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Aug 2017 DOI 10.14302/issn.2574-4526.jddd-17-1688
Patients with inflammatory bowel disease (IBD) frequently visit the emergency department (ED). The use of cputed tomography (CT) scans in this population has drastically increased in recent years and may confer an increased risk of malignancy. Records were obtained for IBD patients aged 18 or older who visited our institutional ED with a gastrointestinal chief complaint and who had a CT scan ordered by an ED physician. A predictive model for identifying a clinically actionable finding (CAF) on CT scan was created using logistic regression carried out on a predetermined set of variables. Data were available on 156 Crohn’s disease (CD) patients contributing 350 visits and 63 ulcerative colitis (UC) patients contributing 114 total visits. CAF was identified at 108/350 (30.9%) of visits in CD patients and 33/114 (29.0%) of visits in UC patients. History of CAF (OR 11.6, CI 4.54-29.6) and a platelet count above 400,000/mL (OR 3.42, CI 1.56-7.50) were the strongest predictors of CAF. History of psychiatric illness (OR 0.67, CI 0.35-1.29) and diarrhea (OR .043, CI 0.23-0.83) were associated with a lower likelihood of CAF. A prediction model was created that was able to detect 94.4% of CAF cases while correctly predicting CAF non-cases 35% of the time. This model holds promise as a tool to reduce imaging in this population.
Apr 2024 DOI 10.14302/issn.2329-9487.jhc-24-5040
Objective Hypertensive crisis is an increasingly frequent medical condition in our context. Its management in medical emergencies is a real challenge for physicians. Few data on hypertensive crisis are available in Chad. The aim of this study was to investigate the epidemiological, clinical and prognostic characteristics of hypertensive crisis in the medical emergency department of Reference National Teaching Hospital in N'Djamena. Patient and methods This was a prospective cohort study running from 1er March 2020 to October 31 2020. Patients presenting with a sudden and severe rise in blood pressure (systolic ≥ 180 mmHg and/or diastolic ≥ 110 mmHg) with or without acute target-organs damage, had been consecutively included and followed up over a period of one (01) month. Epidemic and clinical characteristics on admission, and morbidity and mortality parameters during the course of the disease were collected. The Kaplan-Meier method and the Cox model were used to analyze survival and factors associated with death, with a significance level of p<0.05. Results Of the 3978 hypertensive patients admitted to medical emergencies, 252 had a hypertensive crisis, i.e. a prevalence of 6.3%. Two hundred and seventeen (217) patients were included in the study, divided into 149 cases (69%) of hypertensive emergency and 67 cases (31%) of hypertensive hypertensive urgencies. The mean age of the patients was 55.2 ± 14 years (20 and 80 years) and 67% were male. Hypertension was known in 138 patients (64%). At least one complication was present on admission in 69% of patients. Complications were classified as cardiac (50.7%), neurological (38.2%), kidney impairment (46.5%) and ocular (46.1%). The average number of antihypertensive drugs used was 2 ± 0.83 14. Calcium antagonists (86.5%), diuretics (35.5%), converting enzyme inhibitors or angiotensin II receptor antagonists (33.3%) and betablockers (18%) were the pharmacological classes prescribed. Good compliance during follow-up was observed in 124 patients. One-month survival was 84% for all patients, with a 16% mortality rate. Factors associated with death were the duration of hypertension, and the occurrence of cardiovascular, renal dysfunction and ocular disease (p < 0.05). Conclusion Hypertensive crisis is a frequent pathology in sub-Saharan Africa, with high morbidity and mortality. Prevention requires early detection and effective management of hypertension.
Apr 2022 DOI 10.14302/issn.2379-7835.ijn-22-4155
The diabetic is most of the time admitted in emergency for acute complications. An inventory of these complications will guide promotional programs aimed at preventing the occurrence of these complications. This study was conducted with the aim of identifying acute complications and decompensation factors in diabetics admitted in emergency to the Souro Sanou University Hospital Center (CHUSS).It was an observational study, of descriptive transversal type, with prospective collection for 4 months. It concerned diabetics admitted to the medical and surgical emergency departments of the CHUSS. A total of 90 diabetics were included in the study. The average age was 58.81 ± 14.7 years. Type 2 diabetes accounted for 85.6% of cases. The diagnosis of diabetes was known in 74.4% of cases. The reasons for consultation were dominated by impaired conscientiousness and fever, 54.4% and 50% respectively. Metabolic complications were found in 44.4% of patients. They were dominated by hypoglycemia, which accounted for 55.3% of cases. Dietary error was the main decompensation factor in cases of hypoglycemia and was reported in 71.4% of cases. Metabolic complications are common in diabetics admitted in emergency at the CHUSS. Decompensation factors are mostly preventable.
