First EDition: News for and about the practice of Emergency Medicine
CDC updates guidance on protecting health care workers from Ebola; Malpractice reform failed to curb defensive medicine in the ED; New test will speed enterovirus D68 case confirmation from weeks to days; ED visits by young patients trended up in California; Pit bull bites are worse by several measures;Doubling of US heroin deaths spurs call for increased naloxone access; Opioid-poisoning deaths rose fastest in 55- to 64-year-olds.
In addition, the rate of hospital admissions from the ED did not decrease in any of the reform states.
Data regarding the number of malpractice claims during the study period that were specifically related to ED care are not available. But the malpractice reforms in Texas were associated with a 60% reduction in malpractice claims and a 70% reduction in malpractice payments, the investigators noted.
Nevertheless, “we did not find evidence that these reforms decreased practice intensity, as measured by the rate of the use of advanced imaging, by the rate of hospital admission, or in two of three cases, by average charges. Although there was a small [3.6%] reduction in charges in one of the three sites, our results in aggregate suggest that these strongly protective laws caused little if any change in practice intensity among physicians caring for Medicare patients in emergency departments,” Dr Waxman and his associates said (N. Engl. J. Med. 2014 October 16 [doi:10.1056/NEJMsa1313308]).
Many previous studies, including anonymous surveys of ED physicians, have reported that most practice defensive medicine; up to 30% of CT scans and 19% of MRIs were ordered “for defensive purposes” in one study, and as many as 70% of respondents in another study said they often ordered imaging studies or hospital admissions simply to protect themselves.
New test will speed enterovirus D68 case confirmation from weeks to days
By: Lucas Franki
A new lab test for enterovirus D68 is expected to speed up testing and confirmation of cases, according to a press release from the Centers for Disease Control and Prevention.
The new test is a “real-time” reverse transcription polymerase chain reaction and can identify all strains of EV-D68. The previous test could be used to detect almost any enterovirus, but was labor intensive to perform and not conducive to large-scale testing.
Of the 1,200 samples from 45 states sent to the CDC for EV-D68 testing between Aug. 1 to Oct. 10, less than 200 have been tested and about half have tested positive. The CDC now expects to be able to test around 180 samples a day and complete in 7-10 days the testing on samples received since mid-September, The new method will “reduce what would normally take several weeks to get results to a Dr Anne Schuchat few days,” Dr Anne Schuchat, assistant surgeon general and director of the CDC’s National Center for Immunization and Respiratory Diseases, said in the press release.
As with other enteroviruses, the CDC expects new cases of EV-D68 will decrease in the fall, but faster testing will more accurately show trends of the disease and will help to monitor changes in the outbreak as it winds down, according to the CDC press release. lfranki@frontlinemedcom.com
ED visits by young patients trended up in California
By: Mary Ann Moon
Vitals Key clinical point: Children’s and adolescents’ use of emergency departments increased markedly across all payer categories between 2005 and 2010 in California. Major finding: Youths’ use of EDs statewide rose 11% overall, 23% among the uninsured, 15% among the privately insured, and 7% among those covered by Medicaid in the late 2000s. Data source: A retrospective analysis of all 2-3 million annual visits to California EDs by children up to age 18 in 2005-2010. Disclosures: This study was primarily supported by the California HealthCare Foundation, with additional support from the National Center for Advancing Translational Sciences, the National Institutes of Health, the University of California, and the Robert Wood Johnson Foundation. Dr Hsia and her associates reported having no financial disclosures. |
Children’s and adolescents’ use of emergency departments rose markedly in the late 2000s, a sharp contrast from their steady or decreasing rates of ED use throughout the 1990s and early 2000s, according to a Research Letter to the Editor published online Oct. 14 in JAMA.
The recent uptick in pediatric ED visits also contrasts with a notable decline in adult ED use during the same time period. “These findings suggest that the drivers for ED use differ significantly between youths and adults, and that policies regarding insurance expansion” – that is, coverage through the Affordable Care Act – “may also have varying effects,” said Dr Renee Y. Hsia of the department of emergency medicine, University of California, San Francisco, and San Francisco General Hospital, and her associates.
They performed a retrospective analysis using a database recording all ED visits by children and adolescents up to 18 years of age to general hospitals across California 
