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Trends in emergency department visits during cold weather seasons among patients experiencing homelessness in Ontario, Canada: a retrospective population-based cohort study 加拿大安大略省无家可归者在寒冷季节到急诊室就诊的趋势:一项基于人群的回顾性队列研究
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-04-05 DOI: 10.1007/s43678-024-00675-7
Lucie Richard, Haley Golding, Refik Saskin, Salimah Z. Shariff, Jesse I. R. Jenkinson, Katherine Francombe Pridham, Carolyn Snider, Andrew Boozary, Stephen W. Hwang

Purpose

Recent anecdotal reports suggest increasing numbers of people experiencing homelessness are visiting emergency departments (EDs) during cold weather seasons due to inadequate shelter availability. We examined monthly ED visits among patients experiencing homelessness to determine whether there has been a significant increase in such visits in 2022/2023 compared to prior years.

Methods

We used linked health administrative data to identify cohorts experiencing homelessness in Ontario between October and March of the 2018/2019 to 2022/2023 years. We analyzed the monthly rate of non-urgent ED visits as a proxy measure of visits plausibly attributable to avoidance of cold exposure, examining rates among patients experiencing homelessness compared to housed patients. We excluded visits for overdose or COVID-19. We assessed level and significance of change in the 2022/2023 year as compared to previous cold weather seasons using Poisson regression.

Results

We identified a total of 21,588 non-urgent ED visits across the observation period among patients experiencing homelessness in Ontario. Non-urgent ED visits increased 27% (RR 1.24 [95% CI 1.14–1.34]) in 2022/2023 compared to previous cold weather seasons. In Toronto, such visits increased by 70% (RR 1.68 [95% CI 1.57–1.80]). Among housed patients, non-urgent ED visits did not change significantly during this time period.

Conclusion

Rates of ED visits plausibly attributable to avoidance of cold exposure by individuals experiencing homelessness increased significantly in Ontario in 2022/2023, most notably in Toronto. This increase in ED visits may be related to inadequate access to emergency shelter beds and warming services in the community.

目的最近的轶事报道表明,由于避难所不足,越来越多的无家可归者在寒冷季节前往急诊科就诊。我们研究了无家可归患者的每月急诊就诊情况,以确定 2022/2023 年的此类就诊人数是否比往年显著增加。方法我们使用关联的健康管理数据来识别 2018/2019 年至 2022/2023 年 10 月至 3 月期间安大略省无家可归者的群体。我们分析了每月的非急诊急诊就诊率,以此来替代衡量因避免暴露于寒冷环境而就诊的可能性,并对无家可归患者与有住房患者的就诊率进行了比较。我们排除了因用药过量或 COVID-19 而就诊的患者。我们使用泊松回归法评估了 2022/2023 年与之前寒冷季节相比的变化水平和显著性。与之前的寒冷季节相比,2022/2023 年的非急诊急诊就诊人数增加了 27% (RR 1.24 [95% CI 1.14-1.34])。在多伦多,此类就诊人数增加了 70%(RR 1.68 [95% CI 1.57-1.80])。结论2022/2023年,安大略省因无家可归者避免受寒而导致的急诊就诊率显著增加,其中以多伦多最为明显。急诊室就诊人数的增加可能与社区紧急庇护所床位和取暖服务不足有关。
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引用次数: 0
Non-suicidal self-injury at a Canadian paediatric emergency department 加拿大儿科急诊室发生的非自杀性自伤事件
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-04-02 DOI: 10.1007/s43678-024-00657-9

Abstract

Objective

Our primary objective was to determine agreement between non-suicidal self-injury recorded at triage and during subsequent mental health assessment. The secondary objective was to describe patients who reported non-suicidal self-injury.

Methods

This is a health records review of patients aged 12–18 years who had an Emergency Mental Health Triage form on their health record from an ED visit June 1, 2017–May 31, 2018. We excluded patients with diagnoses of autism spectrum disorder or schizophrenia. We abstracted data from the Mental Health Triage form, Emergency Mental Health and Addictions Service Assessment forms and Assessment of Suicide and Risk Inventory. We calculated Cohen’s Kappa coefficient, sensitivity, and negative predictive value to describe the extent to which the forms agreed and the performance of triage for identifying non-suicidal self-injury. We compared the cohort who reported non-suicidal self-injury with those who did not, using t-tests, Wilcoxon rank-sum tests, and chi-square tests.

