Recurrent Episodes of Acute Pancreatitis Present to the ED with More Severe Disease by CT than First-Time Acute Pancreatitis

Study Objective: Approximately 30% of patients with one episode of acute pancreatitis experience a recurrent episode. The objective of this study is to compare the severity of the first-time episode versus recurrent episodes of acute pancreatitis based on CT scan. Methods: This study was conducted as part of a retrospective chart review at a single academic urban emergency department from 2012-2016. Criteria for inclusion included clinical symptoms of pancreatitis, age greater than or equal to 18 years, ED diagnosis of acute pancreatitis, and, an abdominal CT scan within 24 hours of triage. Exclusion criteria were traumatic cause of acute pancreatitis and pregnancy. Charts were reviewed by a trained abstractor using structured data collection sheets which included data elements such as a history of acute pancreatitis and the results of an abdominal CT scan. Data abstraction was confirmed for interrater reliability. CT Scans were graded using the Modified CT Severity Index (MCTSI) which grades acute pancreatitis by the presence of inflammation, fluid accumulation, necrosis or extra-pancreatic findings. Results: 283 patients were included in the study. Of these, 110 patients resented with recurrent acute pancreatitis and 173 patients presented with first-time acute pancreatitis. We calculated the mean MCTSI score in both groups and found a significantly higher rate of severity in recurrent acute pancreatitis versus first episode (2.09 vs. 1.43, p\u3c0.05.) Conclusion: Patients with recurrent acute pancreatitis are more likely to present with a more severe episode of acute pancreatitis than patients presenting with first-time acute pancreatitis

Nasogastric Decompression is Associated with Increased Hospital Length of Stay but No Reduction in Need for Surgery in ED Patients with Acute Small Bowel Obstruction

Title Nasogastric Decompression is Associated with Increased Hospital Length of Stay but No Reduction in Need for Surgery in ED Patients with Acute Small Bowel Obstruction Background Small bowel obstruction (SBO) is one of the most common causes of surgical admissions, occurring nearly 300,000 times per year and costing the US healthcare system an estimated $1.3 billion dollars annually. Standard early management of acute SBO includes Nasogastric (NG) decompression of the GI tract proximal to the obstruction. This procedure is uncomfortable for patients and there is controversy regarding its clinical benefit. The primary objective of this study was to determine if NG decompression was associated with a reduction in surgical management of small bowel obstruction. Methods We performed a retrospective chart review of 181 patients admitted to an urban academic teaching hospital from the Emergency Department (ED) with a diagnosis of small bowel obstruction and CT confirmation over a two-year period from September 2013 – September 2015. All subjects received an abdominal CT scan read by attending radiologist as either “definite” or “likely” SBO. Using established methods of chart review, a team of abstractors collected data regarding demographic characteristics, past medical history, clinical signs, ED course and hospital course. To accomplish the primary objective, we compared patients who received NG decompression with those that did not, to primary endpoints of surgical intervention, bowel resection during surgery, and hospital length of stay (LOS). Results Among subject population, 93 (51%) of patients received NG decompression and 88 (49%) did not. There was no significant difference in baseline characteristics between the two groups. In patients who received NG decompression, there was no association with a reduction in surgery (p=0.20) or bowel resection (p =0.41.) A significantly increased distribution of median hospital length of stay for those receiving NG decompression versus those who did not receive NG decompression was observed of 5 days versus 3 days (p\u3c0.0001.) Conclusion NG decompression is not associated with a reduction in surgery or a reduction in need for bowel resection but is associated with an increase in hospital length of stay. Future prospective randomized studies are needed to confirm these associations

Evaluating Patient Perceptions on PrEP Screening and Referral in the Acute Care Setting

Pre-exposure prophylaxis (PrEP) for HIV is highly effective, yet uptake has been limited. We measured PrEP knowledge, eligibility, and referral willingness among patients receiving emergency or acute care in Washington, DC. We surveyed HIV-negative patients with STI-related complaints on HIV risk behaviors, PrEP knowledge, eligibility, and willingness for PrEP referral. Among 174 participants, 70% were PrEP unaware and 33% were PrEP eligible. Most participants (81%) supported learning more, 64% would consider taking PrEP, and 28% agreed to immediate referral. Willingness to learn more about PrEP suggests referral from non-traditional settings may increase uptake. Further evaluation of this approach is warranted

Targeted Screening for HIV Pre-Exposure Prophylaxis Eligibility in Two Emergency Departments in Washington, DC

© 2020, Mary Ann Liebert, Inc., publishers. Pre-exposure prophylaxis (PrEP) is an effective method to prevent HIV acquisition in high-risk individuals. This cross-sectional survey study estimated the proportion of patients who were PrEP eligible among a targeted sample of emergency department (ED) patients with chief complaints indicative of HIV risk. Research assistants screened a convenience sample of adult patients who presented to two hospital EDs in Washington, DC, during a 6-month period with genitourinary, substance use, or intentional injury-related complaints. Patients with these complaints who reported being sexually active within the past 6 months and HIV negative completed a computer-assisted survey that included questions on sexual practices and partners, substance use, and attitudes and knowledge about PrEP. We used the Centers for Disease Control and Prevention (CDC) clinical guidelines to determine whether PrEP use was indicated. We report differences in PrEP eligibility by demographic characteristics, knowledge, and attitudes. Of the 410 participants, the majority were black (85%), and heterosexual females (72%). PrEP use was indicated in 20% (N = 84), most commonly because of condomless sex with a person of unknown HIV status (82%) and/or a sexually transmitted infection (STI) diagnosis (41%). One-third (34%) of participants had heard of PrEP. Overall, 36% of the sample (N = 148) wanted to learn more about PrEP while in the ED. The percentage who wanted to learn more about PrEP was higher among PrEP-eligible patients (52%) compared with PrEP-ineligible patients (32%). Using CDC criteria, targeted screening identified that a substantial proportion of ED patients are PrEP eligible based on their self-reported behaviors

Mpox Awareness, Risk Reduction, and Vaccine Acceptance among People with HIV in Washington, DC

People with HIV (PWH) are disproportionally affected by mpox and at risk of severe complications. We assessed mpox knowledge, adoption of preventive behaviors, and vaccination attitudes among PWH enrolled in a longitudinal HIV cohort in Washington, DC, the DC Cohort. We conducted uni- and multivariable analyses comparing participants by vaccination status and HIV risk group, and multinomial regression to identify factors associated with vaccine acceptance. Among 430 PWH, 378 (87.9%) were aware of mpox. Among 373 participants with vaccination status data, 101 (27.1%) were vaccinated, 129 (34.6%) planned to vaccinate, and 143 (38.3%) did not plan to vaccinate. The three vaccination groups differed significantly by age, race, education, HIV risk group, recent STI status, and level of mpox worry (all p p p < 0.05). High levels of mpox awareness were observed among this cohort of PWH with more MSM employing risk reduction behaviors and being vaccinated. Ensuring that PWH, regardless of gender, sexual orientation, or age, understand the risks of mpox may improve vaccination uptake