Reporting Persons With Mental Health Issues: Prospective Study on Gun Control Innovation

School shootings in Parkland, FRL and Santa Fe, TX revived debate about early identification of people who exhibit behavior or symptomology associated with violent behavior. People flagged as at-risk may be reported to third-parties such as psychiatrists and law enforcement and may temporarily or permanently become ineligible to possess firearms. Different stakeholders including teachers, therapists, counselors, family physicians, and emergency physicians could be part of an assessment system to flag individuals. Emergency physicians are uniquely likely to see patients who are experiencing some kind of crisis. This study will assist in determining if emergency physicians are willing to take a role in gun control legislated intervention. An online survey collected information from emergency physicians about: 1) basic demographic characteristics 2) physician knowledge of current firearm eligibility laws 3) physician attitudes about reporting patients to third parties 4) physician attitudes about firearm ownership, permitting and related issues 5) physician political leaning and ideology. The survey will sample emergency departments from a selected urban and rural mix nationwide. Emergency physicians and directors will receive both flyers and emails, directing them to a Qualtrics Web-based survey which includes a consent process. Institutional review board approval for online consent was approved for this study. A power analysis (alpha=.05; beta=.80) suggested that recruiting between 242 and 346 participants equally divided between rural and urban areas would be very good at detecting minimally acceptable differences. 480 EP responded from 42 states with a mean age of 40 yr. (11 SD) with 50% Attendings in practice \u3c7 years; 80 White 61% Male. Party Affiliations: Democrats 50%, Republicans 30% Independent 20%. Political Ideology: Liberals Outnumber Conservatives 2 To 1. The EP knowledge of gun laws was poor with only 42% obtaining a 70% using the NRA, A summary of federal restrictions on the gun purchasing. Over 80% agree across these 3 measures: limit handgun purchase, background checks and handgun restriction on mentally ill patients. Emergency Physicians appear willing to report patients with psychiatric illness and ready to play a role in gun control but are not as informed as one would have hoped. Aside from political leanings and pre-survey expectations, this survey found that physicians can be useful and reliable to report patients with mental health to authorities to be sure they do not possess or make future plans for keeping guns out of the hands of mentally unstable individuals

Sports Medicine for Emergency Medicine Physicians, Too Few to Maintain the Fellowship in Emergency Medicine

[West J Emerg Med. 2012;13(4):342–343.

Global Survey of Outcomes of Neurocritical Care Patients: Analysis of the PRINCE Study Part 2

BACKGROUND: Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. METHODS: We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. RESULTS: We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.03; 95% CI, 1.02 to 1.04); lower GCS (OR 1.20; 95% CI, 1.14 to 1.16 for every point reduction in GCS); pupillary reactivity (OR 1.8; 95% CI, 1.09 to 3.23 for bilateral unreactive pupils); admission source (emergency room versus direct admission [OR 2.2; 95% CI, 1.3 to 3.75]; admission from a general ward versus direct admission [OR 5.85; 95% CI, 2.75 to 12.45; and admission from another ICU versus direct admission [OR 3.34; 95% CI, 1.27 to 8.8]); and the absence of a dedicated neurocritical care unit (NCCU) (OR 1.7; 95% CI, 1.04 to 2.47). CONCLUSION: PRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality.status: publishe