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Point-of-care test (POCT) instrument requests are typically predicated on the premise that faster results will a priori lead to better inpatient care secondary to quicker and targeted treatment. Rapid test [...], Context.--Point-of-care test (POCT) instruments produce lab results with rapid turnaround times. Based on that fact, emergency department (ED) POCT requests are predicated on the belief that rapid test turnaround times lead to improved care, typically a decreased ED length of stay (LOS). Objective.--To compile the available peer-reviewed data regarding use of POCT in the ED with an emphasis on ED-LOS. Data Sources.--An English-language PubMed search using the following free text terms: ("EMERGENCY" AND "POINT OF CARE") NOT ULTRASOUND as well as "RAPID INFECTIOUS DISEASE TESTING." In addition, the PubMed "similar articles" functionality was used to identify related articles that were not identified on the initial search. Conclusions.--Seventy-four references were identified that studied POCT ED use to determine if they resulted in significant changes in ED processes, especially ED-LOS. They were divided into 3 groups: viral-influenza (n = 24), viral-respiratory not otherwise specified (n = 8), and nonviral (n = 42). The nonviral group was further divided into the following groups: chemistry, cardiac, bacterial/ strep, C-reactive protein, D-dimer, drugs of abuse, lactate, and pregnancy. Across all groups there was a trend toward a significantly decreased ED-LOS; however, a number of studies showed no change, and a third group was not assessed for ED-LOS. For POCT to improve ED-LOS it has to be integrated into existing ED processes such that a rapid test result will allow the patient to have a shorter LOS, whether it is to discharge or admission. (Arch Pathol Lab Med. 2021;145:308-319; doi: 10.5858/arpa.2020-0495-RA)

P127 Improving the HIV testing cascade: adequate identification of patients with HIV indicator conditions in hospitals by electronic registration systems C Jordans (1); K Hensley (1); M Vogel (2); J [...]

Author(s): Guodong Liu [sup.1] [sup.2] , Amanda M. Pearl [sup.2] , Lan Kong [sup.1] , Sierra L. Brown [sup.2] , Djibril Ba [sup.1] , Doug L. Leslie [sup.1] [sup.2] , [...], This study reaffirms our previous work documenting a higher number of Emergency Department (ED) visits by adolescent females with Autism Spectrum Disorder (ASD) as compared to adolescent males with ASD, as well as significantly more ED visits by older adolescents than younger adolescents with ASD. Combined externalizing and internalizing psychiatric co-morbidities as well as internalizing conditions alone predict a higher number of ED visits in this study. Illness severity as demonstrated by patterns of visits to primary care physicians and psychiatric referrals prior to ED visits and the prescription of two or more classes of psychotropic medications also predict higher number of ED visits. Finally, as expected, previous ED visits predict future ED visits. The identification of these factors may prove helpful in determining adequacy of current supports and resources for teens with ASD navigating the challenges of adolescence.

Author(s): Julia Budde [sup.1] , Parul Agarwal [sup.2] , Madhu Mazumdar [sup.3] , Jonathan Yeo [sup.4] [sup.5] , Sidney S. Braman [sup.1] Author Affiliations: (Aff1) 0000 0001 0670 2351, grid.59734.3c, [...], Studies on observation unit (OU) use to avoid a hospital admission from the emergency department (ED) have found variable effects on health care resource utilization, and these effects have not been studied in acute exacerbation of chronic obstruction pulmonary disease (AECOPD). We retrospectively collected data for all AECOPD-related ED visits (age > 40) to an urban, academic medical center between February 2013 and April 2017. We examined the total proportion of visits admitted to the hospital before and after availability of an OU and the proportion of visits discharged directly from the ED using segmented regression analysis. There was a 12.8% reduction in hospital admissions after OU availability (79.6 vs. 66.8%, p = 0.0049) without a change in the proportion discharged directly from the ED (p = 0.65). The availability of an OU can decrease hospital AECOPD admissions without affecting the number of patients discharged directly from the ED.

