The Use of NHAMCS Emergency Department Research. Jim Edwards, BS. Research Associate Department of...

The Use of NHAMCS The Use of NHAMCS

Emergency Department Emergency Department ResearchResearch

Jim Edwards, BS.Jim Edwards, BS.Research AssociateResearch Associate

Department of Emergency MedicineDepartment of Emergency Medicine

University of Illinois

College of Medicine

Chicago, IL

ObjectivesObjectives

• Explain the NHAMCS database

• Implementation of database

• Recent publications

DescriptionDescription

• National Hospital Ambulatory Medical Care Survey

• Collect data on the utilization of services and provision of care in ED

DescriptionDescription•National sample•General and short stay hospitals

•No federal, military, or VA•50 states and D.C.•Began annually in 1992

DescriptionDescription

• Four stage sampling

–Geographically defined areas

–Hospitals within areas (~500)

–ED within hospitals (some > 1)

–Pt visits within ED (~24,000)

DescriptionDescription

• CDC personal train hospital staff on data collection

• Data on Patient Record Form during random 4 week recording period

Patient Record FormPatient Record Form

Data

DescriptionDescription

•Demographics

• Payment

•Complaints

•Diagnoses

• Imagining, labs, procedures

Data

DescriptionDescription•Meds

•Providers

•Reason for injury

•Wait time

Data

DescriptionDescription

•Pain

•Disposition

•Place of injury

•Hospital characteristics

• Initial V/S in 2002

CodingCoding

DescriptionDescription

• A Reason for Visit Classification (NCHS)

• ICD-9-CM

• Drug coding classification system (NCHS)

• National Drug Code Directory

SPSSSPSS

• Statistical program

• User friendly

• Handles more cases than Excel

SPSSSPSS

• Download data file

• Download documentation

• Merge files if needed

Joseph and Ward: New-Onset AF Joseph and Ward: New-Onset AF ResultsResults

• Conversion rate after 48 hrs– Sotalol 88%– Amiodarone 77%– Digoxin 58%– P < 0.05 when sotalol compared to digoxin

• Time to conversion SR– Sotalol 13.0 2.5– Amiodarone 18.1 2.9– Digoxin 26.9 3.4– P < 0.05 when sotalol and amiodarone compared to

digoxin

SPSSSPSS

• Imputed variables–Diagnosis

–Reason for visit

–Drugs

–Age ranges

SPSSSPSS

• Dummy variables–One or none

–Allows calculation of 2x2 tablesIV Narc

(1)No IV Narc

(0)

Admit

(1)

75

75%

5

5%

Discharged

(0)

5

5%

15

15%

Patient DemographicsPatient Demographics

CalculationsCalculations  N ( %)

Sex

Male 264 (65)

Female 143 (35)

Age, y  

Mean 41.5 ± 15.3

Median 40.0

<18 12 ( 3)

18-64 359 (88)

>65 36 ( 9)

Ethnicity  

White 356 (88)

Black 38 ( 9)

Other 13 ( 3)

Patient DemographicsPatient Demographics

CalculationsCalculationsPain Level at Presentation  

None 7 ( 2)

Mild 49 (12)

Moderate 102 (25)

Severe 102 (25)

Unknown 147 (36)

Mode of Arrival  

Walk-in 348 (86)

Ambulance 36 ( 9)

Unknown 23 ( 6)

Patient DemographicsPatient Demographics

CalculationsCalculationsDiagnosis (n = 443)  

Renal colic (788.0) 155 (35)

Calculus of the kidney (592.0) 188 (42)

Calculus of the ureter (592.1) 78 (18)

Unspecified urinary calculus (592.9) 6 ( 4)

Hydronephrosis (591.0) 6 ( 1)

Disposition  

Admitted 59 (15)

ProceduresProcedures

CalculationsCalculations  N ( %)

Diagnostic study 400 (98)

Other x-ray 132 (32)

CT 89 (22)

US 20 ( 5)

U/A 319 (78)

CBC 225 (55)

Procedure  

Pain medication 346 (85)

IV fluids 251 (62)

Foley 12 ( 3)

MedicationsMedications

CalculationsCalculationsMedication Class N ( %)

Narcotic 277 (68)

Nonnarcotic 216 (53)

NSAID 191 (47)

Other nonnarcotic 25 ( 6)

Antiemetic 140 (34)

Narcotic and NSAID 139 (34)

Narcotic and other nonnarcotic 10 ( 2)

Narcotic and antiemetic 124 (31)

Nonnarcotic and antiemetic 80 ( 0)

MedicationsMedications

CalculationsCalculationsAgent N ( %)

Parenteral Agents  

Narcotics  

Meperidine 84 (21)

Morphine sulfate 59 (15)

Hydromorphone 37 ( 9)

Meperidine/Promethazine 11 ( 3)

Buprenorphine 6 ( 2)

Botorphanol tartrate 4 ( 1)

NSAIDs  

Ketorolac 190 (47)

Anti-emetics  

Promethazine 88 (22)

Prochlorperazine 32 ( 8)

Droperidol 11 ( 3)

Hydroxyzine 7 ( 2)

Metaclopramide 4 ( 1)

Odds Ratio/Pain MedicationOdds Ratio/Pain Medication

CalculationsCalculations  N (%) OR 95% CI p-value

Ethnicity        

White 306 (86) 1.7 0.76-3.68 0.23

Non-white 40 (79)      

Age        

<65 318 (86) 1.7 0.68-4.20 0.30

>65 53 (78)      

Pain Severity        

Severe 97 (95) 4.0 1.40-12.31 0.01

Moderate, mild, or none 131 (83)      

Severe or moderate 185 (91) 2.9 1.26-6.85 0.01

Mild or none 43 (77)      

Logistic Regression/Pain MedicationLogistic Regression/Pain Medication

CalculationsCalculations    OR 95% CI p-value

Ethnicity        

White   1.2 0.57-2.39 0.69

Age        

<65   2.5 0.78-8.14 0.12

Pain Severity        

Severe   2.6 0.88-7.81 0.08

Severe or moderate   2.2 0.91-5.29 0.08

AdvantagesAdvantages• No data collection needed

• IRB exemption

• Large number of cases

• Free

• Large sample

DisadvantagesDisadvantages

• Lack of information–Drug doses, route, meds before ED

–No pain relief measures

–No VS

–No lab or radiology results

Conclusions Conclusions • No data collection

• Can get lost in the database

• Having and knowing ALL the documentation is key

ConclusionsConclusions

• Lack of information

• Next year vital signs

Contact InformationContact Information

• Jim Edwards–Jedwar10@uic.edu

–Pager 9714