Overall, ED visits jumped from 5.4 million to 6.1 million over the 5-year period—a 13% increase. While visits for patients with private insurance barely increased, with a 5-year difference of just 1%, visits by Medicaid patients increased by 36%, and visits by uninsured patients rose 25%. Visits by patients with coverage in the "other" category decreased by more than 10%, the authors noted.
Medicaid patients also maintained the highest rate of visits such as hypertension, which are potentially preventable with primary care. Among Medicaid recipients, the average yearly rate of ED visits for these problems was 55 per 1,000, compared with 11 per 1,000 for those with private insurance and nearly 17 per 1,000 for those who were uninsured.These visits showed the same kinds of coverage-dependent increases over the study period: a nearly 7% hike among Medicaid beneficiaries and about 6% among the uninsured, but a decline of nearly 1% among privately insured patients.
Neither Dr Hsia nor her coauthors reported any financial disclosures.
Bicycle helmet use remains low
BY SHARON WORCESTER
At the AAP National Conference
ORLANDO—About 11% of more than 1,200 children involved in bicycle-related accidents in Los Angeles County were wearing a helmet at the time of the accident. Los Angeles County mandates bicycle helmet use.
Of the 1,248 children from Los Angeles County who were included in the retrospective study of all injuries related to pediatric bicycle accidents between 2006 and 2011, 85% were boys. The lowest rates of helmet use were seen in children over age 12, and those of minority background and lower socioeconomic status. More than a third (35%) of white children wore helmets, but the rates were much lower for Asian (7%), black (6%), and Hispanic children (4%), said Dr Veronica Sullins of the Harbor-UCLA Medical Center in Torrance, Calif. Helmets were worn by 15% of children with private insurance, compared with nearly 8% of those with public insurance, Dr Sullins noted.
Emergency surgery was required in 6% of the children, and only 34% returned to their preinjury status. Nine patients died as a result of their injuries; eight of those were not wearing a helmet, Dr Sullins reported at the annual meeting of the American Academy of Pediatrics.
More than 150,000 emergency department visits each year are due to bicycle-related head injuries.
Helmet use has been shown to reduce bicycle-related head injuries by 80%; yet the Centers for Disease Control and Prevention reports that only 15% of adults and 19% of children wear helmets most or all of the time when riding a bicycle. An estimated 33 million children ride bicycles—for a total of 10 billion hours —each year, and nearly 400 children die as a result of bicycle crashes. I
Dr Sullins reported having no relevant financial disclosures.
Choosing Wisely: ACEP issues 5 things to avoid in the ED
By M. ALEXANDER OTTO
At the 2013 ACEP Acientific Assembly
Avoiding CT scans of emergency department patients who have minor head injuries and are at low risk based on validated decision rules was one of five practices recommended by The American College of Emergency Physicians as part of the "Choosing Wisely" campaign.
The mission of "Choosing Wisely" - a multi-year effort of the American Board of Internal Medicine (ABIM) Foundation - is to promote conversations among physicians and patients about using appropriate tests and treatments and avoiding care when harm may outweigh benefit.
Since launching in April 2012, more than 80 national, regional and state medical specialty societies and consumer groups have become "Choosing Wisely" partners. ACEP officially joined the campaign in February of this year. ACEP developed its five recommendations through a multi-step process that included input from members, its board of directors, and an expert panel.
The other four treatments and procedures chosen by ACEP and announced at their annual meeting include:
- Avoid placing indwelling urinary catheters in the ED for either urine output monitoring in stable patients who can urinate on their own, or for patient or staff convenience.
- Do not delay available palliative and hospice care services in ED patients who are likely to benefit, such as those who have chronic or incurable diseases. Early referral can improve both quality and quantity of life.
- Avoid antibiotics and wound cultures in ED patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage and with adequate medical follow-up. Opening and draining the abscess is the appropriate treatment; antibiotics offer no benefit.
- Avoid instituting IV fluids before doing a trial of oral hydration in uncomplicated emergency department cases of mild to moderate dehydration of children. To avoid pain and potential complications, it’s preferable to give these fluids by mouth. I