Effects of fine particulate matter from wildfire and non-wildfire sources on emergency-department visits in people who were housed and unhoused in San Diego County (CA, USA) during 2012-20: a time-stratified case-crossover study.

Background: Being unhoused can increase vulnerability to adverse health effects due to air pollution. We aimed to quantify changes in emergency-department visits during and after exposure to wildfire-specific and non-wildfire particulate matter 2·5 μm or less in diameter (PM) in San Diego County (CA, USA) in people who were both unhoused and housed.

Methods: For this time-stratified case-crossover study, we used data on exposure to wildfire-specific PM in California and individual-level data for people admitted to the emergency departments of two hospitals (UC San Diego Health emergency departments at La Jolla and Hillcrest, San Diego) in San Diego County between July 1, 2012, and Dec 31, 2020.

Extreme Heat Events and Emergency Department Visits among Older Adults in California from 2012-2019.

: Extreme heat events are increasing with climate change impacting human health. This study investigates the impact of extreme heat events on Emergency Department (ED) utilization by older adult patients. : We conducted a study of all 324 non-federal hospital EDs in California during an 8-year period from data extracted from the California Department of Health Care Access and Information (HCAI).

Risk Factors and Emergency Department Outcomes in Methamphetamine-Associated Cardiomyopathy: A Case-Control Study.

Background: Methamphetamine-associated cardiomyopathy (MACM) is a known complication of methamphetamine use; however, risk factors and outcomes of patients with MACM are not well understood.

Study Objectives: This study aims to identify risk factors, emergency department (ED) interventions, and outcomes for MACM.

Methods: This case-control study was conducted between 2012 and 2020 at two academic EDs.

Impact of skilled nursing facility (SNF) 3-day hospitalization requirement waiver during the COVID-19 pandemic on emergency department and inpatient SNF discharges in California.

Objective: We sought to study the impact of the Centers for Medicare & Medicaid services (CMS) waiver of the 3-day hospitalization requirement for skilled nursing facility (SNF) care implemented as part of the Federal COVID-19 response on emergency department (ED) and inpatient hospital SNF discharges.

Methods: We conducted a multicenter retrospective cohort study of hospital ED and inpatient visits in California during 18 months before (prewaiver, September 2018-February 2020) and 18 months after (waiver, March 2020-August 2021) waiver implementation. Data were collected from all adult ED and admitted patients utilizing California Department of Health Care Access and Information datasets from all acute care hospitals licensed in the state.

Impact of Implementation of a New Weapons Screening at an Urban Emergency Department.

Background: Violence in the emergency department (ED) setting is well documented in medical literature. Weapons can be used to cause significant injury or mortality, although there is a paucity of literature on weapons and weapons screening in the ED.

Objectives: The purpose of this study was to assess the impact of initiating a weapons screening process on the identification and removal of weapons.

Clinical and financial outcome impacts of comprehensive geriatric assessment in a level 1 geriatric emergency department.

Background: The aging population has led to an increase in emergency department (ED) visits by older adults who have complex medical conditions and high social needs. The purpose of this study was to assess if comprehensive geriatric evaluation and management impacted service utilization and cost by older adults admitted to the ED.

Methods: This is a retrospective matched case-control study at a level 1 geriatric ED (GED) from January 1, 2018-March 31, 2020.

A retrospective review of antibiotic use for acute respiratory infections in urgent-care patients.

Objective: We examined the use of antibiotics for acute respiratory infections in an urgent-care setting.

Design: Retrospective database review.

Setting: The study was conducted in 2 urgent-care clinics staffed by academic emergency physicians in San Diego, California.

Urine testing is associated with inappropriate antibiotic use and increased length of stay in emergency department patients.

Background: Exposing patients with a low probability of disease to diagnostic testing with poor test characteristics leads to false positive results. Providers often act on these false results, which can cause unnecessary evaluation and treatment. The treatment of asymptomatic bacteriuria is discouraged, but it still frequently occurs in the inpatient setting; it is less studied in the Emergency Department (ED).

Geriatric Falls: Patient Characteristics Associated with Emergency Department Revisits.

Introduction: Falls are the leading cause of traumatic injury among elderly adults in the United States, which represents a significant source of morbidity and leads to exorbitant healthcare costs. The purpose of this study was to characterize elderly fall patients and identify risk factors associated with seven-day emergency department (ED) revisits.

Methods: This was a multicenter, retrospective, longitudinal cohort study using non-public data from 321 licensed, nonfederal, general, and acute care hospitals in California obtained from the Department of Healthcare Access and Information from January 1-December 31, 2017.

Heat Waves and Emergency Department Visits Among the Homeless, San Diego, 2012-2019.

To determine the effect of heat waves on emergency department (ED) visits for individuals experiencing homelessness and explore vulnerability factors. We used a unique highly detailed data set on sociodemographics of ED visits in San Diego, California, 2012 to 2019. We applied a time-stratified case-crossover design to study the association between various heat wave definitions and ED visits.

Cancer-related Emergency Department Visits: Comparing Characteristics and Outcomes.

