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Increased Odds of Leaving ED Before Medically Advised Tied to COVID-19 Pandemic

In the United States, the COVID-19 pandemic was associated with increased odds of leaving the emergency department before medically advised (BMA), according to a study published in the April issue of the American Journal of Emergency Medicine.

Yahya Alnashri, M.D., M.P.H., from Prince Sattam bin Abdulaziz University in Al-Kharj, Saudi Arabia, and colleagues conducted a cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey from 2016 to 2021 to examine factors associated with leaving BMA from emergency departments.

Overall, 5.9 million (0.8 percent) of 721.0 million emergency department visits resulted in leaving BMA. The researchers found that the odds of leaving BMA were increased in association with public or no insurance coverage (Medicare, Medicaid/CHIP/state-based, uninsured/self-pay: adjusted odds ratios, 1.74, 1.86, and 1.51, respectively), alcohol or substance use disorders (adjusted odds ratio, 2.19), arrival by ambulance (adjusted odds ratio, 1.68), and being male (adjusted odds ratio, 1.32). Lower odds of leaving BMA were seen in association with hospital admissions and trauma or overdose-related visits (adjusted odds ratios, 0.11 and 0.54, respectively). Significantly increased odds of leaving BMA were seen in association with the COVID-19 pandemic (adjusted odds ratio, 1.44), with an overall increase of 53.6 percent in BMA-related emergency department visits post-March 2020 versus previous years.

"These findings highlight the need for targeted interventions to improve patient-provider communication and ED triage efficiency, especially in resource-constrained facilities serving lower-income individuals," the authors write.

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Minority Children Less Likely to Be Diagnosed With Migraine in Emergency Department

Compared with non-Hispanic White (NHW) children, non-Hispanic Black (NHB) and Hispanic/Latino (HL) children with a headache diagnosis in the emergency department have lower rates of migraine diagnosis, undergo less testing, and receive less intensive treatment, according to a study published online Feb. 5 in Neurology.

Danielle Kellier, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues examined racial and ethnic disparities in the diagnosis, testing, and treatment of pediatric patients (age 5 to 21 years) presenting to the emergency department with headache in a cross-sectional study of visits from 49 children's hospitals between 2016 and 2022.

Of the 160,466 eligible visits, 41.0, 24.8, and 26.0 percent were by NHW, NHB, and HL children, respectively. The researchers found that NHW children were more often diagnosed with migraine compared with NHB and HL children (45.5 percent versus 28.2 and 28.3 percent, respectively). Compared with NHW children, NHB and HL children received less testing, including brain magnetic resonance imaging scans (adjusted odds ratios, 0.56 and 0.54, respectively). The proportion of visits without administration of headache-related medications did not differ between the groups (23.3, 24.6, and 23.4 percent for NHW, NHB, and HLs, respectively). Compared with NHWs, NHB and HL children were more likely to receive only oral medications (adjusted odds ratios, 1.37 and 1.54, respectively) and less likely to be admitted as inpatients (adjusted odds ratios, 0.80 and 0.65, respectively).

"Further research is necessary both to understand how disparities in headache management affect outcomes and to develop interventions to reduce inequity in the management of headache, one of the most common concerns seen in the pediatric emergency department," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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New Bird Flu Strain Detected in the U.S.

A new strain of bird flu, H5N9, has been detected for the first time in the United States, raising concerns about how it continues to spread.

The strain was discovered at a commercial duck farm in California's Merced County, and was reported to the World Organization for Animal Health, which maintains a database of animal disease threats.

The detection comes as the nation continues to battle a growing outbreak of another, more common bird flu strain, H5N1, which is rapidly spreading across poultry farms and infected dairy cows.

While H5N9 is not currently considered a serious threat to humans, experts warn that more mutations could increase the risk of bird flu spreading to people in the future.

Scientists are particularly concerned about a process called "reassortment," The Washington Post reported, where different flu strains mix in infected animals, creating new versions of the virus.

The U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (APHIS) confirmed that the H5N9 strain detected in California is the result of reassortment involving H5N1, the strain that's already spreading rapidly in the U.S.

