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Introduction: In March 2020, shelter-in-place orders were enacted to attenuate the spread of coronavirus 2019 (COVID-19). Emergency departments (EDs) experienced unexpected and dramatic decreases in patient volume, raising concerns about exacerbating health disparities.Methods: We queried our electronic health record to describe the overall change in visits to a two-ED healthcare system in Northern California from March–June 2020 compared to 2019. We compared weekly absolute numbers and proportional change in visits focusing on race/ethnicity, insurance, household income, and acuity. We calculated the z-score to identify whether there was a statistically significant difference in proportions between 2020 and 2019.Results: Overall ED volume declined 28% during the study period. The nadir of volume was 52% of 2019 levels and occurred five weeks after a shelter-in-place order was enacted. Patient demographics also shifted. By week 4 (April 5), the proportion of Hispanic patients decreased by 3.3 percentage points (pp) (P = 0.0053) compared to a 6.2 pp increase in White patients (P = 0.000005). The proportion of patients with commercial insurance increased by 11.6 pp, while Medicaid visits decreased by 9.5 pp (P < 0.00001) at the initiation of shelter-in-place orders. For patients from neighborhoods 400% FPL the week of the shelter-in-place order. Overall, 2020 evidenced a consistently elevated proportion of high-acuity Emergency Severity Index (ESI) level 1 patients compared to 2019. Increased acuity was also demonstrated by an increase in the admission rate, with a 10.8 pp increase from 2019. Although there was an increased proportion of high-acuity patients, the overall census was decreased.Conclusion: Our results demonstrate changing ED utilization patterns circa the shelter-in-place orders. Those from historically vulnerable populations such as Hispanics, those from lower socioeconomic areas, and Medicaid users presented at disproportionately lower rates and numbers than other groups. As the pandemic continues, hospitals should use operations data to monitor utilization patterns by demographic, in addition to clinical indicators. Messaging about availability of emergency care and other services should include vulnerable populations to avoid exacerbating healthcare disparities.

Objective To describe the characteristics and chief complaints of adults seeking emergency care at two Cambodian provincial referral hospitals. Methods Adults aged 18 years or older who presented without an appointment at two public referral hospitals were enrolled in an observational study. Clinical and demographic data were collected and factors associated with hospital admission were identified. Patients were followed up 48 hours and 14 days after presentation. Findings In total, 1295 hospital presentations were documented. We were able to follow up 85% (1098) of patients at 48 hours and 77% (993) at 14 days. The patients' mean age was 42 years and 64% (823) were females. Most arrived by motorbike (722) or taxi ortuk-tuk (312). Most common chief complaints were abdominal pain (36%; 468), respiratory problems (15%; 196) and headache (13%; 174). Of the 1050 patients with recorded vital signs, 280 had abnormal values, excluding temperature, on arrival. Performed diagnostic tests were recorded for 539 patients: 1.2% (15) of patients had electrocardiography and 14% (175) had diagnostic imaging. Subsequently, 783 (60%) patients were admitted and 166 of these underwent surgery. Significant predictors of admission included symptom onset within 3 days before presentation, abnormal vital signs and fever. By 14-day follow-up, 3.9% (39/993) of patients had died and 19% (192/993) remained functionally impaired. Conclusion In emergency admissions in two public hospitals in Cambodia, there is high admission-to-death ratio and limited application of diagnostic techniques. We identified ways to improve procedures, including better documentation of vital signs and increased use of diagnostic techniques. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Decrire les caracteristiques et les principales affections des adultes qui ont recours aux soins d'urgence dans deux hopitaux cambodgiens provinciaux de reference. Methodes Les adultes ages de plus de 18 ans qui se sont presentes sans rendez-vous a deux hopitaux publics de reference, ont ete inscrits a une etude observationnelle. Les donnees cliniques et demographiques ont ete recueillies et les facteurs associes a l'hospitalisation ont ete identifies. Les patients ont ete suivis 48 heures et 14 jours apres leur presentation. Resultats Au total, 1295 presentations a Lhopital ont ete documentees. Nous avons pu suivre 85% (1098) des patients 48 heures et 77% (993) 14 jours apres leur presentation. L'age moyen des patients etait de 42 ans et 64% (823) des patients etaient des femmes. La plupart des patients etaient arrives en moto (722), en taxi ou en tuk-tuk (312). Les principales affections communes etaient en majorite des douleurs abdominales (36%; 468), des problemes respiratoires (15%; 196) et des maux de tete (13%; 174). Parmi les 1050 patients dont les signes vitaux ont ete enregistres, 280 avaient des valeurs anormales, hormis la temperature, lors de leur arrivee. Les tests diagnostiques realises ont ete enregistres pour 539 patients: 1,2% (15) des patients avait beneficie d'une electrocardiographie et 14% (175) des patients avaient beneficie de l'imagerie diagnostique. Par la suite, 783 (60%) patients ont ete hospitalises et 166 