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Acute medical diagnoses are common in “found down” adult patients presenting to the emergency department as trauma
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Jun 3 2015
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Source: J Emerg Med. 49(6):992-997.
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Alternative Title:J Emerg Med
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Description:Background
Patients often present to the ED as “found down” with limited history to suggest a primary traumatic or medical etiology.
Objective
The study objective was to describe the characteristics of “found down” adult patients presenting to the ED as trauma, specifically the incidence of acute medical diagnoses and major trauma.
Methods
Using an institutional trauma registry, we reviewed trauma activations with the cause of injury “found down” between January 2008 and December 2012. We excluded patients with cardiac arrest, transfers from other hospitals, and patients with a more than likely (>50%) traumatic or medical etiology on initial ED presentation. Inclusion and exclusion criteria were reviewed by two independent abstractors. We abstracted demographic, clinical, injury severity, and outcomes variables. Major trauma was defined as injury severity score ≥16.
Results
659 patients were identified with the cause of injury “found down.” A total of 207 (32%) patients met inclusion criteria; median age was 67 years old (IQR 50–82 years old) and 110 (48%) were male. Among the included patients, 137 (66%, 95%Cl 59–73%) had a discharge diagnosis of an acute medical condition, 14 (7%, 95% Cl 4–11%) with major trauma alone, 21 (10%, 95%Cl 6–15) with both an acute medical condition and major trauma, and 35 (17%, 95%Cl 12–23%) with minor trauma. The most common acute medical diagnoses were toxicological (56 patients, 35%; 95%Cl 28–43%) and infectious (32 patients, 20%; 95%Cl 14–27%).
Conclusion
Acute medical diagnoses were common in undifferentiated ED patients “found down” in an institutional trauma registry. Clinicians should maintain a broad differential diagnosis in the workup of the undifferentiated “found down” patient.
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Pubmed ID:26048067
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Pubmed Central ID:PMC4656122
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