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Non-Specific Abdominal Pain: Analyzing Repeat ED Use

Non-Specific Abdominal Pain: Analyzing Repeat ED Use

Research has shown that many patients in the United States present to the ED with gastrointestinal (GI) complaints, but these problems can often lead to inefficient and expensive testing. “In many cases, patients come to the ED with abdominal pain that is non-specific,” explains Andrew C. Meltzer, MD. “Even after diagnostic tests are ordered, ED patients are frequently discharged with a diagnosis of non-specific abdominal pain.” In previous studies, investigators have found that there appears to be a link between GI disorders and psychiatric disorders. The Role of Mental Health Some researchers have theorized that depression and anxiety can be attributed to many cases of non-specific abdominal pain, but few analyses have explored this association in greater detail. To address this issue, Dr. Meltzer and colleagues had a study published in the Western Journal of Emergency Medicine. The study sought to determine if repeat ED use among patients with non-specific abdominal pain might be associated with a diagnosis of moderate to severe depressive disorder. Identifying patients who may clinically benefit from targeted psychiatric screening may help improve their quality of life and enable clinicians to use diagnostic tests more efficiently. For the study, 987 ED patients were screened for major depression during weekday daytime hours using the Patient Health Questionnaire-9 (PHQ-9), a depression screening tool that has been validated in previous research. Each study participant was classified as having no depression, mild depression, or moderate-to-severe depression based on their PHQ-9 results. According to the results, about 62% of patients with non-specific abdominal pain who had moderate or severe depression—defined as scoring a 10 or higher on the PHQ-9—had at...
Emergency Nursing & Workplace Violence

Emergency Nursing & Workplace Violence

ED nurses are too commonly exposed to workplace violence, according to findings of a study involving those who reported experiencing such violence by patients or visitors in their hospital system. The survey, which was completed by 762 participants, found that 76.0% experienced some form of workplace violence, including verbal and/or physical abuse by patients or visitors. Many reported that patients and visitors victimized ED nurses by shouting or yelling at them, swearing or cursing at them, grabbing them, and scratching or kicking them. Workplace Violence Among ED Nurses The study team also found that 12.1% of emergency nurses experienced a significantly greater number of incidents. Nearly one-quarter of nurses noted that they experienced more than 50 verbal patient/visitor violent incidents over their careers, and another 7.3% reported experiencing physical incidents. Perpetrators were primarily white male patients, aged 26 to 35, who were confused or influenced by alcohol or drugs. The authors added that annual workplace violence charges for the 2.1% of nurses reporting injuries were $94,156, representing $78,924 for treatment and $15,232 for indemnity. The research team recommended that hospitals enhance programs for training and incident reporting, particularly for nurses at higher risk of exposure, which includes those who care for patients: ♦ With dementia or Alzheimer’s disease. ♦ With drug-seeking behavior. ♦ Who are under the influence of drugs or alcohol. Source: Journal of Emergency Nursing, May...
MVC-Related Eye Injuries in EDs

MVC-Related Eye Injuries in EDs

National studies have shown that motor vehicle crashes (MVCs) are among the leading causes of injuries in the United States. “Victims of MVCs usually present at EDs for care to manage injuries,” says Grayson W. Armstrong. “Many of these patients come to EDs with unique eye injuries that result from crashes, but few studies have characterized these injuries when they present to EDs. A better understanding of the risk factors for MVC-related eye injuries may help in the diagnosis and management of these patients.” Examining Trends In a retrospective cross-sectional study published in the Western Journal of Emergency Medicine, Armstrong and colleagues investigated the characteristics of MVC-associated eye injuries presenting to EDs. Using the National Electronic Injury Surveillance System All Injury Program, the research team assessed the risk of presenting to an ED with an MVC-related eye injury. From 2001 to 2008, an estimated 75,028 MVC-associated eye injuries presented to EDs, with contusions and abrasions representing the most common diagnoses. The annual rate of ED-treated eye injuries resulting from MVCs declined during the study period. “Our study indicated that roughly two to four in 100,000 Americans suffer MVC-related eye injuries each year,” Grayson says. “Fortunately, the rate of these injuries appears to be decreasing overall.” He notes that advanced frontal airbag systems, which were mandated in 2006, may have played a role in the decrease in rates seen during the study period. Defining At-Risk Groups According to the study, males were at greater risk than females for MVC-related eye injuries, accounting for nearly 60% of cases that were seen in EDs. Rates of eye injury were highest among patients...
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