Dec 2021 DOI 10.14302/issn.2692-1537.ijcv-21-4045
Introduction In December 2019, cases of serious illness causing pneumonia and death were first reported in Wuhan, China.2 The clinical features of Corona Virus Disease-19 (COVID-19) are ranging from asymptomatic to multi organ dysfunction. The disease can progress to pneumonia, respiratory failure and death.4 Thus, a tool is needed that can predict the severity and in-hospital mortality risk of a patient with COVID-19 Pneumonia. The PIRO (predisposition, insult, response, and organ dysfunction) scoring was developed for use in the emergency department to risk stratify sepsis cases.15 Eventually it was adapted in pneumonia cases to predict its severity. Objective To validate PIRO score as an assessment tool for COVID-19 mortality risk among patients with confirmed COVID-19 RT-PCR test among patients aged 19 and above admitted in World Citi Medical Center from March 2020 to August 2020 Methods This study included 93 patients aged 19 and above admitted in World Citi Medical Center with a primary diagnosis of COVID-19 Confirmed with pneumonia between March 2020 to August 2020. The patients’ charts were retrieved from the hospital medical records and case notes were reviewed. A severity assessment score was developed based on PIRO score (Predisposition comorbidities and age; Insult multilobar opacities and viremia; Response shock and hypoxemia; Organ Dysfunciton) were extracted. The patients were stratified in four levels of risk: a)Low,0-2 points; b)Mild,3 points; c)High,4 points; d)Very High,5-8 points. The PIRO score and the clinical outcome were compared. The discriminative ability of PIRO score to predict mortality risk was evaluated under receiver operating characteristic curve (AUC). Results The PIRO score had an excellent predictive ability for in-hospital mortality (AUC0.9197). Analysis of variance showed that higher levels of PIRO scores were significantly associated with higher mortality (p<0.001). Patients with Mild PIRO risk category were 98.65% less likely to expire (p<0.001, 95%CI 0.0015) and High PIRO risk category were 94.47% less likely to expire (p<0.001, 95%CI 0.0124), both compared to patients with Very high PIRO risk category. Finally, Very High PIRO risk category were more than 44 times likely to expire compared to patients with Low, Mild and High PIRO risk category (p<0.001, 95%CI 11.738). Conclusions The PIRO score is a valid risk model that can be used to predict in-hospital mortality, that can help clinicians provide timely and accurate assessment, and hence appropriate management to patients with COVID-19 Pneumonia.
Jul 2019 DOI 10.14302/issn.2641-5518.jcci-19-2909
An 81-year-old male presented to the Emergency Department with urinary retention, subsequent to passing blood clots. A three-way catheter was inserted for continuous bladder irrigation. 48 hours later he deteriorated, with worsening tachypnea and hypoxaemia. Clinical examination and chest x-ray suggested pulmonary odema, managed with intravenous furosemide, and non-invasive ventilation. His irrigation circuit-chart showed he had received 10 litres Normal Saline via the afferent limb, but only 3 litres recorded at the efferent limb. It was suspected the catheter was adjacent to a vascular-cystic interface, however an urgent contrast CT revealed the irrigating catheter perforating the bladder, being situated in the abdominal cavity (see 3 images). His arterial blood-gas analysis demonstrated the expected normal anion-gap academia, however his Strong Ion Difference calculations, sodium-chloride difference of 13 and a normal albumin level, perfectly demonstrated the expected calculated BE of -13. The catheter was withdrawn, and the patient made a full recovery.
Mar 2019 DOI 10.14302/issn.2474-3585.jpmc-19-2633
Motorcycles have been increasing used widely in various urban, suburban and villages in Cameroon with an increased in accidents resulting to injuries among the population. Head and limbs injuries are responsible for most of the cases encountered from related crashes. A prospective study on head and limbs injuries resulting from motorcycle crash were assessed among the different cases brought to the casualty and emergency department of the Kumba district hospital. Most of the injured cases were of motorcycle and other vehicle collisions 203 (47.65) and the least among motorcycle lone crash 51 (11.97). Motorcycle to motorcycle collisions accounted for 107 (25.12 %) of the cases. 65 (15.26%) were motorcycle with pedestrians related collision. Stepping up and facilitating the regulations on licenses and the use of personal protective equipment for riders, improvement of roads infrastructures with pedestrian path, expanding health facilities and equipment, and human resources for health as well as empowering the population on road safety measures will be very important for RTAs control measures of the nation.
