Abstract
Background Patients often present to the emergency department (ED) as "found down," with limited history to suggest a primary traumatic or medical etiology. Objective The 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. Methods Using 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. Results There 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%). Conclusion Acute 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 992-997 |
| Number of pages | 6 |
| Journal | Journal of Emergency Medicine |
| Volume | 49 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 1 2015 |
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Keywords
- brain injuries
- resource allocation
- triage
- wounds and injuries
ASJC Scopus subject areas
- Emergency Medicine
Cite this
Acute medical diagnoses are common in "found down" adult patients presenting to the emergency department as trauma. / Jacobs, Bianca Grecu; Turnipseed, Samuel D; Nguyen, Anna N.; Salcedo, Edgardo; Nishijima, Daniel.
In: Journal of Emergency Medicine, Vol. 49, No. 6, 01.12.2015, p. 992-997.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Acute medical diagnoses are common in "found down" adult patients presenting to the emergency department as trauma
AU - Jacobs, Bianca Grecu
AU - Turnipseed, Samuel D
AU - Nguyen, Anna N.
AU - Salcedo, Edgardo
AU - Nishijima, Daniel
PY - 2015/12/1
Y1 - 2015/12/1
N2 - Background Patients often present to the emergency department (ED) as "found down," with limited history to suggest a primary traumatic or medical etiology. Objective The 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. Methods Using 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. Results There 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%). Conclusion Acute 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.
AB - Background Patients often present to the emergency department (ED) as "found down," with limited history to suggest a primary traumatic or medical etiology. Objective The 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. Methods Using 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. Results There 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%). Conclusion Acute 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.
KW - brain injuries
KW - resource allocation
KW - triage
KW - wounds and injuries
UR - http://www.scopus.com/inward/record.url?scp=84947613907&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84947613907&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2015.03.024
DO - 10.1016/j.jemermed.2015.03.024
M3 - Article
C2 - 26048067
AN - SCOPUS:84947613907
VL - 49
SP - 992
EP - 997
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
SN - 0736-4679
IS - 6
ER -