Abstract：
STUDY OBJECTIVE:Frequent emergency department (ED) users have been the targets of health care reform proposals and hospital crowding interventions, but it is not clear that common assumptions about this group are supported by data. We review the literature pertaining to frequent ED users, their demographics, acuity of illness, and patterns of health care utilization. We seek to inform development of policies directed at frequent ED use and to highlight potential related challenges. METHODS:A systematic review of the literature on frequent ED users was performed. RESULTS:Frequent users comprise 4.5% to 8% of all ED patients but account for 21% to 28% of all visits. Most frequent ED users are white and insured; public insurance is overrepresented. Age is bimodal, with peaks in the group aged 25 to 44 years and older than 65 years. On average, these patients have higher acuity complaints and are at greater risk for hospitalization than occasional ED users. However, the opposite may be true of the highest-frequency ED users. Frequent users are also heavy users of other parts of the health care system. Only a minority of frequent ED users remain in this group long term. Complaints vary with age, location, and usage patterns. CONCLUSION:Frequent ED users are a heterogeneous group along many dimensions and defy popular assumptions. The subgroups have not yet been sufficiently defined to allow clearly directed policy design, and many frequent users present with true medical needs, which may explain why existing attempts to address the phenomena have had mixed success at best.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
LaCalle E,Rabin Edoi
10.1016/j.annemergmed.2010.01.032subject
Has Abstractpub_date
2010-07-01 00:00:00pages
42-8issue
1eissn
0196-0644issn
1097-6760pii
S0196-0644(10)00105-8journal_volume
56pub_type
杂志文章,评审abstract：STUDY OBJECTIVE:Single-payer health care is supported by most Americans, but the effect of single payer on any particular sector of the health care market has not been well explored. We examine the effect of 2 potential single-payer designs, Medicare for All and an alternative including Medicare and Medicaid, on total ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2020.03.003
更新日期：2020-10-01 00:00:00
abstract：STUDY OBJECTIVE:We sought to develop and validate standardized clinical criteria to identify patients presenting to the emergency department whose care may be safely deferred to a later date in a nonemergency setting. METHODS:Using a modified Delphi process, a 17-member multidisciplinary physician panel developed expl...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1067/mem.2000.107003
更新日期：2000-07-01 00:00:00
abstract：:We present the case of a 27-year-old man who sustained a minor head injury and presented with complaints of headache and vomiting. The diagnosis of vertex epidural hematoma is discussed. ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(94)70145-8
更新日期：1994-08-01 00:00:00
abstract：STUDY OBJECTIVE:Methanol poisoning outbreaks are a global public health issue, with delayed treatment causing poor outcomes. Out-of-hospital ethanol administration may improve outcome, but the difficulty of conducting research in outbreaks has meant that its effects have never been assessed. We study the effect of out-...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2016.01.010
更新日期：2016-07-01 00:00:00
abstract：STUDY OBJECTIVE:To evaluate clinical and cellular changes of bone through the rapid growth phase of development after intraosseous infusion of hypertonic or isotonic solutions at slow or fast infusion rates in a pig model. METHODS:This was a prospective, randomized, partially blinded, comparative study using a porcine...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(96)70010-0
更新日期：1996-10-01 00:00:00
abstract：:This clinical policy focuses on critical issues in the evaluation and management of adult patients with seizures. The medical literature was reviewed for articles that pertained to the critical questions posed. Subcommittee members and expert peer reviewers also supplied articles with direct bearing on this policy. Th...
journal_title：Annals of emergency medicine
pub_type： 指南,杂志文章,实务指引
doi：10.1016/S019606440400068X
更新日期：2004-05-01 00:00:00
abstract：STUDY OBJECTIVE:To evaluate the efficacy of IM ketorolac versus that of oral ibuprofen in acute musculoskeletal pain. DESIGN:Randomized, prospective, double-blind clinical trial. SETTING:Urban teaching emergency department with an annual census of 43,000. PARTICIPANTS:Convenience sample of 82 patients aged 18 to 70 ...
