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Introduction: Reducing non-urgent emergency department (ED) visits has been targeted as a method to produce cost savings. To better describe these visits, we sought to compare resource utilization of ED visits characterized as non-urgent at triage to immediate, emergent, or urgent (IEU) visits., Methods: We performed a retrospective, cross-sectional analysis of the 2006-2009 National Hospital Ambulatory Medical Care Survey. Urgency of visits was categorized using the assigned 5-level triage acuity score. We analyzed resource utilization, including diagnostic testing, treatment, and hospitalization within each acuity categorization., Results: From 2006-2009, 10.1% (95% confidence interval [CI], 9.2-11.2) of United States ED visits were categorized as non-urgent. Most (87.8% [95% CI, 86.3-89.2]) non-urgent visits had some diagnostic testing or treatment in the ED. Imaging was common in non-urgent visits (29.8% [95% CI, 27.8-31.8]), although not as frequent as for IEU visits (52.9% [95% CI, 51.6-54.2]). Similarly, procedures were performed less frequently for non-urgent (34.1% [95% CI, 31.8-36.4]) compared to IEU visits (56.3% [95% CI, 53.5-59.0]). Medication administration was similar between the 2 groups (80.6% [95% CI, 79.5-81.7] vs. 76.3% [95% CI, 74.7-77.8], respectively). The rate of hospital admission was 4.0% (95% CI, 3.3-4.8) vs. 19.8% (95% CI, 18.4-21.3) for IEU visits, with admission to a critical care setting for 0.5% of non-urgent visits (95% CI, 0.3-0.6) vs. 3.4% (95% CI, 3.1-3.8) of IEU visits., Conclusions: For most non-urgent ED visits, some diagnostic or therapeutic intervention was performed. Relatively low, but notable proportions of non-urgent ED visits were admitted to the hospital, sometimes to a critical care setting. These data call into question non-urgent ED visits being categorized as "unnecessary," particularly in the setting of limited access to timely primary care for acute illness or injury.

Purpose: To investigate safety and clinical findings of bilevel positive airway pressure (BiPAP) utilization in children 20 kg or less for asthma exacerbations., Methods: Retrospective and prospective descriptive analysis of 165 enrolled subjects with moderate and severe asthma exacerbations who weighed 20 kg or less and who received BiPAP treatment at a large, urban children's hospital pediatric emergency department (PED)., Results: Age was 0.6-8.27 years (mean 3.7 years, SD 1.6 years). None exhibited worsening hypoxia, pneumothorax, or death. Four progressed to intubation after significant period on BiPAP. Overall, BiPAP subjects showed improvement in pediatric asthma score (PAS). BiPAP initiation PAS range was 8-15 (mean 12.1, SD 1.6); BiPAP termination or 4 h PAS mean was 6.3 (SD 2.2); delta PAS showed improvement mean 5.8 (SD 2.4). Seventy-one had trial off BiPAP in PED for clinical improvement; seven were restarted. PED BiPAP duration range was 30-720 min (mean 210 min, SD 158 min); total hospitalization BiPAP duration was 1-90 h. Ninety-nine (60%) subjects were admitted to the PICU and continued BiPAP for 0-47 h (mean 6.6 h, SD 8.6 h). Fifty-seven (35%) required ward admission; none were transferred to PICU. Nine (5%) were discharged home from the PED; none returned within 72 h., Conclusions: BiPAP utilization in acute pediatric asthma exacerbations for patients 20 kg or less is safe and may improve clinical outcomes. These findings warrant future prospective investigation of BiPAP efficacy in pediatric asthma patients.

The objectives of this study were (1) to examine differences in resting metabolic rate (RMR) and cardiovascular risk factors among aerobically trained (n = 36), resistance-trained (n = 18), and untrained (n = 42) young males; and (2) to investigate the influence of body composition, dietary intake, and VO2max as possible modulators of differences in cardiovascular risk among groups. Results showed that RMR, adjusted for differences in fat-free weight (FFW), was 5% higher in aerobically trained males compared with resistance-trained males (P < .01), and 10% higher than that in untrained males (P < .01). Plasma levels of cholesterol and low-density lipoprotein cholesterol (LDL-C) were comparable between resistance-trained and aerobically trained males, but were lower (P < .05) than those in untrained males. (The percent intake of dietary fat was related to plasma cholesterol [r = .32, P < .01] and LDL-C [r = .30, P < .01].) When compared with untrained males, fasting triglyceride (TG) levels were 39% and 43% lower (P < .01) in resistance-trained and aerobically trained males, respectively. When compared with untrained males, the fasting insulin to glucose ratio (I/G) was 45% and 53% lower (P < .01) in resistance- and aerobically trained males, respectively. Mean arterial pressure (MAP) was 7% lower (P < .01) in aerobically trained compared with untrained males. Statistical control for differences in percent body fat or percent intake of dietary fat diminished the differences among the groups for plasma lipids, blood pressure, and the I/G ratio. We conclude that aerobically trained and resistance-trained males have higher resting energy requirements independent of FFW compared with untrained males. Aerobically trained and resistance-trained young males have comparable and favorable cardiovascular disease risk profiles compared with untrained males, and this appears to be related to their low level of adiposity and low intake of dietary fat.

It has been suggested that changes in fat-free weight may not fully explain the decline of resting metabolic rate (RMR) that occurs with aging. We therefore examined the hypothesis that a reduction in maximal aerobic capacity (VO2max) may partially explain the lower RMR in older men, after accounting for differences in fat-free weight and fat weight. We also considered differences in energy intake and plasma thyroid hormones as possible modulators of the age-related decline in RMR in men. Three-hundred healthy men (aged 17 to 78 years) were characterized for: (1) RMR (kcal/min) from indirect calorimetry; (2) body composition from underwater weighing; (3) maximal aerobic capacity from a test of VO2max; (4) plasma thyroid hormones (total triiodothyronine [T3], free T3, total thyroxine [T4], and free T4); and (5) estimated energy intake (kcal/d) from a 3-day food diary. A curvilinear decline of RMR with age was found (P less than .01), in which no relationship was found in men less than 40 years of age (r = .10, slope = 0.002 kcal/min/yr), whereas in men older than 40 years, RMR was negatively related to age (r = -.52, slope = -0.008 kcal/min/yr). After statistical control for differences in fat-free weight and fat weight, a negative relationship between age and RMR persisted (partial r = -.30, P less than .01). It was only after control for fat-free weight, fat weight, and VO2max (partial r = -.10, P greater than .05) that no association between age and RMR was noted.(ABSTRACT TRUNCATED AT 250 WORDS)