Introduction: There is increasing appreciation of the challenges of providing safe and appropriate care to cancer patients in the emergency department (ED). Our goal here was to assess which patient characteristics are associated with more frequent ED revisits.

Methods: This was a retrospective cohort study of all ED visits in California during the 2016 calendar year using data from the California Office of Statewide Health Planning and Development.

Active Cancer Patients Presenting to the Emergency Department with Acute Venous Thromboembolism: A Retrospective Cohort Study on Risks and Outcomes.

Background: There is no prior study that has documented emergency department (ED) outcomes or stratified mortality risks of cancer patients presenting with an acute venous thromboembolism (VTE).

Objective: To evaluate ED treatment of these patients, to document their outcomes, and to identify risk factors associated with death.

Methods: A retrospective cohort study was performed on active cancer patients presenting with deep venous thrombosis or pulmonary embolism to two academic EDs between July 2012 and June 2016.

Ethnic Disparities in COVID-19 Among Older Adults Presenting to the Geriatric Emergency Department.

Background: There is a dearth of epidemiological data on ethnic disparities among older patients with COVID-19. The objective of this study was to characterize ethnic differences in clinical presentation and outcomes from COVID-19 among older U.S.

Age-related incidence and outcomes of sepsis in California, 2008-2015.

Purpose: Sepsis remains amongst the most common causes of death worldwide. It has been described as a disease of the elderly, but contemporary data on risk factors and mortality is lacking.

Materials And Methods: Multi-center longitudinal cohort study using non-public, state of California data from January 1, 2008 to September 31, 2015.

Clinical Features of Patients with COVID-19: is Temperature Screening Useful?

Background: As many businesses reopen after government-induced restrictions, many public agencies and private companies, such as banks, golf courses, and stores, are using temperature screening to assess for possible coronavirus disease 2019 (COVID-19) infection both for patrons and for employees.

Objective: We assessed the frequency of a fever ≥100.4°F and other symptoms associated with COVID-19 among patients in the emergency department (ED) who were tested in the ED for the illness.

Barriers to medication adherence in the emergency department: A cross-sectional study.

Background: Medication nonadherence is a common problem that leads to increased healthcare utilization. It is unclear how patient insight and attitude towards their medications affect adherence in the ED. Furthermore, it is unclear how perceived medication importance differs between patients and ED physicians.

Rates of coinfection with other respiratory pathogens in patients positive for coronavirus disease 2019 (COVID-19).

Objectives: The purpose of this study was to assess coinfection rates of coronavirus disease 2019 (COVID-19) with other respiratory infections on presentation.

Methods: This is a retrospective analysis of data from a 2 hospital academic medical centers and 2 urgent care centers during the initial 2 weeks of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), March 10, 2020 to March 23, 2020. Testing was targeted toward high-risk patients following US Centers for Disease Control and Prevention guidelines.

Frequent Emergency Department Visitors Associated With a Pain-Discharge Diagnosis.

Background: Emergency departments (EDs) have experienced an increase in annual patient visits and length of stay over the past decade. Management of frequent-user patients with pain-related diagnoses are challenging in a time-limited setting.

Objective: The purpose of this study was to describe characteristics of frequent ED users with pain-related diagnoses.

Further study on the physiological effects of an alternative spit mask.

Objectives: Spit masks are used by law enforcement officers and healthcare providers to protect themselves from the spread of communicable disease by subjects who pose a potential risk of biological exposure by spitting. Little research is available regarding the safety of these masks. However, concerns surround the ability of subjects to properly ventilate while wearing these masks as there are several anecdotal incidents of asphyxiation.

The effects of a morphine shortage on emergency department pain control.

Objective: In 2018, due to a national morphine shortage, our two study emergency departments (EDs) were unable to administer intravenous (IV) morphine for over six months. We evaluated the effects of this shortage on analgesia and patient disposition.

Methods: This was a retrospective study in two academic EDs.

Interpretation Accuracy and Interrater Agreement of Pediatric Skin and Soft Tissue Point-of-Care Ultrasound Images among Residents and Faculty.

Background: Point-of-care ultrasound (POCUS) is commonly used to facilitate care in the emergency department. Acquired images are often reviewed by local experts for educational and quality assurance purposes. However, no published study has examined the accuracy and reliability of POCUS image interpretation by multiple reviewers.

Utility of Shunt Series in the Evaluation of Ventriculoperitoneal Shunt Dysfunction in Adults.

Background: When patients present to emergency departments (EDs) with symptoms suspicious for ventriculoperitoneal shunt malfunction, evaluation often includes imaging of the shunt with both computed tomography (CT) of the head without contrast and a plain radiograph "shunt series" (SS). Recent literature has called into question the diagnostic value of the SS for the detection of ventriculoperitoneal shunt complications, suggesting that the plain radiographs provide redundant information and unnecessary exposure to radiation.

Objective: The aim of our study was to assess the frequency of abnormal SS plain radiography and head CT in the evaluation of shunt malfunction in all adult ED patients and to measure the association of abnormalities on CT and SS with surgical intervention.