Journal of the American College of Emergency Physicians open
-
J Am Coll Emerg Physicians Open · Dec 2020
Multicenter registry of United States emergency department patients tested for SARS-CoV-2.
This paper summarizes the methodology for the registry of suspected COVID-19 in emergency care (RECOVER), a large clinical registry of patients from 155 United States (US) emergency departments (EDs) in 27 states tested for SARS-CoV-2 from March-September 2020. The initial goals are to derive and test: (1) a pretest probability instrument for prediction of SARS-CoV-2 test results, and from this instrument, a set of simple criteria to exclude COVID-19 (the COVID-19 Rule-Out Criteria-the CORC rule), and (2) a prognostic instrument for those with COVID-19. ⋯ Abstracted clinical data included 204 variables representing the earliest manifestation of infection, including week of testing, demographics, symptoms, exposure risk, past medical history, test results, admission status, and outcomes 30 days later. In addition to the primary goals, the registry will provide a vital platform for characterizing the course, epidemiology, clinical features, and prognosis of patients tested for COVID-19 in the ED setting.
-
J Am Coll Emerg Physicians Open · Dec 2020
Emergency department crowding associated with increased 30-day mortality: a cohort study in Stockholm Region, Sweden, 2012 to 2016.
Emergency department (ED) crowding is a major problem across the world. Studies investigating the association between crowding and mortality are many, but the quality is inconsistent and there are very few large, high-quality multicenter studies that are properly designed to deal with confounding due to case mix. The aim of this study is to investigate the association between ED crowding and 30-day mortality. ⋯ In a large cohort study including 7 EDs in Stockholm Region, Sweden we identified a significant association between high levels of ED crowding and increased 30-day mortality.
-
J Am Coll Emerg Physicians Open · Dec 2020
Prediction of emergency department resource requirements during triage: An application of current natural language processing techniques.
Accurate triage in the emergency department (ED) is critical for medical safety and operational efficiency. We aimed to predict the number of future required ED resources, as defined by the Emergency Severity Index (ESI) triage protocol, using natural language processing of nursing triage notes. ⋯ Machine learning of nursing triage notes, combined with clinical data available at ED presentation, can be used to predict the number of required future ED resources. These findings suggest that machine learning may be a valuable adjunct tool in the initial triage of ED patients.
-
J Am Coll Emerg Physicians Open · Nov 2020
Incidence, delays, and outcomes of STEMI during COVID-19 outbreak: Analysis from the France PCI registry.
The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) outbreak on incidence, delays, and outcomes of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) in France. ⋯ According to the multicenter France PCI registry, the COVID-19 outbreak in France was associated with a significant decline in STEMI undergoing PPCI and longer transfer time for patients who presented directly to the ED. Mortality rates doubled, but the difference was not statistically significant.
-
J Am Coll Emerg Physicians Open · Nov 2020
Design and implementation of a temporary emergency department-intensive care unit patient care model during the COVID-19 pandemic surge.
The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in rapid surges of critically ill patients infected with coronavirus disease 2019 (COVID-19) pneumonia presenting to the emergency department (ED) and requiring ICU admission nationwide. Despite adaptations in critical care personnel staffing, bed availability and supply provision, many inpatient ICUs have become acutely crowded, leading to boarding of critically ill patients with COVID-19 and other diseases in the ED. ⋯ Critical care-trained emergency physicians took call and came into the hospital overnight/on weekends to provide bedside treatment to admitted ICU patients boarding for prolonged periods in our ED. In this manuscript, we describe the creation and execution of the ED-ICU service and the characteristics and management of the patients who received care under this model.