Results

We screened 955 ED visits and included 914 ED visits where 558 (58.4%) reported a history of non-suicidal self-injury. There were significantly more females in the group reporting non-suicidal self-injury (82.1%, n = 458) compared to the group not reporting non-suicidal self-injury (45.8%, n = 163). Patients reporting non-suicidal self-injury did so in triage and detailed Mental Health Assessment 64.7% of the time (Cohen’s Kappa Coefficient 0.6); triage had sensitivity of 71.5% (95% CI 67.3–75.4) and negative predictive value of 71.2% (95% CI 68.2–74.0). Cutting was the most common method of non-suicidal self-injury (80.3%).

Conclusion

Screening at triage was moderately effective in identifying non-suicidal self-injury compared to a detailed assessment by a specialised mental health team. More than half of children and adolescents with a mental health-related concern in our ED reported a history of non-suicidal self-injury, most of which were female. This symptom is important for delineating patients’ coping strategies.

摘要 目的 我们的首要目标是确定分诊时记录的非自杀性自伤与随后进行的心理健康评估之间的一致性。次要目标是描述报告非自杀性自我伤害的患者。 方法 这是对 2017 年 6 月 1 日至 2018 年 5 月 31 日在急诊室就诊的 12-18 岁患者进行的健康记录审查,这些患者的健康记录上有一份急诊精神健康分诊表。我们排除了诊断为自闭症谱系障碍或精神分裂症的患者。我们从心理健康分诊表、急诊心理健康和成瘾服务评估表以及自杀和风险评估量表中抽取了数据。我们计算了科恩卡帕系数(Cohen's Kappa coefficient)、灵敏度(sensitivity)和负预测值(negative predictive value),以描述各表格的一致程度以及分诊在识别非自杀性自伤方面的表现。我们使用 t 检验、Wilcoxon 秩和检验和卡方检验对报告了非自杀性自伤的人群和未报告的人群进行了比较。 结果 我们对 955 名急诊就诊者进行了筛查,共纳入 914 名急诊就诊者,其中 558 人(58.4%)报告了非自杀性自残史。与未报告非自杀性自我伤害的患者(45.8%,n = 163)相比,报告非自杀性自我伤害的患者中女性明显较多(82.1%,n = 458)。64.7%的患者在分诊和详细心理健康评估中报告了非自杀性自伤行为(科恩卡帕系数0.6);分诊的灵敏度为71.5%(95% CI 67.3-75.4),阴性预测值为71.2%(95% CI 68.2-74.0)。切割是最常见的非自杀性自伤方式(80.3%)。 结论 与专业心理健康团队的详细评估相比,分流筛查在识别非自杀性自我伤害方面的效果一般。在我们的急诊室,超过半数有心理健康相关问题的儿童和青少年都有非自杀性自伤的病史,其中大部分是女性。这一症状对于确定患者的应对策略非常重要。
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引用次数: 0
Rapid HIV testing in emergency departments: a paradigm shift. 急诊科的艾滋病毒快速检测:模式转变。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-01-01 Epub Date: 2023-09-15 DOI: 10.1007/s43678-023-00589-w
Mazen El-Baba, Jessica Kent, Isaac I Bogoch, Kyle Vose, Jennifer Hulme, Megan Landes
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引用次数: 0
Efficacy of hand-held metal detectors in the detection and localization of ingested metallic foreign bodies in children. 手持金属探测器在检测和定位儿童误食金属异物方面的功效。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-01-01 Epub Date: 2023-09-14 DOI: 10.1007/s43678-023-00593-0
Jayanand Mekwan, Kavish Chandra, Paul Atkinson
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引用次数: 0
Just the facts: transgender and gender diverse identities in emergency medicine. 就事论事:急诊医学中的变性人和不同性别身份。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2024-01-01 Epub Date: 2023-09-18 DOI: 10.1007/s43678-023-00583-2
Murdoch Leeies, Ellie Caslake, Carys Massarella
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引用次数: 0
Rates of pediatric emergency department visits vary according to neighborhood marginalization in Ottawa, Canada 加拿大渥太华儿科急诊就诊率因社区边缘化程度而异
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-12-20 DOI: 10.1007/s43678-023-00625-9
Habeeb AlSaeed, Ewa Sucha, Maala Bhatt, Nicholas Mitsakakis, Natalie Bresee, Melanie Bechard

