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155: Preliminary Results of the Survivors of Torture Presenting to an Urban Emergency Department Prevalence Study
Research Forum Abstracts Programs that improve the outpatient management of these complicated patients are likely to reduce ED utilization. The objective of this study was to examine the effect of a citywide care management (CM) project on the subsequent ED utilization of enrolled high utilizers. Methods: We conducted a retrospective cohort study of 33 patients who met the CM project enrollment criteria of Camden City residency with five or more ED visits during a one-year period of time. Enrolled high-utilizing patients were provided with targeted care management to help them towards stabilizing their social environment and finding an appropriate medical home. CM patients were recruited from 11/1/ 2007– 4/30/2008 and followed until 6/30/2008. These patients were then retrospectively matched into a citywide database of all Camden City hospital visits to determine both utilization rates before and after project enrollment. Based on each individual CM patient’s age, sex, and baseline utilization, three matched control patients were selected from the database to form a comparison group of 99 patients. Time to event analysis was performed using multivariable Cox regression. Insurance status, a history of substance abuse, and homelessness were explored as potential confounders. The event of interest was defined as a subsequent ED visit and censoring took place in the event of death, loss to follow-up, and at study completion on 6/30/2008. Results: Fourteen patients in the CM group (42.4%) and 60 patients in the matched control group (60.6%) experienced a subsequent ED visit. Through multivariable Cox regression, having a history of substance abuse was associated with a 60% increased risk of a returning ED visit (hazard ratio 1.60 [CI, 1.01 to 2.55]). After adjustment for a history of substance abuse, CM project enrollment was associated with a 69% reduced risk of subsequent ED utilization (hazard ratio 0.31 [CI, 0.15 to 0.62]). Conclusion: In the early evaluation of this intervention, participation in the CM project was associated with a significantly lower risk of experiencing a subsequent ED visit. This suggests that providing primary medical care and social support, over a relatively short period of time, is effective in decreasing ED visits for high utilizers.
155
Preliminary Results of the Survivors of Torture Presenting to an Urban Emergency Department Prevalence Study
Hexom B, Beattie L/Mount Sinai School of Medicine, New York, NY
Study Objectives: It has been reported that 8 –11% of patients presenting to urban primary care clinics have experienced torture. Given potential barriers to health care access, we hypothesize that emergency departments (EDs) may see higher rates of survivors of torture. As our medical center is located in the most ethnically diverse county in the United States, with the highest portion of foreign-born New York City residents, we sought to determine the prevalence of survivors of torture presenting to our urban ED. Methods: A previously validated survey instrument regarding exposure to torture - the Detection of Torture Survivors Survey - was administered by convenience sample to patients presenting to a New York City ED. Additional questions were asked to determine whether individuals’ experiences met internationally accepted definitions of torture. Surveys were verbally administered to patients regardless of ethnicity or complaint and language interpretation was provided if needed. Prisoners, children under 18 years, critically ill, demented, or disoriented patients were excluded. Results: Preliminary results of the first 185 surveys are presented here and enrollment is ongoing. Mean age was 49.21, 48.6% were female, and 79.5% foreign born. 41 countries of origin were represented; most frequently the United States (n⫽38), Columbia (23), Dominican Republic (18), Mexico (12), Bangladesh (11), and Ecuador (11). Mean duration of residence in the United States for foreign-born patients was 19 years. 9.2% of respondents (17) stated that they had been harmed by groups such as the government, police, military, or rebel soldiers. 10.8% (20) stated they or their family had experienced torture (10 self, 5 family, 5 both). 23 were further asked about their experiences including torture by military (7), police (6), family (5), rebel soldiers (3), individuals (1), or groups of individuals (1). 73.9% (17) of these suffered physical harm, 47.8% (11) emotional harm, 8.7% (2) sexual harm, and 21.7% (5) other. Countries of origin for those reporting torture include the U.S. (7), Columbia (5), Dominican Republic (4), and 1 each for Bangladesh, El Salvador, Honduras, Morocco, Nepal, and Tanzania. Reasons for torture included ethnicity/ tribal affiliation (4), political affiliation (3), religion (2), local customs (2), sexual orientation (1), no reason (4), and other (9). 13 of 22 (59%) left home or country as a result of their torture. 5 of 22 (22.7%) have physical disabilities, 6 of 22 (27.3%)
S48 Annals of Emergency Medicine
have recurrent intrusive or distressing memories, 6 of 22 (27.3%) have ever had a physician ask them about their torture and 3 have requested political asylum. Conclusion: Survivors of torture are a distinct cohort of patients presenting to our urban ED and are of diverse background. We found prevalence rates similar to previously reported studies. Patients self-report torture by many groups including abuse by family, governments, military, and police and for varied reasons including no reason at all. Further data collection will help determine significance and whether self-identification of torture is a significant predictor of torture as defined by international standards. Practitioners should consider asking patients about torture.