Oct 2017 DOI 10.14302/issn.2574-4526.jddd-17-1497
Volvulus occurring during pregnancy is a rare complication, still potentially lethal nowadays for both the mother and child due to several, early arising complications. We report here a case of small bowel volvulus in a 28 weeks and 4 days, 29 years-old, pregnant woman with a past medical history of appendectomy in her childhood. Patient presented in emergency department with abdominal pain and abnormal hepatic tests. Cholangio-MRI suggested bowel obstruction due to volvulus that was confirmed by gastroscopy (showing the obstruction) and intestinal MRI. Patient was first treated by laparoscopy but, due to a very complicated abdominal status with the presence of several adhesions of the small bowel, surgery was changed to an open laparotomy, which allowed discovery and repositioning of small bowel malrotation and removal of adhesions. Both patient and the foetus were healthy after surgery and the patient was then discharged. In the light of this particularly rare case of small bowel volvulus due to malrotion, we will describe the pathology of bowel obstruction and more particularly volvulus during pregnancy and discuss its diagnosis and treatment.
Feb 2017 DOI 10.14302/issn.2474-7785.jarh-16-1398
Oral nutritional supplements (ONS) have been shown to improve patient outcomes in the hospital setting, but limited results from long-term care or community settings exist. Using electronic health records (EHRs) from 2009 to 2014 for both adult inpatients and outpatients, we compare the demographic and clinical characteristics of patients who received ONS (n = 1,251) with a non-ONS control group (n =25,513). Multivariable logistic regression modeling was used to describe and compare differences in baseline characteristics between the groups including age, sex, race, tobacco use, and comorbidities. We found that patients receiving ONS were older and sicker than control patients. Hospitalized ONS patients were more likely to be admitted from the emergency department and have a hospitalization within the last month prior to the index date. Our results suggest that there is a need for nutrition screening and incorporating nutrition status into the EHR as an important way to coordinate hospital and community medical care. ONS can be an important therapy for vulnerable populations in both the hospital and the community settings.
Jan 2017 DOI 10.14302/issn.2470-5020.jnrt-16-1415
Objectives: Computed tomography angiography (CTA) provides early assessment of cerebral vasculature in ED patients presenting with Acute Ischemic Stroke (AIS). Prior studies using 4 row detector CT scanners have suggested that results may be used to determine who receives thrombolytics (tPA). We sought to evaluate the rate of normal CTA and the use of tPA in AIS patients with and without blockages using modern CT technology. Patients and Methods: We conducted a retrospective cohort study of all code stroke patients presenting to our ED over a 3 year period. Inclusion criteria included an ED and neurology diagnosis of AIS with a CTA performed at presentation. All patients had a NIHSS score recorded at presentation and underwent imaging using a 64 row detector scanner with 50cc of non-ionic contrast. Demographic, imaging, and clinical data were collected. Modified Rankin Scores (mRS) were assigned at hospital discharge. Good clinical outcome was defined as a mRS of 0-2. Data are reported as frequencies and medians with interquartile ranges (IQR) as appropriate. Rates of tPA use were evaluated using χ2 testing. Rates of good outcomes were evaluated using odds ratios. Results: A total of 205 subjects met inclusion for analysis of which 103 (50%) were male and 109 (54%) had no blockage on CTA. The median NIHSS score and mortality rates were 14 (IQR 8-19), 14 (14%) with CTA blockage, and 4 (IQR 2-7), 2 (2%) for those without. Of those AIS with a blockage on CTA 46 (48%) were treated with tPA including 29 who were treated with intra-arterial therapy as well while only 13 (13%) of patients without a blockage were treated with tPA. Post tPA bleeding occurred in 12 (13%) patients with blockage on CTA and in 0 patients without blockage. Use of tPA was significantly more frequent in patients with a blockage on CTA, P <0.001. Conclusion: More than half of our AIS patients presenting through our ED have no blockage on CTA. Inter-rater reliability among neuroradiologists evaluating for large vessel occlusion appears to be very good. Patients with AIS and no blockage on CTA have less severe strokes and are less likely to receive tPA. Given the new guidelines recommending endovascular treatment for AIS we expect more emergency departments to begin performing CTA.