“It does suggest there’s enough virus around that reassortment might become more frequent,” Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada, told The Post. “With enough H5 in these animals and enough seasonal flu in humans, you get them together, and you have a recipe for a potential pandemic virus.”

Past bird flu outbreaks have started due to reassortment, making ongoing monitoring critical.

In late November, both H5N1 and H5N9 cases were discovered in a Merced County commercial duck meat farm, which led to the quarantine of the facility and the culling of more than 100,000 birds.

Genetic sequencing confirmed the presence of H5N9 in January, triggering a formal report to health authorities.

According to The Post, Steve Lyle, director of public affairs for the California Department of Food and Agriculture, said no further action is being taken because the flock has already been euthanized. The farm will undergo cleaning and testing before resuming operations.

While H5N9 is not new, with similar strains detected in other countries, its outbreak in the U.S. highlights ongoing risks posed by the bird flu.

“The fact that these [agricultural] operations are having to cull their flocks is costly. We see that when we look at the cost of eggs in the store,” Jennifer Nuzzo, director of the Pandemic Center at Brown University, told The Post. “The fact that cows can continue to get infected is ultimately going to prove costly.”

More information

The U.S. Centers for Disease Control and Prevention has more on the current situation of bird flu.

SOURCE: The Washington Post, media report, Jan. 28, 2025

Postdischarge Contacts Do Not Reduce 30-Day ED Visits, Readmissions

Postdischarge contacts (PDCs) with patients after hospitalization are not associated with reductions in 30-day emergency department use or 30-day readmissions, according to a systematic review and meta-analysis published online Jan. 14 in the Annals of Internal Medicine.

Joel C. Boggan, M.D., M.P.H., from the Durham Veterans Affairs Health Care System in North Carolina, and colleagues examined the effects of PDCs within seven days on 30-day emergency department visits, 30-day hospital readmissions, and patient satisfaction in a review of 13 studies (11 randomized trials).

Twelve of the studies delivered PDCs via telephone. Of the 11 randomized trials, three and one were rated as having low and high risk for bias, respectively. The researchers found that of the PDC interventions, most (10 PDCs) consisted of single telephone contacts, often within three days. Eight of the studies focused on patients who were identified by the authors as being at higher risk. No differences were seen in 30-day emergency department use or 30-day readmissions with PDCs.

"Although our review did not find evidence of significant effects of brief PDC approaches, health care systems should consider the cost-effectiveness of these relatively light-touch approaches on such costly outcomes as hospital readmissions," the authors write. "Such considerations of widespread universal brief PDCs should be balanced with the potential to target investments in more intensive postdischarge approaches focused on patients most likely to benefit from these interventions."

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Admission Rates Vary Greatly by Emergency Department Physicians

Emergency department physicians show wide variability in their admission propensity, despite seeing patients with similar prior health status, according to a study published online Dec. 23 in JAMA Internal Medicine.

Stephen Coussens, Ph.D., and Dan P. Ly, M.D., Ph.D., from the David Geffen School of Medicine at UCLA in Los Angeles, examined whether variation in emergency department physicians' admission propensities was associated with patients' subsequent mortality rates for visits involving chest pain, shortness of breath, and abdominal pain. The analysis included nationwide Veterans Affairs electronic health record data (2011 through 2019) for 2,098 physicians treating 2.1 million patient visits across 105 emergency departments.

The researchers found that physicians' adjusted admission rates varied greatly within the same emergency department (chest pain: 90th percentile of physicians, 56.6 percent admitted versus 10th percentile, 32.6 percent admitted), although there were no associations between these adjusted admission rates and patients' prior health status as measured by their Elixhauser Comorbidity Index score before the emergency visit. Patients admitted by physicians with higher admission rates were more likely to be discharged within 24 hours (31.0 versus 24.8 percent). However, mortality rates for patients did not differ between physicians with higher admission rates and those with lower admission rates.

"Future research that explores how such variation arises and the extent to which it is amenable to safe intervention may prove beneficial to patients, clinicians, and health care systems," the authors write.

