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Scholarly Works (2 results)

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  • Peer Reviewed
Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 18, Issue 5 (2017)

Introduction: Children often present to the emergency department (ED) with minor conditionssuch as fever and have persistently abnormal vital signs. W e hypothesized that a significantportion of children discharged from the ED would have abnormal vital signs and that thosedischarged with abnormal vital signs would experience very few adverse events.

Methods: We performed a retrospective chart review encompassing a 44-month period of allpediatric patients (aged two months to 17 years) who were discharged from the ED with anabnormal pulse rate, respiratory rate, temperature, or oxygen saturation. We used a local qualityassurance database to identify pre-defined adverse events after discharge in this population.Our primary aim was to determine the proportion of children discharged with abnormal vitalsigns and the frequency and nature of adverse events. Additionally, we performed a subanalysiscomparing the rate of adverse events in children discharged with normal vs. abnormalvital signs, as well as a standardized review of the nature of each adverse event.

Results: Of 33,185 children discharged during the study period, 5,540 (17%) of thesepatients had at least one abnormal vital sign. There were 24/5,540 (0.43%) adverse eventsin the children with at least one abnormal vital sign vs. 47/27,645 (0.17%) adverse events inthe children with normal vital signs [relative risk = 2.5 (95% confidence interval, 1.6 to 2.4)].However, upon review of each adverse event we found only one case that was related tothe index visit, was potentially preventable by a 23-hour hospital observation, and causedpermanent disability.

Conclusion: In our study population, 17% of the children were discharged with at least oneabnormal vital sign, and there were very few adverse (0.43%) events associated with this practice.Heart rate was the most common abnormal vital sign leading to an adverse event. Severe adverseevents that were potentially related to the abnormal vital sign(s) were exceedingly rare. Additionalresearch is needed in broader populations to better determine the rate of adverse events andpossible methods of avoiding them. [West J Emerg Med. 2017;18(5)878-883.]

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Cover page: Pediatric Patients Discharged from the Emergency Department with Abnormal Vital SignsCreative Commons 'BY' version 4.0 license
  • Article
  • Peer Reviewed
UC Davis Previously Published Works (2021)
Emergency departments (EDs) have played a major role in the science and practice of HIV population screening. After decades of experience, EDs have demonstrated the capacity to provide testing and linkage to care to large volumes of patients, particularly those who do not otherwise engage the healthcare system. Efforts to expand ED HIV screening in the United States have been accelerated by a collaborative national network of emergency physicians and other stakeholders called EMTIDE (Emergency Medicine Transmissible Infectious Diseases and Epidemics). As the COVID-19 pandemic evolves, EDs nationwide are being tasked with diagnosing and managing COVID-19 in a myriad of capacities, adopting varied approaches based in part on know-how, local disease trends, and the supply chain. The objective of this article is to broadly summarize the lessons learned from decades of ED HIV screening and provide guidance for many analogous issues and challenges in population screening for COVID-19. Over time, and with the accumulated experience from other epidemics, ED screening should develop into an overarching discipline in which the disease in question may vary, but the efficiency of response is increased by prior knowledge and understanding.
    Cover page: COVID‐19 and beyond: Lessons learned from emergency department HIV screening for population‐based screening in healthcare settings
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