Objectives

To determine the association between neighborhood marginalization and rates of pediatric ED visits in Ottawa, Ontario. Secondary objectives investigated if the association between neighborhood marginalization and rates varied by year, acuity, and distance to hospital.

Methods

We calculated rates of pediatric ED visits per 1000 person-years for census dissemination areas within 100 km of the Children’s Hospital of Eastern Ontario for patients < 18 years old from January 2018 through December 2020. The 2016 Ontario Marginalization Index categorized neighborhoods along quintiles of residential instability, material deprivation, ethnic concentration, and dependency. Generalized mixed-effects models determined the incidence rate ratios of pediatric ED visits for each quintile of marginalization; multivariate models were used to control for year of presentation and distance to hospital. Analysis was repeated for low versus high acuity ED visits.

Results

There were 154,146 ED visits from patients in 2055 census dissemination areas within 100 km of CHEO from 2018 to 2020. After controlling for year and distance from hospital in multivariate analyses, there were higher rates of pediatric ED visits for dissemination areas with high residential instability, high material deprivation, and low ethnic concentration. These findings did not change according to visit acuity.

Conclusions

Neighborhood residential instability and material deprivation should be considered when locating alternatives to emergency care.

目标确定安大略省渥太华市邻里边缘化与儿科急诊室就诊率之间的关系。次要目标是调查邻里边缘化与就诊率之间的关系是否因年份、严重程度和医院距离而异。方法我们计算了2018年1月至2020年12月期间,东安大略省儿童医院100公里范围内人口普查分布区每1000人年的儿科急诊室就诊率,患者年龄为18岁。2016 年安大略省边缘化指数按照居住不稳定性、物质匮乏、种族集中和依赖性的五分位数对社区进行了分类。广义混合效应模型确定了每个边缘化五分位数的儿科急诊就诊发生率比;多变量模型用于控制发病年份和医院距离。结果从2018年到2020年,CHEO 100公里范围内2055个人口普查传播区域的患者共就诊154146次。在多变量分析中控制了年份和与医院的距离后,居住不稳定性高、物质匮乏程度高和民族聚集程度低的传播区的儿科急诊就诊率较高。结论在选择急诊替代方案时,应考虑居民区的不稳定性和物质匮乏。
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引用次数: 0
A pickup for a case of hiccups: point-of-care ultrasonography detects a liver abscess in a 74-year-old gentleman 一个打嗝病例的接诊:护理点超声波检查发现一名 74 岁男性患有肝脓肿
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-12-15 DOI: 10.1007/s43678-023-00623-x
Lynette Yan Ee Chung, Yun Ying Ho, Sze Joo Juan
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引用次数: 0
Completeness and accuracy of digital charting vs paper charting in simulated pediatric cardiac arrest: a randomized controlled trial 模拟儿科心脏骤停中数字病历与纸质病历的完整性和准确性:随机对照试验
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-12-15 DOI: 10.1007/s43678-023-00624-w
Alexandra St-Onge-St-Hilaire, Adam Cheng, Jennifer Davidson, Brandi Wan, Yiqun Lin

Objectives

To determine if data collected through digital charting are more complete and more accurate compared to traditional paper-based charting during simulated pediatric cardiac arrest.

Methods

We performed a single-center simulation-based randomized controlled trial. Participants were randomized to a novel handheld digital charting device (intervention group) or to the standard resuscitation paper chart (control group). Participants documented two 15-min simulated pediatric cardiac arrest scenarios. We compared the charting completeness between the two groups. Completeness score (primary outcome) was established by calculating a completeness score for each group based on a list of pre-determined critical tasks. Charting accuracy (secondary outcome) was compared between the two groups, defined as the time interval between the real-time task performance and charted time.

