Physical therapy in the Emergency Department: A prospective cohort study from an Alternatives to Opioids program.

Objective: Musculoskeletal pain complaints are common in the emergency department (ED). The objective of this study was to determine the impact of physical therapy (PT) in the ED on pain and ED return. Methods: A prospective cohort study was performed with those presenting to the ED or Urgent Care at a single academic center for musculoskeletal pain between November 2020 and December 2022. All patients were referred to outpatient PT. During business hours, PT was available to begin treatment in the ED. Long-term follow-up was performed using the electronic health records. Statistical analyses included descriptive and non-parametric pairwise comparisons, Fisher's exact test, and multiple logistic regression. Results: A total of 974 patients were included in the study with 553 completing optional surveys. Back pain was most common. Pain was reduced at ED discharge for all patients, but pain was significantly improved if patients saw PT in the ED. Patients in the ED were less likely to keep their outpatient PT appointments than others, but importantly, patients who saw PT in the ED were less likely to return to the ED for the same complaint up to 1 year later. Those who kept PT appointments were likely to establish or maintain healthcare outside emergency services later. Conclusions: Initiating PT in this ED reduces pain at ED discharge. However, patients who utilized PT were more likely to later utilize health care resources outside of emergency services. Those who saw PT in this ED were less likely to return to the ED for the same complaint up to 1 year later.

Vital Signs Predict Rapid-Response Team Activation Within Twelve Hours of Emergency Department Admission.

INTRODUCTION: Rapid-response teams (RRTs) are interdisciplinary groups created to rapidly assess and treat patients with unexpected clinical deterioration marked by decline in vital signs. Traditionally emergency department (ED) disposition is partially based on the patients' vital signs (VS) at the time of hospital admission. We aimed to identify which patients will have RRT activation within 12 hours of admission based on their ED VS, and if their outcomes differed. METHODS: We conducted a case-control study of patients presenting from January 2009 to December 2012 to a tertiary ED who subsequently had RRT activations within 12 hours of admission (early RRT activations). The medical records of patients 18 years and older admitted to a non-intensive care unit (ICU) setting were reviewed to obtain VS at the time of ED arrival and departure, age, gender and diagnoses. Controls were matched 1:1 on age, gender, and diagnosis. We evaluated VS using cut points (lowest 10%, middle 80% and highest 10%) based on the distribution of VS for all patients. Our study adheres to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for reporting observational studies. RESULTS: A total of 948 patients were included (474 cases and 474 controls). Patients who had RRT activations were more likely to be tachycardic (odds ratio [OR] 2.02, 95% CI [1.25-3.27]), tachypneic (OR 2.92, 95% CI [1.73-4.92]), and had lower oxygen saturations (OR 2.25, 95% CI [1.42-3.56]) upon arrival to the ED. Patients who had RRT activations were more likely to be tachycardic at the time of disposition from the ED (OR 2.76, 95% CI [1.65-4.60]), more likely to have extremes of systolic blood pressure (BP) (OR 1.72, 95% CI [1.08-2.72] for low BP and OR 1.82, 95% CI [1.19-2.80] for high BP), higher respiratory rate (OR 4.15, 95% CI [2.44-7.07]) and lower oxygen saturation (OR 2.29, 95% CI [1.43-3.67]). Early RRT activation was associated with increased healthcare utilization and worse outcomes including increased rates of ICU admission within 72 hours (OR 38.49, 95%CI [19.03-77.87]), invasive interventions (OR 5.49, 95%CI [3.82-7.89]), mortality at 72 hours (OR 4.24, 95%CI [1.60-11.24]), and mortality at one month (OR 4.02, 95%CI [2.44-6.62]). CONCLUSION: After matching for age, gender and ED diagnosis, we found that patients with an abnormal heart rate, respiratory rate or oxygen saturation at the time of ED arrival or departure are more likely to trigger RRT activation within 12 hours of admission. Early RRT activation was associated with higher mortality at 72 hours and one month, increased rates of invasive intervention and ICU admission. Determining risk factors of early RRT activation is of clinical, operational, and financial importance, as improved medical decision-making regarding disposition would maximize allocation of resources while potentially limiting morbidity and mortality.

Measles elimination in the Americas: evolving strategies

The strategy currently used to control measles in most countries has been to immunize each successive birth cohort through the routine health services delivery system. While measles vaccine coverage has increased markedly, significant measles outbreaks have continued to recur. During the past five years, experience in the Americas suggests that measles transmission has been interrupted in a number of countries (Cuba, Chile, and countries in the English-Speaking Caribbean and successfully controlled in all remaining countries. Since 1991 these countries have implemented one-time "catch-up" vaccination campaigns (conducted during a short period, usually 1 week to 1 month, and targeting all children 9 months through 14 years of age, regardless of previous vaccination status or measles disease history). These campaigns have been followed by improvements in routine vaccination services and in surveillance systems, so that the progress of the measles elimination efforts can be sustained and monitored. Follow-up mass vaccination campaigns for children younger than 5 years are planned to take place every 3 to 5 years (AU)