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Rules-Based Electronic Triggers Effectively ID Missed Opportunities in Diagnosis

Rules-based electronic triggers (e-triggers) are useful for post hoc detection of missed opportunities in diagnosis (MODs) in emergency department visits, according to a study published online Dec. 2 in JAMA Internal Medicine.

Viralkumar Vaghani, M.B.B.S., from the Baylor College of Medicine in Houston, and colleagues assessed the performance of a portfolio of e-triggers for identifying MODs in emergency departments. The analysis included treat-and-release emergency department visits at 1,321 Veterans Affairs health care sites.

The researchers found that 203 trigger-positive records were identified for high-risk stroke, 1,981 for symptom-disease dyads, 170 for high-risk abdominal pain, 116,785 for unexpected emergency department return, 14,879 for unexpected hospital return, and 2,090 for abnormal test results not followed up. From 625 randomly selected patient records, 47 MODs (positive predictive values [PPV], 47.0 percent) were identified for stroke, 31 MODs (PPV, 25.8 percent) for abdominal pain, 11 MODs (PPV, 11.0 percent) for emergency department returns, 23 MODs (PPV, 23.0 percent) for hospital returns, 18 MODs (PPV, 18.0 percent) for symptom-disease dyads, and 55 MODs (PPV, 52.4 percent) for test results. The most common diagnostic process breakdown involved the patient-clinician encounter for 108 of 130 MODs (excluding MODs related to the test result e-trigger). For 20 of 185 total MODs, patients experienced severe harm (10.8 percent), and 54 patients experienced moderate harm (29.2 percent).

"Interventions to target emergency department work system factors are urgently needed to support patient-clinician encounters and minimize harm from diagnostic errors," the authors write.

One author disclosed ties to the health information technology industry.

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Studies Examine Cost-Effectiveness of Maternal RSV Vaccination, Nirsevimab in Infants

Seasonal maternal respiratory syncytial virus (RSV) vaccination and nirsevimab for infants demonstrate cost-effectiveness, according to two studies published online Nov. 25 in Pediatrics.

David W. Hutton, Ph.D., from the University of Michigan in Ann Arbor, and colleagues simulated RSV infection and disease with and without seasonal RSVpreF vaccination in half of pregnant women in the annual U.S. birth cohort. The researchers found that 45,693 outpatient visits, 15,866 emergency department visits, and 7,571 hospitalizations among infants would be prevented each year by year-round maternal vaccination. The societal incremental cost of vaccination was $396,280 per quality-adjusted life-year (QALY) saved and decreased to $163,513 per QALY saved with vaccination from September through January. Outcomes ranged from cost-saving to $800,000 per QALY saved with changes to the most influential inputs.

In a second study, Hutton and colleagues simulated health care utilization and deaths from RSV with and without nirsevimab among infants aged 0 to 7 months and aged 8 to 19 months during a single RSV season. The researchers estimated that if half of the U.S. birth cohort received nirsevimab, 107,253 outpatient visits, 38,204 emergency department visits, and 14,341 hospitalizations could be averted each year, which would cost $153,517 per QALY saved. For children facing a 10-fold higher risk for hospitalization, nirsevimab in the second season would cost $308,468 per QALY saved. The cost-effectiveness ratios would be between cost-saving and $323,788 per QALY saved.

"The high costs associated with these products will require those administering these vaccines, such as pediatricians, family physicians, hospitals, and health systems, to be meticulous in their ordering, inventory, and billing management practices to make them feasible to deliver in real-world settings," Sean T. O'Leary, M.D., M.P.H., from the University of Colorado School of Medicine/Children's Hospital Colorado in Aurora, writes in an accompanying editorial. "If these immunizations can be successfully delivered broadly, we will then see the dramatic reductions in the burden from this highly morbid pathogen that these products offer."

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Editorial

Woman Receives World's First Robotic Double-Lung Transplant

A 57-year-old woman with COPD has received the world's first fully robotic double lung transplant.

The breakthrough surgery was performed in October at NYU Langone Health in New York City by Dr. Stephanie Chang. Just a month before, Chang performed a fully robotic single lung transplant — the nation's first.