Dec 2016 DOI 10.14302/issn.2381-862X.jwrh-15-846
Sexual assault is a serious problem in the United States. It is crucial that the medical management of these patients is adequate. The Centers for Disease Control and Prevention (CDC) provides guidelines for appropriate management of these patients. The purpose of this study is to evaluate medical management of survivors of sexual assault at an academic medical center and identify opportunities for improvements in care. We conducted a retrospective, chart review study of patients aged 12 years and older presenting at an academic medical center following sexual assault or rape between 2009 and 2013. Descriptive statistical tests were used to analyze the data. A total of 29 females and 5 males were identified. The majority of patients presented to the medical center within 24 hours of sexual assault or rape and typically presented to the emergency department. Empiric treatment for infections were 8.8% for Hepatitis B, 29.4% for human immunodeficiency virus, 20.6% for gonorrhea, 17.6% for chlamydia, and 8.8% for trichomonas. Among women of reproductive age, 28.0% were provided with emergency contraception. This study found inconsistency in the medical management of sexual assault survivors. Among this small sample size, many patients were not provided with recommended medical treatments. With this knowledge, the medical center plans to implement institutional guidelines and a corresponding order set in the computerized prescriber order entry system to standardize the medical management of sexual assault survivors and educate healthcare professionals. Future studies are warranted to evaluate the impact of standardized guidelines and order set implementation.
Jun 2016 DOI 10.14302/issn.2471-2175.jdrt-15-836
Cellulitis is an acute, spreading pyogenic inflammation of the dermis and subcutaneous tissue, usually complicating a wound, ulcer, or dermatosis. Inappropriate diagnosis of cellulitis is a problem and would need prospective rather than retrospective studies to quantify the extent. There is one national guideline for the management of patients with cellulitis. The aim of this study is to determine the validity of Crest guideline in the patients with non-facial cellulitis. This prospective cohort study was conducted on all Adult patients with cellulites who were admitted at Resole-Akram and Sina emergency department between November 2013 and January 2014. Based on admission duration, the patients were randomly divided into two groups including primary and secondary outcome, <24-hours or >24-hours admission, respectively. Out of 89 admitted patients, 55% were hospitalized over 24 hours and 20% of them had significant systemic symptoms. The most patients (n= 42) had either systemically ill or systemically well or class II followed by classes I (n=28), III (n=18), and IV (n=1). There was significant relevancy between age, fever, PR, infected organ, leukocytosis, diabetes mellitus, IUDA, human bite, and primary outcome. In conclusion, factors associated with admission were age, presence of multiple comorbid conditions, diabetes mellitus, human bite, IUDA, infected organ, leukocytosis and fever. These results showed that the decision in the emergency department was mostly the same as Crest guideline and the prospection of admission and discharge of these patients was almost according to the educations of Crest guideline.
Nov 2013 DOI 10.14302/issn.2328-0182.japst-13-185
Background: Antidepressant agents are commonly implicated in drug overdose, and the toxicological profile varies between agents. Clinical data concerning overdoses are not systematically sought or evaluated in pharmacovigilance. The present study sought to examine the feasibility of collecting Emergency Department data concerning antidepressant overdose. Methods : Presentations to York Hospital due to intentional antidepressant overdose were studied between 2010 and 2011. Data collected were the type of antidepressant, dose, co-ingested drugs, duration of hospital stay, and need for critical care. Community National Health Service prescription data were evaluated across York and North Yorkshire region. Results : There were 250 overdose episodes. These involved a selective serotonin reuptake inhibitor (SSRI) in 183 (73.2%), and a tricyclic in 45 (18.0%), equivalent to 24 episodes per 100,000 prescription items (95% CI 21-28 per 100,000) and 11 per 100,000 (8-15 per 100,000) respectively (P<0.0001). Citalopram was the most commonly prescribed, and associated with 22 overdose episodes per 100,000 (17-27 per 100,000). Fluoxetine was associated with 32 overdose episodes per 100,000 (24-41 per 100,000) (P=0.032 versus citalopram), whereas the lower rates were observed for amitriptyline (13, 9-17 per 100,000) (P=0.004) and dosulepin (2, 0-10 per 100,000) (P=0.001). Conclusions : A higher than expected number of overdose episodes involved an SSRI based on National Health Service primary care prescribing, and fewer episodes involved a tricyclic antidepressant. Clinical outcomes differed between agents, indicating the feasibility of using Emergency Department data to detect different patterns of toxicity between antidepressants. Further work is required to examine whether systematic collection of clinical toxicology data might enhance existing pharmacovigilance systems.