d'entre eux ont subi une operation chirurgicale. Les indicateurs significatifs d'hospitalisation comprenaient l'apparition des symptomes dans les 3 jours precedant la presentation, des signes vitaux anormauxet la fievre. A Tissue du suivi des 14 jours, 3,9% (39/993) des patients etaient decedes et 19% (192/993) des patients presentaient des capacites fonctionnelles diminuees. Conclusion Dans les hospitalisations d'urgence dans les deux hopitaux publics au Cambodge, il y a un rapport hospitalisation-deces eleve et une application limitee des techniques de diagnostic. Nous avons identifie des moyens pour ameliorer les procedures, y compris Ia meilleure documentation des signes vitaux et l'utilisation accrue des techniques de diagnostic. Objetivo Describir las caracteristicas y quejas principales de los adultos que solicitan atencion de emergencia en dos hospitals provinciales de remision de Camboya. Metodos Se inscribio a adultos mayores de 18 anos que acudieron sin cita previa a dos hospitales publicos de remision en un estudio observacional. Se recogieron datos clinicos y demograficos y se identificaron los factores relacionados con el ingreso hospitalario. Se realizo un seguimiento a los pacientes durante 48 horas y 14 dias despues de la visita hospitalaria. Resultados En total, se documentaron 1295 visitas hospitalarias. Se logro realizar un seguimiento del 85 % (1098) y del 77 % (993) de los pacientes a las 48 horas y a los 14 dias, respectivamente. La edad media de los pacientes fue de 42 anos y el 54 % (823) eran mujeres. La mayoria acudio en motocicleta (722), taxi o tuk-tuk (312). Las quejas principales mas comunes fueron dolor abdominal (36 %; 458), problemas respiratorios (15 %; 196) y cefalea (13 %; 174). De los 1050 pacientes con registro de constantes vitales, 280 presentaron valores anomalos, a excepcion de la temperatura corporal, a su llegada. Se registraron las pruebas diagnosticas realizadas en 539 pacientes: se realizo una electrocardiografia al 1,2% (15) e imagenes diagnosticas al 14% (175) de los pacientes. Posteriormente, 783 (60 %) de los pacientes fueron ingresados, de los cuales 166 se sometieron a cirugia. Los predictores significativos para el ingreso incluyeron Ia aparicion de los sintomas 3 dias antes de Ia visita hospitalaria, constantes vitales anomalas yfiebre. Antes de finalizar el seguimiento de 14 dias, el 3,9 % (39/993) de los pacientes habia fallecido y el 19 % (192/993) seguia presentando discapacidades funcionales. Conclusion Las hospitalizaciones de emergencia de dos hospitales publicos de Camboya presentan una elevada relacion entre ingreso y defuncion, asi como un uso limitado de Ias tecnicas de diagnostico. Se identificaron formas de mejorar los procedimientos, como una mejor documentacion de las constantes vitales y un mayor uso de Ias tecnicas de diagnostico., Introduction Emergency medicine is a neglected component of health-care systems in most low- and middle-income countries. Nearly half of deaths and one third of disability adjusted life-years lost in these [...]

Trauma centers provide coordinated specialty care and have been demonstrated to save lives. Many states do not have a comprehensive statewide trauma system. Variable geography, resources, and population distributions present significant challenges to establishing an effective uniform system for pediatric trauma care. We aimed to identify patterns of primary (field) triage and transfer of serious pediatric trauma throughout California. We hypothesized that pediatric primary triage to trauma center care would be positively associated with younger age, increased injury severity, and local emergency medical service (EMS) regions with increased resources. We hypothesized that pediatric trauma transfer would be associated with younger age, increased injury severity, and rural regions with decreased resources. Methods: We conducted a retrospective cohort study of the California Office of Statewide Health Planning and Development emergency department and inpatient discharge data (2005–2015). All patients with serious injury, defined as Injury Severity Score (ISS) >9 were included. Demographic, injury, hospital, and regional characteristics such as distances between patient residence and destination hospitals were tabulated. Univariate and multinomial logit analyses were conducted to analyze individual, hospital, and regional characteristics associated with the outcomes of location of primary triage and transfer. Estimates were converted into predicted probabilities for ease of data interpretation. Results: Primary triage to was to either a pediatric trauma center (37.8%), adult level I/II trauma center (35.0%), adult level III/IV trauma center (1.9%), pediatric non-trauma hospital (3.4%), or an adult non-trauma hospital (21.9%).Younger age, private non-HMO insurance, motor vehicle mechanism, and rural areas were the major factors influencing primary triage to any trauma hospital. Younger age, private non-HMO insurance, higher ISS, fall mechanism, <200 bed hospital, and rural areas were the major factors influencing transfer from a non-trauma hospital to any trauma center. Conclusions: We demonstrate statewide primary triage and transfer patterns for pediatric trauma in a large and varied state. Specifically we identified previously unrecognized individual, hospital, and EMS system associations with pediatric trauma regionalization. Knowledge of these de facto trauma care access patterns has policy and process implications that could improve care for all injured children in need. [ABSTRACT FROM AUTHOR]