Results

Charting data from 34 simulated cardiac arrest events were included in the analysis (n = 18 intervention; n = 16 control). The paper charting group had a higher completeness score (median (IQR) paper vs digital: 72.0% (66.4–76.9%) vs 65.0% (58.5–66.4%), p = 0.015). For accuracy, the digital charting group was superior to the paper charting group for all pre-established critical tasks.

Conclusion

Compared to paper-based charting, digital charting group captured more critical tasks during pediatric simulated resuscitation and was more accurate in the time intervals between real-time tasks performance and charted time. For tasks charted, paper-based charting was significantly more complete and more detailed during simulated pediatric cardiac arrest.

目标确定在模拟小儿心脏骤停过程中,通过数字图表收集的数据是否比传统的纸质图表更完整、更准确。方法我们进行了一项基于单中心模拟的随机对照试验。参与者被随机分配到新型手持式数字图表设备(干预组)或标准复苏纸质图表(对照组)。参与者记录了两个 15 分钟的模拟儿科心脏骤停场景。我们比较了两组的图表完整性。根据预先确定的关键任务列表计算出每组的完整度得分,从而确定完整度得分(主要结果)。对两组的制图准确性(次要结果)进行比较,准确性的定义是实时任务执行时间与制图时间之间的时间间隔。结果分析包括 34 个模拟心脏骤停事件的制图数据(n = 18 个干预组;n = 16 个对照组)。纸质制图组的完整性得分更高(中位数(IQR)纸质制图 vs 数字制图:72.0% (66.4-76.9%) vs 65.0% (58.5-66.4%),p = 0.015)。结论与纸质制表相比,数字制表组在儿科模拟复苏过程中捕捉到的关键任务更多,在实时任务执行和制表时间之间的时间间隔上也更准确。在模拟儿科心脏骤停过程中,纸质病历组所记录的任务明显更完整、更详细。
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引用次数: 0
Dream one, do one, teach one: a mental practice script for bougie assisted cricothyrotomy 梦一、做一、教一:布吉辅助环甲膜切开术的心理练习脚本
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-12-09 DOI: 10.1007/s43678-023-00630-y
Jamie Riggs, Melissa McGowan, Christopher Hicks

Mental practice is an effective method for skill acquisition in medicine. We describe the integration of interview-derived sensory cues with a list of procedural steps into a cohesive script to facilitate mental practice for a High Acuity, Low-Occurrence procedure, the bougie-assisted cricothyrotomy. Data collection occurred through interviews with emergency physicians. Interview transcripts were analyzed on a coding framework based on a previously published list of procedural steps. These cues were integrated with procedural steps to create a narrative script. Eight interview transcripts were analyzed. A total of 328 cues were identified. On average, each participant identified 13.7 cues per procedure. This represents the first attempt to combine cues identified by practitioners along with procedural steps with the aim of supporting rich mental representations of a procedure. We expect that this script will be useful to physicians seeking to improve their skills in this rare procedure.

心理练习是学习医学技能的有效方法。我们描述了如何将访谈中获得的感觉线索与程序步骤列表整合到一个连贯的脚本中,以促进高危、低发生率程序(通气辅助环甲膜切开术)的心理练习。数据收集是通过对急诊医生的访谈进行的。访谈记录是根据之前公布的程序步骤清单,在编码框架的基础上进行分析的。这些线索与手术步骤相结合,形成了叙述性脚本。共分析了 8 份访谈记录。共识别出 328 条线索。平均每位参与者在每个程序中识别出 13.7 条线索。这是首次尝试将从业人员识别的线索与程序步骤相结合,旨在支持丰富的程序心理表征。我们希望这个脚本能为医生提高这种罕见手术的技能提供帮助。
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引用次数: 0
Just the facts: seizure prophylaxis post-traumatic brain injury (TBI). 事实:创伤性脑损伤 (TBI) 后的癫痫预防。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-12-01 Epub Date: 2023-07-13 DOI: 10.1007/s43678-023-00554-7
James Nunn, Kristin Kaupp, Robert S Green
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引用次数: 0
期刊
Canadian Journal of Emergency Medicine
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