journal_title：Annals of emergency medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/s0196-0644(95)70138-9
更新日期：1995-08-01 00:00:00
abstract：:From 1995 to 2000, the National Highway Traffic Safety Administration (NHTSA) sponsored an initiative to create and operate an Automatic Collision Notification (ACN) system on a demonstration basis in a rural area to provide faster and smarter emergency medical responses and in an attempt to save lives and reduce disa...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1067/mem.2001.118454
更新日期：2001-10-01 00:00:00
abstract：:Clinical presentations and pathogeneses of endocarditis and aspects of its diagnosis and management relevant to emergency department practice are reviewed. Guidelines for admission, laboratory evaluation, and decisions regarding the initiation of therapy in the ED are offered. Also discussed are the role of the emerge...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,评审
doi：10.1016/s0196-0644(05)81663-4
更新日期：1991-04-01 00:00:00
abstract：:The traditional use of the throat culture to guide treatment of potential streptococcal pharyngitis recently has been questioned because of the following facts: antibiotic therapy within the first 48 hours of illness reduces the severity and symptoms of streptococcal pharyngitis; more rapid treatment of streptococcal ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(86)80573-x
更新日期：1986-03-01 00:00:00
abstract：STUDY OBJECTIVES:To demonstrate the degree to which pulse oximetry overestimates actual oxyhemoglobin (O2Hb) saturation in patients with carbon monoxide (CO) poisoning. This phenomenon has been reported in fewer than 20 humans in the English medical literature. METHODS:A retrospective chart review of 191 patients eval...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(97)70077-5
更新日期：1997-11-01 00:00:00
abstract：STUDY OBJECTIVES:We assessed the validity and completeness of data in the past medical history (PMH) obtained electronically from parents and examined effects of the human-computer interface and sociodemographic variables on electronic parental report. METHODS:We compared parents' electronic report of PMH data with a ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(00)70052-7
更新日期：2000-04-01 00:00:00
abstract：STUDY OBJECTIVE:We compare the ability of 5 established risk scores to identify patients with suspected acute coronary syndromes who are suitable for discharge after a modified single-presentation high-sensitivity troponin result. METHODS:This was a prospective observational study conducted in a UK district general ho...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2015.07.006
更新日期：2015-12-01 00:00:00
abstract：:Experimental data have suggested that pneumatic external counterpressure improves outcome in intra-abdominal hemorrhage by either a tamponade effect and/or elevation in central systemic blood pressure. As a result, the empiric use of the pneumatic antishock garment (PASG) has become a standard of care, even to the poi...
journal_title：Annals of emergency medicine
pub_type： 临床试验,杂志文章
doi：10.1016/s0196-0644(87)80064-1
更新日期：1987-06-01 00:00:00
abstract：STUDY OBJECTIVE:Physicians often prescribe antibiotics to patients even when there is no clear indication for their use. Previous studies examining antibiotic use in acute bronchitis and upper respiratory infections have been conducted in primary care settings. We evaluate the factors that physicians in the emergency d...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,多中心研究
doi：10.1016/j.annemergmed.2007.03.026
更新日期：2007-09-01 00:00:00
abstract：:A double-blind, randomized study was performed to determine the occurrence of ventricular arrhythmias in acute asthma patients treated with epinephrine, aminophylline, or both in combination. Sixty patients were studied with Holter monitoring during the 90-minute study period. There was no statistical difference among...