"This latest innovation is a watershed moment in lung transplantation surgery worldwide and just the beginning of a new era in patient care," said Dr. Ralph Mosca, chair of cardiothoracic surgery at NYU Grossman School of Medicine, in New York City.

Chang and her team use a da Vinci Xi robot to perform the minimally invasive transplants.

They make small incisions between the ribs, then use the robot to remove and replace the damaged lungs.

The groundbreaking double transplant was performed on Oct. 22, four days after patient Cheryl Mehrkar was added to the transplant list after months of careful evaluation.

"For a long time, I was told I wasn't sick enough for a transplant," she recalled in an NYU news release.

"I'm so grateful to the donor and their family for giving me another chance at life," Mehrkar added. "And I'm so grateful to the doctors and nurses here for giving me hope."

Mehrkar, a volunteer emergency medical technician with the Union Vale Fire Department in Dutchess County, N.Y., inherited a genetic risk for lung disease.

She was 43 when she was diagnosed with COPD in 2010. A bout with COVID-19 in 2022 made her COPD worse.

Until her health relegated her to the sidelines, Mehrkar traveled the world as a scuba divemaster and, with her husband, Shahin, earned a black belt in karate. For many years, they owned a dojo, where she taught martial arts.

Mehrkar said she looks forward to being more active once again and praised her transplant team for making her quality of life a priority.

Surgical director of the lung transplant program at NYU Langone Transplant Institute, Chang was assisted in performing the double transplant by Dr. Travis Geraci and Dr. Eugene Grossi.

"It is one of the greatest privileges to be able to help patients return to a healthy quality of life," Chang said. "By using these robotic systems, we aim to reduce the impact this major surgery has on patients, limit their postoperative pain and give them the best possible outcome."

More information

Johns Hopkins Medicine has more about lung transplantation.

SOURCE: NYU Langone Health/NYU Grossman School of Medicine, news release, Nov. 21, 2024

High Rates of Hep C Seen for Patients Presenting to ED With Opioid Overdose

Patients presenting to emergency departments with opioid overdose have high rates of hepatitis C virus (HCV) infection, according to a study recently published in Cureus.

John A. Swift and Julie Stilley, Ph.D., from the University of Missouri School of Medicine in Columbia, conducted a retrospective cohort study to examine the prevalence of and testing history of HIV and HCV among opioid overdose patients from three emergency departments. One hundred thirty-four encounters for 120 patients were included in the study.

Forty-eight of the patients had a history of HCV testing and 54 had a history of HIV testing. The researchers found that 20 patients tested positive for HCV antibodies and one tested positive for HIV. Eight, six, and six patients had detectable HCV viral loads, undetectable HCV viral loads, and no quantitative testing, respectively. One patient had a detectable HIV viral load. Overall, 16.7 percent of both men and women had a history of a positive HCV test; compared with men, women were more likely to have ever received an HCV test (odds ratio, 2.68). Patients aged 55 to 64 years were more likely to test positive and were least likely to be untested compared with other age groups (odds ratios, 3.889 and 0.190, respectively).

"There may be potential benefits in the implementation of universal opt-out testing for HCV for patients being held for observation following an opioid overdose," the authors write.

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Abortion Rights Measures Pass in 7 States, Fail in 3

In election results that showed protecting women's reproductive freedoms matter to a majority of Americans, abortion rights measures passed in seven states and failed in three.

Missouri, Arizona, Nevada, Colorado, New York, Maryland and Montana all backed those rights, while such amendments were defeated in Florida, Nebraska and South Dakota, leaving those state bans intact.

Voters in Missouri cleared the way to undo one of the nation’s most restrictive abortion bans, while Nevada voters also approved a similar measure. However, the Nevada measure will have to be passed again in 2026 for it to take effect, the Associated Press reported.

“Today, Missourians made history and sent a clear message: decisions around pregnancy, including abortion, birth control and miscarriage care are personal and private and should be left up to patients and their families, not politicians,” Rachel Sweet, campaign manager of Missourians for Constitutional Freedom, told the AP.

