Anaphylaxis risk factors for hospitalization and intensive care: A comparison between adults and children in an upstate New York emergency department.

Background: Anaphylaxis is an acute, systemic allergic reaction that can be life threatening, and with an increasing incidence and costs associated with hospitalization and intensive care. Objective: To assess the risk factors for hospitalization by comparing pediatric and adult patients. Methods: We performed a retrospective chart review for patients with anaphylactic reactions who presented to the Albany Medical Center emergency department between 2005 and 2012. Results: We identified 267 anaphylactic reactions in 258 patients (143 adults). Of those, 128 (48%) were not coded as anaphylaxis despite fulfilling diagnostic criteria. Foods were the most common trigger both in adults and children. Factors associated with increased odds of hospitalization (intensive care unit [ICU] and hospital floor combined) included a severity score of 3 in both children (odds ratio [OR] 41.86 [95% confidence interval {CI}, 2.9-602.48], p = 0.006) and adults (OR 32.52 [95% CI, 6.28-168.35], p < 0.001), and those who received multiple doses of epinephrine in children (OR 15.36 [95% CI, 1.9-121.4], p = 0.009) and adults (OR 11.49 [95% CI, 3.08-44.13], p < 0.001). Patient characteristics associated with ICU admission in children and adults combined included Medicare and/or Medicaid insurance (OR 4.96 [95% CI, 1.14-21.67], p = 0.023), cutaneous symptoms (OR 0.19 [95% CI, 0.04-0.79], p = 0.23), and cardiovascular symptoms (OR 5.8 [95% CI, 1.16-28.87], p = 0.032). Conclusion: Anaphylaxis remains underrecognized and improperly treated in the emergency department. Severity of symptoms and receiving multiple doses of epinephrine were associated with hospitalization in both children and adults. Medicare and/or Medicaid insurance, and cardiovascular or cutaneous symptoms were characteristics associated with ICU admission in our cohort.

Health Literacy in Patients Seeking Orthopaedic Care: Results of the Literacy in Musculoskeletal Problems (LIMP) Project.

BACKGROUND: Health literacy is the most important predictor of an individual's health status, with more frequent hospitalizations, worse control of chronic conditions, and suboptimal treatment outcomes associated with limited literacy. Despite this, little is known about musculoskeletal health literacy. As such, this study utilized a musculoskeletal specific literacy survey (the LiMP questionnaire) to evaluate the level of comprehension in patients presenting to the emergency department with musculoskeletal complaints, with an emphasis on their understanding of anatomy, terminology, diagnosis and treatment of musculoskeletal conditions. The relationship between musculoskeletal specific and general health literacy was also assessed, in addition to the risk factors for limited musculoskeletal comprehension. METHODS: In this cross-sectional study, each of the 248 participants completed a demographic survey, the LiMP questionnaire, and the Newest Vital Sign (NVS), a general health literacy assessment tool. A x(2) analysis was used to compare results from the LiMP questionnaire and NVS, and to evaluate the relationship between musculoskeletal health literacy and demographic parameters. RESULTS: The mean LiMP score was 4.68 ± 1.78 out of a possible nine points. Questions regarding musculoskeletal conditions were answered correctly by 47.4% of respondents. Questions regarding diagnosis and treatment were answered correctly by 31.2% of respondents. Questions regarding anatomy and terminology were answered correctly by 65.3% of respondents. Limited musculoskeletal literacy, defined as LiMP questionnaire scores of <6, was observed in 69% of subjects. Inadequate general health literacy, defined as NVS scores <4, was observed in 48% of subjects. This difference was statistically significant (p<0.001). Those who identified themselves as Caucasian and having an education level of ≥ college were significantly more likely to have adequate musculoskeletal literacy (p=0.001, p<0.001, respectively). CONCLUSIONS: The prevalence of limited musculoskeletal literacy is greater than that of limited general health literacy, with minorities and those with lower education levels most at risk. These findings are consistent with other disease and specialty specific literacy studies. Although such insight will assist providers in accurately targeting education and outreach campaigns, it remains imperative that additional research be performed to determine if limited literacy correlates with increased complications and worse outcomes in those with musculoskeletal conditions. LEVEL OF EVIDENCE: Level IV. The authors have no relevant financial disclosures or conflicts of interest with regard to this manuscript. No funding was received.

Measles investigation: a moving target.

Measles is a highly contagious respiratory infection with significant transmission risk once thought to be on the verge of elimination. Outbreaks in Europe have resulted in resurgence; however, experience with measles is limited in the United States. We describe the impact of 2 measles cases presenting to our emergency department in May 2011. Exposure criteria were defined and revised. Guidance documents were developed and distributed. Suspect cases were masked and escorted to negative pressure. Lack of prompt IgM and polymerase chain reaction testing resulted in delayed disease confirmation. Computerized flagging systems were established. Exposed individuals were screened to determine the need for prophylaxis. Investigation costs were calculated. A total of 171 patients and visitors and 94 employees met exposure criteria. Employees had proof of immunity to measles. Of these, 43 patients and visitors returned for prophylaxis. No subsequent transmission occurred. The conservative cost for these investigations was $63,176.39. Multiple challenges were identified. Inexperience with measles can result in significant outbreaks. Although transmission did occur at another facility, it was prevented at our facility because of rapid case recognition, isolation, health care worker immunity, and multidisciplinary response. Discordance between the Healthcare Infection Control Practices Advisory Committee and public health guidelines for measles control created unnecessary challenges.

Emergency management of blunt chest trauma in children: an evidence-based approach.

Pediatric trauma is commonly encountered in the emergency department, and trauma to the head, chest, and abdomen may be a source of significant morbidity and mortality. As children have unique thoracic anatomical and physiological properties, they may present with diagnostic challenges that the emergency clinician must be aware of. This review examines the effects of blunt trauma to the pediatric chest, as well as its relevant etiologies and associated mortality. Diagnostic and treatment options for commonly encountered injuries such as pulmonary contusions, rib fractures, and pneumothoraces are examined. Additionally, this review discusses rarely encountered--yet highly lethal--chest wall injuries such as blunt cardiac injuries, commotio cordis, nonaccidental trauma, and aortic injuries.