Day 1 :
Northwestern University, USA
Keynote: Post-emergency department adverse outcomes in medicare patients presenting with musculoskeletal conditions
Time : 09:30-10:15
Susan Nedza is the Senior Vice President of Clinical Outcomes at MPA Healthcare Solutions and an Adjunct Assistant Professor at the Feinberg School of Medicine of Northwestern University. She is board-certified in Emergency Medicine and Clinical Informatics. She has received her Bachelor of Science in Chemistry from Gannon University and her Doctorate from Loyola-Stritch School of Medicine. She has also completed the Executive Master's Program at the J L Kellogg Graduate School of Management at Northwestern University. She is experienced as a board-certified Emergency Medicine Specialist, Researcher, Chief Medical Officer at the Centers for Medicare and Medicaid Services, Senior Executive at the American Medical Association and a Health Information Technology Executive.
Statement of the Problem: Little is known regarding adverse events that occur after an acute unscheduled emergency department visit for musculoskeletal conditions that do not require admission to the hospital. If emergency physicians are to make better disposition decisions, it is important that these events be identified. The purpose of this study was to quantify post-discharge adverse events including death, repeat ED visit without admission and admission to the hospital or observation status in a cohort of Medicare-eligible patients within 30-days of an ED visit.
Methodology: 979,511 events for a subset of musculoskeletal system and connective tissue (MDC 08) that occurred in 2014 were identified in a review of 6.9 million ED visits. Visits for any diagnosis that resulted in >90% admission or inpatient observation stays were excluded. Discharge dispositions were identified as were the adverse outcomes of interest.
Finding: 927,006 medicare-eligible individuals made 979,511 eligible ED visits. About 713,842 (72.9%) events resulted in discharge from the ED. The most frequent discharge diagnoses included spinal and pelvic conditions (23.9%), back and neck pain (17%), lower extremity injuries (15.9%), pain or swelling (8.3%) and upper extremity injuries (7.2%). Post-ED visit rates across groups were 5.3% within 7-days of the visit and 11.2% within 30 days. The 30-day mortality rate was 0.2%. Admission or observation stay rates were 2.8% at 7 days and 7.5% within 30 days of the index ED visit.
Conclusion & Significance: This is the first study that identifies the frequency of post-ED visit adverse events for medicare-eligible patients suffering musculoskeletal trauma. The results should convince hospitals and physicians that these events are not rare, provide information regarding populations at risk for these events and to adopt tools that mitigate this risk.
Yuan Rung Hospital, Taiwan
Keynote: Predictability of successful transarterial embolization in pelvic fracture bleeding based on patient initial presentation
Time : 10:15-11:00
Cheng-Cheng Tung is currently working as a General Surgeon in Yuan Rung Hospital, Taiwan. He has completed his medical degree in Taipei Medical University, School of Medicine. Earlier, he had worked as Trauma and General Surgeon at Chang Gung Memorial Hospital. Further, he did his Fellowship at University of Maryland Medical Center and R Adams Cowley Shock Trauma Center. He has done his PhD in Asia University College of Medical and Health Science. His research interest is general surgery, endoscopic surgery and acute care surgery.
Background & Purpose: Pelvic fracture bleeding generally destines hemorrhagic shock. Trans-arterial-embolization (TAE) is regarded as the most useful treatment. However, there are still some initial presentations of the patient impacting the effectiveness of TAE in pelvic fracture bleeding. This retrospective study is to explore profitability of available initial presentations for TAE in pelvic fracture bleeding.
Method: There were 27 charts reviewed retrospectively. The definition of TAE failure was that the patient eventually received an exigent laparotomy due to uncontrolled bleeding after TAE or that the patient was defunct. We analyzed available initial presentations like age, gender, systolic-blood-pressure, heart rate, respiratory rate, body temperature, Glasgow-coma-scale (GCS), injury-severity-score (ISS) and associated-injuries through Pearson’s correlation and independent t-test when the patient received therapeutic TAE. Odds-ratio preceded the cut-off point disclosed through an independent t-test for successful TAE and used to assess the congruity.
Result: Successful TAE didn’t associate with age and gender. Hierarchical statistically significant associations between successful TAE and initial presentations were the patient’s body temperature, associated injury, respiratory rate, systolic-blood-pressure, GCS and ISS. Odds-ratios for all statistically significant initial presentations were within a 95% confidence interval.
Conclusion: Profitability of available initial presentations for TAE is hypothermia prevention with upholding a body temperature of more than 36 °C, determining associated injuries within two organ-systems, keeping the respiratory rate around 22 per minute, sustaining systolic-blood-pressure around 90 mmHg, maintaining a heart-rate of around 100 per-minute as well as the permissiveness of a minor head injury with the GCS more than 13 and a moderate ISS of less than 20.