A multicenter observational study of US adults with acute asthma: who are the frequent users of the emergency department?

BackgroundDespite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population.ObjectiveWe aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits.MethodsA multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit.ResultsOf the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits).ConclusionThis multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these major gaps in asthma care

A multicenter observational study of US adults with acute asthma: who are the frequent users of the emergency department?

BackgroundDespite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population.ObjectiveWe aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits.MethodsA multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit.ResultsOf the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits).ConclusionThis multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these major gaps in asthma care

Ultrasonido en el punto de atención en la formación en medicina de urgencias: documento de postura de la SMME

El uso del ultrasonido en el punto de atención se ha propagado hacia los servicios de urgencias en los últimos 30 años, así se ha posicionado como una herramienta esencial para responder a interrogantes clínicas puntuales, tomar decisiones de tratamiento y guiar una variedad de procedimientos de forma más segura y veloz. Su relevancia creciente en la práctica médica cotidiana lo ubica como un componente central en la formación de profesionales de la salud, específicamente en el campo de la medicina de urgencias. Es imperativo incentivar la adquisición y desarrollo de habilidades en ultrasonido en el punto de atención entre los residentes de medicina de urgencias, con el objetivo de optimizar su práctica clínica diaria y proporcionar una atención de calidad a las personas usuarias de los servicios de urgencias. El Grupo de Interés de Ultrasonido en el Punto de Atención de la Sociedad Mexicana de Medicina de Emergencia emite este documento de postura con el propósito de poner el reflector en este tema y fomentar la integración de esta herramienta como parte de las competencias elementales en el diseño curricular de los programas de formación de especialistas en México y el mundo