Author(s): Carolyn DiGuiseppi [sup.1] , Susan E. Levy [sup.2] , Katherine R. Sabourin [sup.1] , Gnakub N. Soke [sup.1] [sup.3] , Steven Rosenberg [sup.4] , Li-Ching Lee [sup.5] , Eric [...], This study examined caregiver-reported medically-attended injuries among 30-68 month old children with autism spectrum disorder (ASD) compared to general population (POP) and non-ASD developmental disorders (DD) controls in the Study to Explore Early Development. Injuries were common in ASD cases (32.3%) as well as POP (30.2%) and DD (27.8%) controls; most resulted in an emergency visit or hospitalization. After accounting for sociodemographic, health, IQ and behavior differences, odds of injury in ASD cases were significantly higher than DD controls but similar to POP controls. Attention problems mediated the relationships. Clinicians caring for children with both ASD and attention problems should consider providing targeted safety advice. Differences in injury risk between children with ASD vs. other developmental disorders need further study.

A 55-year-old man is brought to a remote British Columbia emergency department with a 1-hour history of crushing retrosternal pain accompanied by shortness of breath and sweating. The following vital [...]

Police stations and hospital emergency units are the places to which people turn in situations of extreme vulnerability. However, making use of these services may have different implications. From the [...], In the context of increasing prosecution by victims of domestic violence, this article compares professionals' responses to specific cases in two different institutional settings in Sao Paulo, women's police stations and hospital emergency services. The article focuses on the first encounter of victims with policewomen and health care popular legal advocates. We take "interpretive relativism" (Geertz 1983) as a fundamental framework for comparing, ethnographically, two contrasting cognitive methods for adjudicating truth to the events narrated by the victims: the skeletonization of facts, typical of police officials, and the schematization of social action, typical of human rights practitioners. We conclude that while policewomen are ambivalent regarding women's capacity to decide for themselves how to use the legal resources offered to them, popular legal advocates, in contrast, seek to empower women by improving their capacity to make well-informed decisions. No contexto de judicializacao crescente por parte das vitimas de violencia domestica, este artigo compara as respostas dadas por profissionais a casos especificos em dois contextos institucionais diferentes, delegacias de defesa da mulher e servicos de emergencia hospitalar, ambos situados em Sao Paulo. O artigo tem como foco o primeiro encontro das vitimas com policiais e promotoras legais populares. Toma-se o "relativismo interpretativo" (Geertz 1983) como abordagem teorica fundamental para comparar, etnograficamente, dois metodos cognitivos diferentes de estabelecer a verdade aos eventos narrados pelas vitimas: a simplificacao dos fatos, tipica da pratica policial, e a esquematizacao da acao social, tipica dos defensores dos direitos humanos. Concluimos que, se bem, as policiais sao ambivalentes a respeito da capacidade das vitimas de decidir por si mesmas como utilizar os recursos legais a elas oferecidos; as promotoras legais populares buscam empoderar as vitimas melhorando a capacidade delas para tomar decisoes bem informadas.

Author(s): Lonnie Zwaigenbaum[sup.1] [sup.7] , David B. Nicholas[sup.2] , Barbara Muskat[sup.3] , Christopher Kilmer[sup.2] , Amanda S. Newton[sup.1] , William R. Craig[sup.1] , Savithiri Ratnapalan[sup.4] , Justine Cohen-Silver[sup.5] , Andrea [...], This study aimed to characterize the perspectives of health professionals who care for children with autism spectrum disorder (ASD) in the emergency department (ED) and to determine what strategies could optimize care. Ten physicians and twelve nurses were interviewed individually. Questions related to experiences, processes, clinical decision-making and outcomes of children with ASD recently seen in the ED. Interviews were audio recorded, transcribed, and analyzed using a qualitative framework. Participants identified factors that facilitated effective care, including communication strategies, parental involvement and teamwork. Barriers identified included child characteristics, the ED environment, and competing demands. Recommendations included additional staff training and stakeholder engagement. However, making accommodations was often described as being at odds with how the ED functioned, with implications for future service planning.