The abortion landscape changed dramatically in the summer of 2022, when the U.S. Supreme Court overturned the landmark Roe v. Wade decision. That 2022 ruling erased a nationwide right to abortion and cleared the way for state bans to take effect.

Missouri becomes the first state where a vote will undo a ban that’s already in place. Currently, abortion is barred at all stages of pregnancy, except when a medical emergency puts a woman’s life at risk.

Meanwhile, Florida became the first state since Roe v. Wade was overturned where abortion opponents won on a ballot measure. While most voters supported an amendment to make abortion a constitutional right, it fell short of the required 60% for passage. Unlike Florida, most states only require a simple majority for constitutional amendments.

Marjorie Dannenfelser, president of the national anti-abortion group SBA Pro-Life America, said in a statement that the result is “a momentous victory for life in Florida and for our entire country.”

The defeat makes permanent the removal of Florida as a destination for abortion for women from nearby Southern states with tough bans. The nearest states with looser restrictions are North Carolina and Virginia, the AP reported.

“The reality is, because of Florida’s constitution, a minority of Florida voters have decided Amendment 4 will not be adopted,” Lauren Brenzel, campaign director for the Yes on 4 Campaign, told the AP.

Still, other states guaranteed abortion rights.

Arizona’s amendment will replace a law that bans abortion after the first 15 weeks of pregnancy. The new measure guarantees the right to an abortion until viability, the AP reported.

In Maryland, the abortion rights amendment won’t make an immediate difference to abortion access because the state already allows it.

Meanwhile, the Colorado measure exceeded the 55% of support required to pass. Besides enshrining access, it also undoes an earlier amendment that barred using state and local government funding for abortion.

And in New York, an equal rights law that will bolster abortion rights also passed. It bans discrimination on the basis of “pregnancy outcomes, and reproductive health care and autonomy,” the AP reported.

At this point, 13 states are enforcing bans at all stages of pregnancy, with some exceptions, the AP reported. Four more bar abortion in most cases after about six weeks of pregnancy -- a time period before most women realize they’re pregnant.

Despite state bans on abortion, a recent report found the number of monthly abortions in the United States has risen slightly, mostly because of the growing use of abortion pills and organized efforts to help women travel for abortion.

More information

The National Library of Medicine has more on abortion.

SOURCE: Associated Press

Boarding Admitted Stroke Patients in Emergency Department Financially Costly

Boarding admitted patients in the emergency department for acute stroke is financially costly, according to a study published online in the October issue of the Annals of Emergency Medicine.

Maureen M. Canellas, M.D., from the University of Massachusetts T.H. Chan School of Medicine in Worcester, and colleagues conducted a prospective observational investigation of patients admitted through an emergency department for management of acute stroke. The cost of patient care activities was estimated during admission, and results were aggregated to estimate the total cost of boarding versus inpatient care.

The researchers found that per patient with acute stroke, the total daily cost was $1,856 and $993 for medical/surgical boarding and inpatient care, respectively, and $2,267 versus $2,165 for intensive care unit (ICU) boarding versus inpatient care. When accounting for costs associated with traveler nurses, these differences were even greater. Emergency department and inpatient nurses spent 293 and 313 minutes/day, respectively, for each medical/surgical boarder and inpatient, and 419 and 787 minutes/day for each ICU boarder and inpatient, respectively. For each medical/surgery boarder versus inpatient, neurology attendings and residents spent 25 and 52 minutes/day versus 62 and 90 minutes/day, respectively.

"Our investigation provides evidence that boarding admitted patients in emergency departments, in addition to known negative quality and safety implications, is financially costly, providing added incentive and urgency for the elimination of boarding," the authors write.

One author disclosed receiving compensation for adjudication of stroke outcomes in the Women's Health Initiative.

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Study Characterizes Pediatric Patients Self-Presenting With Major Trauma

Pediatric patients self-presenting with injuries consistent with major trauma typically have external signs of injury, notably boggy swelling to the head, abdominal bruising, and thigh swelling, according to a study presented at the European Emergency Medicine Congress, held from Oct. 13 to 16 in Copenhagen, Denmark.

