Acute medical diagnoses are common in "found down" adult patients presenting to the emergency department as trauma

Bianca Grecu Jacobs, Samuel D Turnipseed, Anna N. Nguyen, Edgardo Salcedo, Daniel Nishijima

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)992-997
Number of pages6
JournalJournal of Emergency Medicine
Volume49
Issue number6
DOIs
StatePublished - Dec 1 2015

Fingerprint

Hospital Emergency Service
Wounds and Injuries
Registries
Injury Severity Score
Heart Arrest
Toxicology
Differential Diagnosis
History
Demography
Confidence Intervals
Incidence

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 journalArticle

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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.",
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AU - Nguyen, Anna N.

AU - Salcedo, Edgardo

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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

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