Author(s): Lars Heining[sup.1] , Christian Giesa[sup.1] , Santiago Ewig[sup.1] Author Affiliations: (1) Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Kranken-Anstalt Bochum, Bergstrasse 26, 44791, Bochum, Germany Introduction [...], Background The evaluation of the role of novel biomarkers in the management of cardiac and pulmonary conditions has received particular attention in recent years. A further particular perspective is the use of biomarker panels in the evaluation of patients presenting with acute dyspnea. Methods We prospectively evaluated three biomarkers (MR-proANP, PCT, and MR-proADM) in consecutive patients presenting with acute dyspnea in a medical emergency unit during a 4-week period. Patients received a final diagnosis. Biomarkers were tested for their potential to predict diagnoses and survival. No intervention was done. Results Overall, n = 172 patients were included. Of these, 32.6 % had acute heart failure, 16.9 % pneumonia, and 5.8 % died. MR-proANP was the highest in patients with acute heart failure and lung embolism. Dyspnea scores and levels of MR-pro-ANP correlated positively. MR-proANP achieved an AUC of 0.83 for the diagnosis of acute heart failure. Using a cut-off of 120 pmol/l, sensitivity was 91.1 % and specificity 50 %. PPV was 46.8 % and NPV 92.1 %. In patients with MR-proANP >300 pmol/l, PPV raised to 67.3 %. MR-proADM had an AUC of 0.84 for the prediction of death. PPV was 16 % and NPV 98.4 %. The AUC of PCT was 0.74 for the diagnosis of pneumonia. Using a cut-off of 0.25 ng/ml, PCT had a sensitivity of 44.8 % and a specificity of 85.3 %. PPV was 38.2 and NPV 88.4 %. Using a lower cut-off of Conclusions A panel of three biomarkers (MR-proANP, PCT, and MR-proADM) in patients presenting to the emergency unit with acute dyspnea provides information about the probability of acute heart failure, nonsurvival, and pneumonia. These biomarkers achieve low to moderate positive predictive values (PPV) and high negative predictive values (NPV).

Author(s): Rini Vohra[sup.1] , Suresh Madhavan[sup.1] , Usha Sambamoorthi[sup.1] Author Affiliations: (1) Department of Pharmaceutical Systems and Policy, West Virginia University, 1 Medical Center Drive, 26506 9510, Morgantown, WV, USA [...], A cross-sectional analyses using Nationwide Emergency Department Sample (2006-2011) was conducted to examine the trends, type of ED visits, and mean total ED charges for adults aged 22-64 years with and without ASD (matched 1:3). Around 0.4 % ED visits (n = 25,527) were associated with any ASD and rates of such visits more than doubled from 2006 to 2011 (2549-6087 per 100,000 admissions). Adults with ASD visited ED for: primary psychiatric disorder (15 %.sub.ASD vs. 4.2 %.sub.noASD), primary non-psychiatric disorder (16 %.sub.ASD vs. 14 %.sub.noASD), and any injury (24 %.sub.ASD vs. 28 %.sub.noASD). Mean total ED charges for adults with ASD were 2.3 times higher than for adults without ASD. Findings emphasize the need to examine the extent of frequent ED use in this population.

Author(s): Anna Barker 1, Peter Cameron 1,2, Leon Flicker 3,4,5, Glenn Arendts 3,5, Caroline Brand 1,6,7, Christopher Etherton-Beer 3,4,5, Andrew Forbes 1, Terry Haines 8,9, Anne-Marie Hill 10, Peter Hunter [...], Background Falls are a leading reason for older people presenting to the emergency department (ED), and many experience further falls. Little evidence exists to guide secondary prevention in this population. This randomised controlled trial (RCT) investigated whether a 6-month telephone-based patient-centred program-RESPOND-had an effect on falls and fall injuries in older people presenting to the ED after a fall. Methods and findings Community-dwelling people aged 60-90 years presenting to the ED with a fall and planned for discharge home within 72 hours were recruited from two EDs in Australia. Participants were enrolled if they could walk without hands-on assistance, use a telephone, and were free of cognitive impairment (Mini-Mental State Examination > 23). Recruitment occurred between 1 April 2014 and 29 June 2015. Participants were randomised to receive either RESPOND (intervention) or usual care (control). RESPOND comprised (1) home-based risk assessment; (2) 6 months telephone-based education, coaching, goal setting, and support for evidence-based risk factor management; and (3) linkages to existing services. Primary outcomes were falls and fall injuries in the 12-month follow-up. Secondary outcomes included ED presentations, hospital admissions, fractures, death, falls risk, falls efficacy, and quality of life. Assessors blind to group allocation collected outcome data via postal calendars, telephone follow-up, and hospital records. There were 430 people in the primary outcome analysis-217 randomised to RESPOND and 213 to control. The mean age of participants was 73 years; 55% were female. Falls per person-year were 1.15 in the RESPOND group and 1.83 in the control (incidence rate ratio [IRR] 0.65 [95% CI 0.43-0.99]; P = 0.042). There was no significant difference in fall injuries (IRR 0.81 [0.51-1.29]; P = 0.374). The rate of fractures was significantly lower in the RESPOND group compared with the control (0.05 versus 0.12; IRR 0.37 [95% CI 0.15-0.91]; P = 0.03), but there were no significant differences in other secondary outcomes between groups: ED presentations, hospitalisations or falls risk, falls efficacy, and quality of life. There were two deaths in the RESPOND group and one in the control group. No adverse events or unintended harm were reported. Limitations of this study were the high number of dropouts (n = 93); possible underreporting of falls, fall injuries, and hospitalisations across both groups; and the relatively small number of fracture events. Conclusions In this study, providing a telephone-based, patient-centred falls prevention program reduced falls but not fall injuries, in older people presenting to the ED with a fall. Among secondary outcomes, only fractures reduced. Adopting patient-centred strategies into routine clinical practice for falls prevention could offer an opportunity to improve outcomes and reduce falls in patients attending the ED. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).

