BACKGROUND:The directives of the Federal Joint Committee (G-BA) define tiered emergency care structures, but their influence on patient decision-making has not been sufficiently studied. OBJECTIVE (RESEARCH QUESTION):This study examined patient-related determinants of utilising emergency departments (ED) of different emergency levels in Bavaria. MATERIALS AND METHODS:From September to November 2024, we carried out a standardised, cross-sectional survey in 18 ED at basic, extended and comprehensive care levels (n = 7527 participants). Data were analysed descriptively and with multinomial logistic regression. Subjective urgency, reason for visit, travel time and mode of arrival were included as influencing factors. RESULTS:15.4% of respondents who visited the ED independently (n = 5300) chose to do so because of the expected specialization. Patients in comprehensive EDs used emergency medical services significantly more often, rated their urgency higher and more frequently reported neurological, urological or ophthalmological complaints. They accepted longer travel times and were less likely to have sought outpatient care beforehand. DISCUSSION:The choice of emergency level is chiefly influenced by subjective urgency, specialty-related complaint types, mode of arrival and institutional structure. Even the existing heterogeneity among institutions exerts a steering effect. Future management concepts-such as integrated emergency centres-should incorporate these patient preferences and regional care realities to enable need-oriented direction without undersupply.
Carpal collapse (CC), the most common cause of wrist osteoarthritis (OA), results from dissociative carpal instability. The pisotriquetral (PT) joint is usually given little attention, although it can be affected by carpal malalignment, become symptomatic, and may require treatment. The correlation between PT OA and CC has only been investigated in a small case series. The aim of this retrospective data analysis was to investigate the occurrence and severity of PT subluxation and/or PT OA in patients with CC using cross-sectional imaging in a sufficiently large and validated cohort.CT and MRI scans of patients who underwent surgical intervention for pain relief due to CC between 2003 and 2017 were re-evaluated. Parameters for OA and PT joint subluxation were assessed and correlated with the type and severity of CC, classified as scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC), stage II or III.A total of 234 patients (195 men, 39 women) with a mean age of 50±11.6 years were included. Of these, 148 were assigned to the SLAC group (33 patients with stage II; 115 patients with stage III) and 86 to the SNAC group (12 patients with stage II; 74 patients with stage III). PT OA was diagnosed in 76% of all patients; 47% had severe OA. (SLAC stage II: 21%, III: 46%, SNAC stages II and III: 58%). Of 154 patients with PT subluxation, 79% had PT OA, whereas patients without PT subluxation had an OA rate of 69%. Conversely, 69% of patients with PT OA also had PT subluxation, compared with a PT subluxation rate of 55% in patients without PT OA.These results indicate a high co-incidence of PT OA and CC. Obviously, PT OA occurs more frequently and earlier in SNAC than in SLAC, but its prevalence is high in both groups, particularly at stage III CC. This PT pathology concomitant with CC should be considered in all treatment planning, whether conservative or surgical, as it is not readily apparent on standard radiographic imaging.
Die Richtlinien des Gemeinsamen Bundesausschusses (G-BA) definieren gestufte Notfallversorgungsstrukturen. Bislang ist jedoch unzureichend untersucht, inwieweit sich Patienten bei Selbstvorstellungen in Notaufnahmen an der Versorgungsstruktur orientieren. Untersucht wurden patientenbezogene Determinanten der Inanspruchnahme von Notaufnahmen unterschiedlicher Notfallstufen in Bayern. Von September bis November 2024 wurde in 18 Notaufnahmen mit Basis-, erweiterter und umfassender Versorgungsstufe eine standardisierte, querschnittliche Befragung durchgeführt (n = 7527 Teilnehmende). Die Auswertung erfolgte deskriptiv und mittels multinominaler logistischer Regression. Subjektive Dringlichkeit, Beschwerdeanlass, Fahrzeit wurden als Einflussfaktoren berücksichtigt. 15,4
