Methamphetamine Use and Emergency Department Utilization: 20 Years Later

Background. Methamphetamine (MAP) users present to the emergency department (ED) for myriad reasons, including trauma, chest pain, and psychosis. The purpose of this study is to determine how their prevalence, demographics, and resource utilization have changed. Methods. Retrospective review of MAP patients over 3 months in 2016. Demographics, mode of arrival, presenting complaints, disposition, and concomitant cocaine/ethanol use were compared to a 1996 study at the same ED. Results. 638 MAP-positive patients, 3,013 toxicology screens, and 20,203 ED visits represented an increase in prevalence compared to 1996: 461 MAP-positive patients, 3,102 screens, and 32,156 visits. MAP patients were older compared to the past. Mode of arrival was most frequently by ambulance but at a lower proportion than 1996, as was the proportion of MAP patients with positive cocaine toxicology screens and ethanol coingestion. Admission rate was lower compared to the past, as was discharge to jail. The proportion of MAP patients presenting with blunt trauma was lower compared to the past and higher for chest pain. Conclusion. A significant increase in the prevalence of MAP-positive patients was found. Differences in presenting complaints and resource utilization may reflect the shifting demographics of MAP users, as highlighted by an older patient population relative to the past

945-61 A New Approach to Management of Low Risk Patients Presenting to the Emergency Room with Chest Pain: The Immediate Exercise Treadmill Test

To enhance clinical and cost-effective management of low risk patients (pts) with chest pain who traditionally require admission to a monitoring unit to rule out a coronary event, we have applied immediate exercise treadmill testing (ED) directly in the emergency department (ED) in this subset. Based on our initial pilot experience with IETT suggesting its safety and utility, we have extended this approach to a large pt population: n=192.103 men (M), mean age 46 yr. (28–79) and 89 women (W), mean age 49 yr. (31–89). Low risk pts were defined by: chest pain, a normal or nondiagnostic electrocardiogram, no history of corona ry artery disease (CAD) and a negative screening evaluation for acute pulmonary and noncardiac vascular processes. Most recently we have included selected pts with known CAD. IETT entailed symptomlimited testing (prior to report of cardiac isoenzymes). Positive (Pos) IETT: ≥:1.0mm ST-segment,↓ at 80 msec; Nondiagnostic (NonDx) IETT: negative (Neg) test at <85% age-predicted maximum heart rate.ResultsIETTMenpWomenNegativ70% (69/103)n.s53% (47/89)Nondiagnostic22% (23/103)n.s31% (28/89)Positive10%(11/103)n.s16% (14/89)There were no adverse effects of IETT. Based on further studies in 18 Pos pts (coronary angiography—10, stress scintigraphy— 4, stress echocardiography — 4), predictive accuracy of Pos Lett was 67% (12/18; M 67% [6/9J, W 67% [6/9]. Preliminary data revealed no adverse clinical events in Neg pts 1 mono after Lett and selected NonDx pts received further evaluation. IETT is safe in selected pts with chest pain who have traditionally required admission to rule out a coronary event. Pos rate is low but true Pos are not rare and are not readily identifiable by traditional clinical criteria. These results do not differ significantly in M and W The high negative rate of IETT indicates a potential for major savings if this approach were utilized in the criteria for admission of this pt populatio

Acute Medical Diagnoses Are Common in “Found Down” Adult Patients Presenting to the Emergency Department as Trauma

BackgroundPatients often present to the emergency department (ED) as "found down," with limited history to suggest a primary traumatic or medical etiology.ObjectiveThe study objective was to describe the characteristics of "found down" adult patients presenting to the ED as trauma, specifically the incidence of acute medical diagnoses and major trauma.MethodsUsing an institutional trauma registry, we reviewed trauma activations with the cause of injury "found down" between January 2008 and December 2012. We excluded patients with cardiac arrest, transfers from other hospitals, and patients with a more than likely (>50%) traumatic or medical etiology on initial ED presentation. Inclusion and exclusion criteria were reviewed by two independent abstractors. We abstracted demographic, clinical, injury severity, and outcomes variables. Major trauma was defined as Injury Severity Score ≥ 16.ResultsThere were 659 patients identified with the cause of injury "found down." A total of 207 (31%) patients met inclusion criteria; median age was 67 years (interquartile range 50-82 years), and 110 (53%) were male. Among the included patients, 137 (66%, 95% confidence interval [Cl] 59-73%) had a discharge diagnosis of an acute medical condition, 14 (7%, 95% Cl 4-11%) with major trauma alone, 21 (10%, 95% Cl 6-15) with both an acute medical condition and major trauma, and 35 (17%, 95% Cl 12-23%) with minor trauma. The most common acute medical diagnoses were toxicological (56 patients, 35%; 95% Cl 28-43%) and infectious (32 patients, 20%; 95% Cl 14-27%).ConclusionAcute medical diagnoses were common in undifferentiated ED patients "found down" in an institutional trauma registry. Clinicians should maintain a broad differential diagnosis in the workup of the undifferentiated "found down" patient

Methamphetamine Use and Emergency Department Utilization: 20 Years Later

Background. Methamphetamine (MAP) users present to the emergency department (ED) for myriad reasons, including trauma, chest pain, and psychosis. The purpose of this study is to determine how their prevalence, demographics, and resource utilization have changed. Methods. Retrospective review of MAP patients over 3 months in 2016. Demographics, mode of arrival, presenting complaints, disposition, and concomitant cocaine/ethanol use were compared to a 1996 study at the same ED. Results. 638 MAP-positive patients, 3,013 toxicology screens, and 20,203 ED visits represented an increase in prevalence compared to 1996: 461 MAP-positive patients, 3,102 screens, and 32,156 visits. MAP patients were older compared to the past. Mode of arrival was most frequently by ambulance but at a lower proportion than 1996, as was the proportion of MAP patients with positive cocaine toxicology screens and ethanol coingestion. Admission rate was lower compared to the past, as was discharge to jail. The proportion of MAP patients presenting with blunt trauma was lower compared to the past and higher for chest pain. Conclusion. A significant increase in the prevalence of MAP-positive patients was found. Differences in presenting complaints and resource utilization may reflect the shifting demographics of MAP users, as highlighted by an older patient population relative to the past