Author(s): Yu Kawazoe[sup.1] , Tsuyoshi Nakashima[sup.1] , Toshie Iseri[sup.2] , Chiaki Yonetani[sup.2] , Kentaro Ueda[sup.1] , Yuka Fujimoto[sup.2] , Seiya Kato[sup.1] Author Affiliations: (1) Department of Emergency and Critical Care [...], Purpose Stroke volume variation (SVV) measures fluid responsiveness, enabling optimal fluid management under positive pressure ventilation. We aimed to investigate the effect of peak inspiratory pressure (PIP) on SVV under various preload conditions in experimental animals and to ascertain whether SVV indexed to PIP decreases the effect. Methods Mild and moderate hemorrhage models were created in nine anesthetized, mechanically ventilated beagle dogs by sequentially removing 10 and then an additional 10 ml/kg of blood, respectively. In all the animals, PIP was incrementally increased by 4 cmH.sub.2O, from 5 to 21 cmH.sub.2O. SVV was measured by arterial pulse contour analysis. Stroke volume was derived using a thermodilution method, and central venous pressure and mean arterial pressure were also measured. Results SVV increased according to PIP with significant correlation at baseline, with mild hemorrhage and moderate hemorrhage. PIP regression coefficients at baseline and in the mild and moderate hemorrhage models were 0.59, 0.86, and 1.4, respectively. Two-way repeated-measures analysis of variance showed that PIP and the degree of hemorrhage had a significant interaction effect on SVV (p = 0.0016). SVV indexed to PIP reflected the hemorrhage status regardless of PIP changes [greater than or equal to]9 cmH.sub.2O. Conclusions PIP is significantly correlated with SVV, even under hypovolemia, and the effect is enhanced with decreasing preload volumes. Compared with SVV, the indexed SVV was less susceptible to higher inspiratory pressures.

Introduction The non-medical use of prescription opioids has increased dramatically over the past two decades to 'epidemic' proportions with an estimated 10 million individuals [1-6]. Moreover, prescription opioids have been [...], A 2012 committee opinion from the American College of Obstetricians and Gynecologists highlights the considerable increase in opioid addiction in recent years, yet little is known about clinical correlates of prescribed opioids among pregnant women. This study examines clinical and demographic factors associated with the use of opioid analgesics in pregnancy. Data were derived from a prospective cohort study of pregnant women. Participants were administered the Composite International Diagnostic Interview to identify depressive and anxiety disorders and data on medication use were gathered at three assessment points and classified according to the Anatomical Therapeutic Chemical Code (ATC) classification system ATC group N02A. Participants included 2,748 English or Spanish speaking pregnant women. Six percent (n = 165) of women used opioid analgesics at any point in pregnancy. More pregnant women using opioids met diagnostic criteria for major depressive disorder (16 vs. 8% for non users), generalized anxiety disorder (18 vs. 9% for non users), post-traumatic stress disorder (11 vs. 4% for non users) and panic disorder (6 vs. 4% for non users). Women who reported opioid use were also significantly more likely than non users to report using illicit drugs and almost three times as likely to report smoking cigarettes in the second or third trimester of pregnancy (4 and 23%, respectively) as compared to non-opioid users (0.5 and 8%). The use of opioids in pregnancy was associated with higher levels of psychiatric comorbidity and use of other substances as compared to non-opioid users. Keywords Drug use * Pregnancy * Mental health

When we encounter an unexpected critical health problem, a hospital's emergency department (ED) becomes our vital medical resource. Improving an ED's timeliness of care, quality of care, and operational efficiency [...]