Robert Hirst, from Bristol Royal Infirmary in the United Kingdom, and colleagues reported outcomes for pediatric patients presenting with injuries consistent with major trauma between Aug. 5, 2020, and May 6, 2022.

Through the study period, 153 major trauma patients presented to the emergency department, with 24 self-presenting who were eligible for inclusion. The researchers found that the mean patient age was 6.22 years, and 75 percent were male. The mean time to be seen was 58.5 minutes; none of the patients received trauma team activation. The mechanism of injury was mainly falls, sporting injuries, bicycle injuries, and being dropped (50, 25, 8.3, and 4.2 percent, respectively); 12.5 percent of injuries (three patients) were unexplained. Most injuries (95.8 percent) involved a single body region, mainly head injuries (54.2 percent); 33.3 and 12.5 percent were extremity injuries and intra-abdominal injuries, respectively. The median Abbreviated Injury Scale was 3, and median Injury Severity Score was 9. Six children scored >15, classified as major trauma. Most of the patients (91.6 percent) had obvious external signs of injury, notably boggy swelling to head, abdominal bruising, or thigh swelling/deformity; most had relatively unremarkable clinical observations.

"Adoption of simple triage alerts for the three key features identified to prompt immediate senior clinician review might improve management of this group by triggering appropriate trauma team allocation and appropriate allocation of resources for this high-risk population," the authors write.

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Walking Pneumonia Cases Spike Among Young Kids

Walking pneumonia cases are surging among young children in the United States, federal health officials warn.

"Bacterial infections caused by Mycoplasma pneumoniae increased in the United States since late spring and have remained high," a statement issued Friday by the U.S. Centers for Disease Control and Prevention noted. "The proportion of patients discharged from emergency departments with a diagnosis of M. pneumoniae-associated pneumonia or acute bronchitis has been increasing over the past six months, peaking in late August."

The worst rates of the illness have been seen in young children ages 2 to 4, according to the agency.

"The increase in children ages 2–4 years is notable because M. pneumoniae historically hasn't been recognized as a leading cause of pneumonia in this age group," the CDC added.

Close to 7% of emergency room visits with pneumonia in this age group were diagnosed with the bacteria through late September. This has "dropped slightly" from a peak of more than 10% in August, the CDC said.

An agency spokesperson told CBS News that levels are the worst right now in the middle of the country, from Texas through Iowa.

But other states are starting to report surges in walking pneumonia cases.

Wisconsin's health department said Friday that it had received reports of increasing "unusual pneumonia cases" in kids and young adults from doctors around the state.

"The Wisconsin Department of Health Services [DHS] has received multiple notices from clinicians statewide regarding an increased incidence of unusual pneumonia cases among school-aged children and young adults," state health officials said. "These cases are suspected to be infections caused by the bacteria M. pneumoniae."

Meanwhile, health officials in Illinois announced Thursday that they had tracked "several clusters reported in schools throughout the state," alongside increases seen in data from testing labs.

"M. pneumoniae is exclusively a human pathogen, which primarily causes respiratory infections. Infections can occur in the upper and lower respiratory tract. Common manifestations include pharyngitis, pneumonia, and tracheobronchitis," Illinois health officials said. "The bacteria can also cause a wide array of extra-pulmonary manifestations often without obvious respiratory disease. These include neurologic, cardiac, hematologic, rheumatologic and skin complications. Notably, approximately 10% of children with M. pneumoniae infection exhibit a rash."

The number of rhinovirus and enterovirus cases reported to the CDC have also surged in recent weeks, nearing peaks seen during previous fall waves of the diseases.

"It's likely to worsen with pollen and mold counts rising, colder weather keeping everyone inside and the holidays bringing people together," Virginia-based health system VCU Health said last week. In the central part of that state, pediatric pneumonia cases requiring hospitalization are up 30%.

Dr. Marian Michaels, a professor of pediatrics and surgery at Children's Hospital of Pittsburgh, told CBS News that it was "too early to tell for sure" if this year's wave would amount to an unusual increase in hospitalized patients.

Michaels was the co-author of a report published earlier this year by the CDC which found kids sickened with the bacteria increased last year but remained lower than before the pandemic.

