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The Emergency Severity Index (version 3): A Good Predictor of Admission, Length of Stay and Mortality in a European Emergency Department

Abstracts pain at follow-up to pain at discharge. Even with the use of prescribed pain medication, worst pain at follow-up was significantly higher than pain at discharge. Further study of discharge pain management plans and patient use of prescribed pain medications is needed to improve analgesia after ED discharge. Limitations include convenience sampling and relatively low contact for follow-up. Reprinted with permission from the American College of Emergency Physicians. Ann Emerg Med 2004;44:S88 241 ing directly to the “shock room” and bypassing the triage desk, but still getting registered. Conclusion: Based on these results we feel that the ESI is a good predictor of patient severity as reflected in their admission rate, length of stay and mortality. Future research needs to be performed to determine if it also accurately predicts resource utilization. The Emergency Severity Index (version 3): A Good Predictor of Admission, Length of Stay and Mortality in a European Emergency Department. Boeije T, Frederikse MP, van der Heijden FHWM, Mencl F, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands Introduction: The Emergency Severity Index (ESI) triage algorithm is a tool for estimating Emergency Department (ED) patient acuity in triage. It divides patients into 5 categories with 1 and 2 representing the sickest patients, and 4 and 5 the least ill. Until now it has mostly been validated in the United States. We evaluated ESI (version 3) in a busy ED serving a major European city. Hypothesis:ESI triage categories correlate with rate of admission, length of stay and mortality rate of ED patients. Materials and Methods: With E-care, a computer based patient registration system, we prospectively collected data on the triage category, ED length of stay (LOS), disposition, admission rate and mortality of all patients visiting our ED from January 1st through April 30th of 2005. The hospital is a level 2 trauma center, with an EM residency program, and sees approximately 42,000 ED patients annually. Results: A total of 13,820 patients were included. The ESI categories were divided as follows: ESI-1 (0.4%), ESI-2 (14.9%), ESI-3 (28.4%), ESI-4 (26.8%), ESI-5 (27.2%), and non-triaged 2.4%. The total admission rate for all patients was 16.5%, with the highest numbers being seen in ESI-1 (57.1%) and ESI-2 (42.8%), The remaining categories had much lower admission rates: ESI-3 (28.8%), ESI-4 (4.7%), ESI-5 (1.0%). Seven percent of patients were not triaged. The average LOS was 133 minutes. Categorised by ESI it was: ESI-1 (147 min), ESI-2 (177 min), ESI-3 (177 min), ESI-4 (115 min), ESI-5 (87 min), and nontriaged 58 minutes. Overall 11 patients died; 8 in ESI-1 (8/56 14.3%), 2 in ESI-3 (0.05%), and 1 who was not triaged. There were no deaths in triage category 3. Discussion: The ESI was designed to be used as triage tool and indeed it does demonstrate linear correlation between triage category and admission rate. The highest likelihood of death (14.3%) was also predicted by ESI category 1. The remaining categories had too low a mortality rate to show any correlation. LOS, however did not correlate with triage category. ESI category 1 patients had a much shorter LOS than those in Category 2 and 3 because a number of these were rapidly transported to the OR, ICU or cardiac catheterisation laboratory, while those in 2 and 3 often required lengthier work-ups to determine diagnosis and disposition. The seven percent of patients not triaged represents a system problem and is most likely made up of patients present- Complications of Warfarin Therapy and the Correlation of the Outcomes with INR Levels Arzu Denizbasi, Erden Erol Unluer, Ozlem Guneysel, Serkan Eroglu, Mehmet Kosargelir, Marmara University, Faculty of Medicine, Department of Emergency Medicine, Directorate of Health, Emergency Services, Istanbul, Turkey Objectives: Warfarin is the most commonly used oral anticoagulant agent throughout the world. It is an antagonist of vitamin K, a necessary element in the synthesis of clotting factors II, VII, IX and X. It also acts by inhibiting endogenous anticoagulant proteins C and S, which are biologically inactive without the carboxylation of certain glutamic acid residues. The aim of the study is to determine the correlation between the international normalized ratio (INR) levels and the clinical presentation of the patients presenting to the emergency department (ED). Methods: The study was performed prospectively at the Department of Emergency Medicine, Marmara University, between January 2003- May 2005. All the patients using Warfarin and having any complaint of apparent or occult bleeding were included in the study. The presentations, therapies, and outcomes of these patients were analyzed. Differences in outcome variables were determined by the _P2P test for independence and multivariate analysis of variance. Results: During the study period, 61 patients with high INR levels due to warfarin were managed in the ED. The avarage age was 66,9 20 years and 54.0% were male. Fifty-six patients complained of apparent bleeding; presenting as gastric 37.5%, bladder 8.9%, oral 7.1%, colonic 5.3%, lung 3.5%, and intracranial hemorrhages. 62.5% of the patients presented to the ED less than 24 hours after the onset of bleeding. INR levels were over 7.0 in 21.3%, and over 4.0 in 75.4% of patients. While 85.7% of the patients were managed in the ED, 8.2% were managed in the ICU. Only 2 patients died, and both them had INR levels lower than 7.0. There was no significant correlation between the INR levels and the severity of the bleeding or the outcome of the patients (P 0.05, each). The patients were treated by K vitamin and FFP according to the guidelines. Discussion: The pharmacokinetic profile of warfarin is complex, and frequent monitoring is required to maintain patients within the recommended INR target range of 2.0 –3.0. Mortality is increased in patients who are outside the target range. Many factors have been reported as barriers to treatment with warfarin, including interactions between warfarin and other medications and foods, concerns over the risk of bleeding, and practical problems relating to frequent INR monitoring. There are currently no published data that support the hypothesis that a rapid return of a prolonged INR to within the desired range is associated with a reduction in clinical bleeding events. Available evidence on http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Emergency Medicine Elsevier
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