title: Acute Medical Diagnoses Are Common in "Found Down" Adult Patients Presenting to the Emergency Department as Trauma.
abstract: BACKGROUND
  Patients often present to the emergency department (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
  There were 659 patients identified with the cause of injury "found down." A total of 207 (31%) patients met inclusion criteria; median age was 67 years (interquartile range 50-82 years), and 110 (53%) were male. Among the included patients, 137 (66%, 95% confidence interval [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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, California.
authors.forename: Bianca Grecu
authors.initials: BG
authors.lastname: Jacobs
authors.affiliation: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, California.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Turnipseed
authors.affiliation: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, California.
authors.forename: Anna N
authors.initials: AN
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, University of California, Davis School of Medicine, Sacramento, California.
authors.forename: Edgardo S
authors.initials: ES
authors.lastname: Salcedo
authors.affiliation: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, California.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Nishijima
mesh_terms: D015998:Abbreviated Injury Scale; D000208:Acute Disease / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis* / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers; D014218:Triage
keywords: brain injuries; resource allocation; triage; wounds and injuries