Emergency departments (EDs) face an ever-increasing demand to provide effective clinical care despite limited resources.¹ The National Hospital Ambulatory Medical Care Survey reported that, in 2002, 56.5% of all visits to the ED were emergent or urgent.² Few studies have assessed the role that EDs play in delivering eye care in the United States. Ophthalmic care is routinely provided on an outpatient basis, and trained eye care professionals are rarely available in most EDs across the United States. Nevertheless, many patients present to the ED for eye problems.^3,4 A statistical brief published in 2011 used data from the Nationwide Emergency Department Sample (NEDS) and stated that, in 2008, more than 636 000 ED visits for eye injuries occurred.³ Our study uses 6-year data (2006-2011) from the NEDS database to determine changes in ED visits for all ophthalmic problems, including injury- and non–injury-related visits. The largest nationally representative study on this topic,⁵ to our knowledge, was published in 1998 and reported that, from December 1992 through December 1993, 2.3 million estimated ED visits were for conditions related to the eye and its adnexa, and a large proportion of the visits (51%) were for eye conditions other than trauma. A thorough understanding of the burden of emergent and nonemergent eye care is crucial for policymakers to design efficient, patient-oriented, systemic interventions relating to ED use, reimbursement mechanisms, and ophthalmic care. The objectives of this study were to assess the national burden of eye care in the ED for all ages, assess factors associated with ED visits for eye care, and determine changes over time.

Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted. To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Retrospective cohort study involving 223,475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007-2009 versions of the American College of Surgeons National Trauma Data Bank. Transport by helicopter or ground emergency services to level I or level II trauma centers. Survival to hospital discharge and discharge disposition. A total of 61,909 patients were transported by helicopter and 161,566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17,775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score-matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14-1.17; P < .001; absolute risk reduction [ARR], 1.5%). For patients transported to level II trauma centers, helicopter transport was associated with an improved odds of survival (OR, 1.15; 95% CI, 1.13-1.17; P < .001; ARR, 1.4%). A greater proportion (18.2%) of those transported to level I trauma centers by helicopter were discharged to rehabilitation compared with 12.7% transported by ground services (P < .001), and 9.3% transported by helicopter were discharged to intermediate facilities compared with 6.5% by ground services (P < .001). Fewer patients transported by helicopter left level II trauma centers against medical advice (0.5% vs 1.0%, P < .001). Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders.

Identifying predictors of mortality and surgical complications has led to outcome improvements for a variety of surgical conditions. However, similar work has yet to be done for factors affecting outcomes of emergency general surgery (EGS). The objective of this study was to determine the predictors of in-hospital complications and mortality among EGS patients. The Nationwide Inpatient Sample (2003-2011) was queried for patients with conditions encompassing EGS as determined by the American Association for Surgery of Trauma, categorizing them into predefined EGS groups using DRG International Classification of Diseases-9th Rev.-Clinical Modification codes. Primary outcomes considered included incidence of a major complication (pneumonia, pulmonary emboli, urinary tract infections, myocardial infarctions, sepsis, or septic shock) and in-hospital mortality. Separate multivariate logistic regression analyses for complications and mortality were performed to identify risk factors of either outcome from the following domains: patient demographics (age, sex, insurance type, race, and income quartile), comorbidities, and hospital characteristics (location, teaching status, and bed size). This study included 6,712,151 discharge records, weighted to represent 32,910,446 visits for EGS conditions. Mean age was 58.50 (19.74) years; slightly more than half (54.66%) were female. Uninsured patients were more likely to die (odds ratio,1.25; 95% confidence interval, 1.20-1.30), whereas patients in the highest income quartile had the least likelihood of mortality (odds ratio, 0.86; 95% confidence interval, 0.84-0.87). Old age was an independent predictor of mortality for all EGS subdiagnoses. The overall mortality rate was 1.76%; the overall complication rate was 10.03%. Of the patients who died, 62% experienced at least one major complication. Patients requiring resuscitation had the highest likelihood of mortality followed by patients with vascular disease and hepatic disease. Death patterns of EGS patients were discerned using an administrative data set. Understanding patterns of mortality and complications derived from studies such as this could improve hospital benchmarking for EGS, akin to trauma surgery's previous success. Prognostic and epidemiologic study, level III.

There is growing evidence in support of early laparoscopic cholecystectomy (LC) for acute cholecystitis.^1-4 Traditionally, acute cholecystitis has been treated conservatively in the acute phase, with readmission several weeks later for delayed LC. The thought is to allow the initial inflammatory process to subside before surgery and that surgery on inflamed tissue may lead to more complications. However, many studies^5-8 have failed to support this notion.