156
Large Increase in Emergency Department Visits for Head Trauma After Natasha Richardson’s Death
Campo C, Walsh B, Cochrane D, Allegra J/Morristown Memorial Hospital, Morristown, NJ
Study Objective: Actress Natasha Richardson died from a head injury on March 18, 2009. According to some reports, she initially appeared well after sustaining the injury. We hypothesize that the publicity surrounding this tragic event would be associated with an increase in emergency department (ED) visits for evaluation of head trauma. Methods: Design: Retrospective cohort. Setting: Consecutive patients seen by ED physicians in 19 urban, suburban and rural EDs in New Jersey and New York during March 2009. Protocol: We classified patients as having head injury based on ICD9 codes. A priori, we chose to compare the daily visits for head injury for the ten days before and after March 18. We used the Student’s t-test for statistical significance with alpha set at 0.05. Results: Of the 86,791 total ED visits in March, 2009, 2567 (3%) were for head trauma. Of these, females comprised 46%. The median age was 21 years (interquartile range: 7 years to 51 years). There was a 73% (95% confidence interval, 53% to 94%, p ⬍ 0.0001) increase in daily ED visits for head trauma for the 10 days following March 18, 2009 compared to the 10 days before. There was little difference in median age, interquartile age range and sex before and after March 18 for patients presenting to the ED with head injuries. The number of visits for head trauma returned to the pre-March 18 range by March 31. Conclusion: There was a large increase in ED visits for head trauma for a brief period following the death of Natasha Richardson. Media coverage can have a profound influence on ED visits.
157
Patient Perceived Alcohol and Substance Abuse Treatment Needs: An Urban Emergency Department Pilot Study
Scott S, Kassem JN, Nagurka R, Velasco W, Valenzuela R, Grant WD, Lamba S/ The University of Medicine and Dentistry of New Jersey, Newark, NJ; State University of New York Upstate Medical University-University Hospital, Syracuse, NY
Background: Substance abuse (SA) increases the risk of disease, injury, and disability, and this vulnerable population often seeks the emergency department (ED) for their routine health care needs. The ED may represent the only opportunity to connect these patients with adequate referrals to SA rehabilitation facilities. Study Objective: This study is a needs assessment to identify alcohol and SA treatment needs among our ED population with our purpose to further address the patient-perceived barriers. Methods: This pilot study is a convenience sample using a cross-sectional descriptive design to explore the prevalence of alcohol and SA. We used the selfreport survey methodology to assess demographics and patient-perceived barriers. Our study population consisted of consenting adult patients presenting to our urban hospital ED from September ‘08 –February ‘09. Data were analyzed using Microsoft SPSS. Results: We enrolled: 102 patients; 51 male and 51 female; 58% of the respondents were in the age range 30 –53; 57% (58/102) African-Americans; 20% (20/102) Hispanic; 58% (59/101) were high school educated; 72% (72/100) were health insured; 44% (45/101) did not have a primary care provider; 92% (94/102) sought treatment in the ED within the past 1 year; 31% (32/101) identified the ED as their sole health care provider. Sixty-three percent (64/102) of respondents reported depression and 66% (67/102) reported anxiety within the past month. Forty-seven percent (41/88) of respondents reported using drugs for non-medical reasons with 38% (9/24) perceiving a need for drug rehabilitation now. Half (12/24) of those perceiving a need for rehabilitation, used cocaine; 38% (9/24) used heroin;
Volume , . : September
155
Preliminary Results of the Survivors of Torture Presenting to an Urban Emergency Department Prevalence Study
Hexom B, Beattie L/Mount Sinai School of Medicine, New York, NY
Study Objectives: It has been reported that 8 –11% of patients presenting to urban primary care clinics have experienced torture. Given potential barriers to health care access, we hypothesize that emergency departments (EDs) may see higher rates of survivors of torture. As our medical center is located in the most ethnically diverse county in the United States, with the highest portion of foreign-born New York City residents, we sought to determine the prevalence of survivors of torture presenting to our urban ED. Methods: A previously validated survey instrument regarding exposure to torture - the Detection of Torture Survivors Survey - was administered by convenience sample to patients presenting to a New York City ED. Additional questions were asked to determine whether individuals’ experiences met internationally accepted definitions of torture. Surveys were verbally administered to patients regardless of ethnicity or complaint and language interpretation was provided if needed. Prisoners, children under 18 years, critically ill, demented, or disoriented patients were excluded. Results: Preliminary results of the first 185 surveys are presented here and enrollment is ongoing. Mean age was 49.21, 48.6% were female, and 79.5% foreign born. 41 countries of origin were represented; most frequently the United States (n⫽38), Columbia (23), Dominican Republic (18), Mexico (12), Bangladesh (11), and Ecuador (11). Mean duration of residence in the United States for foreign-born patients was 19 years. 