journal_title：Annals of emergency medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/s0196-0644(86)80428-0
更新日期：1986-06-01 00:00:00
abstract：:Our study was conducted to determine the appropriate dose of lidocaine using the larynx and to characterize the onset and duration of therapeutic serum levels. A mean dose of 5.67 +/- 1.2 mg/kg was topically administered to the subglottic region of seven comatose patients through a cricothyroid membrane puncture. Seri...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(82)80062-0
更新日期：1982-09-01 00:00:00
abstract：:This review synthesizes the existing literature to provide evidence-based predictions for the future of emergency care in the United States as a result of the Patient Protection and Affordable Care Act, with a focus on emergency department (ED) visit volume, acuity, and reimbursement. Patient behavior will likely be q...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,评审
doi：10.1016/j.annemergmed.2015.04.007
更新日期：2015-11-01 00:00:00
abstract：:Prothrombin complex concentrates are frequently used to rapidly reverse anticoagulation with vitamin K antagonists associated with life-threatening bleeding. We report a patient receiving warfarin who presented to the emergency department with an international normalization ratio greater than 12.8 in cardiac tamponade...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/j.annemergmed.2008.12.027
更新日期：2009-06-01 00:00:00
abstract：:A 31-year-old white man with a core temperature of 60.8 F (16 C) and ventricular fibrillation was successfullly resuscitated using active core and external rewarming techniques. Rectal temperature at the time of reestablished electromechanical cardiac activity was 68 F (20 C), a temperature previously thought to be in...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(80)80339-8
更新日期：1980-02-01 00:00:00
abstract：:To define the usefulness of the lumbar spine x-ray series in the emergency department and to generate clinical criteria for optimizing its application, we retrospectively studied 552 consecutive emergency department patients for whom lumbar spine x-rays were ordered. Patients were divided into traumatic (47.6%) and no...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(83)80378-3
更新日期：1983-02-01 00:00:00
abstract：:Spontaneous rupture of utero-ovarian vessels during pregnancy is a rare cause of maternal and fetal loss. We report the case of a 30-year-old woman who presented to the emergency department in her third trimester with frank maternal shock. The prompt recognition of shock, correction of hypovolemia, and rapid surgical ...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(94)70052-4
更新日期：1994-02-01 00:00:00
abstract：STUDY OBJECTIVE:Efficient management and allocation of scarce medical resources can improve outcomes for victims of mass casualty events. However, the effectiveness of specific strategies has never been systematically reviewed. We analyze published evidence on strategies to optimize the management and allocation of sca...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,评审
doi：10.1016/j.annemergmed.2013.02.005
更新日期：2013-06-01 00:00:00
abstract：STUDY OBJECTIVE:Intravenous metoclopramide is effective as primary therapy for acute migraine, but the optimal dose of this medication is not yet known. The objective of this study is to compare the efficacy and safety of 3 different doses of intravenous metoclopramide for the treatment of acute migraine. METHODS:This...
journal_title：Annals of emergency medicine
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.annemergmed.2010.11.023
更新日期：2011-05-01 00:00:00
abstract：:The physician assistant (PA) has become an integral part of urban health care. The roles chosen are diverse and often meet the particular needs of physicians or hospitals. We have developed a unique program in emergency services that allows for training and development of PAs in two distinctly different hospital setti...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(80)80338-6
更新日期：1980-02-01 00:00:00
abstract：:One hundred forty-one medical schools were surveyed to determine the emergency medicine core content topics and skills being taught in the curricula. Responses were obtained from 96 schools through two mailings and a telephone followup. Most topics surveyed were offered in the vast majority of medical schools (greater...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(86)80478-4
更新日期：1986-01-01 00:00:00
abstract：STUDY OBJECTIVE:Previous studies have suggested that serum markers of smooth muscle destruction have utility in predicting ectopic pregnancy. Our goal was to determine whether a novel marker of muscle destruction, smooth muscle heavy-chain myosin (SMHC), is elevated in the serum of patients with ectopic pregnancy. MET...
journal_title：Annals of emergency medicine
pub_type： 临床试验,杂志文章
doi：10.1067/mem.2000.109104
更新日期：2000-08-01 00:00:00
abstract：STUDY OBJECTIVE:We determine whether children with immediate posttraumatic seizures require hospitalization for observation of possible neurologic complications. METHODS:This was a prospective observational cohort study of children younger than 18 years with blunt head trauma resulting in immediate posttraumatic seizu...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/S0196064403012071
更新日期：2004-06-01 00:00:00
abstract：:To evaluate the heat burden in parked cars, a study was done to measure inside car temperatures in different situations. A large car and a small car were parked in direct sunlight and in shade. In direct sun, the highest temperatures recorded in the small and large cars were 78 C and 65 C, respectively. The highest te...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(82)80097-8
更新日期：1982-05-01 00:00:00
abstract：:Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), is a propionic acid derivative that possesses analgesic and antipyretic properties through inhibition of prostaglandin synthesis. The propionic acids have been considered the least toxic of the NSAIDs, and one, ibuprofen, is currently available as an over-the-co...
journal_title：Annals of emergency medicine
pub_type： 杂志文章
doi：10.1016/s0196-0644(89)80939-4
更新日期：1989-10-01 00:00:00
