standardized algorithm in hospitalized patients after a first syncope episode, found a prevalence of PE as high as 17% in hospitalized patients. This means that patients with a first episode of syncope should be investigated with a standard diagnostic algorithm to exclude PE.

However, many patients might go through useless and potentially harmful tests, such as computed tomography pulmonary angiogram.

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Cotton Tip Applicators Single Biggest Cause of Eardrum Ruptures

“Qtip” by Rafael Castillo is licensed under CC BY 2.0MedicalResearch.com Interview with:
Eric T. Carniol, MD, MBA
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Toronto
Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Tympanic membrane perforations (aka “popped” or “burst” ear drum) is a common complaint of patients presenting to the emergency room, primary care offices, and otolaryngologist (ENT doctors) offices. These may be caused by trauma, infections, or other causes. As well, many patients will use qtips (cotton-tipped applicators) to clean ears and remove ear wax and are unaware of the potential harms of doing so.

This study was designed to examine the cause of ear drum perforations as diagnosed in emergency departments in the United States.

Foreign body instrumentation of the ear (qtips, hair combs, hair pins, needles, etc) were the cause of 61.2% of perforations. Cotton tip applicators are the single leading cause of traumatic tympanic membrane perforation in all age groups except young adults (13-18) and 19-36 year olds, in which it is the second largest cause (behind water trauma).

Children less than 18 years old constitute nearly 2/3 of all ear drum perforations in the emergency department.

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Rapid Increase in ER Visits For Young Girls With Self-Inflicted Injuries

MedicalResearch.com Interview with:

Dr. Melissa C. Mercado PhD, MSc, MA Behavioral scientist Division of Violence Prevention National Center for Injury Prevention and Control CDC

Dr. Mercado

Dr. Melissa C. Mercado PhD, MSc, MA
Behavioral scientist
Division of Violence Prevention
National Center for Injury Prevention and Control
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Suicide ranks as the 10th leading cause of death for all age groups combined and has been among the top 12 leading causes of death since 1975 in the U.S. In 2015, across all age groups, suicide was responsible for 44,193 deaths in the U.S., which is approximately one suicide every 12 minutes.

Suicide was the second leading cause of death among U.S. youth aged 10-24 years in 2015. Self-inflicted injury is one of the strongest risk factors for suicide.

This study examined trends in non-fatal self-inflicted injuries treated in hospital emergency departments (EDs) among youth aged 10 to 24 years in the United States from 2001-2015.  The overall weighted age-adjusted rate for this group increased by 5.7% annually during the 2008 to 2015 period.  Age-adjusted trends for males overall and across age groups remained stable throughout 2001-2015.  However, rates among females increased significantly, by 8.4% annually. The largest increase among females was observed among those aged 10-14 years, with an increase of 18.8% annually from 2009 to 2015.

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How Much Non-Invasive Testing Is Necessary In ER To Rule Out Heart Attack?

MedicalResearch.com Interview with:

David L. Brown, MD, FACC Professor of Medicine Cardiovascular Division Washington University School of Medicine St. Louis, MO 63110

Dr. Brown

David L. Brown, MD, FACC
Professor of Medicine
Cardiovascular Division
Washington University School of Medicine
St. Louis, MO 63110

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Approximately 10 million patients present to emergency rooms in the US annually for evaluation of acute chest pain.

The goal of that evaluation is to rule out the diagnosis of an acute heart attack. Imaging with coronary CT angiography and stress testing are not part of the diagnostic algorithm for acute heart attack.  Nevertheless many chest pain patients undergo some form of noninvasive cardiac testing in the ER. We found that CCTA or stress testing adding nothing to the care of chest pain patients beyond what is achieved by a history, physical examination, ECG and troponin test.

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Thunderclap Headache: Ottawa Rule To Exclude Subarachnoid Bleeding

MedicalResearch.com Interview with:

Jeff Perry, MD, MSc, CCFP-EM Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician and Epidemiology Program The Ottawa Hospital Ottawa, Ontario

Dr. Perry

Jeff Perry, MD, MSc, CCFP-EM
Professor, Department of Emergency Medicine
Senior Scientist, Ottawa Hospital Research Institute
Research Chair in Emergency Neurological Research, University of Ottawa
Emergency Physician and Epidemiology Program
The Ottawa Hospital
Ottawa, Ontario

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Headache accounts for about 1-2% of all emergency department visits.  One of the most feared diagnosis within these patients is subarachnoid hemorrhage. While investigations are clearly warranted for patients with a diminished level of consciousness or new focal neurological deficits, approximately 50% of patients with subarachnoid hemorrhage (SAH) have no focal or global neurological findings. Deciding whether to image headache patients with no deficits is difficult, especially since timely diagnosis and treatment results in substantially better outcomes.

The desire to never miss a subarachnoid hemorrhage, however, contributes to escalating neuroimaging rates and a dogmatic adherence to lumbar puncture, even if the scan is negative, despite the very high sensitivity of computed tomography. However, a recent population-based study suggested that over 5% of confirmed subarachnoid hemorrhages were missed at initial presentation, especially in smaller hospitals. Therefore, identifying which headache patients require investigations to rule-out SAH is of great importance.

We have previously derived (N=1,999) and refined (N=2,131) the Ottawa SAH Rule. In this study, we conducted an multicenter prospective cohort study at six tertiary care hospitals, and found that the Ottawa SAH Rule performed well, with an 100% sensitivity, and specificity of 13.6%.

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