9.2% of respondents (17) stated that they had been harmed by groups such as the government, police, military, or rebel soldiers. 10.8% (20) stated they or their family had experienced torture (10 self, 5 family, 5 both). 23 were further asked about their experiences including torture by military (7), police (6), family (5), rebel soldiers (3), individuals (1), or groups of individuals (1). 73.9% (17) of these suffered physical harm, 47.8% (11) emotional harm, 8.7% (2) sexual harm, and 21.7% (5) other. Countries of origin for those reporting torture include the U.S. (7), Columbia (5), Dominican Republic (4), and 1 each for Bangladesh, El Salvador, Honduras, Morocco, Nepal, and Tanzania. Reasons for torture included ethnicity/ tribal affiliation (4), political affiliation (3), religion (2), local customs (2), sexual orientation (1), no reason (4), and other (9). 13 of 22 (59%) left home or country as a result of their torture. 5 of 22 (22.7%) have physical disabilities, 6 of 22 (27.3%)
S48 Annals of Emergency Medicine
have recurrent intrusive or distressing memories, 6 of 22 (27.3%) have ever had a physician ask them about their torture and 3 have requested political asylum. Conclusion: Survivors of torture are a distinct cohort of patients presenting to our urban ED and are of diverse background. We found prevalence rates similar to previously reported studies. Patients self-report torture by many groups including abuse by family, governments, military, and police and for varied reasons including no reason at all. Further data collection will help determine significance and whether self-identification of torture is a significant predictor of torture as defined by international standards. Practitioners should consider asking patients about torture.
156
Large Increase in Emergency Department Visits for Head Trauma After Natasha Richardson’s Death
Campo C, Walsh B, Cochrane D, Allegra J/Morristown Memorial Hospital, Morristown, NJ
Study Objective: Actress Natasha Richardson died from a head injury on March 18, 2009. According to some reports, she initially appeared well after sustaining the injury. We hypothesize that the publicity surrounding this tragic event would be associated with an increase in emergency department (ED) visits for evaluation of head trauma. Methods: Design: Retrospective cohort. Setting: Consecutive patients seen by ED physicians in 19 urban, suburban and rural EDs in New Jersey and New York during March 2009. Protocol: We classified patients as having head injury based on ICD9 codes. A priori, we chose to compare the daily visits for head injury for the ten days before and after March 18. We used the Student’s t-test for statistical significance with alpha set at 0.05. Results: Of the 86,791 total ED visits in March, 2009, 2567 (3%) were for head trauma. Of these, females comprised 46%. The median age was 21 years (interquartile range: 7 years to 51 years). There was a 73% (95% confidence interval, 53% to 94%, p ⬍ 0.0001) increase in daily ED visits for head trauma for the 10 days following March 18, 2009 compared to the 10 days before. There was little difference in median age, interquartile age range and sex before and after March 18 for patients presenting to the ED with head injuries. The number of visits for head trauma returned to the pre-March 18 range by March 31. Conclusion: There was a large increase in ED visits for head trauma for a brief period following the death of Natasha Richardson. Media coverage can have a profound influence on ED visits.
157
Patient Perceived Alcohol and Substance Abuse Treatment Needs: An Urban Emergency Department Pilot Study
Scott S, Kassem JN, Nagurka R, Velasco W, Valenzuela R, Grant WD, Lamba S/ The University of Medicine and Dentistry of New Jersey, Newark, NJ; State University of New York Upstate Medical University-University Hospital, Syracuse, NY
Background: Substance abuse (SA) increases the risk of disease, injury, and disability, and this vulnerable population often seeks the emergency department (ED) for their routine health care needs. The ED may represent the only opportunity to connect these patients with adequate referrals to SA rehabilitation facilities. Study Objective: This study is a needs assessment to identify alcohol and SA treatment needs among our ED population with our purpose to further address the patient-perceived barriers. Methods: This pilot study is a convenience sample using a cross-sectional descriptive design to explore the prevalence of alcohol and SA. We used the selfreport survey methodology to assess demographics and patient-perceived barriers. Our study population consisted of consenting adult patients presenting to our urban hospital ED from September ‘08 –February ‘09. Data were analyzed using Microsoft SPSS. Results: We enrolled: 102 patients; 51 male and 51 female; 58% of the respondents were in the age range 30 –53; 57% (58/102) African-Americans; 20% (20/102) Hispanic; 58% (59/101) were high school educated; 72% (72/100) were health insured; 44% (45/101) did not have a primary care provider; 92% (94/102) sought treatment in the ED within the past 1 year; 31% (32/101) identified the ED as their sole health care provider. Sixty-three percent (64/102) of respondents reported depression and 66% (67/102) reported anxiety within the past month. Forty-seven percent (41/88) of respondents reported using drugs for non-medical reasons with 38% (9/24) perceiving a need for drug rehabilitation now. Half (12/24) of those perceiving a need for rehabilitation, used cocaine; 38% (9/24) used heroin;
Volume , . : September