ABSTRACT
Background Heavy alcohol use among college-aged students is common and may lead to Emergency Department (ED) visits. A review of alcohol-intoxicated presentations to a single ED was performed to characterize these encounters and identify factors associated with leaving before treatment completion. Methodology Electronic medical records were reviewed for patients aged 18 to 25 years over a nine-month study period who presented to a university-affiliated ED with isolated alcohol intoxication and were subsequently discharged or left before completion of treatment. The frequency and characteristics of these individuals were compared using chi-square analysis. A series of controlled logistic and multinomial regression models were conducted to examine the predictive significance of potentially confounding variables (age, gender, time and day of presentation, method of hospital arrival, and triage level) associated with premature ED departure and length of stay. Measured ethanol levels and vital sign abnormalities at the time of leaving the ED were identified. Results Four hundred sixty-four patients aged 18 to 25 years presented with isolated alcohol intoxication over the study period. A higher frequency of leaving without completion of treatment was noted in college-aged alcohol-intoxicated individuals compared to the general adult ED population (17.9% versus 3.5%; P < 0.01). Abnormal vital signs (10.5%) and elevated ethanol levels before ED departure when measured (85.2%) were not uncommon. Variables significantly associated with leaving before completion of treatment included arrival by means other than emergency medical service (EMS)/police, lower triage levels, and 11 p.m. to 7 a.m. hospital departure. Conclusions Based on these results, intoxicated college-aged individuals are at high risk for leaving EDs before care completion. The development of targeted protocols to minimize this occurrence and utilizing these ED encounters to consider addressing unhealthy drinking behaviors may be helpful.
ABSTRACT
The violent nature of generalized tonic-clonic seizures puts individuals at risk of a large number of potential injuries. These can occur due both to the profound muscular contractions that accompany these episodes as well as falls and other traumatic events that occur due to the period of loss of consciousness that occurs during generalized seizures. While injuries such as soft tissue contusions, tongue biting, dental injuries, and facial lacerations resulting from falls from standing predominate, bony injuries are not uncommon. We present a case of bilateral scapular fractures that occurred in an otherwise healthy 32-year male who presented with shoulder and back pain and inability to perform any significant movement of his upper arms secondary to pain after experiencing an apparent first-time generalized tonic-clonic seizure. The presence of unilateral and bilateral scapular fractures, while uncommonly described, should be considered as an additional potential orthopedic injury that may occur secondary to a generalized tonic-clonic seizure. In the absence of observed significant forceful traumatic injury, this injury is unusual, and its presence noted in a patient experiencing sudden loss of consciousness should raise heightened concern of seizures as the potential etiology.
ABSTRACT
CONTEXT: One advantage of computed tomographic pulmonary angiograms (CTPA) is that they often show pathology in patients in whom pulmonary embolism (PE) has been excluded. In this investigation, we identified the ancillary findings on CTPAs that were negative for PE to obtain an impression of the type of findings shown. METHODS: This was a retrospective analysis of findings on CTPAs that were negative for PE obtained in nine emergency departments between January 2016 - February 2018. Ancillary findings were assessed by review of the radiographic reports. RESULTS: Ancillary findings were identified in N=338 (40.9%) of 825 patients with CTPAs that were negative for PE. Most ancillary findings, 254 (75.1%) of 338 were pulmonary or pleural abnormalities. Liver, gall bladder, kidney, or pancreatic abnormalities were shown in 26 (7.7%) cases, and abnormalities of the heart or great vessels were shown in 23 (6.8%) of cases. Abnormalities of the esophagus or intestine were shown in 12 (3.6%), abnormalities of the thyroid in 10 (3.0%) and abnormalities of bone or soft tissue lesions were shown in three (0.9%) cases. Inferential statistical procedures demonstrated that the occurrence of ancillary findings in patients with negative CTPAs was proportionately greater in patients who were 50 years and older (p < 0.001), although not between genders (p = 0.145). CONCLUSIONS: Ancillary findings on CTPAs that were negative for PE were frequently reported. Future studies might focus of the extent to which ancillary findings on CTPA assisted physicians in management of the patient.