"The numbers are perhaps increasing a bit, but are still below the pre-pandemic levels for now," Michaels noted.

More information

Yale Medicine has more on walking pneumonia.

SOURCE: U.S. Centers for Disease Control and Prevention, news release, Oct. 18, 2024; CBS News

Biden Proposes That Insurers Cover Over-the-Counter Birth Control

Health insurers would be required to cover the cost of over-the-counter birth control and emergency contraception under new rules proposed by the White House on Monday.

"Since Roe v. Wade was overturned more than two years ago, Republican elected officials have made clear they want to ban or restrict birth control, defund federal programs that help women access contraception, and repeal the Affordable Care Act," President Joe Biden said in a statement on the proposed rules. "And Congressional Republicans have repeatedly blocked federal legislation to safeguard the fundamental right to birth control for women in every state. It’s unacceptable."

"Today, my Administration is taking a major step to expand contraception coverage under the Affordable Care Act. This new action would help ensure that millions of women with private health insurance can access the no-cost contraception they need," he added.

The proposal would include emergency contraception, a newly approved nonprescription birth control pill, spermicides and condoms, and the change would affect 52 million American women of reproductive age who rely on private health insurance.

To help guarantee that women know of this new benefit, most private health plans would be required to disclose that over-the-counter contraception is covered without copayments, the White House noted.

"Today, our Administration is proposing the largest expansion of contraception coverage in more than a decade. This new proposed rule will build on our Administration’s work to protect reproductive freedom by providing millions of women with more options for the affordable contraception they need and deserve," Vice President Kamala Harris said in a statement on the proposal. "That includes coverage for no-cost over-the-counter contraception without a prescription for the first time in our nation’s history."

If finalized, the proposed rules would represent “the most significant expansion of contraception benefits” in more than a decade, Jennifer Klein, director of the White House Gender Policy Council, told the New York Times.

The Affordable Care Act already requires that most private health plans cover contraception without copayments, but that only applies to prescription birth control pills. But last year, the U.S. Food and Drug Administration approved the first over-the-counter birth control pill, called Opill.

The proposed rules will undergo a 60-day comment period before being enacted.

More information

The National Library of Medicine has more on birth control.

SOURCES: White House, news release, Oct. 21,2024; New York Times

Geographic Position Influences Climate Change Risk Perception of Emergency Medical Services

The perception of risk related to climate change among emergency medical societies differs according to geographical position, and few have implemented assessment and preparedness measures for climate change threats, according to a study published online Oct. 13 in the European Journal of Emergency Medicine to coincide with the European Emergency Medicine Congress, held from Oct. 13 to 16 in Copenhagen, Denmark.

Roberta Petrino, M.D., from Ente Ospedaliero Cantonale in Lugano, Switzerland, and colleagues examined the awareness, preparedness, and mitigation plans for climate change threats in a cross-sectional study targeting emergency medical societies in different countries. The survey included 16 closed questions relating to climate change awareness, preparedness, and risks.

Forty-two focus groups responded, representing 36 countries. The researchers found that the mean estimated impact of climate change on national health systems was 6.75, with a mode of 7, while the mean estimated impact on emergency medical systems was 6.96. Only 21.4 and 37.6 percent of respondents reported assessment and preparedness measures, respectively. The only significant difference in the analysis by income was food supply. In analysis by region, the main differences were the risks of extreme weather events, vector-borne disease, and wildfires; food and chain of supplies were the main difference in the analysis by World Risk Index. Education and integration of health services were the main mitigation actions indicated by all respondents.

"All respondents advocated educational programs and strategic plans to face challenges associated with climate change, with the conviction that emergency medicine may play an important role in addressing and mitigating potential health crises," the authors write.

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Single-Substance Exposures Causing Seizures Increased in U.S. Children, 2009 to 2023

Seizures associated with pediatric single-substance exposures are steadily increasing, according to a study presented at the European Emergency Medicine Congress, held from Oct. 12 to 16 in Copenhagen, Denmark.

Rita Farah, Ph.D., from the University of Virginia in Charlottesville, and colleagues assessed characteristics of 30,985 pediatric single-substance exposures that resulted in seizures in patients younger than 20 years using data reported to the U.S. National Poison Data System (2009 through 2023).

The researchers found that the number of exposures with seizures increased from 1,418 cases in 2009 to 2,749 cases in 2023, with an average of a 5 percent yearly increase. The number of exposures with seizure doubled during the study period in patients aged 6 to 12 years and 13 to 19 years, with a 6 percent yearly increase.

The increase in exposures with seizures was in part driven by diphenhydramine-related exposures, which increased from 85 cases in 2009 to 404 cases in 2023. Bupropion-related exposures increased from 162 in 2013 to 431 in 2023. The two most frequently reported substance exposures with seizure between 2009 and 2012 were tramadol and diphenhydramine, but from 2013 to 2023, bupropion and diphenhydramine were the first and second most frequently reported substances. From 2012 to 2015, synthetic cannabinoids ranked third. For status epilepticus, bupropion, diphenhydramine, synthetic cannabinoids, and amphetamines were the most frequently reported substances.

“Preventative measures need to be instituted to prevent a further rise,” the authors wrote.

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Half of Patients Admitted to an ED for Sepsis Died Within Two Years

In a recent study, half of all patients with sepsis admitted to an emergency department died within two years, but the predictive ability of a model was poor, according to a study presented at the European Emergency Medicine Congress, held Oct. 12 to 16 in Copenhagen, Denmark.

Osama Bin Abdullah, M.D., Ph.D., from Slagelse Hospital in Denmark, and colleagues examined long-term all-cause mortality and predictors for mortality in a prospective study of adult patients admitted to an emergency department with sepsis. The analysis included 2,110 patients with suspected infections.

The researchers found that during a median follow-up of two years, 50.6 percent of patients died. An increased risk for mortality was independently associated with age (hazard ratio [HR], 1.04; 95 percent confidence interval [CI], 1.03 to 1.05), a history of cancer (HR, 2.21; 95 percent CI, 1.70 to 2.87), ischemic heart disease (HR, 1.39; 95 percent CI, 1.05 to 1.85), dementia (HR, 1.90; 95 percent CI, 1.41 to 2.57), and previous admission with sepsis (HR, 1.48; 95 percent CI, 1.19 to 1.84) within the last six months before the index admission. The best fit was produced by a model without age (Harrel’s C = 0.488).

“Although we identified several risk factors that clearly increased the risk of death and should provide a focus for clinicians and researchers during the discharge planning process, as well as for developing future prediction studies, we were unable to construct an overall model suitable for predicting mortality in clinical practice,” coauthor Finn E. Nielsen, M.D., D.M.Sc., from Aarhus University Hospital in Denmark, said in a statement.

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Mortality Increased With Delayed Admission for Patients With Hip Fracture

For patients with hip fracture, delayed admission is associated with increased mortality risk, according to a study published online Oct. 8 in Emergency Medicine Journal.

Nicholas D. Clement, M.B.B.S., M.D., Ph.D., from the Royal Infirmary of Edinburgh in the United Kingdom, and colleagues undertook a single-center evaluation involving patients aged older than 50 years who were admitted to a Scottish hospital through the emergency department with a hip fracture from January 2019 to June 2022 to examine the impact of delayed admission, defined as spending more than four hours in the emergency department from arrival.

The cohort included 3,266 patients (mean age, 81 years); 38.6 percent had delayed admission. The researchers identified 1,314 deaths (40.2 percent) during a median follow-up of 529 days. Survival at 90 days was significantly lower for patients with versus without delayed admission (92.9 versus 95.7 percent; hazard ratio, 0.76). There was an independent association for delayed disposition with increased mortality risk at 90 days and final follow-up (adjusted hazard ratios, 1.36 and 1.15, respectively). There was also an association for delay with longer length of hospital stay (difference in medians of one day). No differences were seen in the risk for delirium on the ward or return to place of residence.

"There was an association between emergency department waiting time and poorer hip fracture outcomes," the authors write. "Adoption of emergency department-accelerated care pathways in our institution may help improve their outcomes."

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